KAISER PERMANENTE: Northern California Region Still Needs To Improve Quality, State Says
State HMO regulators said Friday that Kaiser Permanente's Northern California region "has yet to fix ... quality problems" that officials called attention to two years ago. "There have been improvements, but they aren't out of the woods yet," said Department of Corporations senior counsel Anita Ostroff. The San Francisco Chronicle reports that the department released a report following up on an August 1996 finding of widespread shortcomings" in Kaiser Permanente operations. While the follow-up report "found substantial progress has been made in most areas highlighted in the 1996 report," Kaiser Permanente did not get "a clean bill of health."
Two years ago, the state agency found Kaiser was below par in emergency room waiting times, "cost-cutting pressures" on doctors, "unreasonable denials of reimbursement" for emergency room and ambulance services and "mishandling member complaints." Friday's report found "[l]ingering deficiencies" in waiting times and the "complaint-review system." The department "complain[ed] that Kaiser did not prove that it has a method to ensure timely access to routine care." The agency also recommended that Kaiser start reviewing "out-of-plan coverage denials" twice a year instead of annually "in order to protect members from lengthy delays." Kaiser "already has decided to review coverage denials twice a year," an official with the HMO said.
More Work To Do
While the 1996 review "carried threats of disciplinary measures to force Kaiser into compliance," Ostroff "said enough progress has been made in the past two years to eliminate that possibility." However, she said "stepped-up monitoring" of Kaiser will continue. Dr. Philip Madvig, associate executive director of the Permanente Medical Group, Kaiser's Northern Californian physician affiliate, said, "We took the issues they raised very seriously and worked very hard to respond. They are saying now that we're successfully responded to what they said in most areas, even though there are a couple areas where our response will require some further refinement" (Hall, 7/25).
Walnut Creek Probe
The San Francisco Chronicle reports separately that state health officials are looking into the case of a boy who died after receiving "treatment at Kaiser Permanente's Walnut Creek Hospital." Gil Martinez, district administrator for the Department of Health Services Licensing and Certification Division, said the investigation "is focusing on whether the hospital's procedures required transferring the boy ... more quickly" (7/25).