[Editor’s note: KHN is not affiliated with Kaiser Permanente.]
A California law that took effect in July requires health plans to offer timely follow-up appointments for mental health and addiction patients. Whether that’s happening is a point of contention amid an open strike by doctors at Kaiser Permanente in Northern California, who say staff shortages put them under suffocating workloads that make it impossible to provide adequate care.
KP said it is making every effort to hire workers but has been hampered by labor shortages. Therapists — and the National Union of Healthcare Workers, which represents them — counter that the managed-care giant has difficulty attracting physicians because its mental health services have a poor reputation.
The dispute comes at a time when demand for mental health care is increasing. The share of adults with symptoms of depression and anxiety in the United States has nearly quadrupled during the Covid-19 pandemic.
The new law requires state-regulated health plans to provide return appointments no later than 10 days after a previous mental health or substance use session — unless a patient’s therapist allows less frequent visits.
The bill, which was sponsored by the union, was signed by Gov. Gavin Newsom in October and included a grace period for health plans to comply.
Kaiser Permanente did not comply, said Sal Roselli, president of the health care workers union, which represents 2,000 KP mental health physicians in Northern California and 4,000 statewide. “In fact, it’s getting worse,” he said. “Thousands of people are not getting access to the care that doctors say they need.”
The union and its members said patients often have to wait two months for follow-up appointments.
Kaiser Permanente said in an online statement that HMO compliance with the new law is “going well.”
KP has expanded its mental health care capacity by adding nearly 200 physicians, expanding virtual appointments and offering more mental health services through its primary care providers starting in January 2021, said Deb Katsavas, senior vice president of human resources for KP’s Northern California division. In addition, he said, KP has launched a $500,000 recruiting campaign and is “investing $30 million to build a pipeline of new, culturally diverse mental health professionals across California.”
But the picketing clinicians, who began their strike on August 15, say they face regular interruptions in their jobs due to what they describe as persistent staffing shortages.
Alicia Moore, a KP psychologist in Vallejo who leads group therapy sessions in an intensive outpatient program, said her patients may have difficulty maintaining the progress they’ve made after the program ends because they must wait for follow-up appointments. “Our program does a pretty good job of helping people in immediate crisis, but then there’s no therapy appointment to get them out,” said Moore, who picketed Aug. 16 in front of KP’s Oakland Medical Center. “You search for an appointment, and it’s months away.”
Not only are therapists worn out, but many potential new providers don’t want to work for KP, she said. “We actually have several open positions in the clinic, but I think it’s very difficult for Kaiser to fill positions when it’s known by mental health workers as a place where it’s really hard to do a good job because you just don’t do it. There are no appointments to offer patients,” Moore said.
KP also has an attrition problem, the union said.
Mickey Fitzpatrick, a psychologist who worked at Kaiser Permanente for 11 years, said he resigned this year because he was unable to care for patients “the way we are trained in graduate school, consistent with my passion for psychotherapy. A way that is conducive to healing.” .”
The union argues that KP has the money to fix the problem, if it wants to, noting that it posted $8.1 billion in net profit last year and is sitting on about $55 billion in cash and investments.
Both sides disagree about how much time physicians should spend managing patients’ cases outside of therapy sessions.
Katsavas said the union is demanding that doctors’ face-to-face time with patients be reduced so that KPs are willing to do administrative work. The claim, he said, “contradicts the union’s own commitment to help improve access to mental health care.”
The union said clinicians need time for tasks that are not administrative but an integral part of care — such as contacting parents, school officials and social service agencies about minor patients and returning emails and phone calls from concerned adults whose next appointment is six to eight weeks away. may be far
The strike “will only reduce our access to care at a time of unprecedented demand,” Katsavas said. “Across the country, there are not enough mental health care professionals to meet the increased demand for care,” he said. “This poses challenges for Kaiser Permanente and mental health care providers everywhere.”
In an Aug. 15 statement, the California Department of Managed Health Care reminded KP that it must respect timely access and clinical standards despite physicians on the picket line. “DMHC is closely monitoring Kaiser Permanente’s legal compliance during the strike,” the statement said.
Agency spokeswoman Rachel Arezola said the state has so far received 10 complaints related to the new law — all against Kaiser Permanente.
Katsavas said more than 30% of KP physicians continued to care for patients during the strike, and KP psychiatrists, clinical managers and outside mental health providers stepped in to help.
KP’s mental health issues date back many years. In 2013, the agency was fined $4 million by the state for failing to provide timely mental health treatment. It has since been cited twice for failing to address the problem and is currently being investigated by regulators, who saw a 20% increase in mental health complaints against KP last year.
Barbara McDonald of Emeryville said she tried to get help at KP for her 19-year-old daughter, who had engaged in self-destructive behavior. Numerous attempts with Kaiser Permanente over the past few years failed to get her daughter the help she needed, and MacDonald said she spent hundreds of thousands of dollars seeking her diagnosis and treatment elsewhere. He has bipolar and borderline personality disorders, as well as attention-deficit/hyperactivity disorder, McDonald said.
McDonald said at one point her daughter cut her own throat and ended up in KP Hospital for three days.
“The irony is that when you leave mental health problems untreated, they become physical problems as well,” he said. “You can’t tell me that keeping my daughter in the hospital for three days costs less than regular therapy.”
This story was produced by KHN, which publishes California Healthline, the editorially independent service of the California Health Care Foundation.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.
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