mmpc - National Indian Health Board

Findings
Unadjusted mean payments for outpatient services to IHS and Tribal Program providers (Figure 10) for IHS
AIAN were about 60% of the total paid to all providers (Figure 9, see Table 9). For Group 1 the proportion was
58% ($1,800 out of at least $3100 per recipient), while for Group 2 the proportion was 62% ($1,530 out of at
least $2,487 per recipient). The types of outpatient services included in IHS Program services provided by IHS
and Tribal providers is more comprehensive than those included for all providers in ways that cannot be
equalized with MAX claims data. In the Billings Area outpatient service payments for IHS Program outpatient
services are so large that payments to IHS Program providers for IHS outpatient services actually exceed
payments to all providers for Outpatient Visit, Laboratory, Imaging, and Dental services (Table 9).
Figure 10. Unadjusted Mean Payment per Recipient for outpatient services including visits, laboratory and
imaging, and dental services. Compare with Figure 10 unadjusted Mean Payment per Recipient for IHS or Tribal
outpatient services.
Aberdeen
Alaska
Albuquerque
Bemidji
Billings
California
Nashville
Navajo
Oklahoma
Phoenix
Portland
Tucson
Outpatient Payments
to all Providers
$- $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000
The types of outpatient services provided by IHS Program Providers are more comprehensive than those
included here for all providers in ways that cannot be equalized with MAX data. In the Billings Area (Montana &
Wyoming states) these other outpatient services are so much broader that payments to IHS Program Providers
for IHS Program outpatient services actually exceed payments to All Providers for Outpatient Visit, Laboratory,
Imaging, and Dental services for the same recipients.
26
1.IHS Program claims
& Active User
2.IHS Program claims
but Not Active User
3.IHS Active User with
no IHS Program claims
Other AIAN
Whites