Kaiser Permanente

960 babies exposed to TB at San Francisco hospital

Anne Zieger — Wed, 27 Aug 2008 11:25:17 -0400

Kaiser Permanente has discovered that a worker at San Francisco Medical Center had an active case of tuberculosis and may have exposed 960 babies to the disease. The worker, who was a part-time night-shift employee who worked at Kaiser from March 10 to August 10 and is no longer an employee, was assigned to the postpartum unit in the maternity ward of the hospital. Kaiser is notifying the babies' mothers of the risk, which experts say is very low but still requires notification. Kaiser is also notifying 115 employees who might have been exposed to the disease. Kaiser will test and if need be, treat any patient who comes up positive. In the unlikely event that a patient has become infected, the TB strain involved is one that responds will to antibiotics, Kaiser officials noted.

To learn more about the TB scare:
- read this piece from the San Francisco Chronicle

Health plans upset when employers help pay high deductibles

Anne Zieger — Mon, 25 Aug 2008 09:31:22 -0400

High-deductible health plans have been an extremely trendy idea of late, with the assumption being that consumers would use services more cautiously if they had to pay first-dollar coverage on their own. However, some employers have been muddying the waters a bit by buying high-deductible plans, then helping employees with the deductibles through their own payouts or added insurance coverage. The combined package may be as much as 40 percent cheaper than traditional coverage, while offering comparable benefits, according to one estimate for a 40-person business based in California.

Employers like this approach, which brokers have fostered in an effort to win their business. But lately, some health plans have raised a stink over this model, which they say can push costs up substantially by taking away employees' incentive to overuse services. In fact, some California plans are so upset that they're asking employers to sign statements saying that they won't combine high-deductible plans with some types of self-insurance. Employers who won't sign could lose coverage. "Wrap-around schemes really run the risk of destroying lower-premium health products by driving up the price or making them go away completely," says Chris Ohman, president and CEO of the California Association of Health Plans.

To date, Blue Shield, Health Net, Kaiser Permanente and Anthem Blue Cross have sent letters to insurance brokers threatening them with termination of their contract and loss of commissions if they sell so-called "wrap-around" packages. I doubt they're the last.

To learn more about this trend:
- read this Sacramento Business Journal piece

Related Articles:
Study: CDHP use hits 40 percent among big firms
Study: High-deductible plans cut ED visits
Insurers vigorously defend CDHPs
Pediatrics group comes out against CDHPs

CA residents to get renewed health coverage

Anne Zieger — Wed, 13 Aug 2008 13:58:40 -0400

About 3,400 California consumers whose individual policies were improperly revoked will soon get invitations to rejoin their health plan. The letters are being sent out as part of a batch of settlements recently announced between the state's Department of Managed Health Care and a handful of health insurers. Health plans issuing the letters include Health Net, Anthem Blue Cross of California, Blue Shield of California, Kaiser Permanente and PacifiCare, which have reached settlements over their rescission practices that included fines totaling $14 million.

The Department of Managed Health Care has ordered health plans to provide the agency with contact information for hundreds of members with rescinded policies to make sure that the members do indeed get their notices. Meanwhile, the DMHC, the state attorney general's office and health literacy experts have reviewed the noticed to make sure they'll be easily understood by consumers.

What's noteworthy, however, is that despite the fines and reinstatement of consumers, California health plans have not generally conceded that post-facto rescissions are are illegal. Most have gone into settlements screaming loudly that they'd violated no laws, despite the DMHC's firm conviction that they had. All told, it seems that even with laws on the books with arguably ban rescissions for innocent mistakes on applications, the practice is far from dead. There's more controversy to come on this issue, without a doubt.

To learn more about the reinstatements:
- read this Modern Healthcare piece

Related Articles:
WellPoint pays hospitals $11.8M to settle bills from rescissions
BC of California fined $1M for cancellations
Kaiser forced to reinstate coverage
Blue Cross of California settles plan-cancellation suits

CA sues Prime Healthcare for balance-billing insured patients

Anne Zieger — Wed, 02 Jul 2008 12:20:59 -0400

California regulators have filed suit to stop growing hospital chain Prime Healthcare Services from billing commercially-insured patients for fees that insurance companies don't pay. The practice, known as balance billing, is explicitly forbidden in some states, but California law is vague on this topic, according to observers. However, Prime's practices are so extreme in this regard that they must be stopped, according to the state's Department of Managed Health Care (DMHC).

