Report 2009-107.1 Recommendations and Responses in 2013-041

Report 2009-107.1: California Department of Corrections and Rehabilitation: It Fails to Track and Use Data That Would Allow It to More Effectively Monitor and Manage Its Operations

Department Number of Years Reported As Not Fully Implemented Total Recommendations to Department Not Implemented After One Year Not Implemented as of 2012-041 Response Not Implemented as of Most Recent Response
California Correctional Health Care Services 4 5 5 3 1
California Department of Corrections and Rehabilitation 4 9 8 6 4

Recommendation To: Correctional Health Care Services, California

To minimize costs through the use of telemedicine, Health Care Services should review the effectiveness of telemedicine consultations to better understand how to use telemedicine.

Response

This recommendation has been fully implemented. The mission of Telemedicine Services, as outlined in the 2008 "Federal Receiver's Turnaround Plan of Action," is to improve access to care for patient-inmates. However, telemedicine also provides cost-effective care with reduced guarding and transportation costs. The implementation and expansion of telemedicine, has led to improved access to medically necessary specialty services statewide. OIG results indicate that court-ordered timeframes for patient-inmate specialty referrals increased from a 71% compliance rate in Round 1 (2008) to 94% compliance rate in Round 3 (2012) (Attachment 1).

Utilization of telemedicine continues to increase as the inmate population decreases (Attachment 2), indicating acceptance and effectiveness of the modality for medical consultations. Telemedicine-appropriate referrals seen via telemedicine have also increased (44% -2011, 53% -2012 and 59% -2013; Attachments 3-5). Institutional utilization management follows a standardized process with community-standard clinical guidelines to approve referrals (Attachment 6) and determine appropriateness for telemedicine before the consultations. In addition, Telemedicine conducted the following expenditures analysis on the per-encounter cost basis (Attachment A). The analysis indicates that while the annual operational costs of Telemedicine have been steadily contained, we have been improving access to care with the same level of resources. The average estimated per telemedicine encounter savings have been steadily maintained at around $226 per encounter for the last three fiscal years.

Recommendation To: Correctional Health Care Services, California

To minimize costs through the use of telemedicine, Health Care Services should perform a more comprehensive comparison between the cost of using telemedicine and the cost of traditional consultations, beyond the guarding and transportation costs, so that it can make informed decisions regarding the cost effectiveness of using telemedicine.

Response

CCHCS has fully implemented this recommendation. CCHCS has analyzed the costs between telemedicine and traditional consultations and found that telemedicine appointments are billed at the same Medicare rates as in-person visits; therefore, do not reflect cost savings over traditional specialty service encounters beyond the estimated $7.2 million in guarding and transportation costs avoided (Attachment 7 & 8) and potential litigation and public safety costs avoided.

Cost savings is not the only criteria for deciding between a telemedicine consult and traditional consultations as the primary goal of telemedicine is to provide timely access to care. Beyond cost savings and avoidance, Telemedicine Services provide increased access to medically necessary care, particularly in those remote locations where local medical facilities do not provide all the needed services to support the patient-inmate population. Additionally, the use of telemedicine reduces transport of inmates into communities for healthcare through remote management, increasing public safety. The use of telemedicine services is primarily based on efficacy and efficiency of patient care, as well as the needs of each individual institution, rather than cost effectiveness and those factors do not lend themselves to tangible measurement. Nonetheless, with program expenditures totaling $3 million in FY 2011/2012 and $3.3 million in FY 2012/2013 (Attachment 9), guarding and transportation estimated cost avoidance represents a net gain for the CCHCS Telemedicine Program.

Recommendation To: Correctional Health Care Services, California

To increase the use of the telemedicine system, Health Care Services should continue to implement the recommendations that it has adopted from the consultant's review of telemedicine capabilities.

