Hosts Ellen Pogemiller and Ellyn Hefner discuss the complexities of HR1 and its profound impact on Oklahoma’s hospitals with Scott Tohlen, Vice President of Advocacy at the Oklahoma Hospital Association. The conversation delves into the less understood aspects of provider taxes, the Supplemental Hospital Offset Payment Program (SHOP), the shift to Medicaid managed care, and the challenges facing rural hospitals. Scott also shares insights on the state's unique relationship with nonprofit hospitals and the potential long-term effects of HR One, including potential service cuts and economic ramifications. Don't miss this in-depth discussion on healthcare policy, hospital funding, and the future of medical services in Oklahoma.

Welcome to the Between Two Ellens* show.

2

It's a good one and it's a difficult one.

3

We're gonna talk about HR one

and the hospitals in our state.

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Scott Tole is, is on today and

what he talks about is like people

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don't know about provider taxes.

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He's going to also talk about, um,

rural hospitals and how it affects.

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Us.

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He's gonna talk about shop.

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What else did you, um, take away from it?

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Let's, let's, let's say what shop

is, 'cause we never say what it is.

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It's, um, supplemental Hospital

Offset Payment Program.

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Us in our acronyms.

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We forget us in our acronyms.

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Yes, but I, you know.

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Oklahoma Hospital Association

is a statewide association.

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It's nonpartisan.

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Um, they're a big presence at

the Capitol and, you know, have

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the pulse of hospitals, both

rural, urban, and suburban.

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And I think he brings that conversation

perspective to the conversation today.

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And at the end he tells us,

uh, he tells about how maybe

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he had a part in this podcast.

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That's true.

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Well enjoy.

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Here we go.

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Hello, I'm Ellen Pogemiller.

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I'm Ellyn Hefner.

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And this is, uh, Between Two Ellens.

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Today we get to talk, um, about

something that is on a lot of

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people's mind and there's a lot of

misunderstanding, or maybe we should

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just say we don't know enough about it.

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Um, and we have someone who's, uh.

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Great.

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He helps us, uh, kind of talk to

us about things up at the capital.

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So we've known, I've known

you for a little bit.

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You can tell us what your job

title is, but today I'd like

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to, uh, welcome Scott Tolling.

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Thank you.

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Uh, happy to be between two Ellens.

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This seems to be the case.

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Um, so I'm Scott Lene.

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I'm the Vice President of Advocacy

at the Oklahoma Hospital Association.

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Uh, we are a nonpartisan

organization that represents 123.

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Hospitals of 155 of the state,

um, of the state's hospitals.

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Uh, 95% of those rely or sit

in rural areas of the state.

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Um, obviously we represent the

metros, the urbans, the suburbans,

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and everything in between.

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So from the panhandle, the

southeast and northeast, the

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southwest, all members of OHA.

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Um, really the only ones that

we don't represent are those

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who are truly physician-owned.

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Um, we do not represent

ambulatory surgical centers,

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uh, so truly those hospitals.

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Um, Oklahoma is unique in that fact.

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In, in so far as we are nonprofits,

namely 99% nonprofit hospitals

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in the state of Oklahoma.

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Many of those hospitals are public trusts,

so about a third of those hospitals are

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either owned by the city or the county.

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So more than likely, those tend to be

supported by some level of local tax base.

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Great.

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Well, thank you.

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Um, we today though, because of your,

all of your experience, especially with

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the hospitals and what's happening right

now, you're gonna talk about HR one.

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And how it relates to

hospitals between two Allens.

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Yeah.

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Yeah.

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So, so HR one, uh, known as the one Big

Beautiful Bill Act, uh, made some pretty

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significant changes to hospitals and how

they're reimbursed, um, across the us.

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But in Oklahoma, um, in particular,

there are two pieces of hr, one that

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are having significant, that will have

a significant impact upon our hospitals.

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First, um, they made a change to what

federally is referred to as a provider

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tax in Oklahoma referred to that as a fee.

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So nationally that

provider tax is set at 6%.

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Uh, it is being ratcheted down, uh, half

a percentage point until it reaches 3.5%.

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In the state of Oklahoma, what

that will mean is that ours is

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set statutorily at 4% today.

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Um, we will not see that actualization of

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So there's, there is a,

uh, a roadmap of, um.

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Uh, a runway as we've often heard

it referred to as with that.

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Um, so we won't realize that until later.

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There is a cost to that for the

state from that difference, uh,

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of that half percentage point

and, and what that looks like.

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I think we're all having

conversations about.

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Um, I certainly believe that there will

be, uh, in the healthcare authority

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stated most recently this week that

there will be a excess in our fee that's

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collected by the end of that rundown.

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And so what we would love to see, and what

obviously we will advocate for is that

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that fee continues to truly fund hospitals

and not go towards other, uh, items.

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But we have had a longstanding

partnership with the Healthcare Authority.

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Um, this shop fee that we talk

about really flows into everything

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else we'll discuss on HR one.

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So the other key component of HR

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a Medicaid managed care system.

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Okay.

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Uh, with the enactment of the Medicaid

managed care system came a new

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reimbursement model for hospitals

referred to as directed payment program.

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Mm-hmm.

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So when you all at 23rd and Lincoln

hear about, uh, SoonerCare Medicaid

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or sooner select, when you talk

about SoonerCare, and I know this

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is, um, uh, close to you, SoonerCare.

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Is those folks that are in the a, b,

D population, the age blind, disabled

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population, sooner select is those

that are fall into, um, expansion

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category, pregnant women and children,

um, those, uh, that are foster care

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adoptees, those populations, and there's

children's specialty on top of that.

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So HR one made a change to the directive

payment program, which currently,

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well not currently 'cause we are in.

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Current directed payment model prior

to the Directed Payment Pro model,

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uh, Oklahoma Hospitals using our

shop fee went from senior care rates

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to a hundred percent of Medicare.

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That's why the state in 2011 partnered

with OHA to put a fee on our hospitals,

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um, certain segment of our hospitals.

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That's all delineating statute.

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Um, put that fee on to get us up

to a hundred percent of Medicare.

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When we had conversations, uh, around

what Medicaid managed care could look

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like in the States, uh, obviously a

big portion of that was how could we

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otherwise draw down more federal funds

to provide more services or maintain

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services for Oklahoma's hospitals.

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In doing so, uh, we got to 90%

of average commercial rate.

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So for the state of Oklahoma,

that's a significant increase.

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When we went live with Medicaid

managed care in the state of Oklahoma,

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that took many rural hospitals from

the red to the black overnight.

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Mm-hmm.

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So it was significant for them.

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Um, for our critical access

hospitals, they're, they're almost

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our smallest of those small when

it comes to rural hospitals.

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Uh, those are reimbursed at cost and so

they're not losing dollars, uh, for the

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services that they're otherwise providing.

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Well, HR one takes that directive

payment model that we currently have

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and drops it down, uh, 10% beginning

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percent of the Medicare level that

does not cover the cost of care.

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We're all aware of that.

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Um, that will be significant over a 10

year phase down, that equates to $6.7

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billion for our state's hospitals.

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Oh goodness.

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I mean, I'm just going to stop all, just

because the amount of information, like.

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I've heard this, we've talked,

I know that, excuse me.

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Some we hear from federal delegation

and stuff too about this, which

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does not, it doesn't sound as

similar as what you're talking.

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My question is too, is that that is

not any relatable to anyone that is

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living a life, that things are gonna

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we're actually seeing some changes now.

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Um, what is something that,

can you give us a scenario or

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something about what you just.

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Said, especially in our rural hospital,

when we start to make these changes,

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what's something that someone goes

to the hospital and may see a big

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change, whether it's there or not?

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That could be one.

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Yeah.

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Whether it's there or not.

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I think it's a key.

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I mean, rural hospitals

in any hospital, um.

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You cannot make up for that type

of reduction without cutting

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services, just plain and simple.

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Um, and what services

would those be look like?

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Well, we already know that rural Oklahoma

suffers from a lack of OB services.

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Yeah.

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I would expect, you know, potentially

some of those that currently exist.

