UPDATE: 17 Dec, SanFranciscoCBS: KP strike day two
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Four thousand Kaiser mental health workers across California will go on strike Monday for five days, highlighting an unresolved labor issue for the health giant even after it agreed a new contract with other portions of its workforce.
Kaiser has been in negotiations with its mental health workers, who are represented by the National Union of Healthcare Workers, or NUHW, since June 2018. The union postponed a strike scheduled for Nov. 11 after Kaiser’s Chairman and CEO Bernard Tyson died the day before. Greg Adams was named to fill both positions Dec. 10.
Workers and their union say the strike centers on what they say is Kaiser’s inability to fully integrate mental health care into its health system. This has led to months-long waits for patient appointments and what mental health workers call overwhelming caseloads….
—Bizjournals.com Dec. 13, 2019
Of overarcing concern, workplace violation records with roughly $39million in penalties on KP the past decade in California alone, the staggering revenues KP takes in, staggering compensation packages for executives, and huge investments in real-estate, while front-line staff remains at levels inadequate to meet patient needs.
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KP national billion$, top exec pay, for-profit ventures...
Among the issues highlighted by the Coalition of KaiserPermanente Unions AFL-CIO, were KP’s financial realities in contrast to its nonstellar performance as an insurer-and-provider, especially where mental health patients are concerned.
...labor interests across the country [had been] skewering the Oakland, California-based nonprofit provider for soaring profits and what they see as unfair labor practices.
Along with sitting on more than $37 billion in reserves, Kaiser took in more than $5.2 billion in income in the first half of the year alone, heightening scrutiny of the system.
California Governor Gavin Newsom, a Democrat, signed a bill into law earlier this month mandating Kaiser be more transparent within its financial disclosures,
Top management compensation, ranking with corporations under fire such as PG&E, is among those financial realites in question. IRS filings made available by ProPublica's Nonprofit Explorer site showed “medical-care giant” Kaiser Permanente gave Tyson a compensation package —salary, bonus, retirement fund, etc etc— near $16.1million in 2017, nearly a $7mil hike above his
$9.2 million in 2016 from $6 million in 2015 and $4.7 million in 2014. In the same IRS filings, Kaiser states that its mission is to provide "affordable" healthcare services.
On request for comment, KP cited competing for talent with national level profit and nonprofit health plans and hospital organizations. (No information as yet about the compensation package for new CEO & chairman Greg Adams, a 20-year promote-from-within succeeding Tyson in both roles.
The known facts about KP top adminstrators’ comp packages
...are examples of what Steffie Woolhandler, MD, cofounder of nonprofit Physicians for a National Health Program, describes as misallocation of funds collected for medical services. Overly generous compensation for executives of healthcare organizations diverts resources that would be better spent on patients, Woolhandler told Medscape Medical News in an interview.
..."This is money that is being taken out of the healthcare system ... money that is not being spent on medications. It is not being spent on doctor visits," Woolhandler said. "It is not being spent on hospitalizations. It's just going in the pockets of these CEOs."
Noting The Business Journal’s 2018 analysis of salary figures alone for just 5 among top-paid healthcare execs including Tyson, Melissa Walton-Shirley, MD,’s commentary for Medscape on the average $13,244,231 additionally suggested
Next, perform a cursory mental calculation of the salary for the supporting CFOs and other corporate “0s” as well as the “necessary” framework of regional and statewide managers ... . Corporate salaries have built a ravenous machine with an urgent and perpetual need to be fed.
...In the first Democratic presidential debate of 2019, Elizabeth Warren made the following point: “The insurance companies last year alone sucked $23 billion in profits out of the healthcare system, $23 billion. And that doesn't count the money that was paid to executives, the money that was spent lobbying Washington..."
(and where KP is concerned, lobbying officials in California, Colorado, Georgia, Hawaii, Oregon, Washington state, Virginia, Maryland and Washington D.C. capitol area: In California, where the city of Oakland is nearly a KP company town, officials there as well.)
As a basis for comparison, the second and third most compensated for such work in the U.S. in 2017 were J. Knox Singleton, as president of Inova...
a non-profit health organization based in Falls Church, Virginia, near Washington, D.C. The system is a network of hospitals, outpatient services, assisted living and long-term care facilities, and healthcare centers...[4][5]
whose 2017 gross receipts were $791 million serving about 2 million people. Singleton’s package went from $5.7 million in 2016 (excluding deferred compensation from previous years) to to $14.2 million in 2017.
