The ubiquity of cell phones has made it easier for people to call for help when they're experiencing or witnessing an emergency. It’s hard to argue that expanded access to help is a bad thing. But it also means that the cities need to be prepared to deal with many more calls.
The latest performance report from the San Francisco Comptroller's office notes that in 2010, dispatchers answered 91 percent of emergency calls within 10 seconds. In 2014, that had dropped to 77 percent. One major reason is the sheer volume of calls. By 2014, the number of calls was 130 percent of the 2007-2010 volume. In the first three months of 2015, it was 141 percent of the earlier period.
The waiting time data from the Motor Vehicle Division in Arizona show that in 2014, the division succeeded in achieving its goal of an average 23 minutes of waiting. No doubt the men and women who came up with that number were operating in good faith. But it turns out that many customers at the MVD had a very different experience.
When the Attorney General investigated, it found that the 23 minute average reflected the time from when “customer receives a numbered ticket until he/she reaches a customer service window. It does not capture the time spent waiting to receive a numbered ticket or the time to complete a transaction after leaving a customer service window."
The AG’s office employed people -- so called mystery shoppers -- to seek services at seven field offices of the Motor Vehicle Division. They recorded their experiences, and they were actually there up to 88 minutes. Worse yet, from July 2013 to April 2014, nearly 39,000 customers weren't able to complete their transactions on the first visit, regardless of how short their wait was.
While we’ve long been supporters of the use of performance measurement, we have to admit that there are certain challenges that can make it difficult to implement these efforts. For example, there are often several factors that contribute to a specific outcome and it can be difficult to figure out how to parse out causes and effects. One area in which this is particularly true is economic development. A solid example from a recent New York audit: One of the aims of contracted-out advertising was to promote New York tourist attractions, including the Baseball Hall of Fame, which did experience a 17 percent increase in attendance in 2014. But to what extent was this attributable to the advertising? The audit points out that it could also have been related to the selection of Joe Torre as a new honoree. Selections of hall of famers for the previous year had all died prior to 1940.
It’s hard for mayors to increase property taxes without putting their political futures on the line. But Philadelphia Mayor Michael Nutter, who's recommending a 9.3 percent property tax increase next year, is buttressing his argument with easy-to-understand information available to all taxpayers. According to an article in Technical.ly Philly, his administration has produced a new website that “lays out exactly how much your taxes would rise under the new rate and where they would go.” All the taxes would go to schools, but the piece explains “what schools the money would go to and what it would pay for there, like support staff or equipment.”
Whether the tax passes or not, we love the idea of using transparent information to inform the public’s thinking.
In July 2011, Wisconsin began contracting with private vendors, known as transportation brokers, to coordinate the state’s non-emergency medical transportation. But multiple complaints from people who have used the service spurred an audit, which found that “over 49 percent of the people responding to a survey indicated that they had experienced instances in which they had missed or had to reschedule their appointments because drivers arrived more than 15 minutes late to pick them up or did not arrive at all.” What’s more, a little more than one in four people said that they never got picked up for a return trip home at all.
What should the state do to get better service out of brokers? Among the audit recommendations were developing better performance standards, enforcing provisions in contracts that require a speedy response to every complaint, and putting a cap on the number or percentage of late trips permitted each month without punitive actions.
In an effort to find efficiency reforms for North Carolina, the state entered a $3 million contract with Deloitte to find ways to improve management. One of the project’s goals was to restructure the state’s approach to information technology (IT). In early May, Deloitte explained some of the major hurdles the state would have to overcome -- many of which are also common in other states. Less than 25 percent of the state’s 2,600 IT professionals work for the Office of Information Technology Services. The rest are scattered across more than two dozen agencies. This means the state’s IT offices can’t join forces to find shared solutions to technology problems. Moreover, reasonable sums of money can be saved through economies of scale when agencies join forces to make purchases. Meanwhile, about three-quarters of IT projects came in over budget and behind schedule.
"Business and public administration are alike only in all unimportant respects." -- Wallace Sayre, professor of political science at Columbia University
The people who run states and cities are often more concerned with passing good policy than making sure it’s well-implemented. After all, it’s a lot more fun to crash a bottle of champagne on a newly launched ship than it is to steer it through a storm.
Louisiana has gotten waivers from the federal government’s Centers for Medicare and Medicaid Services (CMS) for creating home- and community-based services for people who need long-term care, like the frail elderly or developmentally disabled. This is an alternative to much more expensive institutionally-based care.
As of October 2014, there were 54,677 people waiting to get these services, according to an audit released at the end of April. As of 2014, the legislature had authorized only 18,833 slots. Even then, some 2,862 were left unoccupied. According to the audit, the gap between promises and deliveries is largely “due to budget constraints, attrition and processing time.” What’s more, some 1,070 slots are reserved for special populations, including those in emergency situations, foster children and individuals with Amyotrophic Lateral Sclerosis (ALS), regardless of whether there are enough people who fit into those categories.
One of the ways that Medicaid has attempted to control health costs has been by encouraging hospitals to limit patients’ overnight stays. But like so many other efforts that make intuitive sense, this policy may not be that effective. A May 12 abstract from the National Bureau of Economic Research looked specifically at Medicare and found that extending an inpatient hospital stay may actually help to improve outcomes and save money.
According to the abstract, “20 percent of Medicare patients are readmitted to the hospital within 30 days of discharge, resulting in substantial costs and potentially negative health care outcomes.” For example, for heart attack and pneumonia patients, “Keeping patients for one more day can potentially save five to six times as many lives over outpatient programs.”
At a time when managed care companies are getting a growing share of the state Medicaid market (now covering about three-quarters of all Medicaid recipients, according to the Henry J. Kaiser Foundation) the following seems pretty alarming. It comes from the Department of Health and Human Services Medicaid Fraud Control Unit’s Fiscal Year 2014 Annual Report that came out in April: “Managed care entities lacked the incentive to detect and refer potential fraud ... ” Why? According to the report, managed care companies don’t benefit if a Medicaid fraud unit gets a settlement since many contracts don’t allow them to get a portion of that recovery.