CN allocates $9.4M to ease MRI constraints

BY BRITTNEY BENNETT
Reporter – @cp_bbennett
01/31/2018 08:15 AM
TAHLEQUAH – Cherokee Nation officials announced they are allocating an additional $9.4 million to Contract Health to alleviate budget constraints and re-establish some MRI referrals for patients with “elective orthopedic” cases.

“We are aware our patients have more health needs than we offer and (we) want to help them live healthier lives without exhausting their pocketbooks or going without these needed services,” Dr. Charles Grimm, CN Health Services interim executive director, said. “The Cherokee Nation is making aggressive efforts in several areas to collect more funds from billing patients’ private insurance, Medicaid and other third-party billing streams.”

Grimm attributed the collections increase to improved patient record management using a new electronic health records system and increased provider productivity after implementing a new compensation package. The package rewards providers on productivity and patients treated, leading to more opportunities for third-party billing, he said.

Third-party collections for fiscal year 2018’s first quarter was $36.1 million, up from $26.7 million during the last FY 2017 quarter, according to CN Communications.

The additional funds bring the FY 2018 Contract Health budget to $44.3 million, with $28.4 million received from Indian Health Service and $6.5 million from Cherokee Nation Businesses dividends, officials said.

Previously, Contract Health authorizations for surgeries and MRI referrals were limited to patients classified at Level 1 under the IHS medical priority regulations. The IHS defines Level 1 as “the highest priority medical services,” including “those necessary to prevent the immediate threat to life, limb, or senses.”

If a patient was categorized with an “elective orthopedic” issue such as chronic knee, back or shoulder pain, it would not meet requirements for an approved MRI referral. Instead, patients had to rely on Medicare, Medicaid or private insurance to help cover costs.

“We hope patients understand that Cherokee Nation Health Services strives to meet all needs of tribal citizens, but the same time have had to manage costs, and these additional dollars will help serve even more patients with contract health referrals,” Grimm said. “Our goal is to be able to be able to provide the necessary orthopedic services and related diagnostics for our patients.”

In the CN 2017 Annual Report, 11.8 percent of Health Services’ expenses came from contracted health services, the third-largest expense behind direct patient care at 66.4 percent and community health and education at 12.2 percent.

Grimm said evaluating funding would continue to be an “ongoing process.”

“We will continue to monitor the needs of the patients combined with the payer mix of the various additional funding sources and go from there,” he said.

Contract Health Director Bret Hayes said the tribe always approved referrals for oncology, cardiology and orthopedics. However, elective orthopedics had been halted as referrals grew “exponentially,” while funding grew only “in fits and spurts.”

“Every time we add a doctor we add more patient access. We add more services. Those end up getting more referrals. When I started we had 87 (referrals) a day and now we have 412 a day, so volume has grown exponentially,” Hayes said.

Previously when patients were denied, letters were sent informing them that they could appeal in writing within 30 days and submit their appeals to their local Contract Health coordinators.

“It goes centrally to the Medical Review Committee,” Hayes said. “They just evaluate for medical necessity. For all referrals, they look at the medical background of the case. They can typically appeal it through three levels, so (patients) can appeal it again.”

The process is multi-tiered and for patients to win they must provide relevant medical records.

“We will still evaluate the referrals written by our providers for medical necessity and some referrals may still not meet medical necessity,” said Grimm. “We have an appeals system in place that will enable us to review the cases as they are appealed.”

The Cherokee Phoenix submitted a Freedom of Information Act request for the number of MRI referral approvals and denials, but information was not available as of publication.

While the CN does not have MRI machines available for patients, a new 470,000-square-foot health facility near W.W. Hastings Hospital will feature two when it opens in 2019.

“We will keep (the machines) busy I know,” Hayes said. “It will definitely allow for cheaper and more prompt diagnostics. We do a significant amount of MRIs related to all kinds of things, not just orthopedics.”

However, Hayes said he doesn’t know the financial situation that will occur once the machines are operational. Until demand and cost can meet in the middle, he recommends patients look into government and private insurance options to assure they will receive needed services.

Patient benefits coordinators are available at CN health facilities for those seeking insurance plans related to elective orthopedic MRIs and other services not covered by Contract Health.

Hayes said if patients have private insurance or Medicare then they could get specialty care such as MRIs. He said purchasing insurance through the Affordable Care Act is another way patients can gain access to specialty services, including MRIs.

