A New Way Forward
The changing healthcare landscape requires that members of the MaineHealth family be willing to adapt to survive.
Why change now?
Up until now, our members have felt that this approach has been the best fit for our organizations, which were born in the New England tradition of strong, local governance dating to the days when town meetings were common.
But healthcare is changing.
For one thing, the population we serve is getting older. As a result, more people than ever are covered by Medicare, which doesn’t cover the full cost of caring for those patients. Meanwhile, all our organizations are committed to providing care regardless of ability to pay, and with Maine rejecting Medicaid expansion, that means we must provide more charitable care.
These expenses – the shortfall in government programs like Medicare and the cost of charitable care – are passed on in the form of higher charges to patients with private insurance and those without insurance who can afford to pay for their own care. Understandably, private insurers and self-pay patients are stressed by these rising costs, and they are pushing back, squeezing the revenue stream available to our members.
These pressures are system-wide, but our local healthcare systems are also being severely impacted by other forces.
Today, fewer procedures are taking place at our community hospitals. In fact, in 2015, 20 Maine hospitals – including four MaineHealth members – performed fewer than two inpatient surgeries per day.
That’s partly because many relatively simple procedures are now being done in outpatient clinics. But it’s also because more complex procedures are being done at larger specialized medical centers that can afford expensive new technologies employed by highly specialized providers.
And here’s the problem. Traditionally, surgeries and other complex procedures have provided much of the revenue our community hospitals needed to stay open. Now that money is going away.
Meanwhile, large tertiary care hospitals like Maine Medical Center are seeing growth. Indeed, by 2015, more than 70 percent of all inpatient surgeries in Maine were taking place at just five hospitals.
The net result is that local community hospitals – unable to pass more costs on to private insurers and others - are either now losing money, or can be expected to suffer losses in the near future.
Even the smallest of our members, hospitals with 25 or fewer beds designated as “Critical Access” by the federal government and thus eligible to get more generous government payments, are seeing their finances erode. Last year, four of our seven local healthcare networks lost money. A fifth fell well short of budget.
It’s not all bad news
As a system, we met our budgeted operating margin last year, largely on the strength of Maine Medical Center, which is seeing growing inpatient volume and more complexity in its cases. Our healthcare system rewards these trends but does little for community hospitals as they shift to the important missions of primary and secondary care as well as community health.
The good news is, as a system, MaineHealth is in strong financial shape. Dollars have migrated from rural to urban, from small to large hospitals, but those dollars haven’t gone away. And MaineHealth is positioned, as a system, to deliver the best care in the right place at the right time for all our patients.
The challenge, however, is how do we move those resources back to local healthcare networks in real time? Under our current structure, members can save some money through things like shared purchasing, but in each community, services must pay for themselves. And where we want to link care in system-wide efforts, as with our AMI Perfuse program or our Tele-stroke Program, we have to create a complex set of agreements and billing procedures.
Finding a balance in support of our communities
So our members have started to ask themselves these questions: What can we accomplish if we were unified as one entity with a single budget aimed at making sure each community gets the services it needs? And, just as importantly, can we do this in a way that preserves a measure of local control and input into the care we provide locally?
That is the essence of our unification conversation, but it’s not an easy dialogue in a region where local control is highly valued. Together, we are trying to find the right balance. Sharing resources across the system requires a single Board of Trustees overseeing a system-wide budget, so there’s no getting around the loss of at least some local authority. But we are hopeful this can be accomplished while retaining the local identity of each of our member organizations.
Over the course of summer and early fall, we held a series of forums in our communities on our unification dialogue, and our local organizations are still open to your feedback. Members of the public should free to reach out with any comments or questions the office of the chief executive of any of our member organizations. In coming weeks, our volunteer leaders across the system will be convening to decide if unification is the right approach. Remember, you are an important part of our MaineHealth mission of “Working together so our communities are the healthiest in America.”
Unification Community Forum Schedule
|Western Maine Health /Stephens||28-Jun||Concluded||Harper Conference Center in the Ripley Medical Office Building at 193 Main Street, Norway, Maine.||Abbie Graiver: firstname.lastname@example.org|
|Franklin Memorial Hospital||11-Jul||Concluded||Franklin Memorial Hospital: Bass Room||Jill Gray: JGray2@fchn.org|
|LincolnHealth||12-Jul||Concluded||1812 Farm in Bristol Mills||Scott Shott: Scott.Shott@lchcare.org|
|Southern Maine Health Care||13-Jul||Concluded||Nasson Gym, 457 Maine Street, Springvale||Sue Hadiaris: SBHadiaris@smhc.org|
|Southern Maine Health Care||18-Jul||Concluded||Southern Maine Medical Center, 2nd Floor Classroom||Sue Hadiaris: SBHadiaris@smhc.org|
|LincolnHealth||26-Jul||Concluded||Boothbay Harbor||Scott Shott: Scott.Shott@lchcare.org|
|Maine Medical Center||31-Jul||Concluded
||Dana Center, MMC||Clay Holtzman: CHoltzman@mmc.org|
|Coastal Healthcare Alliance||22-Aug||Concluded||Camden Public Library||Jen Harris: JHarris@mainehealth.org|
|Coastal Healthcare Alliance||24-Aug||Concluded||United Farmers' Market of Maine, 18 Spring St., Belfast||Jen Harris: JHarris@mainehealth.org|
|Coastal Healthcare Alliance||18-Sep||Concluded||Rockland City Hall, 270 Pleasant St., Rockland, ME||Jen Harris: JHarris@mainehealth.org|
|The Memorial Hospital||11-Oct||Concluded||Red Jacket Conference Center, 2251 White Mountain Hwy, North Conway||Kathy Bennett: email@example.com|