http://www.cherokeephoenix.orgDr. Loni Pearish, Vinita Health Center’s acting medical director, and Dr. Johnson Gourd, a physician at Three Rivers Health Center, speak during a May 15 special Health Committee meeting in Tahlequah, Oklahoma. They represented the Cherokee Nation’s Health
System Provider Compensation Committee that submitted a letter this year regarding higher compensation for health providers to help alleviate provider turnover and aid in recruitment. COURTESY
Dr. Loni Pearish, Vinita Health Center’s acting medical director, and Dr. Johnson Gourd, a physician at Three Rivers Health Center, speak during a May 15 special Health Committee meeting in Tahlequah, Oklahoma. They represented the Cherokee Nation’s Health System Provider Compensation Committee that submitted a letter this year regarding higher compensation for health providers to help alleviate provider turnover and aid in recruitment. COURTESY

Cherokee Nation health providers want base pay raises

BY BRITTNEY BENNETT
Reporter – @cp_bbennett
07/31/2017 04:00 PM
TAHLEQUAH, Okla. – A letter from the Cherokee Nation’s Health System Provider Compensation Committee is asking tribal Health Services officials to increase base salaries and incentives to “recruit and retain top quality (health care) providers” to care for patients.

According to the letter, Health Services has increased base salaries once in the past eight years, leading to recruitment difficulties, a loss in providers and increased wait times for patients.

The letter states CN providers are paid $48,000 less annually than the $218,000 base salary outlined in a 2016 physician compensation report. It also asks that base salaries be “adjusted equal to or above market averages” to alleviate turnover.

It states the lack of salary increases have caused providers to resign “after accepting jobs elsewhere for better compensation,” leaving remaining providers to “experience the undue burden of taking on the additional workload for those many empty positions.”

Charles Grim, Health Services deputy executive director, said the organization currently employs 250 providers, of which 160 are physicians and mid-level providers, at all of CN’s health facilities.

He said there were 11 physician vacancies in the past year and that the organization has an average vacancy rate of 10 percent.

In response to the letter, the Tribal Council on May 15 held a meeting in which Health Services Executive Director Connie Davis and Executive Medical Director James Stallcup proposed to instead pay providers annual bonuses based on relative value units or RVUs.

According to a physician search and consulting firm, RVUs calculate the volume of work or effort done by a physician when treating patients. The more complex the visit, the more RVUs a physician earns.

When translating RVUs to revenue, Stallcup said the hospital collects $120 from third-party billing for every RVU delivered by a provider. Once the provider is paid a share of roughly $65, the facility is left with approximately $55.

“The providers actually lose us money because the salary and fringe is higher than the collections per RVU,” Stallcup said regarding raising base pay only. “We don’t have any incentive that provides more service for going above and beyond.”

He said the RVU proposal could increase positive revenue per RVU by 12.5 percent while not eliminating the possibility of base salary increases, which could happen in the first quarter after the RVU system was operational.

“I think that in the first quarter after implementing this we are going to see a revenue jump that is sufficient to provide all of the base salary increase that we need,” he said. “Right now, without some sort of cuts that results in more available funds, I don’t know how we could pursue it. But I would be willing to reconsider it the moment the needle moves on the revenue.”

Davis said RVUs were “a great place to start” to pay providers and increase health care access for patients.

“We can’t take a big jump and devastate our health system revenue and our finances in doing so,” she said. “We’ve got to take steps and be very cautious on how we do it but keep our good docs and let them know we appreciate what they do at the same time.”

However, some Health System Provider Compensation Committee members who attended the May 15 meeting voiced concerns about moving to RVU- based compensation before raising base pay because of “inefficiencies” in the electronic health records system.

Dr. Johnson Gourd, a physician at Three Rivers Health Center in Muskogee, said the EHR system has decreased the amount of patients he sees.

“It’s difficult to navigate a clinic so large by virtue of the system that I don’t have control day-to-day over staff or other things that would allow it to be efficient,” Gourd said. “Ten years ago I was seeing 30 (patients) give or take a day in regular practice. It just doesn’t happen that efficiently here now, so there’s other issues that we have concerning seeing patients. It’s the efficiency and part of that has to do with turnover.”