“There are some really good benefits from the Affordable Care Act if you sign up on the Marketplace and purchase a plan,” he said. “Depending on their plan, the cost is zero and some of those plans have really good deductibles. The other thing is if they’ve got a contract health referral and they’re one of our patients, if they have purchased a plan on marketplace, there is no co-pay or no deductible.”

To enroll in the ACA or change a plan, visit www.healthcare.gov.
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.

News

BY STAFF REPORTS
05/27/2018 04:00 PM
OKLAHOMA CITY – Living in Oklahoma during the late spring and summertime means facing heat conditions that can sometimes reach dangerous temperatures. Heat is one of the leading weather-related killers in the United States, and an estimated 618 people in the United States are killed by extreme heat every year. It is important to know how to protect yourself and others from the impacts of heat waves. Extreme heat can lead to dangerous heat-related illnesses such as heat exhaustion or heat stroke. These illnesses happen when the body is not able to properly cool itself. According to the Centers for Disease Control and Prevention, the body is supposed to cool itself off by sweating. However, in cases of extreme heat, sweat will not evaporate as quickly, preventing the body from releasing heat quickly. Personal factors such as age, weight, dehydration, heart disease, poor circulation, sunburn, and prescription drug and alcohol use can also play a role in whether a person can cool off enough in very hot weather. “People must balance their summertime activity with actions that help the body cool itself,” Robyn Sunday-Allen, Oklahoma City Indian Clinic CEO, said. “It is important that everyone understands the signs of heat illness and should even take time to check on the elderly, friends, family and neighbors during these conditions to ensure their health and safety." Limit outdoor activity. If you like to exercise or even just like being outdoors, it is important to limit your outdoor activity to morning and evening hours. You must start slowly and then gradually pick up your pace. However, if you are exercising in extreme heat and you are left gasping for breath, immediately stop all activity, let someone know where you are, and get into a shaded and cool area to rest. In addition, it is important to protect yourself from the sun by wearing a hat, sunglasses, and sunscreen with a SPF of 30 or higher. Never leave kids or pets unattended in a hot vehicle. As a reminder, the temperature in a car can be deadly during extreme heat. The temperature inside a car can rise 20 degrees Fahrenheit in just 10 minutes, so leaving a window open is not enough. Children who are left unattended in the heat and in parked cars are highly at risk for heat stroke and sometimes even death. To avoid any heat illnesses, dress children in loose, lightweight, light-colored clothing. It is also important that they drink lots of fluids. Check up on the elderly, sick and those without air conditioning. People aged 65 years or older are more at risk to encounter heat-related health problems. Prevent these illnesses by checking up on people in the community during periods of extreme heat. Air conditioning is important to have in conditions of intense heat. If someone is without air conditioning, offer to drive him or her to an air-conditioned location or a safer environment. Also, consider carrying extra bottles of water and other supplies in case others are in need of them.
BY TRAVIS SNELL
Assistant Editor – @cp_tsnell
05/27/2018 08:00 AM
TAHLEQUAH – Cherokee Nation citizens living outside the tribe’s 14-county jurisdiction are eligible for free one-year subscriptions of the Cherokee Phoenix thanks to a $10,000 disbursement from the principal chief’s office on behalf of At-Large Tribal Councilors Mary Baker Shaw and Wanda Hatfield. The Cherokee Phoenix recently received the funds and is taking names on a first-come, first-served basis until the money is depleted. “These funds that have been provided to the Cherokee Phoenix by the joint efforts of our tribal administration and our At-Large (Tribal) Councilors Mary Baker Shaw and Wanda Hatfield will go a long way in providing subscriptions to at-large citizens,” Executive Editor Brandon Scott said. “It has always been our goal here at the Phoenix to make sure that every citizen that wants a copy of the Cherokee Phoenix is able to get one. That is the sole reason we exist. Our success depends on our subscribers. Our ability to remain independent relies solely on the funds we receive from subscriptions, so these funds are not only assisting at-large citizens they are also assisting us in remaining independent. I’d personally like to thank Councilors Baker and Shaw as well as the administration for making this donation possible.” Scott added that there are no restrictions on receiving a free subscription other than living outside the CN jurisdiction and being a CN citizen. Using the fund, at-large CN citizens can apply to receive a free one-year subscription by visiting, calling