Limiting MD Visits

Physician's Money Digest, June15 2003, Volume 10, Issue 11

Wall Street Journal

For 2 years, telephone clerks at 3 Kaiser Permanentecall centers in California got bonus checksfor limiting the number of doctor appointmentsthey made for patients who called the centers andfor keeping calls from patients short. According toa report, from January 2000 toDecember 2001, clerks who spent less than anaverage of 3 minutes 45 seconds per phone calland scheduled appointments for fewer than 35%of the callers got a cash bonus ranging from 2% to4% of their salary. They were also rewarded fortransferring less than half of their calls to registerednurses for further evaluation.

The system has come under fire from theCalifornia Nurses Association, the union that representsKaiser's registered nurses, which has claimedthat the call center system is harmful to patients withserious health problems. The telephone clerks, whohave little or no medical training, are essentiallycharged with evaluating a patient's medical condition,the union maintains, which violates state lawthat does not allow anyone other than a licensedmedical professional to perform that function. Reactingto complaints, the state Department of ManagedHealth Care launched an investigation of the bonusprogram, even though it has been discontinued.