South Dakota Reservation Hospitals Agree to Changes

SIOUX FALLS, S.D. — Two government-run hospitals on Native American reservations in South Dakota will keep receiving crucial federal funding after agreeing to undertake significant measures to improve the quality of care provided to patients.

The Indian Health Service, which administers the hospitals on the Pine Ridge and Rosebud Indian Reservations, announced May 1 that it reached last-chance remediation agreements with the Centers for Medicare and Medicaid Services on Saturday. Under the agreements, the hospitals’ management will be overhauled and a monitor will be appointed to provide periodic assessment reports. Emergency rooms at both facilities will be privatized, as previously proposed.

The agreement for the hospital on the Rosebud Indian Reservation, however, will not immediately result in the reopening of its ER, which has been shut down since early December.

“The agreements are structured to support the hospitals to fully meet safety and quality of care standards,” the Indian Health Service, commonly referred to as IHS, said in a statement Sunday. “IHS intends to work diligently to make the best use of the technical assistance and resources available under the terms of the (system improvement agreements), to take advantage of every opportunity to improve quality of care.”

After inspectors from the Centers for Medicare and Medicaid Services, known as CMS, uncovered serious deficiencies at the two facilities during unannounced visits, the agency earlier this year threatened to end the hospitals’ ability to bill the government for services provided to Medicare- and Medicaid-eligible patients. At the same time, the agency also offered the facilities the opportunity to participate in what constitutes a remediation program, giving each facility reasonable time to implement “robust” changes.

Under the agreements, the CMS-appointed monitor will use onsite visits, interviews and records to provide monthly reports to both agencies. CMS will also form a “quality improvement network” to help the hospitals’ management team, practitioners and staff improve the quality of “health care delivery systems.”

IHS’s obligations in both agreements include ensuring that an “effective system” is in place to identify “unsafe situations and other barriers to safe, high quality care, adverse events and near misses” and to be able to immediately report those issues to hospital and IHS management.

IHS provides free health care to enrolled tribal members as part of the government’s treaty obligations to Native American tribes. The agreements signed Saturday represent a lifeline for each facility because IHS historically has been severely underfunded and its facilities bill Medicare, Medicaid and private insurance for care given to patients who have that coverage. Statistics from a 2005 government study show that reimbursements at the time constituted on average 39 percent of some hospitals’ direct medical care budgets.

The hospitals have been under intense scrutiny following unannounced inspections that began late last year. In October, inspectors cited the Pine Ridge hospital for safety deficiencies, including unsecured drugs and medical records. And in mid-November, an inspection of the Rosebud hospital found conditions so alarming the ER was closed two weeks later, forcing patients to be diverted to facilities about 50 miles away.

Each hospital’s management team will be overhauled under Saturday’s deals, with the option of hiring an external firm that would run the facilities full time and on site for at least the one-year duration of the agreements.

The Pine Ridge hospital agreement includes a provision to train staff on how to properly handle medical records, including complying with privacy laws.

The Rosebud hospital agreement states it will continue to divert patients until a number of conditions are met, including reaching proper staffing levels and conducting a mock survey. IHS would then remain responsible for the ERs at the Rosebud and Pine Ridge hospitals and a hospital in Winnebago, Nebraska, until contracting with a third party that would manage the facilities’ emergency departments.

The ER closure has been a point of contention between IHS and the Rosebud Sioux Tribe – so much so that the tribe filed a federal lawsuit Thursday. In the suit, it asks for IHS and federal officials to be forced to reopen the Rosebud ER citing “immediate and irreparable injury” to tribal members.

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