Wednesday, February 25, 2015

Kaiser Still Failing Mental Health Patients, State Investigation Finds

By Sam Levin
Wed, Feb 25, 2015 at 11:05 AM

click to enlarge Kaiser Richmond. - BERT JOHNSON / FILE PHOTO
  • Bert Johnson / file photo
  • Kaiser Richmond.
In June 2013, the California Department of Managed Health Care (DMHC) issued a $4 million fine against Kaiser Permanente, the Oakland-based healthcare giant, for failing to provide adequate mental health care services. The fine, which was the second-largest penalty in the department's history, came with a cease-and-desist order demanding that the nonprofit corporation immediately correct a number of serious violations. The Express investigated shortcomings in the healthcare nonprofit's mental health care system as part of our "Deadly Delays" series on Kaiser last year (see "A Flawed Model for Care").  

This week, DMHC released results of a follow-up survey it conducted over the last year-and-a-half to analyze Kaiser's progress, finding that in numerous key areas, the organization still has to correct serious deficiencies. While Kaiser has made improvements in how it tracks mental health patients and how it reports data to the state, DMHC's investigation found that Kaiser's behavioral health services are still not sufficiently accessible and that the nonprofit continues to provide inaccurate and misleading information to patients about the services it offers. 

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You can read the full 34-page report here. And here's the state's summary of the two major deficiencies that Kaiser Foundation Health Plan (the insurance provider arm of the nonprofit) has failed to correct: 
Deficiency 3: Although [Kaiser Foundation Health] Plan has made significant strides toward correcting deficiencies concerning its obligation to monitor and provide access to behavioral health services, the Department concludes that the Plan’s corrective actions have not sufficiently fixed the access-related problems identified.

Deficiency 4: Although the Plan implemented policies requiring internal review of printed and on-line health education materials prior to making those materials available to enrollees, the Department’s review revealed individual cases in which providers disseminated inaccurate and misleading health education information to enrollees regarding the scope of their coverage for behavioral health services.
As part of its investigation, the state reviewed the internal changes that Kaiser implemented in the wake of DMHC's original findings and analyzed performance reports and hundreds of medical records from across Kaiser's centers. Simply put, the state found that members continue to lack timely access to appointments. In Kaiser's Northern California region, mental health service appointments did not occur within the time period required by health regulations in 22 percent of the cases the state reviewed. In Kaiser's southern region, the state found those regulatory violations in 9 percent of the records it analyzed. 
click to enlarge Express cover for 8/13/14. - PHOTO BY BERT JOHNSON
  • Photo by Bert Johnson
  • Express cover for 8/13/14.

Regarding inaccurate materials, the state uncovered cases in which providers — in writing and in person — gave incorrect information to members about the services it offers. Specifically, the state found that providers and therapists misrepresented Kaiser's offerings in a way that "can actively discourage patients from obtaining care." Some Kaiser representatives incorrectly described the behavioral health services as "quite limited in scope," the report said. And in some cases where providers misunderstood the range of benefits available to members, the medical professionals subsequently failed to schedule patients for additionally services that their health plans would have covered.  

Here's three examples cited in the report: 
Case #G2 revealed that the patient was told, “Longer term therapy is not a covered benefit under the Kaiser Health Plan. However, if you are interested in exploring this option, I can provide you with suggestions for sliding scale clinics and private therapists in the community.” 

The treating psychiatrist in Case #B23 wrote in an email to the patient, “No one ever sees a therapist once a week in the Kaiser Health Plan. Not a covered benefit for the past 20 something years and will not be a benefit in the future.”

In Case #C10 a father called two weeks after a cancellation to request another appointment. The clinician documented that it was explained to the father that appointments are scheduled on a “first come first served basis.” The patient and the father saw the clinician for a followup visit six weeks after the intake appointment. 
Since Kaiser only corrected two of the four deficiencies the state originally identified, the agency has referred its findings to the DMHC's office of enforcement for further investigation. A subsequent survey of Kaiser's medical and behavioral health services is scheduled to take place later this year, the state said. 

“Although Kaiser has taken substantial steps to identify and monitor issues related to timely access to behavioral health services, significant and serious concerns remain,” Shelley Rouillard, DMHC director, said in a statement. “Kaiser’s actions have not been sufficient to ensure enrollees have consistent timely access to behavioral health services.”

Kaiser issued a lengthy statement on the state survey yesterday that said in part: “We are proud of the progress we have made to improve access to mental health care. ... Since the follow-up review was conducted, we have made even more progress. We have hired new mental health therapists in Northern and Southern California, and we currently are recruiting to hire more. ... While the report acknowledges that Kaiser Permanente 'took significant steps' to track and address timely access challenges, there remain locations where access to appointments is not consistently where it should be. We are continuing to address these challenges, through making caregivers available where they are needed, continuing to recruit more staff, partnering more with community providers, and being more flexible and innovative in finding solutions. We are committed to making sure our patients have access to the mental health care they need, when and where they need it." 

Kaiser said it also agrees that it needs to "do more to improve the clarity and accuracy of the information in our files," while arguing that some of the cases cited in the report lack greater context. Still, the statement said, "We also agree that it is unacceptable for anyone at Kaiser Permanente to provide erroneous information to our members and patients about access to mental health care. We have already addressed the specific cases included in this report. We determined that these cases were isolated examples and not representative of the information we regularly give our members and patients. We are nonetheless engaging in broad additional training and education for our physicians and staff."

You can read Kaiser's full statement here

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