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Open Recommendations (10 total)

Indian Health Service: Opportunities Exist to Improve Clinician Screening Adherence and Oversight

GAO-24-106230
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1 Open Recommendations
Agency Affected Recommendation Status
Indian Health Service The Director of IHS should develop and implement a process to review and update the single, authoritative source of credentialing and privileging requirements, once developed, to ensure that it is updated in a timely manner to reflect any changes in those requirements. (Recommendation 2)
Open – Partially Addressed
IHS agreed with GAO's recommendation and has begun taking steps to implement it. IHS updated its Indian Health Manual to include a requirement for its Medical Staff Credentialing and Privileging Standard Operating Procedure Manual (SOP) to be reviewed and updated biennially. According to IHS, the goal of that review is to ensure that the SOP is current and contains appropriate and adequate policy information and procedural guidelines for IHS staff members to effectively perform their duties and responsibilities. In addition, the SOP notes that staff can provide IHS's Office of Quality with suggestions and edits to the SOP and other credentialing and privileging documents. However, neither the Indian Health Manual nor the SOP clearly delineate how the Office of Quality will maintain and make timely updates to the SOP during the intervening periods between the biennial reviews. To close the recommendation as implemented, IHS needs to show that it has conducted biennial reviews and updated the manual, as necessary, in a timely manner, including in the intervening periods between the biennial reviews.

Indian Health Service: Opportunities Exist to Improve Clinician Screening Adherence and Oversight

GAO-24-106230
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1 Open Recommendations
Agency Affected Recommendation Status
Indian Health Service The Director of IHS should implement regular monitoring of areas' and facilities' adherence to IHS's credentialing and privileging requirements by headquarters officials. Such monitoring could include, headquarter officials conducting audits or reviews of a sample of credentialing and privileging files, and regular reviews of audits conducted by area offices and facilities. (Recommendation 3)
Open
IHS agreed with GAO's recommendation. IHS's Indian Health Manual delineates staff responsibilities for oversight and monitoring of credentialing and privileging compliance. In addition, its Medical Staff Credentialing and Privileging Standard Operating Procedure Manual (SOP) establishes standards for compliance and includes audit tools that can be used for conducting audits of providers' credentialing files. IHS told us that headquarters officials will perform manual audits on a random sample of providers' credentialing files and report compliance rates in a quarterly report to leadership. However, neither the Indian Health Manual nor or the SOP specify (1) the frequency of audits that will be conducted by headquarters officials or (2) the information that would be reported to IHS leadership. To close the recommendation as implemented, IHS needs to show that headquarters officials have actually implemented regular monitoring of areas' and facilities' adherence to IHS's credentialing and privileging requirements, such as evidence that the IHS Office of Quality has conducted regular audits of a random sample of providers' credentialing files.

Indian Health Service: Many Federal Facilities Are in Fair or Poor Condition and Better Data Are Needed on Medical Equipment

GAO-24-105723
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1 Open Recommendations
Agency Affected Recommendation Status
Indian Health Service The Director of IHS should assess the extent of the medical equipment data problems across all IHS areas and service units with federally operated facilities and develop and implement a plan to address any problems identified. The plan should include providing resources and guidance, as appropriate, to help ensure areas and service units have complete and reliable medical equipment data. (Recommendation 1)
Open – Partially Addressed
IHS officials provided documentation that in October 2023, they assessed some medical equipment data quality issues, such as the extent to which records of equipment included in its equipment inventory management system were missing key information, and created a plan for correction. IHS published a guidance manual in collaboration with IHS Area Offices, based on input on medical equipment data problems. The guidance manual outlines required information and "best practice" details to be included for each medical device entered into the inventory management system. Additionally, the manual outlines the responsibilities of system users to maintain compliant and complete equipment records. While this addresses some aspects of the recommendation, IHS has not provided evidence that it assessed the extent of a key source of IHS's medical data equipment problems-- that some medical equipment was not recorded in the system, including by some facilities that were not actively using the inventory management system. In addition, while IHS's guide noted that it expected IHS areas to allocate the necessary resources to achieve its goals for improving the equipment data, it has not explained how it expects areas that are understaffed, which was identified as a key cause of the problems, to address this expectation. We have requested additional information from IHS and are awaiting their response.

Indian Health Service: Many Federal Facilities Are in Fair or Poor Condition and Better Data Are Needed on Medical Equipment

GAO-24-105723
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1 Open Recommendations
Agency Affected Recommendation Status
Indian Health Service The Director of IHS should ensure that headquarters officials regularly monitor area and services units' adherence to IHS medical equipment inventory management policy requirements. Such monitoring could include regularly reviewing area biomedical equipment governance committee meeting minutes and the agency's medical inventory equipment data to assess its completeness and accuracy. (Recommendation 3)
Open
IHS issued an update to its medical management policy on March 27, 2024, as Indian Health Circular 24-06. Officials stated that, per the newly issued circular, IHS will regularly review Area biomedical equipment governance committee meeting minutes and the agency's medical inventory equipment data to assess its completeness and accuracy. We appreciate that IHS has taken steps to further outline responsibilities for monitoring adherence to medical equipment inventory management policy requirements. We plan to keep this recommendation open until IHS has been able to demonstrate regular monitoring over more than one year. This might include, for example, documented reviews of completed Area certifications or meeting minutes from HQ meetings where monitoring was discussed.

