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Item P10 Revised 3/99 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date:_February 21/22, 2001 Division: County Administrator Bulk Item: Yes X No Department: County Administrator AGENDA ITEM WORDING: Approval to conduct an Operational Study of the Monroe County Social Services Transportation Department and the County Community Transportation Coordinator (CTC), Marathon Guidance Clinic by the Florida Commission for the Transportation Disadvantaged (FCTD) in Tallahassee. ITEM BACKGROUND: The Operational Study is scheduled to be conducted during the week of March 26, 2001 by two personnel from the State FCTD Office. A final report will be issued by the State FCTD Office with recommendations for the BOCC to consider in improving the efficiency, effectiveness, and cost saving measures concerning Social Services Transportation and the County CTC as determined by the Operational Study. The County will underwrite the costs of the Operational Study by paying onlv for all Per Diem expenses incurred for the transportation, lodging and meals of the State Officials. The estimated costs for the five-day period should not exceed $3,000. The Community Services Division Director will be the County liaison for the Operational Study Team and will make all arrangements required to support the Operational Study visit. Samples of previous Operational and Technical studies are attached for information and review by the BOCC. PREVIOUS RELEVANT BOCC ACTION: Discussion of a study at previous BOCC meetings, and previous direction to the County Administrator to arrange for an outside agency to conduct a study of the Social Services Transportation. STAFF RECOMMENDATION: Approval. TOTAL COST: Not to exceed $3000 BUDGETED: Yes No X COST TO COUNTY: _$3000 (estimate) REVENUE PRODUCING: Yes No X AMOUNT PER MONTH N/A YEAR N/A APPROVEO BY: COUNTY ATTY NJA OMB/PURCHASING ~ANAGEMENT N/A -~ DIVISION DIRECTOR APPROVAL: -0--.L:::. DIVISION DIRECTOR NAME: JAMES L. Roberts, County Administrator DOCUMENTATION: INCLUDED: YES TO FOllOW: D NOT REQUIRED: D DISPOSITION: AGENDA ITEM #: kB.O. RClI....'_'_'OI.... TrllllPOrtatlolt Disadvantaged Jeb Bush &wmor Peter Gianino Ch.irptlT$on Kenneth R. Filcher Viell' Chairprrnon Jo Ann Hutchinson Ellll'Cutivll' Dil't!Ctor February 2. 2001 James E. Malloch, Director Monroe County Community Services Division 5100 College Road Key West, Flonda 33040 RE: Monroe County Transportation Operational Study Dear Mr. Malloch: Through a series of telephone conversations with you, the Commission has agreed to conduct an Operational Study on the Monroe County Government Transportation system_ This agreement includes the assumption of financial responsibility by Monroe County Government for airfare, rental car. hotel. meals and other associated expenditures for conducting a full operational study of the transportation system operated by the Monroe County Government. The following are issues that have been negotiated and agreed upon: . The Commission will send Edward Griffin, Technical Assistance and Training Supervisor and Ronnie Atkins. Financial Auditor, to conduct the Monroe County Public Transportation Operational Study. . The Monroe County Government agrees to front and absorb all travel expenditures associated with the Operational Study, (Airfare. Rental Car, Hotel Accommodations, Meals. etc.) for two Commission staff. . The Commission will conduct entrance and exit interviews with the supervisory and management personnel directly involved in the day-to-day operations and administration of Monroe County Government's public transportation system. . The Commission will form a written report that encompasses findings and suggestions that may improve system cost effectiveness and efficiencies, and . Submit the report to the Monroe County Community Services Division Director after finalization. Should you require further information, please contact Mary Constiner or Edward Griffin of the Commission Technical Assistance staff either 605 Suwannee Street. MU9 · lelllh.n... FI32399.0450 . Phone: 18501488-6036 . ToU-tree: 180Ul 983.2435. TOO only: 18001848-6084 · Fax: IB501922.7278 WWW.dDt.lt.t..t1.usJc:td Page Two Monroe County Transportation Operational Study February 2, 2001 by telephone at 850-488-6036 or through E-mail at marv. constiner@dot.state.fI.us or edward. ariffin@dot. state. fl. us. Jo Ann Hutchinson Executive Director JAH: me c: Mary Constiner, South Florida Manager Edward I. Griffin, Technical Assistance and Training Supervisor Ronnie Atkins, Financial Auditor TECHNICAL ASSISTANCE OPERATIONAL STUDY Central Florida Regional Transportation Authority (L YNX) COMMUNITY TRANSPORTATION COORDINATOR ORANGE, OSCEOLA, AND SEMINOLE COUNTIES Prepared by: Edward I. Griffin Technical Assistance and Training Team Administrator Commission for the Transportation Disadvantaged December 15, 2000 A technical assistance operational study of the Central Florida Regional Transportation Authority, (LYNX), Community Transportation Coordinator, (CTC), of Orange, Osceola and Seminole Counties, was requested by the Executive Director of the Commission for the Transportation Disadvantaged (CTD). This action was taken as the result of a documented and continuing increase in complaints registered through the Commission's Ombudsman Program regarding quality of service and other service related issues. The operational study was conducted in concert with a special review of the Commission's Quality Assurance and Program Evaluation (QAPE) Section, as well as a review by the Advocacy Center for Persons With Disabilities. This study will be released by the Commission along with the QAPE review in an effort to provide LYNX with a comprehensive report by which to gauge future planning efforts for improvement of the system. Discussions with staff prior to this visit indicated that the system was at a transition crossroads regarding several issues. Among them were restructuring the organization of the system regarding coordination of services, the use and contracting with operators, consideration of the purchase and deployment of new transportation management software, and an evaluation of staffing functions and positioning of the coordinated system within the existing LYNX infrastructure. Edward Griffin, Technical Assistance and Training Team Administrator, conducted a brief study of the components of the LYNX system that deal with functions related to its capacity as the CTC for this area on November 15-17, 2000. The primary issues examined in this study include the following transportation areas that deal with operations and administrative efficiency and effectiveness: A. Organizational Structure B. Call Center Staffing and General Office Administration C. Call Center Trip Reservations D. Call Center Dispatch and Carrier Communications E. Carrier Trip Assignments and Scheduling F. Eligibility Verification, Assessment and Trip Reconciliation G. Complaint Process H. Contracted Operator Observations/Relations I. Transportation Management Software and Computer Hardware Issues J. Mass Transit Bus Pass Utilization K. Other Issues eTO Technical Assistance Operational Study ') On November 15, 2000, Mr. Griffin and Mr. John Irvine of the Commission's TAT and QAPE Sections and Mr. Corey Hinds of the Advocacy Center for Persons With Disabilities met with the following LYNX staff for the purpose of conducting an entrance interview to outline the issues that were to be addressed during the operational study and quality assurance review. Mr. Hinds indicated that he would be shadowing Commission staff and would focus primarily on the complaint process and how it is resolved, and issues specifically relating to Title II and III of the Americans with Disabilities Act (ADA). It was also the intent for purposes of the operational study to interview LYNX staff and allow them to identify specific areas that they felt should receive attention. Present were: Byron Brooks - Interim Executive Director Bill Schneeman - Director of Transit Operations Ernest Kelly - Director of Communications Barbara Parker - Manager of Customer Services Ron Jones - Manager of Paratransit Edward Johnson - Manager of Project Development Vince Stevens - Metroplan Orlando, staff to Local Coordinating Board Following the initial introductory statements by Commission staff and Mr. Hinds, LYNX staff shared observations regarding their assessment of issues that contributed to the problems that resulted in a marked increase in complaints by passengers. Mr. Schneeman observed that problems with the telephone system and the handling of intake calls for reservations and customer service contributed heavily to consumer dissatisfaction. He also was very concerned with the on-time performance of contracted operators, and felt that the poor performance needed to be corrected. It was pointed out that there had been no increase in rates paid to operators in four years or rates charged to participating agencies in the coordinated system since 1992. Mr. Jones presented copies of a very comprehensive PowerPoint presentation that had been presented to the LYNX Board of Directors on October 25, 2000, entitled State of Para transit. The document served as an overview of the paratransit system, how it ties into the LYNX system, the many components of the system, and keys issues and challenges related to its implementation. The introduction included an acknowledgment of common concerns and complaints, including: ~ Punctuality ~ Safety ~ Telephone Hold Time ~ Driver Courtesy ~ Carriers ~ Late Pickups/Missed Trips CTO Technical Assistance Operational Study ., .) These observations were taken from public comment as the result of public hearings related to an increase in the ADA fare. The key points that LYNX staff made to the Board of Directors regarding the future of the A+Link Paratransit system were: ~ Continuing obligation to provide Complimentary ADA service and financial impact ~ Increased responsibilities of LYNX in its role as the Community Transportation Coordinator (CTC) ~ Increase in paratransit ridership of 77% over the last four years ~ Contracted carrier rates not increased in four years ,. Funding for paratransit has not increased in over five years ,. LYNX is nearing 10% limitation on Federal Funds used for ADA services ~ Contractual relationship with contracted carriers In addition to outlining the key issues facing the system and its decision makers, LYNX staff outlined specific policy issues that needed to be explored. Among these were: ~ Understanding and reviewing the role of LYNX as the CTC for the three county area ~ Reviewing the contractual relationship with operators and addressing the rates ~ Exploring service delivery options between true out sourcing and full service in- house ~ Addressing funding sources and discussion of adequacy of rates ~ Discussion of service delivery for citizens beyond ADA requirements Within the outline of all the key issues and policy elements presented were the following recommendations/actions for resolution of problem areas: ~ Selection of Consultant Team for: o Comprehensive assessment of current system and service delivery o Conduct nationwide best practices comparison o Develop model for in-house vs. outsource evaluation ~ Conduct Forums with: o LYNX Accessibility Advisory Committee o Counties' Disability Advisory Boards o Social Service Agencies impacted by transportation issues ,. On-going Administrative Actions: o Transportation Management Software Upgrade o Filling of Customer Service positions as approved by Board o Special meeting with Contracted Operators to address: · Available Capacity · Contract Compliance · On time Performance CTO Technical Assistance Operational Study 4 ~ Special Review and Operational Study by Commission for the Transportation Disadvantaged This document lends credence to the observation that LYNX staff are acutely aware of the serious issues that face LYNX, particularly the A+Link paratransit part of the total delivery model. In addition, it is encouraging that they recognize that external assistance is necessary in order to objectively review the program and make the necessary recommendations. Within the purview of this operational study, many of the issues outlined in the LYNX document will be discussed and suggestions for improvement will be offered. Other issues that were discussed in the entrance interview included difficulties in implementing the integration of fixed-route and paratransit customer service into a single call center unit, and significant issues regarding funding streams, in particular as it relates to the Medicaid Program. It was noted that the low unemployment rate in Orlando made it difficult to recruit and retain qualified staff for the call center. Mr. Schneeman expressed considerable frustration with the implementation of all of the administrative components of Medicaid service delivery, including eligibility determination, electronic billing and claim resolution and denied claims. We discussed the fact that many of these issues were time intensive and at times problematic, but that the requirements were part of Federal and State guidelines and for the most part could not be changed. Coupled with this discussion was the distress with the stagnant rates that are charged to all agencies, including Medicaid, and the frustration with working to amend them to acceptable levels. It was recognized that the downside for funding streams such as TO was that increased rates translated into fewer trips for passengers. Mr. Schneeman stated that the resolution of the rate issue was central to the development of a business plan for the A+Link system, looking at system costs and appropriate compensation for services. Another component of the funding issue that is cause for great concern at LYNX and for most transit properties is the problem of "client dumping" by agencies. Florida Statutes Chapter 427, which governs the Transportation Disadvantaged program, specifically prohibits the transportation of passengers under TO funding, if other agency funding is available to be directed for that purpose. ADA regulations are somewhat more vague, but it remains a problem when agencies take a position that their clients are eligible for ADA paratransit when they have historically sponsored their transportation to agency funded activities. Staff also expressed concern over the lack of standardization between programs, (Medicaid, ADA, Developmental Services, TO, etc.), particularly as it relates to reporting, billing and eligibility. At the risk of not appearing empathetic to their concerns, it was pointed out that this was at the core of the philosophy of coordination of services. A delivery model is shaped that will best meet the needs of all purchasing agencies within a reasonable structure, and within that structure each "nuance" of each funding stream is to be accommodated, be it special reports (DOT, TO), special eligibility verification (Medicaid), or special billing requirements (some Medicaid Waiver Programs). Through this CTD Technical Assistance Operational Study 5 discussion, it became clear that the majority of staff participating in the entrance interview and now charged with oversight of the program, had come from strict transit (fixed-route) backgrounds and had limited understanding and knowledge of the Florida TO Program and specifically the roles and functions of the Community Transportation Coordinator. This is not intended to be a criticism, only an observation that will lend support to recommendations later in this report for training of LYNX staff at all levels involved with the TO program on the basic functions of the program and responsibilities of the CTC. Finally, staff asked for any observations and suggested actions that could improve their relationship with their contracted operators, including recommendations for a better business model to ensure better service. Portions of three days were spent with LYNX staff dedicated to the administration of the coordinated system as well as contracted operators and consumer advocates to conduct interviews and make observations to address the overall concerns of the coordinated transportation system. The following report is a brief synopsis of this study, and should be used as a guide in the planning process as changes are being considered and implemented. A. Organizational Structure Observations: In moving throughout the A+Link program offices, it was clear that there was some disconnect in the reporting hierarchy between the specific "units" of responsibility. At the time, Byron Brooks served as the "Interim" Executive Director of LYNX, and Bill Schneeman the Director of Transit Operations, responsible for direct oversight of A+Link and many other facets of LYNX operations as is Mr. Ernest Kelly, Director of Communications. Other