Mental health patients at Kaiser Permanente in California wait too long for service, but you might not know it from records the HMO keeps.

A survey of facilities belonging to the state’s largest HMO by the California Department of Managed Health Care (DMHC) found a number of factors that made it impossible to gauge how well services were being delivered. The report, released this month, is a follow-up to a preliminary report in August 2012 that listed a series of deficiencies the department wanted addressed.

The department found four broad areas where the HMO, which has 6.8 million members in the state and probably services more mentally ill patients than anyone besides the government, fell short of the mark.

One of them was that, “The Plan does not sufficiently monitor the capacity and availability of its provider network in order to ensure that enrollee appointments are offered within the regulatory timeframes.”

That’s a polite way of saying they couldn’t tell whether patients were seeing doctors in a timely fashion, but there was reason to believe they were not. Kaiser acknowledged that its tracking system needed to be fixed and that some patients were being forced to wait longer than 14 days for their first nonurgent appointment.

The report more specifically cites facilities using paper lists rather than the computerized Patient Appointment Registration Reporting System (PARRS), which skews actual wait times. They also average schedule data rather than plot individual data points, which obscures bad performance.

The report echoes, in more bureaucratic terms, a scathing 2011 report by the National Union of Healthcare Workers that alleged Kaiser “often violates California laws” which require “timely access” to mental health services and “falsified patient scheduling records.”

Like the DMHC, it also had issues with Kaiser and thought that scheduling was only “part of an ongoing pattern of substandard care.”  

Shelly Rouillard, the department's chief deputy, told the San Francisco Chronicle that these and other deficiencies “are really serious.” The department will be checking back with Kaiser in six months, instead of the usual 18, while state regulators ponder whether the repeat deficiencies should subject the HMO to sanctions.

–Ken Broder   

To Learn More:

Kaiser Mental Health Service Reprimanded (by Victoria Colliver, San Francisco Chronicle)

Kaiser Mental Health Care Report: California Regulators Slam Hospital Giant for “Serious” Deficiencies (by Aaron Sankin, Huffington Post)

Routine Medical Survey of Kaiser Foundation Health Plan, Inc. Behavior Health Services (California Department of Managed Health Care) (pdf)

Care Delayed, Care Denied: Kaiser Permanente’s Failure to Provide Timely and Appropriate Mental Health Services (National Union of Healthcare Workers) (pdf)