Budgeting for Correctional Medical Departments, Large and Small
Bachmeier, Kathleen M., Corrections Today
All correctional medical departments are required to address unique challenges when providing medical services to offenders, including managing the overall medical costs per offender. Basically, that involves preparing and maintaining an operating budget for medical services provided. The preparation of a medical budget in a small system has similarities as well as differences from that of a larger correctional system. Managed care principles, medically necessary offender care, constitutional standard of medical care delivery, conservative treatment modalities, and the delivery of quality medical care to offenders becomes the mantra of every correctional medical department. But in a small system, the correctional medical department has to address challenges using an economy of scale approach with limited resources. Consider some of the following administrative actions that small medical departments may implement to contain medical costs while preparing medical department budgets. This financial plan or budget will become the operational financial backbone, helping maintain and enhance the medical department's quality improvement activities.
Preparing for Budget Process
Establishing a mission for the correctional medical department and referring to it often is essential. The mission provides direction for all the medical professionals who practice in the department. It helps set guidelines for the available resources both material and human. And to prevent mission creep, medical department staff often need to ask, "Are we fulfilling our mission?" The medical department remains focused when refering to and fulfilling the mission during problem-solving activities.
The decision to provide medical services to offenders with medical professional employee staffs versus contract medical staffs or contract vendors needs to be fiscally evaluated. This decision is individual per situation and can be complex.
Developing Human Resources, Utilizing Talents
Human resource management--which includes maximizing the talents of professionals--may be more cost-effective for correctional medical departments when contracted providers are not used. An example would be a primary care physician who is able to practice at more than one institution with the use of electronic medical records and teleconferencing. A dental employee may be able to provide services to a number of correctional institutions. The addition of employees versus each correctional medical department in the system contracting independently for medical staff is an opportunity for medical department employees/providers to become involved in quality improvement activities and medical department problem-solving. An unexpected benefit is decreasing offender opportunities to "split" and/or manipulate medical staff: "Dr. Johnson at the Johnson Unit said if 1 did not get Ambien to go to sleep each night, I could become very sick." All licensed professional staff are at a premium in a small correctional system. Sharing physicians, physician assistants, dentists and dental assistants between facilities becomes a necessity. Even traditional lines, such as adult correctional medical departments sharing valuable licensed professional staff with the juvenile system, can be accomplished with some out-of-the-box problem-solving.
Human resources become uniquely valuable in a smaller correctional system. Taking advantage of individual employee talents may streamline care delivery by making more efficient models of patient care delivery systems. A registered nurse may wear many hats in a smaller system--for example, a staff nurse working the regular nursing schedule would spend two days a week being assigned to do all the psychiatric call and three days a week doing primary nursing. A facility's director of nursing could serve as infectious disease nurse, heath care administrator, accreditation authority for health care, and clinical laboratory coordinator, among other things. …