A new era of health care is upon us as we begin to merge into a truly integrated, comprehensive academic health system. We know this merger leads to a lot of questions and we are committed to answering them as more information becomes available.
Table of Contents
Physician and Credentialed Provider Transition Timeline
What happens with providers that are eligible for retirement just a few months after the transition? Is there a way to address this? Special allowances were made for staff with this type of situation. This matter should be reviewed and addressed individually with those where there is concern around such a situation. (Updated August 12)
What is the date of the provider transition to OU Health Partners? The credentialed provider transition to OUHP (OU Health Partners, Inc.) will occur January 1, 2022 instead of the July 1, 2021 merger date. We believe that this longer time frame allows for robust review of information, collection of feedback from providers, and good decision making. (Updated July 2)
What is the benefit of making these changes, for both staff and providers, so rapidly? At the core, this merger is about integrating operations and decision making for the purpose of accelerating much needed system improvements, increasing resources to support our critical missions, assuring nationally competitive compensation, and much more. No other health system in our state, region, or the nation, is waiting to take actions that can immediately improve the likelihood of their future success. Progress toward our goals has been frustratingly slow and difficult to achieve in a system that was not fully integrated.
As for why so rapid, two specific examples of why we must move quickly are:
- The ability to capture 340b pharmacy benefits across more clinics. This means more access to much needed funding that will support key missions such as research-driven care. There is a window of transition available to us that provides an easier clinics conversion. It is available right now due to the easing of some restrictions on provider-based clinics due to COVID-19.
- The need to quickly prepare ourselves for the patient access needed for expanded Medicaid that begins July 1. This now gives a large number of patients a choice in where they receive service. Access to our providers and services is critical before other systems fully capture those patients because patients cannot access our services in a timely fashion or are deterred by disconnects between outpatient and inpatient services. (Updated July 2)
Physician and Credentialed Provider Structure
Will there be a standard definition for “citizenship” for faculty that are dually employed? “Citizenship” is defined as those activities that faculty engage in that are important for meeting department and college missions, but are not individually large enough to count as a specific percent effort on their workplan. These can include participation in committees, attendance at grand rounds, giving occasional lectures to learners, or helping teach staff development classes. Section and department leaders should help faculty understand what those elements are that fall into this category and how they assist in furthering the mission. The term “citizenship” is not meant to be all-encompassing however. Other responsibilities that a faculty member has should be clearly outlined as a part of their job duties so that these are appropriately accounted for and compensated as a part of their work effort for the college. Department chairs and Section chiefs should be clear on what those activities are, the expectations for those activities, and provide clarity on how the faculty is appropriately compensated for those activities that are important to meeting our college’s needs and mission goals. (Updated August 12)
What is OU Health Partners, Inc. and how is it related to OU Health? OU Health Partners, Inc. is the new 501c3, not for profit business entity that serves as the exclusive group practice for all employed credentialled providers in OU Health. OU Health Partners, Inc. will operate under various DBA (‘Doing Business As’) identifiers, such as OU Health Physicians or OU Health Children’s Physicians. OU Health Partners, Inc. is a legal sub-corporation within OU Health that is another Oklahoma not-for-profit corporation that is a fully integrated Academic Health System. It is the only fully integrated Academic Health System in Oklahoma.
We have also worked very hard to find the right balance so as to maximize Physician empowerment and partnership within the day to day management and administration of OU Health. We know that the more informed and empowered our physician leaders are and able to work side by side with management, the better the outcomes will be for our patients. This is one of the reasons we chose a dyad partnership model for organizational leadership throughout OU Health. This model will be described in more detail in our sessions that specifically focus on governance. This is a proven national model that works. It is absolutely necessary to achieve the great patient care, great patient satisfaction, quality and safety we desire for our organization.
Work related to setting up the structure of OU Health Partners, Inc. has been ongoing for months and we now have finalized bylaws for this new entity. These bylaws define the relationship between OU Health Partners, Inc. (doing business as OU Health Physicians) with the OU Health system. As stated before, OU Health Partners, Inc. is a new 501c3 faculty group practice sub-corporation within OU Health. It has its own governing board to oversee operations, policies, procedures and compensation and benefits of OU Health Physicians. Key committees will include many different important functions around clinical strategy, quality, finance, population health, informatics, etc. This structure will help us achieve the goals and strategies for the practice that we need as we continue to grow and expand.
Many have asked how was this structure chosen. That is a very important question. We looked at other highly successful academic medical centers regarding best practices knowing that how the faculty group practice works with the health system can dramatically affect the outcomes of patients in terms of quality care and patient experience. We spent hours on calls with key system leaders and faculty asking questions around what they would do and would not do if they had a chance to do it all over again. What we are doing here reflects the type of path that is a tried and true model in other successful academic medical centers.
Through this new governance and leadership structure, the goal is to empower our physicians and providers to be able to do their best work every day and conduct their day-to-day operations in ways that create the partnerships and teams we need to be successful for years to come. OU Health Partners will be the exclusive provider enterprise for OU Health statewide.
OU Health Partners, Inc. is a modern, incorporated, provider platform designed for an integrated health system. This is a structural path necessary to our success. Whether that success is realized will, however, be dependent on us all taking responsibility and running with it. This will help us further build our services and service lines to improve access to patients that need our services and improve patient outcomes.