or writing the Cherokee Phoenix office and requesting a subscription. The Cherokee Phoenix office is located in the Annex Building on the W.W. Keeler Tribal Complex. The postal address is Cherokee Phoenix, P.O. Box 948, Tahlequah, OK 74465. To call about the fund, call 918-207-4975 or email <a href="mailto: justin-smith@cherokee.org">justin-smith@cherokee.org</a>. The Cherokee Phoenix also has a free website, <a href="http://www.cherokeephoenix.org" target="_blank">www.cherokeephoenix.org</a>, that posts news seven days a week about the Cherokee government, people, history and events of interest. The monthly newspaper is also posted in PDF format to the website at the beginning of each month. Cherokee Nation Businesses in November donated $10,000 to the Cherokee Phoenix’s Elder/Veteran Fund, which provides free subscriptions of its monthly newspaper to elders and/or military veterans who are CN citizens. No income guidelines have been specified for the Cherokee Phoenix Elder/Veteran Fund, and free subscriptions will be given as long as funds last. Tax-deductible donations for the fund can also be sent to the Cherokee Phoenix by check or money order specifying the donation for the Cherokee Phoenix Elder/Veteran Fund. Cash is also accepted at the Cherokee Phoenix offices and local events where Cherokee Phoenix staff members are accepting Elder/Veteran Fund donations. Those who donate can also have entries submitted for them into the Cherokee Phoenix’s quarterly artist giveaway. For every $10 donated or spent on Cherokee Phoenix merchandise, a person gets one entry into the quarterly drawing. The next drawing is July 2 when it gives away a two-piece, 12-foot fishing rod donated by Larry Fulton of Larry’s Bait and Tackle in Fort Gibson.
BY ASSOCIATED PRESS
05/26/2018 04:00 PM
FLAGSTAFF, Ariz. (AP) — American Indian tribes are welcoming an opportunity to offer sports betting in potentially hundreds of casinos across the country after the U.S. Supreme Court cleared the way for states to legalize it. Tribal casinos generate more than $31 billion a year in gross revenue. While adding sports books isn’t expected to boost that number significantly, tribes say it’s another source to deliver services to tribal members. “The conversation is always, ‘Why don’t you do like Vegas?’“ said Sheila Morago, executive director of the Oklahoma Indian Gaming Association. “Everybody always wants to give their customers things they have asked for.” Many tribes give a share of casino profits to states in exchange for exclusive rights to conduct gambling operations. In Arizona, the state’s share was about $100 million last year. Some tribes believe agreements with states already give them the right to control sports betting, while others will work out the details through negotiations in compacts that vary in wording state by state. “It’s going to be important for the tribes that their position as sovereigns and their existing compacts within their states are recognized,” said Valerie Spicer, a co-founder of the consulting firm Trilogy Group. “There’s still a lot of work left to do.” Nearly 240 tribes operate casinos in more than half of U.S. states under the federal Indian Gaming Regulatory Act or as commercial ventures. Some only have games like bingo or pull tabs that don’t need authorization from states. The majority of the roughly 475 tribal casinos have those games and others like slot machines, blackjack and other table games, according to the National Indian Gaming Commission. Sports wagering would fall in the latter category, the commission said. The U.S. Supreme Court on Monday struck down the Professional and Amateur Sports Protection Act on a challenge from New Jersey. The law limited sports betting to four states that met a 1991 deadline to legalize it: Nevada, Delaware, Montana and Oregon. States now can adopt laws regulating sports betting, though some already have the legal framework in place. In California, voters would have to approve a change to the state constitution. As is, California tribes have exclusivity in casino-style gambling, and some believe that includes sports betting. Steve Stallings, the chairman of the California Indian Gaming Commission, said the group that represents 34 tribes wants specifics on what sports betting would encompass before the state moves to legalize it. For example, he said, would it occur at a physical sports book or could wagers be placed online? “Expansion of gaming is a slippery slope,” he said. “Tribes feel like they have somewhat an exclusivity to it. When the state or other interests violate that, then tribes are concerned.” In Arizona, Gov. Doug Ducey saw the U.S. Supreme Court’s decision as a way to modernize tribal gambling compacts and potentially boost revenue to the state. Most of the tribal compacts are up for renewal in 2022. Greg Jones was visiting a casino run by the Navajo Nation east of Flagstaff this week. He said he used to bet regularly on college football and being able to do it at a tribal casino less than an hour from his home beats traveling to Nevada. “It’s a big pot,” he said. “Everyone should be