Health Services implements new provider compensation package

BY BRITTNEY BENNETT
Former Reporter
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.

Health

BY ASSOCIATED PRESS
07/19/2018 04:00 PM
OKLAHOMA CITY (AP) – The federal Centers for Medicare and Medicaid Services has approved Oklahoma’s Medicaid program for a first-in-the-nation drug pricing experiment that supporters say could save taxpayer dollars and provide patients with the most effective medications for their ailments. Under the “value-based purchasing” program approved in late June, the state and a pharmaceutical company would agree to a set payment if its medication works as advertised, but only a fraction of that if the drug is not as effective as promised. “When a company signs an agreement, we hope that they’re going to agree to only have us pay for the therapy that works .... and if it doesn’t work we should get a rebate on it,” said Nancy Nesser, pharmacy director for the Oklahoma Health Care Authority, which administers the Medicaid program in the state. “One thing we’ve learned is that some companies don’t really stand behind their drugs, and it’s kind of scary,” Nesser said. “We’re paying a premium for them and they’re not willing to say that they will work.” The companies are not required to take part, but Nesser said several, which she declined to identify, have shown interest and discussions are underway with three. She said she hopes the program can begin by Aug. 1. “This is a good thing,” said Matt Salo, executive director of the nonpartisan National Medicaid Directors Association, which represents state programs. “It paves the way for states and other payers to start really thinking about how to do value-based purchasing for prescription drugs.” The federal waiver would allow Oklahoma to get around a potential obstacle to value-based contracts. A possible pitfall is Medicaid’s “best price” requirement, which says if any purchaser gets a really good deal on a drug, then Medicaid has to get that lower price too. Some interpret that to apply to value-based deals as well, Salo said. That means that if a drug didn’t work too well, and a state paid only 10 percent of the original price, then every other Medicaid program could get the drug for that rock-bottom price, too. “This seems to allow for paying less for a failed treatment without triggering the ‘best price’ requirement,” Salo said. Oklahoma spent about $650 million on prescription drugs in the fiscal year that ended June 30, Nesser said, and the change could save “a couple of million, maybe.” Medicaid patients, primarily children who do not pay for prescriptions and the elderly, whose costs are fixed, would see no pocketbook impact, according to Oklahoma Health Care Authority spokeswoman Jo Stainsby. “The change we’re looking for is improved health outcomes,” Stainsby said. Oklahoma is “taking the lead” in working to bring down the cost of medications, the AARP director for the state, Sean Voskuhl, said. “It is a great example of how states can implement change in the absence of reform at the federal level,” Voskuhl said.
BY ASSOCIATED PRESS
07/13/2018 12:45 PM
OKLAHOMA CITY (AP) — Oklahoma Gov. Mary Fallin on July 11 signed into place strict emergency rules for medical marijuana that pot advocates say are intentionally aimed at delaying the voter-approved use of medicinal cannabis. The term-limited Republican governor signed the rules just one day after her appointees on the state’s Board of Health adopted them at an emergency meeting after last-minute changes to ban the sale of smokable marijuana and require a pharmacist at every pot dispensary. Those late additions to the rules infuriated longtime medical marijuana advocates who helped get the measure on the ballot in June, when nearly 57 percent of Oklahoma voters approved it. Her quick signature also came just as medical pot advocates were rallying supporters to urge her to reject them. “People are completely angry. They voted for (State Question) 788 and now you have the health department and our governor pull these shenanigans?” said Isaac Caviness, president of Green the Vote, a marijuana advocacy group that pushed for the passage of the state question. “It’s a slap in the face to all activists. It’s a slap in the face to all Oklahomans who voted on 788.” Groups that opposed legalizing medical marijuana – including ones that represent doctors, pharmacists, hospitals and chambers of commerce – earlier this week called for new restrictions on the industry, including a ban on the sale of smokable pot and the pharmacist restriction. The board approved the two provisions against the advice of the health department’s general counsel, who said the rules likely were beyond the agency’s legal authority. Marijuana advocates say they’re considering legal action against the board. In a statement on July 11, Fallin said she thinks the rules were the best way to quickly set up a regulatory framework for medical marijuana. “I know some citizens are not pleased with these actions,” Fallin said. “But I encourage everyone to approach this effort in a constructive fashion in order to honor the will of the citizens of Oklahoma who want a balanced and responsible medical marijuana law.”
