Dr. Jeffrey Weisz
Has Big Plans for
Kaiser Permanente
He not only foresees
membership growth, but plans
to reduce outside referrals to
OHSU and consider the role of
nurse practitioners and
physician assistants
By:  Diane Lund-Muzikant
February 22, 2012

Dr. Jeffrey Weisz is a man on a
mission. As the newly appointed
president and executive medical
director for the Northwest
Permanente Medical Group, he’
s setting his sights high.

“I believe Kaiser is the answer
to healthcare in America, and I’
m going to prove it,” he said in
a candid interview with The
Lund Report. “We’re going to
save more lives, and out
perform everyone with better
service and access, and have
the best price and the best
quality. Insurance companies
that have the best rates win the
market. But, I want the best rate
and the best quality.”

Competitors such as
Providence want Kaiser’s
500,000 members, he said. “But
they’re not getting them. We
have a better chance they’ll
lose them to us because I’m
very laser focused on what
needs to be done. I want to take
over the market and make
Kaiser as big as I can, and
would like to add 20-25,000
new members every year.”

Weisz intends to partner with
private employers interested in
lowering their healthcare costs
and having a healthier work
force.

“We can run a report that no
one else can, and tell
employers how many of their
employees smoke, how many
are overweight, how many of
people with diabetes have their
blood sugar out of control,” he
said. “No one else can do this.
Everyone’s looking for an
answer on how to lower
healthcare costs that are
escalating every year. If you
prevent illness and have higher
quality, you’re going to lower
your costs and save lives. That’
s what I believe in and what I’ll
help bring to the northwest
region.”

Weisz has other changes in
mind as well since joining Kaiser
on January 1.

Reducing Outside Medical Costs

Up until now Kaiser members
have also been able to see
physicians at Oregon Health &
Science University. But that’s
about to change. Unless OHSU
can provide care not available
at Kaiser such as heart
transplants and complicated
pediatric treatments, its
members will have to pay the
bill if they decide to be seen at
OHSU.

“OHSU has a great training
program and 60 percent of our
doctors are trained there, and
we’re spending millions of
dollars in care at OHSU,” he
said. “Up until now, it’s been a
fairly easy path to go over
there. I believe we have the
same quality care.

Once its new hospital opens in
western Washington County
next year, Kaiser will have a
robot in place, at a cost of
several million dollars, and will
no longer need to hospitalize
patients at Providence St.
Vincent Medical Center.
Currently, it uses 30 of its beds
nearly every day.

“We believe we can do better
with our own patients at our own
hospital,” he said. “When the
robot was introduced, virtually
every hospital – other than
Kaiser Sunnyside – bought a
robot immediately because they
wanted to put more patients in
their beds.”

Urologists believe the robot
gives them better surgical
techniques and fewer adverse
complications with nerve injuries
so people having surgery for
prostate cancer can still have
normal sexual function and
fewer continence problems.

“Most young urologists doing
prostate cancer surgery are
trained on the robot, and if you
don’t have one, they don’t want
to join your organization,” he
said. “Medicine has become big
business and there’s a subset
of patients and everyone is
competing for the same group.
When any new technology
comes in, we do an evidence
based analysis to make sure we
should buy this new technology.
If there’s no evidence we won’t
buy it. We didn’t buy the robot
earlier because were waiting for
more literature and more data
to see that it was evidence
based. We want to be careful
because we’re spending our
members’ money.”

Niche Care for Nurse
Practitioners and Physician
Assistants

On a philosophical level, Weisz
believes nurse practitioners and
physician assistants are better
at niche care – becoming an
expert in one or several
diseases. “Don’t forget I went to
medical school, and it’s
complicated to take care of
patients,” he said.

Nurse practitioners could
manage a panel of diabetics,
chronic congestive heart failure
or well baby visits. Now they
usually take care of everything
a patient may need.

“I’m going to try and focus them
more on niche care,” he said.
And, if nurse practitioners and
physician assistants need more
training diabetes, physicians
can teach them.

