The dirty truth about receipts


Guest blogger Joel Sigler is senior manager for Kaiser Permanente National Environmental, Health & Safety

The Center for Total Health has a self- service health assessment machine that provides visitors a printed receipt indicating their weight and body mass index (BMI). Recently, a visitor asked a great question about whether the receipt paper is coated with Bisphenol A (BPA).

BPA is an endocrine disrupter that mimics estrogen in the body. Studies have found that BPA exposure is potentially linked to a number of health concerns including breast cancer, diabetes, heart disease, sexual dysfunction, and obesity (kind of ironic if present in a machine that tells you your BMI). There are many sources of BPA exposure, it is found in many products including food can linings and plastic bottles. Unfortunately, receipt paper is one of the many items that can also potentially contain BPA. Receipt paper is of particular concern because it can easily be absorbed into the body when the receipt is handled. Absorption of BPA is sped up even more if hand sanitizer has been applied before handling a receipt.

We promptly called the manufacturer of the self-service health assessment machine to find out if they knew if the receipt paper contained BPA. The good news is that the manufacturer was very responsive. Within a day they had contacted their receipt paper supplier and verified that it was “BPA free.” They even provided KP a letter from the receipt paper supplier. Kaiser Permanente is continuing to communicate with them to find out about any BPA alternatives that they may be using. Bisphenol S (BPS) and Bisphenol F (BPF) are chemicals commonly used as substitutes for BPA. They are less studied than BPA and haven’t gotten the same attention. But because BPS and BPF are similar in chemical structure to BPA, experts have concern that they could represent similar health risks.

It is important to recognize that product manufacturers aren’t always this responsive. It often takes a lot of effort to get an answer to whether a product contains chemicals of concern, either because they don’t know, or because they don’t think it is important enough to find out. In this case, the question had gotten to the President of the manufacturing company and apparently he had gotten similar questions from other customers. So just asking the question helps drive action. It is unfortunate though that when it comes to chemicals of concern, the onus is on the customer/consumer (and not on manufacturers) to drive efforts to find out if a product is “safe.” Kaiser Permanente puts significant effort into identifying and eliminating chemicals of concern like BPA in the products that the organization purchases and uses.

The Environmental Working Group provides the following recommendations to reduce exposure to BPA from receipt paper:

-Minimize receipt collection by declining receipts at gas pumps, ATMs and other machines when possible.

-Store receipts separately in an envelope in a wallet or purse.

-Never give a child a receipt to hold or play with.

-After handling a receipt, wash hands before preparing and eating food (a universally recommended practice even for those who have not handled receipts).

-Do not use alcohol-based hand cleaners after handling receipts.

-Take advantage of store services that email or archive paperless purchase records.

-Do not recycle receipts and other thermal paper. BPA residues from receipts will contaminate recycled paper.

More information on all of Kaiser Permanente’s environmental stewardship program can be found at

Physician Leadership in the Movement Toward Accountable Care


Blog by Elizabeth Keating
Senior Project Manager, Council of Accountable Physician Practices

“It will not be possible to move the country toward accountable, value-based care without strong physician leadership at all levels of the organization.”

This statement was made by Robert Pearl, M.D., CEO of the Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. Dr. Pearl recently moderated a panel at the CAPG Colloquium held in Washington, DC, on September 29, 2016.

The panel, “Physician Leadership in the Movement Toward Accountable Care,” was hosted by the Council of Accountable Physician Practices (CAPP) and featured CAPP leaders discussing best practices in recruiting, training and developing physician leaders.


“Healthcare systems should view physician leadership as a capital investment for the future with huge ROI,” said Dr. Pearl, who also serves as the chairman of the board of CAPP. “The CAPP medical groups are committed to sharing their considerable experience to help all provider organizations face the challenges ahead.”

Over the course of the discussion, the panel touched on key aspects of their physician leadership development approaches. All agreed that leadership development starts at the moment of recruitment into the organization.

“Every physician is a leader. We start with that assumption,” said Marc Klau, MD, Assistant Medical Director of SCPMG. “Take every physician on as a leader and then expand their capability, because you never know when you will need them.

