Overall, the report found that the HMO "lacked the ability to verify consistent handling of complaints throughout its medical centers or to determine whether serious or chronic problems were being addressed."
Kaiser Permanente will be assessed a record fine today for its haphazard investigations of questionable care, physician performance and patient complaints at its California hospitals, according to state HMO regulators.
The California Department of Managed Health Care said it will levy a $3-million fine against Kaiser, the largest HMO in the state, with 29 medical centers and more than 6 million members. If Kaiser makes necessary improvements, agency director Cindy Ehnes said, she will forgive $1 million of that.The nine Kaiser hospitals examined as part of the report are in Woodland Hills, Fontana, Baldwin Park, West Los Angeles, south Sacramento, San Rafael, South San Francisco, Fresno and San Francisco. The state did not identify which hospitals had the weakest systems.
The managed-care agency found that under the HMO's massive umbrella, individual hospitals had their own rules: Some rigorously pursued potential medical mishaps; others did not.
The vast majority of the report focused on a system called "peer review," a standard quality-assurance mechanism at hospitals in which doctors' committees examine patient cases to determine if the care was appropriate.
A fine of $ 3 million is just an eye wash given the largest HMO insurer in the nation has annual revenues of over $31 billion and profit of $ 1 billion.
ReplyDeletehttp://sanfrancisco.bizjournals.com/sanfrancisco/stories/2006/02/27/newscolumn4.html
Very true, but good someone is doing some auditing somewhere along the line.
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