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Saturday, March 28, 2015

Kaiser ordered to pay woman more than $28 million

Founded in 1945, Kaiser Permanente is one of the nation’s largest not-for-profit health plans, serving approximately 9.6 million members It serves as one HMO model in the U.S.   They promote themselves with the   "THRIVE" icon in their marketing campaigns for the impact of wellness promotion in lowering health care costs while at the same time improving quality of life.

Fast Facts about Kaiser Permanente

Much of their financial stability can be assigned to a highly disciplined and organized approach to  accessibility to expensive testing.   These methods are monitored by utilization review departments. Kaiser is a   ''super HMO' and as such has scaled many operations to higher levels of practice administration far above the  'grass roots' of practicing clinicians.  In fact Kaiser clinicians (like so many other group practice clinicians) have preferred practice guidelines to which they must conform or face sanctions, and even dismissal if they disregard the guidelines.

At times these guidelines, do not serve quality of care well at all.  They may save money for an organization in the short and/or long term,  however many patients complain about restrictive guidelines interferring with their care.  Sometimes it is minor annoyance, however cases such as this occur more than rarely.  In this case the sanction was medico-legal to the tune of $ 28 million dollars.....paid for by a malpractice insurance carrier.  This is another hidden cost of health  care and is not accounted for in health finance analysis.

The story is carried in today's edition of the Los Angeles Times and the San Francisco Chronicle.

Kaiser Permanente is also under scrutiny for it's mental health program and is being accused of  'patient dumping into public health  programs, with a class action lawsuit filed on behalf of their psychiatric patients.

California again slams Kaiser for delays in mental health treatment
For the second time in two years, California regulators slammed HMO giant Kaiser Permanente for causing mental health patients, including some who were severely depressed or suicidal, to endure long delays for treatment.
The medical-malpractice option remains at times the only option for regulating and maintaining true quality of care issues outside the imaginary realm of algorithms and CMS edicts.

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