Federal watchdog says Indian Health Service faces major organizational challenges

HHS' Indian Health Service must address organizational issues to improve quality, the Office of Inspector General said. Image: Sarah Stierch/CC BY 4.0

The Indian Health Service (IHS) has major underlying problems such as a lack of clear structure and roles that could hinder the troubled agency’s efforts to fix rampant quality issues, a federal watchdog said.

On Thursday, Health and Human Services’ Office of Inspector General issued a report based on in-depth interviews with agency officials and HHS officials on quality efforts at IHS. 

In the wake of the steady stream of quality problems, IHS introduced the Quality Framework in November 2016. The agency this year established an Office of Quality and released a strategic plan for 2019-2023.

But any hopes of addressing the systemic problems at the agency's 24 hospitals and related facilities will be dashed if IHS doesn’t take on several underlying issues, according to OIG’s report.

RELATED: GAO: Indian Health Services continues to struggle filling provider vacancies

One of the major issues is a lack of a formal structure or policies and roles focused on correcting problems.

“Officials reported that the lack of structure could lead to frequent changes in policy as leadership changed,” the report said. “In some cases, policies lacked detail and were not specific or prescriptive in mandating particular actions."

Sometimes IHS officials in the field didn’t fully understand roles described in documents from IHS headquarters. 

“Officials also reported that even when policies were in place, the policies were not always followed or fully enforced, including policies for critical functions such as hiring and contracting,” OIG said.

IHS headquarters also needs to do better in communicating with area offices on quality issues at hospitals.

OIG cited the closure of South Dakota-based Rosebud Hospital’s emergency department.

“Hospital staff reported poor relationships between the Great Plains Area Office [of IHS] and Rosebud Hospital, as well as communication breakdowns across IHS, which limited support to identify and correct problems,” the report said. “This, in turn, resulted in a lack of knowledge within IHS regarding whether the agency was making progress, and a slowed sense of urgency.”

IHS hospitals and health facilities have been plagued with quality problems for years.

Most recently, attention has been focused on IHS hospitals in the Great Plains area. Earlier this year, a report from Frontline and the Wall Street Journal described a doctor that sexually abused children but continually was able to work for the agency for decades.

The Centers for Medicare & Medicaid Services terminated a Great Plains hospital from participating in Medicare in 2015 and again in 2017.

Another hospital submitted a quality improvement agreement to appease the agency and a fourth facility decided to stop accepting inpatient admissions altogether, according to the OIG report.

OIG said that IHS has made progress on making recommendations on its five-year strategic plan and quality framework.

However, to fully implement the plans “IHS must continue to work toward fleshing out the related policies and required actions, and include ongoing review of the effectiveness of implementation, such as its new hospital performance metrics and training initiatives.”