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# Department of Health and Human Services

# Indian Health Service

# National Council of Chief Executive Officers (NCCEO)

######## 2005 Annual Report to the General Membership

January 30, 2006

# **NCCEO Executive Committee** 

# 

The 2005 NCCEO Executive Committee consisted of the following members:

Chairperson: Edwin McLemore, Hastings Indian Medical Center

Tahlequah, Oklahoma

Chair-Elect: CAPT Leslie Dye, Neah Bay Service Unit, Portland Area

Secretary: James Cussen, Claremore Indian Hospital, Oklahoma City Area

Immediate Past Chair: Catherine Keene, Wind River Service Unit,

> Fort Washakie, WY, Billings Area

Aberdeen Area Representative: LaVerne Parker, Quentin Burdick Health
Center,

Belcourt, ND

Alaska Area Representative: *Vacant*

Albuquerque Area Representative: CDR James Lyon, Sante Fe Indian
Hospital,

Santa Fe, NM

Bemidji Area Representative: Jenny Jenkins, Cass Lake Service Unit,

Cass Lake, MN

Billings Area Representative: Catherine Keene, Wind River Service Unit,

Fort Washakie, WY

California Area Representative: Maria Hunzeker, Feather River Service
Unit,

Oroville, CA

Nashville Area Representative: *Vacant*

Navajo Area Representative: Floyd Thompson, Gallup Indian Medical
Center,

Gallup, NM

Oklahoma Area Representative: James Cussen, Claremore Indian Hospital,

Claremore, OK

Phoenix Area Representative: Dean Seyler, Whiteriver Service Unit,

Whiteriver, AZ

Portland Area Representative: CAPT Leslie Dye, Neah Bay Service Unit

Neah Bay, WA

Tucson Area Representative: Patti Whitethorne, Sells Service Unit

Sells, AZ

## Planning for the 2006 Combined Councils Meeting (CCM)

Members of the NCCEO Executive Committee, along with members of the
executive committees of the National Nursing Leadership Council, the
National Council of Clinical Directors, and the National Council of
Chief Medical Officers, are responsible for planning the annual Combined
Councils Meeting, and coordinating the logistics, including location,
dates, agenda, speakers, learning objectives, block of sleeping rooms
and breakout facilities. Many "thanks" go to the coordinator of this
year's meeting, CDR Dora Bradley of the Clinical Support Center, for her
leadership and dedication. The leadership of the combined councils
agreed on the following for 2006:

CCM Meeting Location: Phoenix, AZ, Hyatt Regency Downtown

Dates: January 29 -- February 3, 2006

Agenda Items specifically for CEO's at this year's conference:

i.  SES Candidate Development Program

ii. HR Recent Developments

iii. Succession Planning

iv. Performance Contracts and Accountability

# 

# **NCCEO Strategic Planning** 

On April 22, 2005, the NCCEO Executive Committee met in Rockville, MD,
for a full day of strategic planning. The Executive Committee approved
the following vision and mission statements and guiding principles.

> [Vision Statement:]{.underline} The NCCEO will challenge the status
> quo to create and achieve higher expectations.
>
> [Mission Statement:]{.underline} As health care leaders, the NCCEO
> partners, facilitates, supports, and promotes action items to
> strengthen performance improvement and organizational excellence.
>
> [Guiding Principles:]{.underline} The Art of Leadership Requires
> Creativity; Indian Patients Deserve Excellence Throughout the
> Continuum of Care; Expectations of Internal and External Customers
> Serve as the Foundation for Action in the Indian Health System.

The NCCEO held a one-day followup meeting in Scottsdale, AZ, on June
27^th^, in conjunction with the 2005 Indian Health Service Business and
Technology Conference, to work on other items.

# **Monthly NCCEO Conference Calls and Meetings** 

The NCCEO meets monthly by telephone conference on the third Monday of
each month at 12:00 P.M. Eastern Time. The chairperson develops a
tentative agenda for each call; conducts the phone conference; and
announces any changes in the call schedule or agenda. The Secretary
takes, edits, and distributes the minutes. Participants generally are
invited to submit revised and extended Area reports for inclusion in the
minutes. The minutes are available from the Secretary at
<james.cussen@ihs.gov>, and on the NCCEO Webpage. In addition to the
regularly scheduled conference call, the Executive Committee holds
special telephone conferences or in-person meetings, as needed. At least
one meeting of the NCCEO, during each calendar year, occurs jointly with
the other professional councils of the IHS.

# **NCCEO/IHS Management Liaison** 

Ms. Phyllis Eddy, IHS Deputy Director for Management Operations, is to
be commended for her service as the NCCEO liaison with Agency
front-office leadership and staff, during the past year. She has
provided valuable insight into the operations of the Indian Health
Service at the highest echelons and has provided valuable guidance to
the NCCEO in carrying out the initiatives of the Agency. She has
graciously participated in NCCEO conferences, both in person and by
telephone, and has agreed to continue her participation into the
foreseeable future. Ms. Eddy is deserving of special recognition for her
efforts on behalf of the NCCEO.

