National Kaiser Permanente Labor Relations executives meeting with NUHW bargaining team, Oct. 6, 2022
A message from Steve Shields, Senior Vice President, National Labor Relations and Office of LMP, KFHP/H; and Jim Pruitt, Vice President, LMP and Labor Relations, The Permanente Federation.
To our therapists,
Yesterday, we met with NUHW President Sal Rosselli and the NUHW bargaining team to resolve the current labor strike so that you could return to caring for patients who need you. We were optimistic that we could address the remaining issues that union leadership has outlined.
We offered the NUHW bargaining team a proposal that shows again that we have been listening and seeking to resolve the remaining issues and end the strike. Despite our best efforts to reach a resolution and bring this strike to a close, the union leaders refused to bring solutions, offer counters, or make any progress toward concluding this.
Below is a summary of what we proposed to the union yesterday:
1) We understand the value to therapists and their patients for indirect patient care time. And we have already agreed to go from the current level of 15% IPC time to 18%, but the union continues to demand 20%. In order to simplify this and not get caught up in the somewhat complicated math system, we propose going from IPC calculations to a clear, simple, overall percentage of direct and indirect time. So, we propose that 75% of a therapist’s time should be in front of patients, with the other 25% (including our 18% IPC proposal) for non-patient facing time. This would mean you would have 10 hours of indirect patient time every week, up from the current level of 9 hours. We need to remain mindful of the fact that for every additional hour a week not seeing patients across all our therapists, we could lose over 1300 appointments each week for our patients. We have also previously shared that we will have a framework to provide practice support that will dramatically free up therapists’ time by having administrative and clinical professionals, including psychiatric techs, take care of administrative-related tasks and other work that does not require a licensed therapist. This means freeing up more of your indirect time – we estimate this could be as much as 30-45 minutes per day.
2) We understand that the acuity and mix of patient needs in a therapist’s panel can cause challenges, sometimes significant ones. The union is proposing a system of addressing acuity and panel size through a change in the ratio of new and returning patients. We think we have the opportunity to work together to do better than that. As you know, there is currently no accepted model to address the measurement of acuity and its relationship to panel size. We propose immediately addressing this with a new, joint, 18-month Model of Care collaboration between therapists and KP leaders to research and develop an evidence-based model for mental health acuity assessments and assignments for KP, which could serve as a model for other organizations around the country.
3) We’ve heard from our child and adolescent therapists they need a better way to account for the time they spend with parents and families. We proposed that this be done by treating Child/Adolescent providers’ time for these visits as a booked appointment.
4) A critical issue for the bargaining team – and we’re sure for you – is the definition of a new patient. So, we’ve offered a new counterproposal that solidifies the definition of a new patient for the term of the labor agreement and removes a previous restriction that allowed KP to revert back to a previous definition.
5) Recall that we have already agreed to across-the-board wage increases and other economic improvements in the contract. In yesterday’s discussion, we talked about additional economic considerations.
a) We have heard and agreed with the union’s suggestion to consider outcomes-based tools in future incentive bonus structure, as is done in Southern California.
b) We agree with NUHW’s proposal that would increase the differential for non-benefitted employees from $1 per hour to 10% as part of an effort to increase the number of per diem therapists to help with our work.
c) After reviewing the union’s proposal to change pay for exempt employees who work on holidays, we have agreed to offer additional holiday pay for both hourly and exempt employees.
We came yesterday with a clear desire to address concerns, provide real solutions, and reach agreement. The proposals we made yesterday were the right thing to do, because we want to reach an agreement and end this strike. We were disappointed that the union came with no new proposals, offered no counterproposals, and refused to make any progress.
On a final note, the union is very active in attempting to create external pressure for KP to simply accept their demands. We appreciate the voices of stakeholders, but we are ultimately accountable for meeting the needs of our members and employees and working with labor in a productive way to bring this to closure. We sincerely believe that we have stepped up. We are at a place where we need your voice, and your commitment to our patients, to bring this to closure.