He also said the EHR system does not allow him “control of all variables” to complete his job efficiently. “If my nursing is under an entirely different structure, if there’s a nursing shortage, then they pull one of my nurses. It’s not part of my decision-making process for the day, it’s just I show up, I don’t have a nurse. She’s been pulled to cover on another clinic, so I’m down a person.”

He also raised concerns about new providers entering under RVU-based compensation and suggested using RVUs as “an incentive program” for more- seasoned providers.

“You don’t just jump right out into it because if you are brand new out of school you may only see eight or 10 (patients),” he said. “You’re given a guaranteed salary as you transition to RVUs, as you work up to enough patients to pay your overhead, to pay your staff. I don’t want to assume, but there would have to be a period of time where that was transitioned in and looked for without penalizing the providers.”

At the June 19 Health Committee meeting, Tribal Councilor Dick Lay proposed a resolution to “find a good management process” and address concerns outlined in the compensation committee’s letter.

Councilors tabled the resolution, with Health Services administrators saying they are working on a plan that would be presented for the 2018 budget cycle.
About the Author
Brittney Bennett is from Colcord, Oklahoma, and a citizen of the United Keetoowah Band.  She is a 2011 Gates Millennium Scholarship recipient and graduated from the University of Oklahoma in 2015 with a bachelor’s degree in journalism and summa cum laude honors.
 
While in college, Brittney became involved with the Native American Journalists Association and was an inaugural NAJA student fellow in 2014. Continued mentorship from NAJA members and the willingness to give Natives a voice led her to accept a multimedia internship with the Cherokee Phoenix after college.  
 
She left the Cherokee Phoenix in early 2016 before being selected as a Knight-CUNYJ Fellow in New York City later that same year. During the fellowship, she received training from industry professionals with The New York Times and instructors at the City University of New York. As part of the program, she completed a social media internship with USA Today’s editorial department.
 
Now that Brittney has made her way back to the Cherokee Phoenix, she hopes to use the experience gained from her travels to benefit Indian Country and the Cherokee people.
brittney-bennett@cherokee.org • 918-453-5560
Brittney Bennett is from Colcord, Oklahoma, and a citizen of the United Keetoowah Band. She is a 2011 Gates Millennium Scholarship recipient and graduated from the University of Oklahoma in 2015 with a bachelor’s degree in journalism and summa cum laude honors. While in college, Brittney became involved with the Native American Journalists Association and was an inaugural NAJA student fellow in 2014. Continued mentorship from NAJA members and the willingness to give Natives a voice led her to accept a multimedia internship with the Cherokee Phoenix after college. She left the Cherokee Phoenix in early 2016 before being selected as a Knight-CUNYJ Fellow in New York City later that same year. During the fellowship, she received training from industry professionals with The New York Times and instructors at the City University of New York. As part of the program, she completed a social media internship with USA Today’s editorial department. Now that Brittney has made her way back to the Cherokee Phoenix, she hopes to use the experience gained from her travels to benefit Indian Country and the Cherokee people.

