Molly's clarification of Kaiser patients' future options
Kaiser Members:
Many of my Kaiser patients have received a letter from Kaiser with my name at the bottom recommending physicians to replace me. While I have still not seen a copy of the letter, my understanding is that it announces my leaving and gives a list of providers to choose from. The list does not include either Dr. Whitt or Dr. Gleber as options.
I imagine this letter is a form letter generated by Kaiser Permanente when any provider leaves his or her practice. Further, I imagine it was generated before Dr. Whitt made his heroic decision to keep the West Marin Medical Center open. The wheels of bureaucracy are slow to turn. I do not think this letter was meant in anyway to undermine Dr. Whitt’s efforts.
Back in September when I made my announcement, Kaiser notified me that such a letter would go out. When I called in October and November to find out why it hadn’t been sent, I was told because they weren’t sure if Coastal Health Alliance would be buying my practice and they weren’t sure if Dr. Whitt was staying, so they didn’t want to send people away from those options prematurely. For this reason, I assumed after Dr. Whitt announced he would be staying, Kaiser would not send out the letter.
In any event, use the letter as a list of options, keeping in mind that as far as any of us knows, Dr. Whitt and Dr. Gleber (pending credentialing) will be seeing Kaiser patients in my office. Also remember, I wrote only the first letter back in September, not this latest one from Kaiser.
Molly Bourne
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The Kaiser Meeting
The goal of the Kaiser meeting on October 29th was to band together West
Marin Kaiser patients for two reasons: First, to make sense of what has
happened to my office. Second, to form a community alliance to help
Kaiser patients maintain primary care in West Marin. Of note, because I
will not be seeing Kaiser patients in 2008, I did not go to the meeting
last Monday. I did not want my leaving to distract from the issue at
hand for Kaiser patients in West Marin. Bonnie and Rich Clarke, who
helped facilitate the meeting, asked me to clarify a few points on my
website for my Kaiser patients. Bonnie and Rich are not the only people
to ask me these questions, so I have chosen a “frequently asked
questions” format.
Did Kaiser end my contract?
Kaiser did not end my contract. In fact, I did. I am currently able to
see Kaiser patients via a subcontract through the Coastal Health
Alliance (CHA, the umbrella organization running the Point Reyes Clinic,
Bolinas Family Practice and Stinson Beach Medical Clinic). Over ten
years ago when Kaiser and CHA were considering a contract, both parties
were generous enough to include Dr. Whitt (who owned my practice at the
time) as a subcontractor. The contract carried over when I bought the
practice over four years ago.
This summer, when I decided I could not take the financial burden of
running my office in the red, I notified Kaiser that I would be ending
our subcontract. This decision came along with the decision for me to
stop all insurance contracts as of January 1, 2008 and close my office.
Kaiser does not reimburse enough for a small practice like mine to stay
afloat, but in this way, it is no different from any other insurance
company.
There are many things Kaiser could have done to help me stay in West
Marin, but I can say the same thing about all insurance companies. I can
say the same thing about the way health care runs in our country. I see
no reason to single out Kaiser as the entity to blame just because they
insure a large percentage of my practice.
Where can Dr. Molly Bourne’s Kaiser patients go?
Right now, Kaiser is continuing to work with the Coastal Health Alliance
to accommodate my patients in West Marin. Kaiser intends to send a
letter to my patients notifying them of their choices for future
physicians. The same is true for patients of Dr. Whitt and Cheryl
Higgins, FNP.
What can Kaiser patients in West Marin do to help keep their
health care local?
CHA is willing to absorb my Kaiser patients. This will be a burden for
them, but they have the Kaiser contract and they have a mission to
provide a health care safety net for our area. My recommendation is to
embrace them as your health care advocates or to choose a doctor “over
the hill” at Kaiser. If you choose to go to CHA, you might want to ask
if there is a way for Kaiser patients to learn what the on-going issues
are between Kaiser and CHA. For example, I think it would be reasonable
for a patient advocate to be a part of the quarterly Kaiser meetings
that I have been going to with the CHA staff and our Kaiser liaisons. I
have also made this suggestion to Bonnie and Rich Clarke.
Why don’t you become a Kaiser doctor so we can follow you there?
Perhaps one day, if they’ll have me, I will. For now, I want to pursue
my own interests in changing the way health care is done in our country.
I’ve heard Kaiser pays physicians quite well. On the other hand, as a
Kaiser physician, I would not be able to do my other jobs at Serenity
Knolls or Hospice by the Bay, which are important to me.
There are some rumors that Kaiser offered to take over your
practice?
As of last year, Kaiser has a new electronic medical record. This system
is so complicated to learn, before implementing it in West Marin, Kaiser
looked into consolidating how many providers saw Kaiser patients (to
minimize the providers who would need training and to help with the
learning curve). In addition, the fact that there are four sites in West
Marin where Kaiser patients can go, there were additional problems with
firewalls, etc. For this reason, there was some talk last year of having
just one facility see West Marin Kaiser patients. This is what that
rumor alludes to.
What do you see as a major issue in the next few years for
Kaiser patients in West Marin?
I think it is very important that their electronic medical record system
gets in place quickly for West Marin sites. The new system was put in
place over a year ago at Kaiser, but has not been implemented yet in any
of the four West Marin sites that see Kaiser patients. CHA and Kaiser
are both working on this problem and have been for over a year. As
patients, I recommend you stay informed and sit tight. This is one issue
worth keeping close tabs on in the coming year.
Meanwhile, do the things all of us should do to stay healthy: eat right,
exercise if you can, be nice to your neighbors and laugh at yourself.
