With tribal hospital in spotlight, Medicaid expansion talk could be imminent

As federal agencies come to the table with the Rosebud Sioux Tribe to discuss ways to improve health care at an embroiled reservation hospital, Medicaid expansion supporters say the dialogue could propel efforts to grow the health care program for needy people.

With a spotlight shining on the Rosebud hospital, the stage could be set for a broader conversation about improving Indian Health Service (IHS) in the South Dakota.

Gov. Dennis Daugaard has been working for months to strike a deal with federal agencies and private health care providers that would save South Dakota taxpayers millions of dollars that could be used to expand Medicaid in the state to tens of thousands of low income residents.

The Republican governor said he was very concerned about the situation in Rosebud and believed others could be too.

“It just, in my mind, creates more urgency for better health care services by all means, Medicaid expansion included, for Native Americans who are served by these organizations that can’t seem to serve them well’,” Daugaard said.

But skeptics say federal agencies' inability to work together could doom Medicaid expansion talks and perennial efforts to improve health care services for people on the Rosebud Sioux reservation.

Feds deal blow to Rosebud IHS hospital

“It’s hard to be optimistic when you know that the bureaucracy is the culprit in this whole situation,” O.J. Semans, a member of the Rosebud Sioux Tribal Health Board, said.

And with a lingering deadline to strike a deal or lose a crucial funding source, tribal members say they want solutions, not short-term fixes for a hospital that for months has operated without an emergency room.

The Rosebud Indian Health Service hospital last week learned again that the Centers for Medicare and Medicaid Services (CMS) intends to terminate an agreement that allows the hospital to bill for Medicare and Medicaid. Steven Chickering, a CMS regional administrator, in a letter to the hospital's acting administrator said "the condition level deficiencies posed an immediate and serious threat to the health and safety of patients."

The hospital first received a warning that it would lose federal funding last year after the U.S. Department of Health and Human Services (HHS) and CMS determined the hospital had dangerous deficiencies in its ability to provide care. An inspection found that the facility didn't communicate that a patient had an untreated case of Tuberculosis, physicians waited more than an hour in treating a patient having a heart attack and in another case delivered a premature baby on a bathroom floor.

After meeting with hospital administrators, tribal representatives, as well as IHS and HHS agents, a regional administrator for CMS said Friday that the agency would enter into a last-chance agreement with the hospital. Chickering said the agency would agree to push back the deadline for the hospital's potential funding loss from March 16 to May 16. If the hospital can't provide safe, adequate care at that time, they will lose federal funding.

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Chickering, in a letter to IHS Principal Deputy Director Mary Smith, said IHS and the hospital would need additional time to address deficiencies there and to create long-term solutions.

"We also hope such actions would yield broader benefits that extend not only to Rosebud hospital patients, but to patients at other IHS hospitals by virtue of a stronger IHS healthcare infrastructure," Chickering wrote.

IHS in a statement said "providing access to quality health care remains a priority" and the agency "is committed to making improvements to ensure the safe delivery of care for patients at Rosebud Hospital and to implement reforms to stabilize, strengthen and raise the overall quality of care in the IHS Great Plains Area."

The hospital had to shutter its emergency room as a result of the inspection and an inability to fully staff it. Patients have been diverted in the three months since the emergency room has been closed to facilities in Valentine, Neb., and Winner, 44 and 55 miles away respectively.

And those facilities have felt the impact of the additional patient load.

Brent Peterson, administrator of Cherry County hospital in Valentine, said the number of emergency room visits has increased 67 percent from this time last year.

“I’m relatively certain it would be attributable to that,” Peterson said of the patients being transported from Rosebud.

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Peterson said the hospital might have to consider taking on additional staff if the Rosebud emergency room remains shuttered in the long term.

“I know it’s been a challenge for us,” Peterson said. “All departments have seen an impact.”

He said his administration had been in contact with the Rosebud Sioux Tribe, the three health agencies working with the Rosebud hospital and both Nebraska and South Dakota's congressional delegations.

Jody Sperlich, communications director for Winner Regional Healthcare Center, said the hospital's emergency room saw a 20 percent uptick in patient visits over the last three months.

Follow Dana Ferguson on Twitter @bydanaferguson