CONTACTS 

SUBJECTS
Kaiser Review Failure Perform Duty Pay  Csts Referral Patient Treatm

3603 -
3603 -    ..
3604 - Summary/Objective
3605 -
360501 - Follow up ref SDS 16 0000, ref SDS 14 0000.
360502 -
360503 -
360504 -
360506 -  ..
3606 -
3607 -
3608 - Progress
3609 -
360901 - Complex Case Requires Effective Doctor Patient Partnership
360902 -
360903 - Received letter, ref DRT 1 0001 from Karen following up the letter
360904 - yesterday on 070925 confirming telephone discussions, ref SDS 16 QY5I,
360905 - with attachments, ref SDS 16 J16G, and which discussions the primary
360906 - care physician ordered by referral on 070921 to resolve referral
360907 - issues for Millie's care at UCSF. ref SDS 14 QZ82
360909 -         ..
360910 -    1.  I just wanted to let you know that I did receive your email.
360911 -        You have been a wonderful advocate for Millie with these
360912 -        complex issues.  As you noted in your letter Bob Schwartz at
360913 -        UCSF said he would work on concerns you expressed.  I will try
360914 -        to talk to several people here in the next few days  but please
360915 -        understand that I do not have any authority to make a change
360916 -        myself;   I will try to follow through in discussing this with
360917 -        others who can better understand the complexities and can
360918 -        decide whether changes in Millie's experience between Kaiser
360919 -        and UCSF's clinical trial program need to be made.
360920 -
360921 -            [...submitted reply with explanation of patient history
360922 -            shown below. ref SDS 0 4I5G
360924 -  ..
360925 - Karen also called and left a message that she is trying to contact
360926 - Kaiser's Outside Referrals Department.  She has talked to Millie's
360927 - primary care physician and he explained having submitted authorization
360928 - for Millie's referral.  He called Outside Authorizations recently and
360929 - was told this is a Medicare problem; so, Karen wants to hear their
360930 - story.  This aligns with the doctor's letter on 070907 saying he tried
360931 - to get clarification from Outside Authorizations, ref SDS 13 XH5H, on
360932 - his authorization for Millie's referral back in January on 070119.
360933 - ref SDS 5 4R4M
360935 -  ..
360936 - Karen's comment that complex, difficult issues require careful review
360937 - fits Kaiser's team care model of doctor patient partnership, reviewed
360938 - on 990625. ref SDS 1 4185  Doctor's have a lot of support.  Patient's
360939 - are well served by drawing on a support team, per Karen's letter
360940 - today, shown above. ref SDS 0 IF8F  Coordinating the doctor patient
360941 - partnership with an accurate record of patient history leverages
360942 - medical assets to save lives, time, and money by reducing mistakes,
360943 - and discovering opportunities in time to be effective.
360945 -  ..
360946 - Billing complexity arises from balancing requirements between the
360947 - patient, Kaiser, UCSF, Medicare, CMS and prevailing statutes passed by
360948 - Congress and the state legislature.
360950 -  ..
360951 - Karen's finding today that Millie's case is very complex aligns
360952 - with case study on complicated patient history reported in the
360953 - record for 061020. ref SDS 2 T25H
360954 -
360955 -
360956 -
360957 -
360958 -
360959 -
3610 -

SUBJECTS
Kaiser Review Failure Perform Duty Pay Costs Referral Patient Treatm

7603 -
7604 - 1657
760501 -  ..
760502 - Case Study Patient History Kaiser Referral for Treatment at UCSF
760503 -
760504 - Submitted ref DIT 1 0001 replying to Karen's letter, above,
760505 - ref SDS 0 QY5I, saying...
760507 -         ..
760508 -    1.  Thanks for your letter today, ref SDS 0 QY5I and reporting
760509 -        efforts to investigate referral issues on Millie's treatment at
760510 -        UCSF. ref DIT 1 0001 [responding to the letter yesterday on
760511 -        070925, ref SDS 16 JZ7G, with attachments on patient history.
760512 -        ref SDS 16 J16G
760514 -         ..
760515 -    2.  A case study on 070130 summarizes extensive effort over several
760516 -        months for Kaiser's referral to UCSF in Millie's case.  Patient
760517 -        history provides context for applying policy that aligns with
760518 -        contract terms, regulations, and statutes governing the work.
760519 -        ref SDS 7 G46M, ref DIT 1 AS6H
760520 -
760521 -            [On 071001 submitted follow up letter with further
760522 -            background showing requrements for Kaiser to pay for
760523 -            Millie's care on referral to UCSF. ref SDS 17 QY5I
760525 -             ..
760526 -            [On 071001 case study showing clinical trials are
760527 -            prescribed by Kaiser as the best treatment for Millie.
760528 -            ref SDS 17 LE3G
760529 -
760531 -  ..
760532 - Trust Credibility Reliability Doctor Patient Partnership
760533 -
760534 -
760535 -    3.  The core issue is whether the patient can rely on the doctor.
760536 -        If not, then Kaiser must present people who have authority to
760537 -        commit Kaiser so that patients can make reasoned choices on
760538 -        costs and benefits before incurring obligations.  Historically,
760539 -        doctors drive the process, because they present life and death
760540 -        decisions within the doctor patient partnership. ref DIT 1 AS7G
760542 -         ..
760543 -    4.  Realize this is a difficult matter.  Thanks very much for
760544 -        helping out.
760545 -
760546 -
760547 -
760548 -
760549 -
760550 -
7606 -