Prime, one of the fastest-growing hospital chains in California, has acquired a dozen southern California hospitals in recent years. Along the way, it has acquired a controversial reputation, as it often cancels the majority of private insurance contracts these hospitals had in place. Such cancellations allow the hospitals to bill insurers for out-of-network services, allowing Prime to charge higher fees.

Aware of Prime's strategy, and upset at what they see as inflated bills, some insurers have begun sending Prime only partial payments for members treated at its hospitals. Prime, in turn, has been billing patients for the remainder of its fees, sometimes to the tune of as much as $50,000, which has generated a firestorm of protest among patients, insurers and state officials.

In its lawsuit, the DMHC is asking the court to forbid Prime to bill insured patients for bills owed by insurers. This follows previous legal action by Kaiser Permanente, which obtained a temporary restraining order barring the chain from collecting from its members or reporting the bills to credit agencies until the case is resolved.

To learn more about the case:
- read this Los Angeles Times article

Related Articles:
Prime Healthcare picks up three Tenet facilities
California hospital operator boots HMOs
Upstart CA hospital chain buys another facility
State stops acquisition by growing CA hospital chain

Coalition protests healthcare cuts in CA

Fri, 27 Jun 2008 06:59:57 -0400

It's somewhat ironic that a Governor as well known for his commitment to physical fitness as he is for being an aging action adventure hero has proposed deep budget cuts that could leave more than one million Californians without access to healthcare. But if adopted, Arnold Schwarzenegger's budget proposals would cut Medicaid spending by more than $1.1 billion in the fiscal year that begins next Tuesday.

A coalition of providers, carriers, labor unions and consumer advocates have joined forces to protest the cuts. The coalition includes Catholic Healthcare West; the Service Employees International Union; AARP and Health Access California; Kaiser Permanente and Health Net. In January, the same group failed to convince legislators to support a bill that would have funded a $15 billion health care expansion. The proposed cuts are expected to be approved because California has a $17 billion deficit.

Providers are rallying where they can to come up with strategies for ensuring access. For example, Health Net of California said that it will provide up to $5 million in emergency loans to keep safety-net health clinics vulnerable to budget cuts open.

For more info:
- see The Los Angeles Times story

Kaiser, Health Net agree to reinstate 1,200 beneficiaries

Fri, 16 May 2008 06:59:58 -0400

Two of California's largest health plans have agreed to reinstate a total of roughly 1,200 patients whose policies were rescinded after they began incurring high medical expenses.

Under the terms of a settlement brokered by the California Department of Managed Health Care, patients whose insurance was rescinded by Kaiser Permanente or Health Net since 2004 will be allowed to buy a new policy regardless of their medical condition. As part of the deal, Kaiser has agreed to pay a $300,000 fine to the state without admitting wrongdoing, as well as making procedural changes which include developing simpler coverage applications to avoid applicant mistakes. The deal follows a $9 million judgment against Health Net won by a hair salon owner when the plan canceled her coverage while she was undergoing chemotherapy.

The Department of Managed Health Care is now trying to reach similar deals with other major health plans, including Anthem Blue Cross, Blue Shield and PacifiCare, which involve about 4,000 canceled policies.

To learn about the health plans' new deal:
- read this Los Angeles Times article

Related Articles:
Health Net fined $1 million for non-disclosure of cancellation bonuses
BC of California fined $1M for cancellations
WellPoint plan cited for cancellations
CA agency mulls review of policy cancellations

ALSO NOTED: Bird flu pandemic risk rising; Los Angeles hospitals struggle with excess demand; and much more...