# **Charter Revision** 

The previous charter of the NCCEO was issued in 1992 (IHS Circular
92-12). This year Catherine Keene took the lead to ensure that the NCCEO
charter was revised to reflect the changed environment in which we now
live. Recognizing the need for a new charter to more accurately
demonstrate the commitment and dedication of the NCCEO members to the
mission, goals and objectives of the Indian Health Service, the
Executive Committee assisted with the reformulation of a more workable
foundational document for our organization. See Appendix B for new
charter (IHS Circular 2005-10).

## National Listing of CEO's 

In order for the Agency to be able to be in direct contact with Indian
Health Service CEO's on a range of issues and reporting requirements,
Ms. Eddy, Deputy Director for Management Operations, requested that the
NCCEO establish and maintain a listing of CEO's throughout the IHS
system. The Interim Secretary, Mr. James Cussen, coordinated the
development of this national listing and will work to keep it current
during his tenure as the Council secretary.

## Online Recruitment and Retention Survey

To establish a foundation for the recruitment and retention of highly
qualified chief executives, consistent with the IHS succession plan, the
NCCEO is carrying out a national initiative aimed at developing a
profile of current CEO's throughout the Indian health care system. Under
the leadership of CAPT Leslie Dye, the NCCEO sponsored an Agency-wide
survey of CEO's. The "Survey Monkey," a convenient online survey
program, was used to electronically collect and sort the responses. With
a nearly 85% response rate, an exceptionally representative set of data
was obtained from respondents. One survey question focused on the
educational attainment of CEO's, revealing that nearly 2/3 of all
direct-service IHS CEO's have masters degrees or higher, including
nearly 10% with doctoral degrees. Tribal CEO's are being surveyed, as
well. We hope to share the results of those surveys with the NCCEO
membership soon.

**National CEO Awards: New Category**

The NCCEO Executive Committee established a new award category this year
aimed at recognizing longer-term CEO's for their sustained dedicated
service to Indian people. The addition of the "Lifetime Achievement
Award" provides an opportunity for the NCCEO to confer special
recognition upon Indian health CEO's who have successfully taken up the
challenges of leadership in the health care arena for extended periods
of time. The other national award categories (CEO of the Year, Award for
Managerial Excellence, Award for Exceptional Performance, and, when
appropriate, Special Recognition Awards) continue to serve as the basic
framework for recognition of deserving chief executives, and others,
throughout the Indian health care system.

## Senior Executive Service (SES) Candidate Development Program

The SES Candidate Development Program is an intensive HHS program aimed
at developing internal candidates for SES positions. Persons selected
into this program realize several advantages over other applicants for
SES positions within the Department, such as being pre-qualified for an
SES position. This pre-qualification allows the candidate to forego the
regular evaluation through the qualifications review board. The NCCEO
immediate past chair, Catherine Keene, is one of the first IHS employees
to be selected as a candidate in this program. Phyllis Eddy will be
presenting more information related to the scope and intent of the
candidate development program, as well as the application process.

## Medicare Part D Position Statement

The position statement at Appendix A, below, was submitted to the
Director of the Indian Health Service in response to his request for
input concerning the advisability of the Agency establishing a policy on
the payment of Medicare Part D premiums for IHS patients who would
otherwise be ineligible for dual coverage, under Medicare and Medicaid
or Medicare and Private Insurance. The National Council of Chief
Executive Officers appreciates the opportunity to comment on the
Agency's approach to implementing this important national program, and
pledges to support, and to work toward full implementation of, the
Agency's decisions on whether or not to pay the premiums and on the
scope of the payment requirement.

## NCCEO Webpage

Jim Cussen, NCCEO Interim Secretary, assumed the responsibility for
ensuring that information pertinent to the National Council of CEO's is
placed in the appropriate location on the Indian Health Service website
at [www.ihs.gov]{.underline}. The NCCEO webpage includes such items as
the vision and mission statements of the NCCEO; guiding principles;
three-year work plan; and general and committee membership. The webpage
will serve as a valuable tool for the dissemination of information about
NCCEO activities, priorities, and recent developments.

## Workgroup Participation

The NCCEO leadership is frequently asked to participate as a member or
lead of various workgroups or task forces of the Indian Health Service.
Following is a sample listing of the groups that the 2005 NCCEO officers
have participated in.

### Director's Executive Council

## The Director's Executive Council (DEC), is the policy advisory group to the Director of the Indian Health Service, which focuses on issues related to strategic direction, recommends policy, and organizational adjustments called for by changes in the health systems environment. The ultimate goal of the DEC is to recommend policies that will help ensure the cost-effective, timely delivery of quality program or administrative services to support the mission of the Agency at the service unit, Area, and Headquarters operational levels. In FY 2005, at Dr. Charles Grim's direction, the DEC conducted policy analysis and development on four national issues---Health Promotion/Disease Prevention; Administrative Consolidations; Inherent Federal Functions and Residual; Strategic Management of Human Capital.