Managers and Directors report to Mr. Schneeman and Mr. Kelly, but sometimes the responsibilities do not seem to match the area of management. An example of this is that the area controlling the reconciliation of passenger trip data, and ultimately responsible for reconciling data that will be used in the compilation of billing invoices, reports to the Director of Communications. The Manager of Paratransit, Ron Jones, reports to Mr. Schneeman, however, although his title would suggest overall ovePsight for the program, his functions are limited to oversight of the contracted operators and the supervision of two staff dedicated to road supervision. Staff dedicated to the call center intake process report to the Director of Communications, however, so do data entry and complaint processing staff. This does not allow for a proper flow of information as it relates to the administration of the system and its relationship with direct service delivery. Many staff expressed frustration with actions from one department that affected their productivity, but were not clear on how to communicate this fact, or to whom. Improvement Action Plans: Although we are not prepared to suggest specific staffing levels for each department or eTO Technical Assistance Operational Study 6 "unit", or to assign specific units to particular managers, it is certainly an area that needs to be addressed either internally or through an external comprehensive assessment of the program. Our impressions from conversations with internal staff and external customers was that the staffing issue that caused the greatest concern and confusion was the lack of one person that they could identify as responsible for oversight of the entire program. This position would be similar to that of a General Manager, armed with a vision of the total delivery model and clearly versed in the functions of paratransit operations and the administrative duties comprised within the role as CTC. Many staff felt confused as to who was ultimately able to resolve problems or bring the right people to the table to resolve issues, and the designation of this oversight position would help ease communication problems. B. Call Center Staffing and General Office Administration Observations: Our observations regarding this area centered around interviews with Barbara Parker, Manager of Customer Services, Ron Jones, Manager of Paratransit and Jacqueline McCall, Customer Service Supervisor. This area probably saw the most significant changes in operation when LYNX brought all CTC related functions in-house following the departure of the management services firm that had provided those functions for nearly four years. LYNX staff took over those functions in March 1999, and the LYNX fixed-route staff were united into a single call center unit when all staff were moved from the South Street facility to the present facility on Amelia Street in July 2000. Ms. Parker likened this transition to one that took place with fixed-route customer service over six years ago. The ultimate goal for this unit is the implementation of a one call, one stop center for anyone requesting assistance with transportation needs, be it information regarding transit routes, van pools, ride shares, or scheduling a paratransit trip. One reason for our .visit to LYNX was the numerous complaints regarding the accessibility of the telephone lines and excessive call hold times. Shortly before our visit, the entire call center installed a "Sentinel" monitoring system to log times and activity for call center staff to gauge reservation times, call hold times, etc. This application will issue standard and ad hoc reports for better management of this area. This system had been budgeted from planned capital improvements. In addition to the Sentinel system is a Dictaphone recording /monitoring system, where conversation activity can be reviewed, downloaded, and saved for up to thirty days. There are currently 21 lines in the call center, handling over 63,400 calls per month. Also added were 17-inch computer monitors for all workstations, and the addition of five new intake positions, bringing the call center total to 22 agents for reservations/customer service. LYNX staff are very aware of the inadequacy of the present telephone system to handle the volume of calls, and have made this a priority in the assessment of the program and subsequent restructuring. The intent of the consolidation of the fixed-route and paratransit reservations/customer service units is to comply with the one stop concept that LYNX is implementing. All new CTD Technical Assistance Operational Study 7 staff are being cross-trained to handle all functions of both jobs, however, it is our understanding that personnel from the original fixed-route staff have not been cross trained to perform both functions and remain with only their original duties. Perceived disparity in workload had caused problems in the past, and if not corrected soon, will continue to add to tensions in this workplace. It is believed that cross-training will allow for more flexibility in shift schedules and allow for "floaters" to assist during vacations, sick days, etc. At the time of our visit, it had been 4 % months since the consolidation of the two units. All call center new hires are paid the same, at $8.01 starting full time, with a full benefit package. Ms. Parker felt that training was a priority for all staff, but that issues of limited space, time, and the priority of bringing call hold times down took precedent over cross-training. Since Mr. Jones and Ms. McCall came from the paratransit area of call intake/customer service, they held slightly different views. Our perception was that they felt that there was a great degree of difference in the functions of providing fixed-route customer service and handling the tasks of reservations and customer service for the paratransit side. Many of the aspects of paratransit are social service in nature, and involve many decisions and judgment calls that involve not only interaction with passengers, but with operations staff, agencies, and facilities. Mr. Jones felt it was important to point out that when the Medicaid service previously handled through United was brought into the LYNX coordinated system in October of 1999, it represented an additional 500 trips per day and was done with the existing call center staff. It was not until recently that approval was received for additional staff. This would account for some of the difficulties with handling call volume. In addition to the issue of combining fixed-route and paratransit customer service is the discussion of having separate staff handling reservations and customer service, and limiting contact with operators to key customer service agents. This had been the practice employed when these activities were under the purview of the management service entity I and until recently with the "old" LYNX system. From these perspectives, we got the impression from interviews with these staff members that an umbrella/ one stop center is a workable concept, but that a complete marriage of the units is not necessarily a workable idea. In a final observation, Ms. Parker expressed concern that the customers accessing services were not properly trained, and that staff were redoing brochures for TO I ADA I Medicaid rider information in an effort to make those publications more user friendly. Improvement Action Plans: Although we did not include this observation with the interview comments from staff, our initial impression is that the number one priority should be to address the issue of customer responsiveness, where we observed call hold times anywhere from 8 to 20 minutes. Clearly this is unacceptable, and what struck us as curious was that there was not a sense of urgency among staff to do everything possible to address the issue. Granted, there have been some additional phone lines and staff approved and installed, but there is a serious CTD Technical Assistance Operational Study 8 learning curve for these positions and it could be some time before significant improvement is seen. For this reason, we feel that management should take whatever steps necessary to recruit qualified staff, and create training rooms where staff can get "up to speed" as soon as possible. With that said, there needs to be additional train-the-trainer activity where the issues of funding streams, eligibility and client and trip input are clear to those that will be training these staff. Commission staff can assist in this activity as requested. As was stated earlier, LYNX staff should continue to advocate for an upgraded system capable of adequately handling the volume of calls. Meeting customer needs should be the number one priority for this unit, but there are underlying issues that must be resolved for this to happen. The issue of the "us vs. them" mentality that was carried over from the old structure must cease to exist for a productive environment to be created. It is thought that having everyone cross trained to all activities will erase those lines of division, and make for a more equitable workplace. Although we agree with this concept in theory, we do not see it happening in a practical application. In our estimation, the duties of handling paratransit call intake functions are vastly different from providing information regarding the fixed-route, ride share, van pool, and other services. Secondly, we support the separation of duties within the paratransit structure. It is our belief that reservations staff should be separate from customer service, and that only one or two staff should sit in the "hot seat" dealing with changes in trip requests and imparting that information to operators and making changes to carrier assignments. This communication flow and separation of duties is vital in dealing with the continual changes in the operating environment. LYNX will be seeking a comprehensive assessment of the paratransit delivery model and it is our assertion that the structure and organization of the call center should receive a great deal of attention. We can provide examples of best practices, as well as different examples of how this process is handled in other "brokerage model" systems. C. Call Center Trip Reservations Observations: For the specific function of reservations for paratransit service, our primary observations are that there needs to be more staff that are "seasoned" and well versed in their responsibilities. We recognize that many staff are new and still in the training process, but it cannot be underestimated the impact that this "initial contact" can make, not only with clients, but with the operation of the total system. Bad input or misunderstanding of the system can result in scheduling issues, missed passenger appointments, and billing errors. Our main concern is that though our interviews and observations, reservations staff were not clear on the use and input of the proper funding streams for each trip that is scheduled for a client. In many cases, ADA came up as the "default" for entry into the billing code field, but based on the type and eligibility, the trip may have been able to be billed to another funding stream, such as Medicaid. The education of reservations staff to correctly enter this field and understand the process and importance of accurate entry should be a priority. CTD Technical Assistance Operational Study 9 Another area that caused some concern was the mingling of duties between reservations and customer service. We understand that with the one-stop concept the goal is to cross- train staff to perform all functions, but for the purpose of daily implementation, the separation of duties makes more sense. Having all staff dealing with operator dispatchers and client reservations can cause confusion and disconnects in the sharing of information. Improvement Action Plans: A comprehensive training manual does not exist for new staff that are hired for the reservationsl customer service functions. The development of this training manual should be a number one priority for call center management. Veteran staff are training new hires, but there must be a guide that can be used to guarantee consistency in the implementation of procedures. Particularly important is the entry of funding steams for trips. This had been expressed as a problem by LYNX staff in discussions we had this summer at our Annual Conference in Orlando, and we forwarded a resource guide sheet to be used in determining Medicaid compensable trips. We are not sure that this document was reproduced and shared with all reservations staff, but it is used in many systems as an excellent help guide. If LYNX staff needs assistance in developing this manual. Commission staff can assist, both as a resource and providing best practices examples. D. Call Center Dispatch and Carrier Communications Observations: In previous sections we have expressed our preference for separation of duties within the call center. This practice is employed to a degree, as there is a direct dispatch line that rings into only three call center staff. These lines are for the operator dispatchers, and hospital discharge staff. Problems seem to arise when reservation agents are calling operator dispatchers directly, which not only ties up phone lines at both ends, but causes interruptions in the flow of information. A customer service agent may already be working to resolve an issue that the reservations agent is calling in about. Lead personnel that deal primarily with customer service and operator dispatch viewed this as a significant problem that needs to be addressed. Before the move to the present facility, there were dispatchers from two operators that were housed along with LYNX staff, and would have direct contact with most LYNX customer service agents and staff in their respective offices. We did not observe this practice, but we have the impression that it was not a workable model since it is no longer being used. We are not aware of its use in similar brokerage models. A recurring theme among all of the agents was frustration with the inability to reach one operator in particular, United. There is not a direct line to the dispatcher of this operator, and it is often very difficult or impossible to reach the appropriate staff to resolve problems in a timely manner. We are not sure if the operator is contractually obligated to provide a direct line, but we are aware that this was the case in previous contracts. This issue causes . problems not only for LYNX and this operator, but if information is not forwarded or CTD Technical Assistance Operational Study 10 provided, it can ultimately impact other operators in the system. A serious problem that was identified by many staff in this unit was that of many operators giving back trips, often without adequate time to assign and dispatch to another carrier. Calls come into 3 or 4 different reservations/CSR agents, and there is no central point of accountability so that patterns can be identified and shifts of service can be made with the "entire picture" of the service examined. In March of this year, Mr. Edward Mitchell was hired as Call Center Coordinator, reporting directly to Ms. Barbara Parker. Call center agents tell Mr. Mitchell if a particular operator is having a very bad day of giving back trips, but there is not a process for handling that allows for establishing patterns. Our observation is that this supports the use of a central point of contact for this task, a "hot seat", if you will, that is aware of all trips being reassigned. Mr. Mitchell is ultimately responsible for approval of the "cabbing out" of trips that are turned back by operators and cannot be assigned to another contracted operator. Reports are distributed once a month to Mr. Jones, Mr. Brooks, and Mr. Schneeman. Mr. Mitchell recognized that there were far too many cab assignments, over 3600 in a recent month that we examined. He was well aware that the use of cabs was to be "incidental" in nature only and that this was not only a programmatic issue, but very expensive for the system as well. Improvement Action Plans: An assessment of the customer servicel operator dispatch process should be conducted immediately. Since our visit, we have been forwarded local newspaper clippings that have brought a great deal of negative attention to the "cabbing' issue. To address the problem, the first course of action is to have people in authority in control of the action of "giving back" and reassigning trips. This must be monitored and denied when justified. Reports should not be monthly, but daily to the appropriate management staff. If operators are not able to fulfill their obligations, research should be conducted to find out why, and then appropriate action should be taken, including the exercising of liquidated damages