These four things are more powerful than your physician and, certainly,
more valuable than your insurance premium!
Molly Bourne
Notes for the meeting of October 29
(Questions to be posed to Bill Elliott of Kaiser Novato may be seen here)
October 29, 2007
Notes by Elizabeth Zalengo
meeting of Kaiser patients at Dance Palace in Pt. Reyes Station
Michael Mery reported that Dr. Michael Whitt would be willing to
increase his working hours at WMMC but did not know if Kaiser would
honor his authority to treat Kaiser patients.
Toni Littlejohn and Nancy Bertelsen asked if there were any objections
to their videotaping the meeting for Molly so she could use this info
for the future. There were no objections.
Dr. Mike Witte reported that the medical system does not support the way
WMMC has been operating and that it is a nationwide problem, the problem
being that insurance companies only reimburse 50 to 60 cents on the
dollar. He gave the history of Mac Holliday back in the early 90's
wanting to expand medical service to more people in West Marin and
Kaiser was approached and agreed to it because they wanted to increase
their market share of the patient base. They required the contract to
be with a nonprofit and deliver the same quality care that they
provide. Molly Bourne and WMMC has been operating as a subcontractor of
CHA. The key has been the relationship that CHA has maintained with
Kaiser which has been good, but fragile. The recent issue is that
Kaiser is going completely electronic (paperless) which is a threat to
CHA because Kaiser feels CHA and anyone connected with them also needs
to be paperless. This is very daunting for CHA, although they think
they can do it but it may take 2-3 years to get up to speed. Basically
K. is scared of the differences that CHA or WMMC can provide to
patients, such as e-mails, medical web sites, etc. or everything
available online. It is better economically for K. to help patients
via the internet, thus resulting in private practices being squeezed.
This community has the only K. contract of its kind in this country.
Witte feels that we need to present this in a positive way to Bill
Elliott (chief of Kaiser Novato Medical Ctr) how unique we are--at the
point B. Elliott has said that K . is reluctant to extend the contract
for WMMC to remain as a subcontractor. Elliott would like to see it work
out here but his "regional" higher ups question our electronic
capabilities. Elliott is pulled in many directions. Kaiser sees an
electronic health care system as a way to "errorless" medicine in the
future. Also K. is not concerned about market share now as they are a
successful medical system. WMMC has about 720 Kaiser pts. and CHA has
1800--making a very small percentage of the 40,000 Kaiser patients in
the county.
CHA is the only "pay for fee' clinic Kaiser has in the entire country.
Witte said K. could see it as a liability or as a paradigm for the
future
Questions and comments:
Doris Allen reported that Kaiser has done a study of health coops in
Uganda--which is worth looking into as Kaiser could use our unique
situation for a study for future clinics such as ours.
Lisa Bell - board president of CHA -addressed the possibility of a
Kaiser doctor taking over WMMC, Witte commented that no one outside of
K. would be able to go there and that Bill Elliott said "that door was
closed" and is that did happen, would that mean CHA Kaiser patients
could not be treated at CHA--that would need to be negotiated. That is
a question for Bill Elliott and it could threaten Kaiser patients at
Bolinas and Stinson.
Amy Schliftman - physical therapist- said that over the past years she
had been told by both John Seversen and Molly Bourne that the
relationship with Kaiser had been fragile so she never approached Kaiser
to have them reimburse her for seeing K. pts. although this last year
alone she has treated 50 Kaiser pts. who have paid her out of pocket.
M. Witte said the Kaiser bureaucracy makes decisions from a provincial
place not always seeing the bigger picture, but they are people like us
and he thinks they are malleable. Decisions are often made based on the
economic status of that particular year. It's all about insuring
QUALITY OF CARE especially in rural communities.
Someone suggested that maybe Mac Holliday could be asked to help us
again. Richard Geist who was a visionary and was instrumental in
creating the liaison with Kaiser in the 90's unfortunately is no longer
around.
M. Witte addressed the complaint that people have of CHA not being able
to choose a doctor and waiting too long for services--he said that has
improved and CHA now has 4 doctors on staff.
Judith Less said that we should emphasize of unique paradigm to B.
Elliott.
Witte gave a list of all the doctors and nurse practitioners on staff at
CHA and WMMC. It is unknown if additional providers will be brought in
after Jan. at CHA. Any temporary physician at WMMC could only work if
there was a practice in place
Rich Clarke asked the audience what are the questions, concerns,
suggestions and opinions to relay to Kaiser officials..........
Responses:
1. Kaiser used to have a P1 category--(private 1) where one could see
patients outside of Kaiser--is this still viable.
2. Will K. prescriptions still be able to be filled at our local
pharmacy
3. K. may be asked in other areas of the US to provide a non-urban
health care facility as there is a major shortage of primary care
physicians. We have the only model that is working and self-sustaining.
4. We are a viable experiment that someday could be useful for other
models
5. Philip Fradkin has a list of 5 questions that he will give to Bonnie
6. How does K. define medical necessity and what is their standard of
access.
7. Can K. get government help to pursue this model,
8. Will K. provide transportation for those who have to go over the
hill.
9. What is going on with the pharmacy's contract with K. and why it is
not equitable.
10. Is K. willing to consider alternatives to traditional treatments
11. Can we explore grant possibilities to help keep these kinds of
practices open--Kaiser combined with private practice.
Rich Clarke feels the community spirit of THINKING LOCAL and suggested
that we ask Kaiser what can we do to use this place as a demonstration
model.
Someone else suggested that we should tell Kaiser that we want to remain
K. pts. and want to keep the Molly Bourne model going.