BY STAFF REPORTS
07/12/2018 12:30 PM
TAHLEQUAH – According to the U.S. Centers for Disease Control, the most effective way to avoid getting sick from viruses spread by mosquitoes when at home and during travel is to prevent mosquito bites. “Mosquito bites can be more than just annoying and itchy. They can spread viruses that make you sick or, in rare cases, cause death,” the CDC website states. “Although most kinds of mosquitoes are just nuisance mosquitoes, some kinds of mosquitoes in the United States and around the world spread viruses that can cause disease.” The CDC states that mosquitoes bite during the day and night, live indoors and outdoors and search for warm places as temperatures begin to drop. Some will hibernate in enclosed spaces such as garages, sheds and under (or inside) homes to survive cold temperatures. Except for the southernmost states in North America, mosquito season starts in the summer and continues into fall. <strong>Mosquito-borne viruses in the continental U.S.</strong> West Nile virus is the most common virus spread by mosquitoes in the continental United States. People can also get sick from less common viruses spread by mosquitoes such as La Crosse encephalitis or St. Louis encephalitis. In rare cases these can cause severe disease or even be deadly. Most people infected with these viruses do not have symptoms, or have only mild symptoms like fever, headache, nausea, and vomiting. • West Nile is a virus most commonly spread to people by mosquito bites. In North America, cases of WNV occur during mosquito season, which starts in the summer and continues through fall. There are no vaccines to prevent or medications to treat WNV. Fortunately, most people infected with WNV do not have symptoms. About 1 in 5 people who are infected develop a fever and other symptoms. About 1 out of 150 infected people develop a serious, sometimes fatal, illness. • Most cases of Saint Louis encephalitis virus or SLEV disease have occurred in eastern and central states. Most people infected with SLEV have no apparent illness. Initial symptoms of those who become ill include fever, headache, nausea, vomiting and tiredness. Severe neuroinvasive disease (often involving encephalitis, an inflammation of the brain) occurs more commonly in older adults. In rare cases, long-term disability or death can result. There is no specific treatment for SLEV infection. Care is based on symptoms. • Most cases of La Crosse encephalitis virus or LACV disease occur in the upper Midwestern and mid-Atlantic and southeastern states. Many people infected have no apparent symptoms. Among people who become ill, initial symptoms include fever, headache, nausea, vomiting and tiredness. Some who become ill develop severe neuroinvasive disease (disease that affects the nervous system). Severe LACV disease often involves encephalitis and can include seizures, coma and paralysis. Severe disease occurs most often in children under the age of 16. In rare cases, long-term disability or death can result from La Crosse encephalitis. There is no specific treatment for LACV infection. Care is based on symptoms. • The Zika virus is still a problem in many parts of the world. Puerto Rico and U.S. Virgin Islands are areas with risk. Many areas in the United States have the kind of mosquitoes that can spread Zika. It can cause birth defects in babies born to women who were infected during pregnancy. The CDC recommends pregnant women and their partners and couples considering pregnancy know the risks and take prevention steps. <strong>Prevention</strong> • Use insect repellent: When used as directed, Environmental Protection Agency-registered insect repellents are proven safe and effective, even for pregnant and breastfeeding women. Use an EPA-registered insect repellent with DEET, Picaridin, IR3535, Oil of lemon eucalyptus, Para-menthane-diol or 2-undecanone. • Cover up: Wear long-sleeved shirts and long pants. • Keep mosquitoes outside: Use air conditioning or window and door screens. If you are not able to protect yourself from mosquitoes inside your home or hotel, sleep under a mosquito bed net.
