IHS Works to Resolve Management Problem, Still Underfunded Compared to Other Federal Health Programs, Director Says

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WASHINGTON—The Senate Committee on Indian Affairs released an investigative report last year that found that an increasingly high number of Equal Employment Opportunity complaints (EEO) had been filed in the Aberdeen Area, which is made up of IHS and tribally-managed units that serve about 100,000 Indians in North Dakota, South Dakota, Nebraska, and Iowa.

IHS-problems-Roubideaux.jpgIn addition, the report found instances in which doctors and nurses with expired licenses and certifications were treating patients, and several facilities were on the brink of losing their accreditation or certification, among other serious management problems.

Now, the agency is taking a “very aggressive” approach in addressing serious management problems identified by that investigation, IHS Director Yvette Roubideaux, MD, told a U.S. House of Representatives subcommittee.

“We have been very aggressive about addressing the recommendations of the Senate Committee on Indian Affairs,” said Roubideaux. “It is clear that the findings that they had are completely unacceptable. I am taking a very strong tone with all of our staff that we will address these issues and there will be no excuses.”

Roubideaux made her comments at a recent hearing held by the House Committee on Appropriations Subcommittee on Interior, Environment and Related Agencies. House members had asked specifically how IHS was addressing the high number of EEO complaints that the Senate investigation had cited in the Aberdeen Area, compared with the entire IHS.

Roubideaux acknowledged it had been a “big problem” and that IHS moved the oversight of the EEO process from the Aberdeen Area to its headquarters. Since then, the agency has experienced a decrease in the number of EEO complaints coming from the Aberdeen Area.

She also said that IHS is doing more to improve training for employees on handling grievances in the workplace. “Usually, what the employees have a grievance or problem with is their supervisor or another coworker,” said Roubideaux. “What we are doing is improving our human resources. We are going to do more training for all of our employees, not just in the Aberdeen Area, to try to help people manage the relationships they have with their coworkers and their supervisors in the area.”

Roubideaux said that she has put measures in all of the agency’s performance plans to address the issues identified in the Aberdeen Area, but that the problems will not be solved “overnight.” “They are long-standing problems, and we can’t fix them overnight,” she said. “But, I am really confident that we are putting in fundamental changes that, over time will help.”

IHS Budget

Committee members also had several questions about the President’s FY 2012 budget request for IHS. The proposed FY 2012 budget is $4.6 billion, an increase of $571.4 million over the FY 2010 enacted funding level.

Rep. Tom Cole, R-OK, expressed appreciation for the $169.3 million proposed increase in funding for Contract Health Services (CHS), which is a program that pays for referrals for medical services in the private sector that IHS facilities cannot perform. Tribal leaders have expressed concern over the years that funding for CHS often runs out early in the fiscal year, resulting in beneficiaries having to delay needed surgeries or paying out-of-pocket for care that the federal government should be funding.

“How close will this get us to 100%?” said Cole, who wanted to know how much more was needed to cover CHS costs.

Roubideaux said that the proposed additional funding would allow IHS to purchase another 5,700 inpatient admissions, among other services, but that the funding still falls short of the need.

“While this is great progress and we are really grateful for this, there is an incredible need for contract health services to pay for referrals,” she said. “We have been able to estimate that the total unmet need for contract health services on the federal side is about $859 million dollars.”

Rep. Michael Simpson, R-ID, who was a practicing dentist before entering politics, wanted to know how the FY 2012 budget request addresses the need to increase access to dental care for IHS beneficiaries.

The budget includes $107 million for dental care, which is an $18.2 million increase Roubideaux said. “It is allowing us to continue to provide basic preventive-care services and basic restorative and emergency care,” she said. “We really feel this is an important priority, especially for our children.”

Although the agency has reduced its dental vacancy rate from 35% to 17%, Roubideaux acknowledged that the agency needs more dentists.

Roubideaux also told the subcommittee that the agency would need a “significant appropriation” to complete installation of its electronic dental records at its facilities. So far, 60 sites have electronic dental records with 21 in progress, but another 49 sites still need to initiate the process.

Roubideaux was asked at the conclusion of the hearing to describe the per capita expenditures for American Indians and Alaska Natives for health care.

She said that the IHS per capita expenditures on health care are about $3,300 per user. That per capita IHS amount is less than what is spent on prisoners in the federal prison system for health care, she pointed out.

“That’s what our tribal leaders just hate to hear is that we are getting less funding per capita than the prisons and other federal health systems,” she said. “We are committed to trying to address the historic underfunding of the Indian Health Service.”

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