Kaiser gave bonuses to phone reps who limited doctor visits

By Margie Mason, The Associated Press
Saturday May 18, 2002

SAN FRANCISCO — Telephone clerks at the state’s largest HMO were given bonuses for keeping calls with patients brief and limiting the number of doctor appointments scheduled, a program some opponents argue was deceitful and harmful to patients with serious medical problems. 

Oakland-based Kaiser Permanente ran the pilot program at three Northern California call centers from January 2000 to December 2001. It was discontinued after that, Kaiser spokesman Jim Anderson said Friday. 

“At the end of the year they looked at, ’Were we doing a better job for members than when we started it?’ The thought was no,” Anderson said. “The whole purpose of this was designed to help serve members better.” 

The program, backed by the Service Employees International Union Local 250 in Oakland, gave cash bonuses to clerks who made appointments for 15 percent to 35 percent of callers, spent less than an average of three minutes, 45 seconds on the phone per patient and transferred fewer than 50 percent of the calls to registered nurses. The bonuses were based on the established quotas and the quality of work. 

Anderson said the bonuses were between 2 percent and 4 percent of the workers’ salaries. He could not provide the number of employees who received bonuses or specifically how much they were worth. 

SEIU officials said the program’s effectiveness is a moot issue now. 

“This is a dead issue,” said SEIU Local 250 President Sal Rosselli. “It’s a pilot project that’s in the past and not going any further.” 

The California Nurses Association fought against the program from the beginning, saying clerks should not be making decisions on when to transfer calls to nurses and when to book appointments. It considers those duties as evaluating patients’ medical conditions, which is reserved for licensed nurses and physicians, said Jim Ryder, director of the nursing union’s Kaiser Permanente division. 

“We characterize them as morbidity bonuses,” Ryder said. “Patients don’t understand they’re talking to a high school graduate with no nursing background.” 

State HMO investigators have been probing how the call centers handle referrals for at least three months and recently opened an investigation into the bonus program, said Steven Fisher, deputy director of the Department of Managed Health Care. 

“We’re concerned about it and we’re looking at it,” he said. 

But Anderson said the program was set up based on the average amount of time already established with each patient at the call centers in Vallejo, Sacramento and San Jose, which handle Northern California’s 3 million patients. All of the calls initially are answered by the clerks and some are forwarded to licensed nurses. About 1,300 total people work at all three centers. 

A consumer watchdog group that already has filed an unrelated false advertising lawsuit against Kaiser said the bonus program was “shocking and outrageous.” 

“It’s business goals driving medical care, which is a violation of state law and the public trust and contradicts Kaiser’s own ad campaign that care is doctor driven, not business driven,” said Jamie Court, executive director of the Santa Monica-based Foundation for Taxpayer and Consumer Rights. 

“Patients get lost in this telephone hell, but these aren’t people complaining about a credit card bill. These are people with some life-threatening illness, and if even one person falls through the cracks, the system is broken.”