Indian Health Service reaches agreements for troubled facilities

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 on Sunday announced two systems improvement agreements that will prevent two troubled facilities in the Great Plains Area from losing a key source of funding.

The agreements cover the Rosebud Service Unit and the Pine Ridge Service Unit, both in South Dakota. They require the IHS to make numerous improvements so they can keep billing the Centers for Medicaid and Medicare Service for patient care.

"The agency is committed to making improvements to ensure the safe delivery of care for its patients and to implement reforms to stabilize, strengthen and raise the overall quality of care in the IHS Great Plains Area," the agency said in a statement.

The agreement with the Rosebud Service Unit, however, will not result in the immediate reopening of the emergency room at the Rosebud Hospital, the Associated Press reported. Since the diversion was imposed in December, six members of the Rosebud Sioux Tribe have died while in transit to facilities 45 to 55 miles away.

"People are dying every day because we have to be transported so far away," Prairie Rose DuBray Chapin, whose brother Mark DuBray died in February before reaching an emergency room 55 miles away, told The Sioux Falls Argus Leader. "This isn't acceptable, but it is what it is."

The tribe is suing the IHS to force the reopening of the emergency room. The Robins Kaplan law firm filed the case last week and is handling it free of charge.

“This lawsuit asks the federal court in South Dakota to step in and exercise some control over the dysfunctional IHS emergency room on the Rosebud Reservation," said Tim Purdon, the chair of the American Indian Law and Policy Group at the firm and a former U.S. Attorney for North Dakota. "The filing of this case is necessary because IHS has been unable to solve this problem, at grave cost to the vulnerable, rural population of the Rosebud Reservation.”

The agreements run for one year and, during that time, the IHS can continue to bill the CMS for services, according to a fact sheet. William Bear Shield, the chairman of the Rosebud Health Board, told The Argus Leader that the Rosebud Hospital billed about $15 million to Medicare and Medicaid last year.

Separately, the IHS is pursuing a contract with a third party to manage the emergency rooms at the Rosebud and Pine Ridge hospitals but an agreement has not been announced. A contract is also being pursued for the emergency room at the Winnebago Service Unit in Nebraska.

The facility, which lost CMS certification last summer, serves the Omaha Tribe and the Winnebago Tribe.

The full IHS media statement about the systems improvement agreements in the Great Plains follows:
Providing access to quality medical care is a top priority for IHS. The agency is committed to making improvements to ensure the safe delivery of care for its patients and to implement reforms to stabilize, strengthen and raise the overall quality of care in the IHS Great Plains Area.

Centers for Medicare & Medicaid Services (CMS) and IHS have agreed on the terms of two Systems Improvement Agreements (SIAs), one for the IHS Rosebud Hospital and a separate SIA for the IHS Pine Ridge Hospital.

The SIAs strengthen the foundation for immediate and long-term quality improvements at Pine Ridge and Rosebud Hospitals. The agreements are structured to support the hospitals to fully meet safety and quality of care standards. IHS intends to work diligently to make the best use of the technical assistance and resources available under the terms of the SIA, to take advantage of every opportunity to improve quality of care.

The SIAs between IHS and CMS cover a 12-month period, and during this time, IHS will continue billing Medicare and Medicaid. Prior to the end of the SIA, IHS will have to demonstrate that the hospitals are in compliance with requirements of the Medicare program in order to return to good standing with the Medicare program.

Get the Story:
2 reservation hospitals agree to quality-of-care changes (AP 5/1)
Rosebud loses lives, hope as it waits for ER to re-open (The Sioux Falls Argus Leader 5/1)
Rosebud IHS: Man won't return to ‘death hospital’ (The Sioux Falls Argus Leader 5/1)
Rosebud IHS: For some, the drive to ER is too much (The Sioux Falls Argus Leader 5/1)
Rosebud IHS: Woman says hospital took her smile (The Sioux Falls Argus Leader 5/1)

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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