BY STAFF REPORTS
07/06/2018 08:00 AM
TAHLEQUAH – Tribal Councilor Wanda Hatfield is one of two new appointees to the Oklahoma City Indian Clinic board of directors. The board is comprised entirely of Native Americans. Hatfield, a Cherokee Nation citizen, joined the board earlier this year along with Gena Timberman, a Choctaw Nation citizen. “It is an honor to be appointed to the leadership committee of a health institution like the Oklahoma City Indian Clinic, one of the largest and most successful urban Indian clinics in the country. So many Cherokee Nation citizens reside in central Oklahoma and utilize the health and wellness services provided by OKCIC,” Hatfield said. “As a member of the Cherokee Nation Tribal Council, I have advocated for more and better access to quality health care for our citizens, and in my new position I will be just as committed to improved health care opportunities for all Native people in the Oklahoma City area.” Hatfield will serve a three-year term, overseeing the clinic’s finances and directing the strategic plan along with 11 other board members. “Councilor Hatfield has been a champion for American Indian health care and will expand her responsibilities in this new role. She has helped Cherokee Nation Health Services connect and collaborate with other institutions that provide quality care to Indian people, including the Children's Center Rehabilitation Hospital and especially the Oklahoma City Indian Clinic,” Secretary of State Chuck Hoskin Jr. said. “Growing up in Adair County, she knows the health care challenges we face in rural Oklahoma, and as a retired school teacher in the Oklahoma City area, she has a unique grasp of the things our urban tribal citizens need.” Hatfield grew up in the Cherry Tree community near Stilwell in Adair County and attended Stilwell High School. She later received a bachelor’s degree in education from the University of Oklahoma and was an educator at Mid-Del School District in Midwest City for 28 years. She is also a member of Cherokee Nation Businesses advisory board and the Indian Education advisory boards for Mid-Del and Moore schools. “Both of our new board members embody the spirit of the Native American community that we serve,” Robyn Sunday-Allen, OKCIC CEO and Cherokee Nation citizen, said. “Their expertise and individual talents bring energy and fresh ideals to the table. We are honored to have them join our board.” The clinic sees more than 18,000 patients from over 200 federally recognized tribes each year.
BY ASSOCIATED PRESS
06/28/2018 12:00 PM
OKLAHOMA CITY (AP) – The head of Oklahoma’s health agency said on June 27 there’s a framework in place to get the medical marijuana industry rolling in the state soon, despite concerns from Gov. Mary Fallin that a statewide vote “opens the door” for recreational use. Oklahoma voters easily approved a state question on June 26 allowing cannabis to be used as medicine in the traditionally conservative state. The measure says applications for a medical marijuana license must be available on the agency’s website within 30 days of the measure’s passage. A regulatory office to receive applications for medical marijuana licenses, recipients and dispensary growers must be operating within 60 days. Interim Health Commissioner Tom Bates said the Oklahoma Department of Health has been developing proposed rules and regulations in case the medical marijuana program was approved by voters since he was named to the post on April 1. He said the agency is prepared “to implement a medical marijuana model as required by the state question.” “We do have a lot to take care of in a tight timeframe,” Bates said. Bates said state health officials would meet July 10 to consider emergency rules for the new Oklahoma Medical Marijuana Authority. Application information and requirements will be available on the agency’s website by July 26, and applications will be accepted by Aug. 25. Oklahoma’s was the first marijuana question on a state ballot in the U.S. in 2018, with elections scheduled for later this year in Michigan and Utah. Voters in neighboring Arkansas legalized the drug for medical use in 2016, but Oklahoma is among the most conservative states to approve its use. Voters came out in droves in Oklahoma to weigh in on the issue, which made it onto the ballot through a signature drive. The Oklahoma State Election Board says more votes were cast on the marijuana question than in the 2014 general election. In Oklahoma City, 33-year-old Meaghan Hunt said she cast her vote in favor of legalization because she views marijuana as another form of treatment for patients with various ailments. She said she wants them to have as many options as possible. She also believes state coffers could benefit from the cash marijuana crops would deliver. “I’d like to see more taxable revenue coming into our state and if that’s an opportunity to collect taxes, all the better — hopefully for education,” Hunt said. The term-limited Fallin said before the vote that she would call lawmakers into a special session to develop rules to regulate the industry, but she toned down her comments after the election results were clear. “I believe, as well as many Oklahomans, this new law is written so loosely that it opens the door for basically recreational marijuana,” Fallin, a Republican, said in a statement. GOP state Senate leader Greg Treat said he doesn’t think members of his party, the majority, are interested in a special session. “Whatever we do will just to be so make sure we don’t overturn the will of the people,” the president pro tempore-designate told reporters on June 27. Attitudes have shifted sharply on marijuana in recent decades in Oklahoma, especially among young people, said Bill Shapard, a pollster who has surveyed Oklahomans on the issue for more than five years. “I’ve found almost half of all Republicans support it,” Shapard said. Oklahoma’s tough-on-crime ideology also has come at a cost, with the state’s skyrocketing prison population consuming a larger share of the state’s limited funding. In 2016, voters approved a state question to make any drug possession crime a misdemeanor, despite opposition to that proposal from law enforcement and prosecutors.
