Tuesday, July 06, 2010

Talking cents

The dollars needed to preserve the system will not be forthcoming, I'm afraid. Not for a long time, anyway. I believe our choices will be to let it all continue to crumble or start seeing nickels and dimes worth of actual service as more desirable than advocacy denominated in billion dollar bills.

In support of a resolution I've proposed to the San Gabriel/Pomona Regional Center Vendor Advisory Committee, I've recently had the opportunity to retell this story: In 2002 or so, I started receiving a lot of phone calls from Service Coordinators asking me questions that took me by surprise. But they had a pattern: Many asked about the clients' height and weight (useful mostly if you are going on rides at Disneyland or boarding a helicopter;) some asked about the clients' ambulation (useful for special olympics planning;) others asked if the client had been out of service for any extended periods, out of state or hospitalized or in prison (useful for identifying fraud, assuming the same vendor would bill fraudulently and then answer the question diligently.)

The questions were odd and there was no particular place for me to find the answers, so after receiving the calls I would generally get up, search through the client's file and, if that didn't turn up the answer, call the supervisor responsible for the case who would, next time she wasn't with a client search through notes for the answers. Then I would call the SC back with or without the right answer. I don't know how much time SCs were spending on the questions, but Arriba staff were spending several hours per week.

At some point, I found an unimpertinent way of asking "why are you asking?" and the answer came "for the waiver documentation" nine times out of ten. After that I talked to the very smart person in charge of said documentation and we worked out a template, to be included in every progress report, that would answer all of these questions. Staff already, when updating the reports looked in all the places that data would be for the answers to other questions so once we changed our template, the administrative workload here went down sharply and at least some time was saved for the SCs who eventually would learn that the answer was sitting on their own computer. At the very least, the calls per client-question fell from two to one.

Spread that change from Arriba's 100 or so clients to a regional center's some-thousand-and-some, and it might be that half a year of one person's work could be saved. That's not a ton, but it could be enough to turn an administrative position into a service position or a savings.

So, here's a question for commenters who seem to need questions: What are some other small changes that might make the cost of service left while leaving the service intact?


stanley said...

[doug say] here's a question for commenters who seem to need questions: What are some other small changes that might make the cost of service left while leaving the service intact?

Commentaters say:

Eliminate ARCA. Eliminate DDS director. This blog say leadership not important

[andy say] A bottom line reality is, that if DDS and regional centers and area boards and everyone disappeared tomorrow (and someone sent me a reimbursement check on time) the lives of the clients we serve, wouldn't change in any appreciable sense.

WELL OK, eliminate DDS, RCs, ABs too...

Seriously eliminate ARCA

stanley seigler

Doug said...

OK, Stanley, thanks for your suggestion.

Andrew said...

Big D's question: What are some other small changes that might make the cost of service left while leaving the service intact?

I'm sorry, I tried, but my brain won't turn over if it has to "leave the service intact".

The mandate should be that any change must ensure that it's not left intact.

Doug said...

Andy, nice photo. Let me rephrase for you: Leave the value the clients receive undiminished.

Andrew said...

Doug, I'm not trying to be a-hole (some are born with the gift)... but I don't see a lot of value clients receive from the present system. Some do, definitely. But I think most don't. I think, also, that the system does not need to simply identify costs to cut, it needs to distribute the money it has (minus whatever is required to meet DDS's budget) in a way that makes some kind of sense. The better the outcomes, the higher the quality of the service, the more value provided to the indidividual, the provider should be better reimbursed than providers who provide services that do nothing (year in and year out), or do harm, or devalue, dismiss, disrespect, discourage their clientele. Services that do not take some direction from their clientele, that do not involve their clientele in meaningful ways, should not be receiving the highest reimbursement rates. As it stand now, none of this has any effect on the wealth of programs.

I hate to keep returning to my tinny little drum to beat, but I'm getting increasingly fed up with the fact that the level of one's effort, thought, work, time, longevity, responsibility, risk and liability, results and outcomes mean nothing when it comes to reimbursements.

If our services, in any way, reflect our repution as one of the best SLS providers in the state, does it make any sense that after 16 years, anyone anywhere in the state can start the same service and will automatically receive a higher rate than we do? If, as is the case, the clients we serve have recieved the highest ratings for their life quality, health, community involvement, etc. yet given by the exhaustive QMS reviews (quality assurance audits) developed for the Agnews movers, does it make any sense that someone with no experience at all, serving people posing far fewer challenges, in far less expensive regions of the state, receives higher payment the we?

