TAHLEQUAH, Okla. – U.S. Department of Human and Health Services Secretary Tom Price made his first visit to Oklahoma on Sept. 19 to meet with tribal officials from the Cherokee and Pawnee nations as part of a three-day tour of health care facilities and to address tribal health care needs.
Following a tour of the Jack Brown Treatment Facility, a facility for treating Native American youth with substance abuse problems, Price and Principal Chief Bill John Baker held a press conference to address health care issues sweeping Indian Country and the United States.
With the opioid crisis as the main topic, Baker talked about how hard the CN is being hit by the epidemic.
“Pain medications are saturating the Cherokee Nation. In our Indian Child Welfare office, about 40 percent of our foster care cases involve families torn apart by opioids. We have babies being born in our hospital on a monthly basis having to be life-flighted to Tulsa because they entered the world, at no fault of their own, with these powerful drugs in their system,” he said. “Opioid is crippling Indian Country, and the Cherokee Nation is certainly feeling the negative effects. It is literally destroying lives and wrecking families.”
Baker said the CN has filed a lawsuit against the largest distributors of opioid drugs in America, and the case is pending in tribal court.
Price visited the CN as his third stop in Indian Country, while continuing his outreach to bring light to the opioid crisis. He commended the CN for the health care and behavior health services being provided at the W.W. Hastings Hospital and the Jack Brown Treatment Facility.
“The work you’re doing here is really a model not just for Indian Country but for the entire nation,” said Price. “The system of self-governance and health care that exists in Cherokee Nation is one of remarkable expanse and remarkable capability.”
Like the opioid statistics, the numbers in overdose deaths are continuing to get worse in CN and in America. Price said those numbers are “moving in the wrong direction.”
“The number of overdose deaths in Cherokee Nation has more than doubled between 2003 and 2014… The numbers nation wide are astounding with over 60,000 overdose deaths across America in 2016,” he said.
He addressed a five-point strategy the HHS has outlined for health care providers to heed in hopes of finding a solution to the overdose and opioid epidemic. The strategy includes more addiction prevention, treatment and recovery services, more overdose reversers as well as better data, research and pain treatment.
The CN recently received a grant from the Substance Abuse and Mental Health Services Administration for overdose reversers such as the nasal spray Naloxone, which blocks the effects of drugs made from opium or opioids. Price said traveling to different communities across the country allows him to ensure tribes are aware of those types of funding opportunities under the HHS strategy.
“We are committed to fighting alongside Cherokee Nation and others – all American Indians and Alaskan Natives – to make certain this scourge is moved in the right direction, that is decreasing the incidents of this addiction,” he said.
TAHLEQUAH, Okla. – Health Services officials were expected to implement a new provider compensation package on Oct. 1 after soliciting feedback from Tribal Councilors and the Health System Provider Compensation Committee.
“That’s what were pushing for,” Health Services Executive Director Connie Davis said of the projected implementation date. Oct. 1 marks the beginning of fiscal year 2018. “We’re prepping the contracts right now anticipating everything going through.”
Davis declined to share details of the new compensation package, but said the plan was supposed to have been finalized in a Sept. 13 meeting with Principal Chief Bill John Baker, Treasurer Lacey Horn and Secretary of State Chuck Hoskin Jr.
Compensation Committee member Dr. Johnson Gourd, a physician at Three Rivers Health Center in Muskogee, said as of Sept. 19 providers had not received an official document with the changes.
“We have not got official word on that,” he said. “I don’t know what the package entails or what the final numbers are. I don’t know even what to expect. Everything is just hearsay at this point.”
In an April 21 letter, the Compensation Committee asked Health Services officials to increase base salaries and incentives for providers to “recruit and retain top quality (health care) providers” to care 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 and that an increase in base pay at CN has happened once in eight years.
Compensation Committee members said this has led to recruitment difficulties, a loss in providers and increased wait times for patients as remaining providers “experience the undue burden of taking on the additional workload for those many empty positions.”
“You almost feel guilty to be sitting there arguing for more pay, but we want to demonstrate that this is not a money grab by the providers,” Gourd said. “This is simply what the market standards are currently. We’re not saying that the CN is bad. We love it. That’s why we stay. It’s just this is what we are seeing. It’s not a blame game, but trying to keep your head above water as the market changes around you.”
