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 BRITTNEY BENNETT
Reporter – @cp_bbennett
06/13/2018 08:30 AM
TAHLEQUAH – Establishing healthy eating patterns tailored to personal, cultural and traditional preferences that are low in sodium and saturated fat is essential to a balanced diet for young adults between the ages of 20 and 35, Cherokee Nation Clinical Dietitian Tonya Swim said. “All the food and beverage choices a person makes matters,” Swim said. “For most healthy individuals a balanced diet should have a variety of vegetables and whole fruit, low-fat or fat-free diary, half of their grains from whole grain sources, a variety of protein choices, including lean meats, seafood and vegetable sources.” Swim said that while a single healthy eating pattern will not fit everyone, all foods high in saturated fat, sodium and added sugar should be limited. She recommends individuals inspect their food’s nutrition facts label when shopping, especially for those who may buy frozen foods such as microwavable meals. “Most meals like this lack in fruits and vegetables, so adding a whole piece of fruit and a steamed bag of frozen veggies can help to meet a person’s daily fruit and vegetable needs. This is also a great way to add in extra vitamins, minerals and fiber,” she said. A good method of comparing the nutritional values of two or more food items is to examine the label’s percent of daily value, Swim said. “Search for items with the lowest amount of saturated fat and sodium and the highest amount of fiber. Five percent daily value or less of a nutrient per serving is low, and 20 percent daily value or more of a nutrient per serving is high. One nutrient that we want to strive to get more of is fiber, so this nutrient on the nutrition facts label should be as close to 20 percent daily value as possible.” That advice is especially important for those who choose to maintain a vegetarian lifestyle. “If an individual chooses to go 100 percent vegan, please be aware of nutrients that may be lacking in their diet, including iron, zinc, protein, Omega-3 fatty acids, vitamin B-12, vitamin D and calcium,” Swim said. She said food sources for proper iron nutrients include almonds, oatmeal and spinach, while hummus, some whole wheat breads and cashews are good zinc sources. Fortified foods are good vitamin B-12 sources. For protein, Swim recommends peanuts, quinoa, edamame, chickpeas, lentils, black beans and kidney beans, while calcium can be worked into a vegan diet with turnip, mustard and collard greens, figs and kale. Fortified soymilk is also a good source of vitamin D in addition to calcium, while walnuts and flaxseeds are good for Omega-3 fatty acids. “Following a plant-based diet or even a full vegan plan does have health benefits, such as a lower risk of heart disease, some cancers and type 2 diabetes,” Swim said. “If a vegan plan is something you would like to consider, please speak with your health care provider and registered dietitian before you begin.” Young adults should also be aware of what they might be adding to their drinks, including coffee. “It’s important to note that some coffee beverages can include calories from added sugars and saturated fat, such as creamers. So be cautious when getting your specialty coffees,” Swim said. Coffee consumption should also be “moderate,” according to dietary guidelines. “A moderate amount would be three to five 8-ounce cups a day,” Swim said. “This would approximately 400 milligrams of caffeine daily. The exception to this may be if a person has a medical condition in which their medical provider has reduced the amount of caffeine they should have, so talk to your primary provider.” Swim recommends those eligible for services with CN Health Services and seeking more information about individualized diet plans should contact their primary providers and ask to schedule an appointment with a registered dietitian.
BY STAFF REPORTS
06/11/2018 09:00 AM
TAHLEQUAH – People tend to spend more time outdoors in warmer weather. But it’s important to remember that warmer weather brings ticks and the illnesses they can carry. According to the Centers for Disease Control, Oklahoma ranks among the states with the highest ehrlichiosis, Rocky Mountain spotted fever and tularemia rates, and May through August is the stretch of months when ticks are most active. <strong>Ehrlichiosis</strong> The lone star tick is the primary carrier of ehrlichiosis in the United States. Symptoms include fever, headache, fatigue, chills, nausea, vomiting, diarrhea, confusion, rash and muscle aches. Usually these symptoms occur within one to two weeks following a tick bite. Ehrlichiosis can be fatal if not treated correctly. The estimated fatality rate is 1.8 percent. Patients who are treated early may recover quickly on outpatient medication, while those who experience a more severe course may require intravenous antibiotics, prolonged hospitalization or intensive care. The severity may depend on the patient’s immune status. People with compromised immunity caused by immunosuppressive therapies, HIV infection or splenectomy appear to develop a more severe disease and may also have higher fatality rates. Doxycycline is the first line treatment for adults and children of all ages and should be initiated immediately whenever ehrlichiosis is suspected. Use of antibiotics other than doxycycline and other tetracyclines is associated with a higher risk of fatal outcome for some rickettsial infections. Therefore, treatment must be based on clinical suspicion alone and should always begin before laboratory results return. <strong>Rocky Mountain spotted fever</strong> RMSF is transmitted to humans in the United States mostly by the American dog, Rocky Mountain wood and brown dog ticks. Symptoms include fever, headache, abdominal pain, vomiting and muscle pain. A rash may also develop, but is often absent in the first few days, and in some patients, never develops. RMSF can be severe or even fatal if not treated in the first few days of symptoms. Doxycycline is the first line treatment for adults and children of all ages, and is most effective if started before the fifth day of symptoms. Symptoms typically begin