Health Services implements new provider compensation package
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.