2. ABERDEEN AREA INDIAN HEALTH SERVICE May 13, 2013 1

3. Aberdeen Area Indian Health Service The Aberdeen Area Office in Aberdeen, South Dakota, works in conjunction with its 17 Indian Health Service Units and Tribally Managed Service Units to provide health care to approximately 124,443 Native Americans who are members of 16 Federally Recognized Tribes located in North Dakota, South Dakota, Nebraska, and Iowa. 2

4. Aberdeen Area 3

5. Map of North Dakota 4

6. Map of South Dakota 5

7. Map of Nebraska 6

8. Map of Iowa 7

9. Aberdeen Area I.H.S. The Aberdeen Area Service Units include 7 Hospitals, 8 Health Centers and 6 Tribally Operated Service Sites. 8

10. Aberdeen Area I.H.S. Hospitals South Dakota Hospitals  Pine Ridge  Rosebud  Rapid City  Eagle Butte 9

11. Aberdeen Area I.H.S. Hospitals North Dakota Hospitals  Belcourt  Fort Yates Nebraska Hospital  Winnebago 10

12. Aberdeen Area Health Centers South Dakota  Wagner  Sisseton  Fort Thompson  Lower Brule  McLaughlin  Kyle  Wamblee North Dakota  Ft. Totten 11

13. Aberdeen Area Tribal Sites South Dakota  Flandreau Nebraska  Northern Ponca  Omaha  Santee 12

14. Tribal Sites cont… North Dakota  Three Affiliated-Ft. Berthold Iowa  Sac and Fox 13

15. Each facility incorporates a comprehensive health care delivery system. The following is a breakdown of what services are provided at each service unit. 14

16. Hospital services provided The larger facilities, Pine Ridge and Rosebud in South Dakota and Belcourt in North Dakota offer the following services: Belcourt General surgery, Obstetrics, Outpatient Dept., specialty clinics with contracted Specialists, Dental, Mental Health, Physical Therapy, lab, x-ray, Pharmacy, optometry, Public Health Nursing 15

17. Hospital services continued… Rosebud General surgery, Obstetrics, Outpatient Dept., Inpatient Dept., specialty clinics with contracted Specialists, Dental, Mental Health, Optometry, Physical Therapy, lab, x-ray, Pharmacy, Public Health Nursing 16

18. Hospital services continued… Pine Ridge General surgery, Obstetrics, Outpatient Dept., Inpatient Dept., specialty clinics with contracted Specialists, Dental, Mental Health, Optometry, Physical Therapy, lab, x-ray, Pharmacy, Public Health Nursing 17

19. Hospital services continued… Rapid City  Inpatient  Outpatient  Emergency Room …plus other services such as Dental, Optometry, Mental Health, Physical Therapy, and a range of ancillary and support services, Public Health Nursing *They do not provide OR or Obstetric Services 18

20. Hospital services continued… Ft. Yates, ND  Inpatient  Outpatient  Emergency Room …plus other services such as Dental, Optometry, Mental Health, Physical Therapy, and a range of ancillary and support services, Public Health Nursing *They do not provide OR or Obstetric services 19

21. Hospital services continued… Eagle Butte  Inpatient  Outpatient  Emergency Room …plus other services such as Dental, Optometry, Mental Health, Physical Therapy, and a range of ancillary and support services, Public Health Nursing *They do not provide OR or Obstetric services 20

22. Hospitals Services cont…. Winnebago  Inpatient  Outpatient  Emergency Room …plus other services such as Dental, Optometry, Mental Health, Physical Therapy, and a range of ancillary and support services *They do not provide OR or Obstetric services 21

23. Service provided by I.H.S. Health Care sites Outpatient services, pharmacy, lab, X- Ray, Behavioral Health, Public Health nursing, Dental, Environmental Health, Optometry, Dietary, Lab, ENT, Pharmacy, Dental, and Inpatient and contract health specialty referrals to outside facilities. 22

24. 23 Portland109,870 Billings72,585 Aberdeen 124,433 $365 Million Budget Phoenix166,398 California85,881 Albuquerque85,990 Oklahoma339,617 Navajo247,203 Bemidji104,914 Alaska143,131 Tucson27,000 53,495 IHS Headquarters Rockville, MD TOTAL IHS USER POPULATION FOR FY 2012: FOR FY 2012: 1,560,517 South Dakota State Budget $4.3 Billion $4. 1 Billion Budget INDIAN HEALTH SERVICE USER POPULATION BY AREA

25. Eligibility  Must be an enrolled member of a Federally Recognized Tribe/Descendent of an enrolled member  Not all enrolled members utilize IHS  Not all Native Americans are eligible for services 24

26. Aberdeen Area User Population by Service Unit Hospitals  Belcourt-13,573  Winnebago-5,146  Pine Ridge-22,203  Rosebud-12,405  Eagle Butte-8,231  Rapid City-14,265  Ft. Yates-8,823 25

27. User Population cont… Health Centers  Ft. Thompson-3,815  Ft. Berthhold-5,228  Lower Brule-2,087  Sisseton-Wahpeton-6,684  Spirit Lake-5,430  Yankton-3,824 26

28. User Population cont… Tribal Sites  Flandreau-1,506  Northern Ponca-3,134  Omaha-3,539  Sac and Fox-1,577  Santee-1,101  Trenton-1,863 27

29. Providers There are currently 84 Medical providers employed by Aberdeen Area I.H.S. in the following areas. 55 employed in SD IHS sites.  Family Practice  Nurse Practitioner  Physician Assistant  Emergency Room  OR/Surgeons  Obstetrician  Hospitalist 28

30. Providers by Site Hospitals  Belcourt-16  Winnebago-7  Pine Ridge-12  Rosebud-7  Eagle Butte-5  Rapid City-11  Ft. Yates-2 29

31. Providers by Site Health Centers  Ft. Thompson-4  Wanblee-2 McLaughlin-0  Lower Brule-0  Sisseton-Wahpeton-7  Spirit Lake/Ft. Totten-2  Wagner-5  Kyle-2 30

32. Provider Vacancies Overall Aberdeen Area currently has 44 vacant Medical Officer positions. 36 of the vacancies are in SD These vacant positions are filled with contract providers 31

33. Provider Vacancies by Service Unit  Rosebud-6 Lower Brule-3  Pine Ridge-10 Wanblee-0  Rapid City-5 Kyle-0  Eagle Butte-4 Sisseton-3  Ft. Yates-5 Winnebago-1  Belcourt-2 Wagner-0  Ft. Thompson-1 McLaughlin-1  Ft. Totten-1Belcourt-2 32

34. Access to Care Issues  Provider Shortage  Nursing Shortage  IHS funding at 43% of existing need  Transportation  Continuity  Lack of Speciality Services/CHS funding Care has to be provided regardless of 3 rd party resources 33

35. Recruitment Challenges  Rural location of facilities  Schools  Housing  Activities  Distances to nearest shopping mall, grocery shopping, etc.  Salary incentives  Not having the services to keep up skills  Employment 34

36. Recruitment Efforts  Working with a recruitment agency  Offering tribal benefits, such as free hunting and fishing license  Housing when available  Introduction to a local family that can assist with them with orientation to the community.  Benefits-recruitment, retention bonus  Involvement in community activities 35

37. Questions? 36