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
Cherokee Nation health providers want base pay raises
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.
VINITA — Blue Cross and Blue Shield of Oklahoma’s Mobile Assistance Center is hosting an education and enrollment event from 1 to 6 p.m. on Jan. 22 at the Craig County Fairgrounds and Community Center located at 915 E. Apperson Road.
Tribal citizens and all individuals who attend this free come-and-go event are invited to visit with BCBSOK representatives to receive assistance with their health insurance questions and needs. Tribal citizens have the ability to enroll in coverage on the Health Insurance Marketplace at any time, outside of the standard Open Enrollment period. Tribal citizens can also visit to see if they qualify for available financial assistance to help lower the cost of monthly payments. In some cases, this financial assistance may cover the full premium cost. Customer service support will also be available for current members who may have questions about their coverage.
“The Affordable Care Act provides American Indians with opportunities to compare and buy health insurance in a new way,” said BCBSOK President Ted Haynes. “Blue Cross and Blue Shield of Oklahoma wants to help people understand their options so they have an opportunity to enroll and choose a plan that’s right for them.”
To learn more about how to protect their health and finances and save on monthly payments, individuals may attend one of the MAC events, contact an independent, authorized BCBSOK agent, or call BCBSOK’s dedicated customer service representatives and product specialists at 855-636-8702.
To see the full schedule of MAC events, <a href="http://www.cvent.com/Events/Calendar/Calendar.aspx?cal=a0cda9f5-c3a8-4258-ac98-c4c57ad92495" target="_blank">click here</a>. For additional information about health plans and pricing, visit <a href="http://www.BCBSOK.com" target="_blank">BCBSOK.com</a>
STILWELL – The Cherokee Nation is working with nine schools in Adair County to promote healthier lifestyles for students.
Cherokee Nation Public Health provided more than $50,000 total to Maryetta, Stilwell, Greasy, Rocky Mountain, Zion, Bell, Cave Springs, Peavine and Dahlonegah public schools through its School Health Leadership Award program. Each school received $5,700 in 2017 to start programs related to fitness or healthy eating.
Adair County is home of the largest population per capita of CN citizens.
“It is important to instill healthy lifestyle habits, including diet choices, in our youth at a very early age,” Tribal Councilor Frankie Hargis said. “I’m thankful the tribe can help these school systems implement programs that will provide the resources needed to demonstrate these habits to youth in Adair County.”
Additionally, CNPH was selected by the state in 2017 as a Tobacco Settlement Endowment Trust grant recipient for Adair County. With $230,400 in grant funding, the tribe is helping Adair County schools create health initiatives to reduce tobacco use and childhood obesity.
Dahlonegah Public School, for example, received $1,500 in TSET funds from the tribe to improve the school’s walking trail and buy additional fitness equipment.
Dahlonegah Superintendent Jeff Limore said noticeable changes are happening.
“We have been able to teach our students about not only staying active, but to make healthy choices,” he said.
For more information on TSET, visit <a href="https://tset.ok.gov/" target="_blank">https://tset.ok.gov/</a>. For more information on CNPH, 918-453-5600.
CATOOSA – The Indian Health Care Resource Center’s annual dinner, dance and auction, “Dance of the Two Moons.” will be held March 10 in the Hard Rock Hotel & Casino Tulsa located at 777 W. Cherokee St.
This year’s honorary chairs are Jill and Terry Donovan of Rustic Cuff and Interior Logistics, respectively, as they help lead a Wild Wild West-themed party to thank Circle of Life Community Partner and Tiger Natural Gas for helping the center build healthier, stronger lives for Native youths. Rusty Meyers Band, an Oklahoma country music artist, will provide the music. The event’s featured artist is Brandi Hines of Agitsi Stained Glass.
This year’s presenting sponsor is Public Service Company of Oklahoma. Additional sponsors include Tiger Natural Gas, Hard Rock Hotel & Casino Tulsa, Blue Cross & Blue Shield of Oklahoma, Chickasaw and Choctaw nations, Meeks Group, Interior Logistics and Carmelita Skeeter. Griffin Communications (News On 6 and Tulsa CW) is the 2018 Media Sponsor.
The dinner and auction was established 28 years ago as an annual fundraiser to help support Tulsa’s Native American youth. Proceeds from the event support many of IHCRC’s youth programs such as the Restoring Harmony Powwow, Youth Spring Break Camp, Running Strong Run Club and youth summer wellness and cultural camps.
