Kaiser Set To Overhaul Peer Review, Complaint Oversight
Kaiser Permanente on Thursday announced plans to adopt a uniform system for handling complaints at its 29 hospitals statewide after state regulators fined the HMO $3 million for improper handling of complaints and poor oversight of physician review, the Sacramento Bee reports (Chan, Sacramento Bee, 7/27).
The penalty is the result of a Department of Managed Health Care investigation that examined 246 files involving complaints, quality-of-care concerns and other issues from nine hospitals in Kaiser's Southern California and Northern California regions (AP/San Francisco Chronicle, 7/26).
It is the largest fine DMHC ever has issued, although the department could forgive $1 million of the fine if the HMO makes sufficient changes (Feder Ostrov, San Jose Mercury News, 7/27).
The investigation grew out of the state's audit of Kaiser's Northern California kidney transplant program, which was forced by state officials to close last year (AP/San Francisco Chronicle, 7/26).
DMHC Director Cindy Ehnes said Kaiser lacked "the ability to verify there was a consistent handling of complaints throughout its medical centers and to determine whether serious and chronic problems were being addressed" (Sacramento Bee, 7/27).
The report found disparities among each Kaiser facility in how well complaints were addressed and also found no system for reporting trends in complaints to the board of directors.
However, Ehnes said that the fine is not a reflection of the quality of care at Kaiser facilities (San Jose Mercury News, 7/27).
Bernard Tyson, executive vice president of hospital and health plan operations for Kaiser, said, "The survey did not say we have 29 broken programs but that they are inconsistent." He added that DMHC's survey "was not about the quality of care provided to our members; it was concerned with processes" (Robertson, Sacramento Business Journal, 7/26).
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Kaiser will spend $10 million to $13 million to undergo several improvements ordered by the state (Sacramento Bee, 7/27).
DMHC will require Kaiser to have moved toward standardizing peer preview and quality management at its medical centers by Oct. 1. The department will begin conducting unannounced site visits in November to verify that the changes have been made (Sacramento Business Journal, 7/26).
Tyson said the HMO will work "to make sure the follow-ups are happening right away" (Sacramento Bee, 7/27).