Weisz realizes everyone might
not appreciate this new focus
and developed a similar
approach while working in
southern California. “Anytime
you change anything in
healthcare people are always
upset. But, you have to do what’
s right for the patient. It’s very
hard for a doctor to assess a
patient and they went to
medical school for four years. If
someone comes in with acute
abdominal pain, it’s a
complicated thing. Can they feel
the spleen, feel the liver, do
they know what tests to order? It’
s hard for doctors to figure out
and even harder for people who
haven’t gone to medical school.”

When asked to clarify this
statement, Richard Odell,
director of communications and
assistant to the president,
provided the following response
to The Lund Report:

“Dr. Weisz is not talking about
creating a separate structure
for these professionals.  In fact,
just the opposite embedding
them in a specific area of
practice where they would work
along side physicians.

“For example, there is
significant value in using highly
skilled NP's and PA's (rather
than have them managing a
panel of primary care patients)
and having them focus on a
very specific area of practice.

“These areas of practice could
include case and disease
management in coordinating
care across multiple areas of
the care delivery system.  It
could also include placing them
into certain high volume
specialized procedural based
care settings; for example in a
gastroenterology practice
performing colonoscopies; or in
a head/neck surgery practice to
perform myringotomies (placing
tubes in children's ears for
middle ear infections).  There
are many other examples.

“Finally, under the current way
in which Kaiser Permanente
care delivery operates, NWP is
responsible for the practice of
NPs, PAs and mental health
therapists;  but they report to
the Health Plan and not NWP.

“I don't believe that Dr. Weisz
was talking about creating a
separate structure for the work
that nurses and other clinicians
do. He was talking about how
an RN often becomes quite
adept in a certain area of care,
that might be called a 'niche.' A
good example of that would be
the case managers for
congestive heart failure
patients. Much of that care is
coordinated and delivered by
non physicians, in a team care
or medical home type of model,
but the physicians is still the
leader of that team when it
comes to making key clinical
decisions. “

Weisz’ Has a Track Record in
Southern California

Before joining Kaiser Northwest,
Weisz, was executive medical
director and chairman of the
board of the Southern
California Permanente Medical
Group, a position he held since
2004.

Early on, he decided Kaiser
would become number one in
prevention in America. Shortly
after joining Kaiser, he had
attended a national Kaiser
meeting in Oakland on breast
cancer quality screening and
learned that Kaiser’s rate was in
the 70th percentile.

“I got up and said those rates
aren’t high enough, and I don’t
want to go to a meeting where
the rates are mediocre,” he
said. “In just one year we got all
12 medical centers over 80
percent.”

Two years later, Kaiser became
number one in America, having
screened more than 90 percent
of women between the ages of
50-65 for breast cancer.

“The reason that’s important is
because breast cancer is the
number one issue women think
about and if pick up breast
cancer in the early stage, you
can do minimal surgery and don’
t have to do radiation and
chemotherapy or reconstructive
surgery, and you have a better
chance of saving lives.”

Soon the success in breast
screening caught fire in
southern California and Weisz
realized similar spikes in other
healthy measures – from 2004
through 2010, cholesterol
control rose by 22.5 percent;
blood pressure control, 41.8
percent, smoking cessation
decreased by 17 percent;
cervical cancer screening went
up 5.8 percent and colon
cancer screening, by 29.8
percent.

“By picking up the disease
early, you prevent less
advanced disease and spend
less money on chemotherapy
and you can put that money
back in your system so you can
have lower healthcare rates,”
said Weisz who intends to
create similar screening goals
for the Pacific Northwest.

There’s no reason, he said,
anyone over age 50, should die
of colon cancer if polyps can be
identified earlier by investing in
colonoscopies. “We’re spending
millions of dollars on chemo for
advanced disease – why not
pick it up early?” he said.

With Kaiser’s sophisticated
electronic healthcare system,
specialists and primary care
doctors can determine whether
a patient has undergone
screening for colon or breast
cancer, for example.

“Anytime one of our patient’s
goes to a doctor – be it an
allergist or dermatologist, they’ll
take your blood pressure and
start you on screening tools.
That’s how you improve quality
and increase prevention,” he
said.


