CNN Article - Psychologists to Strike

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AbnormalPsych

AbnormalPsych

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cara susanna said:
Conversation with my husband this morning:

Husband (reading the news): Some therapists are going on strike.
Me: Kaiser?
Husband: Yup.

It's so sad that they continue to struggle with all of this, especially the ridiculously large panel sizes.
Click to expand...

Yeah, when I saw the title of the thread, I immediately thought Kaiser before even opening the link.
 
Kaiser has quite a reputation for not providing therapy in a timely or regular manner, and for using psychologists as workhorses. VIa word of mouth, I've heard of someone who works there writing notes after hours and on weekends because they see clients back to back all day. No admin time. Waitlists are ridiculously long to get into see therapists for individual therapy, and appointments are spaced out 3-4 weeks, sometimes more.

Also, a non-profit reporting over $8 billion net income in a year? Where does that excess go when you're a non-profit?

My best wishes to all the psychologists at Kaiser striking--I hope they get everything that their union is advocating for. The irony of Kaiser's rep saying the union is using "unethical" means by striking and not providing needed mental health services when the psychologists are striking unethical conditions by Kaiser--such manipulative language.
 
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foreverbull said:
Kaiser has quite a reputation for not providing therapy in a timely or regular manner, and for using psychologists as workhorses. VIa word of mouth, I've heard of someone who works there writing notes after hours and on weekends because they see clients back to back all day. No admin time. Waitlists are ridiculously long to get into see therapists for individual therapy, and appointments are spaced out 3-4 weeks, sometimes more.

Also, a non-profit reporting over $8 billion net income in a year? Where does that excess go when you're a non-profit?

My best wishes to all the psychologists at Kaiser striking--I hope they get everything that their union is advocating for. The irony of Kaiser's rep saying the union is using "unethical" means by striking and not providing needed mental health services when the psychologists are striking unethical conditions by Kaiser--such manipulative language.
Click to expand...

Non-profit does not mean no profit. It does mean no income taxes. As to where all the money goes, that is a good question. I usually like to start at the top and see how fat those bank accounts are. I can tell the CEO was the highest paid non-profit in the country a few years ago at 18 million in compensation.
 
The NASW code of ethics has an explicit clause about social workers going on strike, not surprisingly APA offers absolutely nothing to guide our ethical decision making in the case of labor disputes. I've always thought this would be a good thing for us to have for this exact reason. A ****ty employer could try and accuse a psychologist of patient abandonment or something for going on a strike and we wouldn't have our code to back us up...
foreverbull said:
Kaiser has quite a reputation for not providing therapy in a timely or regular manner, and for using psychologists as workhorses. VIa word of mouth, I've heard of someone who works there writing notes after hours and on weekends because they see clients back to back all day. No admin time. Waitlists are ridiculously long to get into see therapists for individual therapy, and appointments are spaced out 3-4 weeks, sometimes more.

Also, a non-profit reporting over $8 billion net income in a year? Where does that excess go when you're a non-profit?

My best wishes to all the psychologists at Kaiser striking--I hope they get everything that their union is advocating for. The irony of Kaiser's rep saying the union is using "unethical" means by striking and not providing needed mental health services when the psychologists are striking unethical conditions by Kaiser--such manipulative language.
Click to expand...
 
Sanman said:
Non-profit does not mean no profit. It does mean no income taxes. As to where all the money goes, that is a good question. I usually like to start at the top and see how fat those bank accounts are. I can tell the CEO was the highest paid non-profit in the country a few years ago at 18 million in compensation.
Click to expand...

Profit-wise, it means that that don't have shareholders that they distribute profits/dividends to. But that doesn't mean that they don't have highly paid executives. Also, as long as the excess profit goes to the "organization's purpose" it's ok. "Purpose" being a vague notion.
 
