The Pine Ridge Hospital is an Indian Health Service facility on the Pine Ridge Reservation in South Dakota. Photo: Panhandle Health Group‎

Another Indian Health Service hospital placed in 'immediate jeopardy' status

Crisis continues at Indian Health Service

By Kevin Abourezk

The crisis at the Indian Health Service continues as another hospital has lost its ability to access a key source of funding after a recent survey uncovered a number of problems.

The Centers for Medicare and Medicaid Services (CMS) on Friday placed the facility on the Pine Ridge Reservation in South Dakota on “immediate jeopardy” status, a category used to indicate the likelihood of imminent injury, serious harm, death or impairment to patients. In a final decision, CMS terminated the hospital’s provider agreement, effective November 18.

That means the hospital will no longer be allowed to bill Medicare for services, which will affect its Medicaid funding as well.

“The IHS Pine Ridge Hospital remains open and patients are receiving care, including emergency department, inpatient, outpatient, and all other hospital services,” the IHS said in a press release. “Providing access to quality medical care remains a top priority for IHS.”

The 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.

President Scott Weston was attending at tribal council meeting Friday afternoon when the decision was announced from Washington, D.C. He said he was seeking a statement from the hospital about the loss of Medicare and Medicaid funding and declined to offer further comment when reached.

Although the hospital remains open, the loss of certification represents 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.

Sen. Mike Rounds (R-South Dakota), third from left, met with Oglala Sioux Tribe President Scott Weston, fourth from left, and other Oglala Sioux leaders in Washington, D.C., in February 2017. Photo: Sen. Mike Rounds

Before CMS terminated certification to the IHS hospital that serves the Omaha Tribe and the Winnebago Tribe, the facility was heavily dependent on outside sources of funds. Some 77 percent of third-party reimbursements came from Medicare and Medicaid in the fiscal year prior to the 2015 decision.

And in the current fiscal year, IHS expects 88 percent of collections at all facilities to come from Medicare and Medicaid, according to a budget justification.

In response to the loss of certification at Pine Ridge, the IHS said it will work to help improve the hospital’s health services so it can begin receiving Medicare and Medicaid funding once again.

“These issues did not happen overnight and it will take time to correct them,” the agency said.

But the agency's track record remains shaky. The Omaha-Winnebago Hospital in Nebraska has yet to recover from its CMS termination more than two years ago.

The IHS also has been slammed repeatedly for failing to resolve long-standing problems in the 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 and Omaha-Winnebago hospitals have since been terminated by the CMS. Two additional facilities in the Great Plains -- Rosebud and Sioux San --- were placed in jeopardy and saw reductions in services while the IHS worked to correct deficiencies.

The emergency room at Sioux San has since been shut down completely. Emergency services at Rosebud were cut for seven months, which took a heavy toll on citizens of the Rosebud Sioux Tribe.

“The inadequate care being delivered at IHS facilities across the country has reached crisis level,” Sen Mike Rounds (R-South Dakota) said when he introduced the Independent Outside Audit of the Indian Health Service Act. “It is a serious issue that requires tangible solutions."

His bill, S.465, requires an independent audit to determine where improvements can be made in budget, staffing and management. The Senate Indian Affairs Committee will be taking testimony on the measure on Wednesday.

In response to the loss of the CMS termination at Pine Ridge, IHS said it has begun enhancing staffing levels in the emergency department, extending deployment of U.S. Public Health Service officers to reduce staff and turnover, and improving tele-health consultation.

Additionally, IHS has awarded a new contract to provide emergency department staffing services at Pine Ridge to Central Care Inc. of Alexandria, Virginia. Services will begin in mid-November.

“The emergency department will be federally managed, which will allow for staffing with both contractors and federal employees working together under federal direction,” the agency said. “IHS is working to ensure there is a smooth transition with no disruption in services.”

IHS also said it plans to work with tribal leaders and health care stakeholders in the Great Plains Area to pursue reforms. Members of Congress have introduced the Restoring Accountability in the Indian Health Service Act -- S.1250 and H.R.2662 -- in hopes of fixing what they have said is a "broken" federal agency.

Senate Committee on Indian Affairs Notice:
Legislative Hearing to Receive Testimony on S. 1400 & S. 465 (November 8, 2017)

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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