Dr. Klau described how SCPMG’s expansive geography allows for unique leadership development opportunities because programs begin at the medical center level. He explained that each medical center allows emerging physician leaders to build programs that work toward the Triple Aim goal. He stressed that this display of clinical excellence is critical to growing as a physician leader, because it builds trust among peers.

Dr. Klau also discussed how SCPMG’s leadership programs are geared toward training leaders in Permanente culture, not just administrative practices.

“It’s not about learning to log in to our electronic health record,” he said. “It’s about anchoring people in our history, quality expectations and developing communication skills.”

The panelists overwhelmingly agreed that physician leaders must possess emotional intelligence to be effective.

“The best leaders are going to be visionary but anchored in reality,” said Dr. Klau. “People who have a passion for doing something are the people who will move and change the world.”

The panelists agreed that physicians who are aspiring to lead their health systems or who think they might want to take on a more comprehensive role should start small. Emerging physician leaders could join clinical improvement committees or the first stage of a leadership program to determine if the track is right for them.

Health Care Topics Candidates Ought to Discuss


Dr. Robert Pearl, MD, Chairman and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group, was recently interviewed by Bloomberg BNA’s Alex Ruoff about a primer on health care issues produced by the Council of Accountable Physician Practices (CAPP), which Dr. Pearl chairs. The primer was written for political candidates at all levels of elected office, and encouraged candidates to think beyond the success or failure of the Affordable Care Act (ACA) when considering health care policy.

The primer identified three issues that all elected officials should learn about to make the best policy decisions for their constituents. These include value-based reimbursement for doctors and hospitals, robust and coordinated use of health information technology, and improved quality measurement and reporting.

Dr. Pearl said in the article that neither Democratic candidate Hillary Clinton or Republican Donald Trump has spent much time discussing these topics during their speeches or in their official platforms.

“Both candidates have commented on the exchanges and the price of drugs, but there hasn’t been a discussion about the big changes needed in health care,” he said.

According to the article, although Medicare is already moving doctors into value-based payment systems, CAPP wants the candidates to commit to accelerating the pace of change and push for global capitation in which doctors are paid a flat rate based on the size and health of their patient population instead of for each service they provide.

The article goes on to assert that this shift could help to reduce the annual growth in Medicare spending, which according to the 2016 Medicare Trustees Report, is expected to increase as a portion of overall gross domestic product from its current level of 3.6 percent to 5.6 percent by 2040.

“When you look at what we’re spending on health care, it’s unclear why we’re not talking about changing payments,” Pearl said.


Source: Ruoff, Alex. Why Hasn’t Clinton or Trump Talked About Health IT? Bloomberg BNA, 31 August 2016.

Can you see me now? Video Visits at Kaiser Permanente


Dennis Truong, MD, is an emergency medicine specialist and the telemedicine director for the Mid-Atlantic Permanente Medical Group.

Smart phones and tablets are everywhere. Adoption of these devices now largely spans age, income, race and ethnicity. Americans, of all stripes, are emailing, tweeting, posting, banking, gaming, navigating, checking weather and so much more almost nonstop. Yet when it comes to using those nearly ubiquitous devices, only 2 percent report having access to video visits with their doctor.

In stark contrast, almost 9 in 10 family physicians believe telehealth – the suite of technologies and tactics to deliver virtual medical, health, and education services – is a way to increase access to care. Putting two and two together, that means far more than 2 percent of people should have access to video visits – a core component of telehealth.

Dr. Truong conducts a simulated video visit with a member.

Dr. Truong conducts a simulated video visit.

Why this disconnect? Telehealth regulatory policy for one. From the patchwork of state by state rules to privacy protections to reimbursement rules. Doctors (and some patients) also worry that telehealth has limited diagnostic and treatment value relative to face-to-face care and will adversely impact the day-to-day practice of an office. Not only does it interfere with the routine of quickly moving from one prepped patient to the next, it changes how you chart, plan for space in your office, bill and collect, and so much more.

The regulatory and payment framework must evolve, and technological advances in remote capabilities can help validate telehealth as a reliable solution. But it is easy to overlook the fact that none of it matters if doctors don’t want to change their norms. And, that adoption will fail if the consumer satisfaction barometer is not met as a result of a fragmented experience. At the Mid-Atlantic Permanente Medical Group (MAPMG), and all the Permanente groups of Kaiser Permanente, video visits have become a key part of our clinical offering. Making it work has been a case study in careful planning rather than chasing a “sexy” concept without judiciously working out all the details.