PsyDr said:
The psychologists are devaluing themselves by uniting with lesser trained, lower scope of practice professionals. CA allows psychologists to admit to hospital.
Click to expand...
I was thinking something along the same lines; however, increasing the value and compensation of the midlevels should increase ours. As doctoral professionals, our professional organization should be working on this stuff so that we can support the midlevels, but we should remain separate.
 
smalltownpsych said:
Unfortunately, I am sure that the APA won’t say anything about it or if they do it will be some weak statement which is one reason I left the APA. They don’t seem that interested in advocating for our profession or our field.
Click to expand...
APA as a whole maybe not (although maybe it's been improving recently), but APAPO is definitely more active on that front. I stay in APA because I strongly feel psychologists need a single, national "voice," and the APA is the best we've got; and also to continue supporting the Practice Organization and their advocacy.
 
ohiopsychdoc said:
Yeah, I was part of the AFM union for musicians back in my day as a pro musician. I decided to never again be part of a union after that experience.
Click to expand...

Like most things, there are good and bad. My graduate student union was hugely beneficial and successful, before the state government went on a union busting run. Definitely some bad apples when it comes to unions, but I do think by and large they've been more or a boon to workers than a hindrance in the aggregate.
 
WisNeuro said:
Like most things, there are good and bad. My graduate student union was hugely beneficial and successful, before the state government went on a union busting run. Definitely some bad apples when it comes to unions, but I do think by and large they've been more or a boon to workers than a hindrance in the aggregate.
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Perhaps - I still opt to not get involved for the time being.
 
WisNeuro said:
Like most things, there are good and bad. My graduate student union was hugely beneficial and successful, before the state government went on a union busting run. Definitely some bad apples when it comes to unions, but I do think by and large they've been more or a boon to workers than a hindrance in the aggregate.
Click to expand...
I had a horrible union in an old job and couldn’t opt out of paying them a lot of money every year. Definitely gave me a negative view of unions but I do see how they can be valuable, but mine was every negative stereotype you’ve heard.
 
Pragma said:
I had a horrible union in an old job and couldn’t opt out of paying them a lot of money every year. Definitely gave me a negative view of unions but I do see how they can be valuable, but mine was every negative stereotype you’ve heard.
Click to expand...

I don't doubt it, definitely some shady unions out there. And, I say that coming from a UAW family 😉 Some do a pretty good job at finding that middle ground. And, the numbers for union involvement are fairly consistent regarding increased wages. But yes, they do need appropriate checks and balances.
 
In California, Kaiser is like the shady used car dealer of health care. They will sell you a health insurance plan that is a bit cheaper than that of the competition, and that doesn't work well. This is especially true when it comes to mental health care which they essentially refuse to provide in an adequate way. They have a long and ugly history of this.

Kaiser is currently canceling therapy appointments for thousands of patients (regardless of the severity of their conditions) in anticipation of the strike, and in violation of state law. The Kaiser clinician managers who are implementing this are acting illegally and unethically:


Kaiser is doing this because referring patients to alternate sources of outside care (as is legally required) is deemed too expensive and will cut into their billions of dollars in profits.
 
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msc545 said:
In California, Kaiser is like the shady used car dealer of health care. They will sell you a health insurance plan that is a bit cheaper than that of the competition, and that doesn't work well. This is especially true when it comes to mental health care which they essentially refuse to provide in an adequate way. They have a long and ugly history of this.

Kaiser is currently canceling therapy appointments for thousands of patients (regardless of the severity of their conditions) in anticipation of the strike, and in violation of state law. The Kaiser clinician managers who are implementing this are acting illegally and unethically:


Kaiser is doing this because referring patients to alternate sources of outside care (as is legally required) is deemed too expensive and will cut into their billions of dollars in profits.
Click to expand...
Not sure why kaiser should be on the hook to pay for out of network care for these patients. When nurses go on strike this doesn't happen, just the department is shut down.
 
Heist said:
Not sure why kaiser should be on the hook to pay for out of network care for these patients. When nurses go on strike this doesn't happen, just the department is shut down.
Click to expand...
Just my guess--maybe because the insurance requires they go to a Kaiser facility, but Kaiser facilities now can't reasonably provide the service? Sort of like if a VA shutdown because people went on strike, I suspect VA would be financially obligated to pay for care for the patients at outside facilities. I have no experience or familiarity with Kaiser insurance but wonder if it's a similar situation/setup.

Something like that.
 
