Implement an internal instant messaging system throughout CMS. By utilizing this technology a lot of time and resources could be saved that is otherwise taken up walking to peoples cubes, unnecessarily using e-mail server space for quick questions.88 votes
Ensure that individuals have essential knowledge, leadership, and "people" skills before promotion to management. Create quarterly evaluation process so that employees can give feedback on current managers without fear of consequences.86 votes
When almost every employee in a certain area has similar concerns with a particular manager, it usually goes unnoticed (more like ingnored) unless there's a "big stink" that causes higher management to pay attention. Allow the employees to have some impact on a manager's performance eval. Some managers may not realize how their employees view them, and they may not care until it actually has the potential to affect their evaluation...82 votes
Sitting is recognized by health professionals as one of the most problematic positions in which to spend most of our days. Yet, that is how many of us spend our workday, commute, etc. Here is just one short article about how prolonged sitting can impact your health: http://www.webmd.com/fitness-exercise/news/20100119/prolonged-sitting-boosts-bad-health. Giving employees the option of a height-adjustable workstation would allow employees to sit or stand, at will, throughout the work day. This is a feasible, cost-effective way to improve employee health.79 votes
WiFi access throughout the campus would allow staff to make better use of their laptops and take them to meetings.67 votes
Audit claims data using fraud detection software which is used widely the private insurance industry
Audit/screen claims data for suspect fraud every month using a fraud detection software that will identify unbundling of codes, inappropriate procedures for age and/or sex and other common fraudelent practices. This strategy is widely used by the private health insurance industry.67 votes
CPI is implementing the National Fraud Prevention Program, a comprehensive strategy to leverage existing systems by integrating the data and new tools in innovative ways. An important aspect of this strategy is partnering with the private sector to learn about their capabilities. CPI issued a request for information in the winter of 2011 on best practices from the private sector, and has used that information to develop solicitations for contractors to adapt those solutions to the Medicare program.
Additionally, a contract will be awarded to begin the development of a risk scoring model that will screen claims and providers based on effective predictive models.
Employee communication is a process of exchanging information and creating understanding and behaviors that reinforce the agency's vision, values, and culture and increase employee morale, productivity, performance and retention. Rather than being an afterthought or using the current every-component-for-themselves approach, it should be a planned part of the management of CMS and align with our mission, vision and strategic objectives. We have benchmarked best practices at the top places to work in the Federal government. Let's implement the structures and processes we know are critical to achieving effective and efficient employee communication outcomes.55 votes
The Internal Communications Workgroup presented its final report to senior leadership (OOM, OC, OA) on January 13, 2012. All present agreed on the need for a strategic, coordinated approach to internal communications, but there are no FTEs available for this work at this time and neither OOM nor OC expressed interest in owning it. The workgroup was requested to continue to work on the various recommendations, looking for quick wins (which we explained are never that quick). In particular, there was interest in more widely disseminating information that is already available, piloting SnapComms, improving the CMSNet home page content, and fleshing out the internal communications “audit.” Aryana asked that OA be kept informed of our activities.
Utilize outstationed CMS financial staff to conduct onsite interviews of new providers or those flagged/suspect to validate their legitimacy (performing in a business-like manner, can demonstrate the capability to provide their services, known and/or respected members of the medical or business community in their area).43 votes
CPI recently implemented the requirement that certain providers will undergo site visits, announced and unannounced, prior to enrollment. The provider types are identified in CMS-6028-FC, and include DMEPOS suppliers, Home Health Agencies, Community Mental Health Centers and Ambulance Providers. CMS also has authority to perform a site visit at any time on any provider if there is reason to suspect fraudulent or illegitimate behavior that is best confirmed by an on-site visit.
CPI is considering innovative solutions to conducting site visits like the suggestion to use CMS Staff in the regional offices. CPI just concluded a Request for Information on Site Visits and is currently evaluating responses.
Especially in high-risk areas (i.e. Miami and L.A) pre-pay reviews should become the standard. It would be time consuming and pricey for CMS to implement. However, the ROI would likely be remarkable as billions of dollars of fraud, waste and abuse would be saved (or never paid). There are far too many unscrupulous providers in certain areas of our country. Pre-payment reviews would not only save us from paying their fraudulant claims, it would also help us to identify and punish these individuals.38 votes
Referred to CMS Employee Suggestion Program for consideration by OFM/PCG.
Right now, must training is a one way conversation from OAGM to COTR's. Yet training courses have consistently been filled with questions that would be more easily resolved if contract specialistis and contracting officers were involved in the discussion. CO's & CS's can learn from COTR's in terms of improved processes AND better trained COTRs.37 votes
My suggestion really incorporates many previous suggestions into a larger plan for redesigning the selection, training and oversight of management within CMS. Year after year, we get our survey results which show that we are one of the worst federal agencies to work for, despite having one of the highest grade structures in the federal workforce. Management gathers and tries to determine what employees want or what perks can be provided to obtain better survey results—making CMS one of the “best places to work.” There isn’t anything wrong with this, except that the focus of the conversation is always what we can do for the employees. I think the change that needs to happen in CMS starts with leadership, and only then can it be expected to filter down to the employees. CMS has smart, hardworking employees and managers, but we, as a whole, have a few flaws. There is a lack of accountability in this organization. Finger-pointing, blame-storming and “throwing people under the bus” are common occurrences among various components in this organization. Leadership is every bit as guilty as employees on this one and in many cases; I think the behavior has “trickled down” from leadership and infected the employees. Communication in this organization, as with most large organizations, is poor and lacking. It is not just a cross component phenomenon, it is lacking between management and the very teams that they manage! People avoid difficult conversations in this organization, it is human nature, but it allows negativity and resentment to fester, and fester it has.