## Administrative Consolidations Workgroup Charge

> The purpose of the DEC's work on Issue 2: Administrative
> Consolidations, is to recommend policies to govern any consolidation,
> regionalization, or sharing of administrative functions undertaken by
> the Agency, including human resources, acquisitions, personal
> property, finance, and others designated by the Director.
>
> The recommendations of this workgroup will serve as the foundation for
> a set of policies governing the regionalization, consolidation or
> sharing of administrative services among the Area Offices. The Agency
> must develop strategies for assessing the administrative functions
> that may yield the quickest returns, especially those that are most
> immediately susceptible and amenable to regionalization,
> consolidation, or sharing.
>
> The Administrative Consolidations Leadership Team developed the
> workgroup's charge and work plan. The Leadership Team members are:

-   **Jim Toya**, Chair, Director's Executive Council

-   **Ed McLemore**, Chair, National Council of Chief Executive Officers

-   **Dr. David Yost**, Chair, National Council of Clinical Directors

-   **Richard Truitt**, Staff to the Director's Executive Council

-   **Phyllis Wolfe**, Staff to the Director's Executive Council

> The Administrative Consolidations Workgroup met via conference calls
> and in-person to provide the Leadership Team with guidance, direction
> and priorities for administrative consolidations. Workgroup members
> include:

-   **Phyllis Eddy**, Deputy Director for Management Operations

-   **Jennifer Hovencamp**, Director, Human Resources

-   **Lyska Welbourne**, Acting Director, Division of Acquisitions

-   **Richie Grinnell**, Area Director, Nashville Area Indian Health
    Service

-   **Sandra Winfrey**, Chairperson, National Council of Executive
    Officers

## Succession Plan Advisory Council

> In May 2005, the IHS organized the Succession Plan Advisory Council,
> which is a multidisciplinary team with diverse skill sets, to oversee
> Agency succession planning and other human capital issues on an
> ongoing basis. This team works with Ms. Jennifer Hovencamp, Director,
> Human Resource Management, IHS, to refine and implement the following:

-   Assessment of management team competencies;

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-   Evaluation of existing succession planning activities;

-   Identification of a pipeline for targeted management positions;

-   Development of an action plan to close the gaps between present and
    optimum qualification levels of potential candidates for targeted
    positions; and,

-   Continuous evaluation of the IHS succession plan.

#### Performance Achievement Team

> The IHS Performance Achievement Team was chartered (*See IHS Circular
> 2005-07*) to ensure the efficient and effective coordination of
> performance throughout the Agency. The Team works to enhance and
> reward the integration of a performance management culture across the
> Indian health care system. The Team promotes the performance-related
> budgeting process to provide a more direct link between Agency
> performance and the Government Performance and Results Act (GPRA), the
> President's Management Agenda (PMA), the Office of Management and
> Budget Program Assessment Rating Tool (PART), and the Department's
> Performance and Accountability Report (PAR). The Team supports the IHS
> mission by ensuring the efficient achievement and documentation of a
> high level of performance in meeting the major Federal accountability
> requirements and ensuring that performance results are used to
> effectively advocate for the health care needs of American Indian and
> Alaska Native people.

-   **Business Office Advisory Committee**

> Catherine Keene, Immediate Past Chair of the NCCEO, has served on this
> advisory committee during her tenure as the incumbent chairperson,
> carrying over into her tenure as the immediate past chair. As the
> NCCEO representative to the advisory committee, she has provided input
> from the service unit CEO perspective on training needs, conference
> agendas, priority focus areas for management, and coordination of
> efforts to address business office system issues throughout the
> Agency.

-   **IHS Strategic Plan Workgroup**

> The purpose of this workgroup is to provide advice and input from
> across the Indian Health Service in maintaining an updated IHS
> Strategic Plan. The task of the workgroup will be to provide specific
> recommendations on the core elements of each component of the plan.
> This includes submitting ides and issues which will represent
> community, Agency, administrative and scientific perspectives
> essential to making the strategic plan a functional document that will
> be used to guide the IHS in meeting its mission and goals. The
> workgroup will systematically review and improve the strategic plan
> with an emphasis on pertinent health data, resources, quality of care,
> and access to services.

## Area Highlights

Area representatives provided the following highlights for your
information:

### Aberdeen

**[Staffing Changes]{.underline}**:

> There have been several CEO changes since January 2005: **New
> Appointments**: [LaVerne Parker]{.underline} at Quentin N. Burdick
> Memorial Health Care Facility in March 2005; [Shelly
> Harris]{.underline}, RN, at the Rosebud Service Unit in May 2005;
> [Karol Parker]{.underline} at the Kyle Health Center, a satellite
> clinic under Pine Ridge in January 2006. **Retirements**: [Nancy
> Miller]{.underline}, CEO at Ft. Thompson in December 2005; [Tim
> Yellow]{.underline}, CEO at Ft. Yates, and [Patrick
> Giroux]{.underline}, CEO of Wanblee (satellite of PR).
>
> There are 5 vacant CEO positions as follows: Winnebago, Ft. Berthold,
> Ft. Yates, Ft.Thompson and Wanblee.

