CNN Article - Psychologists to Strike

[WisNeuro]

Side note, but this is my experience with the extent of training rigor and practice of most mid-levels I am around in my clinical work and it frustrates me to no end.

They're just relying on those "common factors" to drive therapeutic change.

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[PikminOC]

Union openly admits its demands will reduce access to mental health care. NUHW Refuses To End Strike With New Kaiser Permanente Offer

 

[WisNeuro]

The union is saying that 30 contact hours is too much? Unless they're willing to take a pay cut, they're just being ridiculous.

 

[msc545]

We need time to do the paperwork that Kaiser and most insurance companies demand using confusing and awkward EMR systems. Right now, Kaiser will give you 10 minutes per patient to do this with NO time to rest between patients. It takes more than 10 minutes to complete the extensive notes, and we need a REST between patients of at least 5 minutes because this is hard work that is mentally exhausting. Kaiser does not want to provide extra time because that means that therapists could not see as many patients in a day as Kaiser deems necessary to maintain their obscene profits. Kaiser would need to hire more therapists to provide the legally required and medically indicated level of treatment that is needed. Hiring more therapists is a problem because of the ****ty pay and the ****ty way they treat mental health providers (except for Psychiatrists who of course are "special"). Nobody wants to work for them.

What Kaiser wants is MORE WORK of poor quality from the providers they have. What providers want is a cap on the number of patients they are responsible for, and enough PAID time to complete the paperwork Kaiser demands.

Patient access is terrible now. It will remain terrible until Kaiser hires more therapists or can use more out-of-network providers (difficult because of their ****ty pay). Every single therapist that is striking can return and it will not improve access.

 

[Pragma]

The union is saying that 30 contact hours is too much? Unless they're willing to take a pay cut, they're just being ridiculous.

A lot of places are 80-90% billable.

 

[AcronymAllergy]

I would agree that 30 contact hours doesn't strike me as excessive and is in line with what I've seen/heard being required across various VA hospitals. That basically works out to 6 hour-long therapy sessions per day for a standard five-day work week, with the last 10 minutes of each of those hour-long blocks being devoted to writing the progress note. That then leaves two-ish hours per day for lunch, breaks, meetings, finishing notes that took longer than expected, etc. Unless I'm missing something?

All that being said, I'm no fan of Kaiser.

 

[PsyDr]

They're just relying on those "common factors" to drive therapeutic change.

California law allows psychologists to admit, order restraints, and requires them to be on medical staff. It's not a common factors thing. Even if Kaiser hopes psychologists don't figure that out.

Got a buddy in CA who makes money off of admitting patients.

 

[sloh]

(except for Psychiatrists who of course are "special").

Is Kaiser even considered a good gig by many psychiatrists?

 

[PikminOC]

Two thirds of them are back at work.

 

[PikminOC]

I would agree that 30 contact hours doesn't strike me as excessive and is in line with what I've seen/heard being required across various VA hospitals. That basically works out to 6 hour-long therapy sessions per day for a standard five-day work week, with the last 10 minutes of each of those hour-long blocks being devoted to writing the progress note. That then leaves two-ish hours per day for lunch, breaks, meetings, finishing notes that took longer than expected, etc. Unless I'm missing something?

All that being said, I'm no fan of Kaiser.

Don't confuse them with facts.

 

[Therapist4Chnge]

I don't have a problem with the 30 contact hours per week, but seeing patients once a month and having huge caseloads are both unsafe and speak to insufficient staffing in a broken system. The strike is primarily about ACCESS and proper care for patients.

 

[Sanman]

The fight is 30 contact hours vs 29 contact hours. Hardly unrealistic on either side. We know how these negotiations go though.

 

[msc545]

Don't confuse them with facts.

You, of course, have had no contact with Kaiser's mental health EMR system, have you?

 

[msc545]

I would agree that 30 contact hours doesn't strike me as excessive and is in line with what I've seen/heard being required across various VA hospitals. That basically works out to 6 hour-long therapy sessions per day for a standard five-day work week, with the last 10 minutes of each of those hour-long blocks being devoted to writing the progress note. That then leaves two-ish hours per day for lunch, breaks, meetings, finishing notes that took longer than expected, etc. Unless I'm missing something?