Mon, 12 May 2008 06:59:50 -0400

> Experts are warning that the risk of a bird flu pandemic is rising. FierceBioResearcher

> Los Angeles hospitals are struggling mightily to cope with excess demand created by the closure of King-Harbor Medical Center. While it was going to reopen in February 2009, some now fear that the planned re-opening will be delayed for years. Article

> Kaiser Permanente has put the finishing touches on the outpatient phase of its costly electronic medical records project. FierceHealthIT

> Iowa nurses should get a raise with the state's hospitals getting a 1 percent boost in Medicaid reimbursement. Article

And Finally... This guy performed a tracheotomy on himself without anesthesia--twice. Article

Los Angeles investigates another patient dumping case

Wed, 07 May 2008 06:59:58 -0400

Los Angeles city prosecutors have begun investigating another alleged patient dumping incident, this time a Costa Mesa hospital, which allegedly took a mentally ill man 42 miles to the city's Skid Row. City prosecutors say College Hospital dropped the man outside of Skid Row's Union Rescue Mission. If the hospital did do what it's accused of doing, it may have violated a state law that makes it a misdemeanor to dump patients in another county.

This follows a string of actions by city officials against providers they contend have engaged in patient dumping. Los Angeles prosecutors have investigated more than 50 cases of alleged dumping since 2005. It has filed charges against a handful of providers, including Kaiser Permanente, which eventually agreed to establish new discharge rules, train employees more and allow monitoring by a former U.S. attorney to settle the matter.

To learn more about these cases:
- read this Los Angeles Times article

Related Articles:
Patient dumping tale is all too familiar
LA sets fines for homeless patient dumping
LA files more patient dumping cases
LA hospital investigated for patient dumping

CA regulators begin broad review of policy cancellations

Fri, 18 Apr 2008 06:59:57 -0400

In a move that could cost health insurers untold dollars, and possibly change the dynamics of the individual coverage market, the California Department of Managed Health Care has begun reviewing thousands of individual policy cancellations by the state's five major health plans. The DMHC will turn over policies dropped by the plans to an independent arbiter, who will determine whether the policies were inappropriately canceled. If the policies were wrongly canceled, the DMHC will require the health plans to reinstate those patients, and what's more, to pay all of the patient's bills incurred while the patients didn't have coverage. Meanwhile, the DMHC is ordering Anthem Blue Cross, Kaiser Permanente and Blue Shield to immediately reinstate 26 patients whose policy cancellations, in its view, were wrong on their face.

This move is perhaps the boldest in a long string of actions the DMHC has taken to prevent the state's health plans from canceling individual policies when individuals incur high medical bills. The DMHC contends that canceling such plans because of innocent mistakes on applications is unlawful.

To learn more about the DMHC's review:
- read this Los Angeles Times article

Related Articles:
BC of California fined $1M for cancellations
Kaiser forced to reinstate coverage
HealthNet set goals, bonuses based on policy cancellations
Kaiser pushes for policy-cancellation rules

Kaiser suspends perinatologist over mistakes

Mon, 03 Mar 2008 06:59:57 -0500

Years after co-workers allegedly reported him to management for inappropriate behavior, Kaiser Permanente has announced that it has suspended high-risk perinatologist Dr. Hamid Safari. As of late last week, Dr. Safari no longer is permitted to provide care to Kaiser members in either hospitals or outpatient settings. Safari was in charge for at least two deliveries that raised questions among other staff members, including one in April 2005 where a baby died, and another in which the baby died six months after her January 2004 birth. In addition, the Medical Board of California has accused Safari of gross negligence.

Safari has been on restrictions since July 2005, after the second baby's death, when it barred him from performing vaginal deliveries and required him to be monitored by fellow clinicians. What may have been the final straw, however, came in January, when CMS inspectors challenged the way Kaiser had handled complaints about Dr. Safari. The Fresno hospital where he was based has said that it took further action "after detailed and comprehensive quality reviews."

To learn more about Safari's situation:
- read this Los Angeles Times piece

Related Articles:
SPOTLIGHT: Kaiser faces criticism over censured doctor. Report
Kaiser profits more than double. Report
Kaiser faces patient dumping charges. Report
Kaiser fined $2 million for transplant problems. Article
Kaiser employee blows whistle on potential $7B loss. Article
Kaiser controversy fells top exec. Article