**[Accomplishments:]{.underline}**

-   Training for Clinical Directors in March 2005 (CD, 101)

-   Training for CEOs in May 2005 (CEO, 101)

-   Recruitment and Retention Conference with focus on Customer Service
    (5/05)

-   Area Awards Ceremony held December 2005 (Belcourt well represented)

-   Teambuilding taking place at all Service Units through Area Contract

-   Completed Area Community Public Health Assessment at all facilities
    to be incorporated into facility strategic plans (Area Contract)

-   Budget Formulation Meeting December 2005

-   Area Strategic Plan re-vitalized in September 2005 and workgroups
    identified with I/T/U membership.

-   Quentin N. Burdick Memorial Health Care Facility selected to pursue
    Magnet Status for Nursing, initial training held at ANMC

-   All hospitals participating in Nurse Preceptorship Program for new
    graduates

-   PIMS implemented at all Service Units in 2005

-   Audio Care auto refill program installed at 3 S.U.s (Belcourt, Rapid
    City, Eagle Butte)

-   CCRF Pharmacists assigned to Belcourt April 2005 to October 2005.

-   IT Strategic Initiative Meeting held in December 2005

-   Develop partnership with VA to train Clinical Application
    Coordinators

### Bemidji

### 

> The direct service CEOs of the Bemidji Area during 2005 were
>
> [Jenny Jenkins]{.underline}, Cass Lake Hospital; [Constance
> James,]{.underline} Red Lake Hospital; and [Jon McArthur]{.underline},
> White Earth Health Center. Bemidji Area CEOs participated in monthly
> meetings, in the Area FY 07 IHS budget formulation process, I/T/U
> meetings and the Direct Tribes Meeting in Albuquerque.
>
> **[Accomplishments:]{.underline}**
>
> \- Participated in Area strategic planning
>
> \- All service units had Continuity of Operations Plans (COOP) in
> place
>
> \- Developed a transitional plan for obtaining HR services from IHSHQ
>
> \- All sites reviewed through Bemidji Area facilities consultation
> process
>
> **Cass Lake Hospital:**
>
> a\. Completed strategic plan, leadership training for supervisors
>
> b\. CAH survey successful -- First full year as CAH with swing beds
>
> c\. EHR committee organized; planning to implement EHR last quarter of
> 2006
>
> **Red Lake Hospital:**
>
> a\. Implemented the Electronic Health Record and brought all clinics
> on board;
>
> b\. JCAHO accreditation November 2005
>
> c\. Partnership with the Minnesota Society of Child and Adolescent
> Psychiatry to provide teams of volunteers to support the community and
> the hospital on weekends
>
> d\. Collaborative efforts between the facility and community resources
> to address critical needs to provide emotional and psychological
> services to survivors of the March 21^st^ tragedy as well as longer
> term rehabilitative issues

**White Earth Health Center:**

a.  JCAHO accreditation May 2005

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a.  Established a Customer Service Initiative

