HomeMy WebLinkAboutFollow-up of Health Services-Customer accessFollow-up report on Health Services - Customer access #12/13-5 November 2012
FOLLOW-UP REPORT
Health Services - Customer access
(Internal audit report #10/11-3 issued January 10, 2012)
To request this information in an alternate format, please call (541) 330-4674 or send email to David.Givans@Deschutes.org
Deschutes County,
Oregon
David Givans, CPA, CIA
Deschutes County Internal Auditor
1300 NW Wall St
PO Box 6005
Bend, OR 97708-6005
(541) 330-4674
David.Givans@deschutes.og
Audit committee:
Gayle McConnell, Chair - Public member
Chris Earnest - Public member
Jean Pedelty - Public member
Greg Quesnel - Public member
Michael Shadrach - Public member
Jennifer Welander - Public member
Anthony DeBone, County Commissioner
Dan Despotopulos, Fair & Expo Director
Scot Langton, County Assessor
Follow-up report on Health Services - Customer access #12/13-5 November 2012
TABLE OF
CONTENTS:
1. INTRODUCTION
1.1. Background ………………………………………...………………................................... 1
1.2. Objectives & Scope ……………………………………..………………………….…….… 1
1.3. Methodology ……………………………………………………..…………………….……. 1
2. FOLLOW-UP RESULTS ……………….…...………………………….............................. 2
3. APPENDIX I – Internal Audit Recommendations - Updated Workplan for
Report #10/11-3 (Status updated as of November 2012) ………….………................ 3-7
Follow-up report on Health Services - Customer access #12/13-5 November 2012
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1.
Introduction
1.1 BACKGROUND
Audit Authority:
The Deschutes County Audit Committee has suggested that follow-ups occur from nine months to one
year after the original report issuance. The Audit Committee’s would like to make sure departments
satisfactorily address recommendations.
1.2 OBJECTIVES and SCOPE
Objectives:
The objective was to follow-up on the outstanding audit recommendations.
Scope:
The follow-up included seventeen (17) recommendations from the internal audit on Health Services -
Customer access (January 2012) (#10/11-3) (issued January 10, 2012).
The follow-up reflects the status as of November 2012. The original internal audit report should be
referenced for the full text of recommendations and discussion.
1.3 METHODOLOGY
The follow-up report was developed from information provided by Michael Ann Benchoff, Behavioral Health
Program Support Manager. In cases where recommendations have not been implemented, comments were
sought for the reasons why and the timing for addressing these. The follow-up is, by nature, subjective. In
determining the status of recommendations that were followed up, we relied on assertions provided by those
involved and did not attempt to independently verify those assertions.
The Health Services Department should be acknowledged for their work in addressing these
recommendations.
Since no substantive audit work was performed, Government Auditing Standards issued by the Comptroller
General of the United States were not followed.
DESCHUTES COUNTY
INTERNAL AUDIT
REPORT
DESCHUTES COUNTY
INTERNAL AUDIT
REPORT
DESCHUTES COUNTY
INTERNAL AUDIT
REPORT
Follow-up report on Health Services - Customer access #12/13-5 November 2012
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2.
Follow-up
Results
Figure I -
How were
recommenda-
tions
implemented?
The follow-up fifteen (17) outstanding recommendations. Management agreed with all of the recommendations.
Figure I provides an overview of the implementation status of the recommendations. The details of the updated
workplans are provided in Appendix I.
With this follow-up, 5 recommendations (29%) have been completed, 4 recommendations (24%) are underway and
8 recommendations (47%) are planned.
Many of these planned recommendations will be addressed through movement to an electronic health records
(EHR) system. A future internal audit is planned to assess how the software has addressed some of their key
compliance issues.
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3. Appendix Appendix I –Updated Workplan for Report #10/11-3 (Status as of November 2012)
Rec#
Recommendation Description
Agreement
Status
Department Comments
Estimated
Date
Assigned
to
1 It is recommended that an interim
process be developed to assure these
client records always match.