Response

Details on the implementation plan and status are summarized in the attached table (Attachments 10-13)

Recommendation To: Corrections and Rehabilitation, Department of

To help it assess the effect of policy changes and manage operations in a cost-effective manner, Corrections should do the following:
• Ensure that its new data system will address its current lack of data available for statewide analysis, specifically data related to identifying the custody staffing cost by inmate characteristics such as security level, age, and custody designation.
• If implementation of its new system continues to be delayed, or if Corrections determines that the new system will not effectively replace the current assignment and scheduling systems used by the institutions, it should improve its existing data related to custody staffing levels and use the data to identify the related costs of various inmate populations.

Response

Updated BIS Status - The Time & Shift module was successfully piloted at Folsom State Prison and is currently live in 14 institutions. It is being implemented in three institutions per month with all institutions live at the end of May 2014. The Training and Events functionality is undergoing revisions to the course catalog and how it will be available in the system. This functionality is scheduled for pilot to begin in April 2014.

Updated SOMS Status - SOMS Classification and Programs module is currently scheduled for deployment in March 2014. Going forward, this data combined with the BIS Time and Shift data will provide the base data necessary to perform analytics concerning staffing costs by inmate level. EIS has expanded the CDCR stakeholders they are working with to include of The Division of Rehabilitative Programming (DRP) and other business areas of CDCR. The basic infrastructure for the data analytic function to conduct correlative analysis of the data contained within seven data sources (BIS, SOMS, COMPAS, CSRA, CalParole EdCATS, ICATS), is complete and initial reports and capabilities are being tested. The priority and business value of such reports is also being assessed to ensure the highest value is worked on first. The specific ability to determine and identify custody staffing cost by inmate characteristics such as security level, age, or custody designation, is reliant on the BIS and SOMS deployments.

Recommendation To: Corrections and Rehabilitation, Department of

To ensure that the State is maximizing the use of funds spent on incarcerating inmates, Corrections should communicate to the Department of Personnel Administration—which is responsible for negotiating labor agreements with employee bargaining units—the cost of allowing any type of leave to be counted as time worked for the purpose of computing overtime compensation.

Response

CDCR has partnered with the Department of Personnel Administration adding GC Section 19844.1 which changed to State's overtime provisions for bargaining units RO1, RO2, RO4, RO6, RO7, RO9, R10, R11, R12, R13, R14, R15, R17, R18, R19, R20, and R21, effective with the March 2009 pay period. The new language states "for the purpose of computing the number of hours worked, time when an employee is excused from work because of holidays, sick leave, vacation, annual leave, compensating time off, or any other leave shall not be considered as time worked by the employee for the purpose of computing cash or compensating time off for overtime." DPA issued Personnel Management Liaisons Memorandum 2009-014 advising of the change. CDCR implemented the change accordingly. GC Section 19844.1 does not include provision for bargaining units RO5, RO8, and R16; however, RO5 and RO8 are not utilized by the CDCR. R16 is utilized and CDCR shall work toward including the language of GC Section 19844.1 in their successor memorandum of understanding, as needed.

Further, the new MOU ratified for BU6 on September 28, 2013, does not allow for the Department to mandate involuntary overtime if staff elects to volunteer even if the staff volunteering are over 80 hours of overtime during the work period. See BU6 MOU section 12.05 Voluntary Overtime BY Seniority. The MOU also has a new 7k process where it is now a 7-day work week and overtime begins after 41 hours, so it is no longer a "work period" but now a "pay period".

Recommendation To: Corrections and Rehabilitation, Department of

To ensure that the State is maximizing the use of funds spent on incarcerating inmates, Corrections should encourage the Department of Personnel Administration to not agree to provisions in bargaining unit agreements that permit any type of leave to be counted as time worked for the purpose of computing overtime compensation.

