Originally
from:http://www.sacbee.com/content/business/story/5973583p-6932278c.html
Kaiser settles two lawsuits
Accused of holding back on care, the HMO will post its
treatment guidelines.
By Lisa Rapaport -- Bee Staff Writer - (Published January 24,
2003)
Kaiser Permanente agreed to make public the treatment
guidelines its
physicians follow and to disclose how they get paid as part of a
settlement
of two lawsuits that accused the HMO of misrepresenting how decisions
about
patient care were made.
Kaiser and three consumer groups that filed the
suits jointly announced
the settlement Thursday.
Kaiser will post on its Web site the standards of
care that its doctors
consult to treat conditions ranging from asthma to visual impairment.
Kaiser
officials said they did not know how soon the information would be
available
on the site, www.kaiserpermanente.org.
During the litigation process, Kaiser also agreed to
improve efforts
to link each HMO member with a primary care physician and to ensure
that
its call-center employees do not receive financial incentives to limit
or deny access to care.
The lawsuits were filed in 1999 in San Francisco
Superior Court and
stemmed, in part, from advertisements Kaiser ran in the late 1990s
promoting
itself as an HMO that placed medical decisions "in the hands of
doctors."
At the time, consumer groups and unions accused Kaiser of giving its
doctors
and call-center workers financial incentives to delay and deny care.
Kaiser and the consumer groups involved said they
could not discuss
all settlement details, including whether the HMO admitted any
wrongdoing
or paid any money to resolve the suits.
Even so, consumer advocates said all of California's
18 million HMO
patients stand to gain from the settlement terms.
"I think that other health plans will have to follow
Kaiser and inform
the public about their clinical guidelines, their compensation of
physicians,
and their arrangements with call-center employees who give medical
advice
and schedule appointments," said Jamie Court, executive director of the
Foundation for Taxpayer and Consumer Rights.
The foundation is one of the groups that sued
Kaiser, along with Consumers
for Quality Care and the Steven Andrew Olsen Coalition for Patients'
Rights.
Kaiser's pledge to post clinical and financial
information online will
give patients far more information about the HMO than health plans are
required to disclose under California law, said Steven Fisher,
spokesman
for the state Department of Managed Health Care, which regulates HMOs.
"We think this is a positive step towards patients
having more information
about how health care works," Fisher said.
Among other things, one of the suits alleged that
Kaiser had falsely
advertised that only its doctors -- and not administrators -- decided
how
to treat patients.
In ads that ran statewide, Kaiser claimed, "There
are no financial pressures
to prevent your physician from giving you the medical care you need. No
one but you and your doctor decides what's right for you. We don't have
insurance administrators to stand in the way of giving our members the
finest medical care available."
In practice, however, the suit alleged that Kaiser
tied a significant
portion of doctors' pay to meeting quotas to limit medical services and
applied quotas for doctors to reduce the number of patients
hospitalized
regardless of medical need.
Kaiser also faced accusations from union and
consumer groups that its
call-center employees who scheduled appointments and gave medical
advice
in Northern California had financial incentives to limit patients'
access
to care.
For most of 2000 and 2001, phone-service
representatives at Kaiser call
centers in Sacramento, Vallejo and San Jose could earn a bonus of up to
10 percent of their salary if they spent an average of less than three
minutes, 45 seconds on each patient call and made appointments for
between
15 percent and 35 percent of callers.
Since then, Kaiser has overhauled its call-center
service in response
to the criticism.
Bernard Tyson, senior vice president for Kaiser
Foundation health plans
and hospitals, said in a prepared statement that it was "gratifying to
turn conflict into a productive collaboration with these important
consumer
groups."
"The goal of Kaiser Permanente is to work hand in
hand with our members
to continually improve quality of care and service," Tyson said.
Kaiser has more than 6 million members in
California, including more
than 550,000 in the Sacramento region.
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