Tickets are $150 per person or $250 per couple. Sponsorship levels are available ranging from $1,000 to $10,000. For more information or to purchase a sponsorship or tickets, visit <a href="http://www.ihcrc2moons.org" target="_blank">www.ihcrc2moons.org</a>.
IHCRC is a nonprofit organization funded through state and federal grants, private foundations and donors as well as fundraisers and a contract with Indian Health Services. Utilizing a patient-centered, multidisciplinary, medical home approach, IHCRC offers a full range of health and wellness services tailored to the Indian community. Services include medical, optometry, dental, pharmacy, transportation, behavioral health, health education and wellness, substance abuse treatment and prevention and youth programs focused on traditions, health and leadership skills. With more than 18,000 active patients representing in excess of 152 tribes, IHCRC provides more than 125,000 patient contacts each year to improve the general health status and reduce the incidence and severity of chronic disease of the urban Indian community. Call Deb Starnes at 918- 382-1203 or email <a href="mailto: firstname.lastname@example.org">email@example.com</a>
for more information.
WASHINGTON – The U.S. Department of Health and Human Services recently announced the release of the Tribal Behavioral Health Agenda, a collaborative tribal-federal blueprint highlighting the extent to which behavioral health challenges affect Native communities.
The agenda also includes strategies and priorities to reduce these problems and improve the behavioral health of American Indians and Alaska Natives.
According to the HHS, American Indians and Alaska Natives represent 2 percent of the total U.S. population (6.6 million people), but experience disproportionately high rates of behavioral health problems such as mental and substance use disorders. In addition, these communities’ behavioral health needs have traditionally been underserved, the HHS states.
Mental and substance use disorders – which may result from adverse childhood experiences, historical and intergenerational trauma and other factors – are also reflected in high rates of interpersonal violence, major depression, excessive alcohol use, suicide and suicide risk, HHS officials said. Overall, these problems pose a corrosive threat to the health and well-being of many American Indians and Alaska Natives, HHS officials said.
“This new initiative represents an important step in our government-to-government relationship and gives American Indian and Alaska Native tribes a greater role in determining how to address their behavioral health needs with urgency and respect,” Kana Enomoto, Substance Abuse and Mental Health Services Administration principal deputy administrator, said.
The Tribal Behavioral Health Agenda blueprint includes the following tenants:
• Provides a clear national statement about the extent and impact of behavioral health and related problems on the well-being of tribal communities,
• Recognizes and supports tribal efforts to incorporate their respective cultural wisdom and traditional practices in programs and services that contribute to improved well-being,
• Establishes five foundational elements that should be considered and integrated into existing and future program and policy efforts, and
• Elevates priorities and strategies to reduce persistent behavioral health problems for Native youth, families, and communities.
Findings from SAMHSA’s National Survey on Drug Use and Health indicate that adult (ages 18 and older) American Indians and Alaska Natives had experienced higher rates of past year mental illness compared with the general population (21.2 percent versus 17.9 percent). Similarly, American Indians and Alaska Natives ages 12 and older had higher levels of past year illicit substance use than the general population (22.9 percent versus 17.8 percent), the survey states.
According to the agenda, its framework is organized around the f0llowing elements that provide content and direction for collaborative efforts:
• Focusing on healing from historical and intergenerational trauma,
• Using a socio-cultural-ecological approach to improving behavioral health,
• Ensuring support for both prevention and recovery,
• Strengthening behavioral health systems and related services and supports, and
• Improving national awareness and visibility of behavioral health issues faced by tribal communities.
“The IHS is committed to improving behavioral health care for the American Indian and Alaska Native people by using the Tribal Behavioral Health Agenda to integrate care within community health systems,” IHS Principal Deputy Director Mary L. Smith said. “This agenda recognizes that successful and sustained behavioral change requires cultural reconnection, community participation, increased resources, and the ability of those serving American Indian and Alaska Native populations to be responsive to emerging issues and changing needs.”
The agenda also includes the American Indian and Alaska Native Cultural Wisdom Declaration, which acknowledges that cultural wisdom and traditional practices are fundamental to achieving improvements in behavioral health. In addition, the agenda uses historical and current contexts for developing the recommendations that form the blueprint. It also incorporates shared priorities and strategies that can be addressed by tribes, federal agencies, and other entities working together.