Indian Health Service: Actions Needed to Improve Use of Data on Adverse Events

GAO-23-105722
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1 Open Recommendations
Agency Affected Recommendation Status
Indian Health Service The Director of IHS should ensure that the appropriate headquarters officials take steps, as appropriate, to address any needed improvements or disseminate any best practices identified based on their review of data on trends in adverse events for—at a minimum—each area. (Recommendation 2)
Open
IHS concurred with this recommendation. In December 2024, IHS officials stated that a learning collaborative to identify and spread evidence-based practices and education to reduce inpatient falls and associated harm is a 2024 Total System Safety (TSS) implementation priority action. The workgroup is collecting baseline data to provide insight into what processes are currently in place at IHS hospitals to reduce inpatient falls. As IHS learns from this learning collaborative, GAO will review documentation of the results of the TSS efforts, including any steps taken to address any needed improvements or disseminate any best practices based on area trends related to falls. We will also continue to monitor whether IHS takes steps to address any needed improvements or disseminate any best practices related to other IHS area trends in adverse events.

Indian Health Service: Actions Needed to Improve Oversight of Federal Facilities' Decision-Making About the Use of Funds

GAO-21-20
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1 Open Recommendations
Agency Affected Recommendation Status
Indian Health Service The Director of IHS should develop a process to ensure that IHS area offices systematically assess how the scope of services provided by federally operated health care facilities will effectively meet the current and future needs of their patient populations, which could include the incorporation of a current community health needs assessment. (Recommendation 1)
Open
IHS agreed with our recommendation. In June 2022, IHS told us that it is working to establish a reporting process to verify that community needs are assessed at least annually. IHS also reported that it had obtained area office feedback on current processes to assess patient population needs. As of January 2023, IHS reported that it was continuing to work on addressing this recommendation. In March 2024, IHS reported that it is developing a policy regarding the incorporation of findings from community health needs assessments into service unit management and oversight. To fully implement this recommendation, IHS must complete the development and implementation of a process to systematically assess patient population needs and establish a process to review these needs along with the scope of services provided by federally operated health care facilities.

Indian Health Service: Actions Needed to Improve Oversight of Federal Facilities' Decision-Making About the Use of Funds

GAO-21-20
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1 Open Recommendations
Agency Affected Recommendation Status
Indian Health Service The Director of IHS should develop a process to guide IHS area offices' review of federally operated health care facilities' spending proposals, both before approval and after they are implemented, and ensure this process is followed. (Recommendation 2)
Open
IHS agreed with our recommendation. In June 2022, IHS reported that it created a new dashboard to provide the agency with more comprehensive financial data at a more granular level. IHS also reported that it has plans to convene financial management staff to discuss this recommendation, conduct a root cause analysis, develop system maps of financial processes, and review, design, and document processes for funding decisions at IHS operated health care facilities. In January 2023, IHS reported that it had conducted interviews with Area finance teams and convened a cross-agency workgroup to begin on these tasks. In March 2024, IHS reported that it was engaged in Governing Body standardization efforts, focused on the implementation of finance committees and budget consent agenda items as the mechanisms to review spending proposals and ensure that a standard review process is followed. To fully implement this recommendation, IHS should develop and implement a process to guide area offices' review of facilities' spending proposals, and develop and implement methods to ensure that the process is followed by the area offices.

Cybersecurity: DHS and Selected Agencies Need to Address Shortcomings in Implementation of Network Monitoring Program

GAO-20-598
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1 Open Recommendations
Agency Affected Recommendation Status
Indian Health Service The Director of IHS should document approved hardware inventory information by associating FISMA systems with the hardware on its network in a format that can be readily integrated into its CDM tools. (Recommendation 10)
Open
As of August 2024, the Indian Health Service has not provided sufficient evidence to close this recommendation. When we confirm what actions IHS has taken we will provide updated information.

Cybersecurity: DHS and Selected Agencies Need to Address Shortcomings in Implementation of Network Monitoring Program

GAO-20-598
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1 Open Recommendations
Agency Affected Recommendation Status
Indian Health Service The Director of IHS should configure its CDM tools to compare configuration settings against federal core benchmarks applicable to its environment. (Recommendation 12)
Open
As of August 2024, the Indian Health Service has not provided sufficient evidence to close this recommendation. When we confirm what actions IHS has taken we will provide updated information.

VA and Indian Health Service: Actions Needed to Strengthen Oversight and Coordination of Health Care for American Indian and Alaska Native Veterans

GAO-19-291
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1 Open Recommendations
Agency Affected Recommendation Status
Indian Health Service As VA and IHS revise the MOU and related performance measures, the Director of IHS should ensure these measures are consistent with the key attributes of successful performance measures, including having measurable targets. (Recommendation 3)
Open
IHS concurred with this recommendation. In December 2021, IHS reported that effective, October 1, 2021, VA and IHS executed a new MOU. The agency reported that IHS and VA will continue working together to develop an annual operation plan to ensure that performance measures include appropriate measurable targets. In February 2022, VA reported that that the draft operational plan was completed on January 30, 2022, and was under review by IHS and VA's Veterans Health Administration (VHA), with a focus on performance targets and measures. In December 2022, IHS reported that the MOU Operational Plan had been completed and tribal consultations were held September through October 2022. Since that time, VA has provided updates on progress towards establishing new MOU-related performance measures. In February 2024, VA provided documentation showing that a MOU Data & Metric Workgroup had developed some MOU-related performance measures and begun collecting some initial data. However, additional work remained, including establishing numerical targets for the measures as well as determining data collection and reporting time frames. In August 2024, VA told us that as of May 2024, oversight of the MOU had been moved from the VHA Office of Rural Health to the VHA Office of Tribal Health, and that as such, the office was taking the opportunity to review the MOU, the Operational Plan, and current performance measures. VA noted that in the wake of this organizational realignment, the Office of Tribal Health would be critically reviewing the establishment of appropriate mutual MOU performance measures and measurable targets for FY 2025. Therefore, the agency noted that the target completion date for this work was being extended until April 2025. As such, the recommendation remains open, and we will continue to monitor VA's and IHS's progress towards implementing measurable targets for the MOU's performance measures.
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