b.  Implemented EHR Team, plan implementation in 2008

-   **Billings**

> The Billings Area consists of six federally-operated and two
> Tribally-operated Service Units. The CEOs are [James
> Kennedy]{.underline} (Browning Hospital with two satellite clinics);
> [Daryl Brockie]{.underline} (Ft. Belknap Critical Access Hospital with
> one satellite clinic); [Julie Bemer]{.underline} (Ft. Peck -- 2
> Ambulatory Care Clinics); [Debby Bends]{.underline} (Lamedeer,
> Ambulatory clinic with ER services); [Charlene Johnson]{.underline}
> (Crow Hospital with two satellite clinics); and [Catherine
> Keene]{.underline} (Wind River -- 2 Ambulatory Care Clinics).
>
> The Area Director has incorporated several initiatives, focusing on
> customer service and employee satisfaction as key elements in how we
> do business. The vision of the Billings Area is our commitment to the
> patient, employees, customer service, and tribal consultation. We
> completed our second employee survey and are developing action plans
> to improve the employees' work environment. The Billings Area also has
> incorporated a "We Care" daily survey of patients to assess how they
> were treated. We hold a regional monthly conference call and talk
> about our scores and share experiences on what we are each doing to
> improve. Service Units are also use a "Balanced Scorecard" to assist
> management in day-to-day decision making as well as improving the
> governing body process. We score ourselves on Access, Administration,
> Quality of Care, and Customer Service. If you call one of our
> facilities, you should be hearing our employees answering the phone
> with a smile on their face, with a kind "Good Morning/Afternoon,"
> advising which department/service area is answering, the name of the
> person answering, and a courteous "How may I help you."
>
> **Highlights from Ft. Belknap:**
>
> Enhanced their EMS Program by hiring a paramedic and getting
> ambulances licensed through the state of Montana.  They are also
> hiring another paramedic and two EMT-I\'s to further enhance their
> ambulance service, and are waiting for a license number to bill for
> drivers when transporting patients to other facilities.
>
>  
>
> CEO has also been working diligently with major contract facilities
> utilized in Montana on networking for improved services to Native
> American patients with a major focus on the need for orientation to
> their staff in better understanding of Native American culture.  One
> hospital in particular, Benefis of Great Falls, MT, now has an
> orientation package in place for [all]{.underline} staff and has seen
> a significant drop in complaints from Indian patients.  They have also
> been successfully working with the Special Projects Coordinator, a
> provider who assists with temporary lodging for critical patient\'s
> families.
>
>  
>
> Daryl, as a board member of the Northcentral Montana Healthcare
> Alliance, is able to bring Indian healthcare issues and facilities to
> the committee and share our needs and concerns.  This has been a great
> benefit and may result this fiscal year in a major piece of equipment
> that will enhance their emergency operations and emergency care for
> our patients. 
>
> **Lamedeer (Northern Cheyenne):**
>
> The Northern Cheyenne Service Unit has gone live with the Electronic
> Health Record.  This process went extremely well and they have been
> asked to be a \"Lessons Learned\" site for EHR training for this
> fiscal year.  The Dental program was interviewed and selected as a
> beta test site for the Electronic Dental Record for this upcoming
> fiscal year, probably in the summer.  Emergency preparedness training
> has been completed for all staff.  They are participating in the VA
> patient safety training with Pam Meyer, QA and Jennie Allies, PT,
> attending a series of three national training events this year.  They
> are also participating in an Asthma research project with their
> pediatrician, Dr. Thomas Scheiner, taking the lead.  The service unit
> has partnered with the tribe and several other entities in the \"War
> on Meth" Task Force.  They are developing policies and protocols for
> methamphetamine-related health issues and prevention and education
> activities.  The service unit has partnered with the VA in a
> telehealth project to bring Mental health services to the veterans
> living in the area. This has been on going for nearly a year and has
> shown to be helpful for our veteran population*.*
>
> **Wind River:**
>
> Wind River now has 2 years of experience with the Electronic Health
> Record and has implemented the consult function for Alcohol, Public
> Health Nursing and Community Health, Contract Health, Behavioral
> Health and Social Services. The consult function has allowed a
> near-paperless system for other departments, as well. Consults are
> being developed for dog bites and Child Protection Services. The
> Service Unit has also been utilizing the scanning function through
> Vista Imaging to scan text documents into the patient record. We have
> begun work on the reminder function as well. We have seen so many
> efficiencies throughout the clinic, resulting from EHR implementation,
> that we cannot envision ever reverting to a paper-based system. Wind
> River initiated an off-site Teen Clinic in one of the local high
> schools, having great response and has incorporated the Electronic
> Health Record at that site. We are also working with our two local
> Contract Inpatient Hospitals having access to our database, so that
> the health summary is available to our providers and Emergency
> Physicians when our patients present.
>
> Cathy Keene, CEO was selected for the SES Candidate Development
> Program offered through the Department. This program is highly
> competitive and she is 1 of 16 to be selected for the 2006 class. She
> is the Billings Area CEO representative to the NCCEO and past chair of
> the NCCEO. She represents the CEOs on the National Business Office
> Committee as well as one of the CEO representatives to the Agency
> Succession Plan Advisory Council.
>
> The Service Unit, with the two local Tribes, is looking at
> establishing a Tribally operated Community Health Center, for the
> underserved and underinsured in the reservation and local community;
> and, developing partnerships between other Federal agencies, state
> government, local and county government officials. The Tribes have
> received much support in this effort that could increase health
> resources to Indian patients.
>
> Efforts in third party resource generation and improved efficiencies
> have allowed the Service Unit to look at expansion of services for the
> next fiscal year. For the first time in a decade, Contract Health
> funds were available at the end of the year. Although the Service Unit
> is funded at 51% of need, we are projecting no deficit for direct care
> into the next fiscal year.
>
> **Crow Hospital:**
>
> The Crow Hospital is in the process of reorganization. They have also
> implemented the M-system supply management program, and are in the
> process of purchasing the Chargemaster program so they can bill for
> supplies.
>
> Charlene Johnson, new CEO for the Crow Service Unit.
>
> **Ft. Peck:**
>
> Currently, implementing the Electronic Health Record

### California

> Highlights in the California Area include:

-   September 2005, Dr. Sophie Two Hawks was appointed as the California
    Area Chief Medical Officer.

-   Beginning the implementation of electronic health records at
    selected Indian Health program sites

-   Development of the Youth Regional Treatment Center program by
    actively selecting sites for implementation of services

-   Working on the development of service agreements between the Indian
    Health Service, Department of Veterans Affairs and local tribal
    programs for the expansion of services to Native American veterans

-   Development of RPMS software packages that provide web-based
    training for programs

-   Increasing access to specialty health care services through the
    expansion of telehealth

-   Assisting tribal programs with disaster preparedness

-   The California Area IHS provided immediate disaster assistance to
    the Yurok, Hoopa, and Karuk Tribes in northwest California. Homes,
    roadways, and community water/waste systems were damaged as a result
    of rain and windstorms over the New Year's holiday.

