Board is examining the various methods of improving the quality of medical and dental care at our Nation's IHS medical clinic in Pawhuska
We have been active now for over a year in an advisory status for the Osage Nation Executive Branch and the Osage Nation Congress. One of our many activities include the examination of various methods with which to improve the quality of medical and dental care at our Nation's IHS medical clinic in Pawhuska. In general, the Indian Health service (IHS) is currently only 70 percent funded to meet the medical and dental needs of all patients served by the IHS. This 30 percent deficit is in part responsible for one's difficulty in getting in to see a medical provider and in receiving medical care. Many of our people go to outside clinics as they perceive that they cannot get seen in a timely fashion at the Pawhuska clinic and in some instances this is true.
Many have developed the mistaken belief and acceptance that this level of care is all we can get for our peoples' medical needs and that we have no choice but to accept the long lines and waits to receive health care. The clinic provides Tribal citizens with excellent service and care and has met their needs for many years but the perception and reality is that not enough personnel are available to see them all and a long wait is a fact of life and has become a barrier to those needing timely medical care.
Public Law 93-638, the Indian Self Determination Education and Assistance (ISDEA) Act, and subsequent revised regulations have provided mechanisms with which sovereign Indian Nations who wish to, might form a business relationship with the Indian Health Service and receive and administer an annual funding agreement which directly empowers a Tribe to enhance performance, functions, services and activities that were previously provided by and in essence “run” by the federal government (as with the operation of the Pawhuska IHS clinic). In other words, if the Osage Nation's elected officials were to decide to enter into such an agreement, then the monies to run the clinic would come directly to the Osage Health and Wellness Division (A branch of the Osage Nation established by Law) and the Osage Nation would operate, make decisions for and implement health care policies thought to be in the best interest of its citizens thereby enabling the Nation to govern their own actions. The thinking is that Osages are in the best position to develop Osage specific standards and policies of care and to prioritize our health care budgets to best meet Osage Health needs, provide enhanced levels of medical care, increase accessibility of services to Tribal citizens and provide for the unique cultural diversity of Osage people.
The agreement could take the form of P.L. 93-638, as revised, contracting which would allow the Osage Nation to have some level of autonomy from Federal influence in carrying out a contract and in the spending of our health care monies. A more preferred method is to compact with the Indian Health Service and receive our funding in one lump sum payment on the first day of the fiscal year with only a minimal yearly reporting requirement. This could then allow us as a Nation to potentially increase our funding by as much as 17 percent by directing that all administrative monies used to support our clinic services in the past should now come to the Nation to augment services as we see fit. In turn we could see increases in third party payments (from improved billing practices that we as a Nation put into place), contract support costs, and interest earned on advance monies could substantially improve our budget with which to provide services (This would allow for the hiring of additional staff, i.e. Doctors and nurses). This would mean that additional monies from the Nation's general treasury would not be needed. Our estimates are that an increase as much as $1.3 million to $2 million dollars could be realized simply by entering into this compact agreement with the IHS and exercising due diligence into transitioning to an Osage Nation run health care system.
There appears to be a misconception that if a Tribal entity were to compact as described above and find itself unable to successfully administer the contract/compact agreement that there could be no going back to the previous IHS clinic management. This is not the case and federal law allows the Tribal entity to reassume (give back) the responsibility for providing these services to the IHS. In extreme cases, the IHS is allowed to take back control and responsibility for providing health services even without tribal consent, this is called resumption and is rarely done as IHS works closely with compacting Tribes to ensure they receive the needed technical assistance to guide them along the compacted path. Even in the event of poor outcomes such as those previously discussed, after a period of revised business and management practices the Tribal entity could once again be awarded a contract or compact to assume control of its health care services with IHS monies.
We are preparing to begin a detailed survey and analysis to determine our capability of assuming such control of our Tribal clinic. We are optimistic that we will confirm that the Osage Nation is indeed capable of successfully operating such a compact and as a consequence improve our health care services such to where our facilities and services are as good or better than any other facility in Oklahoma and become the premiere health care entity of choice for our people to receive accessible, quality health care. Today, 57 percent of all federally recognized tribes have entered into similar agreements as described above. This is an exciting time to ponder these possibilities for the Osage Nation with the hope and expectation that we can provide augmented medical services with programs and priorities established by Osages for Osages.