Health

BY BRITTNEY BENNETT
Reporter – @cp_bbennett
05/25/2018 08:30 AM
SALINA – Proper diets reflecting the onset of puberty and growth for children ages 9-12 and teenagers should be a critical focus for parents, said Cherokee Nation Clinical Dietitian Tonya Swim. “Encouraging healthy choices to help provide adequate energy for growth and development should be the focus,” Swim said. “There is a change that not getting adequate nutrients can result in deficiencies, which could lead to loss of height, osteoporosis and delayed sexual maturation.” Swim recommends establishing healthy habits early for children, including breakfast. “Having a healthy breakfast enhances brain function related to memory, testing and school attendance. Having a high-fiber breakfast with protein, fruit and a low-fat dairy is a great way to start the day off. An example of this could be a whole-grain English muffin with an egg patty prepared using a cooking spray and sliced avocado – the perfect quick breakfast sandwich.” As children mature into teenagers, Swim said they need diets that provide proper nutrients and fuel. “Many teens will double their weight and can add up to 20 percent in height, and they need to make sure and get enough nutrients like calcium to support healthy bone growth. Teens will continue to have growth spurts, and it’s important for them to remember that their body needs food to help fuel healthy growth, especially if they are an athlete. But food for fuel is also important for those active with music or art. Their brains are working to hardwire their ability to process the skills needed for all activities.” Parent should keep taste and appearance in mind when preparing meals, Swim said, as they seem to be important factors to teens. “Health and energy needs don’t matter so much to (teens), so as parents we need to provide those healthy choices in a way that is pleasing to eat and look at.” Staying hydrated is also important as children and teenagers begin participating in sports and other activities. Swim recommends drinking two, 8-ounce glasses of water two hours before an event, as well as sports drinks during and after an event as a way to stay hydrated. “Sports drinks provide fluid, carbohydrates and electrolytes during extreme exercise,” she said. “This helps provide fuel for muscles, help maintain blood sugar levels and quench thirst. They also help to prevent dehydration. For specifics on what you or your student-athlete need contact a registered dietitian who is a board-certified specialist in sports nutrition.” For families on the go to, Swim said planning is a way to keep eating healthy. “Every sporting event has a schedule. Take time once a week to map those out on a calendar and then sit down with the family to see who can help out where. Also, think about preparing extra on nights that you can cook. Then you just need to heat something up. Using the crockpot can be a lifesaver, then dinner is ready when you get home.” For late night events, she said prepare sandwiches when possible and keep snacks handy such as whole fruit, apples, bananas, oranges, walnuts, almonds and skim mozzarella string cheese. Swim said parents must also keep in mind that males and females mature differently and to alter their diets accordingly. “Because girls and boys mature at different ages and their growth spurts occur at different times, there are separate calorie needs. For example, as girls mature one place to focus would be on getting enough iron. The body uses iron to make hemoglobin, the part of the red blood cells that carry oxygen.” Swim said multi-grain rice with salmon and dark green salads are ways to add iron into meals, but recommends contacting a pediatrician or registered dietitian for diet needs.
BY STAFF REPORTS
05/22/2018 12:00 PM
TAHLEQUAH, Okla. – Sequoyah High School is once again participating in the U.S. Department of Agriculture Summer Food Program. It will run May 29 through June 28, Monday through Thursday, at the SHS cafeteria. The program provides nutritious meals at no charge to children during summer vacation. Children aged 18 and under regardless of race, color, national origin, sex, age or disability are eligible to receive meals. Breakfast will be served from 8 a.m. to 9 a.m. and lunch will be from noon to 1 p.m. Adults may eat breakfast for $2.25 and lunch for $4. The cafeteria is at 17091 S. Muskogee Ave. For more information, call 918-453-5190.
BY STAFF REPORTS
04/27/2018 04:00 PM
TULSA – Cherokee Nation clinical dietitian Tonya Swim was awarded “Outstanding Dietitian of the Year for Outstanding Career of Contributions to the Dietetics Profession” on April 19 at the Oklahoma Academy of Nutrition and Dietetic Convention. Swim, who works at the A-Mo Health Center in Salina, is involved with the OkAND organization as public relations and communication chairwoman and has helped increase its social media presence by promoting registered dietitians as nutrition experts and renewing a partnership with Oklahoma City Fox News by coordinating weekly cooking segments. She also served as chairwoman for the 2018 OkAND convention and chaired the event in 2016. As chairwoman, she worked to provide Oklahoma’s registered dietitians and dietetic technicians with opportunities for continuing education. “It was an honor and I am humbled to have received this award. I give most of the credit to the amazing group of dietitians in our state for helping my ideas become reality and to the wonderful company I work for in allowing me to grow as a dietician. I am so blessed with a supportive family who push me to be the best I can. Thank you to everyone,” Swim said.
