Kaiser Permanente and HMOs in general

aways · 12-22-2005, 07:57 PM

I'm just curious about what peoples' experience has been with service at HMOs versus GPs in private practice. My experience with Kaiser Permanente has been quite variable, sometimes great, othertimes horrible. Recently I've had a bad experience there. Anyone have a strong opinion on KP, or HMOs in general?

cantdrv55 · 12-22-2005, 08:50 PM

My brother's a KP doc. We always argue about the quality of svc and patient care at KP. His point is, where else can you see a doc, have a prescription filled, get glasses and an XRay all in the same building? Me, I'd rather drive many miles so I can see MY OWN doc the very day I need him and not have to wait a half hour after my appt. I hate waiting.

EdT82SC · 12-22-2005, 10:03 PM

My wife used to have Kaiser, and they almost killed her. She had pain in her abdomen, but they told her it wasn't her appendix. They kept her in the hospital while trying to figure out what it was. The next day her abdomen felt better because her appendix had burst, but she had a high fever. The day after that her body was in toxic shock, and she was near death. Finally a doctor with a clue saw her, realized the problem, and operated on her. It was weeks before she was out of the hospital, and a couple years before she was back to normal. If they had operated on her when she first came in she would have gone home the next day.

She started a new job shortly after she was out of the hospital, and though Kaiser was one of her choices she didn't choose it. I'm sure there are good doctors at Kaiser, but there are at least some that are clueless.

amity914 · 12-22-2005, 10:23 PM

If you can find a good doctor at Kaiser they are great, but I too have had a bad experience with them when my son almost died.

slodave · slodave's Garage

I have a PPO. I get to choose my doctor. I have abused my body with my hobbies and like the ability to go directly to a shoulder doctor or a knee doctor when needed.

My ex-wife had HMO and they mis-diagnosed a number of her illnesses.

Dave

Don Ro · 12-22-2005, 11:40 PM

Ah, good old FOR-profit Kaiser, the Wal-Mart of health care, with their "care-giver bonus plans" and wrongful death lawsuits.
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I was a member for a few years - no more...too dangerous for me.
Plus, 'got tired of premiums increasing $25 - $35/qtr.
Mention Kaiser around my g/friend (Chiropractic Physician) and she goes ballistic.
'Have my own interesting story about "Kaiser care."
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Aug. 29, 2005
Associated Press
San Jose, CA
21 year old Christopher Robin Wibeto's cause of death is still being investigated by the county coroner's office. But state officials have determined that the San Jose man was wrongly given another patient's medication, a cancer-fighting drug called vincristine.
Indeed, state investigators have found the Kaiser hospital did not follow proper protocol in giving the medication without having the doctor and nurse first confirm it was the right drug for the patient.
http://www.mercurynews.com/mld/mercurynews/news/13058936.htm
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Nov. 08, 2005
Kaiser confirms third patient death
By Julie Sevrens Lyons - Mercury News
Kaiser Permanente officials on Tuesday confirmed a third case in which a 64-year-old patient at a South Bay hospital died after a medication error.
In August, the same hospital was cited following the death of Josephine Frances Hart, a 12-year-old girl who had received a double dose of pneumonia medication.
http://www.mercurynews.com/mld/mercurynews/news/13117889.htm
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Thu, Nov. 10, 2005
Hospitals blamed in more deaths
By David L. Beck
Mercury News
Kaiser Permanente officials have confirmed the deaths of two more patients caused by staff errors at its South Bay hospitals. The deaths bring to at least four the number of fatal incidents at Kaiser facilities during the past 13 months.
http://www.mercurynews.com/mld/mercurynews/news/13129841.htm
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Former Kaiser Doctor Talks To ABC7
Claims Many Medical Mistakes
By Debora Villalon
From: http://abclocal.go.com/kgo/story?section=local&id=3626588
Nov. 11 - KGO - A doctor who once worked at Kaiser Permanente in South San Francisco claims preventable medical mistakes happened too often at that hospital. He says cost-cutting moves put patients' lives in danger, and when he tried to warn Kaiser, he was fired.
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Here's the inside poop: (even includes a Nixon & Erlichman transcript from the "Whitehouse Tapes")

KAISER PERMANENTE - The Unauthorized Tour
First prepared for the Kaiser Papers Web site by Dr. Phillips in early September 2005 as a Public Service for All Who Want to Understand Kaiser Permanente Through Full Transparency - Last updated in Fresno California – October 15, 2005

http://www.kaiserpapers.info/unauthorized-outline.html

"One third of the time the Kaiser care is acceptable, but that is aimed at special people and meant to keep the outside inspectors confused about the two thirds of the time that the care is way below acceptable – often lethal. Kaiser has the Capacity to give care – reflected in the notebooks presented for the outside inspectors (as the latter folks look forward to the sliced beef tenderloin lunch) – but not the Will do so, as there are less profits in doing it right. Inspectors don’t know – or don’t want to know - the difference (and I watched an inspection of Kaiser from the inside)."

