LOS Angeles County

Recommendations 6

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  Who: Your Name: _______________________________________________________________________ Address: ________________________________________________________________________ City, State, Zip, Code: _______________________________________________________________ Telephone: ( ) Extension: ______________
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  5 below; as a result, the Utilization Review Units in the hospitals have been able to timely review accounts to enable timely billing. Also, DHS has developed an inventory status report to identify and prioritize accounts that need a TAR in order to be billed for stronger control. DHS does not bill any accounts that do not have a TAR. RECOMMENDATION No. 2.5 Formalize the point at which Medi-Cal fee-for-service accounts are retrospectively reviewed for patients still in the Department hospitals. 7/18/14 RESPONSE DHS agrees with this recommendation. An assessment will be conducted to determine the staffing needs to perform the concurrent reviews recommended. If necessary, DHS will submit a budget request for additional staffing needed to fully implement this recommendation. Completion of the assessment is anticipated by December 31, 2014. CGJ QUESTION 2.5 Has DHS determined the staffing required to review Medi-Cal fee-for-service accounts for patients still in DHS hospitals? 89 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT 1/30/15 RESPONSE Implemented - Currently Medi-Cal Fee-for-Service patients are reviewed on a daily basis when receiving acute care. DHS utilizes a State approved evidence based proprietary software program (InterQual) for determination of medical necessity. A second level review of the account is completed by a physician to evaluate the medical necessity if InterQual criteria are not met. DHS Utilization Review (UR) Committee has implemented an action plan; where UR nurses are reassigned from other County hospitals should a backlog develop at a DHS facility, to assist in the reviews using approved overtime. Also, additional Physician Advisors are recruited to complete second level reviews. Based on this strategy and assessment, DHS has been able to mitigate the effect of staff shortage at its facilities. RECOMMENDATION No. 2.6 Conduct a Utilization Review staffing analysis at county hospitals as an increase in staff may substantially increase Department cash flow by decreasing backlogs and increasing the timeliness of billings. 7/18/14 RESPONSE DHS agrees with this recommendation. DHS will conduct a staffing analysis to determine if additional staffing will decrease backlogs and increase billing timeliness. If necessary, DHS will submit a budget request for additional staffing needed to fully implement this recommendation. Completion of the evaluation is anticipated by December 31, 2014. CGJ QUESTION 2.6 Has DHS conducted a staffing analysis to determine if additional staffing will reduce backlogs and reduce billing time? 1/30/15 RESPONSE Implemented - In the spring of 2014, DHS performed a comprehensive assessment of staffing needs within inpatient Utilization Review departments with the goal of ensuring sufficient staff are available to complete all inpatient UR related duties which would decrease backlogs and increase billing timeliness. DHS calculated the additional staff needed for each hospital to achieve full staffing levels. These items were included in DHS’ 2014-15 supplemental budget request, approved by the Board of Supervisors on September 30, 2014. Approximately half of the newly added items have been filled to date, with interviews ongoing. RECOMMENDATION No. 2.7 Utilize available systems and tools, and require DHS physicians to report their National Provider Identifier (NPI) number and complete the 855R form linking the NPI number to DHS, as required for Medicare billing purposes, prior to commencing work at a DHS facility. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT 7/18/14 RESPONSE DHS agrees with this recommendation. DHS will assess available systems, tools, and processes to determine how best to implement this recommendation. Completion of the assessment is anticipated by December 31, 2014. CGJ QUESTION 2.7 Does DHS require physicians to report their National Provider Identifier (NPI) number and enter it into the system prior to commencing work at a DHS site? 1/30/15 RESPONSE Partially Implemented - DHS is evaluating the licensed practitioner credentialing process and the utilization of the new Cactus credentialing software to enable improved accountability and control. In the interim, Medical Administration and Finance are working together to initiate enrollment applications for practitioners who provide care to Medicare members. CGJ Question 2.7 as of 02/19/2015 What is the projected date by which DHS expects to fully implement the original recommendation to require DHS physicians to report their NPI number and complete the 855R form linking the NPI number to DHS prior to commencing work at a DHS facility? 