able to dip their foot in the pool.” Tribes in Oklahoma have been trying to get sports betting approved through the state legislature in the last two sessions but have been unsuccessful, Morago said. In Connecticut, the Mohegan Tribe said it’s looking forward to working with the state to legalize and regulate sports betting. “We have long felt that Mohegan Gaming & Entertainment was in a great position to offer this type of gaming at our properties,” spokeswoman Jennifer Harris Ballester wrote in a statement. Ernie Stevens Jr., chairman of the National Indian Gaming Association, said the group has been preparing tribal governments for sports betting with listening sessions outlining internal regulations and negotiations of state gambling compacts. Location and competition would be major factors in tribes’ decisions to add sports betting, he said. “I don’t believe this is going to take the place of our slot machines, but it’s another amenity we can enjoy and people can have fun with,” he said. “And we want to be able to move forward with the overall industry.”
BY ASSOCIATED PRESS
05/26/2018 12:00 PM
TULSA, Okla. (AP) — Experts are looking at how Oklahoma's seismic activity impacts critical infrastructure as frequent, low-level earthquake swarms continue to pop off throughout the state. The Tulsa World reports that Oklahoma has experienced 80 earthquakes of 3.0 or greater magnitudes this year through Thursday morning. The Oklahoma Geological Survey says that 2015 was the state's peak year, with just over 900 quakes of 3.0 or greater. A Society of Exploration Geophysicists article this month said that soil, concrete and steel structures are "susceptible to fatigue" under seismic conditions that weren't considered during design. Scientists worry long-term low-level shaking could affect storage tanks and pipelines in Cushing, an oil hub in Oklahoma. The Tulsa-based society is hosting an August forum to engage experts in discussions on the issues and write for publication.
BY STAFF REPORTS
05/25/2018 03:30 PM
TAHLEQUAH – The Cherokee Nation will host a send-off ceremony for its cyclists who leave Tahlequah on Tuesday for the annual “Remember the Removal” Bike Ride. This year’s cyclists range in age from 18 to 24. They will meet eight cyclists from the Eastern Band of Cherokee Indians in North Carolina for a ride that begins in New Echota, Georgia, on June 3, and concludes around 950 miles later on June 21 in Tahlequah. Cyclists follow the Northern Route of the Trail of Tears - spanning Georgia, Tennessee, Kentucky, Illinois, Missouri, Arkansas and Oklahoma – to retrace the path of their ancestors. Of the estimated 16,000 Cherokees forced to march to Indian Territory in the late 1830s, 4,000 died from exposure, starvation and disease, giving credence to the name Trail of Tears. During the ceremony, tribal leaders will wish the cyclists a successful trip and safe return. The CN riders are Daulton Cochran, Emilee Chavez, Lily Drywater, Dale Eagle, Parker Weavel, Sky Wildcat, Courtney Cowan, Autumn Lawless and Amari McCoy. Jennifer Johnson, a CN citizen and Oklahoma City lawyer, was chosen as this year’s mentor rider. Cherokee Nation Businesses Executive Vice President Chuck Garrett, an avid cyclist, is also expected to join the cyclists during the journey’s first week. Follow the riders at <a href="http://www.facebook.com/removal.ride" target="_blank">www.facebook.com/removal.ride</a> and on Twitter and Instagram with the hashtags #RTR2018 and #WeRemember.
BY STAFF REPORTS
05/25/2018 12:00 PM
OKLAHOMA CITY – Officials with the Oklahoma Senior Games said registration for the 2018 competition is open and will feature 20 events, including new ones such as a power walk, softball, corn hole and washer pitch. Local Senior Games events were held this spring in Yukon and will be held this fall in Ardmore from Sept. 7-14. Fall events will also be held in the Oklahoma City and Tulsa areas. All athletes must be 50 years old by Dec. 31, except for those who compete in badminton, cycling, tennis and table tennis. Those events are open to athletes who are 40 and older by Dec. 31. Participants will compete in one of the following age categories for both individual and/or doubles sports: 50-54, 55-59,60-64, 65-69, 70-74, 75-79, 80-84, 85-89,90-94,95-99 and 100 and older. Team sports are divided into the following brackets: 50-plus, 55-plus, 60-plus, 65-plus, 70-plus, 75-plus, 80-plus and 85-plus. Partner and team age groups will be determined by the age of the youngest partner/team member. Athletes may enter as many events as their schedule allows. Participants finishing in the top places in their age category in each event qualify for National Senior Games set for June 14-25, 2019, in Albuquerque, New Mexico. Early bird registration is $50 before 11:59 p.m. on Aug. 1. After Aug. 1, registration is $60 until two weeks before each event’s entry deadline. Fee includes up to 6 events. Additional events will be $5 each. A $10 fee will be added for paper registrations. For more information, visit <a href="http://okseniorgames.com/" target="_blank">http://okseniorgames.com/</a>.