BY KENLEA HENSON
Former Reporter
06/22/2018 04:00 PM
COMPETITION, Mo. – As the 2018 “Remember the Removal” cyclists made their way to Tahlequah, Oklahoma, and the end of their three-week journey, one may have noticed the riders’ various ages. Although Cherokee Nation cyclists range in ages 16 to 24, the Eastern Band of Cherokee Indians gears its “RTR” bike ride towards improving its citizens’ health. The ages for EBCI cyclists this year ranged from 17 to 62. After finishing day 12 of riding, the older EBCI riders reflected on the nearly 1,000-mile trek to Oklahoma and why they wanted to take it. At age 62, Jan Smith said she took on the challenge to honor her ancestors. She said as an EBCI citizen she receives benefits that help her, and for that, her ancestors deserved some appreciation. “There’s people that paid for that (benefits). They’re the ones that struggled, and if they hadn’t been resilient then I wouldn’t be able to reap those benefits I have,” Smith said. “It’s just a small, small way to pay them back.” Like all cyclists who make the journey, a lot of preparation goes in months before the ride begins to ensure their physical endurance can stand against the strain they place on their bodies. Smith knew her age would work against her, so she started training early. “The first training ride I went to was like 10 miles, and I did terrible, and I thought I have to get in better shape. So I started training and eating better,” she said. “I probably worked out five to six days a week. It takes a lot of hard work.” The consecutive days of riding for hours at a time have been hard on Smith, but she said seeing some of the significant sites along the way have been worth it. EBCI cyclist Lori Owle said she rode ride to learn about the Trail of Tears history firsthand. However, the 47-year-old admitted the physical aspect has been difficult. “Before each ride I get knots in my stomach because of the unknown, but once you complete the day you get a sense of completion,” she said. On day nine, a deer hit Owle and knocked off of her bike. After three hours in the emergency room and three stitches in her finger, she was back on her bike the next day. She said being one of the “older riders” was hard, but that the younger riders were a “blessing.” “My main thought was it was us older riders that would need to watch over the young riders and make sure they don’t get hurt, but then it was me that got hurt,” she said. “They take good care of me, and I think the ride has developed patience in them. It’s really good to know that the younger generation has that kind of compassion.” For EBCI cyclist Bo Taylor participating in the ride had been a goal he worked toward for two years. The 48-year-old was selected for the 2017 ride, but a training accident two days before the ride began left him with nine broken ribs. He said he was determined to ride this year. “What I’ve always said about Cherokees is that we always get back up no matter what happens,” Taylor said. Once his ribs healed, he trained on spin bikes and eventually got back on his bike. He said his favorite moment this year was climbing the Cumberland Gap in eastern mountainous Tennessee without stopping. “For an old dude, knowing I can still do things is good. Two years ago I couldn’t do what I am doing now, so it’s been an awesome journey. I’ve found out a lot about myself.”