While
TPMG (The Permanente Medical Group) is a distinct, physician-led organization, it primarily serves members of
Kaiser Permanente. However, both groups employ a mix of doctors, nurses, and staff. [
1,
2,
3]
The relationship between the two entities can be broken down as follows:
- TPMG (The Permanente Medical Group): This is the autonomous, physician-led organization that handles clinical care for Kaiser patients. While its doctors are TPMG employees, the group also directly employs thousands of clinical staff, including registered nurses. [1, 2, 3, 4]
- Kaiser Permanente (KFH/KFHP): This entity owns and operates the hospitals, health plans, and medical facilities. Kaiser employs its own large network of doctors, thousands of nurses, and administrative staff to keep the broader integrated healthcare system running. [1, 2, 3, 4, 5]
Both entities operate in a close, integrated partnership to deliver care to members across California and other states. [
1,
2] Actual that last line is incorrect, TPMG I think only operates in NCAL.
The confusion usually comes from the fact that Kaiser Permanente operates nationwide through
eight distinct regional Permanente Medical Groups. Each region has its own independent, self-governing group of physicians: [
1,
2,
3,
4]
- The Permanente Medical Group (TPMG): Northern and Central California
- Southern California Permanente Medical Group (SCPMG): Southern California
- Colorado Permanente Medical Group: Colorado
- Northwest Permanente: Oregon and Southwest Washington
- Washington Permanente Medical Group: Western and Central Washington
- Mid-Atlantic Permanente Medical Group: Maryland, Virginia, and Washington, D.C.
- Hawaii Permanente Medical Group: Hawaii
- The Southeast Permanente Medical Group: Georgia [1, 2, 3, 4]
Kaiser/TPMG is regulated as an HMO. The insurance/medical group/hospital governance was actually pretty well delineated under Federal law by the HMO Act of 1973, although we now know it only happened because Henry Kaiser's son, Edgar, and Richard Nixon were trading political favors:
This is a transcript of the 1971 conversation between President Richard Nixon and John D. Ehrlichman that led to the HMO act of 1973:
John D. Ehrlichman: “On the … on the health business …”
President Nixon: “Yeah.”
Ehrlichman: “… we have now narrowed down the vice president’s problems on this thing to one issue, and that is whether we should include these health maintenance organizations like Edgar Kaiser’s Permanente thing. The vice president just cannot see it. We tried 15 ways from Friday to explain it to him and then help him to understand it. He finally says, ‘Well, I don’t think they’ll work, but if the President thinks it’s a good idea, I’ll support him a hundred percent.’”
President Nixon: “Well, what’s … what’s the judgment?”
Ehrlichman: “Well, everybody else’s judgment very strongly is that we go with it.”
President Nixon: “All right.”
Ehrlichman: “And, uh, uh, he’s the one holdout that we have in the whole office.”
President Nixon: “Say that I … I … I’d tell him I have doubts about it, but I think that it’s, uh, now let me ask you, now you give me your judgment. You know I’m not too keen on any of these damn medical programs.”
Ehrlichman: “This, uh, let me, let me tell you how I am …”
President Nixon: [Unclear.]
Ehrlichman: “This … this is a …”
President Nixon: “I don’t [unclear] …”
Ehrlichman: “… private enterprise one.”
President Nixon: “Well, that appeals to me.”
Ehrlichman: “Edgar Kaiser is running his Permanente deal for profit. And the reason that he can … the reason he can do it … I had Edgar Kaiser come in … talk to me about this, and I went into it in some depth. All the incentives are toward less medical care, because …”
President Nixon: [Unclear.]
Ehrlichman: “… the less care they give them, the more money they make.”
President Nixon: “Fine.” [Unclear.]
Ehrlichman: [Unclear] “… and the incentives run the right way.”
President Nixon: “Not bad.”