3/20/2015 Response The target date is July 1, 2015. On this date, the credentialing process will include initiation of NPIs and enrollment of physicians into the Medicare program for the facilities where it is a requirement (Comprehensive Health Centers and Health Centers). RECOMMENDATION No. 2.8 Monitor the processing of Medicare claims to ensure that the implementation of ORCHID, the Department's new electronic health record system is aiding and providing Medicare itemized claims. 7/18/14 RESPONSE DHS agrees with this recommendation. DHS will monitor the processing of Medicare claims and ensure itemized billing is accommodated within the Online Real-Time Centralized Health Information Database (ORCHID), Affinity Patient Accounting, Billing Clearinghouse, etc., as each DHS facility implements ORCHID. ORCHID implementation and associated interfaces for billing is anticipated to be completed prior to December 31, 2014. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT CGJ QUESTION 2.8 Is DHS monitoring the processing of Medicare claims by the new ORCHID system? 1/30/15 RESPONSE Not Implemented – The ORCHID system was successfully implementation at Harbor-UCLA Medical Center on November 1, 2014, however, the interface between ORCHID and the Affinity system has resulted in new challenges impacting the usage of itemize billing from the system. As a result, we have postponed usage of itemize detail coming from the system to generate Medicare claims until a full assessment of the process is completed. The assessment will start in April and is expected to be completed by July 2015. In the interim, we have developed alternative plans to ensure the billing process is resumed. RECOMMENDATION No. 2.9 Track the backlog for coding at all facilities through regular reports, similar to those produced by Los Angeles County’s LAC+USC Medical Center. Aggregate and analyze coding backlog data at all facilities for resulting trends and to identify any problem areas. 7/18/14 RESPONSE DHS agrees with this recommendation. DHS will standardize Health Information Management (HIM) reports to monitor coding backlogs as part of its implementation of ORCHID. ORCHID implementation at DHS’ first facility is anticipated to be completed by November 1, 2014. CGJ QUESTION 2.9 Has DHS standardized Health Information Reports to monitor coding backlogs? 1/30/15 RESPONSE Implemented - DHS has developed an inventory status report to identify and prioritize accounts that need medical record coding. This report is provided to DHS facilities on a weekly basis. Additionally, current monitoring reports (e.g., staffing model, Dashboard report, Coder Output Productivity) used by LAC+USC Medical Center have been expanded to other facilities for identifying coding issues to prevent backlog. RECOMMENDATION No. 2.10 Perform a staffing analysis in Health Information Management (HIM) divisions at all DHS facilities to assess whether additional staff might ameliorate the current HIM backlogs and delays in coding. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT 7/18/14 RESPONSE DHS agrees with this recommendation. DHS will conduct a staffing analysis to determine if additional staffing will decrease HIM backlogs and delays in coding. If necessary, DHS will submit a budget request for additional staffing needed to fully implement this recommendation. Completion of the assessment is anticipated by December 31, 2014. CGJ QUESTION 2.10 Has DHS conducted a staff analysis to determine if additional staff will decrease the HIM backlogs and delays in coding? 1/30/15 RESPONSE Implemented - HIM completed a staffing analysis in October 2014. Based on anticipated production standards, current staffing level was sufficient to handle existing coding volume. However, staffing resource and work volume are not evenly distributed. HIM will work to reallocate staffing needs across all areas to prevent future backlogs. RECOMMENDATION No. 2.11 Implement an electronic notification method for alerting physicians of the patients' required authorization from third party payers when follow-up services are required. 7/18/14 RESPONSE DHS agrees with this recommendation. DHS will study the feasibility of utilizing an electronic notification to alert physicians, utilization review nurses, etc., when third party payer authorization is required for follow-up services as part of its implementation of ORCHID. Completion of the study is anticipated by December 31, 2014. CGJ QUESTION 2.11 Has an electronic notification method been implemented to alert physicians of patients requiring authorization from third party payers for services? 