Since launching video visits three years ago, we carefully worked through the legal and regulatory steps. We put in the necessary equipment, trained every provider, collaboratively chose the specified set of clinical chief complaints that should be eligible for video, and slowly built video visit appointments into the schedule that gave physicians dedicated time for the care. The “competition” isn’t other providers. It is the doctor’s frame of reference. Is this as easy as when the patient is sitting in the exam room ready and waiting with forms completed, vitals collected, and nursing tasks done?

As the industry saw more platforms and pure-play video offerings emerge, we worked to stay true to a principle that says video care shouldn’t be fragmented from the normal care patients receive. Patients do not want to repeat themselves, pay for redundant tests, or fail to get a diagnosis because the doctor doesn’t have enough information to definitively make one. Nor do they want to have their “regular” doctor fail to provide care in consideration of what is known from any previous video encounters.

We purposefully integrated our solution into the same integrated electronic medical record we use for every face-to-face visit, telephone, or email visit. All the information is there to make the right clinical call. The ordering and referring process is identical (and can be done for the patient by the provider). The activity is visible to the patient’s regular provider(s).

When practiced right, it becomes as clear as the face on that smart phone screen that video visits are a powerful tool to improve access and patient satisfaction. The medical community needs to invest in making it not simply available to more patients, but making it available in a way that allows them to integrate that care with their overall primary and specialty care.

Why You Should Reflect on Your Health This September


When was the last time you reflected on your total health journey? From your childhood experiences to your future in old age, what phase of life are you in and how do you envision your health moving forward?

At the Center for Total Health, we believe that having a dialogue about your health is critical, which is why we’re encouraged by the following health-related observances in September and the wisdom they provide us. Along with each observance, we’ve provided questions for reflection and would love to hear your thoughts in the comments section below.

Fruits and Veggies—More Matters and Childhood Obesity

Whether it’s through physical movement or eating more fruits and vegetables, teaching children and adults the importance of leading a healthy lifestyle has the power to end childhood obesity and create a positive ripple effect from the local to the national level.

We observe Fruits and Veggies – More Matters Month and Childhood Obesity Month in September to spread awareness about how people can live healthier lives. In alignment with this mission, CTH showcases work being done across the country to make this goal a reality. Through our immersive exhibits we display change in action —like the implementation of the “Let’s Move! Active Schools” campaign in Miami, featured on our Health Discovery Wall. Our interactive map highlights the locations in Miami that have increased physical activity in schools, showcasing how individual or local change can make a difference.

Health Reflection: What foods and exercise currently support your total health – physically, mentally and emotionally?

Healthy Aging and World Alzheimer’s

Life can be challenging for Leo and Rosemary – two elderly personas featured at CTH. Leo shows signs of cognitive impairment and Rosemary, his wife and caregiver, has to ensure that he takes his medication and goes to his appointments, while also having to care for her own emotional health. With Rosemary’s help, Leo is aging in place, able to live in the comfort of his own home and community.

The month of September provides us the opportunity to address both the challenges as well as the positive aspects of growing older by observing both World Alzheimer’s Month and Healthy Aging Month. These observances touch on a delicate, yet immensely important phase of life – how we age and the responsibilities that come with growing older. We’re reminded to be more intentional with our actions and how they can affect our health later in life.

Health Reflection: In our busy, every day lives how often do we pause to think about how we’d like to age? What are we doing (or not doing) now that could help us age in a stronger, healthier way?

Regardless of age, we can all benefit from discussing what these observances mean for us, our family members and our community.

What’s one way to start prioritizing your health and the health of your friends, family or colleagues? By visiting and hosting a meeting or event at the Center for Total Health. You can find more information here.

I Want To Be The Next Summer Intern!


This summer, I interned at the Center for Total Health through the Kaiser Permanente Mid-Atlantic Summer Internship Program. I am currently a senior at James Madison University majoring in Health Science and with minor in Health Communications.  After graduation in May 2017, I plan on attending graduate school to obtain a Master’s in Public Health.  My future career goal is to educate disadvantaged populations in the United States about various health topics to help eliminate current health disparities in our country.  The Kaiser Permanente Mid-Atlantic Summer Internship Program has tremendously prepared me for success in the future and in an industry-leading healthcare company.

On July 22, 2016, I provided tours to the youth participants of the 2016 DC Summer Youth Employment Program. [Photo By: O Grant]

On July 22, 2016, I provided tours to the youth participants of the 2016 DC Summer Youth Employment Program.
[Photo By: O Grant]

I was given various projects this summer that have honed my skills and knowledge of health.  One project I was given was to provide informative tours of the Center for Total Health to guests.  The tour consists of content exploring topics including Kaiser Permanente’s history, different aspects of total health, and advancements in telemedicine.  Not only have my presentation skills improved, I am now equipped with conversation starters to engage in meaningful dialogues with professionals in health related fields. Another project I was given, also my personal favorite, was the honor to design a display showcasing African-American history throughout Kaiser Permanente.  It will be displayed at a VIP luncheon hosted for top employers and partners of Kaiser Permanente Foundation Health Plan and Hospitals, held in September.  Kaiser Permanente Foundation Health Plan and Hospitals demonstrates and embraces diversity in the workplace, therefore the company is a proud financial contributor to the new African-American History Smithsonian in Washington, DC.  To complete the project, I researched the content, contacted Kaiser Permanente diversity committees, and wrote a creative brief for the display.  This project allowed me to take the initiative and utilize the leadership skills I have learned throughout college.

As a participant of the Kaiser Permanente Mid-Atlantic Summer Internship Program, I also attended weekly professional development forums organized by current Kaiser Permanente employees. The forums were interactive, informative and a key to my professional growth this summer. We discussed resume writing, networking skills, interview tips, professional dress and much more.  In addition to the professional development forums, we attended a Nationals’ baseball game in July and spent an afternoon volunteering with SOME (So Others Might Eat), a community based organization in DC to help poor and homeless residents.

The ten-week program has placed me a step ahead of my peers entering the workforce after graduation in May.  At the conclusion of the program, I have taken away valuable items to place into a portfolio, strong communication skills, confidence in my work ability and strengthened my soft skills in professional office setting.  I am very thankful for this opportunity and appreciate the Center for Total staff for welcoming me on board this summer.  In the future, I would love to work for Kaiser Permanente after completing my education.

If you are interested in being an undergrad intern through the Kaiser Permanente Mid-Atlantic Summer Internship Program next summer, please visit to learn more!

This Week in Total Health: Sweating the Details


Another busy week has drawn to a close at the Center for Total Health.


Brendan O’Grady, WELL AP, explains initial readings to Kathy Gerwig, vice president of Employee Safety, Health and Wellness, and environmental stewardship officer and Carol Corr, AIA, LEED GA, EDAC, Design Program Manager, National Planning and Design, National Facilities Services

On Monday and Tuesday, the center welcomed Delos (@DelosLiving)for the first step of our WELL Building Standard Certification.  Ted Eytan (@tedeytan) wrote an in-depth summary of the experience.


Kathy Porter

Our team was thrilled to meet Kathy Porter, who is the face of the original Alexandra persona used by our design teams, and Cathryn Burby from the American Cancer Society this week.


Cathryn Burby, Senior Director, Community Engagement at the American Cancer Society

August brings heat and humidity to our nation’s capital, making it a notoriously quiet month across the city. Our team is taking advantage of this time to get our ducks in a row for a busy fall. If you’d like to come the Center for Total Health for a tour or event, please let us know!

How do you measure a WELL building? Our Preliminary Audit


KPCTH -2016.08.09 Delos Living Preliminary Audit 01027

We’ve completed our preliminary audit on the way to full WELL (@WELLCertified) certification.

The WELL Building Standard® is an evidence-based system for measuring, certifying and monitoring the performance of building features that impact health and well-being.

The audit includes testing of air, sound, light, and water, performed by an objective third party, in this case Delos (@DelosLiving). As most things I have encountered as a physician in the total health space, I learned that there is much more in our environments that can be measured and managed that we are taught about in medical school.

Fortunately though, there are fellow professionals in health, who are working along side us to make all of our work more impactful. You can see from the photos that the work involves applied science and the judgement to understand what is the best environment for the task. Many of the improvements to be made are not costly, all that’s needed is to know what’s needed.