All that being said, I'm no fan of Kaiser.

It is not excessive but you cannot get notes done in 10 minutes on their EMR system.

 

[PikminOC]

It is not excessive but you cannot get notes done in 10 minutes on their EMR system.

I know it's hard to believe, but some people stay after work to get their notes completed. In medicine, we don't get paid for the notes. We get paid per patient and do the notes afterwards. I've not heard of having breaks between patients too.
Two thirds of the therapists are back anyway.

 

[msc545]

I know it's hard to believe, but some people stay after work to get their notes completed. In medicine, we don't get paid for the notes. We get paid per patient and do the notes afterwards. I've not heard of having breaks between patients too.
Two thirds of the therapists are back anyway.

You are paid far more than therapists are because Kaiser doesn't believe in mental health other than dispensing psych meds that mostly don't work. Please explain why we should work any time for free given that context. You might be ok with giving your time away for free but I am not nor are most therapists. Therapists at Kaiser are underpaid and overworked as it is.

You should spend a day doing our work, and see how you feel, and then maybe you might understand why a brief respite between patients is necessary for most of us.

As for "two-thirds of them are back at work" you are simply parroting Kaiser management propaganda. The majority of them are NOT back at work. Stop assisting strike-breakers.

 

[PikminOC]

You are paid far more than therapists are because Kaiser doesn't believe in mental health other than dispensing psych meds that mostly don't work. Please explain why we should work any time for free given that context. You might be ok with giving your time away for free but I am not nor are most therapists. Therapists at Kaiser are underpaid and overworked as it is.

You should spend a day doing our work, and see how you feel, and then maybe you might understand why a brief respite between patients is necessary for most of us.

As for "two-thirds of them are back at work" you are simply parroting Kaiser management propaganda. The majority of them are NOT back at work. Stop assisting strike-breakers.

I provide therapy to my patients. Many of my patients are full one hour patients. It doesn't have to do with pay. Many therapists have private practices. They don't get paid for the time doing notes. But the do them.
And if you don't like the conditions there you can leave.

 

[PsychPhDone]

I know it's hard to believe, but some people stay after work to get their notes completed. In medicine, we don't get paid for the notes. We get paid per patient and do the notes afterwards. I've not heard of having breaks between patients too.
Two thirds of the therapists are back anyway.

In a hospital system where presumably you are salaried and docked leave hourly, I think it's unreasonable to ask people to do all documentation after hours. Also just bad practice.

Caveat: I work in VA, not Kaiser.

 

[msc545]

I provide therapy to my patients. Many of my patients are full one hour patients. It doesn't have to do with pay. Many therapists have private practices. They don't get paid for the time doing notes. But the do them.
And if you don't like the conditions there you can leave.

Are you a Psychiatrist or trained to do therapy? If not, I doubt that you do any therapy. People in private practice are able to set their own fees at levels that also take into account the time spent on administrative tasks. I don't work at Kaiser although many of my friends did. Most of them have left, as you suggested.

 

[Pragma]

It is not excessive but you cannot get notes done in 10 minutes on their EMR system.

What’s up with their system that makes it take longer? Therapy notes are templated and super quick where I am. I remember learning to finish them in under 10 minutes before the next patient as an intern.

 

[Karskoe82]

Going into week 9 and into mediation. Pelosi and several U.S. Congress members have written letters:

https://nuhw.org/wp-content/uploads/2022-09-30-Pelosi-Letter-Kaiser-Mental-Health-Clinicians.pdf

https://nuhw.org/wp-content/uploads/09-29-2022.KP-JB-ML-to-Kaiser-re-Mental-Health-Compliance.pdf

Not sure if / how related to mental health but the DOJ is investigating Kaiser for medicare fraud:

Kaiser Permanente Defrauded Medicare of $1 Billion, DOJ Alleges (1)

Members of Kaiser Permanente’s health-care consortium defrauded Medicare out of about $1 billion by altering patient medical records to add diagnoses after the fact that either didn’t exist or were unrelated to patient visits, the Department of Justice is alleging.

news.bloomberglaw.com

 

[PikminOC]

Are you a Psychiatrist or trained to do therapy? If not, I doubt that you do any therapy. People in private practice are able to set their own fees at levels that also take into account the time spent on administrative tasks. I don't work at Kaiser although many of my friends did. Most of them have left, as you suggested.

I am both. And it works for me.

 

[PikminOC]

In a hospital system where presumably you are salaried and docked leave hourly, I think it's unreasonable to ask people to do all documentation after hours. Also just bad practice.

Caveat: I work in VA, not Kaiser.

Many hospital systems just have doctors see patients and midlevels see people all day and document on their own time. It's just the way it works. Not everyone works at the VA.

 

[msc545]

I am both. And it works for me.

Fair enough, but you need to understand that what applies to you does not apply to most therapists at Kaiser or in general. Because of your professional degree, you receive special privileges, higher pay, and deference and forbearance that others do not receive even though their training is arguably equivalent to yours, excluding your knowledge of medications and physical medicine, which may or may not be entirely relevant in treating an outpatient mental health population.

According to Glassdoor, you make about 300K - 400K per year at Kaiser and a Ph.D. Psychologist makes 70K-160K at Kaiser, again per Glassdoor. If other therapists made as much as you do, I doubt they would be on strike. The treatment and compensation you receive are much better than what other therapists receive, and so of course you are apparently not unhappy and perfectly willing to donate free time to finish your notes.

I think your experience with your work situation is fundamentally different than that of people with different training doing essentially the same work, and therefore it might be difficult for you to fully appreciate the discomfort and feelings of oppression and distress that led to the strike.

 

[AbnormalPsych]

I would agree that 30 contact hours doesn't strike me as excessive and is in line with what I've seen/heard being required across various VA hospitals. That basically works out to 6 hour-long therapy sessions per day for a standard five-day work week, with the last 10 minutes of each of those hour-long blocks being devoted to writing the progress note. That then leaves two-ish hours per day for lunch, breaks, meetings, finishing notes that took longer than expected, etc. Unless I'm missing something?

All that being said, I'm no fan of Kaiser.

Agreed with the contact hours. But I think from what was posted in some of the earlier articles in the thread and elsewhere online is that they are seeing ~ 4-5 intakes per week, and that was leading to the large panel sizes and wait times for follow up visits being months out.

 

[msc545]

Agreed with the contact hours. But I think from what was posted in some of the earlier articles in the thread and elsewhere online is that they are seeing ~ 4-5 intakes per week, and that was leading to the large panel sizes and wait times for follow up visits being months out.

Therapists at Kaiser cannot refuse new patients, which has led to individual therapists having caseloads of 200-300 or more patients.

 

[PsychPhDone]

Many hospital systems just have doctors see patients and midlevels see people all day and document on their own time. It's just the way it works. Not everyone works at the VA.

Yes I agree that it is not the same for everyone. I'd consider it for double pay.

 

[PsychPhDone]

Therapists at Kaiser cannot refuse new patients, which has led to individual therapists having caseloads of 200-300 or more patients.

This is the key part I am worried about with Kaiser. 29 vs 31 hours, meh. Panel size is problematic.

 

[PikminOC]

Yes I agree that it is not the same for everyone. I'd consider it for double pay.

It's a formula based on how many patients you see. There is no double.

 

[Pragma]

This is the key part I am worried about with Kaiser. 29 vs 31 hours, meh. Panel size is problematic.

Yeah, it poses more of an ethical issue of being able to provide standard of care (200 cases?!)

I still think 31 hours a week of billable is already low average compared what I have seen. The people doing intervention where I am at have higher than that and they have the best work/life balance in my department. For what they get wRVU-wise, I would be happy to trade places as an assessment person.

 

[msc545]

What’s up with their system that makes it take longer? Therapy notes are templated and super quick where I am. I remember learning to finish them in under 10 minutes before the next patient as an intern.

EMR programs are like plants - they grow. The authors of these programs keep "improving" them and the result is redundancy; every single box must be checked and every question answered every time. The result is neither short nor intuitive nor easy.

 

[msc545]

It's a formula based on how many patients you see. There is no double.

So it's kind of like piecework? The more patients you see the more money you make? Does that mean you are a contractor?

 

[PikminOC]

So it's kind of like piecework? The more patients you see the more money you make? Does that mean you are a contractor?

Physicians are paid by rvus. They have targets to hit. Yes the more you see the more you make.

 

[Pragma]

EMR programs are like plants - they grow. The authors of these programs keep "improving" them and the result is redundancy; every single box must be checked and every question answered every time. The result is neither short nor intuitive nor easy.

I mean, yes, that’s annoying. Don’t start talking to me about annoying boxes to check. I have to do that for 5 codes every time. Most of us just habituate to the system?

 

[msc545]

I mean, yes, that’s annoying. Don’t start talking to me about annoying boxes to check. I have to do that for 5 codes every time. Most of us just habituate to the system?

It takes the time it takes. Time is the most precious commodity there is as it can't ever be replaced.

 

[smalltownpsych]

So it's kind of like piecework? The more patients you see the more money you make? Does that mean you are a contractor?

It’s called production based compensation and in my experience they are typically employees who get benefits and have some requirements for scheduling and such so not a contract employee. It is not too dissimilar from when I worked in commission based sales jobs that I worked in during undergrad.

Also, I made 150k per year plus solid benefits with that type of compensation package and I could dictate my notes for transcription. I do agree with Heist that they should probably vote with their feet and get a better job. On the other hand, Kaiser is powerful and has a lot of market influence so am glad they are fighting.

 

[Sanman]

It’s called production based compensation and in my experience they are typically employees who get benefits and have some requirements for scheduling and such so not a contract employee. It is not too dissimilar from when I worked in commission based sales jobs that I worked in during undergrad.

Also, I made 150k per year plus solid benefits with that type of compensation package and I could dictate my notes for transcription. I do agree with Heist that they should probably vote with their feet and get a better job. On the other hand, Kaiser is powerful and has a lot of market influence so am glad they are fighting.

This is where physicians do a better job differentiating skill set and limiting the supply of providers, so they have more leverage on voting with their feet.

 

[WisNeuro]

Throw em all on pure RVU based collections metrics and let them see if that works for them. Then they can work as many contact hours as they want.

 

[msc545]

This is where physicians do a better job differentiating skill set and limiting the supply of providers, so they have more leverage on voting with their feet.

This actually starts with medical school admissions, where getting in depends on getting good undergraduate grades in subjects that are only marginally related to the actual work of physicians. As a result of this and the relatively small number of schools, the number of physicians is very limited in the US, and that drives up salaries.

Conversely, mental health is afflicted by a plethora of online schools and other substandard institutions that grant "degrees" that are too often recognized by state licensing boards as being legitimate. There are far too many master's level practitioners that are incompetent and a lesser but still worrisome number of doctoral-level people that are equally incompetent. The salaries for doctoral-level people are lower than they should be because there are just too many of us.

 

[msc545]

Going into week 9 and into mediation. Pelosi and several U.S. Congress members have written letters:

https://nuhw.org/wp-content/uploads/2022-09-30-Pelosi-Letter-Kaiser-Mental-Health-Clinicians.pdf

https://nuhw.org/wp-content/uploads/09-29-2022.KP-JB-ML-to-Kaiser-re-Mental-Health-Compliance.pdf

Not sure if / how related to mental health but the DOJ is investigating Kaiser for medicare fraud:

Kaiser Permanente Defrauded Medicare of $1 Billion, DOJ Alleges (1)

Members of Kaiser Permanente’s health-care consortium defrauded Medicare out of about $1 billion by altering patient medical records to add diagnoses after the fact that either didn’t exist or were unrelated to patient visits, the Department of Justice is alleging.

news.bloomberglaw.com

Kaiser, which is focused solely on profits, will do nothing about these deficiencies in mental health care until it costs them money, and a lot of money, since they literally have so much money already that a mere fine of a few million dollars means nothing to them.

As an example, several years ago, they were fined four million dollars for the same access problems in mental health care, and they simply paid the fine and kept right on doing the same things with no changes.

 

[WisNeuro]

Actually, MH care, especially inpatient care, are by and large revenue losses for larger organizations. So, they are already likely losing money, especially at institutions with a higher proportion of Medi-Cal patients. So, there's the possibility that they've run the numbers and that the fines would actually be a lower number than ramping up MH hiring and losing even more money. Not so much of a Kaiser problem as opposed to a federal and state reimbursement problem in MH. Honestly, the most equitable solution would be a productivity based payment system. After covering overhead, I imagine many MH providers would see a sizable decrease in pay with their 29-hour/week scheduled contact hours, especially after accounting for no-shows.

 

[Sanman]

This actually starts with medical school admissions, where getting in depends on getting good undergraduate grades in subjects that are only marginally related to the actual work of physicians. As a result of this and the relatively small number of schools, the number of physicians is very limited in the US, and that drives up salaries.

Conversely, mental health is afflicted by a plethora of online schools and other substandard institutions that grant "degrees" that are too often recognized by state licensing boards as being legitimate. There are far too many master's level practitioners that are incompetent and a lesser but still worrisome number of doctoral-level people that are equally incompetent. The salaries for doctoral-level people are lower than they should be because there are just too many of us.

Well, yes. The APA has the ability to accredit all of these schools and internships and challenge the licensing on non-accredited providers that are allowed to be licensed. The AMA does a better job of protecting their turf on these issues.

 

[Pragma]

It takes the time it takes. Time is the most precious commodity there is as it can't ever be replaced.

What system do they use? We’re talking about like 1 minute of clicks in my setting.

 

[WisNeuro]

What system do they use? We’re talking about like 1 minute of clicks in my setting.

Yeah, I've used three systems, including VISTA, and with templates, most documentation can be minimized a great deal. Even for us neuropsychs who have to bill 5 different CPT codes for each patient.

 

[msc545]

What system do they use? We’re talking about like 1 minute of clicks in my setting.

I don't know as I do not and have never, luckily, worked at Kaiser. Whatever it is, I promise you takes a hell of a lot longer than 1 minute to record what is needed.

 

[msc545]

Well, yes. The APA has the ability to accredit all of these schools and internships and challenge the licensing on non-accredited providers that are allowed to be licensed. The AMA does a better job of protecting their turf on these issues.

In my opinion, the APA does nothing of value for Psychologists. I have never belonged, and I never will, for that reason.

 

[Pragma]

I don't know as I do not and have never, luckily, worked at Kaiser. Whatever it is, I promise you takes a hell of a lot longer than 1 minute to record what is needed.

So no first hand knowledge then, got it.

I looked it up and they have Epic which is the same thing many of us use.

 

[msc545]

So no first hand knowledge then, got it.

I looked it up and they have Epic which is the same thing many of us use.

Perhaps many therapists are not as proficient as you are, or perhaps they are using a customized or just a different version. There is clear evidence online that they are using a customized system that just happened to be developed by Epic:

https://international.kaiserpermanente.org/wp-content/uploads/2019/07/EHR_Journey_final.pdf

A custom system is more likely than not completely different from the one you have referenced in your prior posts.

 

[PikminOC]

It takes the time it takes. Time is the most precious commodity there is as it can't ever be replaced.

The more money you make, the more you can pay people to do the things you don't e

Actually, MH care, especially inpatient care, are by and large revenue losses for larger organizations. So, they are already likely losing money, especially at institutions with a higher proportion of Medi-Cal patients. So, there's the possibility that they've run the numbers and that the fines would actually be a lower number than ramping up MH hiring and losing even more money. Not so much of a Kaiser problem as opposed to a federal and state reimbursement problem in MH. Honestly, the most equitable solution would be a productivity based payment system. After covering overhead, I imagine many MH providers would see a sizable decrease in pay with their 29-hour/week scheduled contact hours, especially after accounting for no-shows.

Exactly right

 

[msc545]

The more money you make, the more you can pay people to do the things you don't e

Exactly right

Well then, perhaps they should cease providing mental health care since it seems to impact profitability so severely. Actually - I would like to see some real numbers that support your contentions because most of what you said feels like speculation right now.