1/30/15 RESPONSE Partial Implementation - DHS has created an icon in First Net (the ORCHID ED module) to indicate that a patient has private insurance or is a managed care, assigned to a non-DHS provider. DHS is exploring the possibility of this icon auto- populating based on the insurance type, rather than being manually added by the registration staff. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT CGJ Question 2.11 as of 02/19/2015 What is the method by which DHS will ensure that a patient is identified as requiring third party authorization for follow-up services prior to such services being provided – and – when will that method be fully implemented? 3/20/2015 Response DHS will use the new ORCHID electronic health care system to identify admissions and visits that require third party authorizations. The First Net module/solution in ORCHID will enable the facilities to use an indicator (icon) on the patient's record that will alert providers and staff that an authorization is required. This indicator has been fully implemented at Harbor\UCLA Medical Center and MLK Jr. Outpatient Center and will be implemented at remaining facilities according to the ORCHID install schedule established for the Department. The schedule for the remaining hospitals is: May 1, 2015 for LAC+USC Medical Center, August 1, 2015 High Desert Regional Health Center, October 1, 2015 for Rancho Los Amigos National Rehabilitation Center and February 1, 2016 for Olive View/UCLA Medical Center. In addition, the Department is working on standardizing procedures to ensure facilities refer patients to their appropriate third party plans for follow-up care. RECOMMENDATION No. 2.12 All physicians must be trained on the new electronic notification system and accountability measures should be implemented to ensure that physicians schedule follow-up services appropriately. 7/18/14 RESPONSE DHS agrees with this recommendation. Based upon the outcome of feasibility study conducted on Recommendation 2.11, training will be provided to appropriate staff, e.g., physicians, utilization review nurses, etc., on the electronic notification system. If necessary, DHS will submit a budget request needed to fully implement this recommendation. Completion of the study is anticipated by December 31, 2014, and training will be subsequently scheduled as necessary. CGJ QUESTION 2.12 Are there plans to train physicians on the electronic notification system? 1/30/15 RESPONSE Partial Implementation - DHS has created an icon in First Net (the ORCHID ED module) to indicate that a patient has private insurance or is a managed care, assigned to a non-DHS provider. DHS is exploring the possibility of this icon auto- populating based on the insurance type, rather than being manually added by the registration staff. Once the assessment is completed, training will be provided to the appropriate staff. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT CGJ Question 2.12 as of 02/19/2015 Please identify the classifications or groupings of staff who will receive training on the electronic notification system. What is the status of the training on the electronic notification system and what is the target date for full implementation of the training? 3/20/2015 Response Classifications who have received training include physicians, nursing staff, Utilization Review nurses, clerical support staff and registration staff. These same classifications will receive training of their scheduled ORCHID implementation date. RECOMMENDATION No. 2.13 Require all DHS facilities to regularly pre-screen scheduled outpatient appointments to ensure that authorization is obtained or the patient is referred to a more appropriate provider. 7/18/14 RESPONSE DHS partially agrees with this recommendation. DHS will evaluate facility staffing for pre-screening outpatient appointments (excludes Emergency Room, Urgent Care, and Walk-in Clinics). If necessary, DHS will submit a budget request for additional staffing needed to fully implement this recommendation. Completion of the evaluation is anticipated by December 31, 2014. CGJ QUESTION 2.13 Has DHS evaluated how to pre-screen outpatient appointments to ensure authorization has been obtained? 1/30/15 RESPONSE Partially implemented - DHS has implemented a streamlined model at one facility that has resulted in improvements in the prescreening and outpatient appointment process and is implementing a similar model at all facilities. This effort will ensure patients are appropriately prescreened for eligibility and authorization prior to their appointment and ensure patients are redirected to their appropriate provider. In addition, DHS is working with Human Resources to fill all available registration positions dedicated to the prescreening process and is working with technology staff on improving the eligibility verification system. RECOMMENDATION No. 2.14 Evaluate effective and efficient staffing models to support the need for obtaining authorization from third party payers for inpatient services; such as a designated unit, a centralized staff, or an independent utilization review unit. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT 7/18/14 RESPONSE DHS agrees with this recommendation. DHS will evaluate the feasibility of inpatient staffing to determine the organizational structure and staffing needs in order to effectively obtain authorization from third party payers for inpatient services. If necessary, DHS will submit a budget request for additional staffing needed to fully implement this recommendation. Completion of the evaluation is anticipated by December 31, 2014. CGJ QUESTION 2.14 Has DHS selected a staffing model to expedite service authorization from third party payers? 1/30/15 RESPONSE Implemented - DHS performed a comprehensive assessment of staffing needs within inpatient Utilization Review departments with the goal of ensuring sufficient staff are available to complete all inpatient UR related duties which would decrease backlogs and increase billing timeliness. DHS calculated the additional staff needed for each hospital to achieve full staffing levels. These items were included in DHS’ 2014-15 supplemental budget request, approved by the Board of Supervisors on September 30, 2014. Approximately half of the newly added items have been filled to date, with interviews ongoing. RECOMMENDATION No. 2.15 Determine the cost-effectiveness of implementing third party payers' online authorization tools to ensure timely authorization for inpatient services. 7/18/14 RESPONSE DHS agrees with this recommendation. A study will be conducted to determine the feasibility of obtaining an electronic tool for online third party payer authorization for DHS’ largest payers. If necessary, DHS will submit a budget request for additional staffing, and associated Services and Supplies (S&S) needed to fully implement this recommendation. Completion of the study is anticipated by December 31, 2014. CGJ QUESTION 2.15 Has DHS selected an electronic tool to expedite service authorization from third party payers? 96 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT 1/30/15 RESPONSE Partially Implemented - DHS has approached the software vendor, Provider Advantage, to obtain an online tool for processing prior authorization and "278" referral transactions. An assessment is being completed to determine feasibility. RECOMMENDATION No. 2.16 Collaborate with Cerner, the Department's vendor for its new electronic medical record system, ORCHID, to determine if enhancements in the new system could facilitate online processing of health care plan authorizations for DHS services. 7/18/14 RESPONSE DHS agrees with this recommendation. DHS will collaborate with Cerner to determine the feasibility of using standard functionality or enhancing ORCHID to facilitate electronic online processing of health care plan authorizations for DHS services. If necessary, DHS will submit a budget request needed to fully implement this recommendation. Completion of the evaluation is anticipated by December 31, 2014. CGJ QUESTION 2.16 Has DHS ensured that the new ORCHID system facilitates online processing of health care plan treatment authorizations? 1/30/15 RESPONSE Partially Implemented - ORCHID is built to automate the faxing of key documentation required for authorized inpatient admissions. This includes the initial clinical review done by the utilization review nurse and additional care management information, including progress notes, labs, clinical updates, and additional medical record information. UR nurses at Harbor are now able to enter a fax number into ORCHID, which then generates and sends the selected paperwork. This has eliminated some of the manual work previously done by UR nurses and improved efficiency. ORCHID will be fully implemented DHS-wide by February 2016. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT This page intentionally left blank. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT GROUP HOME Wesley C. Thompson, c hair Larry Lyman, vice chair Earline C. Parker, secretary Doris K. Reed Joyce Simily Margaret M. Yasuda GROUP HOME TOPIC Based on a review of past Los Angeles County Civil Grand Jury final reports, the Los Angeles County 2014–2015 Civil Grand Jury (CGJ) noted that group homes in the County of Los Angeles had not been inspected by a Los Angeles County Civil Grand Jury for the prior eight years. Due to concern for the well-being of minors in group homes, the Group Home Committee (committee) was formed, consisting of six members of the CGJ. The committee’s focus was to determine if the basic needs of the minors—including but not limited to food, housing, clothing, education, and psychological services—were being met.