AcronymAllergy said:
Just my guess--maybe because the insurance requires they go to a Kaiser facility, but Kaiser facilities now can't reasonably provide the service? Sort of like if a VA shutdown because people went on strike, I suspect VA would be financially obligated to pay for care for the patients at outside facilities. I have no experience or familiarity with Kaiser insurance but wonder if it's a similar situation/setup.

Something like that.
Click to expand...

There is something here like this as well. One of the larger healthcare systems created their own insurance network, of which most of it's providers are the preferred in-network providers for the plan. They have to provide necessary care in a "reasonable" time frame. If they cannot provide this, that may have to reimburse the out of network providers at no extra cost to the insured patient.
 
Heist said:
Not sure why kaiser should be on the hook to pay for out of network care for these patients. When nurses go on strike this doesn't happen, just the department is shut down.
Click to expand...

Because Kaiser is 3 entities:

1) A health insurance
2) A hospital group
3) A medical clinic group


Insurance companies have legal requirements to pay for care, with additional requirements that something like 80% of revenue must be used to pay for healthcare. Kaiser, the health insurance, acting like an HMO, has created rules that incentivize subscribers to go to Kaiser brand medical groups. That does not excuse them from paying that 80% of revenue. The medical Group is stating they are understaffed. That is not a legal excuse for the health insurance. The avoidance of using the required percentage for healthcare makes it look like the insurance company is acting like a revenue generating department. There are HUGE legal consequences for when an insurance company's claims department acts as a revenue generating department (e.g., State Farm).
 
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Heist said:
Not sure why kaiser should be on the hook to pay for out of network care for these patients. When nurses go on strike this doesn't happen, just the department is shut down.
Click to expand...

New California state law also requires a first visit within 10 business days and follow up visits within 10 business days, unless deemed not detrimental to the patient to wait longer. These are mental health specific laws.

This is on their public union website:
nuhw.org

Kaiser Don't Deny – Care Delayed Is Care Denied - Kaiser Don't Deny

Open-Ended Strike Starts 10/21 for Kaiser Mental Health in Southern California. Learn More Support the Strike Kaiser, Don’t Deny Kaiser patients and therapists are shining a light on the HMO’s failure to provide patients with timely access to mental health care and the devastating consequences...
nuhw.org
 
cara susanna said:
F/u visits within 10 days?? How the heck do they manage that?
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Welp... they're not. Huge shortage of providers in their outside network, too.

Kaiser striking is nothing new. This has been going on for years. I know plenty of people who like it on the medical side - like for OBGYN. Abhorrent on the MH side for both staff and patients.
 
Heist said:
Not sure why kaiser should be on the hook to pay for out of network care for these patients. When nurses go on strike this doesn't happen, just the department is shut down.
Click to expand...
Do your patients commit suicide or require hospitalization when they can't get appointments because Kaiser is too cheap to hire providers or pay them decently? Ours do. That is why poor Kaiser needs to pay for out-of-network care or fix the problems.
 
AbnormalPsych said:
New California state law also requires a first visit within 10 business days and follow up visits within 10 business days, unless deemed not detrimental to the patient to wait longer. These are mental health specific laws.

This is on their public union website:
nuhw.org

Kaiser Don't Deny – Care Delayed Is Care Denied - Kaiser Don't Deny

Open-Ended Strike Starts 10/21 for Kaiser Mental Health in Southern California. Learn More Support the Strike Kaiser, Don’t Deny Kaiser patients and therapists are shining a light on the HMO’s failure to provide patients with timely access to mental health care and the devastating consequences...
nuhw.org
Click to expand...

New state law...blah, blah. How does this work??? New "state law" starting.....when? Grace period? Or they think this just should be "happens" because they say so? We give big industry and Oil 5-10 and 20 years for goals, don't we? "New California state law" means very little in and of itself to me.
 
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erg923 said:
New state law...blah, blah. How does this work??? New "state law" starting.....when? Grace period? Or they think this just should happens because they say so? We give big industry and Oil 5-10 and 20 years for goals, don't we?
Click to expand...
Big oil and industry don't directly involve life and death. Mental health does.
 
In 2015 Kaiser was on strike for the same reasons they are again today. Nothing is better.
 