Next sessions will focus on governance and management in much more detail so that providers can better understand the “why” and the advantages of this type of system. (Updated July 2)
What do we tell our faculty on visas about how their visas will work under the new plan? Given federal law, if someone is on a current visa, they will remain a 100% employee of the University until they complete that time. Those providing clinical care will serve OU Health Partners just as any other provider does, but compensation for their services will have to be paid to the university through a different mechanism. (Updated July 2)
How is the percentage effort for being a program director calculated? The required effort for program director administration time is based on ACGME requirements for each specialty. These have been calculated by the GME office and reviewed by the Graduate Medical Education Committee of the College of Medicine. The money allocated to each department to cover compensation for this role is based on the approved percent effort required by the ACGME and the appropriate AAMC benchmark compensation for that specialty. (Updated July 2)
We have some contracts from external sources, like the City County Health Department. These don’t generate clinical WRVU’s but generate income. How will the faculty whose time and compensation is derived from that contract be paid? When the revenue from those sources comes in, it will go to OU Health Partners and then will be attributed to the clinical department for compensation of those providers on that contract. It will not go into an unspecified OU Health bucket first as has been noted in various rumors. (Updated July 2)
Can you explain more about how our time will be divided between OU Health and OU Health Partners? Depending on individual roles and responsibilities, credentialed providers may move to a dual employment model that mirrors what is common in many other academic health systems. Clinical work (including clinical time with learners) will be conducted through OU Health Partners, Inc., the new academic clinical practice. Academic and research work will continue through the University of Oklahoma. Compensation for each component of this work will similarly be afforded by either OU Health Partners or the University of Oklahoma. OU will act as the common paymaster for dually employed individuals.
For providers, including APP’s, who have only clinical roles (which, in an academic health system, includes interactions and work with clinical learners), they will be solely employed by OU Health Partners, Inc.
Department leaders have been asked to provide us with the allocation of effort of clinical, academic, and research work for their faculty and other providers. They were asked to provide this information because they have the best insight into the nature and scope of any given persons work. These leaders should now be reviewing these effort allocations with the providers to assure they are accurate. Adjustments may be made as necessary so as to reflect an accurate balance of a provider’s different roles. Currently, information shows that the overall split of effort for faculty providers is about 70% clinical and 30% non-clinical. This can vary by individual however depending on factors such as how much time a faculty is involved in research, administration, or educational leadership roles.
Accurately understanding this allocation of effort across providers work allows us to more accurately model compensation and benchmark ourselves against our peers in a way that assures that we can achieve locally and nationally competitive compensation. For example, to assure fair and competitive compensation for our faculty, clinical compensation can be benchmarked per Medical Group Management Association (MGMA) data and academic/research compensation benchmarked per AAMC or another specific academic group that tracks national level data on compensation. (Updated July 2)
Advanced Practice Providers
OU Health Partners and the OU Faculty, is that same thing? Not necessarily. OU Health Partners is a new 501c3 sub-corporation of OU Health. It is the exclusive employed provider group for OU Health. That includes OU Faculty that are credentialed healthcare providers. Faculty positions, however, are only appointed through OU Colleges and not through OU Health Partners or OU Health. (Updated July 27)
Will there be some system of onboarding, determining consistency in pay grades and scales, etc., that will be more unified for APPs under OU Health Partners? That’s the exact reason for OU Health Partners…so that we may have a more uniform approach than has been present historically. For example, in the past, there have been some APPs employed by the hospital, some in College of Medicine departments, some as hourly staff and others not. Additionally, approaches to roles and compensation were inconsistent and too often very confusing. As one employed provider group under OUHP, we are creating a more uniform approach to meeting the needs of our APP team members and serving our various missions. This includes assuring appropriate role definition and recognition, credentialing, onboarding, professional development, and benchmarking of pay. (Updated July 27)
What about faculty appointments for APPs? How will this be handled? Faculty appointments are determined by the policies in each OU college. They relate to the role and kind of effort a provider has in the academic and research work done by that college. Specifically, around the question of dual employment eligibility for those that have a faculty appointment, provider employment is determined by where funding is provided for the related faculty responsibility. Within the College of Medicine, we have a number of MD faculty who are 100% clinical. All are all involved in some way with teaching learners in their respective clinical settings. Those faculty may, however, be employed in various institutions other than OU such as the VA, Dean McGee Eye Institute, and other systems throughout the state. This now includes OU Health Partners.
Faculty providers may also have various roles and amounts of time working in areas such as educational program development, administration, research, etc. through an OU college. In the College of Medicine, that variation requires us to have a wide variety of faculty appointments, some with larger and well-defined academic and research roles that are only found within OU.
For APPs we’re now trying to create a uniform approach to making determinations around faculty appointments, and using the same approach across all the colleges. For those people who are much more heavily involved in academics and research, a faculty appointment and work as a college employee may be in order, but it won’t mean that everyone in OU Health Partners will be faculty or dually employed. (Updated July 27)
As a staff Nurse Practitioner planning on earning my Ph.D., in a year or two, I’d like to have an appointment with the College of Nursing. Has a way to blend the College of Nursing and OU Health been established? Dean Hoff is looking for an opportunity to have more of our advanced practice nurses with an interest in academics and research have dual employment, similar to what our physician faculty have now in the College of Medicine. We really want to make sure that whether you are an APRN, PA or other credentialed provider, you would all be part of one employment group however, so the potential for a faculty appointment will be as consistent as possible. (Updated July 27)
What about PAs who are already volunteering on days off to give lectures at the OU PA program without any compensation? In our PA program, our core PA faculty are about 80 percent academic and 20 percent clinical. That said, there is plenty of room for a person who is not dually employed to still have a faculty appointment as a volunteer faculty. The College of Medicine has a large number of volunteer faculty across the metro and the state that teach our students and residents. They are essential parts of our education team. (Updated July 27)
PAs and NPs are used interchangeably a lot of time. A lot of us feel we have a lot to lose and want to know we have value in the system. It seems like we’ve been left out of communications. How did that happen? Our email groupings have not helped and unfortunately created the concerns you raise. We have realized that the better part of future communication is to go through an all credentialed provider email group so that people are not inadvertently left out. We’ve had a hit or miss situation early on with how those emails were making it to people. It was part of our learning curve. We are sorry for any confusion or hurt that this has caused and we think we have it solved now. (Updated July 27)
Are we going to be employed by OU Health Partners on a case by case basis and do all OU Health Partners have a potential for dual employment? The vast majority of non-physician credentialled providers that bill for their services will be 100% employed by OU Health Partners. Again, the only distinction we’ve talked about so far where a credentialed provider would be employed by OU Health is when that person is functioning in an administrative role with OU Health. They would then stay in that role under OU Health.
