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Quality Assurance: Kaiser Permanente
Case Management Programs are More Concerned with Reducing Costs Than with Improving the Quality of Care
Rather than relying on generalized statements about case management programs, focused research on Kaiser Permanente (Kaiser) shows an egregious example of a "profits over patients" mentality in case management. By delaying, misdiagnosing, undertreating or not treating at all, Kaiser evidently save millions of dollars, until It gets caught. For example, in June 2010, the California Department of Managed Health Care (DMHC) fined Kaiser a $75,000 administrative penalty for unreasonably delaying diagnosis and treatment of autism for Andrew Arce. According to the DMHC, due to Kaiser's delays and denials, Andrew's treatment was delayed for more than a year and he did not receive needed treatment until he was damaged by Kaiser's delays and denials (Kaiserthrive.org, 2010).
Binding arbitration boards are also finding that Kaiser delays adequate treatment. For example, in November 2008, a Valencia, California couple was awarded $5 million by a binding arbitration panel because Kaiser was failed to timely diagnose and treat Timothy Howard's "transient ischemic attacks (TIA) of the retina which resulted in a devastating stroke" (Kaiserthrive.org, Courtesy of Vicki Travis of the Kaiser Papers, 2009). Though the treating Kaiser neurologist was aware of the need for more extensive testing, she did not order...
Misdiagnosed and underdiagnosed, Mr. Howard continued to suffer TIA, and then had a massive stroke for the incorrectly diagnosed, untreated condition. Since the stroke, Mr. Howard, a once-healthy 46-year-old Middle School assistant principal: is wheelchair bound with no use of his left arm and weakness on his left side; needs 24/7 assistance with all life aspects; suffers cognitive and mental deficits; is clearly unable to work. The cost of his future care is estimated in the millions of dollars (Kaiserthrive.org, Courtesy of Vicki Travis of the Kaiser Papers, 2009).
Finally, cases like the Arce's and Howards' are not isolated incidents; rather, it appears that Kaiser deliberately, methodically puts costs over quality of care. In October 2010, Dr. Richard Della Penna M.D., a former Kaiser physician and one of the country's foremost experts in treatment of the elderly and special needs patients, announced that he will file a lawsuit against Kaiser for its deliberate plan to treat only 5% of the 57,000 chronically ill patients for which Kaiser received $13 Billion in Medicare funds. Directly violating the Medicare Modernization Act of 2003 and the Medicare Improvements for Patients and Providers Act of 2008, Kaiser deliberately avoids proper care management that would provide vital yearly physical, functional and psychosocial assessments for 95% of those 57,000 elderly and special needs patients (Kaiserthrive.org, 2010). Furthermore, Dr.…
3,564,966
(Silberman, JD, DrPH, Poley, & Slifkin, PhD, 2003, p. 25).
The same study shows that case management improves "clinical outcomes" by resulting in fewer emergency room visits, fewer hospitalizations, shorter lengths of stay, fewer re-hospitalizations, more patient satisfaction and greater patient knowledge (Silberman, JD, DrPH, Poley, & Slifkin, PhD, 2003, p.
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