Kaiser fills high-tech demand

From: Sacramento Bee, USA - Mar 5, 2006

Advances in cancer treatment, fertilization, surgery part of new image

By Dorsey Griffith -- Bee Medical Writer
Published 2:15 am PST Sunday, March 5, 2006
Story appeared in Metro section, Page B1

Joyce Bonner has relied on Kaiser Permanente for her health care the past 40 years. Except for the birth of her third son, at the Morse Avenue hospital 36 years ago, most of her doctor's visits have been routine - the kind of preventive maintenance for which the health care giant is best known.

In the view of Bonner and other Sacramento-area members, that image of Kaiser is evolving, growing wider with the addition of the kind of high-tech medical care typically associated with university teaching hospitals and speciality medical groups.

Bonner, 64, was among the first in the region to benefit from one of those sophisticated medical advances: a cochlear implant to restore her hearing.

Other highly specialized services also are finding a home at Kaiser centers in the Sacramento area. With the recent addition of two radiation oncology centers in Roseville and Rancho Cordova, cancer patients can now stay inside the Kaiser system for radiation therapy. And patients who need complex vascular surgeries are no longer sent to Stanford.

Autistic children will have a special center for their care in Rancho Cordova beginning in June. And starting next month, infertile couples can opt for in vitro fertilization at Kaiser's Point West offices.

While patients have to pay out of pocket for some of the new offerings, many are part of the overall benefits packages.

Driving the change over the past few years are membership growth, increased demand for broader services and a shift in the way Kaiser has positioned itself in the health care marketplace.

"There has been an explicit effort to focus on the quality of care, becoming more of a quality leader rather than the low-cost leader," said Jill Yegian, director of health insurance at the California Healthcare Foundation, a health policy group.

"Kaiser is trying to adjust to the fact that managed care as we knew it has undergone significant setbacks," said Walter Zelman, director of the California Policy Institute at the University of Southern California who worked on the Clinton health care reform proposal in the early 1990s.

"People are concerned about quality, about having choice."

But that can be more costly. Jerry Fleming, a Kaiser senior vice president and health plan manager, acknowledged that Kaiser premiums on average have jumped about 10 percent per year the past two years, emphasizing that actual increases vary depending on the buyer's use of services.

"We are in a competitive marketplace, so we have to bring in a premium that allows us to be effective," he said.

Regardless, local Kaiser leaders say they are in a good position to offer increasingly specialized medical services.

Kaiser Permanente's market share has grown steadily in the Sacramento region; with nearly 647,000 members, it owns 34 percent of the market, up from 26 percent a decade ago.

Kaiser's is a unique system in which its Permanente Medical Group works under contract with the Kaiser Foundation Health Plan, but the doctors are responsible for all medical decisions and drive the direction of care.

"Our focus here is to do the right thing," said Dr. Richard Isaacs, an ear, nose and throat specialist and physician-in-chief at Kaiser's South Sacramento and Elk Grove facilities.

"That's one of the powers of the system. There is no administrator telling me what to do."

Mostly, Kaiser doctors are paid an annual salary that does not depend on the number of patients they see or on the cost of the procedures they do.

While many perceive Kaiser's approach as miserly, the doctors' lack of financial incentive pleases Bonner, who is glad her $50,000 cochlear implant surgery was done only after careful medical evaluation. Kaiser covered the entire cost of the procedure, which involves implantation of the device into the skull.

The retired state analyst had been losing her hearing for decades because of otosclerosis, a condition that produces abnormal bone growth in the middle ear. Completely deaf in one ear and with just 10 percent of her hearing left in the other, doctors two years ago deemed her eligible for the implant, which processes sounds from the environment into electrical signals then sends them into electrodes implanted in the patient's cochlea.

Beyond the surgical risks, Bonner was initially reluctant to take the plunge because she would have had to make numerous four-hour trips to Oakland from her home in Volcano, in Amador County. She changed her mind last October, when doctors at Kaiser's South Sacramento facility began offering the surgery.

Although the sounds she hears are different from how she remembers them, every one has been thrilling: "I can hear so many sounds I hadn't heard in years and years, like birds chirping, the car keys dropping, the water running," she said.

Kaiser patients unable to get pregnant will also have additional options soon.

Dr. Jack Rosanz, Kaiser's physician in chief in Sacramento, said the new in-vitro fertilization program addresses demand, and physician recruitment problems.

He said the medical group lost two top-notch reproductive endocrinologists because it lacked an IVF program.

Dr. Kenneth Vu, a reproductive endocrinologist from the University of Hawaii, will run the program for couples who have exhausted other infertility treatments.

"This is the next step for treatment," he said. "We have to do something to meet these women halfway. When we have to go outside the system, the sense is that the system failed."

He said about 150 to 180 women have sought IVF treatment outside of Kaiser over the past couple of years. Kaiser has invested about $2.8 million to develop the program.

Patients will pay out of pocket an estimated $8,000 fee for services, which includes the medications.

In some cases, Kaiser has looked very attractive to highly specialized doctors, who see opportunity in bringing their expertise into the large system with strong support systems in place.

Kaiser now boasts the largest neurosurgery department in the Sacramento region, for example, with nine surgeons and two interventional neuroradiologists.

Dr. Edie Zusman, director of adult neurosurgery at Sutter Neuroscience Institute, who began her career at Kaiser, has noticed the growth since her departure.

"The emphasis in Kaiser at the time was on generalized neurosurgery rather than specialty programs," she said. "(Now) they are making important steps to meeting their members' needs."

It was a factor that attracted Dr. Victor Rodriguez, a highly sought after vascular surgeon specially trained to repair massive and complex aneurysms.

"I've had offers elsewhere, but I like this place," he said. "I like the freedom to expand and grow. If you have the training, you want to be able to do these things."

Kaiser still has its limitations. It sends its heart surgery patients to Mercy hospitals. Some of the most complex neurosurgeries are done at UC Davis. And patients needing organ transplants are sent to the Bay Area.

Still, there are more expansion plans on tap. Highest on the list: a move to establish the Sacramento area's fourth trauma center.

About the writer:
The Bee's Dorsey Griffith can be reached at (916) 321-1089 or dgriffith@sacbee.com.

Copyright © The Sacramento Bee