An aerial view of the Pine Ridge Hospital on the Pine Ridge Reservation in South Dakota. Image: Google Earth

Indian Health Service cites strides in era of COVID-19 as challenges linger

A troubled Indian Health Service hospital serving South Dakota’s Pine Ridge Reservation will once again be able to bill Medicare after earning the highest level of approval from a prestigious healthcare accrediting organization.

The Pine Ridge Hospital lost its ability to bill Medicare for services provided to its patients in November 2017 after the Centers for Medicare and Medicaid Services (CMS) placed the facility on “immediate jeopardy” status, a category used to indicate the likelihood of imminent injury, serious harm, death or impairment to patients. The decision also affected the hospital’s Medicaid funding.

James Driving Hawk, IHS Great Plains Area director, said last Thursday that a CMS survey team conducted a survey of the hospital in December and found the hospital to be 100 percent compliant with federal healthcare standards. The Joint Commission, the nation's oldest and largest standards-setting and accrediting body in health care, then conducted a survey in May and later granted the hospital its highest level of accreditation, its Gold Seal of Approval for Hospital Accreditation.

“We have applied many lessons learned along the way,” Driving Hawk said during a conference call with the media. “We always said true and sustainable change takes time, and we are seeing the results. We saw it in December when the Rosebud IHS Hospital also achieved accreditation by the Joint Commission, and again today with this announcement.”

A view of the old Indian Health Service hospital on the Pine Ridge Reservation in South Dakota. Photo: Rachel Harris

The 45-bed Pine Ridge Hospital isn't the only IHS facility on the reservation. But it is the largest, serving more than 17,000 patients, most of whom are citizens of the Oglala Sioux Tribe.

Although the hospital remained open, the loss of certification represented a severe blow. The IHS, due to chronic under-funding, relies on revenue from Medicare and Medicaid to make up for shortfalls in its budget.

The Pine Ridge Hospital’s loss of accreditation in 2017 further exacerbated problems facing the IHS Great Plains Area, a region that includes South Dakota and Nebraska. A 2010 investigation by the Senate Committee on Indian Affairs warned that five facilities were in danger of losing access to Medicare and Medicaid funds.

The Pine Ridge hospital and another one on the Winnebago Reservation in neighboring Nebraska were later terminated by CMS, Two other facilities – one on the Rosebud Sioux Reservation and Sioux San, both in South Dakota – were placed in jeopardy and saw reductions in services while the IHS worked to correct deficiencies.

The Winnebago hospital remains unable to bill Medicare for emergency services, though it plans to submit an application to CMS by October for recertification, said Danelle Smith, the executive director of the Winnebago Comprehensive Healthcare System.

The Winnebago facility -- now known as Twelve Clans Unity Hospital, a reflection of the tribe's culture and traditions -- continues to bill Medicare for services offered by its clinic, she said.

“We had a very successful mock survey at the end of January and planned to submit the application by now, but then COVID came along and delayed the timeline,” Smith, who is a Winnebago citizen, told Indianz.Com. The hospital serves both the Winnebago Tribe and the neighboring Omaha Tribe.

The emergency room at Sioux San was shut down completely, and a coalition of tribes later took over urgent care services from IHS at the Rapid City, South Dakota, hospital and renamed the new healthcare organization the Oyate Health Center. IHS still operates some healthcare services at Sioux San.

Emergency services at Rosebud were cut for seven months, which took a heavy toll on citizens of the Rosebud Sioux Tribe, and in 2016 the tribe sued the federal government arguing federal health care was promised to the tribe by the 1868 Treaty of Fort Laramie. A federal judge agreed with the tribe, ruling the federal government was required to provide the tribe with “competent physician-led health care.”

"The United States does owe the Tribe some duty to provide health care to its members, even if the fiduciary duty judicially enforceable is just competent physician-led health care based on the construction of the 1868 Treaty of Fort Laramie as explained above," Judge Roberto A. Lange wrote in the March 30 ruling, documents of which are available on Turtle Talk.

The Trump administration is not accepting the decision, treaty rights notwithstanding. The case is now being taken to the 8th Circuit Court of Appeals, with an opening brief due on July 7, according to a scheduling order.

Source: South Dakota Dept of Health

Posted by Oglala Sioux Tribe - OST on Saturday, June 20, 2020

With respect to the Pine Ridge Hospital, Driving Hawk said IHS focused on three areas in working to improve services at the facility: hospital governance and oversight, quality leadership and healthcare, and increased collaboration and communication among all stakeholders. He said IHS also expanded oversight from the Great Plains Area Office to the hospital and increased staffing levels, requirements for medical staff credentialing and education of staff on quality standards.

“In short, our expectations for ourselves have changed,” he said. “We’re holding ourselves to a higher standard.”

“And we are not done. We will continue to improve through our substantial efforts through investments such as a planned renovation at the Pine Ridge emergency department.”

He said the ability to bill Medicare for services will lead to increased revenue for the hospital, funds that IHS will use to pay for facility and program improvements, as well as increased staffing.

“This is going to up open up more opportunities for expansion and improvement on the services that we have,” he said.

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