There will be those, determined on a case by case basis, who will also have another well-defined role in academics and research that would require dual employment. For example: core academic faculty, such as those in our PA program (80% academic) would have dual employment. 80% on the OU side and 20% with OUHP. Additionally, some of our credentialed providers that are substantially paid through a University research grant would also have dual employment. Most research will stay as part of the university. If what you are doing is primarily clinical, you can expect to be employed by OU Health Partners. Remember, “clinical” also includes the teaching of learners within the clinical environment. (Updated July 27)
When will we know the specifics on how employment transition will effect us personally? A number of decisions have to get made and figured out. For that reason, your formal transition, like the physicians, won’t happen until January 1. We know that you want to know now, but the answer is that we are working on getting a lot of the details you will need. We hope to get you these answers in the next couple of months, and certainly well in advance of any transition. One of those aspects includes compensation plans, which are being reworked now by the College of Medicine. We are trying to standardize the compensation for APPs and other credentialed providers as well to do away with the confusion and inconsistencies that have created concerns and problems in the past. We recognize that different roles, responsibilities, and levels of training will always warrant special considerations. We are looking at all these things on a group-wide basis. We are also reaching out to the APP council for input on this.
We will need to have a document that is specific to each individual person. Obviously, a lot of work has to go into that with input from a lot of different departments. (Updated July 27)
So will physicians find out first about the transition plans and compensation? No, we want to roll it all together. We want to make sure there is plenty of time for each provider to see what it looks like for them. There are a lot of different types of credentialled provider positions. We won’t give the information to physicians and leave others in the dark. (Updated July 27)
I rely on what kind of info I get about raises and benefits from my section chief. It would help to have a place I can look it up on a website. We are looking at putting information in an easy to access place so we are not adding to confusion. (Updated July 27)
If you meet the requirements for a faculty role, who would you reach out to see if they need to be reassigned/titled? Right now that goes through departments and department chairs. The College of Medicine Faculty Board is responsible for all college policy on faculty roles, titles, and promotion policy. Department chairs have this information. Dean Zubialde and Dean Crow are also working with Dean Hoff in nursing to assure there is consistency across the colleges. (Updated July 27)
If I’m faculty now, does this transition necessarily mean I may no longer be faculty? No, it doesn’t mean that. Deciding who is appointed as faculty and who isn’t, depends on a person’s specific roles and responsibilities for the academic and research work of a college. For those with faculty appointments now that are largely clinical, when employment changes, you might go to a volunteer faculty appointment. The title may not change, but the status of the appointment as volunteer or non-volunteer could change. That change doesn’t however diminish the role, the importance, the ability to promote academically, or the ability to work on research and publish for those that are doing so currently. The college has many dedicated volunteer faculty around the metro area and state that are an integral part of our work as a college. (Updated July 27)
How do payor and outside clinical contracts work going forward? As of July 1, our payor contracts have been signed over to OU Health Partners, so all of that revenue now goes to OU Health Partners. There is a time limited temporary agreement between OU Health Partners and OU to support the efforts that providers are doing until the January 1 transition. Additionally, we have NICU docs and NPs who provide coverage to other community NICUs. There are also other clinical contracts in place with other systems. That contract money now runs through OU Health Physicians to support the compensation of those doing that work.
The contracts that are not transitioning over are, for the most part, research contracts – those stay with the university. There could be times where a specific research contract might best be subcontracted to OU Health Partners and we’re still working on those details. We don’t want people flip flopping back and forth between OUHP and OU in a way that might affect benefits/retirement. We are trying to figure out the balance between those factors as relates to specific contracts. (Updated July 27)
How do tuition waivers work after January 1? Dually employed faculty will continue to be eligible for an OU tuition waiver for dependents attending OU.
If you become 100% employed by OU Health Partners, those with a dependent attending OU will receive a benefit in the amount of tuition, subject to details that will be forthcoming in policy relating to the timing of when that reimbursement can be received. This policy will pertain to currently enrolled dependent family members or those whose dependents are enrolled beginning in the next three years. Those with dependents entering OU within the next three years will be eligible for four years of benefits. It will not come off the OU bursar account but be a reimbursement payment made to the employee by OU Health Partners. The amount is the same, but it becomes taxable income as the university cannot do it as a waiver under IRS rules. We are trying to make it as equitable as possible, but the fact is that IRS rules and regulations apply here and require this to be shown as a taxable increase in employee income paid by OU Health Partners.