-   During FY 05, the CA Area Sanitation Facilities Construction (SFC)
    program received \$5.4 million in IHS funds and \$7.45 million in
    outside contributions, to construct community and individual
    sanitation facilities throughout CA.

-   IHS collaborations with the U.S. Environmental Protection Agency,
    Department of Housing and Urban Development, Bureau of Indian
    Affairs and Rural Community Assistance Corporation are underway to
    develop a Baseline Needs Assessment (BNA) to ensure that all tribal
    homes have access to safe drinking water and basic sanitation.

-   The CA Area IHS and the U.S. Environmental Protection Agency (EPA)
    secured funding to improve community water supply and storage for
    1,200 Tule River tribal members. The total cost of water system
    improvements is estimated to be \$3,125,000.

-   During FY 05, the Health Facilities Engineering (HFE) program
    expended \$2.4 million on maintenance, expansion, and renovation of
    Indian health facilities throughout California.

### Oklahoma City

> The direct service CEOs of the Oklahoma Area during 2005 were James
> Cussen (Claremore); Terri Schmidt (Clinton); Randy Barnoskie
> (Haskell); Arlene Long (White Cloud); Hickory Starr (Lawton); Rick
> Mize (Pawnee); Ed McLemore (Tahlequah); and Farrell Smith (Wewoka).
> CAPT Frank Williams was selected as the Director of Field Operations.
> Ed McLemore served as the chairperson of the NCCEO and Jim Cussen as
> the secretary of the NCCEO.
>
> The Oklahoma Area CEOs participated in workgroups to streamline
> operations in the areas of Human Resources, Acquisitions, Information
> Technology, Finance, and Property. All service units had their
> Continuity of Operations Plans (COOP) in place by March 30. Each
> facility was surveyed by the Federal Protective Services. The CEOs
> participated in the development of a succession planning for the
> Oklahoma City Area and are being encouraged to participate in the
> American College of Healthcare Executives.
>
> The Claremore Indian Hospital began implementation of the RPMS
> Electronic Health Record and became the first Tobacco Free facility
> within the Area; the Clinton Indian Hospital renewed its JCAHO
> accreditation; the Haskell Health Center digitized dental x-rays and
> is piloting an Indian culturally-sensitive tobacco cessation program;
> the White Cloud Health facility; the Lawton Indian Hospital focused on
> improving its business office operations and is a beta site for the
> Area dashboard concept; the Pawnee Health Center developed a service
> unit strategic plan, received JCAHO accreditation, increased
> collections; the Hasting Indian Medical Center was a beta site for the
> EHR and as a result provides technical EHR expertise throughout the
> Oklahoma Area; and the Wewoka Health Center digitized dental x-rays
> and is a beta site for the Electronic Dental Record (EDR).
>
> The Oklahoma Area CEOs participated in the Oklahoma Area FY 07 IHS
> budget formulation process, the Direct Tribes Meeting in Albuquerque,
> and quarterly Area Joint Conference meetings.

-   **Portland**

> The Portland Area consists of seven federally-operated sites: Fort
> Hall, Idaho (Shirley Alvarez, CEO), Western Oregon (Tom Birdinground,
> CEO), Warm Springs, OR (Carol Devaney, CEO), Colville, WA (Yvonne
> Misiaszek, CEO), Yakama, WA (Donn Kruse, Acting CEO), Wellpinit, WA
> (Kay Moyer, CEO) and Neah Bay, WA (Leslie Dye, CEO). All sites are
> ambulatory care facilities. Roselyn Tso, Director, Office
> Tribal/Service Unit Operations supervise the CEOs. Doni Wilder, Area
> Director.
>
> Portland Area NCCEO representative, Leslie Dye, was elected
> Chair-Elect at last year's Combined Council Meeting and moves to Chair
> at the 2006 meeting.
>
> The common themes for Portland Area Service Units include:

-   Preparation for AAAHC accreditation in CY 06; identification of
    indicators for the 2006 implementation of the Billings Area
    "scorecard" methodology of Governing Body Reviews.

-   Preparation for the implementation of Electronic Health Record (Warm
    Springs was among the first to implement EHR; remains a site for EHR
    training and will implement Electronic Dental Record in 2006).
    Chemawa Health Center implemented EHR in June 2005.

-   Employee and customer satisfaction surveys and collection methods
    have been standardized Area-wide, including Area Office.

-   All Service Units prepared Continuity of Operations Plan and
    conducted a tabletop exercise.

-   The Portland Area Office (with CEO input) is developing a
    "scorecard" for self-assessment.

-   Western Oregon (at Chemawa Indian School), Colville and Fort Hall
    expanded clinic hours to enhance access to care.

-   Most Portland Area Service Units have telemed capability and are
    moving toward digitizing x-rays to decrease radiology contract costs
    and improve patient care.

> The number one challenge for Portland Area Service Units in 2005: the
> lack of funding for Contract Health Services. With no IHS hospitals
> within the three states Area, funding inpatient services is
> particularly taxing.

