The use of telemedicine appears to have averted 13 to 14 costly air transfers to Federal Medical Centers from the three Pennsylvania prisons, thereby saving about $59,000. All but one of these avoided transfers were psychiatric patients who would have been airlifted to MCFP-Springfield.
Two methods were used to estimate the number of transfers that would have occurred in the absence of telemedicine. One was to consider each telemedicine session and ask, "What would have happened without this telemedicine session?" Health services administrators in each of the three prisons answered this question for every teleconsultation performed. The resulting tally showed 13 averted transfers: 11 at USP-Lewisburg, 1 at FCI-Allenwood, and 1 at USP-Allenwood. A second estimation method was to use BOP data on inmate movements from prisons to FMCs and to calculate differences between the 11 months preceding the demonstration and the months during the demonstration period. This exercise found 14 fewer air transfers of psychiatric patients during the demonstration period for all three demonstration prisons in Pennsylvania combined. The two methods therefore suggest that between 13 and 14 air transfers to FMCs were averted by telemedicine during the demonstration period.
The prisons were reportedly able to avoid emergency air transfers for psychiatric reasons because the level of ongoing prisoner care with telemedicine was reportedly higher. The availability of psychiatrists at FMC-Lexington, via telemedicine, and their expertise were thought to result in more effective medication and monitoring of prisoners suffering from psychiatric illnesses. With prisoners thus stabilized and monitored, crises were avoided. When prisoners became agitated, they had quick access to the remote psychiatrist, who was able to "talk them down," thereby sidetracking a downward spiral and averting a transfer to the psychiatric ward at MCFP-Springfield.
Furthermore, the rates of utilizing consulting specialists prior to the implementation of telemedicine cannot be viewed as "normal" due to lockdowns at the penitentiaries, contractual issues with local physicians, and treatment decisions.
To estimate the financial savings incurred by these averted transfers, records were examined from the predemonstration and demonstration periods for inmates who were transferred to Federal Medical Centers. That is, the research team analyzed cost data for transfers that actually occurred and applied the average of these expenditures to the estimated number of transfers that were averted. The cost of transfers included air charter and flight crew, correctional officers accompanying the inmate (and returning), an armed lieutenant, a medical assistant, and chase and lead car escorts. The cost for air transfers to FMCs averaged $4,600 from USP-Lewisburg, $4,102 from FCI-Allenwood, and $3,671 from USP-Allenwood. (No instances of averted transfers were observed among the inmates at FMC-Lexington.)
On the basis of these estimated unit costs and the estimated number of transfers that did not occur as a result of having telemedical capacity at each of the three Pennsylvania prisons, BOP saved $59,134 in air transport costs (see table 2.1, which shows savings associated with averted air transfers to FMCs, using the second method of estimation).
| Table 2.1 Savings Accrued From Averting Transfers to Federal Medical Centers |
Maintaining an inmate at an FMC costs more than maintaining the same inmate at a USP: approximately $51,136 per year at MCFP-Springfield, compared with $22,898 for the same number of days at USP-Lewisburg, $22,688 at USP-Allenwood, and $18,203 at FCI-Allenwood. The marginal cost of housing 14 more prisoners at FMC-Springfield would be less than this average per-inmate cost would suggest, however. This is because the facility could probably have absorbed 14 additional prisoners at little or no significant increase in cost. Therefore, no credit was imputed to telemedicine for reduced housing costs for these prisoners in the calculations. However, if telemedicine was implemented more widely throughout BOP, the decrease in the number of averted bed/days at FMCs would become substantially larger, and the marginal savings from averted FMC housing costs might produce noticeable savings as the FMCs downsized accordingly.
Some BOP administrators suggested that the budgetary consolidation of funds available for outside medical care with those for inside care (which happened just as the telemedicine demonstration was beginning) might have altered the way prisons resorted to transfers of inmates. That is, a reduction in transfers may have resulted from this policy change, rather than from telemedicine itself. If so, this change should have been consistent across all BOP facilities (although in the Northeastern region, where the demonstration prisons are located, administrators did not implement this change as fully as in other regions). To test this hypothesis, data for psychiatric and medical transfers from four other USPs lacking telemedicine were examined to determine if there was a similar pattern of transfer during the same two time periods. The research team observed a large increase in psychiatric transfers from three of the four and a decrease in medical transfers at the four comparison prisons as well as at the three demonstration prisons. The team concluded that the budget policy changes had no consistent impact on the use of transfers to Federal Medical Centers and, therefore, that the estimated reduction in transfers at the demonstration prisons was the result of implementing telemedicine.