A gleaming $45 million hospital in Jenks that opened last month has been unable to treat patients with Blue Cross and Blue Shield of Oklahoma insurance due to a contract dispute, leaving hospital owners worried about the future of the facility, its patients and nearly 130 employees, an investigation by The Frontier has found.
A group of Tulsa orthopedic surgeons who planned to treat patients at the new 25-bed Jenks hospital also fear they will lose their insurance contracts with Blue Cross and Blue Shield of Oklahoma if they treat patients there.
But perhaps the most damaging fallout if the hospital and its doctors can’t work out an agreement with Blue Cross Blue Shield is the possible closure of the Bristow Medical Center. The 30-bed hospital has struggled since 2009 to keep its doors open amid a wave of financial challenges faced by rural hospitals across the state.
Jan Winter Clark, CEO of Bristow Medical Center, opened the Jenks Center for Orthopaedic Reconstruction and Excellence, or CORE, in July along with several financial partners.
Jan Winter Clark
Clark, 44, is a transplanted Texan who is fiercely loyal to her adopted hometown of Bristow. She opened the Jenks facility as a way to shore up the Bristow Medical Center financially, keeping the doors open to patients who depend on the rural hospital.
With the addition of the Jenks hospital this year, the Bristow Medical Center is actually one company with three separate medical campuses. In addition to the Bristow and Jenks hospitals, the company also operates an outpatient primary care clinic in Cushing.
The Jenks hospital had no problems extending existing contracts with other Bristow Medical Center insurers such as Aetna and UnitedHealthcare, Clark said. However, Blue Cross and Blue Shield of Oklahoma has so far declined to extend the existing contract to cover patients at the new CORE hospital.
The insurer controls a majority of the state’s health insurance market and about 18 percent of the market in Tulsa and the surrounding area.
Clark wonders whether the new Jenks facility is simply caught in a web of urban hospital politics. The six orthopedic surgeons who want to treat patients at CORE are currently practicing elsewhere and would likely lure many existing patients to the new hospital.
“Just to put it in a nutshell, we have followed all the rules,” said Clark. “We have tried to work within their requests and in their boundaries and at this point, we haven’t made any headway, but we are hopeful we will reach a contract agreement.”
In an email to The Frontier, a spokeswoman for Blue Cross and Blue Shield of Oklahoma said the company cannot discuss details of its provider contracts or negotiations.
However, the insurer provided a statement from Dr. Joseph Cunningham, divisional senior vice president of health care delivery and chief medical officer for Blue Cross and Blue Shield of Oklahoma: “Blue Cross and Blue Shield of Oklahoma (BCBSOK) offers coverage in all 77 Oklahoma counties and we have a fully adequate network of doctors, hospitals and other ancillary providers serving all markets.
“As one of the only health insurers offering coverage statewide, BCBSOK is a strong supporter of rural doctors and hospitals. … We continually evaluate the composition of our provider networks based on a variety of factors, which includes an assessment of network need and a review of the services provided by each provider,” Cunningham said.
Wayward cows and rattlesnakes, all in a day’s work
Tucked away at the end of a residential street, Bristow Medical Center sits on top of a hill overlooking the small town about 30 miles southwest of Tulsa. The one-story building may be a bit dated but it has a relaxed atmosphere, and hospital staff who occasionally barbecue in the courtyard.
On a recent weekday, nurses and aides gathered around the lobby doors to gawk at a baby rattlesnake, which had accidentally slithered inside and was scooted back out.
Clark says she loves running a hospital in rural Oklahoma, where she’s also made her home. One day she’s dealing with livestock roaming loose on a rural road and the next she’s negotiating large contracts with insurance companies.
But no matter what the day brings, Clark usually crosses paths with someone who came through the 30-bed Bristow hospital, either an employee or a former patient.
“I like going to Walmart and running into people telling me their experiences,” she said during a recent interview in her sunny conference room.
The Bristow Medical Center has struggled in recent years with outdated facilities and many patients without insurance who can’t pay for treatment.
The hospital was built 60 years ago and the city of Bristow still owns the land and building. Plans call for a new operating room this year.
Clark hopes to continue the path of improvement she began in 2009, when the private, for-profit company that ran the hospital then notified the city council it couldn’t afford to continue operating. Before that, the Hillcrest and INTEGRIS hospital systems tried to operate the hospital.
Small hospitals in Oklahoma have been struggling for years to cope with a variety of changes in the healthcare landscape: a shortage of doctors willing to work in rural areas, consolidation of large insurance companies, budget cuts in the state’s Medicaid program and Oklahoma’s refusal to accept a Medicaid expansion that came with the Affordable Care Act.
