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Thanks for tapping in to see read the FAQs on our upcoming pay structure changes. Please first read the Career Development and Performance Management Chapter of this guide in its entirety to see if your question is answered there.
There are a fair number of questions here, so we have tried to organize it by themes as much as possible.
We have not filtered or otherwise edited the questions we have received, except rarely when questions seem duplicative. If you have asked a question, it should be here. Consider using the search function in your browser to find key words or phrases from your own question, or words or phrases you think others might have used.
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The original questions here came from a Survey we distributed. That survey is now closed, but we will continue to take and answer questions.
Send additional questions by tapping on the Feedback or Questions link below.
Important Update: the guide has been updated on 2/9/2020 to clarify that only employees making at least $35,568.00 annually are eligible for salary-based pay, regardless of FTE.
Training
Q: Does the required new hire training affect my productivity?
A: If you are in your probation period, your required training is already factored. Your productivity will be measured at the end (last 4 weeks) of your training period.
For team members past the orientation period, expectations for minimum-required training remain the same as always at no less than 15 hours per year. The guide says: Team Members may complete training at any pace they wish. Paid training time is limited to 8 hours per calendar quarter, with exceptions where Accend authorizes a lengthy training.
Q: Are you open to bringing back monthly (or quarterly?) team meetings as a forum for having these conversations? It's more helpful to talk in person than to email questions about complex changes like this.
A: We will schedule gatherings of teams or all staff as we determine they are needed.
Q: Who can I meet with to review and approve my career plan?
A: Your direct administrative supervisor. Lynsee is also available for questions and is offering drop-in workshops.
Q: How can I tell how many competencies I've earned?
A: Your instructor/trainer will fill out a form for each training, and your supervisor will review these during monthly supervision.
Office/Administrative
Q: How will office staff pay structure work?
When will there be more trainings available to office staff for competency based?
When will the office staff competencies be written/implemented?
Or is there a different plan for office staff pay raise-schedule?
Also curious about competencies since there aren't any for administrative staff and thus no way for us to get a raise.
What will be the measure for pay for administrative/supervisory positions?
A: It works the same. Your supervisor will develop a career plan with you and define the competencies that will best benefit you in your role, or future career, and make a customized training plan with you.
Case Management-Specific
Q Will MNsure Navigation clients count towards clients seen each month?
A: No. Case Managers who want to become navigators will get competency increases for this training.
Q: Will we have a performance intervention if we go below 28 clients?
A: No. Your productivity establishes your pay. We will intervene when your assigned clients' needs are not being met due to lack of effort on your part (e.g. you have not demonstrated efforts to contact them and meet their needs). When you have disengaged clients, ask for referrals. If those that you have not been able to contact re-engage, we will thank you, and work with you to re-assign other clients as needed.
Q: Will outreach clients who have active insurance (that covers TCM services) count towards clients seen each month?
A: It is not clear to us who would be Outreach clients who have active insurance. Most former clients in Outreach status were in that status because they a) were not eligible for Case Management (and now that we offer it might possibly be eligible for Behavioral Health Home Services) or, b) they were uninsured.
For uninsured individuals your job is to help them get insurance if they need services.
For all others, Case Management Outreach status will be replaced by referrals to Information and Referral services. One very specific service: Prior Authorized Info and Referral will count as a client seen. You will be asked by a supervisor to provide this service, and must be prior-authorized to provide it.
Important update related to this question: Accend has been offered a contract for Case Management in St. Louis County. The result of this is that referrals who have non-PMAP Medical Assistance will be eligible immediately for payment for Case Management Services. Addiitonally, clients whose insurance lapses may be eligible for payment if you work diligently to get insurance re-instated and backdated, even if it remains straight Medical Asstance for one month.
Please do not become complacent in your response to insurance flags because of this "out" . It remains your job to help all the people you serve maintain their health insurance coverage so that they can get all of the health care services they need.
We've signed the contract and are waiting on the signatures of County Commissioners. Look for an announcement soon for the effective date of this change.
Q: Say a client comes in for outreach services, has no insurance, is not a client, does not want to become a client. He/she will not count towards my clients seen in the month? If that is correct what incentive is in it for me to continue providing outreach? If it won’t county towards my 28. I have limited incentive to continue providing outreach services as I will be focused on meeting 28+ clients in order to get paid and eliminate a pay cut?
A: If a referred individual does not want to become a client (does not want a service we offer), we will not initiate that individual in any status for that service. We won't ask you to provide outreach.
We plan to eliminate "Outreach" as a status, and service for Case Management referrals. It has been too often a holding pond where too many referrasl just languished without receiving any meaningful services, and the list of outreach clients has grown to up to dozens at in the past. Some referrals who were put there for insurance reasons failed to get initiated after they became insured. Other referrals simply sat there for months without ever even having beeen seen or contacted.
