Adithya Sambamurthy/The Bay Citizen

An e-mail decried "serious problems!" with the Avatar system

An electronic medical records system that plunged the city’s mental health and substance abuse services into administrative turmoil may threaten the jobs of more than a dozen mental health workers, a prominent nonprofit executive has warned.

Conard House, one of the city’s largest mental health providers, with 1,800 low-income clients, will have to cut 13 positions unless an agreement is worked out with the city, the organization’s executive director, Richard Heasley, said in an interview. While that deal has not been settled, a top administrator from the San Francisco Department of Public Health said in an interview Friday that the city intends to help Heasley avoid such layoffs.

The problem stems from Avatar, an $11.2 million software system installed last July by the San Francisco Department of Mental Health to streamline billing and improve patient care.

As The Bay Citizen first reported last November, the software system’s implementation has been rocky. Payments have been delayed to therapists, and social workers have been forced to spend less time with patients because of time-consuming documentation.

In the case of Conard, Heasley said social workers have spent long hours logging treatment plans and other medical information into Avatar, which has cut into their time with clients. The result is that Conard has been unable to file for Medi-Cal reimbursements for as many clinical hours as planned this year, leaving the nonprofit with a projected shortfall of $301,500 for the fiscal year ending in June.

“People were frustrated and intimidated by the system, it was taking too long to get access to the system and to get the information in the right place,” said Heasley.

“We wanted the city to backfill the loss related to Avatar.”

So at the end of December, Heasley met Jo Robinson, director of the San Francisco Department of Public Health’s Community Behavioral Health Services and asked for her help.

“If there is a shortfall at the end of the year, we don’t plan to penalize them,” said Greg Sass, chief financial officer for the San Francisco Department of Public Health. “It’s a brand new system and we recognize that there’s a learning curve.”

As a condition of its $7.2 million contract with the city and county, Conard must submit Medi-Cal reimbursements to the county, which in turn files reimbursement requests with the state Medi-Cal office. Sass said the city plans to pay Conard for the services they have delivered this fiscal year even if they have not logged them into Avatar in a timely manner.

“We won’t hold them responsible as long they are making a good faith effort to get trained on Avatar,” said Sass. “I expect that there will be improvement over the next seven months. If they can improve their productivity, that will reduce the shortfall.”

Sass said his department, which contracts with several dozen clinics, organizations and other providers to provide roughly $200 million worth of mental health and substance abuse services, is watching closely for delays related to Medi-Cal reimbursements.

“It is an evolving situation,” Sass said.