2020 VISION: Integris, St. Mary's heads talk state of health in Enid

Feb. 29--ENID, Okla. -- With Medicaid expansion on the horizon -- either by state question or legislative action -- administrators at both St. Mary's Regional Medical Center and Integris Bass Baptist Health Center are confident health care in Enid is well-positioned to serve the public, even if questions remain about how Medicaid expansion might come to pass.

Growing to maintain services

Both hospitals have had to grow their capacities to treat cancer patients throughout the last three years, since the closure of Dexeus Oncology in 2017 and Mercy Oncology in 2018.

Finny Mathew, president at Integris Bass, said realigning resources becomes a priority when a community the size of Enid starts losing a capacity like oncology services.

"One of the things we do is, whenever we see a service leaving, is we evaluate the impact it has on the community," Mathew said. "If it has a significant impact, that's when it gets put in our strategic plan, so we can maintain those services in the community."

Integris has invested in growing its oncology services since the closures of Dexeus and Mercy, as has St. Mary's.

Krista Roberts, CEO at St. Mary's, said it's taken planning and investment to sustain, and grow, oncology services in Enid throughout the last three years, so patients aren't obligated to travel to Oklahoma City or Tulsa.

That's especially important, she said, for patients who already are traveling from the panhandle or southern Kansas for treatment in Enid.

"I think we've done very well to grow to meet the need for oncology services," Roberts said. "It's been a rapidly expanding service for us, and one that we are making significant investments in. It's a service that's important for us to provide for the people we serve."

Recruiting and retaining medical staff

Whether it's in oncology, family medicine or one of the many areas of specialized care, both hospitals face a challenge common to hospitals across the country -- recruiting and retaining medical staff.

"We are constantly recruiting additional physicians and providers," Roberts said. "We're always collaborating with the community to determine what the health needs are currently, and what they foresee them to be in the future."

Finding doctors who will stay for the long-term means recruiting them and their families, Roberts said, and matching their interests with all Enid and Northwest Oklahoma have to offer.

"We want to collaborate with others to make Enid the most desirable location," Roberts said, "because we recognize candidates have a lot of different opportunities for where they can choose to live and work."

Mathew said a lot of the work is just selecting candidates who will enjoy living in the area.

"When we go after recruits, we're not looking for people who want to be in New York City or Los Angeles," Mathew said. "We're looking for people who enjoy the outdoors, who want to know the parents of the other kids in their kid's class on a personal level. Life here appeals on a level that it doesn't appeal in a big city."

Facing a shortage

In years past a major emphasis in the recruiting challenge has been finding doctors with a passion to work in small- to mid-sized markets. But, both Roberts and Mathew agree the greater challenge now may be finding physicians at all, as the nation continues to experience a physician shortage -- a shortage expected to worsen in the coming years.

According to figures released by the American Hospital Association (AHA) in April 2019, the nation faces a shortage of 46,900 to 121,900 physicians by 2032.

"There's a general shortage in the country, as well as pending retirements in the next 10 years," Mathew said. "That will be significant, and it's only going to get worse if we don't replace those who are retiring."

The greatest projected shortfall isn't in specialty care, but in primary care and family medicine, which the AHA predicts will be short 21,100 to 55,200 physicians in the next 12 years, compared to 24,800 to 65,800 for all non-primary care specialties.

Mathew said the effects of shortages in primary care already are seen in Enid and Northwest Oklahoma.

"I think the biggest gap we have right now is in primary care -- your family practice and internal medicine doctors," he said.

As the shortage of primary care physicians continues, and certainly if it worsens, Mathew said patients may expect to see greater reliance on physician's assistants and nurse practitioners.

Medicaid expansion

Both Mathew and Roberts expressed a desire to see Medicaid expand to offer medical coverage to more Oklahomans. But, both also said they have more questions than answers when it comes to how that might actually be implemented.

The state now faces two possible alternatives: State Question 802, a ballot measure that would amend the state constitution to accept Medicaid expansion from the federal government, and SoonerCare 2.0, Gov. Kevin Stitt's proposed alternative to SQ 802, which would accept federal block grant funds through legislative action.

A major portion of the funding for the state's matching portion of SoonerCare 2.0 is an increase in the Supplemental Hospital Offset Payment Program (SHOPP) fee.

SHOPP fees are provider fees paid to the state by Medicaid service hospitals, with some exemptions. Currently, the SHOPP fees in Oklahoma are set at 2.5% of net patient revenues. The governor's plan would increase that to 4%.

Roberts said she's glad to see initiatives to expand Medicaid coverage but said, "I do have a lot of concerns at this time about SoonerCare 2.0."

"There's not been a lot of transparency nor collaboration with health care providers to this point," Roberts said.

She said SoonerCare 2.0 thus far has not involved broad input from the health care community in its design or plan for implementation.

"I would liken that to successful football teams don't just give the quarterback the playbook," Roberts said. "Everyone needs to be involved, and then we need to go execute it for success. Everyone needs to be involved and know the plan."

"I would hope at this point we would get more collaboration and transparency as to the plan," Roberts said. "The bottom line is there needs to be more transparency and collaboration."

Cost of managing Medicaid

Roberts also raised concerns SoonerCare 2.0 could move Medicaid management in Oklahoma to a third party, likely an out-of-state commercial manager. And that, she said, could significantly increase the cost of offering Medicaid.

Oklahoma Health Care Authority has an administrative fee of 4.35%, but commercial Medicaid managed care plans can charge up to 15% in fees, Roberts said, "which means we could end up only receiving $85 out of every $100 for services for Medicaid enrollees."

"My preference would be to not send Oklahoma dollars to another state," Roberts said, "as both a health care provider and a tax-paying citizen. I would hope those dollars stay in Oklahoma."

Roberts also expressed concern the increase in SHOPP fees could disproportionately affect small rural hospitals, many of which already are struggling to stay open.

"It would have a significant financial impact on us here locally, as well as across the state," Roberts said, "and could potentially be the tipping point for some hospitals in Oklahoma."

Mathew said there may also be some legal problems with using SHOPP to offset the costs of Medicaid expansion.

"The hospitals that pay into SHOPP will be disproportionately impacted compared to other entities that don't pay into SHOPP now," Mathew said, "and there are also legal questions about how SHOPP can and can't be used to attract federal dollars."

But, he added, "the devil is in the details," and those who would actually have to operate under SoonerCare 2.0 have yet to see those details.

"We haven't seen the details of the governor's plan yet," Mathew said. "If there is a middle ground somewhere, which I am sure there is, it's hard to speak in detail about that."

Discussion is healthy

While St. Mary's, Integris Bass and hospitals across the state wait to see how Medicaid will be expanded in the state, Mathew and Roberts agreed -- it's good the topic is gaining traction.

"We favor Medicaid expansion and reform, and we believe the more people covered by some type of insurance the better," Mathew said. "We think improving health care outcomes in Oklahoma is key, and we're willing to lock arms with anyone who wants to work to improve outcomes. The key is that improving health outcomes for Oklahomans is being discussed -- one way or another."

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