Cherokee Nation health providers want base pay raises
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
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.