and other contractual remedies as necessary. In general, this trend must not continue. As a short term solution, we would suggest the use of e-mails rather than telephone contact to alert dispatch staff about trip changes, cancellations, etc. This would allow for a "paper trail" that could help accountability, and also free up phone lines for other contacts. The use of Automatic Vehicle Locators in application with a new transportation management software product would be a long term goal that could afford relief to this problem. E. Carrier Trip Assignments and Scheduling Observations: Trips for contracted operators are not "scheduled" in the true sense of the word in the creation of manifests, but assigned to specific carriers based on the zip code origin of the trips. Operators are sent what is referred to as a pre-schedule edit list, and they are left to CTD Technical Assistance Operational Study 11 schedule their own vehicles and create their own manifests. Although there are tasks for the LYNX "schedulers" to do regarding review of the edit lists and assignment and changes of standing order trips and groups to specific carriers, there are significantly less tasks for this unit compared to a time when all of the trips were being scheduled and assigned to manifests. It should be pointed out that it is our understanding that those tasks were completed with the same FTEs, (2.0), in use now. Another task assigned to this section is Medicaid eligibility verification. This process is discussed in another part of this report, along with the identification of issues. Improvement Action Plans: Without a new transportation management software application, (which will be addressed later in this report) there is probably no reasonable action that can be taken at this time. We would strongly support LYNX taking control of the scheduling of trips and away from the contracted operators, but that is probably not feasible until such time as a new application is procured. Secondly, even if the control is to remain with operators, it would seem a poor use of the existing technology that the computer assisted scheduling utility that is part of the software application is not being utilized by the operators. It is our understanding that all operators are "hand scheduling " their trips for the creation of manifests without using this tool. This is due in part to the fact that they do not have access to this screen through their remote connections. We would urge LYNX staff to explore the viability of sharing this utility to give operators assistance in the creation of efficient manifests. F. Eligibility Verification, Assessment and Trip Reconciliation Observations: The assessment of eligibility for paratransit services is a very complex and important task. We were not able to spend a great amount of time observing this process, but we do have some key observations. In the assessment of eligible Medicaid recipients, although there is a process for assessing needs and moving passengers to the most cost effective mode, staff indicated that although there is a process in place for issuing bus tickets and passes to passengers in lieu of paratransit service, "the issue is not forced" and it still remains primarily the choice of the client as to what service they want. Although we were informed that over 4000 bus passes are issued each month to clients of the numerous funding agencies, including Medicaid, it would appear that this system needs to be reviewed so that a more vigilant stance is taken regarding the assignment of passengers to fixed-route as opposed to paratransit service. There is only one staff member assigned to the task of reviewing applications for ADA and TO service as well as reviewing and assessing Medicaid recipient's request for transportation. The staff member assigned to this task is relatively new to the position, but dedicated to performing the tasks. With this said, it was our observation, as well as that of supervisory staff, that this unit could use at least short term help to better establish the program and solidify process and procedure. CTD Technical Assistance Operational Study 12 Regarding the verification of Medicaid eligibility, which is a separate process, we observed that this was done in the scheduling unit prior to the distribution of the trip pre-edit lists to the operators. We were told that shortly before our visit, there was a malfunction in the transmission software, and that the eligibility of clients had not been checked in over two months. Our observations left us uncertain that this task is being performed regularly and properly, and that the necessary follow up to reverify through contact with recipients was being completed. If eligibility is denied, there is always the option of assigning the service to TO if appropriate to ensure service, but staff seemed unfamiliar with that process. Final observations in this area were from the unit responsible for trip reconciliation and data entry for the purpose of creating the database that forms the basis for the preparation of billing invoices to funding agencies. Curiously, these staff are housed under the supervision of the same manager responsible for client relations and complaint resolution I Mr. Dan Whitfield. These tasks are certainly more financial in nature, but certainly should not be done in a vacuum, as many of the issues are related to activity that originated in the call center with client and trip entry, and often require additional resolution with contracted operator staff to clarify entries. It is our understanding that a business plan has been developed for moving this unit under Finance, but that no action has been taken. Improvement Action Plans: Our suggested improvements in these areas are as follows: ~ Formalize the application and assessment process as soon as possible to include stringent assignment to fixed-route services when appropriate. Enlist additional staff in this area until such time that the process is consistently performed. ~ Ensure that Medicaid eligibility is being checked for all recipients using the system at least once per month to ensure that denied claims are minimized. ~ In assessment of the total delivery model, explore the viability of moving the trip reconciliation unit into Finance for a more uniform approach in compiling billing and invoicing information. Ensure a process is in place to keep communication lines open as necessary with staff involved with trip and client entry and contacted operator staff. G. Complaint Process Observations: More detail on the complaint resolution process will be provided in the QAPE review as well as comment from Mr. Hinds, who will address this area in great detail. Our main observation will center around the part of the process that involves the intake of a complaint that requires input from the contracted operators. Mr. Daniel Whitfield is in charge of Customer Relations and receives and processes complaints that originate in the call center. Mr. Whitfield sends complaints to the appropriate operator, and they are ero Technical Assistance Operational Study 13 contractually obligated to respond back within 24 hours. This entire process is done on paper, and through no electronic record. It is the view from this area that there is a significant disconnect in this process. Although the complaints are registered and responses are received (many may not be acceptable), this area reports to the Director of Communications, which has no direct control of the operators. Ron Jones oversees the relationship with carriers, and he reports directly to the Director of Transit Operations, so there isn't a flow of information and a formal process for determining the need to employ contractual remedies such as liquidated damages, etc. Mr. Jones receives reports regarding unresolved carrier complaints often long after the fact, at the end of the month. Mr. Whitfield feels that the operators are aware of this disconnect in communication, and therefore are not "motivated" to act quickly to resolve issues. Improvement Action Plans: The information that is gathered by Mr. Whitfield is vital in ensuring contract compliance and ensuring that serious issues regarding contracted operators are dealt with in a timely manner. In our experience, the exacting of liquidated damages on operators can be a very complicated process, as issues are often appealed. and discussions go back and forth regarding "which side" was responsible for a piece of the process not being completed, which ultimately results in a service quality complaint. With this said, we believe that it is important that a daily interface take place between those staff responsible tor taking and resolving operator related complaints and those responsible tor operator contract oversight, or combining these functions. If patterns of poor performance are being established, they must be recognized quickly so that assistance, or if necessary, corrective action measures, can be taken. H. Contracted Operator Observations/Relations Observations: It is our initial observation that the main link between contracted operators on a daily basis would be the A+Link Road Supervisors that are on the streets. They have contact with facilities, drivers, and management and dispatch staff of the operators, and probably have the best perspective of the state of service delivery. There are two positions dedicated to this function under the supervision of Ron Jones, Manager of Paratransit. However, due to health problems and attrition, there has not been anyone performing these functions for over three months. It is our understanding that this is being addressed, but it can be tied directly to "loss of control" of the operators and a degradation of public relations with external customers. It was observed that the positions are not always easy to fill, particularly in light of the fact that there is a disparity between the salary for these positions and similar positions in the fixed-route side of operations. The following observations are based on interviews and conversations with staff from two contracted operators, 900 Transit and Seminole Transportation. We felt it was important to get "their side of the story", and encouraged them to be open and frank in their discussions. CTO Technical Assistance Operational Study 14 Some common complaints from the operators were that they cannot reach LYNX to get or provide information, which is the same complaint that was voiced from LYNX staff. The telephone system is obviously inadequate and many of the suggested action items address this issue. Another complaint that was registered had to do with the scheduling of trips, which is not uncommon, except for the fact that little actual "scheduling" is done by LYNX staff. At issue was the fact that standing orders are not anchored to runs properly or adjusted according to information that the operator, passenger or facility has provided. One operator expressed considerable frustration that they "don't know who is in charge" and do not know where to turn to have problems resolved. One operator now has remote access to the dispatch screen of the scheduling software, so that has given them the ability to make changes and tweak schedules as necessary, but the down side is that the information is not always communicated back to LYNX, and this takes control of this operation away from LYNX staff. Another related issue was that input staff were assigning improper zip codes to client addresses, which caused problems when dispatching, but also made for assignments to the wrong operator, resulting in long deadhead for trips they should not have received. Management staff from both operators expressed great concern with their inability to attract and retain drivers for their system. With the low wages they are forced to pay, drivers get from $6.00/hr. to start, and $7.00/hr. after training. Veteran drivers get $10.00/hr. with no benefit package. Many question why LYNX could not assist with recruitment of drivers, better pay, and perhaps assisting in obtaining benefits. Both operators "pointed fingers" at other operators that failed to pull their weight in the system and ended up dumping trips on others at the last minute. A very troubling statement was that contracted operators are actually cabbing out their own trips when they are forced to accommodate passengers that they know they do not have the capacity or time for in an effort to "please LYNX". One staff member at an operator cabbed at least 120 trips in one day during a particularly bad day. The failure for all operators to be able to access live dispatch screens and utilize the scheduling utility is viewed as a significant barrier, but it is recognized that the fault does not necessarily lie with LYNX, but that some operators have failed to meet their contractual obligations to establish remote connections. In all fairness, most staff we interviewed recognized the limitations with the current software, and that some of the tasks that they wanted to complete would only be functional under a new product. LYNX's intent on the procurement of new transportation management software is discussed in another section of this report. Improvement Action Plans: It would appear that relations with operators are at a low point. With the observation of the serious and numerous complaints that the Commission has received regarding service CTO Technical Assistance Operational Study 15 quality, it is quite obvious that LYNX cannot be happy with the performance of their contracted operators, and in the same turn, the operators are quick to blame LYNX for many of the problems that are facing the system. Our recommendation is for an immediate face to face meeting with management staff from LYNX and management staff from each of the contacted operators, both individually and as a group. At this point it serves no one's interest to ascertain who is to blame for the ills that plague the system, only to fix it. If the issue is that the reimbursement is not sufficient to maintain service quality, vehicle upkeep, and recruit and maintain adequate staff, then LYNX must work with operators, funding agencies, the Local Coordinating Board, and the Commission to arrive at rates that can be lived with by the agencies and still provide adequate support for the operators. If operators are simply not living up to their obligations, then the necessary corrective actions should be taken, up to contractually allowed liquidated damages when warranted. The bottom line is that the lines of communication have to open and frank discussions must take place. Service must improve, period. I. Transportation Management Software and Computer Hardware Issues Observations: Staff met with Ms. Tori Iffland, Manager of Information Systems, to discuss plans that LYNX has for the upgrading of the transportation management software for the A+Link system, as well as hardware and other technology upgrades. Ms. Iffland and key LYNX staff are well aware that the Dos-based COMSIS CTPS program that has been in place at LYNX since 1994 is no longer sufficient to manage a program that has grown to well over 3500 trips per day and is comprised of multiple operators that need remote access. The current application is not a true map-based application in the sense of the most recent technology that allows for exact geo-coding of addressees and scheduling based on true map applications. There are also several other limitations that are not uncommon for a technology product that is over six years old. Ms. Iffland indicated that key LYNX personnel would be traveling to several sites in Florida throughout December to look at various products. The LYNX fixed-route system currently uses the Trapeze product for run cutting, so acquisition of a total mobility management product through that vendor is one possibility. After they have fully researched and explored what the total system needs are, it is anticipated that an RFP will be written for procurement of the product. Improvement Action Plans: Commission staff have managed an Intelligent Transportation Systems (ITS) project for over three years and have extensive backgrounds in the procurement of technology driven applications, including transportation management software applications. Through experience in this project, we can offer assistance to LYNX as they develop their system needs. In addition, we can direct staff to other resources where they can do research on applications. We have already provided staff with a web site address to the North Carolina eTO Technical Assistance Operational Study 16 State Dept. of Civil Engineering where there is a tool for analyzing system needs and then providing reviews of specific products that would fit those guidelines. We will provide other resource materials as asked to assist in this process. Briefly, we offer