Agree Completed No interim process was developed to ensure
consistency of documentation between the
paper chart, Accuterm electronic chart and
billing information. The new Electronics Health
Record system (Profiler) went live 10/31/12.
Although initial transition to Profiler will involve
some pre-existing documents continuing to be
located within the physical chart, all new client
documentation will be maintained in the
electronic record (including documentation
created outside of the EHR will be scanned into
the electronic chart).
N/A N/A
2 It is recommended for the department
to develop a system to understand
and monitor screening resource needs
in order to make sure it does not
become a bottleneck for the clients
wanting to be seen. There should be
plans for additional resources and
flexibility to make sure screeners are
available and can perform on a
timelier basis. Supervisor/managers
should be responsible for making sure
there are adequate staff to address
the workload.
Agree Underway DCBH leadership are discussing transformation
of the current access process. The plan is to
create an access team that will be available to
conduct assessments utilizing a walk-in model,
thereby creating same-day access. A meeting
occurred on 11/6/12 with Tom Anderson (DC
interim administrator) and Erik Kropp (System
Administrator). Among the items discussed
was the possibility of adding 1 Behavioral
Health Specialist II position as a mid-year
budget adjustment in order to assist with
staffing of an access team. A start date has not
yet been established but an initial target of
March 1, 2013 has been set.
3/1/2013 DeAnn Carr
3 It is recommended the department
endeavor to streamline and make
more consistent the screening
process for all clients regardless of
program or location.
Agree Planned Refer to content in "Department Comments" for
Recommendation #2.
3/1/2013 DeAnn Carr
4 It is recommended for the department
to calculate and report on these
benchmarking standards on a routine
basis. They should also have these
by age group, program and location
and be able to use that information to
Agree Underway Access standards have been included on the
2012-2013 DCBH Quality Improvement Plan.
The standards reflect contractual obligations
with the Central Oregon Health Board and are
aligned with healthcare quality best practice
standards.
6/1/2013 Michael Ann
Benchoff
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Rec#
Recommendation Description
Agreement
Status
Department Comments
Estimated
Date
Assigned
to
institute targeted improvements.
5 It is recommended for the Department
to evaluate their system for
processing new clients through to
assessment and see if it can be
streamlined.
Agree Completed DCBH leadership have used the results of this
report and the Addictions and Mental Health
Division site review report in evaluation of the
screening/intake/assessment process. Major
barriers to timely access were identified and
resulted in leadership commitment to a new
access model involving a specialized
assessment and intake team that will allow for
same day access for all new clients with a
projected start date of March 1, 2013.
11/1/2013 DeAnn Carr
6 It is recommended for the department
to consider with other contractual
requirements that outside providers
provide information on pertinent
performance metrics. Metrics of
interest might include days from
assumption through to assessment,
counts of services by client by month,
and reasons why clients are not being
provided service. If found necessary,
the ongoing requirements for
information should be added to the
basic contractual elements.
Agree Planned The change to the new walk-in/same-day
access model at DCBH will impact outside
providers. DCBH will be performing all
screenings and assessments. Referrals to
panel providers will be made after the same-
day assessment and appointments scheduled
immediately. It will therefore only be required
to track the screening to assessment to intake
process internally.
3/1/2013 DeAnn Carr &
Michael Ann
Benchoff
7 It is recommended the Department
work on improving the timeliness and
sequence of events through to
assessment.
Agree Planned Refer to content in "Department Comments" for
Recommendation #2.
3/1/2013 DeAnn Carr
8 It is recommended for the department
to look for ways to reduce the days to
assessment for all new clients
entering the system.
Agree Planned Refer to content in "Department Comments" for
Recommendation #2.
3/1/2013 DeAnn Carr
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Rec#
Recommendation Description
Agreement
Status
Department Comments
Estimated
Date
Assigned
to
9 It is recommended for the
department to investigate how
they distribute and monitor
workloads in total and for new
clients. Expectations established
in treatment plans should be used
to extrapolate staffing needs.
