To the Public: Holiday time is a favorite time
for Kaiser or its network of co-enablers
to release infomercials that get gobbled up by reporters who don't want to
pick up the phone to check details or
otherwise delay their holiday focus, e.g., Christmas
shopping. Now we have our pre-Christmas consumption
that Kaiser is a heart Mecca in California -
gag me with
stethoscope Charles Phillips,
bucks the HMO trend
offers new approach to health care
Updated: 8:00 p.m. ET
Dec. 20, 2004
OAKLAND, Calif. - As a member of the Kaiser
HMO in northern California,
heart patient Roshni Nand is the exception.
Nationwide, heart disease is the leading
cause of death, but not for the
3 million members of Kaiser, where it is a stunning 30
percent lower than
the rest of California.
believe many seniors face a deadline before
the first of the year for choosing health
plans. While Kaiser has
spent some $40,000,000 on broccoli ads this year, there
may still be some
seniors who are undecided. Providing exclusive stories to NBC
another way to get an infomercial. It is probably a payback
who got a TV
exclusive some years back on Kaiser's unethical practice of
patient Roshni Nand is the exception."The
article never does establish why
Heart Patient Nand is an exception.
If she survived a high risk cardiac event, that
would have been explained.
Rather she has some sort of chronic heart condition
from which Kaiser has
not prevented in its development.
certainly still the leading cause of death for Kaiser
patients in all
of its current locations - California, Oregon, Colorado,
Georgia, Washington, DC, etc.,
- as well as all the places it has had to
leave - Texas, New York, New England,
Missouri, Utah, North Carolina, etc.
There is no oasis out here so don't start packing
your bags into the covered
wagon. That gold in them there hills is still cholesterol.
a reporter who might have checked out the press release packaged
the pseudoscience behind
Kaiser's big self hug is a 2002 study done
covering the years 1996-1998 by the California Hospital Outcomes
that those years involved the use of a computer system
contracted by Dr. Lawrence
that was tossed out by Mr. Halverson as a $1
figure Kaiser uses for its IT includes the
waste of the $1 billion,
to keep bond holders from having a clue.
As another billion of the $3 billion is used
to track physicians so that
they do as little as possible for their patients, the system
condemned by the government rather than complimented.
heart outcomes data was 100% dependent upon how hospitals translated
care into cardiac codes at the end as well as the outcomes from
Prepaid hospitals like Kaiser as an HMO have less pressure to code
and have the
capacity as a very closed system to generate any outcome they
wish to present to the state. State audits as to accuracy
occur in notebook filled rooms as the
prime rib is brought in for a sumptuous
lunch. (At Kaiser's Christmas Ball, this month
near Fresno, the door
prize was worth $2500, which impressed all the officials
parking and coat room were other observed perks.)
cardiac outcomes in the 2002 study were disputed by many of the
involved. Kaweah Delta Health Care District
California, a top hospital in
the region, wrote the state that their
rating of a 15.2% mortality was in error and the real
rate was 11.9.
That is a major system error. As a physician who knows the
Central Valley well, I would recommend that with the symptom of chest
any Kaiser hospital in favor of Saint Agnes Hospital or
Delta Hospital would
be wise. And I think the state planners
involved in this old study would do the same.
It's the result of a simple formula, says
sure they're on all the right medications,"
says Levin, a cardiologist with
Kaiser Permanente of northern California.
"That they're doing the right lifestyle
changes in terms of weight loss,
stress reduction, smoking cessation and the
the only HMO in the country being sued - Timmis
v. Kaiser -
for the poor quality of its delivered medications.
It encourages pills splitting including cardiovascular
Seniors who split their pills with Kaiser's pill splitters end
uneven pieces. The usual two hundred fragments produced are
down to small, some patients licking up dust at the bottom.
This is hardly an organization
that cares about "right medications" or
advertises open trust for all patients, it has a
hidden agenda set in place
to withhold care from those who have less than
perfect life styles (read most of us). In
fact, Kaiser does not even
offer health care but rather health advice. Patients
their own care. And if they cannot lose weight,
they are noncompliant
And in these groups Kaiser will not search for
illness. Kaiser misses half
its diabetics and does not care
that it is so.
workup is also patient unsafe. Abnormal
cardiac stress tests are
read as normal - see one death in Northern
California and one severe cardiac injury
in California in Southern California.
Half of the patients who normally would be admitted overnight at other
hospitals are sent home from a typical Kaiser Emergency Room to
risk of a heart attack occurring at home.
are not the same as the
national - e.g., the national being an LDL for
diabetics of 100 or less and for Kaiser 130.
own correct heart diets certainly do not appear when Kaiser
physicians have staff
meetings or the state comes by for a supposed review.
Red meat is enjoyed by all.
about preventing problems, instead of just
reacting to them. It's a coordinated
approach reinforced to patients like
Nand by doctors and in free classes.
"Your vascular surgeon and your internist
your cardiologist are all giving you the
same message," says Levin.
sounds like a
Kaiser failure in cardiac prevention now
needing a vascular surgeon.
And why not a cardiac surgeon?
Kaiser's physicians are all asked to practice just past
their level of
expertise. It lowers costs and shifts risks to
what's Kaiser's secret weapon? A $3 billion
computer network that gives doctors
instant information about X-rays and
lab tests, and eliminates hard-to-read prescription orders.
$3 billion computer network "secret weapon" is about as secret
as the War
in Iraq. Kaiser has been pushing its existence in
every government lobby hall and newspaper
in the nation. The trouble
is that the old system was just recently tossed out as no
few know how to use the new system except those taught
this year in Denver.
