One thing Kaiser Permanente is good at when it comes to mental healthcare is wiggling its way out of trouble after regulatory agencies penalize it for violating access-to-care laws.
With Kaiser now under both state and federal oversight for major violations of mental health parity laws, clinicians in California have started filling out Objection to Assignment forms en masse this month, as part of a “blitz to make sure regulators get real-world data about the experience of patients and providers — not just the upbeat reports that Kaiser provides the regulatory agencies.
“It takes a few minutes, and yes, it’s a little extra time, but it feels like we need to document what’s really happening in the clinic,” said Liza Dalmacio, a social worker with Kaiser in San Diego for more than a decade.
So far, Kaiser clinicians have filled out nearly 700 Objection to Assignment (OTA) Forms as part of the May OTA Blitz. The forms include details about the clinicians and their inability to provide proper care for patients. A copy goes to the clinician, to NUHW to share with regulatory agencies, and if the clinician chooses, to their manager.
Dalmacio makes sure her manager gets a copy of every Objection to Assignment form, and she’s seen managers start taking access-to-care requirements more seriously when they know violations are being documented.
“I was someone who wanted to stay under the radar, do my job well, and go home,” Dalmacio said. “But since the strike (in Southern California), we’ve seen how Kaiser is trying to squeeze therapists. It just feels right to complete these forms and stick up for what’s right.”
Over the past three years, Kaiser has been cited for major violations by the California Department of Managed Health Care and the U.S. Department of Labor. The HMO has agreed to pay $231 million in penalties, including a $50 million fine, as part of the settlement agreements. Kaiser is also required to show both agencies that it’s addressing its deficiencies that have resulted in patients waiting too long for care and being forced to pay out of pocket for care they should have gotten from Kaiser.
However, regulatory agencies often show more initiative in citing Kaiser for violations than in requiring Kaiser to improve conditions for patients and providers. With Kaiser now years into the corrective action process with California regulators, clinicians still face many of the same issues that have plagued Kaiser for years: inadequate staffing levels resulting in delayed access to care and inadequate care.
With Kaiser’s first progress report due soon under its settlement agreement with the U.S. Department of Labor, clinicians want to provide data to help federal regulators see for themselves if Kaiser has truly addressed its deficiencies.
“My experience is things are not improving,” said Jane Kostka, a therapist with Kaiser in Sacramento. “I have too many patients, so I’m not able to see them back as soon as they need to be seen.”
Kostka said her patients typically have to wait about six weeks between appointments, in violation of SB 221, the law NUHW sponsored, which requires health plans to provide medically necessary return appointments within 10 business days.
“We’ve told our managers until we’re blue in the face that this type of gap between appointments should only be for people with very minor problems,” Kostka said. “They basically reply that they don’t have any power to hire more therapists and improve the model of care.”
Kostka said management suggests referring patients to Kaiser’s external network, but many wouldn’t qualify because of the seriousness of their conditions, and many more don’t want to start from square one with a new therapist.
In San Diego, Dalmacio works under the Feedback Informed Care Program, where she was able to see patients every week or every other week when she transitioned to the program in 2020. Initially, Dalmacio said managers did a good job limiting caseloads and preserving access, but with staffing not keeping up with demand for services, wait times are now three to four weeks at her clinic.
She’s been told her caseload is too high and asked whether patients still need to be in the program. “The response I get is, are people appropriate for external provider networks, can they do grief groups, can they do a webinar or an app?” she said.
Dalmacio, like many of her colleagues, is holding firm, drawing power from documenting how Kaiser is violating the law and not hiding it from management.
“As a social worker, it’s part of my code of ethics,” she said, referring to the code issued by the National Association of Social Workers. “It states that you should not allow your employer’s policies to interfere with the ethical practice of social work. Your employer does not trump your ethics.”
