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Kaiser Clerks Paid More for Helping Less
May 17 2002
Kaiser Permanente, the state's largest HMO, until
recently had awarded
financial bonuses to call center clerks who spent the least
From January 2000 until last December, telephone
at Kaiser's three call centers in Northern California could
Moreover, a recent Kaiser-commissioned survey of
at those centers found they had "a serious concern" that callers
Nurses "feel unable to help patients and said they
a lot of time
dealing with frustrated members when they are not able to schedule
Nurses did not participate in the clerks' bonus program.
Kaiser spokesman Jim Anderson dismissed
were intended to make it more difficult for patients to access care.
"This was a pilot program, and it was discontinued
because it was determined
that it wasn't working" and didn't improve service to members,
"It's always difficult to balance the amount of
spent with an individual
caller versus the amount of time that the next person has to wait to
Since the nurses survey, Anderson said, Kaiser has made improvements in scheduling, training and appointment availability in Northern California.
The California Nurses Assn., the union
nurses, contends that the main problem with the call centers is that
That amounts to evaluating a patient's medical condition, a task restricted to licensed medical personnel by state law, the union contends.
State HMO regulators said Thursday that they are investigating that complaint.
"If we weren't concerned, we wouldn't be looking at it," said Daniel Zingale, director of the California Department of Managed Health Care.
Although Zingale would not discuss the inquiry in detail, he said his office has the power to order Kaiser to change its call center policies.
Kaiser knows of no state inquiry, Anderson said,
that no regulators
have visited Kaiser facilities regarding these matters.
One of Kaiser's own physicians found problems at
Vallejo call center.
Dr. Harvey Kayman, a doctor at the pediatric call center from
Kayman said pediatric medical providers sent him messages reflecting their "distrust, anger, disappointment and pessimism about the call center."
Patients have complained about "the impersonal
they receive" and believe that the call center "puts a barrier between
Anderson said Kayman's report was unsolicited.
many of the things listed in his report were already on the
The incentive plan for the telephone clerks was
2000 in company memos. The incentives were a joint pilot program
To qualify for a bonus, employees had to meet three of four criteria, according to one memo:
Handle regular calls in less than three minutes and 45 seconds and foreign language calls in under eight minutes 30 seconds.
Schedule or request appointments in 15% to 35% of cases.
Transfer fewer than 50% of calls--60% on nights and weekends--to advice nurses for additional help.
Spend an average of 75% or more of the workday answering calls.
Bonuses, from 2% to 10% of a worker's salary, were
awarded if staff
members met or exceeded the targets, the document says.
An internal document, titled "Talking Points for
Managers," said the
bonuses are a way to "reward and encourage performance
"Kaiser Permanente is making a financial
for the purpose of improving our phone service to members,"
Dr. Linda Peeno, a former health plan medical
who now testifies
against HMOs in malpractice suits, said the Kaiser incentive
"It just virtually ensures that you're not going
evaluation, and you're certainly not going to get access to anyone who
"It's a recipe for not just minimal care, but no care."
In the recent survey, Kaiser's call-center nurses reported feeling pressure to spend little time with each patient.
"The nurses are being forced to quickly deal with
it up and move on to the next one or else they're disciplined,"
Nurses get regular reports outlining their average handling time, and that criterion is factored into their annual evaluation, he said.
"There's tremendous pressure on the nurses to cut off the calls, which is a conflict with their license," Newman said.
Anderson said there is no limit to the amount of
nurses can spend
with callers. The Kaiser documents, obtained by The Times,
According to minutes of a meeting last year, the
Kaiser's Northern California physician group described how in the past
That strategy proved counterproductive because
they got past the telephonic triage system, the doctor said.