BY BRITTNEY BENNETT
Reporter – @cp_bbennett
04/25/2018 09:30 AM
SALLISAW – When Cherokee Nation citizen Shacotah Sanders lost his hair after undergoing chemotherapy for Stage 2 Hodgkin lymphoma last year, his mother, Tammie Simms, shaved her head in solidarity. “Chemotherapy is a really long process. It’s painful. It’s stressful. It’s really emotional because I lost all my hair,” Sanders said. “That was something I was really scared of right there, but the main thing that keeps me going is my mom. She’s like the only one that really keeps me going.” This familial support is once more a shoulder for Sanders to lie on because while his hair has grown back, so too have the cancerous spots in his neck. It is a possibility that he had accepted after going into remission in October. “I had prepared myself for it because there’s always that possibility that it could come back,” Sanders said. “Every three months I have a checkup, a PET scan, and we decided to do one in early March this year. We did it, waited about two weeks to get the results. We went back to my oncologist doctor, and he said that it came back, but it wasn’t as big as last time and not as bad. He said it was in the same spot and at the same stage, Stage 2.” Sanders began undergoing 22 rounds of radiation on April 3 to again battle the cancerous disease, which starts in the white blood cells called lymphocytes. It causes uncontrollable cell reproduction that can potentially invade other tissues throughout the body and disrupt normal tissue function, according to the American Cancer Society. Sanders travels from Sallisaw to Tahlequah’s Northeast Oklahoma Cancer Center five days a week for his radiation sessions and will have checkups every three to six months after the treatments. “The radiation, they take you to a back room with a really big machine and you just lay on it, like a flat surface, and then they put a mesh mask over your face and tilt your head back so they can get to the spots where the cancer is. There’s no needles involved or anything. It’s just a big machine shooting radiation down on your body,” he said. The first time Sanders noticed something amiss with his health was in March 2017. “Every time I went running I noticed my breathing was off quite a bit, so I was just feeling around on my neck and I found these lumps on the right side of my neck, below my jaw. It was just affecting my breathing a lot, so I went to the doctor and had them check it out,” he said. After a PET scan and surgery, doctors removed two of Sanders’ lymph nodes. “They sent them off to be tested and they came back cancerous. They told me it was Stage 2 Hodgkin lymphoma and we started treatment last year in April,” Sanders said. Doctors prescribed Sanders four rounds of chemotherapy at Warren Clinic Medical Oncology in Tahlequah. “I was supposed to do four, but three rounds did it,” Sanders said. “During that time, I still went to work, and I didn’t feel good at all going to work, but I still worked my eight hours a day. I still went to work, put a smile on my face. I had a really good attitude about it.” Though the cancer has returned and forced Sanders to put classes at Carl Albert State College on hold while continuing to work, he remains positive and recommends anyone going through a diagnosis to do the same. “Just have a positive attitude about everything. Surround yourself with positive things, people, family and friends,” he said. Sanders has a GoFundMe account to help with expenses. To donate, visit <a href="http://www.gofundme.com/hodgkins-lymphoma-fight" target="_blank">www.gofundme.com/hodgkins-lymphoma-fight</a>. <strong>Symptoms and Info</strong> Possible symptoms of Hodgkin ymphoma include fever, drenching night sweats and weight loss constituting at least 10 percent of a person’s body weight over the course of six months, according to the American Cancer Society. For more information, visit <a href="www.cancer.org/cancer/hodgkin-lymphoma.html " target="_blank">www.cancer.org/cancer/hodgkin-lymphoma.html</a>.
BY LINDSEY BARK
Reporter
04/20/2018 08:30 AM
TAHLEQUAH – Northeastern State University’s Oklahoma College of Optometry goes back 39 years in its relationship with the Cherokee Nation and in providing Cherokees eye care. NSUOCO works with nine CN clinics, also known as Rural Eye Programs, in Tahlequah, Sallisaw, Stilwell, Jay, Salina, Vinita, Nowata, Muskogee and Ochelata and services 40,000 to 60,000 patients annually. Its first graduating class was in 1983 and has since averaged 28 graduates annually from its four-year doctorate program. The NSU campus clinic contains 20 exam rooms and specialty clinics for dry eye, contact lenses, low vision, vision therapy and infant vision clinic. If a REP is unable to provide a type of eye care, patients are sent to the NSU clinic for further evaluation and treatment. Nate Lighthizer, NSUOCO Continuing Medical Education director and doctor of optometry, said the college has seen