Health Services implements new provider compensation package

Reporter – @cp_bbennett
10/10/2017 08:15 AM
TAHLEQUAH, Okla. – The Cherokee Nation’s Health Services has increased base pay for many physicians in primary care by $35,000 as part of a new compensation package that took effect Oct. 1.

Included in the package are quarterly bonuses based upon relative value units or RVUs.

The package raises the base-pay threshold for nearly 120 doctors at the tribe’s W.W. Hastings Hospital and nine health centers, according to CN Communications.

“Ideally we never want to lose any of our physicians, but we know there are times they leave for larger cities or higher paying jobs just like any other industry. So we hope this move is one that will have a lasting impact,” Health Services Executive Director Connie Davis said.

Additionally, all physicians, advanced practitioners and physician’s assistants above the base-pay threshold will receive a 2 percent raise after CNHS compared regional market salaries with information provided by the Medical Group Management Association, according to administration officials.

Quarterly RVU bonuses will be awarded to providers who meet the MGMA 25th percentile in service to patients. According to a leading 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.

For each RVU achieved over the standard, the dollar value of the RVU increases. According to administration, it will now be possible for providers to see a bonus ranging anywhere from $500 to $30,000 each quarter. The amount of the final quarterly bonus is dependent on several varying factors.

Bonuses were previously awarded semi-annually, based on a merit of 2.5 percent and not incentivized.

Providers will also be eligible for a 3 percent annual merit increase after meeting health compliance standards.

The raise’s cost is outlined in a budget modification that increases the IHS Self-Governance Health budget by $3.4 million.

The changes come after a year of discussion and an April 21 letter signed by the Health System Provider Compensation Committee asking Health Services officials to increase provider base salaries and incentives to “recruit and retain top quality (health care) providers.”

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 salaries has happened only once in eight years.

The letter states lower salaries have 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.”

The new contracts are currently being distributed to providers throughout CNHS including compensation committee member Dr. Johnson Gourd, a physician at Three Rivers Health Center in Muskogee. He called the new contracts “a step in the right direction” for providers and would be watching closely to see how bonuses are awarded.

Gourd had previously voiced concerns about implementing the RVU-based system due to “inefficiencies” with the electronic health records system, which he said does not allow him “control of all variables” to complete his job efficiently.

“That adjustment to getting to those RVU goal numbers will have to come once they’ve implemented it and we see where we’re at in the real world work environment and then we try to make appropriate changes,” he said. “One clinic may have inherent advantages for a provider over others with staff issues or whatever. That I think will work itself out once people are trying to work with that goal and they can identify perhaps the things that are impeding them.”

Dr. Katherine Hughes, D.O and Emergency Room director, said she has yet to see a new contract but is “excited” that it is forthcoming.

“My hope is that it increases our ability to be able to recruit new physicians coming in and retaining the ones we have.”

Hughes has not worked at a facility that uses RVUs, but is “all for anything” to better serve patients.

“I think it has the potential to be really good for everybody,” she said. “As a supervisor, I’m all for anything that’s going to make everybody more productive and decrease our wait time for our patients. We were having a hard time recruiting people on the salary and when they’re coming to a small town, you have to overcome that. It was a lot to overcome, but I hope this will help us be able to attract really good people out here to our system and keep them.”

Dr. Charles Grim, Health Services deputy executive director, said Health Services employs 250 providers, of which 160 are physicians and mid-level providers.

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.

Records from Cherokee Nation state that in the six-year time frame from of 2012 to 2017, there were 130 providers who separated from CNHS. In that same six-year time frame from 2012 to 2017, there were 159 providers who were hired to CNHS.

The jobs included in both these figures include; physicians, physician PRN, physician assistant, physician assistant PRN, certified nurse midwife, certified nurse midwife PRN, certified RN anesthetist, certified RN anesthetist PRN, podiatrist.

The number of departures in large measure are doctors who are PRNs, who are temporary by nature.

CNHS anticipates losing 6 PRN staff annually through its family practice residency program or as temporary docs working in urgent care.

Since 2012 of the 73 PRN, 36 have left due to their residency status ending.

Of course, other providers leave for various reasons, including jobs in urban health facilities, family reasons and retirement.

According to Indian Health Service, the vacancy rate for IHS was 28 percent, while CNHS vacancy rate for just physicians was 23 percent in 2016.

Currently physician vacancy is 17.6 percent and below the previous year.

Total provider vacancy rate for CNHS in 2017 is 12.5 percent while the base-pay increase and bonuses come before the projected September 2019 opening of a CN outpatient facility in Tahlequah that is expected to create more than 800 jobs. In the 2012 fiscal year the total budgeted full-time physician was 76 and the number budgeted in the 2017 fiscal year is currently 92.

