Some employees of the Indian Health Service say a federal government efficiency effort is having the opposite effect.
There’s a new process in place for getting contracts approved, and these providers say it’s led to shortened hours at emergency rooms and urgent care centers, and reduced ultrasound services at one Indian Health Service hospital, among other impacts.
Angus Chen, a reporter with STAT News, has written about what's happening. He joined The Show to talk about the what has to happen now that didn’t have to happen this time last year.
Full conversation
ANGUS CHEN: Yeah, so the process that you're referring to is called PAA-DER, and that stands for presidential appointee approval and departmental Efficiency Review. This is basically a process that provides additional oversight that didn't exist before when it comes to the fulfillment of contracts or requisitions. And this is something that seems to be happening across the federal government. It's not just limited to the Indian Health Service or to Health and Human Services.
MARK BRODIE: And what does it require? Like if if a physician in an Indian Health Service facility wants to do something or order a test or or buy something, it has to go through a different channels now than it used to?
CHEN: Yeah, so the first thing that's important to know is that IHS hospitals rely pretty heavily on contracts. These contracts allow them to access services that are not, you know, within the direct hospital itself, like things that are not done by full-time employees of the IHS, like federal employees. So that can include any kind of reference lab that you might want to send samples to to get a test done. It can be travel contracts for travel nurses or travel doctors, pharmacists, technicians, those kinds of things. These travel workers, you know, actually make up a good portion of the clinical workers at IHS facilities, and it can be supplies.
So if a department needs to buy donor blood or they need to buy, you know, certain bits of equipment, all those things are done through contracts. When you create those things, normally that can just go through the hospital and they have an approval process to to buy stuff. But now it has to go up sort of the chain of command up to the acting director of IHS who needs to approve it, and then that needs to go to HHS, sort of the secretary's office, or the deputy secretary's office at HHS where it undergoes this departmental efficiency review. And gets final approval there.
So there's these added layers of approval that sort of slow things down and really slow things down to the point where people on IHS told me they don't know when they'll get certain contracts approved. And these are critical contracts, you know, these are contracts for clinical staff that the hospital needs to operate. It could be contracts for certain kinds of equipment maintenance, so like, you know, imaging equipment. And if you lose those things, then you actually lose that clinical service in the hospital.
BRODIE: Well, and I would imagine as with so many things in the medical field, time is of the essence like you mentioned, you know, if you need to get a new MRI machine or contract with somebody to use their MRI machine, if it takes extra time, that's X number of patients who maybe won't get the results in a timely manner and lead to worse health outcomes.
CHEN: Yeah, I mean, that's exactly the concern here is that if you end up losing a certain kind of service, and that this actually happened at Gallup Medical Center, which serves residents of the Navajo Nation, they were unable to get quickly a contract approved for an ultrasound technician. And because they weren't able to get that ultrasound technician's contract renewed when, you know, they needed to, they lost overnight ultrasound service in the emergency department.
And this kind of had the effect of people who come into the emergency room, you know, after hours or overnight, and they need an ultrasound in order to get certain conditions diagnosed so that doctors know how to proceed. And so imagine now that, you know, someone comes in, they have an emergency, right? And this emergency, you know, you would normally diagnose it with an ultrasound and you can't really see it that well and other kinds of imaging like CT. And this person experiencing that emergency now needs to wait to get that emergency resolved either by waiting until the morning, when so the ultrasound technician is able to come in, or by being transferred to another hospital, which again can take time.
BRODIE: How prevalent are these problems where hospitals have had to either delay services or miss out on services you mentioned that the facility in Gallup. Is this happening throughout the IHS system?
CHEN: The delays seem to be happening throughout the IHS system, at least wherever I was able to talk to people who work at IHS facilities. And my impression was that the Gallup Hospital was one of the worst situations that I ran into when I was doing reporting on this story. But other hospitals, you know, clinicians at other hospitals I spoke with, said that they were running into similar issues, but they hadn't quite lost the same level of services that Gallup had. But it was certainly was causing them a lot of stress and a lot of administrative burden and employee overload, to deal with this new process, this PAA-DER process.
BRODIE: What are federal officials saying about this? Like anyone from HHS or the Indian Health Service itself?
CHEN: Yeah, so I, I spoke with a spokesperson from HHS and I also spoke with Mark Cruz, who's a new senior adviser in Secretary Kennedy's office. You know, the HHS told me that they created this new process, in response to one of President Trump's executive orders on governmental efficiency. And they said that they didn't, well, they said that this process had not interrupted the IHS's ability to fulfill any responsibilities, and that the goal of this departmental efficiency review was to make sure that federal spending is quote “aligned with the best interests of the American people.”
You know, the statement that this review has not interrupted IHS's ability to fulfill clinical responsibilities is just definitely false, because I got memos from IHS hospitals that showed that they were losing medical services because of this new process, because of the slowdown that was happening because of this process.
BRODIE: Did the federal officials have any response when you pointed that out to them?
CHEN: No, they simply pointed me to another spokesperson at HHS when I brought this up.
BRODIE: So, is this sort of the way it's going to be going forward? Like do folks who work in the IHS facilities seem to think this is just sort of the new normal now?
CHEN: I don't know. I think that people are hoping that this process will either become more streamlined in the future, or that it'll just go away. You know, one person I talked to said that they felt that IHS should get an exemption from the departmental efficiency review process in government, and their argument was that because IHS provides clinical care, like medical care, in a way that really not many other departments of the government do, you know, the exception would be the Veterans Affairs and also the NIH hospitals, which, you know, does a lot of clinical trials and through that will provide care to patients, no other part of the federal government really provides health care in this way, and when you change the way the government works, it can interrupt the flow of care in these facilities and, and that has an impact on people's health.
And so I think people in IHS really hope that there will be an exemption for IHS when it comes to this process and that's what they're, that's what they're asking for whether or not they'll get it, I think is up in the air.
