Skip to main content
Sister Publication Links
  • ESG: THE IMPLEMENTATION IMPERATIVE
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Digital Health
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Unwell in America
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Providers
October 22, 2016 01:00 AM

Putting telemedicine behind bars

Erica Teichert
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print

    Dr. Vinh Pham treats dozens of patients from New York City's Rikers Island jail complex with hepatitis C and other infectious diseases. He knows their frustration with the process of accessing specialist care—and its quality.

    Inmates can spend six to eight hours shackled in holding pens and sitting in traffic as they travel to NYC Health & Hospitals' Bellevue campus for five minutes with a doctor. “That was frustrating for the patient because they went through this tremendous effort to get there and they could only have this very, very limited time to get their concerns addressed,” Pham said.

    "The inmates just palpably seem more relaxed and satisfied with the entire encounter and experience than they used to. It used to be a very negative experience," Dr. Vinh Pham, right, of NYU Langone's Hospital for Joint Diseases, speaking with Dr. Zachary Rosner.

    MH Takeaways

    Using telemedicine to treat inmates could save jails and prisons money while providing more timely and effective care for imprisoned patients.

    Pham and his colleagues came up with a solution. Earlier this year, they introduced telemedicine to Rikers Island, which has some 55,000 inmates come through its doors annually.

    Since the initiative began in May, 52 inmate patients have had virtual checkups and information visits with Bellevue's infectious disease, gastroenterology and urology specialists. They allow Pham and others to spend up to 30 minutes with a patient answering questions and ordering treatment when necessary.

    The inmates “just palpably seem more relaxed and satisfied with the entire encounter and experience than they used to,” Pham said. “It used to be a very negative experience.”

    Demand for inmate healthcare is rising as the U.S. prison population ages. The number of incarcerated men over the age of 55 jumped 82% from 1999 to 2007, according to the U.S. Bureau of Justice Statistics. More than 18% of female inmates in 2011 were over 50 years old, and that proportion has grown faster than their male counterparts over the years. Female prison populations are also more expensive to treat than their male counterparts.

    Prisoners are sicker than the general population. About 40% of prisoners report they have at least one serious chronic illness. Inmates are also at least seven times more likely to have a chronic hepatitis C infection. At Rikers, NYC Health & Hospitals estimates that 12% of the average daily population has hepatitis C.

    Providing care to inmates isn't easy or cheap. California's Legislative Analyst's Office estimated that transporting, guarding and medically treating an inmate could cost more than $2,000 per day, and a Pew Charitable Trusts report found healthcare costs for prison inmates reached nearly $8 billion in 2011. That price tag continues to rise despite growing pressure to cut correctional facility budgets.

    Many federal, state and local correctional facilities are turning to telemedicine as a cost-effective solution for providing high quality care. Telemedicine first sprang up in prisons in the 1990s as a way to provide specialty care for prisoners without ramping up transportation and security spending, according to the U.S. Justice Department.

    It's taken longer for state and local jails to harness telemedicine, even though they incur more than 90% of the costs of corrections in the U.S., according to the Center for Economic and Policy Research in Washington, D.C.

    NYC Health & Hospitals and Rikers are slowly and methodically rolling out the new technology. In May, the system funneled $650,000 into a pilot program. So far, only about a dozen doctors and patient coordinators engage in virtual visits, which are limited to infectious disease, gastroenterology and urology specialists.

    “We have a broad aspiration to do more of this across services,” said Dr. Homer Venters, chief medical officer of Correctional Health Services, a division of NYC Health & Hospitals. “But when we start, we need to identify staff that are really going to champion this.” Venters previously oversaw New York City's correctional health program for the Department of Health and joined NYC Health & Hospitals when the system took the lead on the program.

    Pham is one of those champions. The section chief of infectious disease at NYU Langone Medical Center's Hospital for Joint Diseases, Pham has treated Rikers Island inmates for eight years on an affiliate agreement between the health systems. “Vinh has been very dedicated to getting this project off the ground,” said Dr. Zachary Rosner, deputy director of medical services of Correctional Health Services.

    Pham has seen his patients warm up to the virtual visits. During a visit, Pham sits in his office at Bellevue with a two-screen setup that allows him to see the patient and his or her electronic health record. The inmate joins the video conference from a clinical space on the island. Unshackled and accompanied by a patient navigator, the inmate can ask Pham about their condition and options for continuing care after leaving Rikers. Guards stand watch outside the room for confidentiality and security reasons.

    The goal is to give hepatitis C patients the tools needed to manage their infection, Pham said, even if they're released earlier than expected. “I make it clear to the patients that this is about preventive health,” he said.

    Hepatitis C drugs are notoriously expensive, costing up to $100,000 to for a year's worth of treatments. NYC Health & Hospitals has budgeted $2.5 million in fiscal 2017 for hepatitis C drugs, and $5 million in the ensuing years. In addition, it has partnered with Merck to receive discounts on its new hepatitis C treatment, Zepatier. Those initiatives should help the health system triple the number of inmates who will receive the treatment.

    The virtual visits have also been used in gastroenterology and urology to provide test results, pre-op visits and evaluations for inmates with conditions including mild anemia, Crohn's disease, ulcerative colitis or difficulty with urinating.

    “We've always viewed our role in correctional health as part of the public health system,” Rosner said. “When people are frustrated during a very difficult time for them, we do feel that having robust health systems in place can make a positive out of a very difficult situation.”

    Although Rikers' telemedicine program has started small, the facility has a robust inmate intake program that could help NYC Health & Hospitals quickly ramp up telemedicine visits.

    Upon entering Rikers Island's jail, each inmate gives a complete medical history and gets a physical examination, no matter the length of their stay. Correctional health providers will flag inmates that could benefit from specialist care or even a telemedicine visit during this process, Rosner said.

    The intake process is comprehensive and can include HIV testing and vaccinations, according to Venters. “It's like a hospital admission,” he said.

    For years, federal prisons have had a more robust telemedicine program than local and state jails do. Inmates in federal prison tend to serve much longer sentences and the Justice Department has supported using the technology for decades. An average stint at Rikers lasts 55 days, making it difficult for the local jail to even schedule specialist and telemedicine appointments before individuals leave.

    In January, NYC Health & Hospitals formally took over the entire correctional health program for the city's jails. Venters said that helped Rikers get its telemedicine pilot program off the ground.

    “We were a health system on the outside trying to innovate with a whole other organization,” he said. “Since we came into Health & Hospitals, we've become a whole family.”

    Rikers and the health system are looking at several possibilities for expanding its telemedicine program, including psychiatric consultations and other specialty services. It also plans to add additional NYC Health & Hospital campuses to the telemedicine network.

    “I see this as just the beginning,” Pham said. “I'm very optimistic.”

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    373837936 (1).jpg
    New guidelines aim to limit trans healthcare at Catholic hospitals
    InDepth: Private Equity
    Legal questions surround private equity-backed Noble Health
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Modern Healthcare A.M. Newsletter: Sign up to receive a comprehensive weekday morning newsletter designed for busy healthcare executives who need the latest and most important healthcare news and analysis.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Digital Health
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Unwell in America
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing