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 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>.
BY TRAVIS SNELL
Assistant Editor – @cp_tsnell
04/11/2018 02:30 PM
TAHLEQUAH – According to a Cherokee Nation email, Dr. Charles Grim has been promoted from interim executive director of the tribe’s Health Services to executive director. “I am proud to announce that Dr. Charles Grim will assume the permanent duties as Cherokee Nation’s executive director of Cherokee Nation Health Services,” Principal Chief Bill John Baker stated in the April 9 email. “Without a doubt, Dr. Grim’s experience, leadership and expertise have paved the way for continued growth to better meet the diverse health care needs of the Cherokee Nation.” Grim had been serving as the interim executive director since November after former Executive Director Connie Davis resigned to spend more time with her family. Davis had served in that role since 2012. According to the email, Grim takes control of the largest health care system in Indian Country that services 14 counties in northeast Oklahoma and more than 1.2 million patient visits annually to eight health centers and the W.W. Hastings Hospital. “I feel very honored to be appointed this role and for the opportunity to continue to lead a team that I have held close to my heart for a number of years,” Grim said. “As both an employee and a Cherokee Nation citizen, I appreciate Chief Baker and his vision for the future of the tribe’s health care system and I look forward to what we will all accomplish together for the health of our Cherokee Nation citizens.” Grim, a CN citizen, is a retired assistant Surgeon General and rear admiral in the Commissioned Corps of the U.S. Public Health Services. During his career, Grim has received a Lifetime Achievement Award from the Oklahoma Area Indian Health Service, Health Leader of the Year from Commissioned Officers Association of U.S. Public Health Service, Community Leadership Award from the CN, as well as multiple U.S. Public Health Service medals and citations, including the U.S. Surgeon General’s Exemplary Service Medallion. Since 2013, Grim has served as Health Services deputy director, in which he was second in command of Hastings Hospital, the health centers, Emergency Medical Services, finance and billing services, facilities management, the Jack Brown Youth Regional Treatment Center and a host of public health and community health services and programs. Prior to that, Grim served as Health Services senior director of for more than three years. Preceding his CN employment, Grim spent 26 years working for IHS in clinical, administrative and executive leadership positions. In 2002, President George W. Bush appointed him as director of IHS with a unanimous Senate confirmation. During that time he administered a nationwide multi-billion dollar health care delivery program, with 12 administrative regional offices and over 16,000 employees. He graduated from the University of Oklahoma College of Dentistry and received a master’s degree in public health at the University of Michigan. Grim is expected to oversee Health Services when it opens the 469,000-square-foot Hastings Hospital expansion next year, which will be the largest IHS health center constructed. “Better health care has been the primary objective for my administration since taking office. We have vastly expanded our provider system to serve more communities and tribal citizens than ever before,” Baker stated. “We continue to improve health care by providing more and better services. As an administrator, Dr. Grim is uniquely qualified to ensure we provide the best health care possible in order to create healthier and more productive families.”
BY STAFF REPORTS
04/07/2018 12:00 PM
OKLAHOMA CITY – Oklahoma City Indian Clinic commemorated “Diabetes Alert Day” on March 27 to promote the seriousness of diabetes, particularly when it is left undiagnosed or untreated. One-in-three American adults are at risk for developing Type 2 diabetes, a serious disease that can lead to complications like kidney failure, heart disease, stroke, blindness and amputations. Type 2 diabetes doesn’t have to be permanent. It can be prevented or delayed with healthy lifestyle modifications. The first step is learning about the disease’s risks. “Early detection and treatment of diabetes decreases the risk of developing complications of diabetes," said Robyn Sunday-Allen, CEO of OKCIC. A simple and quick 60-second test located on the American Diabetes Association website can help a person determine if he or she is at risk for developing Type 2 diabetes. American Indian and Alaska Native adults are 2.3 times more likely to be diagnosed with diabetes compared with non-Hispanic whites. Because of this diabetes epidemic, OKCIC has a specific program titled “Special Diabetes Program for Indians,” to provide Native Americans with diabetes treatment and prevention services. Through this grant-funded program OKCIC is able to educate, diagnose and assist patients with their diabetes management through lifestyle changes and intervention. Common signs of diabetes and symptoms include: urinating more than usual, feeling very thirsty, feeling hungry even after eating, feeling tired, having blurred vision, having frequent infections or slow-healing cuts and sores and having tingling, pain or numbness in the hands or feet. Oklahoma City Indian Clinic was established in 1974 to provide excellent health care and wellness services to American Indians in central Oklahoma. The clinic staff cares for more than 18,000 patients from more than 200 federally recognized tribes every year. American Indians can receive a range of services, including medical, dental, pediatrics, prenatal, pharmacy, optometry, physical fitness, nutrition, family programs and behavioral health services. For more information, call 405-948-4900 or visit <a href="http://www.okcic.com" target="_blank">www.okcic.com</a>.
BY STACIE BOSTON
Reporter – @cp_sguthrie
04/04/2018 04:30 PM
SALINA – After passing the 1-year-old mark, children’s environments play a bigger role in eating patterns as diets alter. Tonya Swim, Cherokee Nation clinical dietitian, said as children reach “school age” well-rounded meals are important for muscle and brain growth. <strong>1 to 5 years</strong> Swim said children between 1 and 2 years old eat because of hunger, and at this time their palates change. Around the 2-year-old mark, Swim said children’s appetites “slow down.” “Parents may be concerned at that age that their child’s not eating, but that’s just a normal part of the life stage at that point,” she said. Swim said when children hit the 3- to 4-year-old mark their environments becomes “bigger” influences on their eating patterns. “The only difference is around age 3 or 4 is whenever the environment that the child is in starts to become a bigger influence on their eating patterns rather than that hunger cue,” she said. “That’s where setting a good example for children around that age (is important) because they’re going to want to eat what we eat.” <strong>5 to 8 years</strong> In this age group, which Swim said is “school age,” the focus is ensuring children eat nutritious snacks as their calories increase. “They’re going to need a little more calories than the 1- to 5-year-olds, and then the calories kind of bump up again at the next range.” Swim said breakfast is important for children’s diets as it helps their bodies and brains gain energy to “focus.” “Breakfast is one of the most important meals of the day for school-aged children. That’s what gives their body and their brain the energy to focus. So we want to encourage a nutritious breakfast for school-aged kids,” she said. “That’s going to be a whole grain. It’s going to be a lean protein, an egg, breakfast ham. Those are some lean proteins that we would like to encourage them to have.” She said it’s important to also have well-rounded meals and snacks. “It’s making sure that those whole grains are at every meal. It’s making sure that they have a variety of fruits and vegetables at meals and snacks, the low-fat dairy so that they get their calcium, their potassium, magnesium. An 8-ounce serving of low fat milk at meals is good. String cheese, yogurt parfaits, those can be good snack ideas,” she said. <strong>Extra tips</strong> Don’t use food for praise or punishment, and establish set meal and snack times. “We don’t want to use food for praise or punishment because that can start to develop a negative relationship with food,” Swim said. “Establishing set times for meals and snacks can be very important. Especially family meal times, that’s really important for helping to develop social skills.’ Children may start to develop “picky” eating habits. Introduce new foods in small portions at the beginning of meals. “Don’t give up just because the kid says, ‘I don’t like it.’ We don’t want to give up. We want to keep trying every few days or every week. Try not to bribe them with other foods,” Swim said. “Then again being that good example, tasting the new food yourself.” Physical activity is also important at these ages, she said. “We need to balance the calories that are going in our bodies with the calories that we expend through exercise to help maintain a healthy weight.” Swim said if parents or guardians have concerns they should contact their pediatricians.