Posts Tagged ‘SCPMG’

Raleigh Bledsoe, MD: First black physician for Southern California Permanente Group

posted on January 31, 2014

By Heritage staff

Raleigh Bledsoe, MD, served as chief of Radiology for Kaiser Permanente Southern California Medical Group in the XX

Raleigh Bledsoe, MD, served as chief of Radiology for Kaiser Permanente West Los Angeles Medical Center from 1965 until he retired in 1986.

First in a series marking Black History Month

Raleigh C. Bledsoe, MD, a radiologist whose 32-year career with the Southern California Permanente Medical Group began at the South Bay Medical Center (Harbor City), accomplished a series of trailblazing firsts for his country, his profession and the advancement of black physicians.

Raymond Kay, MD, co-founder of Kaiser Permanente in Southern California, recalled bristling when the International Longshore and Warehouse Union urged SCPMG in the early 1950s to hire black physicians.

“I remember one big union (the ILWU) got me up in front of their board, and they said ‘We don’t think you’re getting enough black doctors,’ said Kay, the SCPMG medical director.

“I said, ‘If your union in any way wants to invade our right to pick the doctors on their qualities, then I’d rather you pull your union out of the health plan.’ ”

Permanente doctors hired for qualifications

Kay was open to diversity on the medical staff but felt the selection should be made on merit.

“I really wanted to pick the doctors on their qualities . . . I didn’t want to put us in a position where (people) would say we were black or Jewish or Korean or something. So I tried to keep a good balance. But I never took a doctor unless I thought he was of the caliber I wanted. And then I didn’t care what his or her color was.”

The impetus for more black doctors came from Bill Chester, civil rights and community leader for the ILWU. Chester campaigned for more blacks in all industries during the 1950s and 1960s.

“We went into every aspect of community life. We encouraged our black members to deposit with savings and loan associations run by blacks. The union did business with Kaiser Hospital, so we met with Edgar Kaiser and said (that) we wanted some black interns and black physicians on the staff,” said Chester in his 2004 ILWU oral history.

First certified black radiologist west of Rockies

In 1954, Harbor City Medical Director Ira “Buck” Wallin, MD, hired Dr. Bledsoe, who became the first black physician on the SCPMG medical staff and the first board-certified black radiologist west of the Rockies.

Dr. Bledsoe had earned an excellent professional reputation and came with enthusiastic references from medical school faculty and colleagues. According to a 1997 obituary published in “Radiology” magazine, Bledsoe had already achieved a distinguished career in the U.S. Army while completing his medical education and training.

A native of Texas, Bledsoe attended Compton College and the University of California, Los Angeles. While serving in the Army, Bledsoe earned his medical degree from Meharry Medical College in Tennessee.

After interning at Los Angeles County General Hospital, Bledsoe served as a captain in the U.S. Army Medical Corps from 1945-48 and was a member of the Tuskegee Airmen. He later completed his residency in radiology at the University of Southern California.

Although Dr. Bledsoe had the support of his Permanente colleagues, it took some time before Harbor City’s members accepted a black physician. Dr. Wallin was warned that people would be upset: “We had longshoremen that stormed out. I got a letter threatening my wife,” he said.

Pete Moore, ILWU regional director in the 1950s, remembers one longshoreman complaining to him about his wife seeing a black doctor at Harbor City. “He didn’t want her to be treated by a black doctor. I told him, ‘hey, get out of the plan. Join the alternative plan,’ and he did.”

So when it came time for Bledsoe to become a partner in the medical group, the battle lines were drawn. Bledsoe was well-liked and competent.

“The doctors saw that if Bledsoe could be kept out because of his race, they were going to be very disappointed in the medical group,” Wallin said. “I had a meeting with Lynn Solomon, MD, Jim Roorda, MD, Walter Cohen, MD, Billie Moore, MD, Harry Shragg, MD, and the other doctors.

“I told Ray (Kay), ‘You’d better talk to us. You have a chance of losing about two-thirds of us. I’m going to submit Raleigh Bledsoe’s name for partnership.’ ”

Bledsoe makes partner

Bledsoe made partner, and he stayed more than 30 years in the SCPMG. In 1965, he transferred to the newly opened West Los Angeles Medical Center and served as chief of Radiology until his retirement in 1986, becoming one of the longest serving chiefs in Kaiser Permanente’s history.

During his career, Dr. Bledsoe designed the radiology units for three hospitals and eight clinics, including the selection of equipment, development of policies and procedures, and the hiring of the radiologists.