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Perhaps they don't tomorrow.

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Um, and at the end of the day, you know,

obviously OLM Hospitals care for patients.

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That's, that's what

our caregiver teams do.

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Um, but we are still businesses.

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Mm-hmm.

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We still have to have a margin

that is in the, in the black.

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Um, and so, you know, if you

walk into our hospital, we

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are going to take care of you.

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So regardless of whether or

not you have a payer source, we

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are going to take care of you.

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Um.

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Yeah, there are other things in our HR one

that, that we know will have some impact.

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Um, and not certainly that the,

that the association has a position

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on those, but so much as we know

that directed payment is gonna have

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an impact, that is a math problem

that is simple for us to calculate.

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Yeah.

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Whether or not people lose coverage

underneath, um, different scenarios

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that have played out under HR one, those

just add to that loss for hospitals.

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Do we know, like are they

predicting how many people will

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lose coverage and how soon?

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I mean, I mean there are certainly

those, uh, groups out there

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that are putting out estimates.

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You know, upwards of 136,000

I think is one that I've seen.

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Um, but again.

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You know, the, the damage is done with

the directed payment program loss.

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Mm-hmm.

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And then how much more of an impact?

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We'll see whenever folks, um, do not have

coverage and they end up in er and that is

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their first point of contact, um, because

of their loss of coverage, which costs.

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Our, our state More money.

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Yeah, definitely.

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I mean, I think another tangible

piece, whether or not people

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don't relate that though.

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Yeah.

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That people don't put those together.

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Like I said, what you said in

the beginning with all that great

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information, people, I don't think,

I mean that can really put that

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in their practical life and then

know the idea that, you know, how.

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Things that we make decisions on federally

that affect our state will affect

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our budget, which in turn means cuts.

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Mm-hmm.

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Services or hospitals closing.

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Um, do you foresee any of that,

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you are a business as a hospital,

you guys are already deciding.

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What kind of decisions

you're making ahead of time.

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Two, keep you in the black or keep things

open or, you know, you're strategically

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finding care across the state if possible.

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So can you talk a little bit about that?

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Well, um, briefly, you all have been

talking about the department, the

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mental health and struggles there.

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They're facing a $40 million shortfall.

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I think we're all aware of it.

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I think 23rd and Lincoln.

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You know, throughout that

building, people are concerned.

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You know, that is a nonpartisan

issue on mental healthcare

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and behavioral healthcare

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with HR one, and, and I, I hate to speak

of it this way, but the providing of

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those types of services are a financial.

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Loser.

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Mm-hmm.

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Like they, they, they do

not pay for themselves.

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And so when you are a hospital and

you're looking at areas in which you

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could trim in order to provide services

elsewhere, behavioral healthcare is

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probably more than likely gonna be those

ones because of its loss on margin.

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And so, if I could reuse that

room for providing a procedure

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that otherwise pays for itself.

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I think you will end up seeing

potentially some of those, which

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just exasperates the issue over here.

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Of course.

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And it costs us more money later on too.

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I mean, but you're, like I said, you're

looking out for the hospitals, so you have

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to make those decisions, and that's one

that is, unless we get our agency, whether

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they're 40 million in the whole, or who

knows, 60 million in the whole, we have to

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figure out a better way to support that.

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I mean, there's so many.

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Agencies or departments or things

that aren't supporting each other.

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Mm-hmm.

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That this makes, this exacerbates it.

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Yeah.

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Would, would you agree?

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Yeah.

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Yeah.

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It's, uh, um, it's, it's, it's starting

to, you know, kind of landslide a bit.

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Um, and I, and I know that people

keep pushing it down, like they

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were talking about kicking the can.

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I was like, I don't know if you're, if

you're struggling with services anyway.

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But we're not kicking the can.

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It's happening now.

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It's just going to

continually getting worse.

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Well, and you said 2032, but you

know, I went to a presentation at a

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hospital where they were showing like

a 10 year plan, and it was year three.

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Mm-hmm.

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You know, it was three years from

now where they were seeing red.

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Mm-hmm.