We will also continue to evaluate this benefit as a recruitment tool. We recognize that it can be a very impactful thing for recruitment and retention. (Updated July 27)
Regarding mental health providers and other non APPs -- are they part of the APP Councils? We need to make sure that that all groups are heard in our discussions. We also need to have a more consistent onboarding process, more consistent voice, more emphasis on the professional development aspect as well. We need to hear from everyone so as leaders, we can make sure those important elements are brought into the voice of this organization. The APP Council will reach out to include others in its communications. (Updated July 27)
What about reimbursements for licensure/CME? Those are all part of professional requirements, so no matter your role, all those are necessary for what you do. Those are part of the benefits structure. (Updated July 27)
Explain how compensation decisions will work. Hospital employees have often gotten raises as part of annual review; OU counterparts may have gone years without raises. That inconsistency is one of the reasons we have done this merger and are restructuring the employment of credentialled providers. We want to standardize this as people with the same qualifications working side by side today may have very different compensation. We are in a highly market competitive environment today so we recognize that and must address it quickly. We will all now be working now for the same group. The expectation is that all these positions will be exempt and not hourly. Recognition of roles and training will be now be consistent and market assessments done regularly to assure we are competitive. (Updated July 27)
Is compensation based on a 40-hour or 36-hour work week? That will need to be addressed by individual service teams. For example, we have physicians who are paid clinically on a productivity basis without any specific expectations for hours as relates to compensation. We have others such as hospitalists and ER providers, whose duty time and compensation are more shift based. The answer is that there are different ways of scheduling work and the appropriate compensation for that work. Much of this is based on how our services and the market have traditionally set expectations for work and compensation. (Updated July 27)
What If you’re not in a dual role, is promotion only through faculty? No. Not being a faculty doesn’t mean you won’t have opportunities for career progression and promotion in non-faculty roles. (Updated July 27)
As APPs (OUP and OUMI), some of us have never had the opportunity to be faculty, administrative executives, clinic directors, APP directors, or have tuition reimbursement for our kids. What are our opportunities? This is a golden moment for us all to advance both clinically and from an academic perspective. It’s up to us to define that as we go forward. We have consultants hired to join us later in the year to review our situation and help us address these very matters. Along with the APP Council, we are all working together. Where we are sitting today and where we will be in a year is going to be different. We are all pioneers.
If you feel really strongly about helping on the advancement ladders and other aspects, sign up for the APP Council committees. It’s all volunteer based, but one person can’t do it. Individuals who feel strongly should reach out and let us know. Contacts for the APP Council are: Karen Genzel – Karen.firstname.lastname@example.org – and Abby Moeller – email@example.com. You can find more information through this QR Code.
The APP Council consists of APRNs, Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), Nurse Practitioner (NP), Certified Nurse Midwives (CNW) and Physician Associates (PA). Traci Bartley – firstname.lastname@example.org -- coodinates a group of LCSWs. (Updated July 27)
Will APPs be included in APIC? Right now, APPs that are employed by OU are not included within APIC because they are covered by the Oklahoma Governmental Tort Claims Act. APPs will no longer be working for the State after January 1, so this Oklahoma state protection will no longer apply and malpractice coverage will be under APIC. The cost for this malpractice coverage through APIC was factored in to integration plans. All protection will be at standard levels and will be effectively an occurrence policy type of protection (the best out there) for all. (Updated July 27)
Who will be our direct leader? The intent is not to change lines of authority. A lot of the organization structure is being developed and will cascade depending on that structure. Even with the physicians, we aren’t going in and saying you no longer report to a specific section chief. APPs may now answer to different people and we are working on making it clearer which team a provider is on and who they report to. The goal here is having well led, effective, and cohesive teams that assure we provide great care and have a great working environment. (Updated July 27)
Currently some APPs are salaried and some are hourly, resulting in a lot of variation. How will APP roles and compensation look with the January 1 transition? APPs in a purely administrative role or other nonclinical role, for example Risk Management, will be employed by OU Health. APPs in a clinical role will be employed by OU Health Partners, Inc. The compensation source will therefore vary based on role. By integrating clinical APPs into OU Health Partners we create a consistent approach to employment, evaluation, onboarding, and professional development. APPs that have substantial responsibilities for nonclinical work such as teaching medical or other health professions students or that do research for OU may also need to have a dual employment status. (Updated July 2)
Will APPs lose their tort protection? APPs working for OU Health Partners, Inc. will no longer fall under Oklahoma tort claims protection as was the case when employed by OU. As such, all APPs in clinical roles will now be covered by OU Health Partners through APIC for their malpractice insurance to assure excellent and consistent coverage at appropriate policy limits comparable with physicians. (Updated July 2)
Funding and Compensation
Will compensation be tied to patient satisfaction scores? If so how can a provider control for implicit bias — which can lead to lower scores for women, people of color, or those that are foreign-born? We all need to be accountable for our work in meeting goals, but we also recognize that any metrics can have bias. This must be noted and addressed in an appropriate and fair fashion. The metrics used will have to fit the goals we set for ourselves. There is certainly no one-size-fits-all. Prudence must always be a component of any type of measurements that departments, sections, and we as an enterprise set for ourselves. (Updated August 12)
Do compensation plans account for inflation? Fair compensation is based on a number of factors that include inflation as just one of the many components. Others factors include local and national trends. It is through appropriate benchmarking to regional and national standards that we will assure that compensation is fair and appropriate. (Updated August 12)
Will some compensation decrease in this new model? The goals of the new model are several fold. First and foremost are fairness and accountability for the work that is done to meet our mission goals. It is only when these are in place that we can provide the desired equity and transparency for compensation within departments and sections, and across the enterprise. When accountability is tied to appropriate benchmarks, the result is fair compensation. That said, benchmarks can both increase and, to a lesser extent, decrease.
Because we do not yet have all of the elements in place yet surrounding new compensation models, the promise for providers is that for this fiscal year (2022), compensation will not decrease unless a person reduces their work effort (i.e. works less than what they are doing today). In many cases, we expect compensation to actually increase, and there has been substantial amounts of new funding added to our budget to address those areas where we anticipate the need for compensation increases. As they are developed, the new models will be used to visibly demonstrate to individual providers what their compensation will look like beginning in the next fiscal years. That way each provider can see and make decisions with leadership on effort and compensation going forward. (Updated August 12)
How will funding for things like continuing medical education (CME), licensure and overall professional development be affected? OU Health has a set amount available for individual providers to help cover costs for things such as licensure, required CME, etc. As for more discretionary items related to mission critical business, Departments will be responsible for making those decisions on allowed time away and what costs will be covered. Those costs will be covered out of departmental budgets. (Updated August 12)
Many people believe there was not enough attention paid to inequities in staff compensation during the transition. When they did the math they found they would be receiving less money than what they were taking home under OU Physicians. Many have health issues of their own, so when you add medical benefits choices into the equation, they will be receiving less on their checks. Why? The plan in place for non-provider staff compensation is a three-step process:
- First and foremost, there was no intention for any staff to have less compensation by transitioning into OU Health. Understanding that many salaries were already low compared with the market, and that there could be shifts in take home pay based on benefits choices and position descriptions that differed between OU Physicians and OU Health, all staff received an additional 2% above what they were previously making. Some positions in areas of known gaps got an additional 2%. Even with this, some staff saw a potential take home pay decrease when making their benefits choices. Additionally, some saw pay discrepancies between themselves and staff on the OU Health side.
