Entry tags:

kaiser patients, kaiser permanente, kaiser workers

Who Will Kaiser Squeeze Next?
A little bird told me that Kaiser is raising Health Plan fees next year to make up for a 5% cut in Medicare reimbursement. Medicare provides a third of Kaiser's executive lifestyle subsidy revenue. Kaiser will be passing this loss on to non-Medicare members and then pinning on enough extra to maintain an "increase in revenue" for 2007. Lower ranking employees are being fed the "tighten your belts" bull.

Here's one I've been saving up for a while. Kaiser Senior Counsel David Armstrong has been casting about for ways to avoid paying other health care providers when patients have to seek care outside the Kaiser system (thanks again, little bird). Behold the quotes:

Quote 1: Its clear that Health Plans are precluded from paying federal program benefits to providers excluded by OIG. However, has anyone addressed payment of these same providers under other, non federal program, commercial lines of business? What about reimbursing members who have out of network benefits directly for services rendered by OIG excluded providers? Thoughts and comment on how to shut this down if possible would be appreciated.

Quote 2: I would like to hear...comments and opinions regarding an HMO's rights (or lack thereof) to onsite access and concurrent review of medical records of patients admitted through the ER of non-contracted hospitals.....in particular to make efficient transfer determinations to contracted facilities upon stablization of the patient. As an alternative, are there any issues surrounding the right to demand medical records and to make retrospective determinations that deny reimbursement of days after the patient was otherwise stablized and could have been transferred to a contracted facility?

Quote 3: Quick question: HIPAA and state laws generally require guaranteed issue or access in the small group market. However, what if the applicant and/or individual members of the proposed small group have a history of prior "bad acts" with your health plan such that they would otherwise fail underwriting guidelines - e.g. prior termination or rescission as the result of late pay, failure to pay or fraud? Unfortunately, I don't find any of these to meet any of the enumerated guaranteed issue exceptions. Therefore, is this a "loophole" that allows persons who would not otherwise qualify individually based upon prior history to reconstitute as a freshly minted new small group and, thereby, obtain another bite at the apple under the protection of the small group legislation?

Quote 4: Does anyone have any model language that they can share that could be added to a standard MCO hospital contract to limit MCO liability for paying for care that is a result of error, omission or failure by the hospital equipment and/or personnel?

Quote 5: I would like to take a survey of reimbursement policies for claims submitted by non-contracted out of network providers. Obviously the health plan has to pay for emergency services but, in the event that your state's regulations are silent on the subject, are other health plans paying charges or something else? If Usual and Customary, how are you calculating the UCR and are you experiencing push back from providers?

As for you provider reps out there, is there any reason why non-contracted providers should be entitled to reimbursement of charges to the extent that they exceed UCR and/or is there any basis for objection to UCR reimbursement?

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Okay, I had to walk away from my computer and laugh for a good ten minutes. Why does Kaiser's "Senior Counsel" need to make public inquiries about how to avoid paying their bills? What a maroon!

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Also, I've been commiserating with yet another Kaiser victim who has been subjected to the same old Kaiser lawyer strategy: avoid responding to Discovery requests, block evidence from getting in front of the Judge, and then motion for Summary Judgment before facts become part of the case. Judges have been condoning this for some unfathomable reason. If anyone has had a similar experience with Kaiser, please contact me (kaiser_scapegoat AT hotmail DOT com). I'd like to put together a packet of affadavits that could be used by all Kaiser victims so they can point to the pattern and have more leverage in getting the evidence in front of the Judge for both arbitration and court cases. My understanding is that even if you signed a settlement concerning medical treatment at Kaiser, that won't preclude you from addressing the conduct of Kaiser's lawyers.

Almost forgot: Kaiser hired a security company that cheated workers out of overtime. I wonder if this ruling also applies to temps and other hourly workers who are forced to come "ten minutes early" to warm up their computers...?

Update: Wow, Kaiser has given over a million dollars of its member's money to the California Hospitals Committee On Issues. This is a CA state lobbying group - more info here. Also, I wonder what Kaiser has against Laguna Honda Hospital...?

This makes me wonder how much Kaiser spends on lobbying at the national level. According to LobbyWatch, Kaiser spent $460,000 on lobbying firms in 2004. However, this doesn't seem to include Kaiser's own lobbying conducted by the Permanente Federation (led by Francis "Jay" Crosson). According to OpenSecrets, Kaiser only reported $240,000 last year, and 80k of that went to the Permanente Federation. That number couldn't possibly include the pay for people doing the lobbying, so somehow the base operations funding gets excluded.

Update 2: Yet another case of Kaiser destroying the evidence. Maybe I should change the Kaiser Thieves logo to Kaiser BabyKillers?