Report 2009-107.2 Recommendations and Responses in 2012-041

Report 2009-107.2: California Department of Corrections and Rehabilitation: Inmates Sentenced Under the Three Strikes Law and a Small Number of Inmates Receiving Specialty Health Care Represent Significant Costs

Department Number of Years Reported As Not Fully Implemented Total Recommendations to Department Not Implemented After One Year Not Implemented as of Most Recent Response
California Department of Corrections and Rehabilitation 2 6 5 4
California Prison Health Care Services 2 5 3 3

Recommendation To: Correctional Health Care Services, California

To determine whether the additional expansion of telemedicine is cost-effective within the California correctional system, Prison Health Care Services should identify and collect the data it needs to estimate the savings of additional telemedicine through an analysis of the cost of specialty care visits currently provided outside of the institution that could be replaced with telemedicine.

Response

In the past, Telemedicine Services did not secure claims data or have technical expertise to perform cost-center analyses. Telemedicine Services is now accessing all specialty claims data on an ongoing basis. Telemedicine Services is developing a methodology to accurately identify specialty referrals seen off-site in providers' facilities that could appropriately be seen via telemedicine (e.g., eligible examination/consultation Current Procedural Terminology (CPT) codes without accompanying procedural CPTs for the same patient, provider, date and time). In addition, Telemedicine Services is investigating ways to measure cost elements for telemedicine that are difficult to estimate/quantify such as the value of increased community safety, improved patient access to specialty care, access-to-care litigation costs avoided, and others.

The future implementation of an enterprise electronic medical record system creates the opportunity to follow patient-inmates receiving telemedicine care to review health outcomes and subsequent utilization as compared with similar patient-inmates receiving care that is not delivered through telemedicine, to refine comparative cost analyses.

Telemedicine Services has gained access to specialties claims data and is starting analyses relating those data to telemedicine scheduling system data. Telemedicine Services is investigating cost analyses methods used by other government and non-governmental agencies that may be usable in trying to quantify some of these intangible variables to inform a cost comparison model. Systems to collect these sorts of data in a standardized way have not been identified or implemented to date. Once improved data and staff expertise to perform analyses are developed, more detailed comparisons will be done on an ongoing basis to inform policy decisions.

The insufficiency of cost center data and inadequate cost analysis methodology and technical analysis expertise have delayed implementing this recommendation. CCHCS is trying to address both of these deficiencies in order to improve efficacy and quality assessments for telemedicine services to inform policy decisions.

  • California State Auditor's Assessment of Status: Not Fully Implemented
  • Completion Date: January 2013
  • Response Date: September 2012

Recommendation To: Correctional Health Care Services, California

To determine whether the additional expansion of telemedicine is cost-effective within the California correctional system, Prison Health Care Services should further analyze the cost-effectiveness of telemedicine through a more robust estimate of savings, including considering factors such as the percent of telemedicine consultations that required subsequent in-person visits because the issue could not be addressed through telemedicine.

Response

Please see response to 2009-107.1 Recommendation 2. Although some telemedicine cost center information (e.g., claims payments; equipment costs, service, and depreciation; IT connectivity costs) is available, other cost elements such as the value of increased community safety, improved patient access to specialty care, access-to-care litigation costs avoided, and others are difficult to estimate/quantify.

The future implementation of an enterprise electronic medical record system creates the opportunity to follow patient-inmates receiving telemedicine specialty and primary care to review health outcomes and subsequent utilization as compared with similar patient-inmates receiving specialty and primary care that is not delivered through telemedicine, to refine comparative cost analyses.

Telemedicine Services is investigating cost analyses methods used by other government and non-governmental agencies that may be usable in trying to quantify some of these intangible variables to inform a cost comparison model. Systems to collect these sorts of data in a standardized way have not been identified or implemented to date. Once cost center modeling, improved data, and staff expertise to perform analyses are developed, more detailed comparisons will be done on an ongoing basis to inform policy decisions.

The insufficiency of cost center data and inadequate cost analysis methodology and technical analysis expertise have delayed implementing this recommendation. CCHCS is trying to address both of these deficiencies in order to improve efficacy and quality assessments for telemedicine services to inform policy decisions.

  • California State Auditor's Assessment of Status: Not Fully Implemented
  • Completion Date: January 2013
  • Response Date: September 2012

Recommendation To: Correctional Health Care Services, California

To ensure that the total amount of overtime worked by custody staff does not unduly reduce their effectiveness and result in unsafe operations, Prison Health Care Services should monitor overtime closely. If its efforts to reduce the number of referrals of inmates to outside specialty services do not reduce the amount of overtime worked by custody staff for the purpose of medical guarding and transportation, Prison Health Care Services should explore other methods of reducing the total amount of overtime worked by custody staff.

Response

Implementation of this recommendation is contingent upon transition of Health Care Access Units (HCAU) to CDCR and completion of assessment of utilization. The plan for implementing this recommendation is as follows. In order to gain efficiencies in utilization while reducing medical guarding and transportation overtime, CDCR has completed the reassessment and finalization of a policy specific to staffing efficiencies. Given this update in policy, CCHCS in coordination with CDCR, plans to assess utilization of Medical Guarding and Transportation resources this fiscal year with a view towards efficient utilization and reduction of overtime, while exploring options for reducing the total amount of overtime worked by custody staff if deemed necessary. The reason CCHCS has not implemented this recommendation is as follows. The assessment was pending on the completion of the CDCR policy specific to staffing efficiency, prior to assessing the medical guarding and transportation utilization to reduce overtime.

