POSTED ON MAY 29, 2013:
A Shock to the System
Health care changing, OU-Tulsa president says
It just really kind of hit me yesterday," said Dr. Gerard Clancy.
The president of the University of Oklahoma-Tulsa had clocked in some hours at the Wayman Tisdale Specialty Health Center, putting to direct use his medical training and expertise in psychiatry.
"Everybody I saw was uninsured. Everybody I saw had not accessed psychiatric care in a long, long time. Everyone I saw could not afford care. Everyone I saw could not afford medication," said Clancy. "Everyone I saw couldn't work because they were so impaired by the illness they were suffering."
He spoke in measured tones, seated in his well-appointed office. Nothing he saw while treating patients could exactly have been a surprise, with Clancy -- also dean of the University of Oklahoma College of Medicine-Tulsa -- a leader in establishing the north Tulsa clinic in the first place to meet community needs.
Still, he used the term "my frustration" when describing the terms of the health care debate -- and what he said gets left out of those talks.
"The thing that is remarkable to me around this entire discussion around Medicaid expansion and the Affordable Care Act is who is advocating for the uninsured?" Clancy said. "The uninsured are a segment of our society that don't have an organized voice for themselves."
In Oklahoma, debate over Medicaid expansion has turned into more of a political blame game. Gov. Mary Fallin has steadfastly declined to accept federal dollars to aid with expanding coverage of the state's uninsured through the Medicaid program. She cited expanded administrative costs, as well as the plan to, over time, shift more of the financial burden to states.
Insure Oklahoma, the state's plan to help low-income residents afford health care coverage, also now appears to be on its last legs with federal dollars drying up and a plan by Fallin to fund it with state dollars failing to gain traction with state legislators.
In Tulsa, Clancy said more clinics have opened up in recent years, serving the uninsured.
"Overall, the safety net is stronger and more accessible. Yes, we've made progress," Clancy said.
But he said that clinics are "pretty much at capacity for what we can handle."
Regardless, Clancy said doctors who might volunteer to help cannot provide all the care needed.
Can the clinics ultimately reduce the size of the population with severe medical needs?
"If they're covered, if they're insured," Clancy said. "If not, those clinics can only do so much. How do you pay for laboratory? How do you pay for medications?"
He added: "You have to actually be able to treat people. And to treat people costs money. There's not free medication out there. There's not free laboratory. There's not free procedures."
But Clancy also pointed out several rays of hope in the Tulsa healthcare landscape, citing efforts aimed squarely at producing a more efficient -- and thus less costly -- way to treat patients.
One element he's experienced first-hand is a data-sharing initiative known as MyHealth Access Network. The program allows doctors to access medical records even if treatment was done elsewhere in the Tulsa area.
"I was getting chronic sinus infections and had a CAT scan done in one health care system, but then had a specialist in another health system. That specialist refused to redo the CT, but instead used MyHealth to get my CT from another place rather than just reordering the test, saving the system close to $1,000. I was so proud of him as he did it," Clancy said.
Along with improved data-sharing, Tulsa is also one of only seven sites nationally for a program aimed at showcasing a new concept in primary care.
In this vision, known as the patient-centered medical-home model, "rather than the primary care doc kind of being in isolation and seeing a patient every 10 to 15 minutes, he's got an entire team," Clancy said. Nurses, social workers, perhaps those in the public health community, along with nurse practitioners and physicians assistances work as a team, Clancy said, providing care that's "much more wellness-focused, much more prevention-focused."
The Tulsa program, known as the Comprehensive Primary Care Initiative, is a demonstration project with federal funding that's aimed at providing a payment structure to make it all work, in part through the OU-Tulsa Sooner Health Access Network that connects participating health care providers.
"What we've seen with the care coordinating programming in place -- it's been in place for about a year now, the Health Access Network -- is a savings of about $22 per person in the program per month. And in the health care world, that's pretty significant. Twenty-two dollars per month, that's a good savings, and that's after the cost of the social work and nurses are already accounted for," Clancy said.
The changes also involve a new role for hospitals, Clancy said. He spoke before news broke about layoffs at St. John Health System, which recently was acquired by Ascension Health, which describes itself as the nation's largest Catholic and non-profit health care system in the country.
Speaking generally, Clancy described the new pressures on hospitals related to health care reform.
"Hospitals now are penalized if someone needs to be re-hospitalized for the same condition again, in particular pneumonia and congestive heart failure. So there's incredible pressure for those hospitals that used to be able to just focus on the hospital," Clancy said. He added: "You're seeing this coming together of outpatient and inpatient services so that the entire episode of illness can be cared for. That's a part of this consolidation, is an integration of outpatient and inpatient services."
Clancy said that hospitals have little choice to embrace such a model, but added that doing so may be especially difficult in rural locations. "If you're not able to build a system, you're really going to struggle," he said.
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