So the computer had nothing to do with the statistics; busy
can simply, with a few clicks, order the
medications, order the tests — even the consultations," says
Liang, senior vice president of Kaiser Permanente.
are not licensed to practice medicine and so they cannot
And consultations have to do with taking a history, doing
an exam, coming up with a group
of diagnoses, and testing. Computer
"consultation" really means following mandatory
popup reminders that cooks
all patients at the same temperature.
integration of medicine and technology in
Oakland, Calif., is attracting worldwide interest from Britain's
health service to the Bush administration. Everyone wants
to see if Kaiser
is a model for the future.
health service is quite aware that Kaiser deals
with a skewed group of mostly working individuals, not a match to their
more public system in England. What
they do want from Kaiser is to
know how they avoid hospitalizing patients. That is Kaiser's
secret." The answer is twofold - one,
keep them out
and, two, rush them out again. When the British
it, they will respond with more than a stiff upper
in the process will, of course, have no choice.
"The kind of coordination that Kaiser has
has set a very high standard and shows us,
I think, in many cases, what's
possible," says Margaret O'Kane, president of the National Committee
the National Committee for Quality Assurance
and sits on its
Board. This is about the kettle designing the best
shade of black. HMOs would love
to substitute their set of rules
for those of the Joint Commission. NCQA and JCAHO
are forever fighting
over who is best. They both have serious problems.
It's all a far cry from the 1990s when
like many others, was dogged by
accusations of putting costs before care.
Now, it uses technology to identify issues
before they become headlines.
lost money in
1997 and 1998 - the first such loss in profit
in 60 years. One
Kaiser physician in Denver said the morale of the
physicians was akin to that of forest rangers
after the Yellowstone Fire.
Without profit for the physicians, Kaiser would fold
in a year. At
that time in 1997, a Draconian plan was set afoot called the Recovery
were to be
cared for by teams, so that personal physicians
could step back
and spend LESS time with them. Care Guidelines were
to force all physicians to practice
the same way - don't search for new
diabetic patients, don't search for right colon cancer,
order fewer tests,
underread tests, tell chronic patients to stay home and cope
nurses do sigmoidoscopies, split pills, use 1970's pills, etc.
was, more than ever, COST BEFORE CARE.
ads - proven untrue in court -
like "in the hands of doctors"
were published everywhere. Kaiser Permanente still
public by pretending that it is "non-profit," the for profit
being in charge. "Kaiser Permanente" is not even registered
the IRS at all, it is only a program and logo.
"We actually removed Vioxx as a medication
our patients before the FDA pulled it,"
has always been
against the whole class of COX-2 inhibitors
since they cost a
lot. Asking Kaiser to study Vioxx, was like asking
direct TV to evaluate the cable
a different way of delivering care, but it's
also a different way of doing business.
Instead of paying doctors for each
service they perform, physicians earn a salary,
with bonuses for keeping
the Kaiser senior
partners - perhaps 3000 such physicians -
the salary is only a
"draw" on the bigger income. First of all, the
salaries are about $200,000 a year.
Benefits add in another $50,000
benefit. Then there is the huge additional
arise from the "excess revenues" of Kaiser Permanente, perhaps
$150,000 a year.
finally, there are
the incomes which are derived from the physicians'
through PermCo including HearEx, CareTouch, Optimal Renal
Care, etc. That allows the physicians to be on both sides of
- a neat trick Martha Stewart needs to learn
while she has free time in
January. The bonuses are for calling patients "external
customers" and "the worried well" so that
they can be ignored
until hospice (read morphine) time.
But experts say adopting such a
model would take
a monumental shift in the health care
we pay for in medical care is for doing
things — for operating on patients, for prescription drugs
earn more when their patients do more," says David Cutler,
does Kaiser. Permanente physicians earn more when they
diagnose sick patients
at Harvard University. "But nobody earns more when the patients are
healthy, e.g., you're
getting old, it's all in
your head, give the cortisone a chance, more
broccoli less beef, etc.
In fact, they even have had the guts in Northern California to redefine
the values for anemia - so that less anemis will be
Harvard likes to help Kaiser with
its press releases because of Henry Kaiser
endowments at the joint contract Kaiser Family
Foundation - Harvard Public
Health-Washington Post that keeps information flowing in the right
Kaiser says its influence is felt in northern
California, where costs are 25 percent less
than the New York area.
able to keep our members healthier; therefore,
it costs less to take care of them,"
says Dr. Francis J. Crosson, executive
director of the Permanente Foundation.
Crosson as the more powerful and more senior half of the two
person head of Kaiser Permanente is an expert at cutting
the physicians' windfall of half of the
$1.4 billion in profits
this year will certainly help him to lead a lifesytle of the rich and
HMO Pediatricians do especially well at denying care to the elderly; it
is a natural fit.
patients like Nand, it all adds up to crucial
support as she lives with a chronic disease.
clearly did not get her disease prevented. Nor did she
get a great restoration.
She got a progression to a chronic disease.
Most likely she will get assigned to a nurse
"Case manager" (read care
manager) whose salary only make sense if such patients
stay home more when
under such supervision. And, in fact, Kaiser's book for
chronic care states that all chronic care is about the same, and home
most sense. When in doubt, you can always try to activate
the Permanente-patient relationship.
2004 MSNBC Interactive
- Is this your
best effort to inform the elderly as they make
their health plan
decisions this Christmas?
were you I would fear the ghost of Christmas future.
Former Kaiser Physician - Charles Phillips, MD, FACEP