Harry Shragg, MD, a colleague of Bledsoe, fondly recalled memories of his friend in a 1986 oral history: “Raleigh was probably, as a diagnostic radiologist, as fine a radiologist as I’ve ever seen and known . . . He was always on the cutting edge of radiology, a constant student, a teacher, a kind man whom anybody would be proud to know.”

Dr. Bledsoe passed away in 1996.

Michael Pucci, senior communications consultant in the Kaiser Permanente Hawaii Region Brand Communications and Public Relations Department, and Heritage writer Ginny McPartland collaborated on this story.  The article was first published in the South Bay (Harbor City) service area’s 60th Anniversary book in 2010.

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Southern California Permanente Medical Group celebrates 60 years

posted on January 8, 2014

By Steve Gilford
Senior consulting historian

Raymond Kay, MD, friend of Garfield and early leader of the Southern California Permanente Medical Group, playing ping pong at the Desert Center  hospital site.

Raymond Kay, MD, friend of Kaiser Permanente founding physician Sidney Garfield and early leader of the Southern California Permanente Medical Group, playing ping pong at the Desert Center hospital site. Kaiser Permanente Heritage photo

As an independent historian with a long-standing interest in Kaiser Permanente, I was fortunate to be invited to the daylong 60th anniversary celebration of the Southern California Permanente Medical Group, held recently in Anaheim, Calif.

The event was to mark the medical group’s formal start in 1953 when 13 Permanente physicians, including Ray Kay, the first medical director, signed a partnership agreement that officially formed SCPMG.

The group’s origin actually goes back to 1943 when Henry J. Kaiser asked Permanente co-founder Sidney Garfield, MD, to establish a health care plan for workers of the Kaiser Steel mill in Fontana.

Today, SCPMG has more than 6,000 physicians practicing in 14 accredited Kaiser Foundation Hospitals and more than 190 medical office buildings.

Pride a theme of celebration

As I observed the events of the day (Sept. 28, 2013), I heard Permanente physicians express pride in the organization and its legacy. But at first I wasn’t entirely sure the expressions were genuine, or if it was similar to the type of pride shown for a football team or one’s alma mater.

As the day unfolded, it became increasingly clear that this was an authentic professional pride rooted in SCPMG’s 60-year history of trials and triumphs.

Pride in the organization can be traced back even further, to the tiny 12-bed hospital Sidney Garfield built in 1933 on a parched and lonely piece of desert land in one of the most physically inhospitable places in the United States.

The organization that sprang from that little frame building in the Mojave Desert, with its one doctor and one nurse, was being celebrated by thousands gathered together in one of the most populous and powerful metropolises of the nation.

Roll call gets vociferous response

Edward Ellison, MD, the SCPMG executive medical director, began the day by calling the roll of Southern California’s medical centers represented at the gathering.  Each medical center team responded to the call with a spontaneous cheer that resonated across the large hall.

There was no question that these physicians were enthusiastic, but it was not yet clear to me just why they were responding with such vigor. Was it like the way people in a talk-show studio audience react when someone mentions their hometown?

Was it just because they had found a comfortable place to practice medicine outside the increasingly stormy arena of fee-for-service medicine, relieved to be insulated from some of the stresses their professional colleagues were facing?

Frank Murray, MD, Kaiser Permanente Southern California medical group executive director, XXX. with Sam Sapin, MD. Sapin was instrumental in the development of the regional graduate medical education program, which opened its first residency program in 1955.

Frank Murray, MD, at left, Kaiser Permanente Southern California medical group executive director, 1982-1993, with Sam Sapin, MD, pediatric cardiologist and SCPMG quality leader.

Or was it truly because they were recognizing that they were a part of an organization that was truly special, with a leadership that encouraged them to practice preventive care and to take great care of their healthy members, as well as their sick patients?

Celebrities tout Permanente’s national role

As a part of the proceedings, there were dramatizations featuring Henry Kaiser, Sidney Garfield and even Rosie the Riveter – all well done and entertaining. They set the stage for Kevin Starr, noted California historian and author, and Nancy Snyderman, MD, chief medical editor, NBC News, and award-winning journalist.

The celebrities’ presentations put the achievements of Kaiser Permanente into perspective, each emphasizing the contribution of the organization to the nation’s health care.

Starr and Snyderman were the stars of the day, but for me the day’s high point was an onstage discussion by the four surviving SCPMG executive medical directors – Frank Murray, MD, 1982-1993, Oliver Goldsmith, MD, 1994- 2004, Jeffrey Weisz, MD, 2004-2011, and Edward Ellison, MD, current executive director.