“As we build onto our health system and create new jobs, this compensation plan will have great timing,” Davis said.
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. • 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.


12/08/2017 04:00 PM
TAHLEQUAH, Okla. – Cherokee Nation physician Dr. James H. Baker was recently awarded a Mastership through the American College of Physicians for his contributions. According to ACP, “Election to Mastership recognizes outstanding and extraordinary career accomplishments and achievements, including the practice of internal medicine, academic contributions to our specialty, and service to the College.” During review of candidates, the ACP’s Awards Committee considers several qualities, including strength of character, perseverance, leadership, compassion and devotion. Clinical expertise and commitment to advancing the art and science of medicine are also taken into account by the committee. “I am so honored to receive this award from my peers and colleagues at the American College of Physicians,” Bake said. “I thank our Oklahoma ACP Chapter of 1,000 internal medicine physicians and medical students for nominating me.” Baker, of Muskogee, is a general physician with more than 30 years of experience. He serves as medical director for CN Three Rivers Health Center and the tribe’s Wilma P. Mankiller Health Center. Baker completed medical school at the University of Oklahoma in 1982 and completed his internal medicine residency at Kansas University in 1987. The mastership is the third award Baker has received from the ACP, including the Meritorious Service Award in 2014 and the Laureate Award in 2015. He is a former governor of the Oklahoma chapter of ACP and a current member. The ACP will honor 2017-18 master recipients at the organization’s annual convention in April 2018 in New Orleans. For more information, visit <a href="" target="_blank"></a>.
12/05/2017 12:00 PM
TAHLEQUAH, Okla. – According to an Oklahoma influenza summary for Nov. 19-25, the influenza geographic spread is “widespread” within the state. The report states that there were 162 positive rapid flu tests at sentinel sites with 78 percent of those positive specimens being influenza A. The summary also states that between Sept. 1 and Nov. 28, 105 influenza-associated hospitalizations were reported to the Acute Disease Service with ages ranging from 0 to 95 years with a median of 62 years of age. The report states that two influenza-associated deaths have been reported among residents of Johnston and McClain counties, and officials said that Oklahoma is experiencing a higher than normal level of influenza activity early in the season. “Our influenza-associated hospitalizations are the highest they have been at this time of year since the 2009-2010 pandemic,” Dr. Sohail Khan, Cherokee Nation health research director, said. “Our influenza-associated hospitalization count is three weeks ahead of the 2014-2015 season when our influenza activity peaked in December and declined to minimal levels by the end of March. This early activity does not mean we will have a more severe season. It does indicate that more influenza will be circulating during the holidays.” Flu, or influenza, is a contagious respiratory infection caused by a variety of flu viruses. Symptoms of flu involve muscle aches and soreness, headache and fever. It enters the body through the mucus membranes such as the nose, eyes or mouth. “Every time you touch your hand to one of these areas, you are possibly infecting yourself with a virus,” Khan said. “This makes it very important to keep your hands germ-free with frequent and thorough hand washing. Encourage family members to do the same to stay well and prevent flu.” Khan said there are three types of flu viruses: A, B, and C. He said type A and B cause the annual influenza epidemics that have up to 20 percent of the population sniffling, aching, coughing and running high fevers. Type C also causes flu, however type C flu symptoms are less severe. The flu is linked to between 3,000 and 49,000 deaths and 200,000 hospitalizations each year in the United States, and seasonal flu vaccines are created to try to avert epidemics. Khan said the best way to prevent seasonal flu is to get vaccinated each year, but good health habits such as covering a cough and washing hands often can help stop the spread of germs and prevent respiratory illnesses such as the flu. There also are flu antiviral drugs that can be used to treat and prevent flu. To prevent the spread of flu, Khan said to avoid close contact; stay home when sick; cover mouth and nose; clean your hands; avoid touching your eyes, nose or mouth; and clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. He also suggests getting plenty of sleep, being physically active, managing stress, drinking plenty of fluids and eating nutritious food.
12/05/2017 08:00 AM