KP’s “nonprofit” revenue comes from sources such as “member” monthly premiums, co-payments, Medicare payments, and research fees utilizing unrecompensed patient data from among their 12million+ members in 736 hospitals, medical offices and other facilities, across California, Colorado, Georgia, Hawaii, Oregon, Washington state, and the capitol area: Virginia, Maryland and Washington D.C. That totaled over $68 billion in gross receipts for 2017.
The last section below touches on KP’s real estate ventures pose as addressing housing as a social determinant of health. But among KP ventures even more distant from healthcare: • June 2013 Golden State Warriors NBA team sponsor Kaiser Permanente becomes naming-rights partner in 3,200-capacity Santa Cruz arena in deal rumored largest ever for NBA's Developmental League. • June 2019 Kaiser deal for Warriors arena plaza & Chase Center area to be renamed “Thrive City” could hit $295 million.
On August 27, 2019 CBS/SanFranciscoBay reported from AP a Bill Targeting Kaiser Permanente Financial Disclosures Heads To Gov. Newsom’s Desk
SACRAMENTO (AP) — Hospital giant Kaiser Permanente would have to disclose more financial information about its hospitals under a bill that has cleared the California Legislature.
The state Senate approved a bill on Monday that would require Kaiser Permanente to disclose revenue and profits for each hospital individually. Right now, Democratic Sen. Richard Pan says the company lumps the numbers together into two categories for its hospitals in Northern California and Southern California.
...Pan said the bill would force Kaiser Permanente to follow the same financial disclosure requirements as other hospitals.
That‘’s gonna be interesting…
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Mental Healthcare as Non-Delivery on Commitment
High performance in healthcare delivery probably would have muted such questions. But KP has been dogged with lawsuits and worker protests for well over a decade. In July Kaiser mental health workers —psychologists, therapists, and social workers— went out on strike for a day, demanding increased staff for basic mental health services and to reduce long waits for mental health appointments. Among the cases:
This past autumn, Kaiser was faced with the possibility of the largest strike of any kind in the US for decades: The Coalition of Kaiser Permanente Unions had warned of
the “nation’s largest walkout since 1997 [Teamsters strike].” ... over 84,000 Kaiser Permanente employees in six states and D.C. may go on strike at their hospitals and clinics in early October
Contract talks had broken off in July without an agreement on wages, benefits, worker safety and staffing adequacy topping the list of issues in negotiation. On September 25, nearly a year to the day after the previous agreement expired, KP and the union negotiating team reached a tentative agreement on most issues, averting the planned nationwide October 14 strike. But concerns about adequacy of staffing and access for mental healthcare were not resolved, and the National Union of Healthcare Workers was left to go it alone.
“Can you imagine if you had cancer and were told you would have to wait 4 months before treatment?” said Sal Rosselli, president of NUHW. “They just don’t care about mental health care.”
Rosselli said that rather than hire replacement workers during the strike, like they do when nurses strike, Kaiser has canceled thousands of appointments for next week.
Kaiser confirmed that some appointments have been postponed.
"Mental health care is being provided during the strike by qualified and licensed professionals, including behavioral health managers, psychiatrists, and contracted therapists," Kaiser said in a statement. "Some non-urgent mental health and other appointments may need to be rescheduled. Any patients affected will be contacted in advance."
Contacted in advance. Not the same as alternative routes to timely access.
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Real Estate, and Oakland as KP’s Company Town
In June, CEO Tyson announced plans to close seven northern California sites, for acquisition by Lane Partners, the commercial-use developer building KP a new national headquarters in Oakland for completion by 2023. In theory, the 29-storey HQ would cut KP operational costs by more than $60 million a year, through consolidation of 7,200 employees and physicians under one roof that will not actually provide wide-spectrum medical services (why then all those physicians?), although it “may” include
a health clinic, community meeting spaces, a showplace for locally-inspired art, and other benefits for the community [that might locally] create jobs, and drive economic growth...
and
85,000 square feet of retail space. The project would encompass the entire block and will require demolishing … other buildings on Broadway.
There were two potential plans proposed by the developers. The other would include less office space, 880,000 square feet, but add 395 units of housing.
...the deal comes on the eve of a planned one-day strike by Kaiser Permanente therapists in San Francisco, who say that the healthcare company's mental health care is worsening. The therapists say that staffing has declined while demand for services has increased.
Kaiser workers at the meeting questioned why Kaiser could afford a new headquarters but not better care for its patients.