They presented the organizational challenges that they had faced in their time and told how they had overcome them.

Through all their recollections flowed a strong streak of natural idealism that had helped them shape their responses to the challenges of their time at the helm. Their remarks – more than any other presentation – made it clear that SCPMG leaders created and passed on a strong legacy that was to be treasured, defended and enhanced.

As the day drew to a close, Dr. Ellison summed up what he felt was special about Permanente Medicine and SCPMG. We are building infrastructure for the future . . . I am confident that our approach to achieving the total health of our patients in mind, body and spirit is the successful path to that future.

“Our conquering, enduring spirit, combined with our passion for medicine and our caring from the heart, will sustain us for the next 60 years,” he told the group.

Often, when you hear such presentations made by leaders in front of their staffs, if you listen carefully you can hear quiet undertones of mildly cynical scoffing or snickering from the rank and file who may have a quite different perspective on the relation between idealism and reality.

That afternoon I was listening closely for that tell-tale buzz from among the 3,000 people in the hall. I didn’t hear it.

What I did hear was enthusiastic agreement with what Dr. Ellison was saying. I understood then that the pride I had sensed in the responses to his morning roll call of the medical centers had been genuine and had only been enhanced by the day’s focus on the achievements and potential of Permanente Medicine.

I left Anaheim with a renewed sense of pride in my association with Kaiser Permanente, for my modest part in searching out, saving and communicating its history to new generations of physicians who will preserve and expand the legacy begun by its founders.

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The Roots of Southern California Kaiser Permanente

posted on October 7, 2013
Cover of Southern California Planning for Health featuring Los Angeles hospital - Fall 1957
Cover of Southern California Planning for Health featuring expansion of operating room facilities at the new Los Angeles hospital – Fall 1957

By Lincoln Cushing, Heritage writer

The Kaiser Foundation Health Plan’s first beachhead in Southern California was a modest hospital for workers at the Fontana Steel Mill.

The plant was built by Henry J. Kaiser in 1942 as the first West Coast source of the rolled steel plates needed to build Liberty and Victory ships for World War II.

After the war the Health Plan in Fontana went public, and with the strong support of labor unions like the Retail Clerks International Union and the International Longshoremen and Warehousemen Union it began to grow throughout the region.

The first facility outside of Fontana was established in Harbor City in 1950 when the entire West Coast ILWU signed up for the plan.

The next year the Retail Clerks International Union signed on and facilities were founded in Los Angeles, at an inauspicious clinic on La Cienega Boulevard; the state-of-the-art Permanente Foundation Hospital on Sunset Boulevard would not be built until 1953.

On January 1 of that year 13 physicians signed the Southern California Permanente Medical Group’s first Partnership Agreement with  Raymond Kay, MD, as Medical Director.

Special thanks to Cathy Romero, Communications Production Specialist, Pasadena, for providing the Heritage Resources archive with scans of the Southern California Planning for Health newsletters.

Short link to this story:

Article in Southern California Planning for Health on Retail Clerks Union group members, Winter 1952-1953
Article in Southern California Planning for Health on Retail Clerks Union group members, Winter 1952-1953

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Birth of the National Committee for Quality Assurance

posted on March 21, 2012

By Ginny McPartland
Heritage writer

Fourth in a series

Heart specialists of the Southern California Region's Sunset Medical Center go over videotapes at the conclusion of a cardiac catheterization. KP physicians draw on each other's expertise to provide high quality care. KP 1985 Annual Report photo

How good was the problem-based approach to quality assessment developed in the early 1970s by Kaiser Permanente’s pioneers Len Rubin, MD, and Sam Sapin, MD? Soon after its unveiling, the Comprehensive Quality Assurance System was to be put to the test.

In 1979, at the behest of the federal Office for Health Maintenance Organizations (HMOs), the first incarnation of the National Committee for Quality Assurance (NCQA), was formed. Sponsored by the Group Health Association of America and the American Association of Foundations for Medical Care, the committee invited Sapin and Rubin to join.

In short order, the committee adopted Rubin’s problem-focused review method. NCQA’s emphasis was on identifying and correcting problems, and traditional audits were not required, reported Sapin who served NCQA as a board member and surveyor from 1980 to 1987.

Sapin and Rubin knew the review method worked because they had used it to evaluate KP care in both Northern and Southern California. The KP scheme had two levels: first, identifying possible trouble spots by a variety of means and judging the problems according to 56 monitoring criteria; and second, to fix the problem through process change.