TAHLEQUAH, Okla. – In 2015, the Cherokee Nation became the first tribe to launch an elimination project with the U.S. Centers for Disease Control and Prevention to screen and treat tribal citizens for hepatitis C. And since the project’s inception, more than 40,000 people have been screen. CN officials proclaimed Oct. 30 as Hepatitis C Awareness Day and said the tribe continues its efforts to reach it goal of screening 80,000 patients. “Hepatitis C is a virus that affects primarily the liver but it can affect other organs, too. It was isolated in 1989, although we knew it existed long before that time,” Dr. Jorge Mera, CN director of infectious disease, said. Hepatitis C was identified as non-A or non-B hepatitis before it was labeled as a third virus. Symptoms are not present unless it has not been identified or treated for a period of time and cirrhosis of the liver sets in. “The symptoms are basically symptoms of cirrhosis. So anything that inflames the liver for many years may end up causing a lot of scarring of that liver and when the scarring is sever enough we label it as cirrhosis,” Mera said. The virus can be contracted several ways. Mera said in approximately 90 percent of cases, people who inject drugs and share needles, syringes or paraphernalia, contract it. In the past, blood transfusions played an important role in contracting the virus until 1992 when blood banks began checking for it. Tattooing in a non-professional parlor can also play a role. There is also a small chance, roughly 5 percent, that a mother can transmit the disease to her newborn child, Mera said. He said there are ideal and practical ways to prevent the disease from spreading. “Ideal would be that people would not use illegal drugs and not inject them. We know that we can mitigate that but we will never reach zero on that. That’s a reality. People have been using illegal drugs for millenniums, and it’s not going away soon,” Mera said. He said if people use drugs they should use clean needles and syringes each time they inject and to not share needles with anyone. He added that there is a need for needle and syringe exchange services, which is illegal in Oklahoma. Other tribes and places in the United States, such as New York City and San Francisco, are creating their own hepatitis C elimination programs. “Now the advantage they have over us is that they have needle and syringe services. It’s going to be very difficult to eliminate hep C if you don’t have needle and syringe services because there will be a point that people will continue to transmit, and I can only go and catch them and treat them. But I would like to cut that transmission,” Mera said. To prevent the disease’s consequences once it is contracted is for people ages 20 to 72 years old to get screened. “We offer free screenings and free treatments at W.W. Hastings Hospital in Tahlequah, Oklahoma,” Mera said. “In Cherokee Nation, 3.4 percent of Cherokees ages 20 to 72 are positive for hepatitis C. In other Native American communities there have been reported rates as high as 8 percent and also lower rates.” He said hepatitis C is the top “killer of blood-born pathogens” than any other reportable disease of the CDC and has killed more than the rest of the reportable diseases combined. “Hepatitis C mortality is greater in Native Americans in general than non-Native American populations in the United States,” Mera said. Mera said the screening process is simple and all one has to do is request a screening in the Urgent Care or with their providers at W.W. Hastings Hospital. The screening contains a blood drop, in which results are ready in 24 hours. He said treatment options, depending on the severity of the virus, is taking a pill regiment for eight to 12 weeks, in which 95 percent cure rates have been seen. “It’s the only chronic infectious disease that you can cure and, to my knowledge, is the only chronic disease you can cure. Because you can’t cure diabetes or high blood pressure, those you have to treat for life, or HIV for that matter. But this is eight to 12 weeks and you’re done.” He said though the treatment is simple the hard part is getting people to get tested. Roughly 50 percent of the population of the 85 percent goal has been screened. Approximately 78 percent have tested positive and more than 90 percent have been cured of the virus. “On cure rates we’re meeting our goal. On screening we still have a ways to go. And in engagement of care there’s still room for improvement,” Mera said. “I would really like to eliminate hepatitis C from Cherokee Nation. That would be my goal.”
11/24/2017 02:00 PM
TAHLEQUAH, Okla. – During the Nov. 13 Health Committee meeting, Secretary of State Chuck Hoskin Jr. said Health Services Executive Director Connie Davis had resigned and was being replaced in the interim by Dr. Charles Grim. Davis, whose career experience spans over 28 years in the health field, began her career at W.W. Hastings Hospital in 1988. In 2004, she joined Tahlequah City Hospital as vice president of patient care and chief nursing officer until she became the Cherokee Nation’s Health Services executive director in 2012. “She is going to devote some more time to her family, particularly her mother,” Hoskin said. “We certainly appreciate her service. Dr. Grim has been named interim executive director of Health, effective immediately.” Grim, a CN citizen, is a retired assistant Surgeon General and rear admiral in the Commissioned Corps of the U.S. Public Health Services. During his career, Grim has received honors and awards, including a Lifetime Achievement Award from the Oklahoma Area Indian Health Service, Health Leader of the Year from Commissioned Officers Association of U.S. Public Health Service, Community Leadership Award from the CN as well as multiple U.S. Public Health Service medals and citations, including the U.S. Surgeon General’s Exemplary Service Medallion. Since 2013, Grim has served as Health Services deputy director, in which he was second in charge of Hastings Hospital, eight outpatient health centers, Emergency Medical Services, finance and billing services, facilities management, the Jack Brown Youth Regional Treatment Center and a host of public health and