If a client legitimatley needs Information and Referral Services that we can provide, see the answer to the similar question just above for how those services will be provided and be prior-authorized.
On the other hand, if you continue to improve your MI skills as an intake interviewer, and you meet a reticent client who is eligible for our services, you might find yourself more successful in engaging them for services for which they are eligible.
Q: Will intake clients who qualify for TCM services and have active insurance count towards clients seen each month?
A: Yes, if the intake results in a follow-up appointment and the referred individual engages in services.
Q: Do you take the average of three months of clients seen to determine your pay for the next 3 months or is it the lowest number of clients seen for the 3 months that determines your pay for the next 3 months?
A: We use averages and round down. Consider these examples:
John is full time sees 30 people in January, 29 in February, and 28 in March. This averages out to 29 individuals seen per month. John is eligible for a bonus for exceeding his productivity target.
Mary is full-time and sees 28 people in January, 27 in February, and 26 in March. This averages 27, and Mary will see a productivity adjustment in her pay and it will be based on 27 clients seen per month. In April, May and June, Mary sees 28 clients every month. She is eligible for a bonus in July by exceeding her current productivity rating of 27 clients. Her bonus restores her to full pay for 100% productivity for the second quarter.
Q: How many extra clients should we take on, when there is difficulty getting insurance back for a client, and when clients are engaged just enough to keep their services but, don't see or talk to us on a monthly basis?
A: Manage your caseload the way you see fit, following the guidance of your supervisor. Something you should be discussing with them is whether or not your clients are meaningfully engaged in the Case Management Service. Are you assesssing needs and making referrals, monitoring progress and advocating for improvement where it is needed? The recent Health Partners audit of our Case Management services emphasized this in their review: they see too many cases where Case Management clients who are not meaningfully engaged (benefiting from the service) because of inconsistent engagement on their part.
And remember this: Individuals who perceive the service as meeting their needs will engage. Those who don't perceive value in the service will not. Are you providing a responsive service that they value and that is meeting their needs?
Q: How does it work if you are full time one month and then lower your FTE the next month? What average would you take then?
A: This is a case management question. Your averages would be calculated based on your FTE during any given month. The average at the end of the quarter is the average number of individuals you see +/- the target for your FTE in that month.
Consider this example: In January, you are a 1.0. You see 29 people (one more than the base target of 28). In February, you switch to 0.9, but becuase it takes awhile to transition everyone to new providers, you see 26 In February (matching the 0.9 target, and then only 25 in March (one fewer). Because you exceeded your target in January by one, and fell short of it (25 vs 26) In March by one, you still averaged your target for your FTE for the quarter.
Q: Do case managers need to worry about productivity time anymore since only phone contacts and face to faces count towards target time?
A: Case Management Target Productivity is clients seen per month. Make contact with all of your clients in the first 10 business days of each month, as has long been the expectation. Then go about meeting the needs you identify in these triage contacts during the rest of the month.
Q: What if two case managers see an active insured client in the same month? Who gets “credit” for seeing that client? Both staff? There are many times and situations where more than one staff see the same client in a month, at different times.
A: This is an excellent question. It is especially applicable as we try to move toward partnerships of Case Management Mentors + Associates, or BHH Systems Navigators + Behavioral Health Home Specialists. Considering that, the answer has two parts:
1) Where there is no team (partnership) and each of you saw an individual in the same month (perhaps because of a mid-month transfer or other reason), both get credit for seeing an individual for a meaningful service. In this case, we're just looking back at each individual case manager for how many people to whom they provided a meaningful service.
2) Where there is a team (partnership between a Case Manager and an Associate or Systems Navigator and BHH Specialist), you are evaluated as a team. As an offical team, you will divvy up the work, each client getting services from the most appropriate team member. Each partner gets credit for the full portion of the combined caseload of 56 individuals served. This will require effective partnership, plannning and coordination.
Salary, Comp Time and PTO
Q: What is the base salary for a therapist trainee
A: See the lines for Psychotherapy and mixed Psychotherapy positions in the guide. These include Trainees, and productivity is considered. These are starting rates and go up from there based on competencies. Consider a mixed position (Psychotherapy + ARMHS, or Pscyotherapy + CTSS) which, while having a lower base rate, might actually result in a higher pay rate based on productivity.
Q: How is comp time kept track of in an official manner? (ex. comp hours bank separate from PTO)
A: Each quarter we calculate your hours worked (In and Out) and your FTE. The records are always there and available to you and to us. If your work hours + PTO requested is higher than what is required for your FTE, you will not be debited for all of the PTO you have requested. If it is lower, you may be debited for more PTO than you requested. Exceptions apply to unpaid FMLA leave. Read the guide section on salaried positions here.
