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The second objective of this effort was to improve the quality of care while reforming services. When you're feeling anxious or scared, your body releases stress hormones such as adrenaline and cortisol.

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The Wind River Service Unit has used increased reimbursements to purchase new x-ray equipment and to renovate the outpatient department to increase the of exam rooms. John E. There's been a lot of discussion in Montana recently about the challenges facing the Indian Health Service, and I'm really glad to have the opportunity today to update you on some progress we've made, but to discuss the work that clearly remains to be done, and I'm really looking forward to hearing recommendations.

I am glad to have the opportunity to update you on the progress we have made and the work that remains. However, the rescission and sequestration cuts reduced the Billings Area PRC budget by approximately three million dollars, and, by the end of FYthree Service Units were only able to approve referrals for payments for Medical Priority 1.

Between FY and FYthe total of purchase orders issued for referrals approved for payment increased from approximatelyto approximately ,; and, during the same time period, the of denials decreased from approximately 28, to 23, We have made improvements in our Tribal consultation process, which helps set Agency priorities for improvements and measure progress.

My second priority to reform the IHS includes instilling ability into the IHS management structure, setting goals for managers and then holding them able when targets are not achieved. Jon Tester, Chairman of the Committee, presiding.

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IHS is striving to fulfill its role as a health system and represents the only source of healthcare for many of our American Indians and Alaska Native patients, and Bililngs we are operating in a constrained fiscal environment, funding is critical, and while the IHS budget has increased by 33 percent sinceand thank you for your advocacy on that, the need continues to be ificant and challenges remain.

In an attachment that I will share in follow up, I will provide a detailed listing of recent reforms and changes in the Billings Area, and, in particular, the steps being taken to improve IHS service to tribes in this Area as a result of the IHS Area Oversight Reviews. The Billings Area Business Offices are focusing on making improvements in this area. Their input and recommendations are helping guide priorities for actions and improvements.

These improvements in Area Governing Body oversight will help ensure regular review of improvements and progress on Agency reforms. The change also resulted in the strengthening of the relationship between the Area office and the Service Units. The restructuring assistqnce the quarterly Governing Body meetings improved the sharing of both administrative and clinical data.

However, I know that what matters to members of syress tribes in the Billings Area is asssistance day-to-day care they receive from our service units and hospitals. I know we've got limited time today so I'm going to wrap meeding up so we can get to Dr.

In many regulae when we are discussing this, we are discussing issues literally of life and death. last reviewed: 15 October Next review due: 15 October Thank you, and good morning, Senator Tester. Moreover, the circumstances in many of our communities--poverty, unemployment, and crime--often exacerbate the challenges we face.

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Government Publishing Office] S. It seems so often that in all of our discussions, policy and politics, the idea of care gets lost. For example, the Northern Assustance Service Unit currently has 56 Veterans registered in the Resource and Patient Management System and is billing and collecting reimbursements from VA for direct care services provided to eligible Veterans. The remaining facilities are administered by the IHS, but Tribes operate some of the programs associated with those facilities.

They have collaborated with VA at the regional and local levels to establish an area within the Blackfeet Service Unit for VA to provide clinic and Tele-health services for eligible Veterans. The Billings Area Master Plan completed in estimated the need for healthcare facility expansion and staff at the Service Unit level would have to double by to serve the projected growth of the population served. Regupar to These reforms are being implemented throughout IHS at a national, system-wide level.

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In order to continue our commitment to Tribal consultation, I am in the process of personally conducting listening sessions in all IHS Areas this year to hear views from Tribes on how we can continue to make progress on our Agency reforms. I also appreciate Dr.

Over the last year, the Fort Belknap Service Unit has noted ificant improvements in access to care. The Billings Area continues to monitor and update each subject identified in the initial oversight report.

One important new initiative is our hospital consortium which is working to improve quality and maintain accreditation requirements in all our hospitals by establishing a system-wide business approach to accreditation. Some of these efforts are detailed below.

For example, since implementing Improving Assistace Care concepts, the Fort Belknap Service Unit has doubled the of patients with access to outpatient services. When it became clear last year that the facility had ificant challenges, we requested an outside team of experts from the Commissioned Corps conduct a review of the quality of care and provide us with a set of recommendations which we are now being implemented.

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The Area Office located in Billings, Montana is the administrative headquarters for eight service units consisting of three hospitals, eleven ambulatory health centers, and four health stations. In closing, I just want to say that I really truly believe that the only way we are going to improve the health of our community is to work in partnership and have both of us working on action steps together that will make lasting improvements, and we are committed to do that.

Before I get into my prepared remarks, I just want to say something that was pointed out to me by one of the tribal members in the hall, and that is that we are not having this hearing for the sake of having a hearing, we are having a hearing to find out what the problems are, how pervasive they are and look for ideas on how to fix them. We are making improvements in the hiring process, recruitment and retention efforts, and, for our third priority, are working on a of initiatives to improve the quality of and access to care and promote healthy Tribal communities.

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An important element of this is improving our business practices, which is something the Billings Area tribes emphasized at the recent listening session. We want to make tribal leaders stronger and Indian Country stronger, and we want to make the Indian Health Service stronger in providing the services that are so critically important for the folks in this room today and a whole lot of other folks who couldn't make it.

Roubideaux for being here today. IHS provides comprehensive health service delivery to approximately 2. The Indian Health Service provides healthcare to roughly 2.

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Government Printing Office Internet: bookstore. Mark L. So in conclusion, while we are making progress in and are committed to making progress and changing and improving the IHS, we know that much more needs to be done.