community health services and programs. Prior to that, Grim served as Health Services senior director of for more than three years. Preceding his CN employment, Grim spent 26 years working for Indian Health Services in numerous clinical, administrative and executive leadership positions. In 2002, President George W. Bush appointed him as director of IHS with a unanimous Senate confirmation. During that time he administered a nationwide multi-billion dollar health care delivery program, with 12 administrative regional offices and over 16,000 employees. Grim holds a bachelor’s degree in microbiology from the University of Oklahoma, a doctorate of dental surgery from the University of Oklahoma College of Dentistry and a master’s degree in health services administration from the University of Michigan School of Public Health. “When I retired from the Indian Health Service and got hired to work for the Cherokee Nation it was pretty incredible for me. It’s a dream come true. I thought I might go the rest of my career and never get to work here. I’ve learned a lot over the years, both educationally and experientially and the thought that I have got to apply a lot of that here for my tribe and my citizens and my people has really meant a lot,” he said during the Health Committee meeting. Grim also thanked Davis for her time as Health Services executive director. “We have one of the biggest tribal health systems in the country, one of the largest populations to serve in the country, and she did a very, very good job of trying to stay on top of all the issues that were thrown at us on a daily basis. She had a good team of people around her, many of those sitting behind me but some of them you never see. You see some of them in your clinic when you’re going around, but I just wanted to thank her publically…” he said. Grim will serve as interim director until an executive director is named. “We always want to fill positions parentally, and the resignation was just tendered so naturally our first move was to name an interim, and we could not have a more capable interim than Dr. Grim. As the days and weeks pass we will be looking at a permanent person to fill that position, but we have all the confidence in the world in Dr. Grim,” Hoskin said.
11/15/2017 04:00 PM
CLAREMORE, Okla. – The Claremore Indian Hospital will sponsor a Veterans Affairs Enrollment Fair on Dec. 7 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.
11/13/2017 12:00 PM
TAHLEQUAH, Okla. – According to a Cherokee Nation Communications release, the tribe’s Health Services has screened more than 40,000 tribal citizens for hepatitis C after becoming the first tribe in the country to launch an elimination project two years ago with the U.S. Centers for Disease Control and Prevention. Principal Chief Bill John Baker declared Oct. 30 as Hepatitis C Awareness Day in the CN as tribal and Health Services officials gathered for a proclamation signing ceremony. The release states the tribe’s goal is to screen 80,000 patients between age 20 and 65 for hepatitis C during a three-year period. In October 2016, the tribe had screened 23,000 patients. “When this program started in 2015, we had high hopes for what it would mean for the long-term health of Cherokee Nation citizens,” Baker said. “The positive results have been beyond even our highest expectations. We have treated and cured more than 680 people with a 90 percent success rate. That success is allowing people once afflicted with the hepatitis C virus to live healthier and happier lives. The Cherokee Nation Health Services staff has collaborated with international infectious-disease experts to create and sustain this modern health care blueprint. It’s not often a disease can be completely eliminated from a citizenry, but it’s something we are achieving in the Cherokee Nation with our hepatitis C efforts.” Of those screened, about 1,200 patients tested positive and more than 680 patients are either currently being treated for hepatitis C or have been cured. “The Cherokee Nation is demonstrating to other communities across the United States how to effectively test and treat those living with hepatitis C and prevent new infections, so that someday the threat of hepatitis C will be eliminated,” Dr. John Ward, director of CDC’s Division of Viral Hepatitis, said. Hepatitis C is a liver infection caused by the hepatitis C virus, usually through the transfer of blood. Most people become infected with the hepatitis C virus by sharing needles, through unlicensed tattooing or because they had a blood transfusion before 1992. For some people, hepatitis C is a short-term illness, but for about 70 percent of people who become infected, it becomes a long-term, chronic infection, according to the CDC. Dr. Jorge Mera, Health Services’ Infectious Disease director, said the project continues to gain momentum with his office looking more at prevention of hepatitis C and the potential increase from the opioid crisis happening throughout the United States. “Our efforts now need to be directed at preventing hepatitis C, which in the United States today is driven by injected drug use,” Mera said. “Prevention strategies include expanding our medication-assisted treatment program for opioid addiction. We are also beginning a serious discussion about needle- and syringe-exchange programs.” Health Services has partnered with the CDC and the Oklahoma Department of Health to track and share knowledge. For more information about the elimination project or to get screened, visit <a href="" target="_blank"></a>.