Health-Care Networks, Access Being Reviewed

By MARIE PRICE World Capitol Bureau

OKLAHOMA CITY — A legislatively created task force took its first steps Wednesday in a study of whether keeping specialty hospitals and ambulatory surgical centers out of managed-care networks reduces access to health care.

Sen. Gilmer Capps, D-Snyder, said the Surgical Patient Choice Task Force must report to the governor and the Legislature before Jan. 1.

Don Burman, CEO of the Orthopedic Hospital of Oklahoma in Tulsa, said 21 states have “any willing provider” laws that require health insurance networks to accept hospitals and other providers who meet their standards.

“We’re coming at this from the access point of view,” he said.

Frank Stone, deputy commissioner for the state Insurance Department, said Oklahoma has such a law, although it is not as far- reaching as other states’.

Burman said the system should let the market work, allowing patients access to all complying facilities and doctors.

He said the issue is one of access and control. It has been made political, he said, but that should be set aside.

“Let the consumer make the decision,” Burman added. “We should have equal access, and our patients ought to have access to us, as well.”

Bert Marshall, group vice president of public affairs for Blue Cross and Blue Shield of Oklahoma, replied that “no one is barred from going where they want.”

Managed-care systems tend to pay differently for in-network and out-of-network care, however.

Specialty facilities choose to set up in a particular area, and insurers should be able to choose with whom to contract, Marshall added.

“It’s a free-market system,” he added. “We should be able to choose our long-term partners.”

Requiring insurers to take all providers would bring government interference into the contracting process, Marshall said.

He said the panel must consider that community hospitals provide a range of care, including emergency and indigent services, that specialty facilities don’t offer.

He also said the impact of specialty hospitals on community facilities is a concern.

Marie Price (405) 528-2465

marie.price@tulsaworld.com