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And they presented it to a group of board

members and it was silence afterwards.

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And so I struggled with like,

what are the appropriate questions

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that we should be asking?

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Yes.

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If you're a hospital, what are the

type of questions you think they're at?

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Talking about internally

as they move forward?

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Well, I think, you know, and, and there's

nothing that I haven't said publicly

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that I wouldn't otherwise say here.

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You know, oftentimes if a, if a

rural hospital is struggling, um.

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It is not unlikely that folks would seek

to partner with a larger system mm-hmm.

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Um, to manage them.

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And, and whether that's a larger system,

uh, you know, like some of the metro

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here in Oklahoma City or in Tulsa or

one of our regional hospitals, uh,

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that may manage a number of rural, um.

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I would suspect that they're gonna

have to reevaluate those relationships.

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Right.

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Because that is still a

financial burden for them.

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Um, but you know, these are, we say

this all the time at OHA, it is about

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Oklahomans taking care of Oklahomans.

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Mm-hmm.

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And so none of this comes without pain.

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Mm-hmm.

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But it is the reality of you have.

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Limited dollars, limited

reimbursement, and something we

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haven't particularly touched on yet.

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Um, but it's all about payer mix.

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Mm-hmm.

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Right?

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Mm-hmm.

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And so for the state of Oklahoma,

the majority of the payers for

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our hospitals, Medicare, Medicaid,

and then third party mm-hmm.

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And Medicaid, Medicare,

make up the majority.

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And we are the largest provider

within the healthcare authority,

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the State's Medicaid agency.

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Um, and so when these changes come,

they have significant impact upon.

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Us.

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Uh, one of the another things we kind

of touched on was like just hospitals

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in rural areas and workforces, but you

know, we talk about workforce shortage in

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healthcare communities, but if you don't

know that that hospital's gonna be there

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in a year or two, it's gonna be very hard

for you to recruit physicians, you know?

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And so.

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Trying to create stability in our

rural communities, but how impactful

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is a hospital in a rural community?

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Well, we often talk about education

and public schools being some of the

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top employers in rural communities,

hospitals are no different than that.

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We tend to be in the top two.

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Um, and we pay far above the minimum

wage and the majority of areas.

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And so, um, you know, we are, uh, top

employers in those areas, in especially

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those rural areas of the state, whether

you're talking about the Panhandle

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or Southeast Oklahoma, et cetera.

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Um.

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To your point about workforce,

I think what's even, you know,

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more recruitment is one thing.

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Mm-hmm.

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But what you often see in rural

Oklahoma, many places around, uh, the

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state, is they may have a partnership

with their local career tech.

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Mm-hmm.

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And so they're training, you

know, on the job within their

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facilities and vice versa.

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And so.

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You know, I, I, I would be shocked

if you didn't see some impact in,

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into those areas in the relationship.

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So obviously we need those positions in

rural areas, um, but we also need other,

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uh, healthcare providers in those areas.

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And so all of it gets impacted,

um, potentially when you don't have

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the dollars to otherwise go out

and recruit and hire and retain.

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I was talking to a chairwoman, wrote

the other day, and she's a provider.

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You know, she's a provider, and she

was talking about how the lack of

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providers just on their clinic is just.

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It, it's just intense.

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You know, she's, she's trying, trying

to catch up plus do her job and she

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does a great job at the capitol.

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My question too, though, is a little

bit related to that about, um, you know,

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we, we keep talking about the, the math

problem, but the effects that these

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decisions that we're making, um, with

workforce, with our small towns, rural,

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even in our urban, do you just think

this is one of those dominoes that's.

327

If, if something's not shored up,

it'll it, it'll just com happen

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quicker and affect other areas.

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I mean, education, your career tech, is

that something that you think it's either

330

working all together or this is a real big

one that could knock a bunch of them down?

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Hospitals are an economic driver across

the state, whether rural or urban.

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And so I can sit here and tell

you the math equation of $6.7

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billion in loss.

334

That doesn't get into how it otherwise

spirals out into the rest of the economy.

335

That's what I like to talk about.

