Electronic Health Records

Kaiser Permanente cited for EHR mental health violations

Kaiser Permanente, the largest healthcare provider in California, has been cited by the California Department of Managed Healthcare (DMHC) for keeping two sets of patient records: an official EHR that it showed to state inspectors, and a parallel paper record that hid violations of the state’s “timely access” law that mandates shorter wait times for mental healthcare than Kaiser was able to provide.  The inaccuracies involved in the HMO’s dual record keeping system meant that mental health patients may have waited weeks longer than the law stipulates for appointments, resulting in illegal denials of access to care for schizophrenia, autism, depression and suicidal ideation, among other serious conditions.

The problem stems from Kaiser’s double appointment keeping procedures.  While there is an electronic version – the version that gets reported to government officials – Kaiser also used paper lists in some facilities, rendering its electronic appointment wait time calculators useless.

“If an appointment date is changed, the system does not retain a history of booking dates,” the DMHC report explains. “The system’s last booking date is applied to wait time calculations. Therefore, if a provider changes the appointment date, the Plan/PARRS calculates the wait time between the last booked date and the date of the new appointment, which excludes the wait time from the date of initial appointment request. This results in inaccurate reports of wait times that are shorter than actual wait times.”

Instead of two days between contacting the enrollee and booking an appointment, as the law requires, staff would record an initial contact on paper and then ask the patient to call back during the next window for booking appointments, which could be up to four weeks later.  The electronic appointment system would record the initial contact as taking place during the later booking window, effectively ignoring the additional wait time between the patient’s first contact and the electronically scheduled appointment.

“This report confirms what every Kaiser clinician knows,” psychologist Dr. Andris Skuja, PhD told Scoop San Diego. “Kaiser doesn’t take mental health care for its patients seriously. Our patients have serious needs. The last thing they need is for their care to be illegally curtailed by an HMO that’s already making billions in profits, just so Kaiser can make a few more pennies on the dollar at patients’ expense.”  California law requires that patients wait no longer than ten days for a mental health consultation.

It was Kaiser’s own mental health staff that brought the complaint against their employer in a lengthy condemnation of the healthcare giant’s practices.  “Treatment is ‘one size fits all’ with overemphasis on medications, groups and educational classes in place of effective levels of scientifically-based, best practices care. [Patient] care treatment is too little in frequency, amount and/or duration,” says the complaint. “When such evaluations finally do take place, clinicians report they are often cursory and insufficient, but nonetheless are coded as if they were thorough and complete. Kaiser appears to be miscoding these procedures in a manner that may result in fraudulent claims to Medicare and other governmental and private purchasers.”

Kaiser claims that it has addressed the government’s concerns, which were initially brought to the HMO’s attention in August of 2012, but DMHC found that the corrections have not yet been made.  “If [Kaiser] does not effectively monitor wait times and ensure that enrollees are not waiting excessively for an initial appointment or between appointments with their provider,” the DMHC concludes, “significant numbers of enrollees with untreated or prolonged health conditions may suffer harm.”

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