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  When: Date(s) of incident: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 165 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT
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  Where: Names and addresses of other departments, agencies or officials involved in this complaint. Include dates and types of contact, i.e. phone, letter, personal. Use additional sheets if necessary. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
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  Why/How: Attach pertinent documents and correspondence with dates. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 166 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT Complaint Guidelines Communications from the public can provide valuable information to the Civil Grand Jury. Any private citizen, government employee, or officer may submit a completed complaint form to request that the Civil Grand Jury conduct an investigation. This complaint must be in writing and is treated as confidential. Prior to submitting the Complaint Form to the Grand Jury office, please retain a copy for your records if needed. Receipt of all complaints will be acknowledged. If the Civil Grand Jury determines that a matter is within the legally permissible scope of its investigative powers and would warrant further inquiry, additional information may be requested. If a matter does not fall within the Civil Grand Jury's investigative authority, or the jury determines not to investigate a complaint, no action will be taken and there will be no further contact from the Civil Grand Jury. The findings of any investigation conducted by the Civil Grand Jury can be communicated only in a formal final report published at the conclusion of the Grand Jury's term, June 30th. Some complaints are not suitable for civil grand jury action. For example, the Civil Grand Jury has no jurisdiction over judicial performance, actions of the court, or cases that are pending in the courts. Grievances of this nature must be resolved through the established judicial appeal system. The Civil Grand Jury has no jurisdiction or authority to investigate federal or state agencies. Only causes of action occurring within the County of Los Angeles are eligible for review. The jurisdiction of the Civil Grand Jury includes the following: • Consideration of evidence of misconduct against public officials within Los Angeles County. • Inquiry into the condition and management of the jails within the county. • Investigation and report on the operations, accounts, and records of the officers, departments or functions of the county including those operations, accounts, and records of any special legislative district or other district in the county created pursuant to state law for which the officers of the county are serving in their ex officio capacity as officers of the districts. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT • Investigation of the books and records of any incorporated city or joint powers agency located in the county. Mail complaint form to: Los Angeles County Civil Grand Jury Clara Shortridge Foltz Criminal Justice Center 210 W. Temple Street, 11th Floor, Room 11-506 Los Angeles, CA 90012 168 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT CONTINUITY COMMITTEE Ken Star, chair Jim Contreras, vice chair Simeon Zano, secretary Shari E. Pearce John A. Rangel Wesley C. Thompson Margaret M. Yasuda CONTINUITY COMMITTEE The Continuity Committee serves a statutory function of the Los Angeles County Civil Grand Jury: to archive and organize responses to the previous year’s Final Report. The Los Angeles County 2014–2015 Civil Grand Jury (CGJ) also ensured continued retention of CGJ materials and changed the method of indexing that information. California Penal Code Section 933(c) mandates responses, , to the previous year’s reports by the public agencies to whom recommendations were made by the Final Report. The CGJ followed up to ensure reasonably timely compliance by the agencies addressed in the 2013–2014 Final Report. Penal Code Section 933.05 requires that agency responses be specific to each individual finding and recommendation. The committee reviewed the responses and found they substantially complied with the legal requirements. Please take note that the responses filed by the agencies are much more extensive than indicated in the following pages and were placed with the custodians set forth in Penal Code Section 933(c) and also on the CGJ website at http://grandjury.co.la.ca.us/gjreports.html. ARCHIVAL/ORGANIZATIONAL ROLE The committee has continued the actions of its predecessors in maintaining copies of previous reports and responses, both hard copy and electronic. Past Continuity committees have also prepared tables of reports and recommendations for the following year’s jury to use as a
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  1 Los Angeles Department of Water and Power’s research and development lab at the La Kretz Innovation Campus should work with the UCLA La Kretz Center for California Conservation Science to request academic research into groundwater remediation in the San Fernando Basin to help speed the cleanup of the San Fernando Basin Aquifer. As described in the committee’s interview report with LADWP’s Chief Sustainability and Economic Development Officer. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT