Indian Health Services, a branch of HHS, is the principal federal healthcare provider for American Indians and Alaska Natives. While providers at these facilities are charged with caring for one of the nation's most vulnerable population, IHS hospital administrators report several significant, interrelated challenges that hinder the quality of care at their facilities, according to a new report from HHS' Office of the Inspector General.
While the Obama administration has proposed increasing funding for IHS from $402 million to $6.6 billion for fiscal year 2017, the challenges facing these facilities are considerable and may contribute to the serious health issues afflicting the Native American population, according to an article from The Washington Post.
Here are four things to know about the challenges facing IHS hospitals.
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1. Access to care: The number of outpatients seen at IHS hospitals increased 70 percent (from 695,941 users to 1,181,613 users) from 1986 to 2013. The high patient volume can overburden these facilities due to limited capacity and services. Service limitations result in referrals to other non-IHS care providers. Due to funding constraints, not all referrals are approved. In 2013, 147,000 such referrals were denied. Many of the 28 IHS hospitals have limited capacity and are equipped with fewer than 50 beds. Remote locations also hinder care quality and patient access to care, with some post-acute care patients having to travel 100 to 200 miles to get to an IHS facility.
2. Physician vacancy: Despite the high influx of outpatients, few patients are admitted to inpatient wards at IHS hospitals, which contributes to low staff recruitment and physician retention. In 2014, the physician vacancy rate was 33 percent. The national average in 2013 was 8 percent.
3. Aging infrastructure: Major renovation projects at the two oldest IHS hospitals have not been conducted in nearly eight decades. According to the HHS report, a majority of IHS hospital administrators "reported that old or inadequate physical environments challenged their ability to provide quality care and maintain compliance with the CoPs (Conditions of Participation developed by CMS that must be met in order to participate in Medicare and Medicaid). For example, the aging structure in one IHS hospital caused sewage to leak into the operating room after its old pipes corroded."
4. Vulnerable population: Findings from a report from IHS on American Indian health trends in 2014 highlight the serious health challenges afflicting this demographic. When compared with the general population, death rates related to many conditions and adverse events are substantially higher among Indian and Alaska Natives, including alcohol related death rate (520 percent greater for American Indians and Alaska Natives), tuberculosis (450 percent greater), diabetes mellitus (177 percent greater), suicide (60 percent greater) and pneumonia and influenza (37 percent greater).
Sen. Jon Tester, D-Mont., vice chairman of the Indian Affairs Committee, told the Post via email that the HHS report "confirm[s] what I've heard from folks in Indian country for years: IHS needs serious reforms. Congress has a role to play by ensuring IHS has the resources it needs to provide care and recruit healthcare providers."
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