Kaiser call centers under scrutiny

Following a complaint from a staff nurse, California regulators will investigate whether the health plan allowed untrained staff to offer medical advice.

By Emily Berry — Posted Feb. 4, 2009

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California's Dept. of Managed Health Care is investigating whether Kaiser Permanente allowed call center operators to offer medical advice to its members, in violation of state law.

The state investigation is in response to a complaint filed by a nurse who works for Kaiser, DMHC spokeswoman Lynne Randolph said.

"She was concerned that call agents may be providing more medically based information than she felt was appropriate," Randolph said. The complaint was received in July 2008, and the department followed up with interviews before launching an investigation, she said.

Randolph said investigators likely would visit a call center site in January as part of the inquiry.

DMHC fined Kaiser $3 million in August 2007 for failure to ensure adequate quality at its 29 California hospitals.

The state has received very few complaints about the call centers prior to this one, Randolph said.

The three regional call centers serve 3.3 million members who live in Northern California, Kaiser spokeswoman Gerri Ginsburg said.

"The immediate recording you get is, of course, 'if you're having a major emergency, hang up and call 911,' " she said.

According to a statement from Kaiser, most of the calls the center handles are nonmedical. Operators help with appointment requests and questions about hours or directions to offices. Of the approximately 14 million calls the centers receive each year, between 25% and 30% are forwarded to nurses.

A state law passed in 2003 requires that health plans ensure that nonlicensed employees do not offer medical advice.

As part of determining whether Kaiser violated that law, the state will look at the scripts that nonlicensed call center employees use, Randolph said.

According to Kaiser, when a member calls with a medical problem, an operator reads from a script written by Permanente Medical Group staff physicians to figure out whether to forward the caller to a nurse to discuss the problem.

Ginsburg said there are 1,200 telephone service representatives and 800 nurses on staff at the centers, with more than 100 emergency physicians rotating on-call shifts for when nurses want further review.

The service representatives who answer calls must have a high school diploma or equivalent and a year of experience in customer service. They undergo four weeks of training followed by 90 days on probation, Ginsburg said.

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