Saturday, October 30, 2004
Is Kaiser the Future of American Health Care?
"In Northern California alone, Kaiser spends $55 million a year on chronic-care management programs. "But what's really expensive is if we don't take care of these people and manage their chronic conditions," said Dr. Robert Mithun, chief of internal medicine at Kaiser's medical center in San Francisco.
Dr. Mithun's comment may seem like no more than common sense, but it does not reflect the typical logic of the dominant fee-for-service model of health care. Most doctors and hospitals get a fee from insurers for each patient visit, clinical test, surgical procedure or day a patient spends in a hospital. In practice, the fee-for-service system is often an invitation to do more of everything - more visits, more tests, more surgery. What gets done is what gets paid for, and insurers usually do not pay for preventive care or chronic care management provided by nurses or in group classes, like the ones at Kaiser."
How true. Insurers are moving away from preventive measures instead of embracing it. In the long run, the focus on prevention will be key in controlling costs.
"In Northern California alone, Kaiser spends $55 million a year on chronic-care management programs. "But what's really expensive is if we don't take care of these people and manage their chronic conditions," said Dr. Robert Mithun, chief of internal medicine at Kaiser's medical center in San Francisco.
Dr. Mithun's comment may seem like no more than common sense, but it does not reflect the typical logic of the dominant fee-for-service model of health care. Most doctors and hospitals get a fee from insurers for each patient visit, clinical test, surgical procedure or day a patient spends in a hospital. In practice, the fee-for-service system is often an invitation to do more of everything - more visits, more tests, more surgery. What gets done is what gets paid for, and insurers usually do not pay for preventive care or chronic care management provided by nurses or in group classes, like the ones at Kaiser."
How true. Insurers are moving away from preventive measures instead of embracing it. In the long run, the focus on prevention will be key in controlling costs.
Posted by Kevin |
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Comments:
As a nurse with 15 years experience, I must reply to this post. There are two medical systems in this country that make me shudder with stress and fear when I consider them. The first is the Military the second is the Kaiser system.
As a nurse who works mainly with seniors I have known the hell that is the Kaiser system. When you are dealing with frail individuals who need more attention to detail and need someone available by phone, Kaiser is the worst system to be involved with. Kaiser fails to repond to outside vendors in a timely fashion, their system of out sourcing resources is time consuming and confusing. They fail to bring in out side resources when necessary. They fail to understand a residents condition fully, for example, expecting an alzheimers patient who gets angry and abusive when an accucheck (finger stick) is preformed. And even though she has not had a high blood sugar in over a year, they continue to require the test DAILY. Any other system would look at this and see it as unnecessary. Which it is.
They follow a list of instructions on the page, do not use their brains, the phone system is absurb, the communication to families and nurses in facilties caring for the elderly is non existent. Physicians refuse to make house calls to long term care facitlies, even when you are talking about end stage alz. residents.
As a nurse I have spent HOURS on the phone trying to get a prescription written for a cold, or a flu. The physicians do not return required paperwork in a timely manner.
So, if Kaiser becomes the 'standard' of American Healthcare. I am leaving. Dont' even get me started on the Military.
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As a nurse who works mainly with seniors I have known the hell that is the Kaiser system. When you are dealing with frail individuals who need more attention to detail and need someone available by phone, Kaiser is the worst system to be involved with. Kaiser fails to repond to outside vendors in a timely fashion, their system of out sourcing resources is time consuming and confusing. They fail to bring in out side resources when necessary. They fail to understand a residents condition fully, for example, expecting an alzheimers patient who gets angry and abusive when an accucheck (finger stick) is preformed. And even though she has not had a high blood sugar in over a year, they continue to require the test DAILY. Any other system would look at this and see it as unnecessary. Which it is.
They follow a list of instructions on the page, do not use their brains, the phone system is absurb, the communication to families and nurses in facilties caring for the elderly is non existent. Physicians refuse to make house calls to long term care facitlies, even when you are talking about end stage alz. residents.
As a nurse I have spent HOURS on the phone trying to get a prescription written for a cold, or a flu. The physicians do not return required paperwork in a timely manner.
So, if Kaiser becomes the 'standard' of American Healthcare. I am leaving. Dont' even get me started on the Military.
