News Column

La Frontera continues staff reductions

July 19, 2014

By Diana Alba Soular, Las Cruces Sun-News, N.M.

July 19--LAS CRUCES -- Staff numbers have continued to drop at a firm handling Medicaid-funded care for southern New Mexico residents with mental illness and addictions.

The Tucson, Arizona-based La Frontera has reduced staffing from the 400 employees it inherited after being brought in by the state in the summer of 2013 to replace six nonprofits that are being investigated by the state Attorney General's Office for possible overbilling and fraud. Also, a number of staff have quit, La Frontera officials and employees said.

Meanwhile, some employees of La Frontera's Las Cruces operations said the reductions, extra paperwork requirements and computer system changes are adding to an already-heavy workload, prompting high stress and low morale in throughout the workplace. They said the situation is resulting in paperwork errors and is affecting services to clients -- low-income Las Crucens who struggle with drug problems, schizophrenia, bipolar disorder or other behavioral health woes.

Further drop

Presently, there 313 employees working in La Frontera's New Mexico operations, said Mary Jo Silcox, La Frontera's Las Cruces-based executive director.

That's about 22 percent -- or 87 people -- fewer than the staffing level when the firm took over as a provider.

Since April, eight people have been fired for performance reasons, and those were "mostly in Las Cruces," Silcox said. Their positions were eliminated. Another seven people resigned in May and June, Silcox said. Of those seven resignations, some will be filled with new hires, but some won't.

The recent reductions follow an earlier wave of layoffs, firings and resignations that happened in the first few months of 2014.

Arizona-based La Frontera CEO Dan Ranieri said the organization in January determined it had 60 people too many on its payroll, and because the nonprofit was losing money, it needed to bring spending in line with revenues. After the first wave of staffing reductions, La Frontera tried other steps, he said.

"We were hoping to increase productivity (of employees) and do some other expense reductions to be able to break even," he said.

But that didn't cut expenses enough, Ranieri said. Because personnel makes up more than 70 percent of the group's costs, that was a key area to cut, he said.

"The options were either to do layoffs or cut everybody's pay," he said. "We're basically trying to stabilize the organization financially."

In reducing personnel, Ranieri said administrators "tried to reduce staff for folks who weren't actually seeing clients."

"When we did do reductions on the clinical side, it would be with staff whose service delivery wasn't particularly high," he said.

Ranieri said most clinical employees must spend between 100 and 125 hours of time with clients each month.

"The minimum we require is 100," Silcox said. "The goal is really to get to 125."

Hours spent with clients is the basis for the agency billing for its services.

Employees in two specific programs that are more time-intensive to carry out than others don't have the same benchmarks, Silcox said.

Therapists who formerly worked for Southwest Counseling Center -- a Las Cruces nonprofit pushed out by the state in the behavioral health-care shake-up -- said they were required to provide slightly more than 100 hours of client service per month, a metric tracked closely by that agency.

Ranieri said some of the staffing reductions resulted from changes to the standards for what's billable to Medicaid, which have been "tightened up" over the past year. Plus, some new caps have been set on the amount of certain types of services that are provided to children.

"Consequently, we're not providing as much service," he said.

Workplace pressures

Several staff members have quit La Frontera because of displeasure -- for several reasons -- over work conditions, some Las Cruces-based employees said.

As employees resign, are laid off or are fired from La Frontera, their caseloads have been redistributed to remaining employees, said some La Frontera staff. And that has increased their stress level.

Clinical staff at La Frontera said they're squeezed between conflicting pressures. On one hand, they're mandated to meet hours-of-service benchmarks with clients. But paperwork requirements -- and the time it takes to fill those out -- also have increased.

"We cannot keep up with the numbers if they keep inundating us with paperwork," said one Las Cruces-based La Frontera employee, whose identity is being withheld because of concerns about retaliation. "It's resulted in burnout for the clinicians."

Ranieri said key reasons La Frontera is now a state provider are because "a lot of billings weren't done properly and documentations weren't done properly." But it's part of the job of La Frontera employees to keep on top of that paperwork, he said.

"I've been in this business 38 years, and that's the piece that has changed the most," he said. "The documentation has gotten so much more cumbersome. But we don't make those rules."

Officials with Southwest Counseling Center and Families & Youth Inc., two Las Cruces agencies, have denied any wrongdoing in their Medicaid billing and operations. The allegations came from a consultant's audit for the Health Services Department that found 15 agencies in New Mexico may have overbilled Medicaid for more than $36 million. The AG's Office has since cleared two of the agencies, The Counseling Center in Alamogordo and Easter Seals El Mirador in Santa Fe, though HSD has reopened the overbilling case of Easter Seals with the Attorney General's Office.