### Tucson

> Sells Service Unit successfully passed the JCAHO accreditation in
> October 2005.
>
> The Tele-Health Program of monitoring Congestive Heart Failure in the
> home setting was established in CY 05 and SSU currently has 2 patients
> in the Program.
>
> On-site ultrasonography services at SSU has been determined to be a
> vital service and will result in a cost savings to CHS and SSU.
>
> Cardiovascular Disease Risk Reduction Demonstration Project Grant
> awarded to Tohono O'odham Nation Health Dept. in consortium with
> Indian Health Service. This project increases the quality of care by
> utilizing an intensive case management approach to the care, treatment
> and education of patients with diabetes who are at risk of developing
> cardiovascular disease.
>
> The IHS Electronic Health Record implementation is planned for the
> Santa Rosa Health Center and at the Westside (San Simon) Health Center
> upon opening. A full-time Clinical Applications Coordinator has been
> hired and is leading the team.
>
> Dr. Lois Steele implemented a training program in partnership with the
> Tohono O'odham Community College. A three credit hour medical
> terminology class was taught by Dr. Steele and was tele-videoed
> between Sells Hospital and San Xavier Health Center. Twenty one (21)
> students (both IHS and community members) out of twenty four (24)
> completed the class in December 2005.
>
> San Xavier Facility Manager, Jennifer Procter, received the IHS
> Sanitation Facilities Project Engineer of the Year Award.
>
> The Service Unit Director, Patti Whitethorne was selected to
> participate as a "Leadership Fellow" in the Arizona Hospital and
> Healthcare Association's (AzHHA's) 2006 Leadership Development
> Program***: Building the Leadership Bench for Arizona Health Care.***
> This is a ten-month program for 2006.
>
> The Sells Replacement Steering Committee is preparing for the
> submission of a PJD/POR/PJDQ for the Sells Replacement Facility. The
> Tohono O'odham Nation approved the concept of an Alternative Rural
> Hospital to be constructed to replace the existing hospital.
>
> The Westside (San Simon) Health Center is near completion. Anticipated
> completion is in late spring of 2006. Completion of housing
> anticipated in fall of 2006.
>
> The Santa Rosa Health Center reports that in 2005, the University of
> Arizona Vision screening program began providing services at SRHC
> monthly, target population is children 6-24 months of age. Focus is
> prevention and early detection of vision problems.
>
> The new San Xavier Dental Clinic will open for business at the end of
> January 2006. The SX Dental clinic will move from a 4-chair facility
> to a 13-chair state of the art facility.

### Other Areas

> Reports may be available directly from the representatives from Areas
> not shown above.

###### Appendix A

> Department of Health and Human Services
>
> Indian Health Service
>
> National Council of Chief Executive Officers
>
> [Position Statement on Medicare Part D Premiums: Payment by
> IHS]{.underline}
>
> During the Combined Councils Meeting in San Diego, CA, in March 2005,
> the Director of the Indian Health Service requested that the National
> Council of Chief Executive Officers (NCCEO) consider the advisability
> of the Indian Health Service seeking legislative authority for the
> payment of Medicare Part D premiums for selected patients. The NCCEO
> submits the following comments on the Agency's participation in this
> important national program. With the qualifications described below,
> the NCCEO endorses Indian Health Service participation in the program.
>
> **[General Discussion]{.underline}**
>
> The Indian Health Service has estimated that approximately 100,000
> American Indian and Alaska Native active users are Medicare eligible
> and could potentially qualify for the Medicare Prescription Drug
> Benefit. Approximately 35,000 IHS beneficiaries are currently not
> covered by any prescription drug coverage and will be eligible for
> Medicare drug coverage under Part D. These beneficiaries are not
> eligible for Part D coverage unless they, or someone on their behalf,
> pay an average premium of \$37/month or \$444/year.
>
> The Indian Health Service is presently considering the advisability of
> the IHS paying the premiums on behalf of the Part D enrollees who do
> not presently have other resource coverage for medications. Unless the
> IHS is able to pay the Part D premiums on behalf of its beneficiaries,
> many of them more than likely will not enroll in the program. The IHS
> has been advised that it will need to have specific statutory
> authority in order to be able to pay Part D premiums on behalf of its
> beneficiaries. Legislation has been introduced in the Senate to
> provide that authority.
>
> 2006 STANDARD BENEFIT
>
> \$37 Average Monthly
>
> Premium Then COVER RANGES

