November 8, 207
WASHINGTON—U.S. Sen. Mike Rounds (R-S.D.) today spoke in support of his legislation, S. 465, the Independent Outside Audit of the Indian Health Service Act of 2017, during a Senate Committee on Indian Affairs hearing. Since taking office in 2015, Rounds and his staff have analyzed the IHS and its shortcomings, concluding there are three primary areas of concern: there is no funding allocation strategy for the 12 IHS regions, there is no standard of quality measurement and there is high turnover of staff resulting in low accountability amongst management. Rounds’ assessment legislation is the first step toward setting us on a path to address the agency’s longstanding failures.
“For years, tribal members in my home state of South Dakota have dealt with unimaginable horrors in dealing with IHS facilities,” said Rounds in his opening remarks. “Tribal members are suffering and even dying due to inadequate and disgraceful care. IHS will only continue to fail unless we take a close look into the operations, funding, quality of care, and management at IHS. I believe that a comprehensive assessment of IHS is a necessary first step toward making calculated and systematic changes at IHS.”
Rounds’ remarks as prepared for delivery:
Good afternoon, I first want to start off by thanking Chairman Hoeven, Vice-Chairman Udall and the members of the Senate Committee on Indian Affairs for their dedicated service to the Native American communities.
Today, I am introducing my bill to provide for a comprehensive assessment of the Indian Health Service, S.465.
As you know, the IHS is the agency responsible for providing health care for American Indians and Alaska Natives as required by federal treaty agreement.
For years, tribal members in my home state of South Dakota have dealt with unimaginable horrors in dealing with IHS facilities.
Upon taking office in 2015, my staff and I have spent significant time trying to learn more about these problems.
In our research, we found four primary areas of concern: there is no funding allocation strategy for the 12 IHS regions, there is no standard of quality measurement, there is high turnover of staff resulting in low accountability amongst management and there is no consultation with tribes.
The IHS serves approximately 2.2 million Native Americans, who are members of 567 federally recognized tribes.
For fiscal year 2017, IHS was appropriated just under $5 billion dollars in discretionary funding and $147 million dollars in mandatory funding from the Special Diabetes Program.
This does not include third-party collections of approximately $1.1 billion dollars.
Despite a large user population and an annual appropriation of $5 billion, IHS does NOT have a funding formula.
Regional allocations are not based upon the number of people who received healthcare through IHS, regional user population growth or types of services offered.
While many believe that IHS is underfunded, from my standpoint, investing more taxpayer money into a dysfunctional system will only compound the problem. IHS lacks an efficient system and accountability; this needs to be addressed before we consider funding. Then, I agree it will be time to talk about adequate funding.
Furthermore, there are no consistent qualitative measurements. The most recent qualitative measurements are from 2008 – nearly a decade old – so it’s unclear if IHS management has a sense of which regions are successful or failing.
IHS divides itself into 12 service areas in the United States. IHS’s Great Plains Area, which serves South Dakota tribal members, has the worst health care disparities of all IHS regions, including:
- Lowest life expectancy,
- Highest diabetes death rate, 5 times the U.S. average,
- Highest TB death rate, and
- Highest overall age adjusted death rate.
To give you an idea of some of the things we are seeing and hearing in our area:
- The Wall Street Journal reported in June 2017, “At the Indian Health Service hospital in Pine Ridge, South Dakota, a 57-year-old man was sent home with a bronchitis diagnosis—only to die five hours later of heart failure.”
- When a patient at the federal agency’s Winnebago, Nebraska, facility stopped breathing, nurses responding to the “code blue” found the emergency supply cart was empty, and the man died.
- In Sisseton, South Dakota, a high school prom queen was coughing up blood. An IHS doctor gave her cough syrup and antianxiety medication; within days she died of a blood clot in her lung.
- And just this August, IHS officials announced that patients who have recently received care at the podiatry clinic in the Winnebago IHS Hospital may have been exposed to HIV and hepatitis.
Because there are not standard of quality expectations and a methodology to measure quality; these facilities are failing very basic quality performances that our people deserve. In fact, the quality problems have become so pervasive, that the Centers for Medicare and Medicaid Services, or CMS, accreditation of several IHS facilities are in jeopardy.
Throughout the past year-and-a-half, the Rosebud and Pine Ridge Hospitals in the Great Plains Region have been operating under a Systems Improvement Agreement with CMS trying to regain their accreditation status.
Thankfully, the Systems Improvement Agreement at Rosebud was completed on September 1st of this year.
However, our office was made aware of multiple timeline extensions in Pine Ridge because these IHS direct-care facilities continued to fail CMS surveys.
Just last Friday, the Pine Ridge IHS Hospital was deemed not in compliance with CMS’s conditions of participation for emergency services. By issuing a final notification for the Pine Ridge IHS Hospital, the facility is in immediate jeopardy status and hospital’s provider agreement will be terminated at the end of next week.
Termination means that IHS can no longer bill Medicare for services, impacting Medicaid funding as well. Further, future third-party revenue available to IHS to fund services, maintenance projects and other necessary costs will likely be reduced.
Finally, there is high turnover throughout the entire IHS organization.
For example, within my home state’s Great Plains Region, we’ve had 5 different area directors in the last 21 months. That’s an average tenure in this important management position of roughly 4 months. And as you may know, nationally there has not been a permanent director leading IHS since February of 2015.
Tribal members are suffering and even dying due to inadequate and disgraceful care.
IHS will only continue to fail unless we take a close look into the operations, funding, quality of care, and management at IHS. I believe that a comprehensive assessment of IHS is a necessary first step toward making calculated and systematic changes at IHS.
S. 465 would accomplish this goal and set us on a path to address the long standing failures of IHS.
My legislation would require the Inspector General of the Department of Health and Human Services to conduct an assessment of IHS’s health care delivery systems and financial management processes only at direct-care facilities. Let me be clear, this assessment is not proposed for tribes with 638 Agreements in place; only direct IHS facilities.
This assessment I am proposing is a proven model for identifying potential reforms. We all remember the problems in 2014 in Veterans Administration health care. To address this issue Congress passed legislation calling for the Secretary of the VA to conduct an overall and systematic assessment of VA healthcare.
The integrated report was completed within the mandated timeframe of less than a year, and was officially submitted to the Secretary of the VA in September 2015. The assessment provided feedback and recommended changes that could lead to improvement in health outcomes.
The same should be done for the Indian Health Service.