Q: Will comp time reflect overtime? (1 hour over time=1.5 hours comp)
A: No. comp time is not overtime. Comp time reduces the amount of PTO you have to use. Neither Comp Time nor PTO is required by law. This is a benefit we offer associated with PTO, also a benefit that is discretionary (other than sick and safe time ordinances with which we also comply) and is not covered by either US or Minnesota labor laws. PTO is a benefit offered at the discretion of the employer. This has been held up by the Minnesota Supreme Court.
Q: Will we have two different PTO banks?
A: Nothing like that is planned at this time.
Comp time is not PTO. Comp time allows salaried employees to flex their hours across weeks and pay periods in a given quarter to respond to changing workloads and the needs of the people they serve.
Comp time is related to PTO only in this way: if your work hours + PTO you have requested during the quarter exceeds the total hours required for your FTE, you may not have to use all of the PTO you requested.
See the section under the header "How Does PTO Work for Salaried Employees?" in the guide here for explanation and and an example.
Q: Will my pay be my exact current wages that would equal my exact FTE time? FTE times my current wage? And will this change with the new competencies
A: If you move to salary, your new salary will be based on your current wage X your FTE hours per pay period (80, 72, 64), with the increases for competencies, and adjustments for productivity applied.
Update: you may not be eligible for salary-based pay if you are not earning at least $35,568 regardless of your FTE at the time we implement this change.
To be eligible for salary-based pay, your current hourly wage must be:
At 1.0 - $17.10 or higher
At 0.9 - $19.00 or higher
At 0.8 - $21.38 or higher
Q: How does making EIDBI salaried actually benefit the employees and the kids we serve? It sounds like it mostly benefits the company.
A: If you examine the pay tables in the guide here, you will notice that Salary Positions are are planned only for EIDBI Lead staff.
We may at some point the the future offer salaried positions, and the benefits that go with them, to Level I EIDBI staff who are functioning highly independently.
Nonetheless is not clear to us how paying providers salary or hourly should have an impact on the quality of services staff provide.
Talk to a currently salaried employee about the benefits of that system, especially as regards PTO and Comp Time. And read the guide here to learn more about these benefits.
Impact On People We Serve
Q: Will kids be cancelled at the end of the quarter when all the staff needs to hurry and get like days off because comp time doesn't roll over? That sounds like the company would be losing money.
A: Comp time is not PTO. For a salaried employee, comp time reduces the amount of PTO you need to use each quarter. This is a substantial benefit. For an hourly employee, there is no such thing as comp time. Your are paid for each hour that you work, including overtime pay at 1.5X your wage if you work overtime.
Q: What is the incentive for spending more time with clients?
A: 1) Meeting their needs. 2) Accomplishing the mission. 3) Increasing your productivity.
Q: How do you figure this pay model is client centered?
A: It emphasizes and rewards seeing clients and meeting their needs with highly trained and motivated staff. The rest is up to you.
Miscellaneous
Q: Why is this a better pay structure than the previous?
A: Several reasons. To list a few:
1) It makes your career development and pay self-determined. You pick the pace that you want to advance. You need not wait for annual increases.
2) As you develop competency towards an eventual promotion to a new position, those competencies count immediately toward your pay, even if there are not yet openings for the position you seek.
3) It rewards high performers and controls costs for underperformers, eliminating the need to keep pay low for the high performers based on the lowest common denominator of low productivity and underperformers.
Q: How do you base competency?
A: See the guide description of that here.
Q: How will quarterly bonuses be paid out?
A: In the first paycheck for the first pay period of new quarter, for the previous quarter. This is the check that comes three weeks after the end of the quarter. See the definitions of quarters in the guide here.
Q. How does the bonus part work for hourly staff? Does it apply to them?
A. Bonuses apply to everyone who exceeds their productivity rating for the quarter.
Q: Why does comp time not roll over? I still worked and should be compensated one way or another.
A: Comp time accumulates for a quarter for salary staff, then is factored into PTO and resets. Take time off if you need it. Manage your own overtime. There is no need to make comp time a bone of contention. Work higher than your weekly FTE when you need to respond to client needs. Go home when you do not have work to do. This system is designed for self-determination and client-centered work.
Q: What if we suddenly have several clients re-engage? How will we be supported with a high case load?
A: We will thank you for your support of the clients, and of the mission by not giving up on them. We'll ask you to meet their needs until we can re-assign them or others on your now, too-large caseload. This will help improve your target productivity for the quarter.
Q: Will my paycheck change? How often?
A: Your paycheck will go up as you demonstrate new competencies, and you may request a review every 12 weeks. Your paycheck will go down if you a) are not meeting the productivity target on which it was based, or b) are not working the FTE on which is was based and have exhausted all of your PTO. This could happen during any monthly administrative supervision.
