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U.S. Department of Health and Human Services
Indian Health Manual

Wait Time Standards for Primary Care Visits In the Indian Health Service Direct Care Facilities

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
Rockville, Maryland 20857

Refer to:OQ

INDIAN HEALTH SERVICE CIRCULAR NO. 19-03

WAIT TIME STANDARDS FOR PRIMARY CARE VISITS IN THE INDIAN HEALTH SERVICE DIRECT CARE FACILITIES

Sec.

  1. Purpose
  2. Background
  3. Definitions
  4. Appointed Wait Time Measures
  5. Standard
  6. Reporting
  7. Supersedure
  8. Effective Date
  1. PURPOSE. This circular establishes the Indian Health Service (IHS) appointment wait time standards for primary care visits in IHS direct care facilities.
  2. BACKGROUND. Access to comprehensive, quality health care services is important for promoting and maintaining health, preventing and managing disease, reducing unnecessary disability, preventing premature death, and achieving health equity. Healthy People 2020 defines health goals and objectives for the nation. The initiative includes "Access to Health Services" as a Topic Area and one of the objectives is to "Reduce the proportion of persons who are unable to obtain or delayed in obtaining necessary medical care." Although national benchmarks do not exist, the access to care literature describes standards established by major providers such as the Military Health System and numerous private insurers. Additionally, IHS completed a comprehensive review of the literature, which included a review of publications originating from or supported by Agency for Healthcare Research and Quality, Health Resources and Services Administration, Tribal programs, and other non-federal sources.

    Timely access to health services aims to achieve optimum health outcomes and also determines patient experience of care. Longer wait times negatively affect the patient experience of care, perceptions of information, instructions, and the overall treatment provided by physicians and other caregivers. Multiple complicated and interrelated factors may affect patient wait times. Therefore, the standard set forth in this circular must not supersede sound clinical judgment and management of critical resources to provide high quality patient care.

    Standards are operational goals of the IHS and can change for reasons beyond the IHS's control such as, but not limited to, facility resources, patient medical needs, and emergency response, and without notice to the patient. Therefore, when possible, patients must be informed that IHS patient wait times are not guaranteed.

  3. DEFINITIONS.
    1. Appointment Wait Time. This is the time (in hours or days) patients must wait before they can see a health care provider for an appointment.
    2. Primary Care.Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for developing a partnership with patients to address the large majority of personal health care needs in the context of family and community. For the purpose of this circular, primary care includes routine and preventive care defined below.
    3. Routine Care. Routine primary care includes office visits for the treatment of symptoms, chronic or acute illnesses and diseases, and follow-up care for an ongoing medical condition.
    4. Preventative Care. Preventive care includes services such as screening tests, counseling services, and immunizations to find or prevent specific medical conditions in patients who have no signs or symptoms of those conditions. Some preventive services are provided to catch diseases early, and others are provided to prevent diseases entirely.
  4. APPOINTMENT WAIT TIME MEASURE. The Mean Appointment Wait Time for Primary Care measure will be collected in all primary care settings in IHS direct care facilities. It is the average time (in days) measured from the day of engagement with the scheduler (scheduling of appointment) to the day on which the primary care appointment is scheduled (appointment date).
  5. STANDARD.The standard for Mean Appointment Wait Time for Primary Care standard is no more than 28 days.
  6. REPORTING.

    All IHS hospitals with an ED will report the ED Core Measure Set at least quarterly to governance.

  7. SUPERSEDURE. This circular supersedes IHS Circular No. 17-11, "Wait Time Standards for Primary and Urgent Care Visits in the Indian Health Service Direct Care Facilities," dated August 25, 2017, in its entirety.
  8. EFFECTIVE DATE.

    This IHS Circular is effective upon the date of signature.


/Michael D. Weahkee/
RADM Michael D. Weahkee, MBA, MHSA
Assistant Surgeon General, U.S. Public Health Service
Acting Director
Indian Health Service
Distribution:  IHS-wide
Date:  06/12/2019