A final federal rule meant to more fairly compensate services provided outside of the Indian Health Service and ostensibly increase access to healthcare for Native Americans could have the opposite effect, according to some stakeholders.
The rule allows tribal and urban Indian health programs to pay physicians outside of IHS facilities rates similar to Medicare when beneficiaries need care not available at IHS facilities. The goal is to lower spending and stretch the IHS' limited $5 billion budget.
Some, like Devin Delrow, director of federal relations at the National Indian Health Board, a Washington, D.C.-based not-for-profit, believe the move will push providers to take in more patients to offset the lower rates.
Others strongly disagree.
“Depending on how those 'Medicare-like rates' compare to their current payments, I imagine some physicians may limit or stop taking referrals from IHS,” said Jennifer Lawrence Hanscom, CEO of the Washington State Medical Association, adding that it could be especially damaging to physicians offering specialty services.
Before the rule, hospitals were already required to accept Medicare rates from federal and tribal programs when they accepted patients from IHS-funded facilities. Physicians and other non-hospital providers were paid at either billed charges or negotiated rates.
A 2013 Government Accountability Office report (PDF) found that IHS was paying two times as much as Medicare and about one and a quarter times as much as what private insurers would have paid as a result of the policy.
“For years Indian health programs have been paying higher rates than private health insurers and other federal programs,” IHS Principal Deputy Director Mary Smith said in a statement. “This new regulation offers tribes the option to negotiate reasonable rates.”
“The goal here is to get more services to our patients in an atmosphere of declining access to the specialist care we need,” said Ed Fox, a member of a CMS tribal advisory group and health director for the Skokomish tribe in Washington state. “The rule recognizes that low rates without access to providers is a pyrrhic victory.”
To prevent any access issues, IHS is allowing facilities to opt into the rule.
This provision recognizes tribal sovereignty by allowing them to determine how best to meet the healthcare needs of their communities.
This is the second major pay policy the White House has released in recent weeks to address Native American healthcare services. Last month, the CMS announced it would pay 100% of primary and specialty healthcare services that are purchased from private healthcare providers because they are not available at Indian Health Service or tribal healthcare facilities. That decision only covers Native Americans eligible for Medicaid.