these key point guidelines that should be adhered to when acquiring transportation management software. ~ Ensure that there is adequate training provided within the price structure offered, and that the training is long term and timely, and not simply "install, train, and disappear" . ~ If possible, seek out other users of the product that are within reasonable distance that can be used in peer-to-peer training as well as sending staff to their sites when appropriate. ~ Ensure that the vendor offers adequate support. ~ Be very clear in procurement about the specific functions that you want the product to perform. Beware of the mounting costs of "customization". ~ Make every effort to hire an individual that has had extensive experience with the product and can act as the on-site "expert". It will prove to be an invaluable investment. J. Mass Transit Bus Pass Utilization Observations: The assessment process of determining the most appropriate and cost-effective mode of transportation for passengers was discussed in an earlier section, but it is important to readdress this area to emphasize its importance to LYNX as well as the participating funding agencies. Most social service agencies as well as the Commission are faced with the dilemma of far less funding for trips than demand for services. For this reason, the screening of individuals and the issuing of bus passes in lieu of more costly paratransit service is vital to the survival of many agencies. For LYNX, it presents a very positive opportunity. The fixed-route service already exists and operational costs are fixed. Issuing passes can increase revenues, while reducing the demand on paratransit service. This program is a Win-Win for everyone. Improvement Action Plans: While the positive benefits of this program are well documented, it can be time intensive to administratively manage, and involves dedication to documentation and the development of a strong process for assessing and tracking the distribution to various clients/passengers/agencies. LYNX must ensure that adequate staff is in place, as well as a solid procedure guide, to administer this program properly. eTO Technical Assistance Operational Study 17 K. Other Issues Observations: We met briefly with Mr. Jack Couture from the LYNX Accessibility Advisory Committee. This group is comprised of nine users of the system, both fixed-route and paratransit. The group meets once a month, and through discussions at those meetings, Mr. Couture has become well aware of the challenges facing the A+Link paratransit system. It was his observation that a lack of communication to passengers, and some misconceptions and misunderstandings of the program caused some of the problems. He was concerned that even members of this board, those with the most information about the programs, were at times confused about how various programs worked. Improvement Action Plans: At Mr. Couture's suggestion and request, we have offered to teach a basic course in TO rules, regulation, process and procedures as well as detailed explanations of the functions and responsibilities of the Community Transportation Coordinator (CTC) for this advisory board at the direction of LYNX management. Mr. Ron Jones is the LYNX liaison to this board and has given preliminary approval based on final approval by LYNX upper management. We feel that this training is important for those that represent and interact with users of the system. Exit Interview/ Conclusion/ Priority Action Items We are aware of and have reviewed the September 2000 FT A final report from the Americans with Disabilities Act (ADA) of 1990 Paratransit Assessment conducted at LYNX in May 1999. This assessment focused on the ADA aspects of the service delivery model, but we recognize that many of the observations and recommendations are relevant to the overall administration of the program and recognize that LYNX staff will make every offer to address the issues and adopt as many recommendations as possible. Many of the issues regarded pick up times and windows, and in general, responsiveness to passenger needs. In the State of Paratransit presentation discussed earlier in this report, LYNX staff provided detailed analysis and recommendations to many of the concerns outlined in the FT A report. We have also received a copy of the scope of work for the consultant team that will be conducting a thorough assessment of the entire paratransitl coordinated system delivery model and developing a formula for restructuring the system based on recommendations from the ADA assessment, their findings, and other resources, including the observations and recommendations made in this report. On November 17,2000, an exit interview was conducted by Mr. Edward Griffin and Mr. John Irvine of the Commission and Mr. Corey Hinds of the Advocacy Center for Persons With Disabilities with the following LYNX staff: CTO Technical Assistance Operational Study 18 Bill Schneeman - Director of Transit Operations Ernest Kelly - Director of Communications Barbara Parker - Manager of Customer Services Ron Jones - Manager of Paratransit Both Mr. Irvine and Mr. Hinds shared their observations and provided preliminary outlines of what their reports would entail. For the Operational Study component, based on our conversations and observations, the following key points are critical to address as the organization begins the process of restructuring. ~ Communication It was timely to receive a copy of NewsLink, the LYNX newsletter, the day before the exit interview. The Executive Director's Message by Mr. Brooks centered on communication and its importance to the health and success of the organization. Our observations within the A+Link structure was that there was a clear lack of communication between the various "units" charged with specific tasks within this system, and quite evident that there was a lack of understanding of what the responsibility of each "unit" was, and more importantly, how each unit was to interact with others to complete the total delivery model. Based on our observations, there is a serious fragmentation of the delivery system, and a Jack of vision of the "Big Picture" by most staff, including management. Each unit was struggling to define their roles and operate productively and efficiently, however, there was not a clear vision of the ultimate system goal. Staff agreed with this assessment, and agreed to the following: Ed Griffin from the Commission for the Transportation Disadvantaged will teach a basic course in TD rules, regulation, process and procedures as well as detailed explanations of the functions and responsibilities of the Community Transportation Coordinator (CTC) for all LYNX staff involved in any aspect of the TD program. "TD 202" will be offered in early January based on schedules as determined by LYNX management. ~ Oversight Based on conversations throughout the different units, we arrived at another conclusion in addition to the fragmentation and communication problems. Although Mr. Schneeman is the Director of Transit Operations and has oversight for the system along with Mr. Kelly, Director of Communications, these are only one of the many functions under their realm of responsibilities. With that said, based on conversations with internal staff and external customers, there is a lack of one person that they could identify as "the buck stops here". This position would be similar to that of a General Manager that has a vision of the total delivery model and clearly understands the functions of paratransit operations and the administrative duties comprised within the role as eTC. This ties back to the fragmentation CTD Technical Assistance Operational Study 19. and communication issues, as many felt confused as to who was ultimately able to resolve problems or bring the right people to the table to accomplish that task. Any organizational restructuring should strongly consider the appointment of an individual that is dedicated solely to the administration of this program. ~ LYNX - Total Mobility Management When this system was managed by a contracted entity, based on our observations, as well as those from within that organization and LYNX it was recognized that this program was not always given proper recognition as "part of the LYNX family". The "us vs. them" mentality strained relations between LYNX and their contractor, and this observation was generally acknowledged by those in this interview that had experience with the system. The problem that now exists is that this mentality has not disappeared since the transition, with all of these functions coming "in-house", and operated with LYNX staff. There are some issues within the call center where staff came from the fixed-route and paratransit sides and are now multitasking to perform similar functions. This was also observed in other areas where the complexities of this system were thrust on sections that had had responsibilities for providing support to the fixed-route side of the delivery model, and now were given tasks related to the A+Link program. It is imperative that the A+Link model be viewed as part of the LYNX family and as a critical element in the total mobility management concept. In our years of observing the LYNX system, the representation of a positive image to the community has always been a priority. The neglect or alienation of this part of program can do great harm to this image. These observations are very subjective and are supported through insight and perception rather than concrete facts, but through our conversations with staff, this issue was consistently repeated. Steps should be taken to improve the internal and external image of the A+Link program and to impress upon all LYNX staff its legitimacy and importance to the total mobility management system. The TD 202 should help in educating staff about the program, but additional effort is needed from within the organization. ~ Contracted Operator (Carrier) Relations The image of the A+Link program is tied very prominently to the contracted operators. As your ambassadors in the community, in addition to the call intake staff, they are the first (and last) points of contact and impression for passengers, facilities and others in the community. The fact that the paratransit vehicles no longer carry the "A+Link" logo and are labeled only by each private carrier designation indicates there is no longer any "name recognition" or image to uphold as it ties directly to the system. With the recent negative feedback regarding service delivery, it may be beneficial that there is not a direct tie to LYNX, but in the same context, perhaps there is not the sense of urgency to correct the problem if vehicles were labeled with the LYNX logo. We are aware that the consultant comprehensive study will explore many options regarding direct service delivery, but as CTD Technical Assistance Operational Study 20 was outlined earlier, it is clear that a more direct control of this part of the program is necessary to ensure contract compliance and have readily available remedies to problems. ~ Transportation Management Software This issue was detailed earlier in this report, so we will not offer additional comments other than to emphasize that the acquisition of a new product to manage the system is imperative. It was not clear from the work plan submitted by the system assessment consultant whether or not recommendations on the procurement of software applications would be offered, but surely any plans for the restructuring of the system would be incomplete without consideration of the incorporation of a new management tool. As was outlined earlier, the incorporation with the fixed-route system for a utilization of total mobility management will reduce fragmentation of services, improve overall system efficiencies and support this concept. ~ Specific Administrative Actions The following actions are suggested that could and should take place immediately to address problem issues: o Although additional phone lines and personnel have been put in place to meet demand and address hold-time issues, the use of e-mail to notify operators of changes and to obtain information should be explored as a remedy for long holds or unanswered calls with operators. This ultimately can be handled through a transportation management software with real time remote communications with operators. o The development of a consistent system to verify Medicaid eligibility for recipients in order to reduce denied claims should be implemented immediately. We can assist in this process as necessary. o The training of intake staff to properly and consistently assign the correct bill code to passenger trips is vital. It is our contention that many trips billed to ADA may have other funding streams such as Medicaid that may be responsible. Again, we can assist in this training process as necessary . On behalf of the Commission, we would like to thank LYNX staff for the opportunity to return to your system and offer guidance as you enter these exciting and challenging times for the A+Link system. It is our hope that these observations and suggestions can be incorporated into other reports and assessments for the development of a plan that will take the program to the level of excellence you wish to reach. The Commission stands ready to offer further assistance as necessary to assist you in obtaining these goals. CTO Technical Assistance Operational Study 21 TECHNICAL ASSISTANCE OPERATIONAL STUDY GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. COMMUNITY TRANSPORTATION COORDINATOR - MONROE COUNTY Prepared by: Florida Commission for the Transportation Disadvantaged Edward I. Griffin, Technical Assistance and Training Section Supervisor Margaret Furlong, Transportation Disadvantaged Specialist Ronald Atkins, Financial Auditor May 24, 2000 A technical assistance operational study of the Guidance Clinic of the Middle Keys, (GCMK) Inc., the Community Transportation Coordinator (CTC) of Monroe County, was requested by Mr. David G. Rice, Ph.D., Chief Executive Officer. Mr. Rice recognized that there were many operational and financial challenges facing his organization, particularly since assuming the added responsibility of coordinating all non-emergency Medicaid transportation services. Mr. Rice expressed specific concerns with his organization's ability to continue to provide the same level of service without operating at a deficit and to resolve the financial and organizational problems that have contributed to this problem. Given these issues, Mr. Rice requested that the operational study focus on both roles as CTC and operator. At the last meeting of the Monroe County Local Coordinating Board (LCB), a subcommittee was appointed to look into the fact that GCMK was providing more services than what they could afford. GCMK is projecting an annualized loss of $35,000 for the transportation department in total as the CTC and as an operator. Edward Griffin, Technical Assistance and Training Team Administrator, Margaret Furlong, Transportation Disadvantaged Specialist, and Ronald Atkins, Financial Auditor, conducted a study of the Guidance Clinic of the Middle Keys, Inc. system on April 25- 26, 2000. The study involved a review of records, policies, and procedures, observance of operations, and conversations with staff dedicated to the administration and financial management of the GCMK transportation system. The following report is a brief synopsis of this study. This study does not preclude that GCMK staff could study other items (internally for changes and actions), but simply brings forth the most apparent challenges that face the system at this time. The primary issues examined in this study included the following transportation areas that deal with operations efficiency and effectiveness, including an examination of financial and contract management and staffing issues. 