Some councilmembers expressed empathy for the plight of the workers [patient plight apparently unmentioned], but pointed out that Kaiser was not constructing the building and had only committed to use it...
A 70-year presence in Oakland and for years its single largest employer, KP anticipates the HQ project generating
a one-time $23-million economic benefit in addition to more than $15 million annually in local tax revenues for the city,
On July 9 amid questions about campaign donations from Kaiser’s developer, Lane Partners, to elected officials, particularly the Mayor and a councilmember, Oakland’s City Council approved sale of an uptown public parking garage to Lane for the HQ. The vote was 6-0 despite objections by local Kaiser workers.
KP is involved in other real-estate and housing ventures. For example as reported September 16 by healthcare finance news.com
Kaiser Permanente and Enterprise Community Partners have partnered to create and retain affordable housing {links added} in communities in California and elsewhere where home prices are steep.
In San Francisco, for example, the average asking price for a home is reportedly $1.3 million.
In numerous articles on these KP projects, phrasings by KP assert that KP means to address homelessness as a social determinant of health, with comparisons made to New York’s Montefiore hospital housing successes with that demographic. But “affordable housing” conventionally means not homeless persons alone, but what’s
deemed affordable to those with a median household income or below[1] as rated by the [national or local government according to] a recognized housing affordability index. Most of the literature on affordable housing refers to mortgages and number of forms that exist along a continuum – from emergency shelters, to transitional housing, to non-market rental (also known as social or subsidized housing), to formal and informal rental, indigenous housing, and ending with affordable home ownership...[2][3][4][5]
and healthcarefinance’s article mentions KP mentioning
Bay Area workers having to make the long trek to work because living close to their employers is out of their budget. Some have two- to three-hour commutes …
We hope to grow to $85 and $100 million," [said John Vu, vice president for Strategy, Community Health at Kaiser Permanente] of the equity fund [for the KP-ECP partnership]. "We're welcoming other investors.
Because there's little land left to build on in these areas, the partnership is working to preserve what's there by making capital available for affordable housing developers that are willing to buy up buildings and keep them…
The building in East Oakland is for anyone to use, not just patients or employees of Kaiser...
which is to say, for them and others — housing affordable for a demographic rather closer to median household income than to Montefiore’s homeless demographic. As “the largest vertically integrated health plan in the country and the largest and most complex health care nonprofit organization", KP’s housing investments may more accurately resemble the President’s re-election campaign executive order touting increased MedicareAdvantage (MA) benefits that actually are not govt-funded but premium add-ons. The add-ons are unquestionably health-beneficial goods and services; they just happen to be out of the financial reach of low-income MA patients and they’re not available at all to ordinary Medicare patients.
In this light, KP’s affordable East Oakland housing is a standard component of the bosses’ company town. Live in the company’s housing. Take what healthcare the company gives, it likely being also your boss (KP is Oakland’s mega-employer). Purchase your necessities at the company’s 85,000 square feet of retail space. If you live there, your options are very very very limited, and the boss writes the price ticket. Note that KP workers protested the sale to KP of Oakland’s public parking — commuters who’d rather not be trapped 24/7 in the company town?
In America’s history, the company town worked to the company’s massive advantage, and broke the workers’ backs. And their unions. Look at mining country today and imagine a slightly more gentrified version under KP’s benevolence tomorrow.
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To put it most simply, follow the money. All of it. All the way from where it comes from to where it finally ends up.
For backstory:
- November 13 KaiserPermanente Class Action Settlement on Mental Health Patients Forced into Medi-Cal/Medicaid
- September 25 KaiserPerm & Coalition of Unions Reach Tentative Agreement: Oct.14 Strike Averted Pending Vote
- September 10 As Unions' Public Approval Rises, Calif Grocer Strike Averted, KaiserPerm Nat'l Strike Looms
- and other diaries by various kosaks at the KaiserPermanente tag
Full source list:
- SanFranciscoCBS — Dec 17, 2019 — Kaiser Permanente Mental Health Workers Strike For 2nd Day
- BizJournals.com — Dec 13, 2019 — 4,000 California Kaiser mental health workers will strike Monday
- HealthcareDive.com — Dec 11, 2019 — Kaiser interim chief Greg Adams named full-time CEO
- HealthcareDive.com — Sept 25, 2019 — Kaiser strike called off as company, unions reach tentative agreement
- opb.org — Sept 27, 2019 — Biggest Strike US Has Seen In Years Poised To Hit Kaiser Permanente
- HealthcareFinanceNews.com — Sept 16, 2019 — Kaiser Permanente and Enterprise are investing in affordable housing — referencing HealthcarefinanceNews.com — July 5, 2018 — What Montefiore's 300% ROI from social determinants investments means for the future of other hospitals: The New York City health system created a program focusing on housing homeless patients that has already reaped big rewards.