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I, I just think the needs of the, of what

that's gonna happen is always, people

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aren't really paying attention, especially

with a, if they don't understand your.

338

You know, uh, the beginning of

how you talked about HR one, I

339

just don't think people, I don't

understand and who to believe on

340

that too, but continue, I'm sorry.

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Well, you, you know, OHA has had

and continues to have outreach

342

with our congressional delegation.

343

Um, and that's important, right?

344

In any conversation to have those, those

doors open to have that communication.

345

Um, and they've all

been consistent, right?

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That, uh, the state should pick up.

347

A greater share, uh, of the cost of all

of this and, you know, always open to

348

having those debates and conversations.

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I think, um, you know, for Oklahoma,

recognizing that we do, uh, well, we are.

350

Potentially more negatively

impacted than many other states.

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And so just being cognizant of that.

352

Um, and I think, you know, to some degree

that they, that they certainly are.

353

Um, and I haven't talked to anyone at

23rd and Lincoln that isn't concerned.

354

Mm-hmm.

355

And it is certainly fostering a greater

conversation about what does healthcare

356

look like and what does healthcare

look like in rural Oklahoma long term.

357

Um, and I think folks

recognize that this is.

358

Is potentially going to be very painful.

359

Mm-hmm.

360

One of the aspects of HR one was

also a 50 million rural RHTP.

361

RHTP.

362

Okay.

363

Transformation Rural Health

Transformation Program Transformation.

364

I was gonna ask you, can you tell

us a little bit about that program?

365

We talked about it a little

at the capital this week.

366

Yes.

367

Yeah, no, great question.

368

Um, because the Rural Health

Transformation Program is often

369

referred to and has been referred to

as a, uh, fund for rural hospitals.

370

That is not what HR one says.

371

That's not what it's HR one

says that it is for, uh, certain

372

hospitals, certainly rural, but

also for federally qualified health

373

centers, for, uh, certified community

behavioral health centers, CCBHCs.

374

Um, those entities are also, uh,

able to apply for those dollars.

375

Um, but more importantly, you

know, the $50 billion fund,

376

um, nationally, that doesn't.

377

It can't be used for operations, no.

378

Mm-hmm.

379

And so it doesn't, even, even if it were

to a, be able to go towards hospital's

380

operations, it, uh, wouldn't even make

up for a third of what we are otherwise

381

losing underneath the directive payment.

382

Yeah.

383

And that's, that was the piece I

didn't know until this week that

384

someone asked is tho, are those

one-time payments or is it ongoing?

385

And they described it

as one-time payments.

386

And I thought, well,

that's not what I was.

387

That was not my understanding when

I or originally heard about it.

388

There's more guardrails on it than,

than what was initially came out.

389

It is a five year program.

390

Mm-hmm.

391

So it's a five year grant program.

392

I think the state could, at

a minimum, expect to see 200

393

million, um, per year at a minimum.

394

Uh, I think it has been said

numerous times that Oklahoma

395

would otherwise qualify, um, for.

396

Meets the metrics for many of those

items underneath the grant program.

397

And so certainly, um, looking forward

to, uh, any conversations that the,

398

like delegation has, uh, to ensure

that those dollars, you know, really

399

do come back to the state of Oklahoma.

400

Um, and we, at OHA, we

have submitted our own, um.

401

Uh, requests for information to the

Department of Health, uh, for ideas for

402

how to otherwise utilize those dollars.

403

Department of Health is the one that's

managing that for us in the state.

404

Okay.

405

Yeah.

406

And, and they're, they're

working really hard on it.

407

I, um, got to go with, uh, representative

Stinson to go and talk about that when

408

we went to DC and, you know, they're

helping give us some ideas on how to do

409

it with the Department of Health, and I

think they're really trying to understand.

410

Because there is a claw back in it.

411

Mm-hmm.

412

Um, that, uh, if to do

it in the right way.

413

So we end up getting all of the money

that we can, even though it's not

414

enough for what you were talking about.

415

So I do think that, that behind the scenes

people are really trying to work together.

416

I've seen more, I don't know, um, agencies

and people coming together than I have.