1. Staffing and General Office Administration 2. Billing and Contracting - Medicaid! TD 3. Co-Payment Collection - Medicaid 4. Rate Structurel Trip Priorities 5. Scheduling of Trips/ Special Service/ Service Delivery 6. Drivers - Work Assignments 7. Scheduling - Manifests 8. Scheduling - Creation of Runs 9. Transportation Management Software 10. Coordination Contractors 11. Relationship with Monroe County Social Services 12. Exit Interview/ Conclusion 1. Staffing and General Office Administration Observations: The Guidance Clinic of the Middle Keys, (GCMK) Inc., has been the Community Transportation Coordinator (CTC) for Monroe County since October 1, 1997. The CTC acts as a partial brokerage and provides some of the transportation services itself. The CTC began Medicaid coordination on January I, 2000. Coordination in Monroe County offers some unique challenges with the long trip distances, the limited number of medical facilities, and the limitations of having only one major highway serving the Keys. Prior to becoming the CTc. the Guidance Clinic of the Middle Keys, Inc. was a coordination contractor/operator within the system. In the entrance interview, Mr. Rice met with the Commission Team and the following GCMK staff: Kevin Pipher - Transportation Coordinator Jo Ann Orr - Incumbent Financial Officer (Retiring) Marianne Kramarz - Recently hired Financial Officer Mr. Rice proceeded to discuss what areas that he wanted us to observe, and to emphasize his resolve to identify financial and organizational problems that threaten his organization's ability to continue to provide the same level of service without operating at a deficit. Mr. Rice stressed 3 Medicaid billing and funding, coordination/management fees, additional funding opportunities. and operational efficiencies as areas needing attention. Mr. Kevin Pipher is the Transportation Coordinator for GCMK, charged with the success of direct service delivery as well as maintenance, scheduling, reservations, and accurate records in order to allow for billing of services. Mr. Pipher's position as Transportation Coordinator constitutes.7 Full Time Equivalent (FTE). Assisting Mr. Pipher with reservations, scheduling, trip logging and reconciliation is Ms. Lynn Roussin, who works in that position full time equaling 1 FTE. The Chief Financial Officer is responsible for ensuring that all billing has been tabulated and forwarded to the appropriate agencies, driver and transportation staff payroll, all vehicle fuel and maintenance financial matters, and the overall fmancial health of the organization. The Chief Executive Officer has overall organizational responsibly. 4 Suqqested Actions: Reservations Staff was provided a "Summary Sheet" that fully outlines which Medicaid compensable services are authorized for transportation. A thorough training session should be given to all existing and any new staff to reinforce understanding of this topic. Billing/Data Entry/Trip Reconciliation There were some very serious billing issues discovered that centered around the rate structure configuration within the transportation management software. This will be addressed in detail later in the report. In addition, there were issues surrounding recapturing lost revenue from this miscalculation, and to that end, a letter was drafted by Mr. Griffin to the Area Medicaid Office to assist GCMK with identifying solutions to the problem. A copy of this letter is attached to this report. Scheduling The only scheduling issue raised in this report regarded the continuation of the service route through alternative funding and the use of Monroe County Social Services in a "hub and spoke" environment with GCMK. These issues are discussed in detail later in the report. 2. Billing and Contracting - Medicaid! TD Observations: GCMK primarily transports and bills Medicaid for transportation services that are centered around services provided at their facility including the daily community mental health program. Service routes were initially created to serve these mental health clients. Additionally, Medicaid trips are also provided by Monroe County Social Services (MCSS) who provides most of the random "doctor appointment" trips within each of the three zones set up for the Lower. Middle and Upper Keys. MCSS has a minimum charge of $5.00 for each Medicaid trip. For long distance trips that involve transport out of the county, (primarily to Greater Miami area), contracted taxi companies provide this service. GCMK will eventually bill all Medicaid services through their provider number, but at the present time, the two contracted taxicab companies and MCSS continue to bill through their own provider numbers. This is problematic, because even though the CTC receives the remittance voucher information regarding expenditures for Medicaid transportation services, this information is received long after the fact, and the CTC is unable to timely monitor expenditures in order to observe the target allocation for Medicaid transportation expenditures. In examining the rate structure and the receipt of revenue, it was discovered that there 5 was a problem of GCMK not billing for additional passengers because of improper software configuration. As established in the Transportation Disadvantaged Service Plan, the Medicaid reimbursement rate for GCMK is the mileage fee for the "longest mileage passenger" in a shared ride environment, plus an additional fee of $3 per passenger. The transportation management software program being used allows for direct billing to Consultec, the Medicaid fiscal agent, so it is imperative that the configuration within the program be set up properly, as the user does not re-enter and verify the information on a trip by trip basis. Another problem identified was that the system was configured to bill for shared mileage for all passengers rather than the "longest mileage passenger" fee which is how the Medicaid rate structure was set up. While the end result of mileage was accurate in the amount that was charged Medicaid, it did not accurately reflect the agreed upon structure, and complicated the additional passenger issue. Mr. Griffin talked at length with the software vendor while on site with the Transportation Coordinator to facilitate the addition of fields and the creation of additional billing codes to accommodate the different co-pay exemptions, additional passengers, and the "longest rider". It is our understanding all of these issues have been corrected and as of April 27, 2000, all trips will be billed correctly. All that remains is the collection of past due revenue from improper billing, and this was addressed in a letter to Medicaid that was drafted by Mr. Griffin. A copy of the draft letter is provided as an attachment to this report. Another significant problem identified was that the Medicaid program refuses to pay for long distance trips (Le Miami) where the appointment was scheduled, the trip delivered, and the patient was not seen because of the doctor being called away or any number of other reasons that were not the fault of the passenger. The end result is that the CTC still has to pay the subcontractor for delivering the service, even though Medicaid will not pay because they cannot verify a corresponding medical service. A Medicaid HMO has 5-6 trips per week traveling long distance (Homestead) to dental services. (Dental services have been a challenge for Medicaid since many providers are not willing to be a Medicaid provider.)The Medicaid Program office should assist the CTC in working to coordinate these trips to be scheduled together on one day so that cost-efficient grouping could be exercised. Regarding the expenditure of Transportation Disadvantaged Trust Fund (TDTF) dollars, the main issues identified were regarding the relationship with coordination contractors and charging of the management fee. These issues are discussed in detail later in the report. Suqqested Actions: 6 We have suggested that the CTC begin immediately the procedure of calling all provider offices for long distance trips and requesting written verification of the appointment. If an appointment is canceled after this verification and the passenger is transported, then the CTC must work together with the Medicaid Program office for resolution of this issue. One possible resolution might be for the Medicaid Program Office to prior authorize all long distance trips, with the understanding that prior authorization would insure provider payment. 3. Co-Payments Observations: Medicaid collection of co-payments is a big problem, almost zero collection rate because of client base. Many of riders travel several times a week and have limited incomes and are unable to afford the co-pay for this frequent use. This has been a serious problem throughout many areas of the state, and Monroe County is no exception. Suqqested Actions: It is suggested that GCMK staff work closely with Medicaid Area Office staff to identify ways to encourage participation by passengers that are required to pay co-payments and to track lost revenue carefully so that these figures can be calculated into future rates. 4. Rate Structure/ Trip Priorities Observations: New rates established for services provided by GCMK for the Medicaid program effective January 1, 2000 are as follows: $1.50/ mile per one way trip for the "longest rider", with $3.00 for each additional passenger. $1.63/ trip coordination fee. It is the conclusion of the CTD team that this type of rate structure actually discourages multi- loading, and that serious discussions should begin to design a more equitable rate structure. More on this is included later in the report. The following is an example of how the current structure works and its drawbacks. Examole: 7 Three riders making the same 30 mile trip. Individual trips provided for each rider: Rider Miles Rate Billable Fee Rider 130 miles $1.50 per mile Rider 230 miles $1.50 per mile Rider 3 30 miles $1.50 per mile $45.00 $45.00 $45.00 Total Billable to Medicaid $135.00 Multi-load three riders on one trip Rider Miles Rate Billable Fee Rider 1 Rider 2 Rider 3 30 miles 30 miles 30 miles $1.50 per mile $3.00 additional rider $3.00 additional rider $45.00 $ 3.00 $ 3.00 $51.00 Total Billable to Medicaid In this example with three riders, the effective per vehicle mile rate for the two additional riders is only twenty cents per mile ( 2 riders @ $3.00/30 miles) or ten cents per mile individually. Suqqested Actions: This type of rate structure actually discourages multi-loading and we encourage the CTC and the LCa to design a more equitable rate structure. The current reimbursement for the core service delivery of "service route" trips to the community mental health centers do not break even based on the information discussed above. A letter was drafted by the team for GCMK that detailed this issue that will be forwarded to the Area Medicaid office in an effort to begin dialogue on addressing the deficit and adjusting rates. Commission staff will continue to monitor and assist in this effort. Marianne Kramarz has been hired to replace Jo Ann Orr as Chief Financial Officer when Ms. Orr retires. Ms. Kramarz has prior experience in cost accounting and job costing. She should proceed with her plans to conduct analysis to develop standard costs for the different services provided by GCMK. This cost information will allow management to make informed judgements when negotiating new contracts and rates 8 with operators and other entities. The analysis of cost of services can also be used by management to determine where internal changes are needed to increase efficiency and cost effectiveness. GCMK will need accurate cost information to effectively use their available funding and provide service to those whose needs are greatest. Priorities Observations: The CTC needs to work with the LCB to develop priorities for trips funded by the TDTF. The CTC has proposed the following priorities: 1. Medicalffreatment 2. Daycare 3. Life sustaining shopping! other Suqaested Actions: The .GTC should encourage the LCB to adopt priorities. The CTC should consider offering lower priority trips on a more limited basis. For example, a low activity day such as Tuesday might be the only day shopping trips are allowed. The CTC should be mindful of their riders' needs when creating these limitations. The CTC should continue to pursue better coordination with the dialysis clinics and dental services patients in order to attempt to consolidate passengers to the same days of the week to promote efficiency. 5. Scheduling of Trips/ Special Service/ Service Delivery Observations: Taxicab companies are only used to deliver long distance medical trips and occasional spot help with "zonal service". MCSS provides most local trips within certain zones. When MCSS cannot provide a trip, GCMK will try to accommodate the trip request into their routes, if the schedule permits. GCMK primarily transports and bills Medicaid for transportation services that are centered around services at their facility, and this translates into the "service routes" that they operate. When GCMK adds additional riders to their service route that constitutes a great degree of deviation from their route, it is problematic in that the service is not cost-effective in terms of the provider, and the time involved often disrupts the time schedule of the route. A possible solution is an arrangement with MCSS, which is discussed in the next section. GCMK is a receiving facility for Baker Act clients and they are receiving a car from the Sheriffs office to deliver this service. This is a good example of a cooperative arrangement with the county. Stretcher service was requested by Medicaid when GCMK became coordinator of 9 Medicaid services, and they offered the service at $75 base + mileage. Medicaid rejected this offer and countered with $25 base + mileage. Now they are paying up to $350 one way for providers to deadhead from Miami. GCMK receives only the coordination fee of $1.63 for negotiating with carriers and arranging this service on behalf of the agency. Mr. Griffin has drafted a letter for use by GCMK to Medicaid to readdress this issue and come back to the table to re-negotiate this service to the benefit of both parties. A copy of the draft letter is provided as an attachment. Suqqested Actions: GCMK should continue to try to increase coordination with MCSS. The MCSS could use the "hub and spoke" method to bring riders to transfer points for GCMK to transport' on their service routes for the longer distance trips outside of the zone. Working cooperatively to facilitate inter-zonal trips would help to meet riders' needs and increase efficiency. The CTC should also try to readdress the non-emergency stretcher issue with Medicaid as soon as possible for the mutual benefit of both agencies and the community. F. Drivers - Work Assignments Observations: Currently, GCMK has seven vehicles with four in service. An observation following our visit was that the Transportation Coordinator was out of the office for most of the week to cover a run operated by a driver out on vacation. Suqqested Actions: It is important that sufficient backup drivers be available. Look at options from the fire department, school systems, retirees, volunteers, etc. to fill gaps. 7. Transportation Management Software Observations: There are two workstations that are networked together and have the CTS transportation management software application installed. The CTS application is a DOS-based program that is in use in several systems throughout the state. Although there are no mapping utilities or scheduling operations available with this product, as a client and funding source management product it is more than adequate, particularly for the volume of trips being provided within the system. The product is leased on a monthly basis at a cost of $375/ month, which included full maintenance for both workstations. SUS!2ested Actions: In light of the problems that surfaced with the configuration of the rate structure in the 10 transportation management software, it is imperative that training on all facets of the CTS Program for both staffbe a priority. Both staffhave a basic knowledge and understanding of use of the product, but an advanced training would allow them to get the most out of the product in the way of analysis and reports. This product is being used by several other CTCs in the state. and GCMK can use peer training through contact with other systems to get educated rather than relying solely on the vendor. Commission staff have provided GCMK with a list of users so that they can tie into a peer-to-peer users group environment. 