In response to the letter, the Tribal Council held a May 15 meeting in which Davis and Executive Medical Director James Stallcup proposed annual bonuses based on relative value units or RVUs.
According to a physician search and consulting firm, RVUs calculate work volume 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. Once the provider is paid a share of roughly $65, the facility is left with approximately $55.
Stallcup said the RVU proposal could increase positive revenue per RVU by 12.5 percent while keeping the base salary increase possibility, which could happen in the first quarter after the RVU system was operational.
However, Gourd and other Compensation Committee members voiced concerns about moving to RVU-based compensation before raising base pay because of “inefficiencies” in the electronic health records system.
Gourd said the EHR system has decreased the amount of patients he sees and does not allow him “control of all variables” to complete his job efficiently. He also raised concerns about new providers entering under RVU-based compensation and suggested using RVUs as “an incentive program” for more-seasoned providers.
Dr. Charles Grim, Health Services deputy executive director, said the organization employs 250 providers, of which 160 are physicians and mid-level providers, at all of CN’s health facilities.
Davis said in a Sept. 11 Health Committee meeting that the Health Services turnover rate is 12 percent compared to the nationwide rate of 14 percent. She also said that in the past year Health Services has lost nine full-time physicians, 11 PRNs or “as needed” workers, five advanced practice registered nurses, two physician assistants and one certified registered nurse anesthetist.
A Government Records Act request submitted by Tribal Councilor David Walkingstick states that in the past six years, 104 providers have left Health Services.
Davis said Human Resources conducts exit interviews for providers who leave and that Health Services officials have not seen the information from those interviews. However, Davis said no one leaving the department has cited to her that compensation was their reason for leaving.
“No one has said, ‘I’m not making enough money. I’m leaving,’ and left. Thankfully,” Davis said.
In light of Health Services being left out of the exit interview process, Tribal Councilor Joe Byrd suggested sending “upper level” staff to sit in on the interviews. “I think if you just let HR take care of it, they really don’t know what they have contributed to the tribe. That’s just a suggestion.”
CLAREMORE, Okla. – The Claremore Indian Hospital will sponsor a Veterans Affairs Enrollment Fair on Sept. 21 in the hospital’s Conference Room 1.
Hospital officials said the fair is set for 10 a.m. to 2 p.m. to assist their Native American veteran patients in applying for eligibility for health care services through the VA.
“We will have Claremore Indian Hospital benefit coordinators and representatives from the VA and Disabled American Veterans to assist with the application processes,” Sheila Dishno, Claremore Indian Hospital patient benefit coordinator, said. “Please make plans to attend and bring your financial information (income and resource information) and DD-214 (military discharge) papers.”
If already enrolled, call 918-342-6240 or 918-342-6559 so a hospital official can update your file.
AUSTIN, Texas – Casting for Recovery, a national nonprofit organization providing free fly fishing retreats for women with breast cancer, will hold a retreat exclusively for Native American women in October in Tahlequah, Oklahoma.
Set for Oct. 13-15, Native American women who reside in Oklahoma and have received a breast cancer diagnosis are eligible to apply. Up to 14 women will be randomly selected to attend the retreat at no cost. Meals, lodging, equipment and supplies will be provided for each participant. The deadline to apply is Aug. 11.
CfR officials said Native American women face numerous cultural and economic barriers to cancer care. By providing support, education and resources, CfR officials said they hope to improve the quality of life for Native American women, creating a ripple effect for health in their communities.
CfR officials said the program empowers women with educational resources, a new support group and fly fishing, which promotes emotional, physical, and spiritual healing. For more information or to apply for this retreat, visit <a href="https://castingforrecovery.org/breast-cancer-retreats/arkansas-oklahoma/" target="_blank">https://castingforrecovery.org/breast-cancer-retreats/arkansas-oklahoma/</a> or call Susan Gaetz at 512-940-0246.
CfR is a 501(c)(3) nonprofit founded in 1996 featuring a program that combines breast cancer education and peer support with the therapeutic sport of fly fishing. Officials said its retreats offer opportunities for women to find inspiration, discover renewed energy for life and experience healing connections with other women and nature. CfR’s retreats are open to women of all ages, all stages of breast cancer treatment and recovery, and are free to participants.
?For more information, visit <a href="https://castingforrecovery.org" target="_blank">https://castingforrecovery.org</a>.
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.