Comment
I wonder if Dr. Weisz got
pushed out of Southern
California Permanente Medical
Group for supporting doctors
who concealed urology X-rays.  
My doctors claimed that a large
number of X-rays had been
taken of me on June 15, 2011
at Garfield Specialty Center in
San Diego (which boasts that all
X-rays are digitized), but that
only a tiny fraction of my X-rays
had been saved--on thermal
paper!  Also, Dr. Weisz
supported the falsification of a
report about the X-rays.
Maura Larkins
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Northwest Permanente's president changes mind about
addressing 'ruthless administrator' lawsuit; readers weigh in
Aimee Green
Oregon Live
April 28, 2014
      

A story about a former Kaiser Permanente oncologist who is suing the HMO for $7
million -- claiming she had no choice but to leave after profits were prioritized over
patient care -- generated a flurry of comments from readers last Wednesday.

And it has spurred several calls or emails a day ever since to this reporter from
current and former Kaiser staff who say they can relate to the complaints Dr.
Jennifer Lycette included in her Multnomah County Circuit Court lawsuit.

Lycette’s suit alleges that patient care took a nosedive after the Northwest
Permanente Medical Group hired a “ruthless administrator,” Jeffrey Weisz, as
president and executive medical director in 2011.

A Kaiser spokesman put out a short statement Wednesday saying that patients
“come first” and that “allegations that claim otherwise are not supported by fact.”

But Weisz wanted to say more. His executive assistant contacted The Oregonian on
Friday to set up an interview. But on Monday, Weisz’s assistant called The
Oregonian to say that meeting wouldn’t happen. She didn’t give a reason.

Among Lycette’s complaints:

  Administration severely clamped down on oncologists referring patients to
specialists or clinical trials outside the Kaiser system, even if the oncologists thought
it was in patients’ best interests.


  Money-minded administration began requiring patients who were being treated at
Doernbecher Children’s Hospital to immediately be transferred to Kaiser’s adult
oncology clinic the day they turned 18 -- even though Lycette believed that these
patients would be better treated by pediatric oncologists because of the type of
cancers they had.

“(Lycette) knew two of these patients, both of whom died at the age of 19,” states
the suit. “Had these patients remained at the Doernbecher Pediatric Hospital, their
families would have had the support services in place for families who lose a child to
cancer. As a pediatric cancer center, Doernbecher had social workers, nutritionists,
physical therapists, occupational therapists, all with special training in pediatric
cancers. (Lycette’s) department did not have these same tools.”

A few readers praised Lycette for speaking so frankly.

Doldrums:

"Good for Dr Lycette, it's disgusting to cause pain and discomfort to those already
suffering, especially if the motive is profit. Administrators have no business dictating
to physicians about how they practice medicine."


Some readers spoke of their experience with Kaiser doctors -- great or not so great.

Must_B_Rain:

"I had colon cancer and had several oncologists at Kaiser in Portland Oregon.

They took great care of me and continue to do so. Best hospitals I have ever been
to. Thanks all who work at Kaiser Permanente!"

OC-Paul:

"I had Kaiser coverage for about 6 years. They damn near killed me. My doc was so
rushed, on my last visit I was still talking as he walked out the door. For years he told
me the tumor in my neck was nothing to worry about unless it got bigger. Well bigger
it got until it was almost inoperable. I switched insurance companies and found that I
had to have major surgery, and I was off work for months. I now have a partially
paralyzed throat and a paralyzed vocal cord. If my doc would have referred me to a
specialist the tumor could have been removed when it was small. I will never ever
step foot in a Kaiser facility again."


Others readers debated how Kaiser, a “non-profit” organization, could be concerned
about profits.

Fresh From Cali:

How does a not-for-profit organization maximize profits?

cpvon:

…”non-profits are not taxed on their profits. A not-for-profit entity is a tax code
designation. It does not mean they are not allowed to make and accumulate profits.”

nevetando:

@Fresh From Cali by redistributing it among administrative staff. non-profit only has
to mean two things in health care

1. you provide a "community benefit"

2. you reinvest profit into services

George Halvorson, CEO of Kaiser made $7.74 Million in salary in 2012 and was one
of the highest paid health administrators in the nation.
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