Captive Audience

There aren't many patients rich or important enough for a hospital to consider building a brand-new wing just for them. But Denver Health Medical Center is on the verge of bestowing such VIP treatment on one group: prisoners.

Last week, administrators for the medical center (formerly Denver General) pitched the hospital's board of directors on a new forensics wing. The sixteen-bed, $4 million structure would be devoted entirely to treating prisoners from the state Department of Corrections and Denver-area jails, along with any other felons the hospital might get onto its gurneys. The hospital has already hired an architect to draw up preliminary plans; projected completion is set for the spring of 1999.

"We're trying to play up our strengths," explains Stephanie Thomas, chief operating officer of Denver Health, the quasi-governmental agency that runs the hospital. "Prisoner care is one of those strengths. We're very good at it. And it fits in with our mission of caring for the area's underserved."

But it's more than just benevolence that's driving the hospital to consider only its second major addition in the past three decades. Last December, Colorado Access, the one-year-old managed-care company comprising Denver Health Medical Center, University Hospital and Children's Hospital, began a pilot program to provide medical care for convicts in Colorado state prisons.

The result? "We've done well," says Beverly Long, correctional-care program manager for Colorado Access. "It's been a wonderful project."

Denver Health's Thomas is more specific. "The contract," she says, "has been a very profitable one."

While Thomas says specific figures aren't yet available, patching up convicts has proved so profitable that Denver Health wants the job permanently. Next month, the state Department of Corrections will put a new, five-year contract out to bid. Colorado Access will be among those submitting a proposal, which will include the medical center's new forensics wing as a centerpiece.

A dedicated hospital wing and an exclusive contract to treat Colorado's convicts could be just the beginning of Denver Health's new commitment to criminal offenders' well-being. Long says that if everything goes according to plan, Colorado Access will soon try to service federal prisoners as well. In the meantime, she adds, the hospital and the HMO will aggressively try to snag contracts with as many Denver-area jails as possible. Someday soon, they may even look for opportunities to offer health care to prisoners in other states.

Colorado Access and Denver Health aren't alone in their wide-ranging search--even behind bars--for new patients. Managed health care has forced many medical providers into a strange, upside-down world that wouldn't have made any sense just a few years ago.

Take Medicaid and Medicare patients. Sick and injured people covered by the federal government's insurance plans for the poor and elderly were once shunned by hospitals and clinics as a drain on profits. Today, however, they are being pursued by HMOs as large and dependable sources of revenue.

Prisoners could be the next hot new source of money for a select group of managed-care providers and hospitals. St. Thomas Moore Hospital, in Canon City, which treats many state and federal inmates, is considering upgrading its prisoner-care facilities. Indeed, although supplying medical care to convicts has some obvious liabilities--there are security risks, and other patients may not cotton to sharing an ER with a rapist--the prison population carries clear benefits for health-care organizations struggling to bring in cash.

For starters, prisoners--unlike the rest of the country's population--have a constitutional right to health care. That means that if they need medicine, they get it, or a lawsuit is probably close behind. Better still, all prisoners--also unlike people who haven't committed any crime--are insured. Treatment of prisoners, from the lowliest scofflaw to condemned murderers, is paid for in full by taxpayers.

Finally, points out Thomas, "prisoners also don't miss many appointments; administrators like that."

As a cooperating city and county agency, Denver Health Medical Center has treated Denver County jail prisoners for years. Early this year, the hospital split off from the rest of city government into a semi-autonomous agency, with the capability--and responsibility--to drum up more business. The hospital had also joined forces with Denver's other public hospitals a year earlier to form Colorado Access, a nonprofit health-maintenance organization that focuses on attracting Medicaid business.

That all sounded good to the Department of Corrections, which has been spending more and more money on health care. In 1996 the state prison system dropped $25 million on inmate medical services for its 10,800 prisoners. And, with an 8 percent annual increase in prisoners, "we were looking at coming up $2 million short," says Matthew Mayes, director of finance for the Corrections Department's medical program. "We knew we had to do something."

So in the spring of 1996 the DOC solicited proposals from area health-care providers. Only a few responded, and Colorado Access's setup seemed best. The company began supplying DOC's inmate medical care last December.

While the corrections department's Division of Clinical Services continues to provide primary care for inmates, Colorado Access has put together a new network of medical specialists throughout the state who have agreed to treat convicts for set prices. That alone was a big step forward, says Mayes. "In the past, if an inmate needed a specialist, our scheduler would just go to the Yellow Pages," he recalls.

The HMO also agreed to help the corrections department with utilization management and claims billing and to set up a "telemedicine" consulting service through which DOC physicians could get help and treatment advice from Denver doctors.

Although Mayes says he will begin soliciting proposals for the new five-year contract to deliver health care to the state's inmates, the current deal with Colorado Access will remain in place through next summer. So far, he says, the arrangement has been remarkably successful. Over the past year, the average length of a hospital stay for state prisoners dropped to 3.5 days from 4.58 days before Colorado Access got involved. And the cost of treating prisoners decreased from just under $3,000 per inmate to $2,119.

For their part, of course, Colorado Access and Denver Health have earned good money. Colorado Access gets paid for its administrative expertise in managing DOC's inmates, and Denver Health Medical Center cashes in by treating a large number of patients who are actually insured--a relative rarity at the hospital, the largest provider of free and indigent health care in the region.

Which is exactly why Denver Health wants to treat more and more prisoners in its brand-new forensics wing. The hospital already has a locked facility that is used exclusively for inmates, but it is fifty years old and about 200 yards from the main facility; Thomas says the distance heightens security risks whenever a patient must be moved from the ward to the hospital. The new forensics wing, she points out, would be safer.

Indeed, Thomas contends that providing medical treatment to prisoners is a specialty that not every facility can handle. An unusually large number of convicts have AIDS, for example, and the population behind bars is aging. A growing number of the prisoners are women.

And then there are the inherent security problems. Wards must be locked and watched. Every time a patient is moved, he must be accompanied by a guard. Many prisoners are kept handcuffed until anesthesia kicks in, and then are bound up again as soon as they come to.

Some of the concerns are less obvious. A prisoner can't be left alone with IVs or other equipment that could be turned into prison contraband. Even scheduling must be considered.

"When you see, say, an orthopedic patient, you can't tell him when the follow-up visit is going to be," says Thomas. "He might start planning an escape."

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