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Pos Provider Salary Cost Review

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Presented to Executive Office of Health and Human Service

Presented to Executive Office of Health and Human Service

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  • For DCM, Non-Spe DC and DCS, there is a very strong, significant correlation between the variation in ave salaries by region and the COLA index.
  • Largely explained by a greater proportion of DPH FTEs in this region than other Depts. DPH ave salaries tend to be higher for Clinical positions.
  • No single Dept consistently provides for a higher ave salary across staff categories.
  • Transcript

    • 1. A Salary Analysis of the Purchase of Service (POS) System
      By: Yuanjing Ren
      Instructor: A. James. Lee
      May 2010
      University of Massachusetts Lowell
    • 2. Background – EOHHS POS system
      EOHHS and its 14 agencies relays on a network of 1000 + independent, large non-profit providers to deliver a wide range of human services to vulnerable populations.
      Services delivered include child welfare, public health services, substance abuse treatment, shelter for the homeless, home care for disabled or mentally ill, children with physical/mental problems, family support programs, adoption programs and other social services.
      EOHHS
    • 3. Background – Rate-Setting Process
      Some providers have contracts with multiple Departments and thus have to negotiate and execute separate contracts with each department, with different reimbursement rates being set for the same services by different departments.
      Every fiscal year, EOHHS negotiates with thousands providers individually regarding the Department-specific contracts. The procurement process is unnecessarily time-consuming and costly, with much potential for efficiency improvement.
    • 4. Background – Chapter 257
      Chapter 257 of Acts of 2008 gives EOHHS the authority of determining the fair salary distribution of the services providers. Within a four year timeframe, EOHHS and DHCFP will work to streamline the contracting process and procurement cycles in general, including cost analysis and rate development of similar types of services.
      Secretariat Master Agreements¹ will be used to enable every provider to just have one Master contract that can be applied across POS Departments.
      A panel of qualified members of the provider community will be invited.
      Chapter 257 will transform the current cost reimbursement system to a unit rate prospective rate system.
      ¹ The “Master Agreement” is an existing, more flexible OSD purchasing and contract management framework.
    • 5. Chapter 257 Reform (illustration)
      Providers
      Purchasing Department
      Purchasing Department
      Purchasing Department
      Purchasing Department
      Purchasing Department
      Purchasing Department
      Providers
      Dept
      Secretariat Master Agreements
      • By Service Class
      • 6. DHCFP rate schedules
      Dept
      Dept
      Dept
      Dept
      Dept
      Dept
      Secretariat Master Agreements
      • Panel of qualified providers
      • 7. Departments purchase via rate agreements
      Dept
      Dept
      Dept
      Dept
      Dept
      Dept
      Dept
      Source: Chapter 257 of the Acts of 2008. Provider Information & Dialogue Session: Family Stabilization Service Class
    • 8. Analytic Methodologies
      Outline
      To develop a database of salary cost of the POS system
      Outliers identification andexclusion
      General salary cost review
      Regional Variation Impact Analysis
      Departmental Variation Impact Analysis
      Policy implications
    • 9. Data Source
      FY08 and FY09 UFR Schedule B
      EOHHS region Map
      - Islands, Boston, NE, SE, West, Central
      MA Town & City Cost of living index
      Massachusetts Minimum Wage Law
    • 10.
    • 11. For ease of analysis, positions were classified into 6 main categories
    • 12. Sample characteristics
      • The sample excluded outliers that were outside of +/- 2 Standard Deviation from the Mean for each position.
      * 2009 data was pulled in February 2010, when it was too early to expect a full data set.
    • 13. Change in Average Weighted Salary by staff Categories, FY08 - FY09
      The decrease in Medical staff salary was driven largely by a 5% decrease in the average RN salary.
    • 14. Sample characteristics
    • 15. General Salary Review - 2008
    • 16. General Salary Review - 2009
    • 17. Regional Analysis
    • 18. Regional Variance, 08
    • 19. Regional Variance, 09
    • 20. COLA Vs. Relative Average Regional Salary Levels
      • The relative average regional salary ratio is the average salary of one certain region divided by the average salary of the state.
      • 21. The weighted average for COLA index and Relative Average Regional Salary ratios is 1.00.
      • 22. *The sample size for Island is insufficient
    • Regional analysis
    • 23. Regional analysis
      DPH FTEs
    • 24. Departmental Analysis
    • 25. Departmental Variance, 08
    • 26. Departmental Variance, 09
    • 27. Direct Care Management Category
      This pattern is consistent for all positions within the DCM category, with the exception of Supervising Professional, which has a small number of FTEs.
    • 28. Medical Category – position level
      RN is the most commonly funded Medical position.
      Ave salary for RNs funded through Elder Affairs is substantially lower than for other departments.
    • 29. Clinical Category – position level
    • 30. Policy Implications
      • A fair salary distribution across region and purchasing department is critical for providers to retain the quality staff, keep organizations in good financial health, stabilize the human service industry and deliver quality human services.
      • 31. Salary rates for knowledge-intensive positions are obviously higher than low-knowledge-intensive positions. Similarly, the variations are higher in knowledge-intensive position.
      • 32. For most staff categories, the average regional salaries are strongly associated with the market-based cost of living expenses. Factoring regional differences into POS rates would result in consistently lower rates for some regions and higher rates for others.
    • Policy Implications (Continued)
      • The departmental reimbursement rate is closely associated with the population size it serves and the financial health of the purchasing dept.
      • 33. Departmental preferences for Doctorate and MA level staffs could explain most of the variation in Medical and Clinical staff salaries.
      • 34. Departments and providers frequently comment that many of the Direct Care position titles are interchangeable and vaguely defined. A reworking of the UFR Direct Care titles and definitions may be helpful.
      • 35. More study is needed to ascertain whether departmental salary variations within a staff category or position reflect differences in staff qualifications that are not captured in the UFR, or inequity between departments

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