417

Mostly we silo ourselves, but I was

really, if anything, that's some.

418

Good news that may come out of

this is that we're really trying

419

to work Oklahoma together.

420

Yeah, I absolutely agree.

421

You know, we've had open dialogue

with, uh, commissioner Reed at

422

the health department and others.

423

Um.

424

And we don't see that door

shutting, you know, anytime soon.

425

You know, I think the team that they

have there at the health department

426

that is really spearheading all of this,

um, they're doing their due diligence.

427

You know, they view this as, I believe

certainly, um, the president wants it

428

viewed as this is a opportunity to have,

um, a real, uh, transformational impact.

429

And so with the team that Oklahoma

has in place, I am, you know,

430

wanna be hopeful about that.

431

And so, um.

432

I think time will tell the, and

bipartisan, I will throw in that too.

433

You know, not just the agencies and

working together, but it's, it's nice

434

when, you know, someone asks, you

know, someone on the other side of the

435

aisle, Hey, can you sit in on this?

436

And so I appreciate that too.

437

Um, or then even ask a question.

438

But, um, so, um, what, what questions

that, what, what's like the wildest

439

misunderstanding do you think is

out there about HR one in Oklahoma?

440

The wildest misunderstanding that's

being out there, like you said, when

441

you know, in the conversations that you

have, because I, I, I think sometimes

442

what, what you're saying or what we talk

about 20 on 23rd and Lincoln and how

443

there's an understanding about working

together and stuff, and, but sometimes

444

I hear what's out there that doesn't

really match what I'm reading or you're

445

doing or saying or, or promoting for, or

talking about for Oklahomans, you know.

446

It to some degree.

447

I think it has to do less about HR one,

and it has more to do with the lack

448

of understanding of how our shop fee

really undergirds the Medicaid agency.

449

Okay.

450

And so when, when I talk about our

shop fee, um, that went into place

451

in 2011, that is a tax voluntary

fee that hospitals, uh, um.

452

Placed on themselves.

453

A certain segment of hospitals

placed on themselves to give to

454

the state is the state's match to

draw down more federal dollars.

455

As I mentioned earlier, that got

us up to a hundred percent of the

456

Medicare level that, um, whenever

State Question 8 0 2 passed on Medicaid

457

expansion, our fee was set at, uh, 4%.

458

To help pay for Medicaid expansion.

459

Mm-hmm.

460

So not only does it pay for that

state share, uh, generally for

461

draw down, whenever expansion

occurred, then it paid for that.

462

And um, and then whenever we moved to

the directed payment model, um, our

463

fee now pays for the upper payment

limit, so that a hundred percent

464

Medicare the managed care gap.

465

So it helps the state with their.

466

Pull down from that piece.

467

And then it also funds, uh, a bit

of Medicaid expansion because the

468

premium taxes that the managed care

entities pay, that also goes to

469

help pay for Medicaid expansion.

470

And then there's just a, a, another

transfer out annually to another, uh,

471

revolving fund that the state has.

472

And all this is set statutorily.

473

And so.

474

Uh, I believe last year our hospitals

paid, well, I think it's this

475

year, 20 25, 360 $9 million in,

uh, shop fees to hand to the state

476

and allow them to use to draw down.

477

So, I mean, I would contend certainly,

and I understand it's certainly my

478

role, but we have a very successful

private public partnership with the

479

state that has allowed them to utilize

these dollars to draw down more.

480

I, I don't think that most people

truly understand how that works.

481

Okay.

482

And, you know, we can own that

as a hospital association for

483

not explaining that well enough.

484

Um, but we have also had former

lawmakers that are no longer there,

485

that we're also considered, I think,

among many experts in this space.

486

And so, you know, for us it's

about a reeducation in light of hr.

487

One about what exactly our fee

pays for and what it doesn't.

488

And I think that that is, um.

489

The reeducation, you know, just

continually telling our stories and how

490

we support each other and how we make it

work in Oklahoma, I think is important.

491

So I don't think it's a, it's a sort

of a ding on all of us that we, you

492

know, we do things, we pass legislation

and what trickles down to the effects

493

we have to keep telling people why

and if it's working or if it's not.