patients from 2 months old to 102 years old. “We all have different vision needs. That’s one of the beauties of having a college is we have 35 faculty members that are either here, in (W.W.) Hastings (Hospital) or in the REPs, and a lot them have different interests. We have doctors that specialize in infant vision and vision therapy. They’re the expert in the 6-month-old and the 2-, 3-, 4-, 5-year-old. Other doctors, they’re the expert in the 80-year-olds,” Lighthizer said. He said students begin in “didactically heavy” classes, building foundations and learning about systemic diseases, eye diseases, procedures when giving primary care, looking at the eye with microscopes and other program aspects. He said students begin seeing patients at the end of the second year and into the third year. CN citizen and fourth-year student Seth Rich said he applied for the NSU program because of the experience it would give him treating patients by the time he graduates. “I’m from this area, so I wanted to serve basically in the population that I grew up in. Here at NSU we see more patients compared to any other optometry school by the time we graduate. We have more patient interactions that any other optometry school is going to have and more clinical experience because we start seeing patients a year early than most other schools,” he said. Rich said he also has experience using the REPs and seeing the eye care needs among Cherokees. “We deal with a lot of diabetic patients here at Cherokee Nation, and that has a really large effect on the eyes. Being able to be in this area and serve a population that has a huge need for us is a big deal because I personally have a lot of family ties to this area want to be in a community where I feel like I’m going to be contributing and giving back and helping the overall health of the population with health and exams,” he said. Rich said the program prepares students to “go out into the real world” and treat patients of any need. “I feel very confident going out into the population and serving basically anybody that walks in the door.” CN citizen Tara Comingdeer Fields, who is in her first year at NSUOCO, said she chose the program because of her area ties. “It’s not specifically just Cherokee Indians that I want to serve, but overall Native Americans. My background is I grew up in a traditional family, so the medicines and traditions that we did just kind of stuck with me, and now I want to help people.” Comingdeer Fields and Rich are recipients of Indian Health Services scholarships for optometry and will work under an IHS contract upon graduation. Lighthizer said CN citizens make up between 10 to 15 percent of the NSUOCO’s students and that it’s usually rewarding for a Cherokee to grow up using CN eye care services and then go through the program and become a provider. “It’s just a very mutually beneficial relationship between Cherokee Nation to be able to have all of these patients seen and then obviously for the education for students to be able to see patients and hone their skills.”
BY STAFF REPORTS
04/19/2018 04:00 PM
SANTA ANA PUEBLO, N.M. – The Notah Begay III (NB3) Foundation, with a grant from the Comcast Foundation and in partnership with Cultivating Coders, is accepting applications for a national competition for Native youth to design a mobile app focusing on improving the health and nutrition of Native youth – designed by Native youth. The competition is open to individuals or teams of Native youth, ages 13-18, experienced in coding, design and digital media and/or mobile technology. Participants must submit a completed application with supporting documents that includes a four-page outline and video of the app. Contest applications will be accepted until July 1. Learn about the contest criteria, eligibility and application process at: <a href="http://www.nb3foundation.org/healthy-kids-healthy-futures-app-contest/" target="_blank">http://www.nb3foundation.org/healthy-kids-healthy-futures-app-contest/</a>. “The NB3 Foundation recognizes that more and more Native youth are using their mobile devices and APPs to track their physical activity, nutrition and even water intake. This competition is an integral step for the Foundation in the direction of connecting youth with technology to build healthier lifestyles,” NB3 Foundation President and CEO Justin Kii Huenemann, said. The contest’s intent is to engage and challenge creative and tech-savvy Native youth from across Indian Country to think creatively, culturally and digitally about their diet, nutrition, exercise and fitness; and turn that knowledge into a solution or problem-solving mobile app that may be used by the NB3 Foundation. A panel of NB3 Foundation staff and experts will choose a first-, second- and third-place winners. The first-place winner will proceed to work with Cultivating Coders, a software company and social enterprise focused on priming the next generation of coders to develop, design and implement their own solutions to address their local challenges, to further develop the app into a minimum viable product. For more information or questions about the application process, email Simone Duran, NB3 Foundation program assistant, at <a href="mailto: simone@nb3f.org">simone@nb3f.org</a> or call 505-867-0775, ext. 104.