An Argument for Medicare Based Contracting

 I have written before about the effectiveness of Medicare based contracting in saving money for a correctional facility.  The following story is a prime example of how one catastrophic case can wipe out the entire year’s health care budget.

If this facility had such a contract in place, the most that would have been spent was $35,000-$40, 000. 

This episode shows why a discount off of billed charges contract is not effective.  Sure, It’s easier to figure out the reimbursement than a Medicare contract is, but in the long run, you will end up spending way more than you need to.   

Prisoner’s suicide attempt breaks budget

By Richard Gazarik
TRIBUNE-REVIEW
Tuesday, March 4, 2008

It will cost Westmoreland County taxpayers more than $400,000 to pay for the medical treatment of a convicted heroin dealer who tried to commit suicide at the county prison last summer.

Warden John Walton on Monday told the prison board the medical bills to treat George R. Richardsen, 23, of Brackenridge, Allegheny County, are $420,000.  The money includes a helicopter flight to Pittsburgh for treatment and an eight-day stay in the intensive care unit of UPMC Presbyterian in Oakland.

Under terms of a contract with Naphcare Inc. of Birmingham, Ala., the county’s medical provider, the prison advances the company $250,000 to pay for health care beyond the basic coverage the jail is required to provide for inmates. That money will be applied toward the Richardsen bill, and the county will have to pay the balance.  

“That blows the whole budget,” Walton said. “We could get wiped out with one big incident every year.”

He said that under state law, counties are required to provide “basic medical coverage” to prisoners in county lockups. When inmates first come to the jail, they usually are covered by Medical Assistance.

He said “99.9 percent” of the inmates lose their coverage once they’re incarcerated, and the responsibility for their care falls on the county.

“There’s nothing you can do about it,” Walton said. “You can’t parole them once treatment is started. We’re stuck. It can happen any time.”

Walton questioned why the county should have to bear the financial burden since Richardsen’s injuries were self-inflicted.

Commissioner Kim Ward said such incidents force the county to budget more money in the future to cover health care.

“He was stupid and we have to pay for it,” she said.

Richardsen, who is lodged in the state prison at Camp Hill, was sentenced in November in Westmoreland County to nine to 18 months in prison after he pleaded guilty to gun, drug, assault and conspiracy charges.

After police issued a bench warrant for his arrest in August, he surrendered and police found 150 bags of heroin on him.

After he was taken to the jail, he was in a unit for newly arrived prisoners when he jumped from a second-tier cell block to the concrete floor 20 feet below. He suffered serious head and neck injuries.

Richardsen faces a nonjury trial March 11 in Allegheny County on drug charges.

Progress in Boston

Here’s yet another city that is taking actions in order to improve the community and reduce crime.  This type of reform is what we need here in Jacksonville if we really want to improve things.  This story was in yesterday’s Boston Herald.

A new approach

Prison chief seeks ways to stop cons from reoffending

By Laura Crimaldi / Sunday Focus: Crime and Punishment

The state’s new prison chief wants to reverse what he sees as the failed “busting rocks” philosophy of the past two decades and make inmate rehabilitation and re-entry a cornerstone of his tenure.

In a wide-ranging interview with the Herald, Department of Correction Commissioner Harold W. Clarke, 56, said the punishment-only approach ushered in during the William F. Weld years – when the former two-term governor famously declared that state prison should be a rock-breaking tour of hell – has made society less safe and failed to provide exiting inmates with the basic skills needed to lead lawful or productive lives.

“We got tough and what have we gotten for that? Do we feel any safer?” asked Clarke, who began on Nov. 26, 2007, after years at the helm of prison systems in Nebraska and Washington state. “Rates of recidivism are climbing. We are going in the wrong direction and this is getting worse.”

He cited statistics that show that 80 percent of state prison inmates read below a sixth-grade level and more than 50 percent were unemployed at the time of their incarceration. A Pew Center on the States report released Thursday found that close to 2.3 million Americans – one in every 100 American adults – are behind bars.

Some 97 percent of those inmates – 11,000 of whom are in Massachusetts state prisons – will be released one day, he noted.

Clarke said Massachusetts recidivism rates are alarming. In 1999, for example, of the 21,912 inmates released to the street, 589 (20 percent) were re-incarcerated within the first year of post-release, 352 (12 percent) in their second year of post-release, and 185 (6 percent) in their third year of post-release, for a total of 1,126 (30 percent) recidivists over the three-year period.

“Good re-entry is good public safety,” said Clarke, who most recently ran the Washington State Department of Corrections for two years. “Offenders do not come to prison to be punished. They came to prison as punishment.”

While touring DOC facilities for the past three months, Clarke noted he is repeatedly given the same welcome from staff, guards and inmates alike: “Hi. How are you? Welcome and good luck.” He said: “Everyone seems to agree this is a job that requires a lot of luck.”

Clarke said he wants to jump on prisoner classification, concerns about the professionalism of some correction officers and security related to inmate shakedowns. While Clarke said he has not observed any serious security breaches, he said he is concerned about staff exposing the facilities to security problems by “cutting corners.”

He said the DOC has a technical assistance grant from the National Institute of Corrections to conduct a review of the system’s culture, especially relationships between staff and offenders. Clarke, who unlike his predecessors wants to be out front both inside the prisons and before the public and the Legislature, made clear he has no problem being tough.

“We need to at all times be professional in our actions. If it requires us using force or taking measures to control an offender’s behavior when they are being abusive or posing a danger we must do so. But when that behavior on our part is not necessarily required then we must show the offender the other side,” Clarke said.

Clarke, who has 34 years of experience in corrections, recalled years ago hearing Weld’s oft-quoted statements that prison should be “a tour through the circles of hell” where inmates should learn the “joys of busting rocks.”

“I think that would be totally counterproductive to what we are trying to achieve,” said Clarke.

The DOC is in the process of reviewing its programs for re-entry, job training, education and substance abuse treatment, Clarke said. Of the system’s 11,003 inmates, there are only 250 prisoners assigned to four pre-release centers, Clarke said. The DOC discharges 2,500 inmates annually.

In Washington, about 700 of the 18,500 inmates in the state prison system were enrolled in a work-release program, Clarke said. A new law there requires the building of one new pre-release center in Washington each year over the next 10 years, he said.

The Massachusetts Correction Officers Federated Union, which feuded bitterly with former DOC Commissioner Kathleen M. Dennehy, is hoping to have a better relationship with Clarke, said union president Steve Kenneway.

“This guy seems to want to be part of the solution for our issues as we have committed to be part of the solution for the department’s problems,” said Kenneway.

He said the union is opposed to re-allocating funds used for security to pay for re-entry measures.

“We’ve been painted as this group that’s anti-re-entry. What we are opposed to is taking funds from the security end of the this business to fund a program that is basically experimental,” Kenneway said.

Lawmakers said there is legislative support to focus on re-entry.

“No one is talking about sending people to Harvard, giving them a nice TV and pampering them. We are saying, Let’s segregate the dangerous and the sexually dangerous and let’s look at the 90 percent of substance abusers in jail and get them treatment and get them ready to come back,” said state Rep. Michael A. Costello (D-Newburyport), chairman of the House Committee on Public Safety and Homeland Security, the legislative panel that oversees DOC matters.

State Sen. James E. Timilty (D-Walpole), whose district includes the maximum security prison at MCI-Cedar Junction, said the morale of correction officers has improved since Clarke took over.

“I am excited that this new commissioner is here and that he’s engaged and I want him to succeed,” Timilty said. “The re-entry centerpiece is not just the commissioner talking about that. That’s the correction officers too.”