I believe that for employees to truly be happy and feel valued, they need to feel heard, they need to be involved in decision-making, they need to be listened to and feedback from them needs to not just be solicited, but acted upon. Respect for each other in the workplace has to be a given, not an option. Conversations must focus on how we find solutions to workplace obstacles and not on “who’s to blame.” In order for any of that to happen, you need to have management/leadership ranks who hold those values dear and consistently promote that behavior by modeling it and expecting it, from their team. Let me just say here, that my hands are by no means clean, I have learned many of these lessons the hard way, and continue to learn them. Earning the trust and respect of our employees will take time and a lot of effort, and this is the only way I can think of to start us off down that path.
CMS is structured in a way that promotes technical expertise into management. In order to get your 14, making you eligible for a 15 management position, you either have to be a technical advisor or a special assistant—neither of these positions insures, develops or promotes the ability to lead and manage. Consequently, what CMS has at its helm is largely a group of really great and hard working technical advisors, who may or may not have ever had any interest (or skill) in leading people. Add to that that CMS does not have a formal, structured management development program and while all managers must go through LINC (leadership in context) training, many don’t get to attend until they have been in management for several months (which is often several months too late).
There is also no formal structure for employees to provide feedback to their managers (i.e., a 360 degree review), so managers can remain blissfully unaware of the mistakes they are making with their team. Finally, many managers have been burned with EEO or other types of grievances and are fearful of dealing with problem employees, others just don’t want to be bothered because it’s “too much paperwork.” Allowing poor performance or misconduct lowers the morale of those employees who are following the rules and are working hard. They see their neighbors getting away with surfing the net, talking all day on personal calls, taking the extended version of lunch and they wonder why they are working so hard. After all, nothing bad happened to X, right?
So, for those of you that are still reading, what does all this mean…well, it means that CMS needs to make a firm commitment to the selection, development and oversight of its leadership. At a minimum, CMS should:
1) Create a “management track” GS-14. Certain divisions have deputy directors, others don’t. I suggest using those positions, pooling them for the agency and allowing a certain number of management development 14s. These 14s would be selected not for their technical expertise, but based on their interest in leadership. They would rotate through different divisions in the agency, working under a variety of CMS senior leadership who are committed to leadership development.
2) Management training would be more intensive and would occur BEFORE managers were given an actual team to lead. Emotional Intelligence, Crucial Conversations and LINC would all be required, at a minimum.
3) Managers would be subject to a 360 review bi-annually. Managers who continually received poor feedback or showed no improvement from year-to-year would be removed from the management ranks.
• The 360-degree review of a manager by their employees should be anonymous. This would avoid the potential for even sub-conscious retaliation by the manager.
• The 360-degree review should include a numeric rating as well as the opportunity for employees to provide written narrative to explain the basis for their rating on any element. Any manager that gets a combined, overall rating from all their employees below a certain numeric value is flagged (it may be a good idea to throw out the highest and lowest ratings when calculating the overall value).
• Managers who receive an overall rating below a certain numeric value should be subject to PIPs based on the results of the 360-degree review.
4) Every Manager’s PMAP would include a “leadership” element; this would include developing and leading staff, as well as dealing with problem employees and working to rectify such situations appropriately.
5) If an employee or employees report that a manager yells or uses abusive/foul language when talking to employees or other managers, that manager will be warned once. If the unprofessional language occurs again the manager will be removed from their current position and barred from any leadership/management position (including that of team leader). The agency should communicate (and enforce) a clear, zero-tolerance for unprofessional/abusive language on the part of managers (and all employees, really).
6) Once the management 360 is implemented, it should be implemented for employees as well. The goal of this not so much to allow employees to “rate” one another, but to provide an avenue where co-workers can provide constructive feedback to each other. Employees would need to solicit feedback from their managers and their co-workers and would be expected to be responsive to that feedback as well. This would include adding an element to all employee PMAPs on being receptive to feedback and responsive to it as well.
I’m sure there is probably more that needs to be done, but I think this is the minimum that would need to be implemented to get us on the right track. Obviously, this suggestion will make some managers and some employees very upset, but I think those that will be most bothered by these changes are those that have no real interest in improvement, (luckily, I believe this is a small minority in CMS) and unfortunately, sometimes progress takes a few casualties.
My suggestion really incorporates many previous suggestions into a larger plan for redesigning the selection, training and oversight of management within CMS. Year after year, we get our survey results which show that we are one of the worst federal agencies to work for, despite having one of the highest grade structures in the federal workforce. Management gathers and tries to determine what employees want or what perks can be provided to obtain better survey results—making CMS one of the “best places to work.” There isn’t anything wrong with this, except that the focus of the conversation is always what…28 votes
Don't charge employees an hour or 2 for Holidays when on a compress work schedule. CMS is the only agency that does this.23 votes
Clearly define the roles and responsibilities for both the COTR and the GTL so that each are clear. Train the COTR's and GTL's according to the defined division of work.19 votes
Redesign training that is more case-study based of the top 5 types of contracts a PO will encounter.
Redesign training that is more case-study based of the top 5 types of contracts a PO will encounter.19 votes
Performance excellence standards begins with Leadership and a model. The Baldrige model has worked for other government agencies, hospitals, schools and businesses. Why not give it a try?19 votes
Compile fraud profiles based on data pulled from CMS/IRS/state Medicaid etc. and use to ID new fraud
Pull data from across platforms, including 1-800-Medicare, mymedicare.gov, IRS data, state Medicaid and other claims. Create profiles from known fraud cases and use new data to inform and pursue potential cases of fraud.18 votes
CPI is working to develop just these types of fraud profiles both for individuals and for the identification of new schemes. The National Fraud Prevention Program is designed to incorporate lessons learned on an on-going basis through a continual feedback loop in the analytics.
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