8. Coordination Contractors Observations and Suggested Actions: The Coordination Contractor Heron House is providing many more trips per month than was originally forecasted. Their reimbursement from GCMK is capped at $2,400 per month based on a rate of$5.70 per one way trip. The problem this arrangement causes for GCMK is that when trips in excess of the budgeted amount are provided by Heron House and reimbursed at $5.70 per trip, the reimbursement for the additional trips effectively reduces the coordination fees GCMK is able to bill to the Commission for the Transportation Disadvantaged. The billing structure needs to be changed to insure that GCMK receives the originally budgeted amount of coordination fees for this contract. In effect, the coordination fees should be deducted from the maximum reimbursement before the amount payable to Heron House is calculated. Under this arrangement, any additional trips provided beyond the budgeted amount would not reduce the revenues received by GCMK. The "coordination fee" was originally based on anticipated cost divided by the number of anticipated trips, creating a rate of $2.71. The example below illustrates the problem. Example Budqet Rounded Rate per Trip Paid to Heron House $5.70 X $2.71 X 285 Trips = $1,628.00 285 Trips = $ 773.00 $2,400.00 $2,400.00 Coordination Fee CHANGE TO $2.71 throuqhout Total Reimbursed by CTD Example with Trips Exceedinq Budqet Levels Rate per Trip Paid to Heron House $5.70 X 400 Trips = $2,280.00 11 Coordination Fee $2.71 X 400 Trips = $1,084.00 $3,364.00 $2,400.00 Total Reimbursed by CTD The Heron House receives $2,280.00 (400 Trips @ $5.70) and the maximum reimbursement from the CTD is $2,400.00. The remaining amount available for the GCMK coordination fee is only $120 compared to the originally anticipated $773. The Wesley House Community Center, Inc, another coordination contractor that is basically allotted a set amount of money from the TDTF to subsidize their transportation costs, however, they do not overbill and collection of the anticipated coordination fee is not a problem. A problem identified with Wesley House is that many of the children being transported need attendants and this expense cannot be paid for through the TDTF other than to pay for the trip of the attendant. A resolution ,of how to prov.ide and pay for this service should be discussed with the Local Coordinating Board. K. Relationship with Monroe County Social Services Monroe County Social Services (MCSS) has a cost to the coordinated system at approximately $4.00/ mile, which is extremely high. This system is funded through a county-wide gas tax at the rate of nearly $1 million per year according to Mr. Rice. Unfortunately, none of this funding is available to the CTC. The city of Marathon has incorporated, and there has been discussion of pulling their contributions to the county gas tax fund and funding the coordinated system. MCSS has a sophisticated transportation management software application (Trapeze) that has been in use for six months. The team was not able to observe this application, however, it is our understanding that it is a Windows-based mapping program. Mr. Griffin has an extensive background with these type of products and regrets that he was not able to observe the MCSS operation, however, it was expressed that by GCMK staff that most trips provided by MCSS are single use, with rare multi-loading, and that the scheduling/mapped based utilities of the application are not being utilized to their full potential. It is our understanding that MCSS provided 50,000 trips per year at a cost to the county of $1 million. MCSS bills Medicaid on their own for services and Mr. Pipher from GCMK receives a copy of the remittance voucher. This is problematic, since the CTC is responsible for monitoring the allocation, and cannot control what is being expended by other entities. GCMK is working to obtain assistance from the County for additional 12 funding for system. L. Exit Interviewl Conclusion In the exit interview, Mr. Rice again met with the Commission Team, Kevin Pipher and the Chair of the Monroe County Local Coordinating Board, County Commissioner George Neugent. The following were the key summary issues to be addressed by GCMK: 1. All corrections that were made and/or suggested to correct the problems with the rate calculations in the transportation management software should be certified as acted upon. In addition, considerable effort should be made to arrange with Medicaid a satisfactory solution to the "underbilling" issue to recoup the lost revenues, and to initiate discussion for the provision of stretcher services. 2. Innovations Look at "Friday Shopping Junket" to group aU life sustaining shopping tips for cost-efficiency while still providing much needed service. Initiate contact with local Department of Transportation staff to investigate use of 5311 grant funding to subsidize operating expenses. 3. Address the Medicaid Service Routes and issue of the current rates not allowing the provider to break even. Perform analysis to determine cost of delivering services and either adjust the rate itself or the structure. 4. Address invoicing issue with Coordination fees and the Coordination Contractors. 5. Work with the LCB to prioritize trips to match services provided to funding available. 6. Begin analysis and development of a hub & spoke Feeder Service 13 in conjunction with MCSS. It was a pleasure meeting and working with Mr. Rice and his staff. We are encouraged by the fact that they recognized problems and sought help in finding resolutions. We are confident that we have identified the major issues facing this agency, and are ready to provide additional technical assistance as necessary to ensure the success of the system. Draft Medicaid letter attachments are found on the following two pages. May 1, 2000 Ms. Judith Rosenbaum, Ed. D. Agency for Health Care Administration -Medicaid Koger Center, Manchester Bldg. 14 8355 NW 53rd Street, Second Floor Miami, Florida 33166 Dear Ms. Rosenbaum, In our recent conversation with you and staff from the C Transportation Disadvantaged, we informed you that Medicaid transportation services due to an error in th our transportation management software. The rate rider to be billed the full passenger mileage rate for additional riders billed at $3.00 per passenger. Beg through April 26, 2000, the single passenger mileag among all passengers, however, no additional $3.0 billed. A very close estimate of the amount under bill XXXXXXXXXXXXX. The necessary modifications to the software h beginning with services billed April 27, 200 rider billed at the full passenger mileag riders billed at $3.00 per passenger, approved in the Transportation Dis Moraroe County CTC system for DGR:kp cc: Marga~ urlong, Commission for the Transportation Disadvantaged May 1, 2000 Agency for Health Care Administration -Medicaid Koger Center, Manchester Bldg. 8355 NW 53rd Street, Second Floor Miami, Florida 33166 Dear Ms. Rosenbaum, In our recent conversation with you and staff from th Transportation Disadvantaged, we informed you tha seriously consider and negotiate for the provision 0 Medicaid in Monroe County. As we discussed with from your office in XXXXXX of 1999, and proposed the county at $75/ flat pick up + $XXX per mile. Our and countered with a rate of $25/ flat pick up + $XXX determined we could not provide the service at th counter proposal. Since that time, we have been for Medicaid, contacting providers in Dade Co rate" among respondents. The average co XXXXXXXX. We feel that it is in the bes yours to sit down at the table and s rate for delivery of these services b ortunity of our ystem. In allows for only one and the rest billed as e costs of service te structure of this type han en ti-Ioading, which is a very tion of services and keeping rates in check. . Pipher at your earliest convenience at to discuss these issues. Thank you n to this matter. t Furlong, Commission for the Transportation Disadvantaged TECHNICAL ASSISTANCE OPERATIONAL STUDY GOOD WHEELS, INC. COMMUNITY TRANSPORTATION COORDINATOR - GLADESI HENDRY OPERATOR - LEE COUNTY Prepared by: Florida Commission for the Transportation Disadvantaged Technical Assistance and Training Section Edward I. Griffin, Supervisor Margaret Furlong, Specialist October 29, 1999 A technical assistance operational study of Good Wheels, Inc., the Community Transportation Coordinator (CTC) of Glades and Hendry Counties, and a major operator in the Lee County coordinated transportation system, was requested by Mr. Gary Bryant, recently appointed President of Good Wheels, Inc. Edward Griffin, Technical Assistance and Training Team Administrator, conducted an operational study of the Good Wheels Collier County CTC system on March 10 and 11, 1999. Shortly after, Good Wheels relinquished their role as CTC in Collier County, and underwent a major organizational restructuring. With many operational and financial challenges facing his organization, Mr. Bryant recognized that another operational study was in order. focusing on both roles as CTC and operator. Edward Griffin, Technical Assistance and Training Team Administrator, and Margaret Furlong, Technical Assistance Specialist, conducted a study of the Good Wheels Inc., system on September 8 and 9, 1999. The study involved a review of records, policies, and procedures, observance of operations, and conversations with staff dedicated to the administration of the Good Wheels transportation system. The following report is a brief synopsis of this study. This study does not preclude that Good Wheels staff could study other items (internally for changes and Actions), but simply brings forth the most apparent challenges that face the system at this time. The primary issues examined in this study included the following transportation areas that deal with operations efficiency and effectiveness, including an examination of financial management and staffing issues. 1. Staffing and General Office Administration 2. Billing and Contracting - Medicaid! TD 3. Co-Payments 4. Eligibility Verification - Medicaid 5. Trip Logging and Reconciliation 6. Rate Structure 7. Scheduling - Return Trips 8. Drivers - Work Assignments 9. Scheduling - Manifests 1 o. Scheduling - Creation of Runs 11. Dispatching and Customer Service Relations 12. Transportation Management Software Issues 13. Computer Hardware Y2K Compliance Issues 14. Conclusion 1. Staffing and General Office Administration Observations: Following the departure of Good Wheels, Inc., from their role as the Community Transportation Coordinator of Collier County, the Board of Directors began a major restructuring of the management staff of the organization. Most of the upper management was replaced, with Mr. Gary Bryant hired as President. Mr. Bryant did not have direct transportation delivery experience. however, he is a retired Air Force officer, and has many years experience in managing large units of personnel, and complex scopes of work. Mr. Bryant soon surrounded himself with qualified management staff to assist him. Mr. Robert Bowman is the Operations Manager, charged with the success of direct service delivery. Mr. Bowman brings with him some transportation delivery experience, but his primary expertise is in personnel management gained from several years of military service. Martha Nagata is the Vice President of Finance, responsible primarily for the financial management of the organization. Mr. Gordon Deadmon is Maintenance Supervisor, responsible for the vehicle fleet, and Mr. Carl Kerstann is the Compliance Officer, responsible for driver training, Drug & Alcohol testing and compliance, and all other driver related record keeping duties. The overall management structure is as follows: Good Wheels, Inc. Operational Study - October 29, 1999 .., -' ORGANIZATIONAL CHART (LEVEL 1-3, Top to Bottom) LEVEL 1: 1.0 President LEVEL 2: 2.0 Maintenance, 2.1 Operations, 2.2 Finance LEVEL 3: 3.0 Reporting, 3.1 Reservations, 3.2 Scheduling, 3.3 Dispatch, 3.4 Drivers In the entrance interview, Mr. Bryant invited us into his office, along with the management staff, to discuss what areas that he wanted us to observe, and to present the action plan that he had developed to address the concerns that his staff had identified. In May, staff identified three main areas of concern: 1.) Complaints regarding the quality of service had reached serious levels; 2.) The organization held no operational reserves, with $150,000 overdue in vendor payments, and another $200,000 in debt service; and 3.) A glaring need for two more radio frequencies to address a serious communication problem between base and drivers. To that end, a phase oriented action plan was developed to address recognized deficiencies in the system. The following are the three action phases. Good Wheels Action Plan Phase 1 Goal: Stabilize Organization Time Period: June 15 - September 1, 1999 1.) Action Plan 99-1 Economic Recovery a) Customer Service b) Operate Efficiently c) Cost Reduction d) Establish Professionalism 2.) Improve Technology (Hardware/Software) 3.) Fill out organization 4.) Total system improvement vs. Band Aids 5.) Enforce "Be there/Be square" (Driver on-time performance) 6.) Review contracts /existing business relationships 7.) TD Politics (LCBs/Agencies) 8.) Focus on TEAMWORK! 9.) Review Administrative/Maintenance Programs Good Wheels, Inc. Operational Study - October 29, 1999 4 Obviously, this was a very lofty list of goals to accomplish in a very short time period, but many of these issues were successfully addressed, and many are ongoing. The specifics of the action plan will be discussed in more detail in Suggested Actions, however, we would point out that we very impressed and encouraged how well thought out the plan was, and the commitment of management staff to ensure its success. Good Wheels Action Plan Phase 2 Goal: Operational Recovery Time Period: October 1, 1999 - July 1,2000 1.) Payoff existing debts and establish operational reserves; 2.) Add key staff as necessary; 3.) Train new staff and retrain existing staff; 4.) Review overall system efficiency. Good Wheels Action Plan Phase 3 Goal: Enhancement and expansion of company operations Time Period: Following completion of Phase 2 1.) More opportunities as operator; 2.) Re-establishment of Inter-City bus route. Administrative/ Operational Staffing Observations Reservations 2 Full-time staff, in addition to 1 part-time in a.m. and p.m. Dispatchers 1 Full-time in a.m., 1 in p.m., assignment of assistant to help during heavy periods and a part-time staff for weekend assignment. Billing/Data Entry/Trip Reconciliation 4 Full-time staff, had been 5 until recently. Scheduling 1 Full-time staff. Good Wheels, Inc. Operational Study - October 29, 1999 5 suqaested Actions: We certainly applaud the action plan that has been developed by Good Wheels, and also concur with their prioritization of issues to address. In general terms, the resolution of the financial stability should certainly take highest priority, and we believe staff recognizes that. We firmly believe that a solid core of upper management staff have been assembled that have a common vision and commitment to the success of the system, and are willing to make the necessary sacrifices to reach those goals. The details of suggested actions regarding staffing will be addressed throughout this study relative to each operational topic, but the following represents some general suggested actions. Reservations Staff should be provided a "Cheat Sheet" that fully outlines which Medicaid compensable services are authorized for transportation. CTD staff can provide this document, however, a thorough training session should be given to all existing and any new staff to reinforce understanding of this topic. In addition, it was very evident in reviewing the billing/trip reconciliation process that reservations staff did not fully understand the multiple funding streams used, and very often made mistakes when entering the appropriate billing code. These mistakes only serve to create problems and additional workloads with each step of the process until the final invoice is prepared. A lot of administrative time could be saved by addressing this issue correctly at the point of intake. Reservationists often used paper entry forms to take trip requests because the computer entry was very time consuming. After the customer was off the phone the trip was entered into the scheduling system. This is addressed later in the report in more detail. The reservation area was very open and hand held phones were used to answer incoming calls. Headsets would be a good investment to reduce the time it takes to answer the phone, allow the reservationists to easily enter information, and create a quieter environment for the other surrounding staff. Reservationists can also be used to educate riders on the how the coordinated system works. Since Mr. Bryant has taken over the management at Good Wheels, the organization has taken on the role of the "New Good Wheels". Reservationists answer the phone saying "This is the New Good Wheels, how can I help you". This would be an appropriate time to share any policy changes or reinforce existing policies. Reservationists could remind riders what the pick- up windows and cancellation policies are when the passenger is making the reservation. This is an ideal opportunity to educate the customer on how the system works. Having educated riders can help make operations run smoothly in the coordinated system and improve public image. Dispatchers One full-time in a.m. and another in p.m., assignment of assistant to help during Good Wheels, Inc. Operational Study - October 29, 1999 6 heavy periods and a part-time staff for weekend assignment. It is imperative that dispatchers have an intimate knowledge of the software, and use it in the daily functions of their job. It is strongly recommended that they be cross-trained in the intricacies of scheduling to assist in that function. Billing/Data Entry/Trip Reconciliation The initial general observation relative to this unit of four staff was that their work area was quite noisy and often crowded with other staff. The billing/data entry/trip reconciliation staff area needs partitioning from the rest of the operation for noise reduction. This will allow staff to work in an environment that will be conducive to focusing on the important task of accountability and billing. Staff also need training on how to code in trips for the purposes of trip check in and billing. Scheduling One full-time staff is assigned to this function, and as was suggested earlier, it is very imperative to have others assigned as back- ups to this role. It is also important that this staff member know the software as well as or better than anyone on staff. The foundation of standing orders and assignment of constraints in the system for vehicle assignments and parameters is crucial to efficiencies, and the scheduler must be able to understand how those functions are carried out. If necessary, this staff member could be sent for training at other systems in the state that are using the same transportation management software. The biggest challenge facing the system will be to continue to focus on the /lNew Good Wheels" and continue to improve employee morale and the external customer perceptions. 