An investigation in 2013 by Oklahoma Watch and the Tulsa World found that more than half of the small general hospitals in the state lost money in each year between 2009 to 2012.
Meanwhile, urban hospitals with more than 100 beds fared much better during that time, with less than 20 percent losing money, the investigation showed.
City leaders fought to keep Bristow’s hospital open, because if it had closed even for a day, every single feature would have to be brought up to code in order to reopen. That would cost millions of dollars.
Clark and two partners came on board in 2010 and tried to stabilize the financial situation, keep the doors open and remake the hospital’s image among locals.
When Clark first arrived, the hospital was running out of bandages and IV antibiotics and lacked credit to purchase more.
In 2011, she and her partners added the outpatient Cimarron Healthcare Center in Cushing. The facility, which employs about 40 people, provides primary care, specialty surgery and walk-in urgent care.
Adding the Cushing hospital to the company helped stabilize the financial picture in the meantime.
The Bristow hospital was known as a Band-Aid station; patients were patched up and sent to Tulsa.
“We are so close to Tulsa. People who can and have the means go to Tulsa for treatment,” she said. “We care for the patients who don’t have the option to go elsewhere.”
In addition to juggling the fate of three hospitals, Clark is caring for a father who was recently diagnosed with an aggressive form of cancer.
As she walks through the hospital on a recent day, Clark is stopped by a woman who wants to discuss the Bristow City Council meeting that night. The woman tells Clark she plans to implore city leaders to fund much-needed repairs for the ER and operating rooms.
Clark politely interrupts her after noticing the woman’s face is drooping on one side. It’s a telltale sign of stroke in older women.
“Did you just have dental work done?”
Yes, she replies.
A wave of relief washes over Clark’s concerned face.
She started her hospital career as a nurse, and it’s a role that’s hard for her to leave behind.
Rodeo death sparked doctor’s passion
Until Dr. Mark Brandenburg began commuting from a Tulsa suburb to work in the emergency room at Bristow Medical Center, he said he didn’t understand why the patients couldn’t just drive to hospitals in the city.
“It never crossed my mind that there would be people who did not have the money to pay for gas to travel 30 miles for care,” he said.
Dr. Mark Brandenburg at work in the small ER at Bristow Medical Center. DYLAN GOFORTH/THE FRONTIER
Sadly, he notes, many rural hospitals in Oklahoma have closed in recent years.
An investigation by the Associated Press in May found that one in five Oklahoma hospitals are financially vulnerable and could close. The Craig General Hospital in Vinita declared bankruptcy earlier this year, the seventh rural hospital in recent years to do so.
Brandenburg’s interest in rural medicine was sparked by an emergency room patient he treated outside of Oklahoma City years ago: a rodeo cowboy who died from a head injury sustained while bull riding.
The life cut short sparked a pet project for Brandenburg that became a passion over the years: Convincing rodeo cowboys to wear helmets during bull riding events.
It can be a tough sell, but he brags that more than half the riders at a recent PBR tournament in Tulsa opted for helmets. (Think NASCAR, he tells them — your head could be a billboard space).
Head injuries from kicking horses, bucking bulls and ATV accidents are common sights in a rural emergency room, he said.
“We get a fair number of patients who come in on the back of a pickup,” he said.
There’s a do-it-yourself mentality among his rural patients.
“I bet half the stitches we put in get taken out at home,” he said.
Partnership could inspire others
Twenty-seven miles away is a slick building with polished marble floors that Clark hopes may save her little rural hospital.
The CORE hospital in Jenks is designed for outpatient and inpatient surgeries, many by sought-after orthopedic surgeons whose patients have insurance and the means to pay the bills.
It is double the square footage of the Bristow Hospital and has all the newest equipment, even its own small ER.
“This one will be absolutely successful if we’re allowed to play on the same field as everyone else,” Clark said.
Sen. Brian Bingman, R-Sapulpa, praised Clark’s innovative approach to keeping the Bristow hospital financially stable. Bingman, who is president pro tempore of the Senate, recently toured the Jenks hospital and described it as a “very, very state-of-the-art facility.”
“Rural hospitals have been challenged the last several years trying to attract doctors and patients. … This partnership is kind of a novelty in that you’ve got this new facility and the doctors will rotate several days a week into Cushing and Bristow.”
Bingman said other struggling rural hospitals may be interested in following Clark’s example.
“I think it’s a novel idea if the numbers work. … Your federal dollars are limited. State dollars are tight right now. I think this model could be a way to help rural Oklahoma.”
