Older offenders driving TDCJ healthcare costs

Texas' Correctional Managed Health Care Committee meets in Dallas next week and they've posted the backup material related to their agenda online. (Large file - 169-page pdf.) Here are a few highlights that jumped out at me from that lengthy document:

Correctional managed care in Texas lost a total of $24.2 million in the first three quarters of FY 2009, with losses of $5-7 million per month throughout the spring. One of the attachments describes $48 million the Lege approved in supplemental funding to UTMB and Texas Tech to cover these shortfalls. Who knows, however, if they've accurately budgeted going forward?

In the most recent quarter, vacancy rates for psychiatrists at TDCJ topped 35%. The vacancy rate for physicians was 15% - a little higher for nurses and dentists.

Even though the overall inmate population is declining slightly, the older, sicker inmate population continues to increase, according to the minutes from the committee's last meeting:

Mr. McNutt ... reported that the offender population slightly decreased to 150,225 at the end of the second quarter FY 2009 compared to 151,723 for the same time period a year ago.

The aging offenders continue to rise at a steady rate and Mr. McNutt reported that the number of offenders 55+ at the end of second quarter FY2008 was 10,211 compared to 10,824 this second quarter FY 2009 which is an increase of about 5.9%.

More on why older offenders are more expensive:

the older offenders access the health care delivery system at a much higher acuity and frequency than younger offenders. Hospital costs received to date this fiscal year for older offenders averaged approximately $1,634 per offender vs. $260 for younger offenders. While comprising only about 7.2% of the overall service population, older offenders account for 32.7% of the hospitalization costs. Older offenders are represented four times more often in the dialysis population averaging about $20.8K per patient per year. Providing dialysis treatment for an average of 188 patients through this quarter cost $1,961,176.

In the next biennium, the Legislature budgeted $97.8 million for psychiatric care and $836.7 million for acute care - that's nearly a billion dollars per biennium for Texas inmate healthcare, with the number of older, high-cost inmates growing.

Of inmates recommended by TDCJ as good candidates for "Medically Recommened Intensive Supervision," the parole board refused to consider 76% of them in 2008. Of those they agree to consider, 90% were approved.

At UTMB, which provides care for about four-fifths of Texas inmates, nurses account for 77% of inmate encounters with health care providers; physicians just 9.3%, mental health providers 5.5%, dentists 4.7%. For inmates covered by Texas Tech, only 74% of encounters were with nurses and just 5.7% were with physicians.

Finally, when money is tight, prevention gets cut. Another attachment says only 3,350 inmates participated in peer education in March 2009 systemwide compared to 7,334 in March 2008; peer education numbers were also lower in April and May.

There's a lot more information in this lengthy document, but those are the items that stood out upon initial perusal.