By George A. Vascellaro, D.O., Family Physician and Chief Medical Officer, CPN Health Services
For almost nine years now, I have had the privilege of working diligently at the Citizen Potawatomi Nation Health Services as a family physician and in numerous leadership roles, the latest being Chief Medical Officer. This role is unique at CPNHS. The CMO reports directly to the Nation’s independent governing body and has day-to-day responsibility to steward the entire health care system, both as a medical professional and head of operations. In comparison to other tribal health systems, this managerial role would encompass that of the Secretary of Health and Chief Medical Officer.
Starting my career with CPNHS in August 2012, I joined the West Clinic as the lone medical provider, taking over for a temporary physician serving 20 patients a week. I saw 20 on my first day, and things have not slowed down since.
One of my earliest surprises was the large number of patients who asked me, “How long are you going to stay?”
This was foreign to me, and my answer always was, “For as long as I can.”
There used to be a high provider turnover rate at CPNHS, which is still common for many Indian health and tribal health care systems.
I am proud to write that provider turnover has not been an issue at CPNHS since. In fact, CPNHS has been complimented on the stability of its medical professional staff during our last two surveys by the Accreditation Association for Ambulatory Healthcare. This is even more special to me in the CMO role as I have personally recruited 15 of 24 medical professionals on staff, including seven who are Citizen Potawatomi Nation tribal members.
Three family physicians — Dr. Roselius, Dr. Wilson and Dr. Kennedye — as well as three nurse practitioners — Destiny Mitchell, Crystal Marcum, and Christine Munoz — and our Chiropractor Dr. Wylie Briggs are all proud Citizen Potawatomi. They are all exceptional young providers with bright medical and leadership futures. This is a prime example of the wise investment CPN made in the education of its Tribal youth and is now reaping some of the benefits.
Patient care at CPNHS is high-quality care with customer service, which has made us a tribal health system where patients choose to come first. This was far from the case when I first started.
CPNHS has had numerous types of expansion over the past nine years. These include medical professionals, departments, and services, as evidenced by the increase in patients and patient visits across our health system. We have added mammography, CT, MRI, optometry, urgent care, physical therapy, specialty clinic and chiropractic services.
Specifically, our specialty clinic now has two cardiologists, an orthopedist, a podiatrist, adult audiology and a general surgeon, who also does our EGDs and colonoscopies. I am currently in negotiations to potentially add urology and vascular surgery/limb salvage.
Our pharmacy formulary has also expanded significantly, while purchased referred care coverage has improved greatly and is optimally leveraged with our internally managed Affordable Care Act Program.
The CPNHS operational organizational hierarchy has been modernized over the past two years with the assistance of our independent governing body. This started in 2019 with the creation of the Chief Medical Officer and Medical Professional Director roles. In 2020, the CPNHS Operations Director role was split into two positions. The clinical operations director is primarily responsible for CPNHS’ front-end business operations. The health finance procurement director is responsible for CPNHS’ back-end business operations. This very stable pyramid hierarchy of top leadership has proven very successful, surviving the ultimate of “stress tests” during COVID-19. CPNHS’ overall response to the once-in-a-lifetime global pandemic, including vaccinations, was second to none, and all of these roles played a critical part.
Dr. Roselius, a family physician with master’s in public health, has served as the Medical Professional Director since its inception.
Lauren Bristow, a CPN tribal member with a master’s in health care administration, has served as our Clinical Operations Director since its inception.
Bethel Acres native Chris Skillings serves as our Health Finance Procurement Director.
The leadership structure at CPNHS is strong and held up well during unprecedented times. This organization also allows for efficient workflow, collaboration and cross-coverage.
Another large part of the CMO role that I truly enjoy is strategic planning for the health system.
CPNHS is currently undergoing a significant departmental location re-organization to make the operations and care delivery systems as efficient as possible. The chiropractic clinic in Tecumseh, the first in a tribal health system that I am aware of, was completed during the COVID-19 pandemic and is almost at full capacity after just a few short months. The renovation of Mission Hill Hospital’s third floor is almost complete, and CPNHS business and PRC offices should move there in a couple of months. This will give us more space to expand the West Clinic pharmacy and lab as well as move the urgent care clinic to the West Campus. This increases accessibility to all the patients in our service area and will be the foundational move to eventually allow for expansion of the urgent care hours to evenings, holidays and weekends. Consequently, this will further minimize our patients need to go to emergency rooms.
Optometry will then move to the old urgent care area at East Clinic and finally an East pharmacy expansion.
The future is just as bright. In the September 2020 governing board meeting, I gave an update on CPNHS expansion status and ideas that included 17 bullet points, one of which was telehealth. This expansion, if done right and a few laws implemented during COVID-19 to benefit telehealth stay on the books, could potentially allow CPNHS to serve CPN tribal members anywhere they lived in the United States.
These plans also included a Choctaw, Oklahoma-based PCP clinic similar to the West Clinic. Positively, the Tribe already owns the land there. Additional expansion plans include adding an acupuncturist to the chiropractic clinic, construction of stand-alone retail/drive thru pharmacies, a sleep lab at Mission Hill, ambulance services, infusion center, outpatient surgical center and mobile health clinic. You may have heard chatter about these from other sources, but I want you to know they were proposed internally last year.
From my perspective, little to any of this could have been accomplished without the unwavering full support I feel CPNHS and myself have received over the last nine years from Tribal Chairman John “Rocky” Barrett and Tribal Vice-Chairman Linda Capps. Health care has long been a top priority of CPN leadership, and I couldn’t have transformed all my expertise to this effort without heavily relying on their steady leadership and wise council.
Lastly, I want to end with an emotional personal story that only a few of you know that almost prevented much of this from occurring. Chairman Barrett and Vice-Chairman Capps took a huge chance in hiring me all those years ago. They knew full well I needed a major thoracic surgery, and they still hired me.
Then the worst happened. The most dreaded complication of thoracic surgery — chylothorax, which has a significant mortality rate — affected me. An anticipated 10-day hospital stay turned into three months. Due to this and other serious complications, as a physician, I am very aware that my last nine years have truly been on borrowed time. The Chairman and Vice-Chairman could easily have been justified to release me from my contract, but they didn’t. They stood by me and were supportive of a patient with my prolonged recovery. It is something I will never forget and one of the many positive reasons they have given me to work so hard as a physician and as a leader at CPNHS. Because of this and many other memorable experiences working at CPNHS, I plan to continue to serve diligently as long as I am still welcome and will do so with a heart posture of gratitude.