- HealthcareDive.com — Sept 13, 2019 — Colorado union votes to strike at Kaiser, bringing 'yes' votes nationwide to 42K
- goodjobsfirst.org VIOLATION TRACKER: 57 KP workplace violation records and $38,657,920 in penalties on KP between 2000 and Sept 2018.
- HealthcareDive.com — Sept 6, 2019 — Starting in 2020, profit-soaring Kaiser loses California non-profit privilege of minimal expense & revenue breakdown. Another bill, requiring nonprofit health systems to report more on executive and physician compensation is wending its way thru’ state legislature.
- SacramentoBee — Sept 6, 2019 — Newsom signs SEIU-backed bill requiring Kaiser to share more hospital financial data — consumer group Health Access California, the California Public Employees’ Retirement System, business groups such as Small Business Majority were among other supporters of the bill.
..As part of the legislation, Kaiser will have to break out expenses and revenue for each of its facilities; break out revenue by type of payor (Medicare, Medi-Cal or private insurance) at each facility; and break out rate increases by type of service (hospital, physician services, pharmacy, radiology and laboratory).
“We think it’s an important transparency measure,” said Anthony Wright, the executive director of Health Access California. “Right now, we do require rate review of our insurers, and Kaiser has had a fairly broad exemption from much of the rate review processes that other insurers have to follow, and what this bill does is fairly simple. It ensures Kaiser is providing the same types of information justifying their rates as other health insurers have to do...”
- NW Labor Presss.org — Sept 5, 2019 — Massive Kaiser Permanente strike could come in October
- American Prospect — Sept 3, 2019 — Kaiser Hospital Workers Mobilize for Largest Strike in Two Decades
- HealthcareDive.com — Aug. 29, 2019 — Kaiser Permanente workers are set to strike. Does it mark a new trend?
- CBSNews — Aug. 27, 2019 — Bill Targeting Kaiser Permanente Financial Disclosures Heads To Gov. Newsom’s Desk
- cpr.org — Aug 26, 2019 — If Kaiser Permanente Votes To Strike, Thousands Of Workers Would Walk Out From The Colorado Health Care Giant
- San Diego Reader — 26 August 2019 — Kaiser to face largest strike anywhere in 20 years — Unions claim company made $5.2 billion in profits the first 6 months of 2019.
- danilfineman.com — Aug 22, 2019 — Kaiser mortgage to rehab Metropolis Heights reasonably priced houses
- LA Times — Aug 12, 2019 — Kaiser Permanente workers in California vote to approve strike
- HealthcareDive.com — Aug 12, 2019 [2nd quarter of 2019] KP net income $2 billion, up from 2018 2nd Qtr $653 million.
- Medscape — August 2, 2019 — Docs Get Tiny Raises While Nonprofit Healthcare CEOs get >$10M
- Wikipedia — KaiserPermanente as of July 2019.
- ABCNews — July 20, 2019 Oakland City Council approves $28mill sale to KP of public parking garage
- Forbes — Jul 12, 2019 — 85,000 KP Health Workers Threaten Strike
- ABCNews — July 10, 2019 — Kaiser mental health workers strike in San Francisco, demand more staffing for patients
- ABC7 — July 10, 2019 — Oakland approves sale of city-owned [public] garage for Kaiser HQ
- Medscape — July 5, 2019 — Are Exorbitant Corporate Salaries in Healthcare Unethical?
- SanFranciscoChronicle — June 23, 2019 — KaiserPerm deal for Warriors arena plaza & Chase Center area to be renamed “Thrive City” could hit $295 million.
- HealthcareDive.com — June 18, 2019 — Kaiser Permanente announces new headquarters in California
- Modern Healthcare — June 17, 2019 — $900million New KP HQ in Oakland
- Kaiser Permanente.org — Local ‘markets’ and other “Fast Facts” as of June 2019.
- ABCNews — March 11, 2019 — Family speaks out after grandfather told he’s dying by KP doctor video robot.
- HealthcareDive.com — [First quarter of 2019] KP net income nearly $3.2 billion compared with about $1.2 billion the prior-year period [following open enrollment seasons].