Agree Planned DCBH began recruitment for a Utilization
Review Specialist position to add to the
Quality Management team in August 2012.
This position will regularly evaluate and
analyze caseload and staffing patterns to
determine efficiency of treatment and staff
time. No candidate has been hired to
date.
2/1/2013 Michael Ann
Benchoff
10 It is recommended for additional
cross training needs to occur
between front desk staff (and
fiscal). This might also results in
more consistent job duties among
staff.
Agree Underway The nature of job duties at DCHS is in
transition as cultural and work
transformation efforts are underway.
DCHS leadership will be participating in a
retreat at the end of November 2012.
Staffing patterns, roles, and descriptions
are on the agenda for discussion and
planning. Cross-training of all staff will be
a natural consequence of any redesign.
2/1/2013 DeAnn Carr &
Michael Ann
Benchoff
11 It is recommended for the
department to consider whether
an electronic system could be
developed to verify OHP status of
appointmented clients. In
addition, the department appears
to need a policy to address the
OHP clients that lose coverage.
Agree Planned The Oregon Administrative Rules do not
require a policy to address the OHP clients
that lose coverage. However, the issues
around sliding fee scale and verification of
income for individuals not currently
receiving coverage are currently under
discussion. Once the details have been
mapped out and finalized, a procedure will
be written.
2/1/2013 DeAnn Carr
12 It should be emphasized when the
new system comes online that
staff will be required utilize the
new system for appointments and
documentation.
Agree Completed Electronic Health Record system went live
10/31/12. All appointments and
documentation are made in the new
system.
10/31/2012 DeAnn Carr
13 It is recommended for more staff
to have the ability and training to
establish clients in the system.
Agree Completed All DCBH staff have received training on
how to enroll new clients into the new
Electronic Health Record system as of
10/31/12.
10/31/2012 Christina Grijalva
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Rec#
Recommendation Description
Agreement
Status
Department Comments
Estimated
Date
Assigned
to
14 It is recommended that some of
these metrics be incorporated in
the electronic records system if
they are deemed relevant to
monitoring operations.
Agree Completed Levels of acuity at entry are being
documented and tracked within the new
Electronic Health Records system.
Reports on acuity and access timelines will
be run monthly and reviewed in the
Behavioral Health Quality Council
quarterly. Additionally, these reports will
be used to create quarterly and annual
performance reporting to the Central
Oregon Health Board.
10/31/2012 Christina Grijalva
15 It is recommended the two
departments consider how they
may consolidate and/or coordinate
on similar topics and learn from
the other’s best practices. Areas
to investigate might include, client
reception, call handling and phone
message tree, and appointment
reminders. Fiscal services even
with the disparate systems might
be improved and made more
consistent with similar practices
employed or performed together.
Agree Planned DCHS leadership retreat scheduled for
November 30, 2012. Department
integration efforts will be discussed at that
time.
11/26/2012 DeAnn Carr &
Scott Johnson
16 It is recommended the department
look for ways to provide a
common reception area given the
movement to coordinate treatment
of physical and mental health
issues.
Agree Planned See Department Comments for
Recommendation #15.
11/26/2012 DeAnn Carr &
Scott Johnson
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Rec#
Recommendation Description
Agreement
Status
Department Comments
Estimated
Date
Assigned
to
17 It is recommended that the
department finalize some
measures and get them in the
hands of users. An additional
suggestion is to make sure they
are being used and that staff are
trained to interpret the results.
Additional metrics may be useful
and developed as additional
drivers are identified.
Agree Underway DCBH created a Quality Improvement
Work Plan for 2012-2013 in August 2012.
Access standards and other performance
metrics are included in the plan. A
Behavioral Health Quality Council
(comprised of DCBH supervisors and
managers) began meeting 11/1/12 and will
meet monthly to review progress towards
achieving performance standards.
Additionally, the BHQC will submit
quarterly and annual reports to DCBH
leadership, the Behavioral Health Advisory
Board and the Central Oregon Health
Board.
7/1/2013 Michael Ann
Benchoff
{END OF REPORT}