Rx for Ailing Indian Health Service: Changes in Spending, Recruitment
PBS | Frontline | Dec. 31, 2019
By Christopher Weaver and Anna Wilde Mathews, The Wall Street Journal
Some of the biggest problems plaguing the troubled Indian Health Service, which cares for 2.6 million Native Americans, could be addressed by taking some relatively straightforward steps, according to IHS employees, tribal members, U.S. lawmakers and outside health-care experts.
A series of articles by The Wall Street Journal has identified numerous deficiencies at the federal agency, including problem employees, recruitment challenges and regulatory lapses. The turmoil has sparked calls for changes.
The agency has chronic problems, and it is underfunded and overwhelmed, said Earl Pomeroy, a former Democratic North Dakota congressman.
Nevertheless, said James Bresette, a former deputy director of the agency’s clinical-services arm, “there’s definitely some low-hanging fruit” that he believes the agency is capable of addressing.
The Journal’s reporting on the agency and new interviews with people who have faced the problems suggest several possible courses of action.
Seek More Funds
Congress has provided modest increases to the IHS’s operating funding in recent years, but that still leaves the agency far behind other federal health programs. Medicare spends about three times as much per patient.
“We’re at Congress’s whim in that regard,” the agency’s acting director, Michael Weahkee, said in a meeting with tribal leaders earlier this year. Rear Adm. Weahkee was nominated to become the agency’s permanent leader in October.
The agency’s leaders and federal overseers have stopped short of asking Congress for major new infusions during annual budget negotiations.
At a December Senate hearing on his nomination, Adm. Weahkee was asked if he would commit to advocating for more upfront funding for the IHS. Doing so might set him at odds with his superiors in the Trump administration. He declined to say he would seek more funding.
In a written statement, the IHS said it “works proactively within the administration and with the Congress to ensure the needs of Indian Country are fully understood.”
Change Spending Practices
The IHS, which doesn’t offer a full range of medical services at its hospitals, is supposed to pay for patients to get additional necessary care from outside hospitals and doctors. That funding falls short of what patients need, according to the agency’s own data, and the IHS distributes it unequally.
In its Tucson, Ariz., region, the IHS allocated about $8,100 per uninsured patient in 2020, compared with around $1,000 in its Oklahoma area, a Journal analysis of 2017 agency data and budget records shows. In the Great Plains region, which includes the Rosebud Indian Health Service hospital in South Dakota, the allocation is about $2,200 per uninsured patient.
The disparities result from an outdated allocation formula that doesn’t take the needs of the patients into consideration — and means that in low-spending areas common services are often denied.
“It’s basically rationing,” said Douglas Lehmann, a former IHS doctor at Rosebud.
The agency could fix this, said Ron Cornelius, a former Great Plains regional leader. But with finite resources, he said, “you’d have winners and losers, and so far nobody has taken that up.”
The agency said one of its work groups recently recommended keeping the formula the same, and that its ability to change it was limited.
Eight IHS-run hospitals with a combined 82 beds averaged less than one patient a night in 2018, according to IHS reports to federal regulators.
The agency could close seldom-used inpatient wards located where there are other options and redirect the money, including toward better primary care for patients with serious chronic health problems.
The agency said it might be appropriate to redirect resources from inpatient care to other services, such as specialty medical treatment, at some facilities where admissions have declined, and that it would consult the tribes before making any decisions.
Parker Indian Health Center, in a tiny Arizona town, is about 1.5 miles from a private facility, La Paz Regional Hospital. La Paz’s 22 beds were about one-quarter full last year, regulatory records show. The IHS hospital, with around 20 beds, was only about 3% full, the records show.
Neither facility delivers babies, forcing women to travel at least 40 miles for that service, according to the Arizona Center for Rural Health.
It doesn’t make any sense to have two critical-access hospitals so close together, but not other needed services, said Daniel Derksen, a University of Arizona professor and the center’s director.
Kevin Brown, the chief executive of La Paz Regional, declined to comment. The Colorado River Indian Tribes, which the Parker hospital serves, said in a written statement “the facility is underutilized due to operational issues such as a lack of staff, and treatment decisions in which patients are released too soon.” The tribe said any reallocation of funding there would be a disservice to members that it would oppose.
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