Health Services implements new provider compensation package

BY BRITTNEY BENNETT
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.
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 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.
BY STAFF REPORTS
04/17/2018 08:00 AM
VINITA – The Cherokee Nation’s Behavioral Health is using federal grants to train law enforcement, youth workers and health officials to better handle mental illness. Behavioral Health special projects officer Tonya Boone, a certified instructor, has led eight classes, including her most recent adult mental health first-aid class at the CN Vinita Health Center. “I was certified in August of 2017 and have since certified around 150 individuals,” Boone said. More than 20 people from CN Health Services and surrounding health care agencies were involved in the most recent training in Vinita. During the eight-hour course, participants memorized a five-step action plan and were taught how to identify mental health risk factors, offer support and be effective communicators. Only about 5,000 instructors nationwide are certified to teach mental health first aid, including six from the CN. Behavioral Health Clinic Administrator Joni Lyon said for her team of certified instructors it is about more than training. It’s about making a difference in the lives of those who may be suffering from a mental illness or substance abuse. “We are invested in providing education and information for our communities regarding mental health and substance abuse,” Lyon said. “Our department acknowledges that Cherokee Nation is not exempt from these types of issues and wants to ensure our communities are provided with appropriate information and education to assist persons seeking services in their community.” All five courses, funded through a Substance Abuse and Mental Health Service Administration grant and the Indian Health Service, teach specific risk factors and warning signs of mental illness and how they relate to an emergency situation. Instructors can be certified in any of the courses and certifications must be renewed every three years. So far in 2018, the tribe has certified more than 100 participants in mental health first aid and was expected to offer four classes relating to youth at the Jack Brown Youth Treatment Center in Tahlequah in April. Behavioral Health offers various services to all federally recognized tribal citizens, including specialized services for women, individual and group therapy for mental health and substance abuse, relapse prevention, children and family treatment and parenting classes. In addition to counseling, the department handles psychological testing for children and adults. For CN citizens living within the tribe’s jurisdictional boundaries, referral services for substance abuse and psychiatric stabilization are also available. For more information on mental health first-aid training, visit <a href="http://www.mentalhealthfirstaid.com" target="_blank">www.mentalhealthfirstaid.com</a>.