Data source: Telemedicine encounter forms.
Site coordinators collected data during each telemedicine encounter. One item asked what would have happened in the absence of telemedicine. This information was supplied by the physician assistant presenting the case and verified later by the health services administrator or assistant administrator. In some cases, patients would have been sent to a local specialist in the community. In these cases, telemedicine was substituting one-for-one for an external encounter and was counted as an averted external consultation.
Averted External Specialist Encounters: Costs
Data sources: Invoices and other financial records at each prison and administrative cost analysis conducted by Ronald Waldron and Al Turner.
The cost of external encounters was computed as the estimated cost of the specialist medical care, security, and other administrative costs incurred when an inmate goes outside the prison to a local health care provider. Assembling these costs required a set of cases to examine. External encounters in the year preceding the demonstration that might have been appropriate for telemedicine were identified. For each of these, several cost elements were collected.
Security/escort. At the Allenwood prisons, guards accompanying inmates on trips to local physicians are always paid time-and-a-half overtime; these overtime charges were obtained from the finance office of each prison for all external encounters of interest. At Lewisburg, staff are assigned to escort duty as regular employees (that is, no overtime); the average number of hours per trip and the number and Government Service levels of guards (average salary and benefits) were calculated to estimate security escort costs. A physician assistant always accompanies the inmate on external specialist encounters, and the cost of this individual (average hourly salary and benefits) was included.
Medical care. These data are taken directly from invoices and payments for each external specialist encounter.
Other. Mr. Waldron and Mr. Turner conducted a cost analysis at USP-Florence, Colorado, to calculate the time involved in processing an external specialist encounter, reviewing security needs, approvals, etc. The time and cost they calculated per external encounter are applied here to all such encounters, at all prisons.
With these data, an average cost of external encounters was estimated and applied to the number of directly avoided external encounters, to estimate total savings associated with such averted consultations.