- To address this, the second step is that staff who saw a loss in take home pay during the transition will receive an additional amount to assure there is no loss of take-home pay after benefits choices. This will occur in July. The staff in this situation should get a confirmation letter on this soon.
- Lastly, we are beginning the phase of actively researching the way job codes are categorized in OU Physicians and translating those into OU Health job codes. This analysis will also recognize unique roles and specialized training in order to assure these staff are being paid at appropriate market competitive rates. In this phase we will take a hard look at compensation to make sure it is market competitive and appropriate across the enterprise. Substantial resources have been added to address these potential compensation discrepancies. We did not, and do not, want any staff leaving over perceived inequities. (Updated July 2)
Will we offer signing bonuses or other incentives in outpatient positions? Yes. We are looking at incentives for recruiting nurses, MAs, senior MAs and other roles where we have significant needs given the very tight job market in the metro area today. (Updated July 2)
For faculty who will be dually employed, how does compensation work given that clinical and academics are often mixed together across what faculty do? Clinical work (both direct patient care and clinical administration) is being paid through OU Health Partners after January 1, 2022. That work includes the teaching of residents and students while in a clinical setting. The term “clinical setting” is defined as any setting and/or work where clinical bills are generated by a provider and or other clinical revenue is generated via professional services contracts for the work done by those providers. Work that is not performed in such clinical settings and that specifically supports the academic and or research missions (including academic administrative roles such as a program or clerkship director, course directors, and others) is paid through the College of Medicine.
These various clinical, academic and research responsibilities and the compensation for each setting and role will be defined by a workplan generated by departments for each faculty. Why? The goal is transparency, fairness and assurance of appropriately-benchmarked compensation for the work that is needed to support our missions, whether that is clinical or academic. That level of transparency is something that has, unfortunately, not been present in some areas across the college. Lack of transparency in compensation has created significant concerns and distrust by many faculty, especially junior faculty. These efforts are designed to correct that. (Updated July 2)
What happens if a Department runs out of money? For example, the Genetics program is vital to the mission, but will never break even. The Department of Pediatrics currently supplements that program to make things work. Programs such as Genetics serve multiple missions. Each program must therefore be looked at in light of its academic, research and clinical missions and the funding needed to support it. The College of Medicine receives a limited amount of funding from the state and other sources to support the core academic work of the medical school. Other academic and research revenue comes to the College via sources such as direct mission support from OU Health. The College’s first priority is to assure that these funds are used to support the required functions of the medical school so that the school and its core programs meet and exceed accreditation standards. To assure that this is accomplished, the College must make sure that funding is fairly allocated to the various departments based on the services their faculty provide in meeting the core educational and research needs of the medical school. As was said in our meetings, that funding is limited however. The good news going forward is that as OU Health becomes increasingly successful, more money will be available to support the academic and research missions of the College through a direct mission support formula that is built into this merger. The success of our health system is therefore critical to the academic and research missions of the College of Medicine as well.
Over the years, departments have made choices to take clinically earned revenue and put this money into supporting various aspects of programmatic, academic, and research missions. If not done carefully, over time what happens is that clinical compensation goes down and, pretty soon, clinical compensation for providers is no longer market competitive. Since clinical compensation is the largest portion of clinical faculty compensation, departments then have a hard time retaining faculty because they can go elsewhere and make more money. Frankly, that problem has occurred far too often.
In our new model, we have a mechanism where a department can still take a certain portion of those clinically generated dollars and apportion them to the academic and research missions. What is different going forward, however, is that we will require those departmental decisions to be above board, approved by the College of Medicine and OU Health Partners, and monitored to assure they are meeting intended goals and not compromising competitive clinical compensation.
All that said, in some cases where there are significant funding discrepancies in supporting a program, there will be hard choices that will have to be made going forward. Why? Because we do not have unlimited resources and we have to be good stewards of our resources. Should that happen, we will be transparent and above board about both the why and what. As you will recall hearing, the College and OU Health Partners are putting substantial resource increases into both academic and clinical missions for this new fiscal year. That said, undoubtedly, there will still be some hard choices to make going forward.
What is different for departments -- and their budgeting -- in the new integrated model is that the enterprise, not departments, is assuming the responsibility and risk for all clinical program expenses. In the case of Genetics, funding for the clinical mission now becomes a responsibility of OU Health, and the burden is no longer just on the department of Pediatrics. That is a good thing, because departments can now focus on assuring appropriate payment for the missions that they are obligated to support as a part of the medical school.
Lastly, another goal of both the College of Medicine and OU Health Partners is to assure that provider and faculty compensation is market competitive. Whether you’re in a profitable clinical discipline or one that has historically had difficulty even breaking even on professional fees, the payment made for work done is based on what the appropriate compensation benchmark is, not just what funds were available from professional fees. That said, departments will still need to be good stewards of the resources they receive and make hard decisions sometimes in order to not overspend. (Updated July 2)
We are being told we will be compensated competitively, but when will we see the proof of this? Departmental compensation plans have not yet been finalized. Why? This involves a multi-step process in order to do it right. The first part of the process requires getting good information on the roles and responsibilities of each faculty across each mission and then using that information to model the faculty effort on both clinical and academic sides. This first step has to be done correctly before moving to step two. We are not fully convinced that this has happened yet, and are actively working with business managers and clinical chairs to assure this step is completed accurately. Step two is then using that data and rolling out the compensation models so that faculty and providers can see and understand them. Though many faculty have been completely unaware of this fact, a group of about 15 or more multi-departmental faculty (including basic science) have been working for well over a year to help us define appropriate compensation plan models.
