Courtesy Senate Committee on Indian Affairs
Indian Health Service Principal Deputy Director Mary Smith is seen here earlier this year at a Senate Committee on Indian Affairs hearing. She recently laid out a new IHS plan to provide care to American Indians and Alaska Natives.

Native Lives at Stake: IHS Unveils Plan to Improve Medical Care

Tanya H. Lee

The Indian Health Service has a new plan to provide high-quality, patient-centered, safe medical care to the 2.2 million American Indians and Alaska Native it serves.

“We are committed to providing quality health care so we are our patients’ first choice for health care even when they have other options,” says IHS Principal Deputy Director Mary L. Smith.

The Indian Health Service (IHS) Quality Framework, 2016-2017 and Quality Framework Implementation Plan were issued November 16 following the October release of two more in a decades-long series of reports on deficiencies in the federal agency’s performance.

Under the Framework, IHS will establish a Quality Office at headquarters, overseen by a Deputy Director of Quality, who will report to the IHS Director. Smith says the agency is working aggressively to fill the position as soon as possible.

IHS will increase its efforts to recruit and retain highly qualified medical and administrative staff and improve data collection, analysis and reporting. It will also employ a single accrediting organization for all IHS direct service facilities. In July, IHS entered into a $700,000 contract with the Joint Commission on Accreditation of Healthcare Organizations to improve the quality of care and patient safety at IHS hospitals in eight states—Arizona, Minnesota, Montana, Nebraska, New Mexico, North Dakota, South Dakota and Oklahoma. Under the Framework, by 2017 all 26 IHS-operated hospitals will be evaluated by one accrediting agency.

The agency will standardize credentialing of medical staff. “The goal of the Quality Framework credentialing standardization objective is to ensure a consistent and efficient process across IHS that facilitates the hiring of qualified practitioners,” according to an IHS spokesman.

IHS will also survey patients to find out what they think of the service they are receiving.

Improving patient safety is a high priority and the agency will address the severe safety lapses that sometimes occur at its facilities by educating and encouraging staff to report incidents consistently and by having a centralized system for monitoring risks and adverse events. The framework also calls for decreasing the incidence of healthcare associated infections using measures such as increasing staff compliance with hand-washing regimes.

In October, the Office of the Inspector General for the U.S. Health and Human Services Department (under which IHS operates) issued two reports, “Indian Health Service Hospitals: Longstanding Challenges Warrant Focused Attention to Support Quality Care” and “Hospitals: More Monitoring Needed to Ensure Quality Care.” The reports found IHS exercised limited oversight of its hospitals due in part to inadequate data collection and review and difficulty with electronic health systems. Quality of care suffers, according to the reports, because while more and more people are turning to IHS for their care, the agency offers only a limited scope of services with little access to specialists and has outdated equipment and facilities.

IHS hospitals in the Great Plains area came in for scathing criticism then the Senate Committee on Indian Affairs took testimony on conditions there both in Washington and in the field beginning last February.

Smith gave ICTMN an update on those hospitals. “We have been working aggressively to improve the conditions at the hospitals in the Great Plains and actually I’m pleased to report several significant things that have happened.

“First, two of the hospitals that were cited by CMS [Centers for Medicare and Medicaid Services] are currently operating under Systems Improvement Agreements, which are long-term agreements to get at the root cause of the problems at those facilities. We are making considerable progress working very closely with the CMS on those agreements. A second major initiative in the Great Plains is the contract that we announced in July with the Joint Commission, which is doing assessments at all the Great Plains hospitals.”

Also, in September, IHS awarded a telemedicine services contract to Avera Health to provide services to the seven hospitals and other health centers and facilities in the area.

The Indian Health Service’s 12 area offices and 170 IHS- and tribally-managed service units provide nearly 40,000 inpatient admissions each year and more than 13 million outpatient visits. The 2016 federal appropriation for IHS was $4.8 billion. IHS spent $3,688 per patient in 2015, compared with an average $9,523 per year per patient expenditure for the nation as a whole.

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