"Kaiser Permanente is simply a FOR profit BUSINESS PLAN (only a concept and not a registered business entity or taxable entity) trying to be viewed by patients and the press as a not for profit "Medical Care Plan.""
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Want more?...
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http://www.kaiserpapers.org/truth.html
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http://www.kaiserpapers.org/

island_dude · 12-23-2005, 05:43 AM

My experiences with Kaiser mid-atlantic have largely been good. You can generally bypass a lot of the hoops they force you to jump through the get the right treatment. They have never said no to me on any tests or procedures I have asked for.

Where they are very good is in treatment that can be planned out ahead of time. The prenatal and pediatric services are well organized and they are reasonably flexible. I have stuck with them over a number of years, and despite certain real anoyances I have found them to be lots better than others.

It doesn't surprise me that they have their share of incompetent doctors. They make it pretty easy to switch though.

Moses · 12-23-2005, 06:48 AM

The problem with Kaiser has nothing to do with the quality of the physicians. The doctors are fine, but they are bound by treatment protocols based on cost, not safety.

Kaiser is fine until you have a real problem. Ill give you an example in the field of obstetrics; if a pregnant woman at full term breaks her water and does not go into labor, the fetal mortality rate is four times higher if she is left at home to await the onset of labor. Every private practice physician I know will admit these patients to the hospital and induce labor. It is expensive, but absolutely the safest course. At Kaiser, they let them stay home. Every year this policy will lose a few babies, but the cost is minimal compared to the cost of the safest treatment. (Remember, Kaiser patients must sign a malpractice waiver in favor of arbitration.) Private practice physicians rarely care what the cost of our treatment is because if something goes wrong, our ass is on the line. No arbitration agreement backed by a huge healthcare monolith, just a little doc vs. an injured plaintiff and his hungry attorney. Think that makes us more careful? Hell, yes.

The example I cited is duplicated in every specialty I know of in Kaiser. In Kaiser, you will be sicker before you get the "expensive" medicine. You will be more disabled before you get a hip replacement, men will get fewer colonoscopys and women will get fewer mammograms. It's just the way the system works.

Kaiser. Good people, good medicine...good luck.

cantdrv55 · 12-23-2005, 06:53 AM

Quote:

Originally posted by Moses

Kaiser. Good people, good medicine...good luck.

LoL. I'm going to rib my brother with this one.

amity914 · 08:12 AM

okay, My son is having some shortness of breath and I take him to KP. They tell me that he has asthma and that he was diagnosed when he was two, its here in his records. I say WTF, Why wasn't I notified (he's 4 at the time) I take him to all appts so I know that I have never been told this by anyone. So they give him a few nebulizer treatments and he is no better, but they give us the machine, tubing and all the other stuff for at home care, and are about to shove us out the door when a pediatric doc. comes in and says "hes going to the hospital now" When we get there they send him to x-ray instead of treatment. So we get upstairs and still waiting for treatment he passes out, then they send him to OHSU, because the hospital coldn't fix his problems. He was in intensive care for 3 days.

My co-worker lost her child, when a KP doctor gave her a med that made her fetus die, didn't remove it and she got an infection that almost killed her and left her infertile.

A friends mother was prescribed a Medication in her last trimester that killed her baby.

Hiedi

Hiedi

tcar · 12-23-2005, 09:15 AM

Heidi,
That's horrible. What WAS wrong with your son? Was it asthma?

aways · 12-23-2005, 11:26 AM

Some of these are truly horrible stories. Thankfully my experiences have been more related to poor service than to botched diagnoses. I guess it's inevitable that when you deal with a giant bureaucracy that customer service and individual attention will suffer. I'm sure there are many good doctors there, but when they are restricted to 10 minutes per patient, you're not going to always get the individual attention that you deserve. I was told by a doctor friend of mine who worked for Kaiser for a while that the average Kaiser GP on permanent staff has about 2000 patients! I almost never can make an appointment with my assigned doctor, since he's usually booked two months out... I end up seeing some random doctor, and rarely have I seen the same one twice. It's hard to have any continuity of treatment in that kind of system.

