Playing Doctor at Kaiser
Kaiser Permanente’s recent attempt at cost-cutting should anger and frighten anyone who’s ever made an anxious middle-of-the-night call to his or her HMO to determine whether a 3-year-old with a fever needs to see a doctor.
The Kaiser program, now canceled, rewarded telephone clerks for spending as little time as possible handling calls from patients and for making as few doctor appointments as possible.
Telephone triage is a frustrating fact of life in the modern health-care system. However, it shouldn’t be wielded as a potentially dangerous cost-cutting tool, as it was from January 2000 to last December when telephone service representatives at three Kaiser call centers in Northern California earned bonuses by quickly disposing of calls.
The bonuses, up to 10% of a clerk’s salary, were based on keeping calls short, transferring as few callers as possible to advice nurses and limiting the percentage who received doctor appointments.
An internal Kaiser document, titled “Talking Points for Managers,” described the bonuses as a way to “reward and encourage performance improvements.” If saving seconds, turning clerks into medical decision makers and pinching the last dollar are the correct measures of HMO health-care performance, we are all in serious trouble.
The California Department of Managed Health Care is right to investigate whether Kaiser clerks are, in essence, evaluating patients’ medical conditions. That’s a process rightly restricted to licensed medical personnel.
Kaiser contends that it was simply trying to improve customer service by reducing the amount of time callers were spending on hold, but word of the cost-cutting gambit is far more likely to upset patients who figured that the friendly voices at the other end of the line belonged to medical personnel.
One reason the defunct program didn’t work was because some callers persisted, refusing to hang up until they got answers or appointments.
A Kaiser physician wrote a report to Kaiser executives about the call centers’ problems early in 2000, saying other doctors had expressed “distrust, anger, disappointment and pessimism” about the Vallejo call center. He called for a complete revision so that it “no longer functions as a barrier, but an agent of communication.” The executives didn’t listen then. They are being forced to listen now.
