Indian Health Service considers changes in troubled Great Plains

Mary Smith, the acting director of the Indian Health Service, speaks with Great Plains tribal leaders in Aberdeen, South Dakota, on April 5, 2016. Photo from Department of Health and Human Services / Twitter

The Indian Health Service is seeking input about potential changes in the troubled Great Plains Area.

The agency will host four consultation sessions this summer to ask tribes and urban Indian organizations about operations in the region. The goal is to be responsive to patient needs.

"This consultation is part of a strategic discussion with tribal leaders about how the Great Plains Area Office can be more supportive and patient focused. The priority here is to support the needs of the tribes in the Great Plains Area," Mary Smith, the acting leader of the IHS, said in a press release. "I believe that partnership is the key to transforming IHS. IHS is committed to listening to concerns and to working with the tribes in the Great Plains Area to explore options."

The Great Plains Area serves 130,000 patients in Iowa, Nebraska, South Dakota and North Dakota. The region has faced intense scrutiny due to long-standing management and quality of care challenges, with facilities in Nebraska and South Dakota considered to be among the worst performing.

The Omaha Winnebago Hospital in Nebraska, which serves the Omaha Tribe and the Winnebago Tribe -- lost certification from the Centers for Medicaid and Medicare Service last summer. The facility can no longer bill Medicaid and Medicare for services, which represents a key source of revenue.

The Sioux San Hospital is an Indian Health Service facility in Rapid City, South Dakota. Photo by Colorado National Guard Medical Detachment / Flickr

Three more facilities in South Dakota -- the Pine Ridge Hospital, the Rosebud Hospital and the Sioux San Hospital -- were threatened with the same. But the IHS reached systems improvement agreements with CMS to continue billing for Medicaid and Medicare while improvements are made at all three locations.

The ongoing problems have led one tribal leader to call for the Great Plains office in Aberdeen, South Dakota, to be closed. Aberdeen is a long distance from nearly every reservation in the region and there are no IHS hospitals or clinics in the city, which is also home to a Bureau of Indian Affairs regional office.

"In all my years the area office hasn't done anything for our people and we are going to close it down," President John Steele of the Oglala Sioux Tribe told The Lakota Country Times.

Smith traveled to Aberdeen in April to hear the complaints first-hand and she also went reservations in the region to meet with tribal leaders during her visit. The trip came less than a month after she became head of the agency.

According to a briefing document presented by Smith in Aberdeen, tribes in the region have already called for greater consultation, higher pay for physicians, additional funds for the purchased / referred care program and more assistance with self-governance efforts.

Indianz.Com SoundCloud: Sen. John Thune (R-South Dakota) discusses S.2953, the Indian Health Service Accountability Act, May 25, 2016

The IHS has since approved the first self-governance compact in the region. As of Wednesday, the Spirit Lake Nation of North Dakota is responsible for running the Spirit Lake Health Center.

"To me, the solution ... is to compact and let some professional company manage it for us," Chairman Harold Frazier of the Cheyenne River Sioux Tribe told the Senate Committee on Indian Affairs at a listening session in Washington, D.C., in February.

In addition to the listening session, the committee hosted a hearing to focus on the Great Plains. The panel is heading to South Dakota on June 17 to learn more about the challenges in the region and to take testimony on S.2953, the Indian Health Service Accountability Act, a bill that seeks to improve accountability, transparency and patient care at the troubled agency.

The upcoming IHS consultations will entail two telephone sessions on June 22 and August 10. Two in-person sessions will be held July 13 in Aberdeen and August 30 in Rapid City. A notice is being published in the Federal Register on Friday.

Forthcoming Federal Register Notice:
Notice of Tribal consultation and urban confer sessions on the state of the Great Plains Area IHS (To Be Published June 3, 2016)

Senate Committee on Indian Affairs Notice:
Oversight/Legislative FIELD Hearing on "Improving Accountability and Quality of Care at the Indian Health Service though S. 2953." (June 17, 2016)

Government Accountability Office Report:
INDIAN HEALTH SERVICE: Actions Needed to Improve Oversight of Patient Wait Times (April 29, 2016)

Senate Committee on Indian Affairs Report:
In Critical Condition: The urgent need to reform the Indian Health Service’s Aberdeen Area (December 2010)

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