Patients are waiting 2 months to be seen. Staff members are burning-out as a result of being overworked and repeatedly apologizing to patients who cannot be seen for 4-8 weeks. Disenfranchised populations, children, teens, and older adults are being mistreated by a corrupt system that values profits over patients and providers.
I have been employed by Kaiser Permanente as a clinical psychologist for the past 20 years in the Department of Child & Family Psychiatry in San Leandro, CA. We have been dealing with the same broken system for 20 years, where patients must wait 4-8 weeks before returning to see their primary mental health provider. Therapists in both southern and northern California have protested, went on strike, complained to the Department of Managed Healthcare (DMHC), the American Psychological Association, the Association of Marriage and Family Therapists, the California Psychological Association, reported to the Sacramento Bee, Kaiser Health News, been featured on local news broadcasts, enlisted Governor Newsom and Patrick Kennedy in our fight for best practice mental health services. All these efforts have led nowhere. Hundreds of therapists have left Kaiser Permanente as a result of burnout, debilitating morale, poor work conditions, and organizational leadership that gouges our salaries and benefits in order to maximize profits, no matter the costs to patients and providers.
California State Senator Scott Weiner brought forward SB221, which was passed by the CA State Senate. SB221 allows mental health providers to see returning patients within 10 days of their last treatment encounter. This state law was passed to hold HMOs accountable for long wait times and unethical mental health delivery systems. Kaiser is now manipulating this state law by establishing a universal return note template that forces therapists to choose treatment recommendations that defy any known best practice model, and places the onus on providers for their inability to see patients in a timely manner.
Approximately 6 years ago, Kaiser created the Connect to Care (CTC) department. This department receives initial phone calls from Kaiser members requesting mental health services. This first phone encounter, where a brief psychological screening is conducted, is coded and billed as a psychiatric intake interview. It is considered the first treatment encounter. A psychiatric intake interview must offer a list of symptoms, an initial diagnosis, a mental status exam, and a treatment plan. Once again, Kaiser codes and bills this phone service as if the patient is seen in the clinic. In the case of a parent requesting services for a minor, the patient in question is never spoken to. Therefore, a diagnosis, mental status exam, and treatment plan cannot be created, as the patient is not present for questioning.
Furthermore, as mentioned, this service is coded and billed as a Psychiatric Intake Interview, which is billed at a higher rate than a return appointment. Keep this in mind as I elaborate on what happens after this initial phone screening.
If CTC determines that the patient needs to be seen by a clinic based mental health provider, it books a Psychiatric Intake Interview with a provider such as myself. I then see this patient in the clinic and conduct an intake interview which is billed once again as a Psychiatric Intake Interview. Thus, Kaiser is double billing for the same service, which is medical fraud. This is especially important for Medi-Cal system which is being double billed for the same intake procedure. I have reported this to Medi-Cal officials, the Department of Managed Healthcare (DMHC) as well as to the internal Kaiser compliance office. No action was taken to correct this fraudulent practice by Medi-Cal, DMHC or Kaiser’s compliance office.
As of today, as I write this post, my next available return visit is August 23rd. Twenty-nine days away for a patient struggling with PTSD, major depression, debilitating anxiety or gender identity issues. Imagine telling a young person, “I am sorry, I can’t see you for another month” as they struggle and suffer with flashbacks, suicidal thinking, self-cutting, substance abuse, autism, ADHD, nightmares, and social isolation. Imagine apologizing over and over to the parents of these young people, who are desperately trying to access basic mental health services for their child. The second leading cause of death for ages 10-14 is suicide. The third leading cause of death for ages 15-24 is suicide. The second leading cause of death for ages 25-34 is suicide. These numbers represent people and families affected with lifetime grief and sorrow for their loved ones taken by suicide.
Twenty plus years of unethical treatment and corporate corruption have led to the karmic consequences of Kaiser’s monstrous mental health care system. No one wants to work at Kaiser. Therapists are leaving by the masses. A reputational effect has spoiled any chance for Kaiser to recruit enough mental health providers to deal with the onslaught of members who need and require best practice mental health treatment. COVID has only exacerbated the need for comprehensive mental health services, most everyone in the United State is well aware of this. Local managers have no power to change the system. Area leaders have no power to change the system. The responsibility lies with CEO Gregory Adams and his 13 member executive leadership team (https://doctorsatkaisertpmg.com/our-leaders/) led by Richard Isaacs, MD. When will these men do the right thing? When we they recognize the obvious damage Kaiser Permanente inflicts on those members with mental illnesses? Would either of these so-called leaders be comfortable with once every 6-week treatment for their son, daughter or spouse suffering from major depression?
Oh yeah, having just lost my mother, Kaiser Permanente allows 3 days of bereavement leave for all therapists in Northern California. Once again, Kaiser Permanente putting profits ahead of its providers.
We are on a sinking ship, trying to plug the holes. No more plugging the holes for corporate vandals. Please send your complaints to the CA Department of Managed Healthcare firstname.lastname@example.org. My trust and belief in DMHC is eroding. They have yet to act on our collective complaints and accounts of unethical treatment. Yet another governmental agency that lacks integrity and moral backbone.