An investigation into the remaining behavioral health providers is ongoing.

Arizona vs. New Mexico

Meanwhile, some employees said there's a disconnect in Las Cruces between employees of the former nonprofit providers and administrators. Some employees believe administrators are trying to impose Arizona's mental health care practices in New Mexico, a state with different rules. There's also a culture clash and a lot of distrust because of the firings and layoffs, they said.

"It's really us against them: Arizona and New Mexico," said the La Frontera employee whose identity is being withheld.

There's only been one administrator from Arizona who's been moved to New Mexico, Ranieri said. He said he understands why there would be tension after colleagues are terminated or laid off. But he said the reality was the organization had to reduce its costs.

Another La Frontera staff member in Las Cruces said clients -- many of whom tend to fare better with consistency -- feel the impacts of stressed-out therapists and rapidly changing personnel. In some cases, certain documents -- treatment plans that are a road map to a patient's care -- are expired, thanks to the changes in personnel and larger caseloads, the employee said.

"The turnaround on clinical staff does affect the clients," said the employee, whose identity also is being withheld.

Records tumult

Employees said their workplace problems are compounded by a series of changing records-keeping systems at La Frontera over the past year.

In the first few days of La Frontera's operations a year ago, many employees didn't have computers because the previous organizations had taken them when they vacated their offices, making way for the new provider.

Employees of the former Southwest Counseling Center, who transferred to La Frontera's payroll after the state suspended Medicaid funding to the agency, said they started out hand writing their official records because of the lack of computers. Then, they got computers after a few weeks but those didn't have medical and clinical records-keeping software. Eventually, they were given the software, but that program crashed toward the end of 2013, and a new program -- one on which staff had little training -- took its place.

Employees said the chaos with the record keeping, along with turnover in staff, contributed to incomplete client files, as well as adding to the difficulty of their jobs.

Ranieri acknowledged there have been several changes in the record-keeping systems. And that has led to extra work for employees, particularly because the newest software is still being implemented. But he said once that process finishes, record-keeping will be much smoother.

"I'm a clinician and psychologist by training, and if the medical records aren't working smoothly, it's a nightmare," he said. "But the bottom line is, it's not like we're doing something evil to them. That's how you run a business nowadays; that's part of the job."

Problems caused by the medical records, however, are "not the reason people get let go," Ranieri said. Rather, he contended, that's because of shortcomings in job performance.

"Some of that's true, but people exaggerate it to fit their story," he said of the impact of the record-keeping changes.

Subsidies cut

On Jan. 1, the state stopped subsidies to La Frontera and other new behavioral health care providers within New Mexico, meaning they now get the bulk of their funding via Medicaid billing.

That's how Families & Youth Inc., a Las Cruces nonprofit that provided child behavioral health care, and Southwest Counseling Center, which provided mainly adult behavioral health care, operated for years before the shake-up. They were two of the six firms replaced by La Frontera in southern New Mexico.

Jose Frietze, chief executive director for Families & Youth Inc., said his nonprofit, too, was losing money -- about $200,000 a month before the state swept in. He said "almost every agency taken over by the state" lost money, if only revenue from Medicaid client billing was factored in.

"The system was underfunded," he said.

But Frietze said he didn't want to cut staff levels at Families and Youth Inc. because the demand for services from clients was high.

"We had lost money but we looked for ways to close that gap, through grants and other sources," he said. "We just weren't ready to close the doors and get rid of people and services because those were essential services."

Almost stable?

Ranieri said La Frontera's goal was to reach financial stability by July 1. While the final numbers aren't in, the organization was headed in the right direction with fewer losses each month. He said employees likely will notice it's smoother.

"But the work load demands in terms of the service delivery -- that's not going to change, and for some people that's an issue," he said.

With the expansion of eligibility for Medicaid under the federal Affordable Care Act, there will be more potential clients in Las Cruces going forward, Ranieri said. That could result in the need for more staff.

"I think it's happening, but it's happening slowly," he said the ramp up in demand.

Still, the Affordable Care Act also opened the door for traditional primary medical care providers to enter the arena of mental health care, which could dampen any new demand for La Frontera's services.

Diana Alba Soular may be reached at 575-541-5443.

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(c)2014 the Las Cruces Sun-News (Las Cruces, N.M.)

Visit the Las Cruces Sun-News (Las Cruces, N.M.) at www.lcsun-news.com

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Source: Las Cruces Sun-News (NM)


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