Response

CDCR has partnered with the Department of Personnel Administration adding GC Section 19844.1 which changed to State's overtime provisions for bargaining units RO1, RO2, RO4, RO6, RO7, RO9, R10, R11, R12, R13, R14, R15, R17, R18, R19, R20, and R21, effective with the March 2009 pay period. The new language states "for the purpose of computing the number of hours worked, time when an employee is excused from work because of holidays, sick leave, vacation, annual leave, compensating time off, or any other leave shall not be considered as time worked by the employee for the purpose of computing cash or compensating time off for overtime." DPA issued Personnel Management Liaisons Memorandum 2009-014 advising of the change. CDCR implemented the change accordingly. GC Section 19844.1 does not include provision for bargaining units RO5, RO8, and R16; however, RO5 and RO8 are not utilized by the CDCR. R16 is utilized and CDCR shall work toward including the language of GC Section 19844.1 in their successor memorandum of understanding, as needed.

Further, the new MOU ratified for BU6 on September 28, 2013, does not allow for the Department to mandate involuntary overtime if staff elects to volunteer even if the staff volunteering are over 80 hours of overtime during the work period. See BU6 MOU section 12.05 Voluntary Overtime BY Seniority. The MOU also has a new 7k process where it is now a 7-day work week and overtime begins after 41 hours, so it is no longer a "work period" but now a "pay period".

Recommendation To: Corrections and Rehabilitation, Department of

To more closely align its operations with state law and its own policy, make certain that inmates are provided with an adequate level of supervision, and protect the health and safety of employees and inmates, Corrections should encourage the Department of Personnel Administration to negotiate a reduction in the amount of voluntary overtime a correctional officer is allowed to work in future collective bargaining unit agreements, in order to reduce the likelihood that involuntary overtime will cause them to work more than 80 hours of overtime in total during a month.

Response

As stated previously, the new MOU ratified for BU6 on September 28, 2013, does not allow for the Department to mandate involuntary overtime if staff elects to volunteer even if the staff volunteering are over 80 hours of overtime during the work period. See BU6 MOU section 12.05 Voluntary Overtime BY Seniority. The MOU also has a new 7k process where it is now a 7-day work week and overtime begins after 41 hours, so it is no longer a "work period" but now a "pay period".

Recommendation To: Corrections and Rehabilitation, Department of

To more closely align its operations with state law and its own policy, make certain that inmates are provided with an adequate level of supervision, and protect the health and safety of employees and inmates, Corrections should better ensure that it prevents the instances in which correctional officers work beyond the voluntary overtime limit in a pay period.

Response

As stated in Recommendation 5, the new MOU ratified for BU6 on September 28, 2013, does not allow for the Department to mandate involuntary overtime if staff elects to volunteer even if the staff volunteering are over 80 hours of overtime during the work period. See BU6 MOU section 12.05 Voluntary Overtime BY Seniority. The MOU also has a new 7k process where it is now a 7-day work week and overtime begins after 41 hours, so it is no longer a "work period" but now a "pay period".

Recommendation To: Corrections and Rehabilitation, Department of

To ensure that it can determine whether it is in compliance with state law and can measure the efficacy of its programs in reducing recidivism, Corrections should track, maintain, and use historical program assignment and waiting list data by inmate.

Response

Updated BIS Status - The Personnel Cost Planning (PCP) module was originally deployed in November 2012. Enhancements to the PCP module to improve reporting capabilities and address inaccuracies in staff costing have been identified by the Business and are in currently in the development phase. These enhancements are scheduled to be in place by June 2014.

Updated SOMS Status - SOMS Classification and Programs deployment is currently scheduled for deployment in March 2014. Going forward, this data will provide much of the information necessary to begin to perform analytics concerning rehabilitative program effects. SOMS and CDCR Enterprise Information Services (EIS) is working with CDCR business programs including the Office of Research (OR) to continue efforts to leverage data out of various data sources within the CDCR. The basic infrastructure has been implemented as part of the SOMS project. The EIS and OR have agreed to continue to work together so that as the new SOMS functionality is deployed, the new data elements can be included in data provided to OR.

Current Status of Recommendations

All Recommendations in 2013-041