Correctional Health 101

Keeping pace with the rush of hearings, committee meetings, and sub-committee meetings, the UTMB team met with TDCJ, TYC, and other stakeholder groups for hearings before the House Appropriations Sub-Committee. The House Subcommittee on Corrections is charged with holding hearings on HB-1 funding recommendations for all correctional health care initiatives over the next biennium. 

Let me begin by saying that UTMB has no intention turning its back on the state’s prison health care system. The university is proud of its Correctional Managed Care program and the 3,000 men and women who work day in and day out to ensure that offenders have access to health care. And, UTMB officials look forward to working with state leadership and others toward a contract that makes sense for all stakeholders.  

Now, back to the sub-committee meeting.  UTMB President Callender, William (Bill) Elger, executive vice president for business and finance, and Dr. Owen Murray, vice president for offender health services, addressed a number of questions resulting from the recent State Auditor’s report on UTMB’s Correctional Managed Care (CMC) operations.  In a nutshell, the report had raised questions about: the rate UTMB charges to provide offender care; certain salary adjustments; how UTMB allocates direct and shared costs; charges that appeared unrelated to direct patient care; and the structure of the program as a division within the university.

Mr. Elger took the opportunity to explain how UTMB sets its rates for offender care, noting that the charge for CMC patients is 81 percent less than its allowable rates for regular Medicare patients.  He assured the sub-committee members that UTMB did not use any CMC funds to provide performance-based incentives to eligible employees, and confirmed that offender burials, autopsy services, and meals for security officers guarding patients in off-site hospitals are allowable expenses under the current UTMB-TDCJ contract.  Finally, he clarified that the indirect costs in question had actually been approved in 2006, and noted that UTMB has reduced those costs from $16 million to $8 million over the past four years.

In fact, cost savings initiatives — such as the use of electronic health records and telemedicine, 340B Pharmacy pricing, pharmacy automation and medication reclamation, evidence-based treatment guidelines, and chronic diseases management clinics — have kept the cost of offender care in Texas ($9.88 per offender per day in fiscal year 2010) among the lowest in the nation.  This, combined with excellent health outcomes, has established this state as the place others come to learn how to deliver high-quality, cost-effective, evidence-based correctional health care.

Unfortunately, UTMB can no longer afford to cover the funding shortfall for prison health care while waiting for a supplemental appropriation.  Doing so requires UTMB to tap into general university revenues, which pulls essential funding away from its academic and clinical programs.  

The dialogue continues as we move on to a hearing before the Senate Finance Committee that will focus on a thorough discussion of correctional health care in its entirety.  Clearly a lot of people are now focused on the important task of demystifying a very complex issue and working toward a solution that will benefit all.

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