This important task has therefore not been being done in a vacuum as some perceive. Making progress is no simple task given that we currently have 20+ different clinical compensation plans in place across departments at present, often with little consistency or transparency. That historical legacy has not served us well. Going forward, the College of Medicine in conjunction with OU Health Partner’s Board will review every departmental clinical compensation plan with a goal of assuring the plans are fair and transparent to faculty and providers. Departments will then also be responsible for arriving at fair compensation for each individual faculty and providers within the boundaries of those plans. We fully understand that one size does not fit all, but, we will have to standardize some aspects of compensation plans that have similar characteristics in order to create equity, fairness, and transparency in compensation. These goals are ones that we believe everyone can support. (Updated July 2)
You say there will be support for those departments that don’t generate adequate money through their clinical professional fees to support competitive clinical compensation. What specifically will be done to support those specialties? Departments are now very dependent on clinical revenues generated from professional fees that may be too low to adequately support the clinical work that is actually being done. These revenues can also vary widely from department to department. We know full well that there are some disciplines that cannot make it on what can be billed and collected through professional fees alone despite being very clinically productive. That growing discrepancy has created winners and losers over the years within our departments.
Correcting this problem is one of the core reasons that this integration is so important. In our new model, OU Health is responsible for covering all clinical costs and assuring that OU Health Partners is paid fairly for the services provided in order to assure market competitive compensation for the work done. This new model allows for sharing of clinical revenue that comes from various core services across both provider and hospital entities. That sharing is key to making things work in today’s highly competitive markets. If you look at a Mercy or Integris, that is exactly what they do and it is the reason that they can provide highly competitive compensation to their employed providers. It is also one of the reasons they have the ability to recruit our faculty away from us with offers of higher compensation. (Updated July 2)
Can you explain how this is beneficial to us financially and not just a bunch of cost cutting measures? When looking at total system allocations of funding for both compensation and benefits (i.e. total compensation) for both transitioning staff and providers, there are no decreases. We have allocated for significant increases in funding. These increases are for both the staff transitioning to OU Health now, and for providers transitioning to OU Health Partners, Inc. in January. There is also additional funding being allocated to our departments within the College of Medicine for academic and research work.
There was absolutely no cost cutting intention for compensation and benefits in this merger. Benefits structures and plans available for providers changed only because of the legal requirements of the merger and not because of finances.
The new practice structure afforded by OUHP will now let us set both compensation and total compensation (i.e. comp and benefits) at competitive national amounts benchmarked to local and national market compensation data, thus allowing us to ensure our providers are compensated appropriately and competitively. This is a proven structure within academic health systems across the nation and allows for better sharing and movement of resources to assure we can and will remain competitive rather than getting further and further behind as we have too often been doing in the past. (Updated July 2)
It sounds like all of our money will be flowing to OU Health. Can you explain how money will flow back into the academic departments?
- A workgroup which includes representative faculty has been working for a year and a half to design plans that allow us to more appropriately, consistently, and fairly compensate our providers for the work being done.
- The College of Medicine will continue to fairly allocate funding to departments for academic work and research, work that is vital to the medical school’s success.
- Because OU Health will be doing all billing and collections for both OUHP (providers) and hospitals, there is a detailed clinical service agreement between OU Health and OU Health Partners for payment of provider clinical services. Payment flowing through this agreement is specific enough to allow OUHP to accurately benchmark these payments against national benchmarks and assure competitive payment for that work. That benchmarking is key in order to have the funding needed to be nationally competitive and attract national talent.
- Historically, every clinical department in the COM supports academic/research to a certain degree through its clinical earnings. A mechanism has been built that will allow departments to allocate a portion of their clinical dollars earned in OUHP to the OU Foundation, or University, in order to continue to support academics and research. The amount and distribution of this support varies by department. To assure transparency, the OUHP board will assure that it is fair and monitored to assure it is used for intended goals.
- Funding earned by OUHP will then be delivered to departments to support their provider compensation plan. Department leaders are beginning to create the models to distribute those funds through their department in a way that meets their specific goals. These will have to be approved by the OUHP Board to assure they are fair, meet appropriate guidelines, and are competitive so as to assure they are able to recruit and retain talent.
- Compensation decisions for individual providers will be made by department leaders, not system leaders. (Updated July 2)
Will everyone who is currently faculty retain their faculty appointment on January 1? Historically, faculty appointments for APPs were granted not only because of a specific academic role but also to make some providers eligible for certain clinical incentive structures. With the creation of OU Health Partners, a faculty role is no longer a requirement to take advantage of these clinical incentives. All clinical providers, including Advanced Practice Providers, will now be part of OU Health Partners.
