The continued growth in this population, combined with the state's budget shortfalls, has created challenges and opportunities for policymakers and Department staff. The following are some of the Department's accomplishments in inmate health care in FY0910.
For several years, the Department had determined a need for additional secure hospital beds to serve inmates in South Florida. Part of this determination was based on the growing need for inpatient and outpatient hospital services for elderly patients. (Elderly inmates account for almost 48% of all hospital days.) On July 17, 2009, the Department opened a new 24-bed secure hospital unit at Kendall Hospital in Miami-Dade County. Accomplished at no cost to the taxpayers (Kendall paid for all planning and constructions costs), this improvement doubled the secure hospital bed space in Region IV (South Florida area) and will result in an enhanced network of specialists, a higher quality of care to inmates, and reduced transportation and security costs.
Hospital services are both contractual and non-contractual (some refuse to enter into contracts with the Department). The Department sought and obtained Proviso language in FY 08/09 limiting reimbursement for non-contracted services (both hospital charges and in-hospital physician charges) to 110% of Medicare. In FY 09/10, this became statute and was expanded to all non-contracted services, resulting in FY09/10 savings of $24 million. Savings since inception have been $50.2 million.
In this partnership between the Department and two County Health Departments, the Department of Corrections pays the Department of Health providers to provide Sexually Transmitted Disease (STD) and HIV care for inmates in nine facilities, thereby qualifying for Federal 340-B pricing discounts. Savings: $4.9 million for FY09/10.
Most dental staff had been gradually outsourced due to our inability to recruit dentists at then-State salaries. Unfortunately, external salaries were close to double state salaries. Salaries for DOC dentists were raised slightly to be competitive, recruitment became successful and services were able to be brought in-house. Savings: $4.8 million.
Most inmate medications are dispensed in blister packs, allowing refunds on unused medications and relieving security concerns. Changing from a private vendor to the Department of Health, we realized a 66% savings, or $1.4 million in FY09/10.
Established nursing positions in each region to act as case managers for local hospitalizations, allowing earlier discharges for infirmary care or transfer to Reception and Medical Center hospital for continued hospital care. Separate positions were created to review all consults for medical necessity and to triage approved elective consults to the most cost-effective setting. Cost Avoidance: $12 million for FY09/10.
Established step-wise medication protocols for the common classes of psychotropic drugs, ensuring that safer, well-established generic drugs were utilized first before newer brand name medications could be tried. Savings: $2.1 million in FY09/10.