  • California State Auditor's Assessment of Status: Not Fully Implemented
  • Completion Date: Unknown
  • Response Date: September 2012

Recommendation To: Corrections and Rehabilitation, Department of

To address the erroneous sentencing information and inappropriately assigned convictions in its data system, Corrections should complete its cleanup of data that will be transferred into the new system, ensuring that this review includes a detailed evaluation of convictions that have been assigned outdated sentencing information as well as deleting erroneous sentencing information, before it begins using its new data system.

Response

The EIS/SOMS team will continue to perform data analysis and assist in correcting data issues identified and approved by the Case Records Unit. Several clean-up activities are in process including, a complete review and update of the Offense Edit Table, removal of offense codes with no inmate data and clean up of codes that we placed in comment fields and now are available in data fields. The Sentence Calculation module of the SOMS project is currently scheduled for deployment in the Spring of 2013.

  • California State Auditor's Assessment of Status: Not Fully Implemented
  • Completion Date: Spring 2013
  • Response Date: September 2012

Recommendation To: Corrections and Rehabilitation, Department of

To address the erroneous sentencing information and inappropriately assigned convictions in its data system, Corrections should create a schedule for regular checks of the accuracy of existing sentencing information, as well as the accuracy with which sentencing information has been assigned to convictions.

Response

The recommendation was fully implemented in May 2011. A copy of our revised “OBIS Offense Edit Table Update Procedures were provided as an attachment to BSA in (Month/Year) and can be provided again upon request. The task of updating the offenses in our OBIS system was reassigned from the Legal Processing Unit Case Records Manager to a Case Records Administrator during that time. The system is updated at minimum twice a year. In addition, Case Records receives, on a regular basis, the Chaptered Legislative Report from CDCR's Office of Legal Affairs. This report is a tool to assist us in identifying new or amended statues that require an update to our OBIS Offense Edit Table

  • California State Auditor's Assessment of Status: Not Fully Implemented
  • Response Date: September 2012

Recommendation To: Corrections and Rehabilitation, Department of

To ensure that custody staffing meets institutional needs, and to provide staff the opportunity to use the amount of leave that they earn in the future, Corrections should update its staffing formulas to accurately represent each of the factors for which custody staff are unavailable to work, such as vacation or sick leave. Corrections should attend to this project before implementing its new business information system to ensure the updated formulas can be used as soon as practical. In addition, Corrections should create a policy for regularly scheduled reviews of the data used in the staffing formulas and update the formulas as necessary.

Response

Effective July 23, 2012, the Division of Adult Institutions of the California Department of Corrections (CDCR) implemented the Blueprint, The Future of California Corrections. This implementation established uniform, standardized staffing at the institutions that will enable the department to operate more efficiently and safely. This model replaced the previous 6 to1 ratio-driven staffing model. This implementation is considered complete, with some minor necessary adjustments at specific institutions based on further reviews.

CDCR also obtained additional relief funding based on accruals to assist in covering the significant scheduled and unscheduled absences to include Vacation, Holiday, Sick, Family Leave Act (FMLA), Jury Duty, Bereavement, Military leaves, etc. Accruals and usage will be reviewed and evaluated for any necessary relief updates.

  • California State Auditor's Assessment of Status: Fully Implemented
  • Completion Date: September 2012
  • Response Date: September 2012

Recommendation To: Corrections and Rehabilitation, Department of

To better communicate to policy makers the annual cost of incarceration, and to provide a more accurate estimate of expenditures associated with changes in the large leave balances of custody staff—many of whom require relief coverage when they are absent—Corrections should provide a calculation of the annual increase or decrease in its liability for the leave balances of custody staff to better explain the cause of changes in expenditures to the relevant legislative policy and fiscal committees.

Response

Through the Management Information Retrieval System (MIRS), the CDCR has the ability to calculate accumulated leave balances of custody staff. The department is currently producing monthly reports of current leave balances. However, projecting how or when leave balances are used or compensated is very challenging.

  • California State Auditor's Assessment of Status: Not Fully Implemented
  • Response Date: September 2012

Recommendation To: Corrections and Rehabilitation, Department of

To better communicate to policy makers the annual cost of incarceration, and to provide a more accurate estimate of expenditures associated with changes in the large leave balances of custody staff—many of whom require relief coverage when they are absent—Corrections should provide an estimate of the annual cost of leave balances likely to be paid for retiring custody staff to the relevant legislative policy and fiscal committees.

Response

Given the amount of change associated with Public Safety Realignment and the CDCR Blueprint, we are not able to estimate with any real precision the annual cost of leave balances likely to be paid for retiring custody staff. There are simply too many factors currently in flux to reasonably estimate the number of potential lump sum payouts relative to custody staff.

  • California State Auditor's Assessment of Status: Will Not Implement
  • Response Date: September 2012

Current Status of Recommendations

All Recommendations in 2012-041