Going forward, the faculty appointment will be based on a provider’s contribution to the academic and or research work of the medical school (or other college) and tied to a specific academic role. Employment status alone will not be the primary factor. Providers will be informed well in advance of January 1 if any changes will be made to their current faculty appointment. The creation of OUHP will also open up the possibility of faculty roles and dual employment in other OUHSC colleges besides the College of Medicine. This is something we have needed for a long time and are now working on with the other colleges to be sure we have a fair and consistent approach to granting faculty appointments across them. (Updated July 2)
Can providers choose which benefits (OUHP or HSC) package they want to have? Medical, Dental, and Vision benefits are provided by OUHP for all clinical providers regardless of single or dual employment. Other benefits available then pertain to employment status with OU and/or OU Health. Several components of those are detailed below. Whether a provider has single or dual employment is dependent on the specific work being done by a provider for either OUHP, OU, or both (dual employment). Specifics on benefits will be discussed individually when the exact employment arrangement of each provider is determined by their department. (Updated July 2)
Is benefits availability based on the percentage allocation of work in either OUHP or the University? At this time, there is no minimum threshold of effort allocation to either the University or OUHP that must be met to be eligible for the benefits associated with the work being done for the employer. (Updated July 2)
Oklahoma Teacher’s Retirement System (OTRS)
Will experts be available to consult with providers regarding options and impact for their OTRS? We are currently exploring with OU and OTRS the best options to provide retirement management guidance to providers who have OTRS and will continue to update you as more information is available. They are interested in working with us and we are currently in the process of developing a tool to do sample calculations and projections for provider use. (Updated August 12)
If I have dual employment at the University, will I still be able to keep my Oklahoma Teacher’s Retirement (OTRS)? The portion of your compensation that is earned through the University is eligible for University retirement plans including OTRS. For OTRS, attributable years of service is dependent on the percentage of your FTE employment that is allocated to the University. The impact of a reduction in the number of attributable years of service due to part time employment with OU may affect the outcome. This can be roughly estimated using the OTRS calculators available on their website. More specific information requires review and discussion with OTRS directly. (Updated July 2)
If I have do not have dual employment at the University, will I still be able to keep my Oklahoma Teacher’s Retirement (OTRS)? For those who will not be dually employed, they will no longer be able to contribute to their OTRS plan. If a person is already vested in OTRS, there are personal choices that can be made. First, the member can leave principal in OTRS and collect a defined payout at age 62 or if/when they meet an appropriate rule for full eligibility (e.g. rule of 90 or 80). OTRS calculators for modeling payout are available on the OTRS website. Secondly, the member may elect to take the principal plus some accumulated interest that is in OTRS and roll it into a different qualified retirement plan account. (Updated July 2)
Extended Sick Leave
What about the Extended Sick Leave (ESL) I have saved with the University? For those who become dually employed January 1, 2022 with the University and OU Health Partners, we are currently anticipating that your University ESL will remain with the University related to the time associated with your University work effort should you become sick or ill and not be able to work. For those in OTRS, they can also elect to use ESL to purchase additional years of service within OTRS after retirement or termination of employment with the University.
For providers that transfer fully to OU Health Partners on January 1 and no longer have employment with OU, instead of having ESL to cover in the event of illness, there is a short-term disability policy that covers a set percentage of clinical compensation based on years of service. It is however capped at a certain amount per month. We are now in discussions around programs that may need to be developed to augment these limits for higher earning providers to assure that we are both locally and nationally competitive. (Updated July 2)
Paid Time Off and Holidays
There was a subtle change in language in the communication that came out two weeks ago that said providers will be able to sell back PTO. Now the FAQ says there may be a time when providers are able to sell PTO. Why the discrepancy? OU Health allows its employed providers to sell back a portion of their PTO. That will not change. What was noted however in the updated FAQ’s is that in the case of dually employed providers, we also must be attentive as to how we mesh PTO in OU Health and PTO in the College of Medicine going forward. We have to look at what a sell back policy may mean for a dual employee before a final decision is made on how this will work. For those providers who will not be dually employed, OU Health Partners will follow OU Health policy on this. (Updated July 2)
For those who will have dual employment, will my PTO transfer to OU Health? Specific details in this area requires further careful consideration for dually employed providers and is under intense discussion as we speak. It is anticipated that your full PTO balance will remain available for work associated with both OU and OUHP. There may also be a future option to have a PTO Cash Out policy. This option must be defined further and any decision approved also by the OU Regents. (Updated July 2)
For those that do not have dual employment, will my PTO transfer to OU Health? As has been stated before in communications, it is anticipated that for providers that will not be dually employed, the full PTO balance would transfer and be available for work associated with OUHP. Though details are still being worked out, it is likely you will also have the option to take advantage of a PTO Cash Out policy associated with OU Health. This will be subject to certain limits however and this is under discussion. (Updated July 2)
Will providers continue to have access to the OU Dependent Tuition Waiver if they are dually employed? Those who have dual employment with the University will be able to take advantage of the OU Dependent Tuition Waiver. At this time, there is no minimum threshold of allocation to the University that must be met to be eligible for the waiver. (Updated July 2)
Years of Service
Will my years of service be honored? Years of Service will be honored as long as there are no breaks in service. (Updated July 2)
If I took a break from my job to further my education, does that count as a break in service that will affect my years of service? Leadership is considering development of a special appeal policy for this situation. We highly value your education and want to make sure that it does not have negative impact. (Updated July 2)
Will expanding primary care be a goal of OU Health? Definitely. Dr. Rachel Franklin has been appointed as Physician Executive of our Community Health and Primary Care Division, with a special emphasis on this. Primary care matters. It’s a priority for the enterprise. Primary care is important not just to feed patients to our system, but also as they key to addressing needs for access and value based care models that will be our future. (Updated August 12)
We have tons of inefficient processes and structures in place right now, will this transition help improve any of that?
- We are very aware the system needs to improve. Dyadic leadership that assures that provider leadership is working directly alongside management and operational leadership will streamline decision making and hasten solutions. In addition, a more streamlined organizational management structure throughout the organization will facilitate better and faster decisions and solutions.
- Structural improvements include finding ways to increase patient access (Patients first), provider productivity, patient satisfaction scores, and more. These are critical so that we can attract patients and serve the needs of our state.
- Structures are being rebuilt to create more provider leadership within the system, create a new provider practice that is valuable to and promotes growth and development for APPs, and also creates an efficient nursing structure that supports retention and personal growth and development. (Updated July 2)
Will grants be able to be written from the non-profit perspective or will those continue to process through the university? Grants will continue to route through the University and it will continue to be the entity that accepts the grant. (Updated July 2)
Will research continue to receive funding? It is clear that robust research programs are an important part of what makes an academic health system prosper. As we improve our structures and operations we will develop pathways that allow us to reap the benefits and place even more funding back into critical research functions. This is one of the primary goals of any academic system and is what makes them unique. This is known as “the virtuous cycle” of academic health. (Updated July 2)
Can you tell us about the staffing that is currently coming from agencies? Currently, because the staffing shortage is a red-alert priority, we are filling critical positions at both the staff and provider level with agency employees. This is only a temporary solution in response to the large number of vacancies we are experiencing across the system.
