The Indian Health Service

Wgu Ltt1 Task 2

Intro to task two:

The Indian Health Service (IHS):

The IHS is a health care system for nearly 2 million American Indians and Alaska Natives who belong to the 566 different, federally recognized, tribes in 35 states. 1 IHS is an agency within HHS, which is the Department of Health and Human Services. 2 The Indian Health Service was established in 1955 taking over from the Bureau of Indian Affairs. It is based on Article I, Section 8 of the Constitution and the relationship developed from numerous treaties, Executive Orders, and Supreme Court decisions 3. The IHS is the primary health care provider for the American Indian people 4, and it’s dedicated to raise their health and well-being to the highest level.

Health Information Exchange(s):

A Health Information Exchange is the virtualization of healthcare information electronically, and access to said information exchanged between HIE members. This data spans across organizations within a community, or hospital system, or even whole regions. HIEs facilitate transmitting protected health information to other organizations and government agencies according to national standards. HIEs often include collaboration among physicians, home health, nursing homes, hospitals, and mental health facilities. 5

Federal Employees Health Benefits Program:

The FEHB Program is for Federal employees present and retired as well as their survivors. Members have the widest selection of health plans in the country. With the ability to choose from among consumer or high deductible plans for catastrophic risk protection, health savings/reimbursable accounts and lower premiums, or fee for service (FFS) plans, and their Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMO) if the employee resides within the area serviced by the plan. 6

Meaningful Use:

Electronic health records provide many positive factors for providers and the patients the care for. The benefits depend on how they're used and what information they process. Meaningful use is defined as the set of standards put forth by the Centers for Medicare & Medicaid Services (CMS). CMS has tied incentive programs for the use of electronic health records which allow providers and hospitals that are eligible to earn incentive payments by meeting specific criteria. They do this by reporting to CMS on how the use of the electronic health records (EHR) can improve clinical care. As well as reporting on the exchange of health information to improve quality care. 7

TRICARE:

TRICARE was formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). It stands for the triple option benefit plan that is available for military service members, their families and their survivors. TRICARE brings together the health care provided at military hospitals and treatment facilities. It supplements them with a multitude of civilian health care providers to give access to quality care for the beneficiaries. 8

ICD-10:

In October 2014 ICD-9 is set to transition from the current coding system to the new which is ICD-10 providing more specific code sets. The ICD-10 code sets will allow the U.S. to compare health information more precisely with other governments. The Health Insurance Portability and Accountability Act require that all insurance plans in the U.S. make the change to ICD-10. 9

A.1 Standards

Accreditation presents the "top standard" in the healthcare industry for the organizations that can attain it. It demonstrates that the Hospital/Facility/Organization has passed the accreditation test and is committed to providing the highest quality in care. The Joint Commission on Accreditation of Hospitals is the healthcare accreditation organization which is used by the IHS to accredit its health care programs. CITE. Accreditation is not required and it is not permanent. Healthcare providers are re-surveyed every three years unless an incident causes a re-survey 10.

The Office of the National Coordinator for Health IT along with the Center for Medicare and Medicaid Services have compiled a list of Electronic Health Record products used for the attestation of Meaningful Use under the CMS Medicare and Medicaid EHR Incentive Program. 11

A.2a Clinical Quality

HIEs have no direct impact on the clinical quality provided. With the exception of cases were health information is shared that may have been unknown to the current provider and that information assists with the diagnoses or treatment of that particular patient. 12

Meaningful use impacts clinical quality by providing a system in which better documentation can assist in providing improved care. It also can improve the accuracy of diagnoses and the quality of outcomes in patient care. 13

ICD-10 has no real impact on the clinical quality as it is only used for coding billing information.

A.2b Reimbursement

The IHS provides healthcare services reimbursement through the authority provided by the Snyder Act of 1921. The reimbursement is for the services provided at IHS hospitals, clinics and health care centers. 14

The FEHB program provides reimbursement for services provided under its blanket of programs from HMOs, PPOs, preferred provider networks and various other types of plans.

TRICARE provides reimbursement for services provided at its members

HIEs provide no reimbursement as that is outside the scope of their purpose.

Meaningful use provides reimbursement through a payment timeline for using certified