Tulsa World: Tulsa at a health-care tipping point

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Tulsa at a health-care tipping point

By JANET PEARSON Associate Editor
Published: 11/13/2008 2:21 AM
Last Modified: 11/13/2008 2:59 AM

The September announcement that the Oklahoma State University medical school will move its residency program to St. Francis Hospital does not represent an end to Tulsa's chronic health-care woes. In fact, in some ways, it would make things worse. Perhaps much worse.

It's clearer than ever Tulsa is at a tipping point that requires an unprecedented, unified effort to resolve.

If Tulsa leaders don't come together on a plan soon that addresses all medical school issues and indigent health-care demands, lawmakers can justifiably tell us to take a hike. We don't have much time left to come up with that plan.

In September, the OSU Center for Health Sciences announced it would move its residency training program from the old downtown osteopathic hospital to St. Francis Hospital next summer. OSU leaders felt they had no choice because a continuing physician-training agreement with the hospital's owner, Ardent Health Services, couldn't be worked out.

Actually, the two parties had worked out several training agreements in recent years; the sticking point was — and still is — funding.

The problem is that old downtown hospital, now known as the OSU Medical Center, has become over the years this region's de-facto indigent care hospital, a role that results in higher-than-usual losses. Because Tulsa doesn't have a publicly supported hospital, other Tulsa hospitals also must absorb significant losses every year.

In an effort to get out from under the mounting losses at the OSU

hospital, Ardent has attempted to transfer the hospital to state ownership for a nominal sum. But some state leaders, including some Tulsa lawmakers, balked at the idea of the state "getting back into the hospital business" — a reference to problems experienced in Oklahoma City which were ultimately addressed through negotiation of a subsidized, public-private arrangement.

Tulsa leaders long have argued this urban region should be entitled to similar treatment — and similar state subsidies — and finally won general agreement in the last few years that Tulsa is overdue for some state assistance.

But how state help is to be doled out remains the multimillion-dollar question. If OSU leaves the downtown hospital, that likely would mean its closure — and that would mean an unmanageable load of indigent patients would be shifted to other Tulsa hospitals, especially St. John Medical Center and Hillcrest HealthCare System.

The goals of the University of Oklahoma's fledgling School of Community Medicine here and its developing north Tulsa "super-clinic" also could be affected by an OSU move to St. Francis.

Once OSU and St. Francis announced their new training deal, other stakeholders frantically went to work on addressing the resulting issues they would face. After months of debate and analysis, it became clear to many: Keeping OSU at the downtown hospital would be the most cost-effective way to address all the issues health-care providers face in this region.

According to some estimates, keeping OSU downtown would require an annual state subsidy of about $12 million a year, plus some one-time capital funding. This plan could be set up to limit losses to the state and to the new hospital manager, who would operate the hospital after it is transferred to a new public trust.

This plan has numerous benefits: It retains the existing federal revenue stream flowing to the OSU Medical Center and does away with the need to try to capture federal funding for the St. Francis plan. It also does away with concerns about obtaining accreditation for residency training at St. Francis, a process that could take years and could be imperiled by funding uncertainties.

Estimates indicate that if OSU moves to St. Francis, total costs to meet all the physician training and indigent-care needs in Tulsa could exceed $50 million a year.

OSU leaders might not want to try to resurrect the old plan to save the downtown hospital, and who could blame them? State leaders have fought it for years, and that old public-policy bugaboo about the state owning the hospital still is in play. But even OSU leaders would have to admit staying at the old hospital would be the best alternative for all, if it could be worked out. That was, after all, their first choice.

In recent days, Mayor Kathy Taylor launched an aggressive new initiative aimed at solidifying once and for all a plan that keeps OSU downtown. Her leadership would have been helpful months ago, but at least now she appears fully engaged.

In a letter dated Monday, she said if that objective is not achieved, that failure will lead to a "crippling crisis of medical access which will have a devastating impact on Tulsa citizens and indeed the state."

She is not exaggerating. Without the OSU hospital, an estimated 40,000 emergency room visits and 10,000 hospital stays will be dumped on other Tulsa facilities, which literally cannot handle that increase in demand.

"We are at a tipping point for Tulsa's health-care system. The loss of OSUMC as a medical facility will place undue burden on the remainder of the city's hospitals, and could create a cascade of failure, where no one, no matter whether they are insured or uninsured, will receive adequate care due to overcrowding and the slow financial strangulation of Tulsa's medical facilities," says a Nov. 12 letter from St. John's leadership to St. Francis CEO Jake Henry.

The mayor wants a "groundbreaking" solution developed by Dec. 1, a pivotal date that insiders say will bring about further dismantling of the old hospital. Time will tell whether Tulsa can pull it together by then.

Janet Pearson, 581-8328
janet.pearson@tulsaworld.com By JANET PEARSON Associate Editor

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guitchess, (11/13/2008 9:44:04 AM)

This is a problem simply caused by greed. The OSU administrators are the perpetrators in this instance. Forgetting for the moment personal monetary gain. They are greedy for the latest and greatest drugs/technologies/facilities. They also have the greedy agenda of school name proliferation. They want to be able to say their school is the best, regardless of how their decisions affect the community. They are willing to stress an already overly stressed health care system just so they can boast of their ability to stay cutting edge. Regardless of the fact that they could serve the community adequately with what they have now.

Oklahoma is not a rich state. We have never been, and, most likely, will we ever be the the trail blazing, cutting edge medical state. Let a state with more resources do the more experimental work. We should just use what we know works to improve our communities and our state.

If our government leaders have any fortitude, they will say stay where you are, use what you have, or loose all funding. It's clear that the leaders of OSU don't have the well being of our communities or state at the top of their priorities.

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Wandering Wonderer, (11/14/2008 8:39:04 AM)

How would a 12 million annual subsidy cover projected losses by the hospital head that are at 24 million a year. That appears to be 12 million short, by my math anyway, and appears to not permit even a single dime applied to renovate a relic facility.

Wasn't that renovation need recently reported as an estimated 80 million?. I seems to recall that figure being mentioned in a State Treasurer's quote from a recent article.

Everyone wanted to 'trust' the facility out months ago, but oddly, no one with business sense wanted to step up and run that public trust. Perhaps they did the math and saw a 12 million subsidy is not covering 24 million in losses and 80 million in needed renovations.

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