The Preliminary Audit is a stage in the process to full WELL Building Certification. The Center for Total Health is the perfect place, on many levels, to go through the process, with many experts here to help us!

KPCTH -2016.08.09 Delos Living Preliminary Audit 01044

Left to Right: Brendan O’Grady, WELL AP, Delos; Madeline Evans, WELL AP, LEED Green Associate, Delos; Kathy Gerwig, vice president of Employee Safety, Health and Wellness, and Environmental Stewardship Officer at Kaiser Permanente, and Carol Corr, AIA, LEED GA, EDAC, design program manager, National Planning and Design, National Facilities Services, Kaiser Permanente

Mayor, What Will You Do To Improve My Health?


On July 19,  Smart Growth America (@SmartGrowthUSA) hosted its annual Local Leaders Council (@SGALocalLeaders),meeting at the Center for Total Health.  Attendees included influential leaders from various communities around the nation including mayors, city council members, county officials, city managers and agency heads. The event allowed these influential leaders to incorporate total health into their community and the content at the center provided a perfect backdrop.

Geoffrey Anderson, president of Smart Growth America, started off the event with a warm welcome. Parris Glendening, former governor of Maryland, and Rick Danner, mayor of Greer, South Carolina, both spoke about the excellent solutions Smart Growth America has developed.  The keynote speaker, Amy Liu (@amy_liuw), the vice president and director of Metropolitan Policy Program at Brookings, touched on growth and planning during her talk, titled  “Economic Development for All”.  Through her work in urban and social planning in challenged economic communities in Philadelphia, she has learned numerous solutions to improving residents overall quality of life by improving the economy in a neighborhood.  As Amy Liu stated, “Better jobs, access to grocery stores and community programs for youth will improve the health of disadvantaged residents.”  It was a pleasure hearing Amy Liu’s solutions and ideas for creating healthier neighborhoods, mainly in metropolitan areas such as Washington, DC, and its surroundings.

Throughout the day, Smart Growth America rotated through different breakout sessions and seminars for guests to discuss and brainstorm solutions.  One such seminar was Creative Placemaking Strategies, giving community leaders tools for success. Another was Revitalization without Displacement, which encouraged leaders to  brainstorm strategies to improve the economy in their community.  Guests also networked with one another over a catered lunch and were invited on a 20 minute guided walking tour with Ted Eytan, MD, (@tedeytan). The event ended with a closing plenary discussion by Peg Moertl, the senior vice president of Community Development Banking of PNC Bank, Sarah Goldfarb, director of Policy and Research of Jersey City Redevelopment Agency, Ken Bowers, planning director in Raleigh, North Carolina, and Dean Gordon, director of Business Growth in Birmingham, Alabama.

Once again, the center is glad Smart Growth America held this inspirational annual event at the Kaiser Permanente Center for Total Health.  If you would like to host an event at our center, please visit our website.

Week in Total Health: All About the Future


The week of July 18 was a busy one for the Center for Total Health, with six events in five days, including three for 100 people each.

The week started off with the Smart Growth America Local Leaders Summit (@SGALocalLeaders), a gathering of local officials from cities and towns across the country. The day covered a number of strategies for building health into municipalities of all sizes, from small, rural towns to large, urban cities. True to form, the attendees enjoyed a walk through the neighborhood, including a view of our complete street from the bridge above.

SGA Walk

A health organization team retreat and a school nutrition non-profit training kept us on our toes on Wednesday.

The end of the week was filled by young residents of Washington, DC, participating in the city’s Summer Youth Employment Program (@MBSYEP). Over two days, nearly 200 participants came to the CTH to participate in health workshops led by Kaiser Permanente’s  (@KPMidAtlantic) Health Education team on topics ranging from quality ratings to relaxation techniques.

Deputy Mayor for Greater Economic Opportunity Courtney R. Snowden (@DMGEOSnowden) spoke to the students, reminding them that every minute of every day is an opportunity to work toward their goals. It was great to spend two days with the future of this city.

Deputy Mayor for Greater Economic Opportunity Courtney R. Snowden addresses SYEP participants.

Deputy Mayor Snowden addresses SYEP participants