Don Ro · 12-23-2005, 01:05 PM

One of my Kaiser stories.
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Began my own business in '79, soon had 8 employees, I was doing everything - ran myself ragged.
Managed to navigate through a burn-out in '85.
In 1988, another burn-out came down the line, only this time I could see it being worse - full-blown depression on the horizon. My psyche was biting its own teeth - I was a mess!
Decided to call my Kaiser's Psych Dept. for an appt.
A woman at the front desk answered. She did her best to dissuade me from making an appt. - that was clear.
Finally, she played her trump card - the earliest appt. would be in 3 weeks or so.
I said, "I may be dead by then."
Got an appt. for the next day.
In my bedroom, preparing for the short trip to that appt., I heard a message being left on my answering machine.
"This is (whatever her name was), I'm stuck in traffic (*) and can't make our appt.
Please call the office and make another one." Click.
I did so immediately.
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That first appt. with her, I sat down in the chair. She had a file folder in her lap.
She said, "Tell me about your marriage, Mr. Harrison."
I said, "I'm not Mr. Harrison and I've never been married."
She said, "Oh, I thought in our last meeting you told me you were married."
I said, "I have never met you before just now."
She then said, "OK then, what seems to be the problem, what brought you here?"
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10 minutes later, I interrupted myself, saying, "I have to get out of here." - and walked out.
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Next day, I called the Dept. head - female psychiatrist - to report my experience.
Her immediate response was, "Would you like to make an appt. with someone else?"
No "I'm so sorry you had such a bad experience, I'll look into this immediately." ...etc.
Zero interest/compassion/empathy.
I said, "No, I'll pass. Thanks anyway."
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That same afternoon, I called So. Cal. Kaiser to find out how to terminate my membership...which I did.
Amazing to me that, being in such a state of psychological survival, I had the will/strength to even make a phone call to get myself out of the Kaiser circus.
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(*) I saved this message, recorded onto a cassette tape and listened to it with a headset...so did two friends.
Sure enough, the faint sound in the background was NOT traffic, it was the sound of a television.
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That's one of my Kaiser stories.
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ps This episode turned out to be a blessing in disguise.
I soon was able to bring info into my life that set my alarm clock for a genuine awakening.
Hail awareness!

amity914 · 12-23-2005, 01:23 PM

Quote:

Originally posted by tcar
Heidi,
That's horrible. What WAS wrong with your son? Was it asthma?

Yes, It was asthma. I did however find a really good doctor there who was able to get him on maintenence meds and educate me about asthma.

Moses · 05:56 AM

Quote:

Originally posted by Wayne at Pelican Parts
I know for an ABSOLUTE FACT that Kaiser delivers the babies within 24 hrs. Same thing happened to one of my employees too - they delivered, even though the water broke 3 months early. The baby spent about 2 months in the NICU (expensive).

So, get your facts straight!!!
-Wayne

Civil but pointed response sent via PM.

Moses · 12-24-2005, 07:29 AM

http://en.wikipedia.org/wiki/Kaiser_Permanente

"Kaiser represents itself as not-for-profit by distributing its profit - about $1.8 billion in 2004 - half to physicians and half to hospitals. 50% of Kaiser's umbrella revenue goes back to its for-profit medical groups. The physician kickback allows them to double their salaries and retire with millionaire benefit packages. Kaiser disclosed to Medicare in 1985 that it sets a profit target each year which is achieved by the withholding of care.
Edgar Kaiser took the "less care, more profit" message to President Nixon (caught on tapes!) that set in motion the HMO Act of 1973. Kaiser was and is only a prepaid health plan. The term Health Maintenance Organization was created in 1973 as a way to get people to let Congress pass such a one way act."

The Kaiser empire is divided into Divisions, which comprise hospitals, which manage departments. The departments have budgets. The departments design independent treatment protocols to reign in spending in order to control cost and maximize profit. It should not come as a surprise to learn that different departments within different hospitals have different protocols.

Of course, happy anecdotes about care at Kaiser are singularly meaningless. Even the 1962 New York Mets won 40 games. The truth would lie in an independent outcomes analysis, which has never been done (or at least published).

I stand firm on the facts reported in my previous post and I remain convinced that in Kaiser, you will be sicker before you get the "expensive" medicine. You will be more disabled before you get a hip replacement, men will get fewer colonoscopys and women will get fewer mammograms. It's just the way the system works.