Sapin describes the Southern California Permanente Medical Group regional quality reviews of the 1980s: “The program began with a modest number of criteria, and regular reports were distributed to chiefs of service, medical directors and administrators.  Medical centers were identified only by code number. The results were enclosed in a bright yellow folder. We hoped to put the recipients in a receptive frame of mind for their easy-to-recognize quality of care monitoring report,” Sapin explained.

The Permanente Medical Group executive director Bruce Sams, Jr., MD, featured in the 1988 annual report, noted the group practice model gives KP physicians more control over the quality of care than their counterparts in fee-for-service practice. KP 1988 annual report photo

“During the 1980s, these regular reports appeared to generate more quality assurance activity than did the previous classic (traditional) medical audits,” Sapin said.

National quality group loses financial support

NCQA floundered in the early 1980s due to the withdrawal of financial support. “NCQA’s status is presently precarious unless the parent organizations, the HMOs which are surveyed and some of the states, provide funds for its operation,” Sapin reported to the KP board of directors in 1983.

Even though member HMOs and the Office of HMOs inWashington, D.C., were satisfied with the surveys, there was an undercurrent pushing for a review agency independent of HMOs. James Doherty, CEO of the Group Health Association of America for 15 years, said in 1996, “HMOs needed to subject their operations to external review by an independent quality assurance body.”

NCQA regenerates and launches renewed mission

In 1990, the NCQA managed to get funding to reconfigure as an independent agency with a $308,000 grant from the Robert Wood Johnson Foundation and matching funds from HMOs. The board was reconstituted to have 20 members, the majority representing purchasers (largely employers) of care, health plans or consumers.

John Iglehart, editor of Health Affairs journal and national correspondent for the New England Journal of Medicine in the 1980s, was interviewed for the KP publication Spectrum, Spring 1987.

Six physicians, including four medical directors of managed care plans, and Dr. Thomas R. Reardon, a trustee of the American Medical Association, also served on the new NCQA board in the 1990s, according to a 1996 New England Journal of Medicine (NEJM) article by John K. Iglehart, then NEJM national correspondent and editor of the Health Affairs journal. (Iglehart was KP’s vice president of government relations in Washington, D.C., from 1979 to 1981.)

The author notes, “Although strong ties still exist (with managed care leaders), the NCQA is a conduit through which employers apply pressure on health plans to continually raise their quality horizons. This pressure creates a tension that reverberates throughout the NCQA’s relationship with health plans.”

Consortium hammers out first HEDIS measures

With the reconfigured NCQA, Kaiser Permanente and six other large employers went to work to fashion quality performance measures. These measures, which cover inpatient and outpatient care, would come to be known as HEDIS or HMO Employer Data and Information Set.

In the 1993 Quality Agenda in Action report, KP CEO Dr. David Lawrence wrote: “HEDIS is the basis for. . .a national effort of 30 major managed health care plans and a group of consumers and business representatives. . .to develop a system that will enable (purchasers) to compare health plans on the basis of quality indicators.”

NCQA released its initial set of quality measures in 1991, and about 330 health plans measured their performance according to the HEDIS system and reported their results to employers, Iglehart reported in his NEJM article.

KP's 1986 annual report focused on quality of care. The report covered many facets of quality, including cost, structure of assessment, data availability and the role of government.

He wrote: “The NCQA standards are evolving. . .A recent version (HEDIS 2.5) incorporated more than 60 performance indicators that cover quality of care, access to and satisfaction with care, the use of services, finances and management. Most indicators, however, assess administrative performance or utilization rather than quality of care.

“The nine quality measures focus on process, particularly the use of preventive services, which can be readily measured. Only two indicators measure a health outcome (low birth weight) or a proxy for a health outcome (hospitalization rates for patients with asthma),” Iglehart wrote.

On its Web site today, NCQA touts its HEDIS system as the industry standard for comparison of health care providers. “HEDIS allows for standardized measurement, standardized reporting and accurate, objective side-by-side comparisons . . . We work to make sure that all measures address important issues, are scientifically sound and are not overly burdensome or costly to implement.”

Examples of current HEDIS measures include: Advising smokers to quit; antidepressant medication management, breast cancer screening, cervical cancer screening, children and adolescent access to primary care physician; children and adolescent immunization status; comprehensive diabetes care; controlling high blood pressure; and prenatal and postpartum care.

Next time: 1990s begin with supercharged KP quality agenda


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