- search — Jan-Aug 2019 RxHomeFund/ThrivingCommunities/...
- HeathcareDive.com — [First half of 2018] KP posted nearly $40billion in revenue
- National Union of Health Workers — January 7, 2019 Chronology: Kaiser Permanente’s Mental Health Crisis
- ProPublica Nonprofit Explorer 2019 — Form 990, Schedule J for KP Fiscal Year Ending Dec 2017.
- goodjobsfirst.org WORKPLACE VIOLATION TRACKER - 56 workplace violatIon records and $37,757,920 in penalties on KP, 2000 - 2018.
- ABCNews -- December 20, 2018 — Thousands of KP’s unionized mental health workers make arrangements to meet patient needs for the week before walking out on strike.
- ModernHealthcare.com — Dec 20, 2018 — KP settles in 2014 patient class action lawsuit.
- TheBusinessJournals.com — Nov 14, 2018 — Hospitals and health systems with highest-paid leaders...
- ABCNews — September 3, 2018 — Over 1,000 Kaiser employees and their unions and supporters marched in Oakland to protest planned job cuts and outsourcing.
- HealthcareDive.com — Aug. 24, 2018 — KP reported $39.9billion in operating revenue for the first six months of 2018
- HealthcareDive.com — April 30, 2018 — 55,000 member SEIU-UHW protests KP layoffs & outsourcing of pharmacy warehouse & call center operations.
- ABCNews — September 18, 2017 — Kaiser nurses rally for better resources for patients at 21 California locations as contract end approaches and negotiations drag on.
- HealthcareDive.com — August 31, 2017 — NorthBay Healthcare’s 2nd Lawsuit vs Kaiser Permanente for underpayment on Emergency Department care.
- ABCNews -- July 12, 2015 — Thousands of Kaiser mental health professionals strike for better resouces after 5 years of contract negotiations fail to remedy dearth from increased patient ‘memberships’.
- medscape.com — July 5, 2017 — Despite three warnings and a multimillion-dollar fine a few years ago, Kaiser Permanente still fails to provide members with appropriate access to mental health care,
- Los Angeles Daily News — March 26, 2015 — CalState Student wins $28.2mil KP lawsuit for negligence causing loss of leg, half pelvis & parts of spine.
- medscape.com — Feb 25, 2015 — For 2nd time in 2 years, the state of California faults HMO giant KP on failing access to patients for mental health care
- ABCNews — Jan 26, 2015 — KaiserPerm averts strike by tentative agreement w/ California Nurses Association/National Nurses United for 18,000 employees’ 3-year contract:
...The nurses claimed Kaiser was cutting back on its patient care standards by decreasing hospital services, making restrictions on admitting patients for hospital care and discharging patients early though they needed further hospitalization, according to the CNA.
[Also] that Kaiser provided them with insufficient resources, equipment and training that put nurses and patients at risk.
- PressDemocrat — January 10, 2015 — Kaiser braces for strike Monday by mental health clinicians
- topclassactions.com — Sept 11, 2014 — Class Action Suit alleges KP tells guardians of psychiatric patient ‘members’ they can only receive care if they cancel KP insurance/“membership & get covered by Medicare & Medi-Cal
- Medscape - April 3, 2013 — California Dept of Managed Health Care (DMHC) cites Kaiser Permanente in mental health service cover-up
- sportspromedia.com — June 13, 2012 — Golden State Warriors NBA team sponsor Kaiser Permanente becomes naming-rights partner in 3,200-capacity Santa Cruz arena in deal rumored largest ever for NBA's Developmental League.
- HuffingtonPost — November 14, 2011 — Kaiser Permanente Makes Billions In Profits While Overburdening Staff: Report “Kaiser Permanente has made an estimated $5.7 billion in profit since 2009.”
- AMA Journal of Ethics — January 2009 — elderly woman suffering from dementia off by Kaiser Permanente Bellflower Medical Center at Union Rescue Mission, an organization that serves the needy and homeless, in nothing but a hospital gown
- npr.org — November 2006 — Kaiser Faces Charges for [literally] Dumping Homeless Patient [on skid row].
- kaiserthrive.org — April 2006 — Kaiser Permanente sued for lack of disabled accommodations.
- kaiserthrive.org — March 2006 — Patient Dumping on skid row said caught on tape.
- lmpartnership.org — 1997 Labor Management Partnership Agreement between Kaiser Permanente and the Coalition of Kaiser Permanente Unions