two to 14 days after the bite. The disease frequently begins as a sudden onset of fever and headache and most people visit a health care provider during the first few days of symptoms. Because early symptoms may be non-specific, several visits may occur before the diagnosis is made and correct treatment begins. It is a serious illness that can be fatal in the first eight days of symptoms if not treated correctly. A classic case involves a rash that first appears two to five days after the onset of fever as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles and spreads to include the trunk and sometimes the palms and soles. Often the rash varies from this description, and people who fail to develop a rash, or develop an atypical rash, are at increased risk of being misdiagnosed. The red to purple, spotted (petechial) rash is usually not seen until the sixth day or later after onset of symptoms and occurs in 35 percent to 60 percent of patients with the infection. This is a sign of progression to severe disease, and every attempt should be made to begin treatment before petechiae develop. <strong>Tularemia</strong> The bacterium that causes tularemia can enter through the skin, eyes, mouth or lungs. In the United States, ticks that transmit tularemia to humans include the dog, wood and lone star ticks. Deer flies have been shown to transmit it in the western United States. Symptoms vary depending on how the bacteria enter the body. Illness ranges from mild to life-threatening. All forms are accompanied by fever, which can be as high as 104 degrees Fahrenheit. Main forms of this disease are: • Ulceroglandular. This is the most common form and usually occurs following a tick or deer fly bite or after handing of an infected animal. A skin ulcer appears where the bacteria entered. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin. • Glandular. Similar to ulceroglandular tularemia but without an ulcer. Also generally acquired through the bite of an infected tick or deer fly or from handling sick or dead animals. • Oculoglandular. This form occurs when the bacteria enter through the eye. This can occur when a person is butchering an infected animal and touches his or her eyes. Symptoms include irritation and inflammation of the eye and swelling of lymph glands in front of the ear. • Oropharyngeal. This form results from eating or drinking contaminated food or water. Patients with oropharyngeal tularemia may have sore throat, mouth ulcers, tonsillitis and swelling of lymph glands in the neck. • Pneumonic. This is the most serious form. Symptoms include cough, chest pain, and difficulty breathing. This form results from breathing dusts or aerosols containing the organism. It can also occur when other forms of tularemia (e.g. ulceroglandular) are left untreated and the bacteria spread through the bloodstream to the lungs. • Typhoidal. This form is characterized by any combination of the general symptoms (without the localizing symptoms of other syndromes). Tularemia is rare, and symptoms can be mistaken for common illnesses. It’s important to share with your health care provider any likely exposures, such as tick and deer fly bites, or contact with sick or dead animals. Antibiotics used to treat tularemia include streptomycin, gentamicin, doxycycline and ciprofloxacin. Treatment usually lasts 10 to 21 days depending on the stage of illness and the medication used. Although symptoms may last for weeks, most patients completely recover. <strong>Preventive Measures</strong> While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months when ticks are most active. • Avoid wooded and brushy areas with high grass and leaf litter. • Walk in the center of trails. • Use repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours. • Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth. • Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5 percent permethrin. It remains protective through several washings. Pre-treated clothing is available and may be protective longer. • Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you. • Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair. • Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats and day packs. • Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors. • If the clothes are damp, additional time may be needed. • If the clothes require washing first, hot water is recommended. Cold and medium temperature water will not kill ticks effectively. If the clothes cannot be washed in hot water, tumble dry on low heat for 90 minutes or high heat for 60 minutes. The clothes should be warm and completely dry.
BY ASSOCIATED PRESS
06/09/2018 02:00 PM
TULSA (AP) – Oklahoma has high rates of death from heart disease, stroke, cancer and respiratory disease despite a decrease in smoking, according to a new report. Less than 20 percent of Oklahoma adults smoke, down from 25 percent a decade ago, according to the State of the State’s Health Report that was released Monday, The Tulsa World reported . The teen smoking rate was 13 percent in 2015, down from about a third of teens smoking in 2005. However, the state still has a high rate of health issues tied with smoking, such as lung cancer and heart disease, the report found. The effects of smoking aren’t automatically reversed by quitting, said Leanne Stephens, a spokeswoman for the Tulsa Health Department. She said that according to the U.S. Department of Health and Human Services, cancer risks can be cut in half within five years of quitting and the risk of a stroke could be reduced to that of a nonsmoker within two to five years. Increasing rates of obesity may also be contributing to high rates of heart disease, the report said. The state has seen its obesity rate more than double since the 1990s, the report found. About a third of adults in Oklahoma and 20 percent of adolescents are overweight, the report said. Obesity also likely contributes to the state’s high rate of diabetes, with 12 percent of the population with the disease. “The prevention of obesity is a complex problem and requires a multi-faceted approach,” Stephens said. “There are many factors that contribute to obesity rates, including poor diet and inactivity.”