+-----------------+------------+-----------+--------------+----------+
| # **B           | > FROM:    | > TO:     | > \% COVERED | ###      |
| ENEFIT STAGES** |            |           | > BY BENEFIT |  TROOP\* |
+-----------------+------------+-----------+--------------+----------+
| > ANNUAL        | > \$0      | > \$250   | > 0%         | >        |
| > DEDUCTIBLE    |            |           |              |  (\$250) |
+-----------------+------------+-----------+--------------+----------+
| ## I            | > \$250.01 | > \$2,250 | > 75%        | >        |
| NITIAL COVERAGE |            |           |              |  (\$500) |
+-----------------+------------+-----------+--------------+----------+
| ## COVERAGE GAP | >          | > \$5,100 | > 0%         | > (      |
|                 | \$2,250.01 |           |              | \$2,850) |
+-----------------+------------+-----------+--------------+----------+
| > CATASTROPHIC  | >          | > NO      | > 95%        | > (      |
| > COVERAGE      | \$5,100.01 | >         |              | \$3,600) |
|                 |            | > MAXIMUM |              |          |
+-----------------+------------+-----------+--------------+----------+

> \*Troop is true-out-of-pocket expense (not reimbursable to IHS)
>
> The payment of premiums for Part D patients can provide tremendous
> relief for seniors who otherwise would not be able to participate in
> the new Part D benefit, but, in practice, initial projections of the
> cost savings for the IHS and increased access to resources by
> patients, may not be realized, mainly for the following reasons:

1.  [Recoupments]{.underline}: The maximum yearly amount that a facility
    can recoup is approximately \$1000 per patient, after the
    deductible, payments for the monthly premiums, and
    true-out-of-pocket expenses are factored in.

2.  [Selection for Coverage:]{.underline} The issue of the premiums
    being paid Agency-wide, Area-wide, facility-wide or on behalf of
    selected individual patients, must also be resolved. The
    identification of individual patients for whom premiums should be
    paid would require an extraordinarily labor-intensive effort, and
    may have legal complications and local considerations. The legal
    complications may involve the equitability of the selection process
    for individuals for whom the premiums would be paid. Local
    considerations may include which subset of Medicare Part D-eligible
    patients would have their premiums paid by the IHS and whether or
    not the selection criteria would be equitably applied. If the
    decision is made to pay the monthly premiums, the decision should
    apply throughout the Agency. Service units must be required to
    participate in an Agency-wide program based upon a standardized set
    of criteria. Without such standardization, service units more than
    likely would either opt out of the program or participate in a
    non-standardized manner resulting in further confusion over what
    services and benefits are available through the program.

3.  [Plan Selection:]{.underline} Patients for whom the IHS pays monthly
    premiums may not enroll in the most beneficial plan for the patient
    or for the IHS. Extraordinary effort would be required to educate
    patients on the plan(s) that would be most beneficial for them,
    considering possible changes in the plans and changes in the
    medication regimen prescribed by the patient's IHS provider or a
    non-IHS provider, unknown to the IHS.

4.  [Vendor Selection:]{.underline} Patients could potentially access
    their Part D benefits through a non-IHS pharmacy even though IHS
    provided the funding for the premium. This would result in outlays
    of already limited resources, with no tangible return on the
    investment.

5.  [Plan Changeability:]{.underline} Formularies and plans are subject
    to change or adjustment during the year, and those changes would
    require a recalculation of the initial projected reimbursement rates
    and amounts for particular patients.

#### [Recommendations]{.underline}

> I. The NCCEO has considered whether or not it would be advisable for
> the Agency to support legislation authorizing the payment of premiums
> for Medicare Part D for eligible patients. The NCCEO recommends that
> payment of Part D premiums for IHS patients be required only if
> supplemental recurring funds are appropriated for this purpose and a
> workable system is developed to ensure that the supplemental funding
> is distributed throughout the IHS network of programs to the
> components where the premiums are actually paid.
>
> II\. The NCCEO further recommends that Indian Health Service resources
> be concentrated in the areas of assisting patients with signing up for
> extra-help, which would allow a portion of their monthly premiums to
> be paid from other sources; determining which
>
> plans would provide the best benefits for patients and the Agency;
> and, advising patients to sign up for the plans providing the best
> range of benefits for the patients.
>
> III\. Finally, the NCCEO recommends that the Agency decision be made
> applicable Agency-wide, and not subject to Area, service unit, or
> individual patient discretion as to whether or not the IHS will pay
> Part D premiums. Agency-wide applicability of the decision is the only
> way to ensure equitability among all eligible patients.

##### Conclusion

> The National Council of Chief Executive Officers appreciates the
> opportunity comment on the Agency's approach to implementing this
> important national program, and pledges to support, and to work toward
> full implementation of, the Agency's decisions on whether or not to
> pay the premiums and on the scope of applicability of the requirement
> for the payment of Part D premiums.
>
> Respectfully submitted on behalf of the National Council of Chief
> Executive Officers:
>
> [/s/ Edwin L. McLemore October 12, 2005]{.underline}
>
> Edwin McLemore, J.D. Date
>
> Chairperson

####### Appendix B

> ![](media/image3.png){width="6.249305555555556in"
> height="8.065972222222221in"}
>
> ![](media/image4.png){width="6.249305555555556in"
> height="8.065972222222221in"}
>
> ![](media/image5.png){width="6.249305555555556in"
> height="8.065972222222221in"}
>
> ![](media/image6.png){width="6.249305555555556in"
> height="8.065972222222221in"}