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     Indian Health Manual

Circular 17-11


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

Refer to: OCPS

INDIAN HEALTH SERVICE CIRCULAR NO. 17-11

Effective Date:  08/25/17

WAIT TIME STANDARDS FOR PRIMARY AND URGENT CARE VISITS
IN THE INDIAN HEALTH SERVICE DIRECT CARE FACILITIES
  1. PURPOSE.  This circular establishes the Indian Health Service (IHS) appointment wait time standards for primary (routine and preventive) and urgent care visits in IHS direct care facilities.

    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 AHRQ, HRSA, 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.  Wait times are affected by multiple complicated and interrelated factors, so nothing in this standard should supersede sound clinical judgment and management of critical resources to provide high quality patient care.

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

  2. 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 purposes 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. Preventive 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 meant to catch diseases early, and others are meant to prevent diseases entirely.
    5. Urgent Care.  Urgent Care is the provision of immediate medical service offering outpatient care for the treatment of acute and chronic illness and injury.  Urgent Care generally addresses symptoms which do not threaten life, limb or eyesight, but need attention to prevent the development of a serious risk to health.  Urgent care may also be called a "sick visit."
  3. APPOINTMENT WAIT TIME MEASURES.  The following core measures will be collected in all primary and urgent care settings in IHS direct care facilities.
    1. Mean Appointment Time for Primary Care.  This is the average time (in days) measured from the day of engagement with the scheduler (scheduling of appointment) to the day for which the primary care appointment is scheduled (appointment date).
    2. Mean Appointment Wait Time for Urgent Care.  This is the average time (in hours) measured as the number of hours from engagement with the scheduler (scheduling of appointment) to the urgent or sick visit appointment.  It excludes Emergency Department (ED) visits, but may include same-day appointments within or outside of primary care (such as an urgent care setting).
  4. STANDARDS.
    1. Mean Appointment Wait Time for Primary Care of 28 days or less.
    2. Mean Appointment Wait Time for Urgent Care of 48 hours or less.
  5. 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:  August 25, 2017
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