BY STAFF REPORTS
06/07/2018 04:00 PM
CLAREMORE – The Claremore Indian Hospital will sponsor a Veterans Affairs Enrollment Fair from 10 a.m. to 2 p.m. on June 26. Hospital officials said the fair is to assist their Native American veteran patients in applying for eligibility for health care services through the VA. “We will have Claremore Indian Hospital benefit coordinators and representatives from the VA to assist with the application processes,” Sheila Dishno, Claremore Indian Hospital patient benefit coordinator, said. “We will also have Oklahoma Department of Veterans Affairs here to help with those that need help filing a service claim. Please make plans to attend and bring your financial information (income and resource information) and DD-214 (military discharge) papers.” If already enrolled, call 918-342-6240, 918-342-6511 or 918-342-6559 so a hospital official can update your file.
BY STAFF REPORTS
06/03/2018 04:00 PM
CLAREMORE, Okla. – Blue Cross & Blue Shield of Oklahoma will be at the Claremore Indian Hospital on June 11 to assist patients with signing up for free to low-cost health insurance. The insurance company will be in Conference Room 2 from 9 a.m. to 3 p.m. to help people sign up for health insurance. Sheila Dishno, patient benefit coordinator at the hospital, said people who attend the fair should bring their Social Security cards, pay stubs, W-2 forms or wage and tax statements, policy numbers for any current health insurance and information about any health insurance they or their families could get from an employer. The hospital is located at 101 S. Moore Ave. For more information, call 918-342-6240, 918-342-6559 or 918-342-6511.
BY ASSOCIATED PRESS
05/28/2018 12:00 PM
TAHLEQUAH (AP) – Recovering addict Judith Anderson figures if she hadn’t entered a program that caught and treated the hepatitis C she contracted after years of intravenous drug use, she wouldn’t be alive to convince others to get checked out. The 74-year-old resident of Sallisaw said the potentially fatal liver disease sapped her of energy and “any desire to go anywhere or do anything.” “It was like living with a death sentence,” she said of the infection that the U.S. Centers for Disease Control and Prevention said in 2016 killed more people than HIV and tuberculosis combined. “You’re just tired all the time.” But things changed for Anderson, a citizen of the Cherokee Nation, because she took advantage of the tribe’s aggressive program to test for and treat hepatitis C. Federal officials say it could serve as a national model in the fight against the infection. The CN, the second-largest tribe in the U.S. after the Navajo Nation, started the program three years ago looking to screen 80,000 of its 350,000 citizens, mainly targeting those 20 to 65 because of their statistically higher chances of having the disease. More than half of the target group has been screened, with more than 1,300 citizens testing positive, and a 90 percent cure rate among those who have started treatment, the tribe says. CDC official John Ward, whose agency is providing technical assistance to the tribe, said the CN is the first community to set such an ambitious goal to eliminate the disease. “It’s a trailblazing project for the entire country,” Ward said. The CN, which operates the largest tribal health care system in the U.S., are shouldering the cost of the program. The Tahlequah-based tribe is also capitalizing on medical advances that have seen the cost of the antiviral drugs used to treat the disease plummet from around $90,000 per patient just a few years ago to between $15,000 and $20,000. “We’re running the health system, why not take care of them early and give them a much better, longer quality of life?” Principal Chief Bill John Baker said. “It’s less stress later on by us doing it ... it’s a model for all the other tribes to be able to follow.” Hepatitis C is spread through infected blood, and hundreds tested positive for the disease in the Cherokee program after injecting drugs with unclean needles. Tribal health officials blame the nation’s opioid crisis for the increase in those cases. When prescription pills run out, many addicts turn to the streets for cheaper and more readily available drugs such as heroin, which is often injected directly into veins. The CN is suing several major drug distributors for what it claims is the companies’ failure to prevent the flow of illegally prescribed opioids to its citizens. Dr. Jorge Mera, the tribe’s director of infectious diseases, is on the front line of treatment. “In the last two years, I started hearing the word heroin more and more, every day,” Mera said in a recent interview at the W.W. Hastings Hospital in Tahlequah. “Now we are seeing a younger population coming (with hepatitis C) that’s predominantly due to IV drug use.” In addition to battling the drug epidemic and statistics that show they are 2.5 times more likely to die from hepatitis C, many Native Americans already must contend with rampant poverty and high unemployment that has plagued tribes for generations. “For Native Americans or any other group that undergoes a lack of nutrition, more violence, lack of opportunity — those kind of group experiences can change the biology of groups of people to make them more prone to addiction,” said Judy Grisel, a professor of psychology and neuroscience at Bucknell University and a recovering drug addict and hepatitis C survivor who has been sober more than 30 years. To be sure, the tribe is unique in that it is absorbing the costs of treating its citizens, but Ward, the CDC official, said communities can learn from the CN program by “involving a local champion and setting a goal for eliminating the disease.” “These efforts can inspire a community, help to develop partnerships and encourage accountability,” Ward said. “The Cherokee Nation was successful in part because it developed strategies to finance testing and treatment.”