October 23, 2019

Why some Native American tribes are breaking with Indian Health Service

Daily Briefing

    A growing number of Native American tribes are taking control of troubled government-run hospitals in an effort to improve care for their communities, but some are finding the turnaround is both slow and costly.

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    Background

    HHS' Indian Health Service (IHS) oversees 24 hospitals in the United States that provides medical care to 2.2 million of the nation's 3.7 million members of federally recognized Native American Tribes and Alaska Native people.

    However, federal data and investigations over the years have raised concerns about the quality of care provided at IHS facilities. For instance, a New York Times analysis of government data found 25% of medical positions within IHS are vacant. In addition, the Times found Native Americans who live in states with IHS hospitals are three to five times more likely to die from preventable diseases—such as alcohol-related illnesses, diabetes, and liver disease—than they are for other races combined.

    One South Dakota hospital in particular has been the focus of several federal investigations, the Times reports.

    Five government investigations found patients at Sioux San Indian Health Service Hospital died from inadequate care, often received incorrect diagnoses, and were treated by staff who had not been screened hepatitis and tuberculosis. In 2017, IHS and Congress shut down the hospital's emergency department and inpatient unit, leaving an often understaffed urgent care clinic to care for local tribes.

    More tribes break with IHS, at a steep financial cost

    But tribes increasingly are stepping in to take over poorly managed federal facilities, the Times reports.

    For instance, tribes in Arizona, South Dakota, and Nebraska have taken over six IHS hospitals since 2009, including Sioux San, which had been run by the Great Plains Tribal Chairmen's Health Board since mid-July.

    According to the Times, the change in management at Sioux San has enabled the community to develop a plan to get newer equipment, hire more qualified health care workers, and reopen the inpatient hospital and ED.

    However, the tribal board quickly realized that it will take millions of dollars and several years to reopen those facilities.

    Some tribes have been able to rely casino revenue to improve health care in their communities, but the Times reports that that revenue stream is not an option for the Great Plains tribal board. Instead, the board plans to apply for federal grants outside of IHS and to try to increase the amount they can receive from Medicare and Medicaid.

    The Alaska Native Tribal Health Consortium—which cut ties with IHS in 1998 and, according to the Times, is viewed as one of the most successful tribal-run health systems—relies on a similar funding plan comprised of federal grants, a partnership with the Department of Veterans Affairs, and billing Medicaid and Medicare.

    While the board works to gather funds to reopen Sioux San's closed facilities, Jerilyn Church, the CEO of the Great Plains Tribal Chairmen's Health Board, said they are working to launch a pilot program to secure private insurance for some of the sickest patients in the community. The board also "is addressing the hospital's vacancies, reviewing its bill practices, and researching grant opportunities to bring new money for equipment and hiring" (Walker, New York Times, 10/15; Owens, "Vitals," Axios, 10/16).

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