We continue to work towards developing a skilled and resilient workforce, both to provide excellent patient care but also to have team members that value commitment to our mission as OU Health. A large team of recruiters is making every effort and working tirelessly to fill open positions. (Updated August 12)
Is there any direction on physician or resident recruitment? Most residents are snatched up after their first or second year. As the largest educator of providers and nurses for the state, addressing the current barriers to recruitment of our learners will take creativity, and new ways of thinking. This must be top priority. In addition we are trying to create an enterprise structure that physicians want to join both from an operational and enterprise culture perspective. When people value the people and culture they work with, they will want to stay and be a part of the mission. (Updated August 12)
Is there any sort of strategic plan in place for growth of the new OU Health Partners structure? One of the key goals of developing OU Health Partners is to develop an aligned and unified team and strategic plan. We will all work together to take stock of our resources, challenges, and opportunities to develop our strategy as a key partner in the OU Health enterprise. We want to be partners in identifying the most critical issues and taking action on fixing them immediately. With the new governance and operational structure, we will be able to combine management, financial investments, provider leadership, and more, into a prioritized strategic approach that will allow us to achieve the success we know we are capable of. (Updated August 12)
What are the recruitment strategies? How quickly can we get people in to fill gaps? Before July 1, we took open requisitions within the practice and provided that information to our recruiters, who in turn are bringing in more and more external resources to help with identifying candidates. We cannot not know exactly what the exact turnaround time for this will be, but we are working hard to assure it is being done as quickly as possible. The system fully understands the high cost of turnover and inadequate staffing, both from a revenue generation standpoint as well as a quality, safety, patient and provider satisfaction standpoint. (Updated July 2)
What are you doing about recruitment? We have a huge number of vacancies and I don’t understand how we will fill them all? Under OU Physicians we formerly had two recruiters assigned to the College of Medicine. There were also many associated bottlenecks in procedures for hiring difficult to find professionals. In this new structure we now have 23 dedicated recruiters. Leadership is working closely with these recruiters to analyze volumes and clinical growth plans and to develop appropriate recruitment plans that align with our goals and strategy. We are receiving expert guidance on how to recruit and retain positions across the board including the most difficult to recruit professionals.
We know that our recruiting and retention initiatives have been less than perfect for many years, but we are taking this opportunity to build something new and better that supports us in reaching our full potential.
Retention is also an important part of this situation and we are taking action to retain the talent we already have, primarily through compensation adjustments that account for items such as increased cost of benefits as well as specialty-specific positions that are very valuable to our mission. (Updated July 2)
Staff Transition Information
Can you tell me more about how compensation adjustments were made for my staff? Please click here to view the Compensation Adjustment Guide for staff. This guide covers phases 1 and 2 of the process. Not mentioned in this document is Phase 1.5, which includes reviews and adjustments made on a case-by-case basis for employees who, based on their OU Health benefits selections, may have seen a loss in their overall compensation. Compensation for these staff will be adjusted so they do not experience that loss. (Updated July 2)
What about leaders (who aren’t transitioning) of staff who are included in the July 1 transition? How are they supposed to process items like PTO requests for their employees? Supervisors of transitioning employees, whether or not they themselves have transitioned to OU Health, will have access in to Workday to complete tasks like approving PTO requests. (Updated July 2)
You are moving many of our administrative assistants to OU Health and cancelled all their Pcards, how am I supposed to have things paid for? Pcards were cancelled so that finance staff could complete the required reconciliations in advance of July 1. Please contact the Dean’s office if you have an expense to be covered with a Pcard and someone will be able to assist you. (Updated July 2)
I know of a staff member that I don’t think should be included in the transition, who can I talk to about that? Please contact Anne Barnes, Senior Associate Dean for Admin and Finance and Chief Administrative Officer, to discuss your concerns. (Updated July 2)
We understand the new initiative is “Keeping the patient first,” and we really want to do this. In the Pediatric Diabetes Clinic, we had a team (doctors/nurses/support staff) that had been together for years. Training them took quite a while. On June 30th, several nursing staff from that team left to take jobs elsewhere because of concerns with the staff transition. Now the children of Oklahoma will not be receiving all of the care from the team they deserve. This is a serious concern and it will be helpful to fully understand what was behind those staff members’ decisions to leave. With around 1,500 people transitioning, we knew there would be a number of issues that would arise. We also fully admit that there was confusion in the transition process and that communication around staff compensation and benefits didn’t occur as smoothly as we had hoped it would. Understanding what went wrong, addressing concerns quickly and learning from mistakes is critical to our future success. We will work closely with groups affected by such departures to learn from this and address needs as quickly as possible. Our goal truly is “patients first.” Moving forward, when there is an issue, let’s work together to quickly understand the situation and get it addressed immediately. (Updated July 2)
Why are non-faculty credentialed providers not getting communications on these sessions? We currently have two email databases -- one is all credentialled providers and the other is just faculty. We have thus found that our key APP group has not always been getting the intended communications due to discrepancies between lists. We are correcting this as we speak. (Updated July 2)
Is APIC reorganizing its coverage for providers? Some providers are hearing that APIC is going to a claims made rather than an occurrence policy. There is no new move to change the coverage level of providers or the type of coverage afforded. What we have now is effective and is not changing. APIC currently provides both a claims made policy and a tail policy for providers. This combination is, in effect, an occurrence policy. That is not changing with the system integration, so providers can be assured that they have the full coverage they need, even should they leave OU Health. (Updated July 2)