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| Georgia Cuts Health Care Costs in Wake of Budget Crisis |
| By Michelle Gaseau, Managing Editor |
| Published: 09/22/2003 |
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All across the country, corrections agencies are struggling to find ways to make smaller state budget appropriations fit their growing needs - and often have to look at prison closing and staff cuts to do so. In Georgia, correctional health care officials were able to utilize some streamlining techniques to reduce the cost per inmate for physical health care by a significant amount. "What happened was, we came up with a budget for fiscal year 2003, but there was only X number of dollars available and it became clear that we, like a lot of states, are having budgetary issues. And, we were not going to be budgeted for the amount that our staff had come up with. Our leadership said these are the dollars and we tried to figure out how it was going to happen," said Bill Kissell, Director of Health Services for the Georgia Department of Corrections. Kissell said the effort to solve the budgetary gap was a joint one between the DOC, the Medical College of Georgia, which provides physical health care services, and the department's mental health provider. The total cost of health care for inmates in 2003 was $143,680,480 or $9.13 per inmate per day, which was a 4.9 percent reduction from the inmate health care costs in fiscal year 2002. Physical health care costs declined by five percent and mental health care costs declined by four percent. "Most of our success in 2003 was due to the field professionals; they are the ones doing the hard work . This year a lot of it was focused on helping them do their jobs easier with computerization and modifying forms to make them more user-friendly and making the administrative part of their jobs easier," Kissell said. The Corrections Connection recently spoke with Kissell about how the Georgia DOC accomplished these savings and the strategies the agency employed. Q: How was the DOC able to reduce costs? What changes did the DOC make in health care services? Kissell: First we reduced staffing patterns. We increased our lapse factor (or our position vacancy rate) to approximately 20 percent and we had to be very cautious we weren't back filling positions that were left vacant by design with overtime. Staff had to work harder; there is no question. Administrators who were also providers had to work shifts, nurses and health services administrators were working shifts. People were willing to do it and they hung in there. This year [to help them] we looked for ways to go toward automation for various logs and paperwork. We wanted to computerize and reduce and eliminate things for staff - especially in the nursing area. There are things such as logs of emergency room visits that used to be manual but if done on the computer it's quicker. We have not yet gone to a records management system, but our goal is to get there. We also instituted a drug formulary control. Some of the things we looked at were the medications on our formulary. In the area of mental health we removed expensive anti-psychotics and decided to go with acceptable medications that are cost efficient and can do the job. We also did away with expensive anti-depressants besides generic Prozac. But, we have kept in place a mechanism for a provider to request a medication that isn't on the formulary, but they have to show why they want to go off formulary. One example in the case of an inmate coming in who is on a specific medication - but the doctors have to show why they [want to keep them on it.] It's a big-ticket item. We reduced what we spent on psychotropic medications by $400,000. Also the DOC took back from the Medical College of Georgia the utilization management function where a team of physicians and nurses look at specialty care areas and hospitalizations. So, if an MRI is requested, we used standard industry-accepted tools to ensure that it is needed. We determine if the doctor has exhausted all internal resources before going to specialty care. Also we are making sure patients are in the free-world hospital for only as long as they need to be and when they are able to come back to an infirmary or our flagship medical hospital, we want that to occur. The DOC is ultimately responsible for paying the bills and we thought the responsibility should go with the group paying. We have more at stake. With HIV care and other chronic illnesses, we made sure that current acceptable practices were in place and medications that are used are the most efficient. We wanted to make sure for all chronic illnesses that we reduced the number of bad outcomes that lead to expensive hospitalizations. Being seen routinely for all chronic illnesses, having medications adjusted when needed, and the patients monitored as best they can, is all a part of that. Also MCG developed a secure hospital unit with pre-established rates that are competitive. It's also a win for security because there are only a certain number of officers necessary to be at the hospital; now we can go three officers per shift. In addition, we developed something called suturing sites. Instead of inmates going out to emergency rooms to be sutured - if there was an injury off-hours when there wasn't a doctor there, we have inmates brought to a facility and a provider is paid to come back in. We did that regionally and the prison staff enjoyed bringing someone to a secure setting. We created these regional suturing sites and we also focused on reducing emergency room visits. Every bed is monitored every day to make sure the bed is needed by that person. We are doing the same things as managed care. Anything that can be held over until the primary care doctor comes back the next day, we try to hold over. Q: What recommendations would you give other agencies for streamlining health care costs? Kissell: The biggest recommendation is to make sure your staffing is as lean and as mean as possible. The staffing patterns should be as efficient as possible. We don't want to compromise our clinical effectiveness, but we need to be efficient from band-aid to MRI. To do this, we developed a staffing committee and our staffing was analyzed and it was painful. This analysis was done through an interdisciplinary team that included staff from the DOC correctional health care [department], security and the Medical College of Georgia. [Through this analysis] we reduced our psychiatric and psychological staff by 30 percent. We went to a different model where we said we'd provide X number of providers and gave [the existing providers] a raise. They basically have to work until the job is done - it was a private practice model. We have them earn more income in return and we saved a tremendous amount of money. It has gone beautifully. They psychiatrists have embraced it and we feel the program is doing just fine. This year [as a result of the hard work of staff] we were able to decrease our lapse factor by another five percent. We will continue these efficiency actions and we have also expanded some - to reduce costs even further -- but we are trying to find things for 2004 to help staff do things easier. For more information about the Georgia DOC's plan, visit the agency's website at http://www.dcor.state.ga.us/pdf/hsovrFY03.pdf |
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