Health Care Services Overview Pennsylvania Department … · Health Care Services Overview...
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Health Care Services Overview Pennsylvania Department of Corrections Richard S. Ellers Director Bureau of Health Care Services Pennsylvania Department of Corrections [email protected] 717-728-5311
Transcript of Health Care Services Overview Pennsylvania Department … · Health Care Services Overview...
Health Care Services Overview Pennsylvania Department of Corrections Richard S. Ellers Director Bureau of Health Care Services Pennsylvania Department of Corrections [email protected] 717-728-5311
27 State Correctional Institutions
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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)
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Presenter
Presentation Notes
# of inmates listed is a monthly average in 2007. The year end total was 46,028. 95% Males and 5% Females Nationally, for the first time in U.S. history, more than one of every 100 adults is in jail or prison at the beginning of 2008
Pennsylvania DOC Inmate Demographics
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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
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
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Vendor employs practitioners (physician, CRNP and PA), administrative staff; nursing staff at two facilities
DOC employs nurses, administrative staff; dentists,
hygienists, and dental assistants
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Medical Contract Staffing
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
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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
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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
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Mental Health Contract Staffing
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
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Presenter
Presentation Notes
Special Psychiatric Evaluations parole; commutation; consultation-liaison; hepatitis C treatment; case conferences, on inmates being considered for community re-entry and placement in mental health community corrections centers, Evaluations of Guilty But Mentally Ill (GBMI) Category I and Category II inmates
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)
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Mental Health Contract Scope of Services
(continued)
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)
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Pharmacy Contract
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$0.00
$10.00
$20.00
$30.00
$40.00
$50.00
$60.00
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
Medication Costs per Inmate (Excludes HIV Meds)
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Presenter
Presentation Notes
FY 04-05 - $105,819,000 total FY 05-06 - $111,643,000 total FY 06-07 0 $114,616,000 (projected total)
4211
7628
4471
7911
4504
8149
4741
8402
5161
$200
0$4
000
$600
0$8
000
2007 2008 2009 2010 2011
(source: DOC data and Kaiser Family Foundation)
Total Medical Cost per YearPennsylvania DOC vs US General Population
DOC Patients US General Population
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11.53
20.86
12.24
21.66
12.33
22.31
12.98
23.00
14.13
0.00
$10
$15
$18$20
2007 2008 2009 2010 2011
National Average Correctional Cost: $17.98source: DOC data and Kaiser Family Foundation
Total Medical Cost per Patient per DayPennsylvania DOC vs US General Population
DOC Patients US General Population
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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
Cost Drivers
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Obtain 340B pricing: HIV (650 inmates treated –cost of $16.5M,
40% of pharmacy budget); Hepatitis C, Hemophiliac treatment- blood 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
Cost Savings Initiatives
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
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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
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Quality Inmate Health Care Requires
