Health Care Services Overview Pennsylvania Department of Corrections Richard S. Ellers Director Bureau of Health Care Services Pennsylvania Department of Corrections rellers@pa.gov 717-728-5311
27 State Correctional Institutions 2
Pennsylvania DOC Demographics 27 State Correctional Institutions 25 male & 2 Female facilities 49,320 Inmates 46,856 males (95%) 2,464 females (5%) DOC Budget FY 12-13 is $1.87B (7% State Budget) $34,000 annual cost per inmate or $94/day $5,161 is for medical care or $14.13/day Medical budget for FY 12-13 decreased from $236M to $217M due to Act 22 (Medicaid & Medicare billing) 3
Pennsylvania DOC Inmate Demographics Half of inmates age 25-39 56% inmates African-American 8,461 inmates are > age 50; 16.5% of DOC population 46% inmates from Philadelphia & Allegheny Counties (23% of state population) Average Length of Stay= 3.6 years 90% of inmates return to the community 4
Pennsylvania Model Three separate statewide vendors: - Medical, Mental Health, Pharmacy - Subcontractors for Laboratory, X-ray, Supplies Separate cost accounting - Large cost savings Coordinated Quality Improvement - Greater accountability Recruitment and hiring of Practitioners: Physician, CRNP, PA; contracts with hospitals, specialists Central oversight and contract monitoring: QI Plan 5
DOC Staffing Compared to Vendor 6
Medical Contract Staffing Vendor employs practitioners (physician, CRNP and PA), administrative staff; nursing staff at two facilities DOC employs nurses, administrative staff; dentists, hygienists, and dental assistants 7
MEDICAL CONTRACT SCOPE OF WORK All costs for outpatient services- capped rate Intake History and Physical Exams Misc. Inmate Evaluations including: Clearance for Food Service, Boot Camp, Sports, and Work assignments Chronic Disease Management Utilization Review Medication Formulary Management Inpatient/Hospital Monitoring Staff/Employee Applicant Physicals TB Testing Daily Sick Call and Physician Sessions Infirmary Operations Long Term Care Renal Dialysis End of Life Care ECG Services X-Ray Services Emergency Services Ambulance Services Laboratory Services Vision Care 8
MEDICAL CONTRACT SCOPE OF WORK (continued) Audiology Oncology Specialty Services including: Internal Medicine Orthopedic Surgery Dermatology Neurology Neurosurgery Nephrology Ophthalmology Gastroenterology ENT Podiatry Urology Endocrinology Cardiology Oral Surgery Other Specialty Referrals Rehabilitative Services/Psychiatry including: Physical Therapy Occupational Therapy Rehabilitative Services 9
Mental Health Contract Staffing Vendor employs psychiatrists, certified nurse practitioners, state and regional administrative staff; Practitioners, nurses, social workers, activities specialists and administrative staff at four (4) Mental Health Units DOC employs psychologists 10
Mental Health Contract Scope of Services Psychiatry Services Receptions and Classifications Writing initial Individualized Treatment Plans Participation in PRT meetings with other treatment staff Assessment, admission, treatment, and discharge of inmates into and from POCs Special Psychiatric Evaluations Forensic Psychiatry Treatments - Psychopharmacology practice Weekly individual & group therapies for mentally ill inmates in SNUs ECG Services 11
Mental Health Contract Scope of Services (continued) Inpatient Mental Health Units 4 (3 male & 1 female) Operate inpatient forensic mental health units (MHU) Twenty-four hour on call coverage for psychiatric emergencies Nursing Orientation, Education, Training, and Performance Assessment for MHU nurses Discharge Planning Quality Improvement Inspections and Audits Psychiatry services for the 90-bed inpatient Forensic Treatment Center (FTC) 12
Pharmacy Contract Formulary Management: 92% of medications prescribed are generic Stock psychotropic medications Medication returns and credits Purchase medications at actual acquisition cost, pay provider a dispensing fee Comprehensive review and approval process for all non formulary medications Specialized QI reports Independent, third party review to validate medication actual acquisition prices Automated ordering, inventory, Medication Administration Record (MAR) 13
$60.00 Medication Costs per Inmate (Excludes HIV Meds) $50.00 $40.00 $30.00 $20.00 $10.00 $0.00 SEP-03 MAY-04 JAN-05 SEP-05 MAY-06 JAN-07 SEP-07 MAY-08 JAN-09 SEP-09 MAY-10 JAN-11 SEP-11 MAY-12 14
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Total Medical Cost per Year Pennsylvania DOC vs US General Population $2000 $4000 $6000 $8000 4211 7628 4471 7911 4504 8149 4741 8402 5161 2007 2008 2009 2010 2011 DOC Patients US General Population (source: DOC data and Kaiser Family Foundation)
Total Medical Cost per Patient per Day Pennsylvania DOC vs US General Population 20.86 21.66 22.31 23.00 $20 $18 $15 11.53 12.24 12.33 12.98 14.13 $10 2007 2008 2009 2010 2011 0.00 DOC Patients National Average Correctional Cost: $17.98 source: DOC data and Kaiser Family Foundation US General Population 17
Cost Drivers YEAR HOSPITAL HOSPITAL AVERAGE LENGTH DAILY COST ANNUAL COST ADMISSIONS INPATIENT DAYS of STAY PER INMATE PER INMATE 2008-9 1562 6,921 4.43 $12.23 $4,504 2009-10 1515 7,057 4.66 $12.98 $4,741 2010-11 1733 7,896 4.56 $14.13 $5,171 18
Cost Savings Initiatives Obtain 340B pricing: HIV (650 inmates treated cost of $16.5M, 40% of pharmacy budget); Hepatitis C, Hemophiliac treatmentblood factor products Use of CRNP, PA s, Nurse Assistants Specialty Centers of Care: Long Term Care, Hepatitis C, Oncology/Chemotherapy, Same Day Surgery Telemedicine: Specialists, chronic care, psychiatry, pre and post hospital care Electronic Medical Record 19
Cost Savings Initiatives PA Act 22 legislation enacted and PA Medicaid Plan amended to cap inpatient services at Medicaid rates; with qualifying inmate conditions/disabilities eligible for federal matching funds. Billing through Department of Public Welfare Outpatient services capped at Medicare rates; billing handled by medical vendor Access to Care- not all services at all facilities: infirmaries, specialty care, chronic disease management Practitioner recruitment for primary care practitioners will be exacerbated by Affordable Care Act 20
Quality Inmate Health Care Requires Commitment of the Executive and Facility leadership Appropriate allocation of resources Adherence to ACA correctional standards and clinical protocols Extensive clinical and quality improvement monitoring processes Trained health care staff Proactive partnerships with medical, mental health and pharmacy vendors 21