In late 1999 United Health Care created a high media fanfare announcing that it would leave medical decisions up to the patient and his or her physician. Since the announcement a lot more about their "new" policy has come to light. We have seen that they did not include the mental health division in the new policy (these are the patients who are least likely to be able to speak up for themselves) and that the physicians would be held to task for ordering too many expensive procedures and tests - to the point of being kicked out of the network and/or having their reimbursement for the procedures retroactively denied. Basically that meant that if a physician spent too much (what UHC thought was too much, not necessarily what their peers thought was excessive) he or she stood to lose all his or her patients and, on top of it all, to not be paid for the work that they already did. All UHC did, in this announcement, was transfer the burden of providing services to their already beleaguered practitioners therefore shielding themselves from what they saw coming out of Washington in the form of the Norwood-Dingell Patients Bill of Rights legislation.
How Kaiser Responded
The story was so big that Kaiser Permanente took the unusual step of faxing reporters immediately following United HealthCare's announcement. Kaiser offered to let the media interview "senior [Kaiser] physicians... to comment on... United Health's decision." Why would Kaiser feel the need to respond so urgently to an announcement by another health plan? "Because all the leading newspapers implied that this was a breakthrough, so Kaiser felt the need to clarify things," says Robert Pearl, M.D., executive director and CEO of the Permanente Medical Group, in Oakland. "We have been doing this for 50 years and plan to continue to leave decision making between physicians and their patients for the next 50."
The low-down by Chuck Phillips, M.D.
recently worked 18 months in the Kaiser Emergency Room in Fresno,
California --often exceeding the monthly hours of the full time
physicians. The idea that
decisions are in the hands of the individual treating physician and the
patient being treated is a complete hoax. Here are a few experiences I had
in this environment:
is the most anti-physician setting in the Valley. My documentation file exceeds
three inches. They refuse to
debate me in any forum.
it may be "in the hands of doctors" who have ERISA protection as coaches
at the top, it is certainly not in the hands of physicians at the
bottom. Those physicians who
stay have either been "Kaiserized" into accepting compromised care or who
are self described "slaves" working unpaid hours into the night trying to
do the job right. Even the
physicians inside have complained in an internal newsletter "Hope" that
the $100 million spent now per year on advertising might better be spent
on patient care.
This would not be the best time to brag about a 50 year success story about to clone itself into the future. This would be a better time to rebuild the entire system around the few physician stars still hanging on within.
Phillips, MD - past Kaiser physician
Kaiser actually tries to distance itself from its own exclusive, physician
group called The Permanente Medical Group (TPMG) -- who shares its
headquarters, advertising, lawyers, etc. -- so that proven mistakes can be
blamed on outside "contractors" as in the "Death by HMO"