January 26, 2011

Update: Comments on article about call centers

We believe a recent news story provided an unbalanced portrayal of Kaiser Permanente's Appointment and Advice Call Centers.

Kaiser Permanente is dedicated to providing our patients with superior 21st century health care, and our call centers play an important role in our commitment to quality, safety and convenience for our members. Our call centers provide personalized "one-stop" access to information and care for the convenience of our 3.3 million members in Northern California, and they do so 24 hours a day, seven days a week.

We believe Kaiser Permanente Appointment and Advice Call Centers are in compliance with the law. Our call centers handle about 14 million calls per year. Most of these calls are not urgent and are to schedule appointments or to ask for non-medical information. These non-urgent calls are handled by Telephone Service Representatives, who play essentially the same role as a receptionist in any physician's office.

Our TSRs receive extensive training and ongoing coaching, and they understand the scope of their duties, which includes providing information to our members about services, transmitting messages to members' physicians, and making appointments for care. They do not provide medical advice or make medical decisions. Only licensed clinicians provide medical advice or make medical decisions.

Any caller who requests medical advice, or asks to speak to a nurse, or whose answers to doctor-written questions require speaking to a clinician, is transferred to an advice nurse. An employee found to deny a caller's request to speak to an advice nurse is subject to progressive discipline and could face suspension or termination.

We understand losing a loved one is an emotional situation for any family, and we extend our sympathy to the two families identified in the paper for their losses. Patient privacy laws prohibit us from publicly discussing individual patient cases, but we encourage any Kaiser Permanente member with questions or concerns to contact our Member Service Representatives at (800) 464-4000.

Our goal is to provide the best care possible and the best service possible, and for our members to be highly satisfied with the care and service they receive. We regularly survey our members, and the surveys show that more than 90 percent of our members rate our call centers as good, very good or excellent. Members appreciate the value and convenience of our call centers, and they like the convenient access to knowledgeable people for general information and to medical professionals for their health care needs.

Last year, we received one patient complaint for every 12,000 calls we handled. The health and safety of our patients is our top priority, so any concern or question raised by a patient, physician, or employee is fully investigated. Additionally, our state-of-the-art quality assurance program continually monitors the performance of our TSRs and our RNs. We tape all calls for quality assurance purposes and also listen to random calls to ensure that our employees perform within the scope of their training.

We are pleased that the Department of Managed Health Care has accepted our invitation to review our call center operations, and we look forward to their visit and answering their questions.


Original content (posted Jan. 11, 2008)

A recent news story may raise unwarranted concerns about the role of Telephone Service Representatives at Kaiser Permanente's Northern California Appointment and Advice Call Centers. Our Appointment and Advice Call Centers provide personalized service for the care and convenience of 3.3 million members.

Kaiser Permanente Appointment and Advice Call Centers are in compliance with the law. Calls are initially answered by trained non-nurse Telephone Service Representatives. They play essentially the same role as the receptionist at a doctor's office which is not part of Kaiser Permanente. Kaiser Permanente Telephone Service Representatives do not provide medical advice or make medical decisions. They are able to provide information to our members about services, transmit messages to the member's physician, and make appointments for care.

Telephone Service Representatives are trained to transfer callers who report any of a list of urgent symptoms, such as chest pain, shortness of breath, stroke symptoms, etc., to an advice nurse within seconds. Any caller who requests advice, or whose answers to doctor-written questions require speaking to a clinician, is transferred immediately to an advice nurse.

In contrast to Telephone Service Representatives, our advice nurses assess, provide advice, and triage members by clinical urgency to emergency services, clinic visits, self-care or to talk with a physician. Advice nurses may consult with physicians available at the call center on cases.

Kaiser Permanente Appointment and Advice Call Centers are located in Sacramento, San Jose, and Vallejo. They operate 24 hours a day, seven days a week. They handle about 50,000 calls per day, or roughly 14 million calls per year. The majority of calls are non-critical or non-urgent: 20-25 percent are requests for simple information, such as hours of operation or directions; 20-25 percent are for booking routine appointments, such as well baby checks, Pap smears, etc.; and 28 percent are to leave messages for the member's physician. About 25-30 percent of calls result in a transfer to an advice nurse.

Telephone Service Representatives follow interactive scripts, developed and regularly reviewed by physicians, that follow a linear, "yes-no" flow based on information being relayed by the member. The "yes-no" responses direct the Representative to the next question or action. If needed, based on the scripts or on a request from the patient, the patient is connected with an advice nurse based on the information provided.

Every call is taped and documented, and all concerns or questions, raised either by the patient or by quality assurance review, are investigated as part of an extensive quality assurance program.

Member satisfaction with our call centers is extremely high. More than 90 percent of our members rate our call center service as excellent, very good or good. They appreciate the "one stop" access to knowledgeable people for scheduling and directions and to medical professionals for health care needs.

We welcome the opportunity to provide Department of Managed Health Care representatives a firsthand look at our call center, where they can review scripts in context with operations. We will be happy to address any questions the Department has.