St. Francis Hospital is set to leave the Blue Cross Blue Shield network at the end of the month. It could be a big change for healthcare in Tulsa.
What’s behind the potential split? Dr. Diane Heaton is an oncologist and president of the Tulsa Medical Society.
She says the St. Francis system has grown over the last 20 years by purchasing smaller practices, and when a large network absorbs small providers, it charges insurance companies more for services since operating costs are higher for hospitals.
“Let’s say they bought my practice, they would then change the rates to hospital rates that can be over 7,000 times more,” said Heaton.
With changes in Oklahoma healthcare and what Heaton called a “significant Medicare reimbursement” for providers, more competition is expected in the Tulsa market, especially with cheaper telemedicine in play. Telemedicine cuts down on brick and mortar costs.
"One of the interesting things that’s happening is a number of outside companies that do kind of a capitated virtual hospital - so they work very hard to keep patients out of the hospital - are moving into the Tulsa market,” said Heaton.
Heaton said that may be another reason for the hardship during the complicated negotiations between Blue Cross Blue Shield and St. Francis.
The hospital has said BCBS changed terms at the last moment, while BCBS maintained the hospital's growth and high prices are a problem.
“Blue Cross Blue Shield sees this as a moment in time when they’re vulnerable, and they’re not going to pay the extra anymore,” said Heaton.
In statements to KWGS, both organizations said they are still working toward an agreement.
The deadline is July 29th.