Q. Can staff test out of training if they have already attending the training in the past and want a chance to go straight to demonstrating them to be able to earn the competencies?
A. No. For anyone above the base as of January 1, 2020, they have already received pay increases under the previous pay system. While not tied directly to training, these (annual or other) increases assumed increasing competence. Pay increases going forward require demonstration of new skills (competencies.)
Q: Can you prove you are in compliance with city ordinances and the law?
A: Yes.
See the guide here and the embedded links to the FLSA on questions about salary-based pay.
As for any other part of this structure, we are essentially required to: 1) pay at least minimum wage, 2) pay you on time, and 3) not discriminate. This structure helps us prevent discrimination by establishing standard guidelines for all positions.
If you have any other specific questions, feel free to send them via the link below.
Another good reference is The Employer's Guide to Employment Law in Minnesota.
Feel free also to browse the MInnesota Department of Labor and Industry website, here.
Q: What is Accend going to do going forward to ensure no further payroll mistakes?
A: We are always diligently working to improve our systems.
Q: Why does this seem wrong?
A: Ask an ambitious and productive coworker who will benefit from it if they feel the same way.
Q: Do you recognize the toll payroll mistakes take on the staff?
A: We do. That is why we have always followed two simple rules: 1) Fix mistakes and provide back pay if needed when someone is underpaid. 2) When staff have been overpaid by mistake, either a) accept the loss as our mistake, or b) work with the team member who has received and extraordinarily large overpayment to make sure the plan to recoup it does not cause financial stress or difficulty.
The best guidance we have for you is to inform us immediately if you think there has been an error in either direction.
Q: Can I have the option to continue to get paid the same way I have been getting paid? Without moving to the new structure?
A: This structure is designed to reward high performers who are constantly working to improve their skills. Consider taking on that challenge.
Q: What is the productivity adjustment in April?
A: See the guide here and ask your supervisor for help if you don't understand it.
Q: Will my wages be lowered if my productivity goes down because of client factors like cancellations?
A: Yes. Monitor engagement and ask for referrals if you need them because of disengaged clients. And, look in the mirror: Why the cancellations? Have you been person-centered and responsive? Do the people assigned to your feel your are meeting their needs? (If so, they will keep appointments. If not, they will not.) Seek guidance from your Clinical or Administrative Supervisor if you have high cancellations. This is part of the art and science of behavioral health care.
Q: What does the pay structure look like for clinical supervisors?
A: The same. We will meet with you to develop a customized career and training plan.
Q: Are you not aware of the population we work with? SPMI, severe substance abuse, etc. etc. The best case manager in the world is going to have a hard time engaging certain clients. We should take a look in the mirror? We are constantly meeting peoples needs, going above and beyond every day, provide responsive and person centered services, and yet we are being punished if a client doesn’t show up?
A: The complex needs of the people we serve is the basis of our mission, and the reason they need high quality case management services. Our pay structure is not designed to punish you, rather to encourage and reward effective services.
As a Case Manager, you will receive training in the near future that includes feedback from one of our primary stakeholders (the payer: Health Partners during a recent audit) that challenges us to providing services that change behavior and health outcomes for people, not just ticks them off of a list of contacts. What they told us they see: there were too many clients who were intermittently engaged and, when eventually contacted, not receiving a case management service that had the followig meaningful results (we take this feedback to heart, and agree with it):
Good Case Management is:
- effective and person-centered assessment and planning,
- effective engagement,
- referrals to needed services,
- and effective monitoring of these services that
- help change behavior and behavioral choices, and
- improve health and quality of life
The ultimate answer to your question is a Clincial one. Are you providing a service with results? Are you using effective interventions? Can you change or adapt your strategies and methods to improve outcomes and engagement? Should someone else step in and try with your intermittently engaged client? This is a window and mirror exercise. Explore these questions with your Clinical and Administrative Supervisors and manage your caseload with this in mind.
One more thing to consider as regards clients who use substances as self-medication for symptoms: they need really skilled people to help them identify a new, healthier path. Our goal is to equip you with the tools to do that. Motivational Interviewing comes out of the substance abuse treatment world. It is an Evidence-Based Practice with the intention and proven result of improving engagement and outcomes. How are your MI skills? Do you want to enhance them? If so, consider adding this to your career plan.
Career Planning, Competency-Based Training, Competency, and Productivity-Based Pay are all designed with one intention: reward staff for improving their skills in order to improve the quality, effectiveness and outcomes of the services we provide to the people we serve. This is the challenge we face every day, and the challenge we now set before you as shared one. Are you interested in taking up this challenge? If so, we will do everything we can to support you.
Shared mission: shared results: shared rewards.
This guide is a living document. We want to improve it with your help. Do you have questions? Found a typo? Find yourself wanting more information? Please send us your thoughts about anything in this chapter by tapping on the link below.
