Volume 1, Issue 4

“The County has acted shamefully.” These are the words from an ‘angry’ and ‘distrustful’ subcontractor (provider) that treats clients with mental illness for Riverside county. This provider’s comments were part of an “open ended survey” conducted by Riverside County Mental Health and delivered to Quality Improvement Committee (QIC) upon request of this writer. As we moved through the material, another provider stated, “Our agency is very dissatisfied with the way that you interact with us.” These two providers are not alone. Out of 66 responses from opened ended surveys completed by subcontractors for Riverside County Mental Health, over 70% of them didn’t have much of anything good to say about the way the County does business. Another survey response echoes similar problems, “Sixty days plus payment is creating a real cash flow problem for us. We have had to pay therapists at the end of the month that services were performed, yet we are sometimes not paid for two months. We don't have an extra $30,000 sitting around to fill in this gap. HELP!”

These problems gained attention months ago in a QIC meeting when we enquired as to why 20% of the providers responded negatively. In essence, the County requested for more time to gather the comments and would respond in a future QIC assembly.

QIC – Two months later when the raw survey responses were delivered, it appeared closer to 70% of contracted providers responded to the survey negatively when the evidence was produced. The QIC Chair, Donna Dahl asked if the committee wanted to do anything with this information. Then out of a quiet

Follow-up –
I contacted Sherry Matsumoto after QIC to set up a meeting to make sense of these complaints against the Riverside County Mental Health. Subsequently, I contacted, Ms. Dahl as to the payment TERMS the county has with providers. She indicated most claims are processed within 3 days of receipt, and, per their CC3 reports, 99% of all processed claims are usually compiled the second week of the month, and then delivered downtown to the Auditor for the actual check writing, which could delay the check an additional 4 to 10 days. Although, Ms. Dahl cautioned, the Auditor occasionally takes longer to send out checks, “for example at year end when they are closing out books and are very busy.”

This information indicates that 99% of the provider payments could fluctuate from 10 to 44 days (3 day process + 31 day month + 10 Auditor). And longer if the county Auditor is delayed. And, there is another glitch, there are delays if the provider needs additional authorization because their clients need and/or are using more services.

Our Results –
Causing Additional Delays in Payment

After reviewing, and coding the negative responses (over 70%) from providers, we have found the largest complaint concerned a whopping 29% communication problem followed by 24% griping about the enormous paperwork. Also, about twice as many complained about slow pay as to low pay. 13% complained about problems with treatment authorization,

 

9% were upset of payments getting delayed for picky documentation, and last, some complained that the Central Access Team (CAT) was difficult to work with. Additionally, some providers are so upset; they refuse, or limit their work with the county.

Perspective —
Ms. Dahl indicated that 148 providers were paid this month, and the total claims for providers could vary from 3000 to 4500. Doing the math, that averages to about 25 claims per provider.

Of Concern —
Out of the 66 providers that responded to the survey, 47 were negative, 11 positive, and 8 were neutral.

Experience —
From my experience, most venders (providers) will not respond negatively to their customers (county) and place their business in jeopardy. We are surprised 47 providers were brave enough to respond negatively.

Recommendation —
QIC explore via sub-committee areas/methods/follow-up to improve the following:

• communication,
• streamline paperwork,
• expediting treatment authorization requests,
• payment delays

Please see back pages for results. We will revisit this important issue in future issues of PIN.