If you were considering working for Kaiser, consider this.

[Sanman]

this became the food thread lol

Got to eat something while you're on strike.

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[cara susanna]

If I take my southern California native husband to a Mexican restaurant in Milwaukee, I will report back.

 

[The Cinnabon]

If I take my southern California native husband to a Mexican restaurant in Milwaukee, I will report back.

It's also worth it to stop by Foundation if you drink at all (on Bremen in Riverwest). It's the best tiki bar I've ever visited and the area is gorgeous in the winter (I say this as a former Riverwest resident, so I'm biased).

 

[WisNeuro]

It's also worth it to stop by Foundation if you drink at all (on Bremen in Riverwest). It's the best tiki bar I've ever visited and the area is gorgeous in the winter (I say this as a former Riverwest resident, so I'm biased).

Seconded, love that place. Along with Bryant's (cocktail bar).

 

[Fan_of_Meehl]

I understand. Kaiser offered me an obscene amount of money last year to "come on board" during the 3+ month strike by all of their mental health workers in NorCal over their policy of overbooking patients to the point that people had to wait months for a second appointment, and providers had individual caseloads of 200 and 300 patients.

I turned them down because I won't cross any picket line (and they had plenty), and I don't trust Kaiser to do the right thing or follow the law at all.

The California Dept of Managed Care has a rule that HMOs like Kaiser must schedule a follow-up psychotherapy visit with a date within 10 days of the first visit. Kaiser has been ignoring that rule for many years with no repercussions because they are a huge healthcare provider in California, and the DMC is afraid to enforce the law against them.

"patients having to wait months for a second appointment and providers having individual caseloads of 200 and 300 patients."

Many therapists in the VA are facing this now. Anyone who actually works hard to keep their caseloads cleared out just gets more (no maximum number per week/month) intakes scheduled in every available slot until they're also backed up so far with their caseload to the point where they simply cannot offer actual psychotherapy (which pretty much has to be weekly or at least every two weeks for appointments).

Scheduling people for monthly sessions (or less frequently) is rampant in bureaucratized healthcare systems these days but...

How is this not Medicaid fraud when people are 'billing'/coding these encounters as 'psychotherapy?'

There are psychologists in my system scheduling patients 2-5 months out for their 'next psychotherapy' session.

Meanwhile, nobody has even done the 'back of the dinner napkin' arithmetic analysis regarding how many new patients you could possibly take on to your caseload over some period of time and not have your clinic get overwhelmed and backed up.

Leadership will never be 'accountable' because their solution is always to blame providers. Even when logic/arithmetic would make it abundantly clear to five seconds of thought that a single provider with, say, 20-25 weekly slots to see patients in cannot possibly handle 15-20 new patients (intakes) in a month. If, even in the ideal case, it takes 12 weeks to take someone through an evidence-based protocol then, even assuming perfect attendance and response, you'd expect to be able to 'clear' about the number of weekly slots (20?) you have in a three month (12-session) period. Empirically, I have seen how many people I can 'clear' out of a full-time caseload and it appears to be about 80-100 per year (new cases, start to finish) and that's me working my a%% off to get people in and get people out.

No one is looking at the 'fluid dynamics' of flow of patients in and out of psychotherapy caseloads.

No one is looking at the (implicit) logical contradictions in the 'management position(s)' (alternates, based on the phases of the moon/mood) that:

(a) providers must have every psychotherapy slot filled for at least the next 1-2 months or they are 'underworked' or 'lazy' or 'not productive' while, at the same time...

(b) providers must be able to schedule three months of weekly EBP psychotherapy sessions or they suck because they aren't 'doing' EBP with all their patients

If I was doing EBP with all my patients (which all the overlords exhort me to do), I'd only be able to have a caseload of about 20 patients at a time.

It's math.

It's protozoan level logic.

What the hell, folks?

 

[smalltownpsych]

"patients having to wait months for a second appointment and providers having individual caseloads of 200 and 300 patients."

Many therapists in the VA are facing this now. Anyone who actually works hard to keep their caseloads cleared out just gets more (no maximum number per week/month) intakes scheduled in every available slot until they're also backed up so far with their caseload to the point where they simply cannot offer actual psychotherapy (which pretty much has to be weekly or at least every two weeks for appointments).

Scheduling people for monthly sessions (or less frequently) is rampant in bureaucratized healthcare systems these days but...

How is this not Medicaid fraud when people are 'billing'/coding these encounters as 'psychotherapy?'

There are psychologists in my system scheduling patients 2-5 months out for their 'next psychotherapy' session.

Meanwhile, nobody has even done the 'back of the dinner napkin' arithmetic analysis regarding how many new patients you could possibly take on to your caseload over some period of time and not have your clinic get overwhelmed and backed up.

Leadership will never be 'accountable' because their solution is always to blame providers. Even when logic/arithmetic would make it abundantly clear to five seconds of thought that a single provider with, say, 20-25 weekly slots to see patients in cannot possibly handle 15-20 new patients (intakes) in a month. If, even in the ideal case, it takes 12 weeks to take someone through an evidence-based protocol then, even assuming perfect attendance and response, you'd expect to be able to 'clear' about the number of weekly slots (20?) you have in a three month (12-session) period. Empirically, I have seen how many people I can 'clear' out of a full-time caseload and it appears to be about 80-100 per year (new cases, start to finish) and that's me working my a%% off to get people in and get people out.

No one is looking at the 'fluid dynamics' of flow of patients in and out of psychotherapy caseloads.

No one is looking at the (implicit) logical contradictions in the 'management position(s)' (alternates, based on the phases of the moon/mood) that:

(a) providers must have every psychotherapy slot filled for at least the next 1-2 months or they are 'underworked' or 'lazy' or 'not productive' while, at the same time...

(b) providers must be able to schedule three months of weekly EBP psychotherapy sessions or they suck because they aren't 'doing' EBP with all their patients

If I was doing EBP with all my patients (which all the overlords exhort me to do), I'd only be able to have a caseload of about 20 patients at a time.

It's math.

It's protozoan level logic.

What the hell, folks?

The numbers are really easy actually and there are people involved who know them and are using them to their own advantage. Most people are just vulnerable and go along with plausible stuff and it only takes one or two smart and selfish people to use that.

Insurance companies know the numbers very well and sometimes what they pay even coincides with patient benefit depending on the cost benefit analysis. X number of psychotherapy hours reduces inpatient days or ED visits or ICU by Z amount. X plus Y hours might lower Z but it’s a curve with diminishing results. X minus Y can also lower Z because if the patient gets sick enough then they might drop off altogether and the more sick patients dropping off the insurance benefits the equation for insurance.

The VA is a little more complicated because it is more about justifying more budget and you need lots of sick patients to do that and also more of a role for portraying like you really care about people since there is no profit motive just a power motive which is harder to measure.

And Carl Rogers believed that all people were innately good. What a Pollyanna! 😂

 

[msc545]

Both you and Fan_Meehl are quite right about all of this and a bit more that perhaps you might consider.

Carl Rogers didn't recall that Sociopaths rise to the top in many organizations, the VA and insurance companies and Kaiser being three of them. We are reaping the "benefits" of their ascendance.

 

[msc545]

"patients having to wait months for a second appointment and providers having individual caseloads of 200 and 300 patients."

Many therapists in the VA are facing this now. Anyone who actually works hard to keep their caseloads cleared out just gets more (no maximum number per week/month) intakes scheduled in every available slot until they're also backed up so far with their caseload to the point where they simply cannot offer actual psychotherapy (which pretty much has to be weekly or at least every two weeks for appointments).

Scheduling people for monthly sessions (or less frequently) is rampant in bureaucratized healthcare systems these days but...

How is this not Medicaid fraud when people are 'billing'/coding these encounters as 'psychotherapy?'

There are psychologists in my system scheduling patients 2-5 months out for their 'next psychotherapy' session.

Meanwhile, nobody has even done the 'back of the dinner napkin' arithmetic analysis regarding how many new patients you could possibly take on to your caseload over some period of time and not have your clinic get overwhelmed and backed up.

Leadership will never be 'accountable' because their solution is always to blame providers. Even when logic/arithmetic would make it abundantly clear to five seconds of thought that a single provider with, say, 20-25 weekly slots to see patients in cannot possibly handle 15-20 new patients (intakes) in a month. If, even in the ideal case, it takes 12 weeks to take someone through an evidence-based protocol then, even assuming perfect attendance and response, you'd expect to be able to 'clear' about the number of weekly slots (20?) you have in a three month (12-session) period. Empirically, I have seen how many people I can 'clear' out of a full-time caseload and it appears to be about 80-100 per year (new cases, start to finish) and that's me working my a%% off to get people in and get people out.

No one is looking at the 'fluid dynamics' of flow of patients in and out of psychotherapy caseloads.

No one is looking at the (implicit) logical contradictions in the 'management position(s)' (alternates, based on the phases of the moon/mood) that:

(a) providers must have every psychotherapy slot filled for at least the next 1-2 months or they are 'underworked' or 'lazy' or 'not productive' while, at the same time...

(b) providers must be able to schedule three months of weekly EBP psychotherapy sessions or they suck because they aren't 'doing' EBP with all their patients

If I was doing EBP with all my patients (which all the overlords exhort me to do), I'd only be able to have a caseload of about 20 patients at a time.

It's math.

It's protozoan level logic.

What the hell, folks?

Exactly.

 

[msc545]

Is this a W-2 position? I assume it is 1099 if you are referring to yourself as a consultant. 1099 gives you a lot more freedom as you are essentially working for yourself.

Yes 1099. I won't work as a W-2 employee.

 

[msc545]

Yes 1099. I won't work as a W-2 employee.

California’s largest health system agreed to a $200 million settlement on October 12 following an investigation that found the system has failed to provide timely behavioral health appointments for patients and has canceled more than 100,000 appointments.

Kaiser Permanente, which also runs a health plan, will “undertake a systemic overhaul” of its behavioral health services, Mary Watanabe, director of the Department of Managed Health Care (DMHC), the regulatory body that oversees managed care plans in California, said in a statement.

The DMHC began investigating Kaiser in May 2022 after the Oakland-based health system saw a 20% increase in behavioral health patient complaints in 2021, the DMHC said in a statement.

 

[WisNeuro]

Did Kaiser kick your dog, or piss in your Corn Flakes or something?

 

[Sanman]

Did Kaiser kick your dog, or piss in your Corn Flakes or something?

Like Henry Kaiser himself pissing in your Corn Flakes? Now that would be a story....

 

[WisNeuro]

Like Henry Kaiser himself passing in your Corn Flakes? Now that would be a story....

Can Zombies piss?

 

[Sanman]

Can Zombies piss?

The existential questions.

 

[msc545]

The existential questions.

No. Kaiser killing my close friend out of profit-driven negligence.

 

[WisNeuro]

That seems a little melodramatic.