PsyDr said:
Because Kaiser is 3 entities:

1) A health insurance
2) A hospital group
3) A medical clinic group


Insurance companies have legal requirements to pay for care, with additional requirements that something like 80% of revenue must be used to pay for healthcare. Kaiser, the health insurance, acting like an HMO, has created rules that incentivize subscribers to go to Kaiser brand medical groups. That does not excuse them from paying that 80% of revenue. The medical Group is stating they are understaffed. That is not a legal excuse for the health insurance. The avoidance of using the required percentage for healthcare makes it look like the insurance company is acting like a revenue generating department. There are HUGE legal consequences for when an insurance company's claims department acts as a revenue generating department (e.g., State Farm).
Click to expand...
I've seen insurance deny many things. They just have the patient pay for it and absolve themselves. I do prior authorization all the time that is denied
 
Laws have changed - something may happen this time.
 
erg923 said:
New state law...blah, blah. How does this work??? New "state law" starting.....when? Grace period? Or they think this just should be "happens" because they say so? We give big industry and Oil 5-10 and 20 years for goals, don't we? "New California state law" means very little in and of itself to me.
Click to expand...

How do laws work?

It said it started in July on that webpage. It also looks like the state is doing some kind of monitoring:

Newsroom | DMHC Press Releases and Newsletters

Media relations contact information, press releases and recent articles.
www.dmhc.ca.gov
 
Heist said:
I've seen insurance deny many things. They just have the patient pay for it and absolve themselves. I do prior authorization all the time that is denied
Click to expand...
People that have Kaiser cannot generally afford to pay for anything else.
 
msc545 said:
Maybe they are but Kaiser is politically very powerful.
Click to expand...

Seems to be.

Now I'm going down a rabbit hole online. Should be interesting few weeks ahead.

It looks like a number of state and local government officials are making their positions known:

"This strike is a long time coming," said state Sen. Scott Wiener, D-San Francisco, among a growing number of state legislative leaders backing the workers. "There have been major issues at Kaiser in terms of providing people with timely access or any access to mental health and addiction treatment and the workers have been advocating for years to have more staffing and compliance with the law and that hasn’t happened."

"Oakland City Councilmember Dan Kalb, who joined Oakland staffers on the picket line on Tuesday, said mental health care has been undervalued for far too long."

www.kqed.org

Kaiser Mental Health Workers Strike for Third Day in Fight for Increased Staffing and Wages | KQED

Thousands of Kaiser psychologists, therapists and social workers picketed for a third day outside Kaiser facilities in Northern California, after negotiations with management broke down over the weekend.
www.kqed.org www.kqed.org
 
Heist said:
Doesn't matter. Medicaid denies claims too.
Click to expand...

Have you read through the the policy statements regarding what you are asking for a prior auth for? These are usually pretty straightforward and the biggest reason for denials is people being completely unaware of existing guidelines. Also, do you have an office assistant or something? You seem to have a difficult time navigating different aspects of healthcare, and a dedicated staff person may decrease your time on unreimbursed activity.
 
Heist said:
Doesn't matter. Medicaid denies claims too.
Click to expand...
All of this is really NOT about denial of claims, although that certainly does happen in various contexts. It is more about the delay of service and overwork of providers.
 
Heist said:
I've seen insurance deny many things. They just have the patient pay for it and absolve themselves. I do prior authorization all the time that is denied
Click to expand...
So what? That’s not what I said. Are you misreading my statement or arguing in bad faith?

The health insurance must pay 80% of premiums towards healthcare. It is illegal for a claims department to serve as a revenue generating department. Those are two separate and established legal standards. You asked why they should have to pay. That’s your answer. They are legally obligated to pay.
 
PsychPhDone said:
Welp... they're not. Huge shortage of providers in their outside network, too.

Kaiser striking is nothing new. This has been going on for years. I know plenty of people who like it on the medical side - like for OBGYN. Abhorrent on the MH side for both staff and patients.
Click to expand...

I know that Kaiser is terrible, but I don't know how many clinics could manage consistent 10 day initial access AND f/u. The VA certainly can't

Edit: Oh, this is for HMOs. I admit I don't know much about HMOs.
 
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