Tulsa Regional Medical Center's future still clouded

Journal Record, The (Oklahoma City), Dec 21, 2005 by John Dobberstein

A joint legislative commission wants more time to study the complicated scenarios swirling around Tulsa Regional Medical Center and Oklahoma State University's teaching program.

With anxiety building over Ardent Health Service's plans for the medical center, the commission wants to examine whether building a new teaching hospital, signing a lease with Ardent, or a state purchase of TRMC would be the best option to stabilize OSU's Center for Health Sciences.

The commission's recommendations came in a final 16-page report released Dec. 15. The report addresses both the relationship between TRMC and OSU, and Medicaid funding problems in the Tulsa metro area.

Ardent has offered to sell TRMC to the state for $165 million, after its lease proposal to the state in April didn't win over lawmakers. The state hasn't acted on the purchase offer.

The joint commission asked to be extended for another year and be allowed to hire a consultant to advise on options to stabilize the OSU program, including a lease/purchase arrangement, building a new teaching hospital or development of community-based residency programs. The commission also suggested the University Hospital Authority be expanded to include a greater statewide mission.

Shifting ownership

After purchasing Hillcrest HealthCare System last year, Ardent proposed to transfer OSU residents to its other Tulsa hospitals and convert TRMC into a long-term care or behavioral health facility. But the university and Ardent signed a four-year agreement - dependent on enhanced Medicaid funding from the state - to delay any action.

There is considerable OSU unrest about the future of its teaching program at TRMC, the commission said, although the residency program doesn't depend on TRMC funding. Ardent owns the medical residency slots at TRMC and the corporation has said the slots can't be transferred to another hospital, or to OSU.

The commission members want to explore whether or not the residency slots can be transferred.

Every time we have a new owner, we have concerns about the long- term stability of programs, said Karen Wicker, spokeswoman for the OSU Center for Health Sciences. We just want a solution to the long- term stability issue.

Hillcrest officials have expressed disappointment at the report and sent letters to both the joint commission and Hillcrest employees, correcting what Hillcrest President and CEO Kevin Gross said were factual and unsubstantiated errors.

Gross criticized the state commission for unfairly casting a negative light on Ardent, which donated a $7 million office building to the OU College of Medicine in Tulsa this year. Ardent supports two other residency programs, he said, and is committed to finding a solution for the OSU teaching program.

The reality is that our commitment has not changed since the Ardent purchase, said Tyra Palmer, a spokeswoman for Hillcrest. We have more residents than anyone in eastern Oklahoma. It's disappointing to read that (Hillcrest's commitment) is being questioned.

Lots of options

For years, TRMC had been an independently owned hospital, serving as a vital pipeline for physicians to practice in rural Oklahoma. But lately, conditions haven't been very stable. The hospital has had four different owners in eight years.

OSU officials are worried the uncertainty of private ownership will hurt recruitment of students to their program and could jeopardize the availability of health care to rural areas. The university took its concerns to the state Legislature last year.

Hillcrest has a 34 percent market share in the Tulsa market, but it also has 61 percent of the market's Medicaid patient days - without the funding scheme of a public hospital. The health system has been bailed out financially by the state Legislature three times since 2000.

Because TRMC and Hillcrest Medical Center are only a few miles apart, Ardent officials believe some services could be consolidated, Palmer said. Gross told the joint commission that there is excess capacity at the two hospitals for about 10 months out of the year.

There is a precedent in Oklahoma for a public-private partnership to oversee a public hospital. In Oklahoma City, the University Hospitals Authority and Trust maintains a joint-operating agreement with HCA Inc. to run the state-owned OU Medical Center. The commission said the state of Oklahoma divested itself of the medical center over a three-year period and there were no ill effects from restructuring.

There could be advantages to relocating OSU residents to other hospitals in Tulsa, the commission said, noting that TRMC is not and has never been a charity care hospital. Saint Francis and Saint John health systems treat fewer indigent patients and handle more complicated trauma cases because they have neurologists on staff, the commission said.

But Wicker said the university would rather not move its residency program to another hospital in Tulsa, because the concern is with private ownership and possible changes in philosophy and direction.

We'd just be trading one landlord for another, Wicker said.