The capital and operating costs associated with both conventional and telemedicine consultations must be paid regardless of the number of specialist encounters once telemedicine is introduced. The costs of in-prison or telemedical specialist consultations, however, are paid only when a patient sees a specialist directly or remotely. Both telemedicine and conventional medicine must pay specialists. Telemedicine specialists are paid by the hour, and specialist costs for telemedicine are calculated on the basis of average length of telemedicine sessions. Conventional, in-prison specialists are paid each time they enter the prison, regardless of how many patients they see. With data on the number of patients seen by each specialist each time they come to the prison, an average physician cost per conventional care patient encounter was calculated.

Telemedicine incurs additional costs for the telecommunications line, which again varies by the length of each call; these costs are accounted for by the hour. Also included are small costs for the physician assistants who present the case to the remote specialist and for correctional officers who escort patients from FCI-Allenwood to USP-Allenwood for teleconsultations.

The costs that accrue to each conventional internal or telemedical consultation between a specialist and an inmate are represented in Equation B.6.

The last two terms in this equation are zero for conventional care because communication and extra personnel costs exist only for telemedicine consultations.