2. Billing and Contracting - Medicaid! TD/ WAGES Observations: Management is in the process of evaluating contracts to determine which ones are breaking even, making money or losing money. Management is also scrutinizing every aspect of their business to look for ways to generate revenues and to get refocused on their core business. One example is the decision to stop providing Driver's School classes open to the public for a fee until a time when the organization is financially stable. The Vice President of Finance is relatively new and not trained in the use of the transportation management software, and in order to generate necessary reports to make informed decisions, it is imperative that she be brought up to speed as soon as possible. WAGES Good Wheels, Inc. Operational Study - October 29, 1999 7 Good Wheels holds the contract for the WAGES transportation for Glades, Hendry, Collier, Lee and Charlotte Counties. Currently, both the rider and the WAGES case manager make trip reservations. Drivers are finding many of the standing orders result in rider no-shows. These standing orders cannot be removed from the schedule without authorization from the WAGES case manager. Good Wheels needs to work with the case managers to improve communication and to find a method to efficiently remove these standing orders from the schedule while still meeting the needs of the WAGES recipient. suqqested Actions: The integration and consolidation of billing functions within a centralized transportation management software program not only gives the user assurances of integrity of the data, it also allows for unlimited reporting functions, and the opportunity to successfully analyze data for the entire system. The opportunity to segregate and report data for particular funding streams, apply budgetary constraints, and use queries to extract particular data fields for financial analysis is paramount to good system management. For that reason, we would strongly suggest that the Finance Department be intimately involved in the training process on the new software upgrade, and consideration should be given to networking so that the Vice President of Finance is tied in directly to the system and can receive reports and generate invoices directly from the system. Integration and consolidation of these functions will significantly reduce duplication of data entry functions and increase the efficiency of existing administrative staff. 3. Co-Payments Observations: The reporting and recording of passenger co-payments is clearly recognized as a paper intensive process, but should be improved with the implementation of the new software upgrade. Currently, Good Wheels operates in two distinct environments that have co- payments associated with them. As the CTC for Glades and Hendry, all trip information is recorded into the PtMS software management system, from which manifests are produced, and all records and billing information is extracted. The collection of co- payments is not tied back into PtMS so that you can see a side-by-side comparison of what was expected to be collected and what actually was. There is no reconciliation of the data to determine collection success in an effort to identify if this is a problem. For the trips that are provided for the Lee County CTC, since the CTC prepares the manifests and reconciles the information, they can produce a report that shows expected versus collected co-payments based on the information that was recorded on the manifests. If this information is not being provided, it should be asked for. In general, the co-payment collection and reconciliation process is extremely paper intensive, and fragmented from other system administration. sUQQested Actions: Good Wheels, Inc. Operational Study - October 29, 1999 8 Co-payment information should be collected and recorded on the manifest and then checked in and reconciled at the same type as the general manifest reconciliation is done. For immediate disposition of collections at the end of each day, the driver can total the amount collected, note this on the manifest and turn the collection in with a copy of the front face of the manifest, which can include a signature of attestation of accuracy by each driver. The software upgrade will allow for an accurate tracking of collections based on manifest reconciliation, which will save at least one step, and allow for an integrated tracking of collection for any number of reporting queries. 4. Eligibility Verification - Medicaid! TD Observations: As the CTC for Glades and Hendry Counties, Good Wheels is responsible for eligibility determination for both Medicaid and TO funding streams. For Medicaid, when a new client is entered into the system, or an existing client has a field that indicates that their eligibility has not been verified within the month, then each Medicaid number is checked individually, and this process is done on another computer, and the information extracted is then hand entered back into the system. For standing orders, Medicaid clients are not re-verified every month as a regular practice, but only when a schedule change or information change would "remind" staff that it should be done. For the TO eligibility process, no information is taken over the phone, but an application package is mailed out to those that request it, then staff from the billing department review the application and approve as appropriate. Currently, there are no constraints on funding for TO in Glades and Hendry, and no process by which budget constraints can be set within the software program to prevent "overbooking" of the funding stream. sUQQested Actions: The integration of the Medicaid eligibility information within the transportation management software as the process is being undertaken is imperative in eliminating duplicative work by staff. In a similar report compiled for the Clay County CTC earlier this year, these issues were addressed as this system also has the PtMS product. We believe that the vendor was contacted regarding this enhanced development of the software, and it may be a component of the upgrade that is being developed. If not, Good Wheels should push for this development, since they will save significant administrative time, limit chances for human error and ensure that no trips are being provided for those not eligible. 5. Trip Logging and Reconciliation Observations: The process of trip reconciliation appeared to be an extremely intensive operation with a lot of Good Wheels, Inc. Operational Study - October 29, 1999 9 duplication. It is important to have a good system of checks and balances, but the new software should provide this without the extensive administrative work. As was stated earlier, given the amount of trips being provided on a daily basis, the amount of staff dedicated to this function seems out of proportion to other staff functions. The decision to enter time and mileaqe for every trip provides for a lot of information in order to generate operational reports, however, it is very time intensive, and there are other ways of gathering this information while ensuring accuracy. It appeared that staff were always correcting information during the reconciliation process, and were having to accommodate for multi-loading and "shave" miles due to excessive miles logged because of this process. This accounts for a lot of staff time, and it would appear that software upgrades and other changes in the system calculations could alleviate this problem. As an operator for the Lee County system, Good Wheels downloads files two times a month, then basically re-verifies every trip through a trip check-in process that has already been completed by the coordinator, representing a complete duplication of the same function. Although the Finance Manger expressed serious concern that this was necessary because of several errors made by the coordinator, another remedy could be found. suqaested Actions: The software being used, particularly with the upgrade being installed, will allow for the calculation of mileage based on established zones and rectilinear calculations based on the geocenter of the zone. Mileage could be billed on this, and a preliminary analysis could be conducted to see how this compared to the actual mileage to judge the fiscal impact of using this methodology. To expound on this further, we found that the majority of billings are flat rate, so mileage is irrelevant as far as the billing is concerned. For gathering vehicle mileage information, the beginning an ending mileage of a vehicle run is recorded, less non-revenue travel, and this could be used to extract information relative to operational issues. For on-time performance and other operational issues, a sampling of data could be used to measure these performance standards. Another recommendation is that driver training should include a section on recording information on the manifest. Billing staff should be allowed to assist in the training and stress the importance of having accurate information to bill and stay in business. Regarding the reconciliation of data from services provided as an operator in the Lee County system, some accord should be reached so that staff from both offices are not recording the very same information. Perhaps the coordinator would allow for your staff to be at their office and enter the information directly there. They could then assume the Good Wheels, Inc. Operational Study - October 29, 1999 10 function of spot-checking the work of your staff to ensure that it was being inputted accurately. 6. Rate Structure Observations: Preliminary analysis by Good Wheels indicated that the rates that were in place for the Glades/ Hendry CTC system were sufficient to operate in the black, as well as the separate contract in place with the WAGES program. Their analysis did indicate, however, that the service that was being provided as an operator for the Lee County CTC was running at a deficit, and negotiations were initiated that would raise the group rate to a level that would sustain this operation. Also discussed was the opportunity to schedule more trips in the "down time" between the groups that were being serviced in the morning and afternoon on most of the runs operated for this system. suqaested Actions: Recent conversations with Mr. Bryant have indicated that the Lee County Local Coordinating Board (LCB) approved an increase in the group rate, but that the increase would be charged against the surplus fund rather than implemented as a rate increase that would be charged to the agencies. The danger of this of course, is the fact that the increase could be only temporary in nature, and the depletion of the surplus could cause payments to all operators within this system to be less timely, since the purpose of the surplus is to create cash flow for that purpose. Good Wheels should work with riders in Hendry and Glades Counties to negotiate pick-up times to fill-in down time during the middle of the day. Other strategies have been discussed to make the operation of this service not run at a deficit, and those will be discussed elsewhere in this report. 7. Scheduling - Return Trips Observations: Good Wheels staff does not schedule return trips for demand response trips that are included on manifests other than a few program trips with standing orders or out-of- county and some long distance return trips. All other return trips are treated as a will- calls, passengers call in the request, then the vehicle is dispatched. sUQQested Actions: The coordinator should always try to schedule return trips, just as they should schedule all other trips within a body of work (runs). This allows for more efficient vehicle assignments, cuts down on customer service and dispatching time, eliminates "afternoon frenzy", and allows for a more definitive idea of what is expected/needed of drivers that they assign to the runs. Return times can be reasonably estimated, and most passengers will be ready when the van arrives. Good Wheels' customer service can always call ahead if they anticipate a problem. Also, there are always operational Good Wheels, Inc. Operational Study - October 29, 1999 II remedies such as a "floater vehicle" that can "sweep up" those that were not ready at the prescribed time. These strategies should significantly increase the efficiency of the system, resulting in fewer vehicles on the road and fewer driver hours to complete the same number of trips. H. Drivers - Work Assignments Observations: Currently there are over forty drivers working in the system. Since the changeover in management there have been a number of new hires, and there have been some problems ensuring that timely adequate training is being provided. There are five lead drivers assigned to specific geographic areas that assist other drivers throughout the day over the radio with locations, reassignments of trips, etc. These drivers maintain the most contact with the base dispatcher, however, radio transmissions continue to be a problem throughout much of the service area. suqaested Actions: While having lead drivers does help in some situations, it does not truly reflect leadership or oversight for service delivery. Since the reduction of service complaints and the delivery of quality, on-time service is a very high priority for the recovery process of Good Wheels, we feel that the hiring and use of Road Supervisors should be done as soon as possible. This would not only help to monitor on-time performance and to solve service delivery problems before they become serious, these individuals can also act as ambassadors for your system, visiting facilities and agencies where there are many deliveries to ensure that everyone is satisfied with the service, and to identify potential problems. Since there are no Automated Vehicle Locators on any of the vehicles in the system, the dispatcher must depend on the drivers for accurate information regarding their location when dispatching trips. The presence of Road Supervisors will ensure that drivers are aware that someone from Good Wheels is monitoring drivers' performance, and action will be taken accordingly. Regarding driver training, it is very important that proper and adequate training is being provided to new drivers in a timely manner to ensure quality service. As a contractor with the Lee County CTC, perhaps an effort can be made to coordinate with them for the training needs of all of the drivers in your system. As the software upgrade is installed and scheduling efficiencies are realized through the use of accurate mapping, computer aided batch scheduling, analyzation and re-creation of routes (runs), and the scheduling of return trips, the positive outcome from that process would be that the number of vehicles used would decrease. Given that assumption, I would recommend watching the driver count carefully, and not be in any hurry to fill any vacancies as attrition occurs. The current practice of having all drivers operate in relatively the same hourly Good Wheels, Inc. Operational Study - October 29, 1999 12 schedules really puts constraints on how the scheduler can set up runs for the possibility for split shifts and extended hours to accommodate the needs of particular facilities and to operate most efficiently. Finally, as the computer system is upgraded and will have the capacity to run several applications, I would highly recommend the procurement of a software program that can track all driver records, including training and testing programs. 