494

And clearly this was working for us.

495

And so it's nice that you can tell that

story in an educational piece that we can

496

all learn and, and I wanna be fair, right?

497

I mean, managed care, uh, has been

in place in the state of Oklahoma

498

in its current format with the

directive payment for one year.

499

Mm-hmm.

500

And so, but that one year, as I noted

up front, you know, that went from some

501

hospitals being the red and the black

overnight, and so it was significant.

502

For our hospitals to maintain their

operations in their communities.

503

I mean, I, I, I, I point

out one particular hospital.

504

I know that in the state, and I know

that they're not, um, necessarily unique,

505

but their hospital, um, their cafeteria

is open on a Sunday, and it is the only

506

restaurant that is open on a Sunday.

507

Because it is that small of a

community and they open their doors and

508

that's where people go after church.

509

Mm-hmm.

510

And so those are the little things

that we don't necessarily chat about.

511

Um, I always say our hospitals need to

do a better job at telling your story.

512

Mm-hmm.

513

That is one of those stories that, you

know, our hospitals are community hubs.

514

In many places around the state

and, and for them to recognize

515

and promote that, that we are

Oklahomans taking care of Oklahomans.

516

I love that.

517

One of the things that we wanna

do on the podcast is also kind of

518

like translate this to like policy.

519

Mm-hmm.

520

And how we talk about policy.

521

So, you know, if people are

like, well, what should I be

522

advocating for, asking more about.

523

In the policy realm, you know,

what are, what would you provide to

524

those people in the policy realm?

525

Well, you know, it's, for me it's

less about necessarily policy and more

526

about education and, and being aware

of how the systems work, um, and how.

527

Ever you want to choose

to get involved with that?

528

Mm-hmm.

529

Um, you know, for, for myself and,

and my family, you know, obviously

530

I work in the healthcare space.

531

Um, but my son is someone who has been

a benefit of Oklahoma's hospitals.

532

Mm-hmm.

533

You know, he's someone who

underwent open heart surgery.

534

Uh, we have you.

535

Arguably the number one, uh,

pediatric cardiologist in

536

the nation, if not the world.

537

And, you know, that is amazing

that I don't think people,

538

you know, really understand.

539

Um, and so it's.

540

I, I think it just goes back

to storytelling for hospitals.

541

Mm-hmm.

542

And, and letting their communities

know that, you know, these, this

543

is what we deliver back to you.

544

Mm-hmm.

545

Mm-hmm.

546

Um, and, and it's, it is not about

profit at the end of the day.

547

It is about taking care of all of us

at the end of the day, because, you

548

know, I've said this before, probably

said it to both of you, and I know I've

549

said it plenty of times, hospitals are.

550

Often the site of our greatest

joy and our greatest pain.

551

Mm-hmm.

552

You know, and, um, and for us to

always recognize that, you know, I,

553

I have always, you know, led my space

by what is best for the patients,

554

what is best for the hospital.

555

And, um, and I believe our

members truly believe that.

556

And, um, you know, we always open our

board meetings in a moment of prayer.

557

Um, I don't know how many

other associations do that, but

558

that is very important for us.

559

Um.

560

And so just recognizing that, you

know, yes, we are, uh, we have big

561

hospitals, small hospitals, everything

in between, but these are all

562

Oklahomans taking care of each other.

563

I kind of shout out to the

hospital in my district, Integris.

564

I had all three babies there

and, uh, recently I, I was at

565

an interim study yesterday.

566

It was mine.

567

Um, health, AI, and energy, just

talking about all the things that

568

we can prove in healthcare with ai.

569

There's so much, I mean that we could.

570

So help, um, so help, you know,

not have the stalls that we did

571

because my son needed a surgery.

572

It took six months for him to get

to the hospital for the surgery,

573

and not because of anything

else, but, you know, paperwork.

574

I wanna say, yeah, you know, the, and how

it, how long it takes for communication

575

and translation and all of our laws and

all the things that we do and insurance.

576

But once we got to Integris,

like once we got there.

