OIG Site Visits to Indian Health Service Hospitals in the Billings, Montana Area

The report summarizes our observations from our June 2014 site visits to Blackfeet Community Hospital and Crow Northern Cheyenne Hospital, both in IHS's Billings Area, which covers the States of Montana and Wyoming. During the site visits, we interviewed hospital officials and representatives from tribes served by these hospitals. We also observed key hospital departments and reviewed hospital documentation. Our observations highlight the challenges faced by these hospitals and the strategies that the hospitals use to provide services to their patients. These site visits expand on prior OIG work that has examined longstanding challenges that IHS and tribal facilities face and that affect IHS beneficiaries' access to care.

We observed that Blackfeet Community Hospital faced staffing challenges in providing services and used various strategies that partially addressed these staffing challenges. Despite efforts to address continuity of care, Blackfeet Community Hospital faced challenges arranging for post-discharge services for patients.

We observed that in response to staffing and service limitations, Crow-Northern Cheyenne Hospital used temporary contracts and Purchased/Referred Care funding to provide services to its patients. Crow-Northern Cheyenne Hospital used patient transfers and agreements with other facilities to link patients to the services they needed.

In partnership with tribes, IHS provides health services for more than 2 million American Indians and Alaska Natives living in the United States. IHS directly operates 28 acute care hospitals in 8 States and provides preventive health and primary care services at other health care facilities. Together, these facilities serve members of the 566 federally recognized tribes.