1. Scheduling - Manifests Observations: We must confess that we view the position of scheduler as perhaps the most important of all in a paratransit system. With this said, it appears that a priority has not been given to training and retaining a quality individual to fill this role. Without a proper foundation created within the transportation management software by which to create runs, standing orders, adjust times. and to manipulate the traveling boundary constraints ofvehic1es and the "speed" of the system, workable manifests cannot be efficiently created. Without a foundation of solid manifests, a system will degrade into complete chaos shortly after the day has begun. In the current system, the scheduler can cancel trips in the daily order format, but cannot make adjustments, whether short term or permanent cancellations to standing orders. As the system now stands, only reservations staff are allowed to make these adjustments. Also, with the current version of the software being used, the system does not give accurate traveling times, but rather, gives a default time that does not allow for accurate computer-aided schedules. Currently, staff "imports" information about routes for the day into an Excel spreadsheet to review the scope of work for each vehicle for the day, but this information is probably available in the software upgrade. Other concerns noted by management were the difficulties of training drivers to use pick up - ordered manifests vs. stop-ordered manifests, and the lack of trips for demand response scheduling between 10 a.m. and 2 p.m. suqaested Actions: The review and manipulation of standing orders is imperative to creating a manageable system, and the scheduler must have the training and the authority to make any and all changes as necessary. In addition to training, a system must be developed by which standing changes are handled in a systematic and timely way to ensure accuracy of manifests and to cut down on no-shows. If driver use of manifests is a problem, a meeting should be held to find which manifest is most conducive to all involved, and then the necessary training for all drivers, check- in staff, schedulers, and dispatchers should occur to ensure that everyone can use the Good Wheels, Inc. Operational Study - October 29, 1999 13 format correctly. 10. Scheduling/Creation of Runs Observations: Good Wheels operates over 1600 trips/day on an average for all of the separate service delivery models that they are involved with as both a CTC and contracted operator. The W AGES contract represents almost 65% of those trips. Under the current scenario, there are 43 dedicated vehicles/scheduled runs. It should also be indicated here that there are no backup vehicles within the system, as they are all being used on a daily basis. The lack of adequate and efficient transportation management software in managing the system is most evident in the scheduling of service and creation of runs. Without a true geo-coded mapping utility and a system by which runs are anchored and viewed, and random trips are batch scheduled with the aid of technology, there is no hope that the system will run efficiently and that service will be of acceptable quality. There are many practices in place already that promote scheduling efficiencies and the software upgrade can certainly build on those. There are some geographical considerations now for the placement and scheduling of particular runs, with "permanent" assignments in some areas. These practices promote multi-loading and afford great efficiencies. With that said, our observations indicated that there was neither the time nor the understanding of the software utility to ensure that all of the standing orders were being reviewed regularly and that the pickup and drop-off times were being monitored and adjusted so that a proper foundation was built for all scheduled runs in order that accurate batch scheduling could be done in a computer-aided fashion. All scheduling is being done basically "by hand" for over 1600 trips a day, and there is no way that it could be done in the most efficient manner. Another problem that was expressed by Good Wheels staff was that the group runs that were being given by the Lee County CTC were not being scheduled efficiently, and that the random trips that were being provided during the gap or down times were not sufficient to operate efficiently. Although the group rate increase will address this to some degree, we have some other suggestions that will be discussed in the next section. Sueg:ested Actions: It is critical that the FOOT Section 53 11 grant amendment be approved so that the necessary hardware and software upgrades be completed as soon as possible. This will be discussed in more detail in the following sections, but here we will speak specifically to the necessity as it relates to scheduling efficiencies. To realize maximum efficiency in a system such as managed by Good Wheels, it is imperative that trip assignment be based on stable consistent runs and on an examination of the most logical routing that is in the best interest of the system. It is hoped that the system upgrades will offer Good Wheels, Inc. Operational Study - October 29, 1999 14 many enhancements that promote that goal. The anchored standing orders within runs should all be reviewed and all times adjusted to reflect accuracy. As a rule, this should be done by the scheduler as the first order of business daily. The scheduling utility will provide time ordered listings of the standing order schedules, affording the scheduler the opportunity to modify pickup order and times to achieve maximum efficiencies. In addition, the software will allow for limitation parameters for each vehicle that will allow for geographic limitations for where vehicles can travel, thus promoting additional scheduling efficiencies. After this has been done, the computer aided scheduler will allow for an analysis that promotes the most efficient placement of random demand response trips among existing run opportunities. After adjustments have been made to the current configurations, an on-going analysis can be undertaken that will allow for the suggestion of modifications or eliminations of runs, using trip data for the development of service routes and other innovations. Above all, it is imperative that the scheduler have an in depth understanding of the software program and use it to its fullest potential. In reference to the "inefficient" group runs provided by the Lee County CTC, there are several strategies to deal with this. One way to overcome some of these inefficiencies would be to embrace the use of part-time drivers to accommodate these runs and to operate at least some of them in a split-shift scenario. As all ofus in this business know, there is rarely sufficient volume during the periods from 10:00 a.m. until 2:00 p.m., and it may be that by utilizing only some of these group runs during that time period, some efficiencies can be gained. Good Wheels should work with riders in Glades and Hendry Counties to negotiate trips during low volume periods to fill-in down times. The use of EMS/Fire personnel as part-time drivers has proven highly beneficial in other coordinated systems, and your area should have several retired people that could be willing to work limited hours. Part time drivers can also be used in spot duty and to compensate for those on leave, sick, workmen's comp., etc. This area should be given serious attention as the system evolves, as it is an area where significant cost savings can be realized. 11. Dispatching/Customer ServiceIReservations Observations: When riders call to schedule a trip, they usually speak to a reservationist. As was discussed previously in this report, most trips do not have a scheduled return. Currently, reservationists answer the phone saying "This is the New Good Wheels, how can I help?". If a question arises concerning a trip scheduled for the current day, or for the multitude of "will-calls", the reservations staff transfers the call to the dispatcher and informs the caller that they are being transferred to the "Driver's Manager", rather than to Customer Service. Good Wheels, Inc. Operational Study - October 29, 1999 15 Management currently uses complaints to monitor service performance. Additionally, the President and the Vice President of Operations monitor the radio during the peak morning periods to evaluate daily service delivery. Customer service satisfaction surveys are performed by the LCB as part of the annual evaluation, and by CTD staff biannually. Another observation was noted during the morning hours of observation, the dispatcher did not have the computer on, and therefore was not using the transportation management software to monitor, assist, and transfer trips in the course of the day, but rather, was recording all of this information on paper, and apparently it was only used to verify, if necessary, the transfers that had been recorded on the driver manifests. Both the drivers and dispatcher were recording cancels and no-shows by hand, but this information was not logged into the system until much later at the time of manifest reconciliation. In addition, drivers are calling in their start times and odometer readings, and these are being hand recorded by the dispatcher, rather than entered into the software system. Sue:e:ested Actions: Riders should be educated on how the system works. Reservationists often have the most contact with riders and other customers and can use the call time as an opportunity to educate riders on the no-show policies, pick-up windows, and request them to schedule pick-up times. Surveys should also be performed by the CTC on a frequent basis to determine customer service satisfaction. Surveys could be done in a variety of ways such as distributing postage paid mail-in postcards to riders on the vehicle or calling a percentage of riders. A combination of methods might be effective, since the postcard allows the rider to be anonymous and the phone call addresses riders that may be unable or have difficulty reading. There appears to be an inordinate amount of dispatching, even with "scheduled trips". Assignment of all trips to designated runs, including return trips, should reduce the amount of radio time involved with dispatching. In addition, complete recording of all required information on the manifests will allow the drivers to input data directly on them rather than calling the information into base, cutting back significantly on radio time. This will also prevent duplication of effort as far as recording of data. With the scheduling of return trips, the system should see some reduction in customer service calls, as the passenger will not need to call unless they are finished very early, . or if they were not ready at first pick up, and then become a true will-call. The pick ups should be more timely, and the passenger will have a realistic expectation when to expect their ride. As radio time is reduced, the dispatcher may also have time for multi- tasking. In addition, a true customer service area could be created, whereas a call by the dispatcher out to the drivers would not be necessary in every instance to answer the question of the caller. A restructuring of this department should be a priority to improveyservice to customers and to operate much more efficiently from an administrative perspective. 12. Transportation Management Software Good Wheels, Inc. Operational Study - October 29, 1999 16 Observations: We have spoken at length regarding the need for upgrades to the present system as it relates to billing! trip reconciliation functions, dispatching, and scheduling. Another area that would benefit with this upgrade is the reservations/intake area. Particularly for the WAGES client trips. which are often multi-legged trips, it is imperative that the system be fast and efficient so that the information can be entered quickly. In the present system, the ability of the hardware to process is so slow that reservations staff write out trips on paper and then enter them later when they have time and the system is not being pulled down by other functions such as running extensive reports, etc. This practice is simple unacceptable. Staff time and resources are so limited that no function should be completed more than once. One reason given for continuing to use paper is that it left a "paper trail" of entry. This is also not necessary since the log-in of a reservations staff as a user will allow for a record of entry so that management can identify when a trip was entered and by whom. The current version (6.1) being used by Good Wheels has some Y2K compliance issues. and the vendor has resolved all of these within the 7.0 version upgrade and added a host of exciting features that primarily enhance schedule efficiency and accuracy. The support agreement that Good Wheels has with the vendor dictates that all upgrades be installed. Presently, the vendor will not support the product in place. SUI!!!:ested Actions: The transportation management software that is currently being used may possibly be adequate to meet the needs of the system as it now exists if the Y2K compliance issue is addressed, but it still has several limitations that promote inefficient operations, and it is not adequate to promote growth in the system and to reach the level of performance expected. Inefficiencies can be addressed in two areas, operations and administration. For operations, efficiencies in scheduling and reduction in vehicle use and mileage, and increased multi-loading can be achieved with true computer-assisted scheduling based on geo-coded mapping utilities as is available with the 7.0 version upgrade to PtMS. Training on all facets of the PtMS Program for all staff should be a priority. It is obvious that most staff only have a cursory knowledge of use of the product in the current version, and with the enhancements that will be available in the upgrade, all staff should be proficient in its use. As we discussed earlier, this product is being used by two other CTCs in the state, and if necessary, staff could be sent to these systems to get educated rather than relying on the vendor for this training. 13. Computer Hardware Y2K Compliance Observations and SUlllZested Actions:: In the action plan formulated by Mr. Bryant and staff, they identified technology as a #1 priority, Good Wheels, Inc. Operational Study - October 29, 1999 17 and we concur. The amendment to the FDOT grant was for $58,000, to be used to upgrade the computer technology at Good Wheels. About $46,000 is to be used exclusively for servers and workstations, and the remaining $12,000 will be used for peripheral devises, network modifications and upgrades, and other infrastructure upgrades such as cabling. We cannot emphasize enough both the need and urgency of immediate implementation of this plan once it is approved. None of the transportation management software upgrades can be utilized unless the system is satisfactorily upgraded to accommodate them, and Good Wheels cannot begin the long journey back to fiscal health, system efficiency, and customer confidence without the proper tools. N. Conclusion Good Wheels has done a good job identifying the problems and the tasks to address the operational and financial issues facing the organization. Good Wheels has also put a management team in place that sees customer service as a top priority and the team is committed to providing riders with quality transportation. Good Wheels should continue to work with local and state agencies to enhance operational efficiency and maintain fmancial stability. In our view, the priorities that should be considered for recovery are as follows: 1. Securement of the amendment to the DOT 5310 grant to allow for the purchase of new computer hardware and administrative management software. 2. Installation of the upgrades to the transportation management software. 3. Review of all contracted work, identifying inefficient workloads. and making necessary adjustments or elimination of work operating at a deficit. 4. Adoption of recommendations to scheduling in concert with software upgrades. including scheduling of return trips. 5. Resolution of trip logging and reconciliation issues. 6. Training - Training -Training! On a positive note we must end with saying that management has taken the absolutely right approach in tackling this situation. They have worked diligently to identify Good Wheels, Inc. Operational Study - October 29, 1999 18 the problems, they have surrounded themselves with capable people, asked for help, and above all, given customer service the highest priority. CTD staff members are available for additional follow up or to provide further technical assistance. Best of luck! Good Wheels, Inc. Operational Study - October 29, 1999 19