577

It was one of those things that

from the moment we got in the door,

578

our whole family, me, my son, and

my, my other son that was with

579

me, we just felt so taken care of.

580

Yeah.

581

From every interaction we had

that they focused on William,

582

you know, and not just.

583

The way they do other patients, my

son may need a little extra, but I

584

was just truly impressed with the

way we were taken care of even after.

585

And so I do know that the, the care that

that hospitals in Oklahoma and I'm, I'm

586

not sure that my Integris is the only one

that does it, but I do think that it's an

587

important part of our community as well.

588

And how we do have.

589

The best successes in

some of the saddest times.

590

Yeah.

591

Um, so I do think, you know, that the way,

I hope that it continues to be like that.

592

Um, but we know that change is coming

and then we'll still try to remember

593

that Oklahoma standard and how we do it.

594

Yeah.

595

Yeah.

596

Definitely.

597

Well, thank you.

598

I think, um, do you have

any other questions for him?

599

No, I.

600

But I'm so happy that

you question for him.

601

Oh, that's right.

602

He gets to ask us questions.

603

Well, of course.

604

But I just wanna say again, how

happy I am that you're here.

605

Was that, that wasn't so bad, was it?

606

No, no.

607

It was fine.

608

But again, I think that these are

things that we have to, you know,

609

explain to people a little bit

deeper, um, because people are making

610

really quick judgements about it.

611

Mm-hmm.

612

And I think it's more detailed

and lives are counting on it.

613

And, um, the wellbeing of our Oklahomans.

614

I mean, you've highlighted it.

615

I think you've highlighted as well.

616

I mean, we're all in this together.

617

Mm-hmm.

618

Yeah.

619

You know, regardless of

what ends up happening.

620

And so that's the focus.

621

Great.

622

So I.

623

And between two Ellens, we ask our

guests to ask the Ellens a question.

624

Yeah.

625

Do you have a question for us?

626

I, I have a great question for you both.

627

Um, kind of just curious of the origin

for, I was just thinking if you don't

628

ask that question, we have to say

that, have to say at the end, so.

629

So this is actually self-serving.

630

So do you wanna tell the story or no?

631

Did we tell the story?

632

I was just an observer.

633

Observer.

634

Well, yeah, I was late to the dinner.

635

I'll just say that.

636

Yeah.

637

So, uh, we, and when I walked in,

I'm sorry, I just saw Scott and I

638

go, oh, I gotta sit next to Scott.

639

No, we.

640

So we have at the table our Democratic,

um, kind of like caucus retreat.

641

And we were in Tulsa, and, um, we had

gone out to dinner with the Oklahoma

642

Hospital Association, and Scott sat

next to us or sat next to me, you, and

643

then I was late and I sat next to you.

644

And Scott looks at both of us and he

said, um, I'm like, you should have

645

a podcast called Between Two Ellens.

646

And here we're that literally, I

mean, in January, I think it was.

647

Are you here later?

648

Yeah.

649

So yeah, thank you so much for your

inspiration, for your creativity,

650

but I think down my part, but

I think also, you know, we,

651

we do have the same names.

652

We're.

653

We're same and different in a lot of

things, but I think you pointed out

654

that night the conversation between us

that night was, was really great and,

655

and, and different, we both even had

different questions or different ideas

656

or, and, but the whole thing that.

657

You know, working together and

trying to find better for Oklahoma.

658

So yeah, you were the inspiration.

659

You started it.

660

So we can either blame

you or celebrate you.

661

I guess we'll see on the views.

662

So is that the real question or did

you have That was real question.

663

That's what I got.

664

I love it.

665

Yeah, I love it.

666

I love it too.

667

So the answer is you.

668

Yeah.

669

Well thank you again for being

here and, and you know, any kind

670

of updates that you can give us.

671

We do have, uh, a website and we

have social media, um, Instagram,

672

so we can update that as well.

673

Um, afterwards, if there's anything

changes new when the, the rural health

674

RHTP comes out and how that affects

hospitals, we'd love to hear it.

675

Yeah.

676

Awesome.

677

Thank you, Scott.

678

Thank you so much.