Report 2009-107.2 Recommendations and Responses in 2013-041

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 2012-041 Response Not Implemented as of Most Recent Response
California Correctional Health Care Services 3 5 3 3 2
California Department of Corrections and Rehabilitation 3 6 5 4 4

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

CCHCS has implemented this recommendation to the extent possible. We are unable to assess further due to lack of staffing and data resources.

CCHCS has determined that Telemedicine appointments are billed at the same Medicare rates as in-person office visits and, therefore, do not reflect cost savings over traditional specialty service appointments. The primary goal of Telemedicine Services is to provide timely access to medically necessary care. In addition to increasing access to specialty care, CCHCS developed and implemented Primary Care Telemedicine in 2010. Primary Care Telemedicine utilizes civil-service CCHCS physicians to provide needed patient care to those remote locations that have had difficulty recruiting and/or retaining physicians and has improved access to primary care in mulitiple institutions statewide.

Telemedicine Services provide increased access to care, particularly in those remote locations where local medical facilities do not provide all the needed services to support the patient-inmate population. Expansion of Telemedicine Services shall primarily be based on efficacy and efficiency of patient care, as well as the needs of each individual institution, rather than cost effectiveness. Additionally, the use of telemedicine reduces transport of inmates into communities for healthcare through remote management, increasing public safety.

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

CCHCS cannot fully implement this recommendation because the needed IT and personnel resources are not currently available to provide this level of in-depth data analysis.

Within Telemedicine Services' current resources, implementation of this recommendation would yield unreliable data. For example, the current system does not distinguish whether a follow-up encounter is scheduled in accordance with the patient's routine conservative plan of care or of the efficacy of a previous telemedicine encounter. Needed IT and personnel resources are not currently available to provide this level of in-depth analysis.

Rather than rely on retrospective data to determine efficacy of telemedicine encounters, Institutional utilization management teams follow a standardized process to approve referrals (Attachment 6) and determine appropriateness for telemedicine services before the consultations. Those referrals deemed not appropriate for telemedicine are routed for in-person office visits.

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 the CDCR staffing model for community hospital guarding details, combined with the CCHCS Utilization Management Unit implementing an additional review step within the Referral for Services process, has resulted in a reduction of offsite specialty provider referrals, overtime hours and overtime dollars. The total number of CCHCS statewide referrals for offsite provider services in Fiscal Year 2010/2011 equated to 118,910 and have declined to 78,990 in Fiscal Year 2012/2013. Medical Transportation overtime hours for the same time period has been reduced from 451,066 to 377,646. Likewise, hospital guarding overtime hours were reduced from 740,989 to 645,456.

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

SOMS Update - The SOMS statute table, formerly known as the OBIS Offense Edit Table, has been updated by correcting outdated information and adding new statute codes that were missing. As a result, CDCR can now enter offenses and enhancements into SOMS that were previously placed in the comments field in OBIS.

The Sentence Calculation module of the SOMS project was implemented in August 2013. The module includes an automated sentence calculator which reduces human error and provides uniformity of sentencing and crediting and loss of credit business rules.

Before and during the Sentence Calculation deployment, legacy system data continues to be reviewed and compared to the calculator for accuracy.

As part of the data conversion process, inaccurate data was identified and corrected prior to loading OBIS data into SOMS. Reports of identified problems were generated and sent out to institution Records offices for cleanup.

A tremendous amount of testing was completed over a period of approximately six months by a team of seven full time staff using the cleansed data to ensure results of the application were correct and could be relied upon.

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 OBIS Edit table has been replaced with the SOMS statute table; the table has been updated by correcting outdated information and adding new statute codes that were missing from the OBIS Edit table.

As part of the data conversion process, inaccurate data was identified and corrected prior to loading OBIS data into SOMS. A tremendous amount of testing was completed over a period of approximately six months to ensure results of the application were correct and could be relied upon.

Going forward, a Case Records Administrator has been assigned to complete at least an annual update to the statute table. The Case Records Administrator will be working with the SOMS team to add any new statute codes or amended statutes to the SOMS statute table.

Sentencing data continues to be checked on a regular basis during case records audits that occur throughout an offender's incarceration period (i.e., Intake, Transfer, 60-Day 10-Day prior to release). Additionally, monthly data quality reports will be generated on an ongoing basis for cleanup as needed in order to maintain the integrity of the offender sentencing data in the SOMS system.

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

CDCR's Budget Management Branch is currently relying on monthly MIRS reports to track leave balance liability by Classification. An annual MIRS report of accumulated leave balances for custody staff will be submitted in October 2013 and for the period ending June 30 every year thereafter beginning in 2014.

Further, the relief formula approved through CDCR's Blueprint is based off of a blend of leave usage and accrual. CDCR's Division of Adult Institutions has submitted a relief increase Budget Concept Proposal for Fiscal Year 14/15 for Relief factor that is based solely on leave usage. Our intent is to continue to track the leave usage and accruals of CDCR custody staff to determine the most effective means of controlling future liabilities while maintaining institution security and fiscal responsibility.

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

CDCR's Budget Management Branch will calculate an annual projected separation payment (lump sum) figures based on actual prior year expenditures and taking into account all factors unique to the coming year, in October 2013 and for the period ending June 30 every year thereafter beginning in 2014.

Current Status of Recommendations

All Recommendations in 2013-041