According to the HHS, tribal leaders called for improved collaboration with federal agencies to address behavioral health challenges. The agenda is the result of consultation among tribal leaders, the SAMHSA, IHS and the National Indian Health Board.
“Tribal leaders and stakeholders provided meaningful and comprehensive input to create the Tribal Behavioral Health Agenda, which will be a valuable tool and resource to address the critical behavioral health needs we see across Indian Country,” NIHB Executive Director Stacy Bohlen said.
HHS officials said the agenda honors the relationship the U.S. government has with federally recognized tribes and reflects effective government-to-government interactions. They said the agenda’s development was based on identifying the perspectives of tribes while building strategies based on their shared values and beliefs.
TAHLEQUAH, Okla. – With construction following a February groundbreaking on the Cherokee Nation’s new health facility near W.W. Hastings Hospital, tribal officials are now planning for employment for when it’s completed in September 2019.
The outpatient and primary care facility, which Indian Health Services awarded to the CN, is one of the largest joint venture agreements between a tribe and IHS, according to a CN press release.
Once completed, the facility will be the largest health center of any tribe in the country at approximately 470,000 square feet and four stories high. It will serve as the primary health care access point for American Indians and Alaskan Natives residing in the Tahlequah service area.
The facility will feature five surgical suites and two endoscopy suites inside its ambulatory surgical center. It will house a specialty clinic and feature 33 dental chairs, six eye exam rooms and three audiology-testing booths. Space will also be expanded for rehabilitation services, behavioral health and a wellness center.
During the past several months, construction crews have transformed 45 acres into the health center’s beginning stages. So far concrete foundations have been poured and steel structures are going up. As a result, 350 construction jobs have been created.
“I don’t think we can overstate the amount of payroll dollars this thing has. We are working with our TERO (Tribal Employment Rights Office) contractors and TERO sub-contractors to keep as much of that payroll in our community as we possibly can. You can see the number of trucks going in and out of here and the impact it has,” Brain Hail, W.W. Hastings Hospital CEO, said.
Hospital officials meet with architects and contractors monthly for construction updates, and Hail said the expansion is being designed to “accommodate” staff and patients.
“The staff has done a really good job of responding to questions quickly during the design phase, so we can get the design phase completed. We also have done mockups so the facility will be constructed to accommodate the staff that is using it,” he said. “We also try to be very focused on the patients’ experience to make sure they don’t have to walk any further then absolutely necessary, especially our elders.”
With regards to a proactive patient experience, he said parking would significantly increase at the facility. Hospital officials are also in the planning phase for hiring staff. With a larger facility and additional services, the facility will require an additional 800 health care professionals.
Hail said the hospital is working with the tribe’s Education and Career Services departments to prepare a work force for the facility’s opening.
“We are trying to be proactive with Education and Career Services to make sure they’re aware of the needs that we are going to have when we open the new facility so they can start adjusting their scholarships, start adjusting the training they provide and start getting ready to prepare our workforce for the facility. We also have our offices of professional recruitment and retention aware of what we are going to need, so they can be recruiting people now and getting them ready to join us when we open,” he said.
While the center’s opening less than two years away, positions in certain areas will be needed as early as six months to a year prior to the opening. Those areas include information technology, environmental services, facilities management and security. To ensure those positions are secured before the opening, Hail said officials are requesting early funding.
With Hastings Hospital being more than 35 years old and approximately 180,000 square foot, it was designed to serve 60,000 patient visits annually. However, in 2016, the hospital saw nearly 400,000 patient visits, and in 2017 it handled more than 500,000 patient visits.
As patient visits increase, Hail said officials are planning for the future with the new facility.
“The current facility is in need of expansion and modernization to serve current and future demands,” he said. “We are basically working for a 20-to-25-year timeline to try to anticipate what we need for the next 20 to 25 years in health care and the community.”
Officials are also planning for the future through recruitment and a partnership with the Oklahoma State University Center for Health and Sciences to expand its medical school to Tahlequah.
Inpatient operations, emergency services, labor and delivery decks, diagnostic imaging and pharmacy will remain at Hastings Hospital. And the medical school will occupy Hastings’ remaining space after the new facility is finished.
“We are doing everything that we can to try and expand the number of professionals that will be available to us. What everyone sees is where people train is where they tend to stay, so we want to train as many people in our area so they stay in the area,” he said.
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="http://www.acponline.org" target="_blank">www.acponline.org</a>.