When some services have been well-funded for years without any discernible outcomes, and others with dramatic and measurable results have been starved ... why not try to balance things out a bit, and save some money to boot?

The fact that every service crys poor, (always has and always will) seems to be enough of a reason to not touch anyone's funding ... We'll just cut rates across the board ... as if that's somehow the "fair" way to address a budget crisis. If no one is willing to admit that some services have, for years, been considerably better funded than others ... than this system is pathetically inept and incapable of repairing it's own problems.

Yours in continual disbelief,


Doug said...

Well, Andrew, I don't think it reflects on anything but the species that everyone cries poor. You know that I agree that we ought to be paying for value, not cost, with the entities doing no good or doing harm not paid.

But, to my way of thinking, it is just as discouraging if you can't look to your own process and find something that could be done more efficiently as it is if nobody can be put out of business for non-accomplishment.

Also, Sacramento seems so far from the regional centers who seem so far the services that seem so far from the clients. I can't imagine we're ready for big change. We might be ready for small change.

Andrew said...

Doug, I've been looking for things to streamline, eliminate, simplify, and make more efficient for two and half years. Every purchase, every reimbursement, every expense is scrutinized for its need, or value, every month when I sign a check for it ... and yes, I pause, over my paycheck. I am, simply, not an efficient person. But I used to have others who were, manage key functions of the agency.

We've cut down on staff reimbursements, for costs that were more generous than necessary, or of no value to our clients. I'm transferring all of our cell phone services from the lying bastards at Verizon to a service, and its humanless computer interface, through Wal-Mart (and Wal-Mart has always felt like going to hell, to me) at a savings of $500 month.

We have strictly limited PTO cash outs for staff. Restricted payroll advances to a "next check" payoff requirement. Cut health and dental benefits again. Limited the help we provide staff with financial emergencies. Lived with a copier that makes every copy look like your peering through a screen door. Eliminated all business printing. And there's more to be done. I'm reviewing our insurance (liability, employment practices, etc.) and comparing it's annual cost to other agencies. It seems we may have a broker that stinks.

The danger with efficiencies is when they lead to greater inefficiencies. About a year ago we tried our third bookkeeper in three years. We'd gone from a full-time bookkeeper and benefits manager to a good part-time bookkeeper who got a better job, to a young, (dumb) cheap, part-time bookkeeper who we've just "let go". Lot's of mistakes which I now will pay someone (I hope decent) to go back and report on the damage. And that 'aint efficient, though it was meant to be ... or hoped for.

I think there has been great value in looking at every expense with a new perspective, and I am happy with most of what we've done to streamline and simplify things. I imagine we'll survive, come what may. But, I don't think it should be this hard ... especially when I know I could happily sustain cuts of 10 percent, with normal SLS rate.

I would not have a problem taking a larger cut (assuming I had the rates of others) in order to spare cuts to another service that has been chronically underfunded (and was an important service ... respite, for example). I think in this way too, I walk a different line than most of my colleagues.

But I'm right and they're wrong!

(present company excepted ... all three of you)


stanley said...

[andy say] etc, etc, etc...I walk a different line than most of my colleagues. But I'm right and they're wrong,

indeed you are...except aboot DDS leadership…and;

why does “no good deed shall go unpunished” come to mind

stanley seigler

paul said...

“What are some other small changes that might make the cost of service left while leaving the service intact?”

I think that this is an inappropriate audience for such a question because, after all, your talk with the “very smart person in charge of said documentation” address inefficiencies at the said REGIONAL CENTER. Perhaps you should direct your question there?

Also – your idea probably downsized an entire department of 12 to just 2 people (well - probably not because doing so would be 'efficient'). That leaves 10 people unemployed and not paying state income tax. That reduces the general fund, which results in cuts to people with disabilities.

So – my question to you. Why do you have such hate for people with disabilities?

Doug said...

Andy, I agree with you on this: It is very hard to rationalize where to cut in an irrational system of expenditures. When 80% of the community-based branch budget is distributed to vendors at a rate based primarily on date of birth and trickery, it is a little hard to see how anything smart can be done before changing the compensation structure.

Spending too little on an important part of the business is not efficient, as you've discovered.

Stanley, a lot of stupid stuff gets punished, too. It's reward we seem to have trouble with.

Paul, I hate cuddly little kittens worse.

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