Hancock County’s three hospitals are no different than their counterparts in other rural areas of the state. They share the same challenges of delivering health care to an aging, low-income population suffering from a variety of chronic conditions while also attempting to balance the bottom line to offset rising costs and reductions in reimbursement for care.
Two hospitals — Blue Hill Memorial Hospital in Blue Hill and Maine Coast Memorial Hospital in Ellsworth — have responded these challenges by joining Eastern Maine Healthcare Systems (EMHS), which now has nine member hospitals.
Mount Desert Island Hospital in Bar Harbor has chosen to remain independent but last year became one of five hospitals in the Maine Rural Health Collective, which shares many of the same goals of efficiencies through collaboration as EMHS.
Maine Coast Memorial Hospital (MCMH) completed its affiliation with Eastern Maine Healthcare Systems in October.
“We’re well into the integration process,” said hospital President and CEO Charlie Therrien. He estimates it will take another three and six months for that process to be complete. The switchover should be invisible to patients.
“In terms of direct patient care, people shouldn’t see any changes,” Therrien said.
Therrien and his counterparts in Blue Hill and Bar Harbor would agree that a major benefit in collaborating with other health care providers comes from economies of scale. Whether stocking up on Tylenol or pricing health insurance coverage for employees, the more you buy, the cheaper it gets.
Patient care is another matter.
“There is no economy of scale between the clinician and the patient,” pointed out Art Blank, president and CEO of Mount Desert Island Hospital (MDIH).
Collaboration, however, can improve patient care in a number of ways. The possibility of job sharing with other nearby hospitals can make a difference in attracting quality physicians. In addition, having a specialist in-house, if only part-time, can make it easier for patients to get care, said John Ronan, president and CEO of Blue Hill Memorial Hospital (BHMH).
BHMH joined EMHS in 2005. Ronan said MCMH’s affiliation with EMHS is strengthening the ties between the Ellsworth hospital and BHMH, a relationship where patients are to benefit. One example would be a greater sharing of clinicians.
“We’re looking at the opportunity to change and influence health care in Hancock County,” Ronan said.
MDI Hospital and MCMH have shared some services for a while. That relationship is not expected to change, Blank said.
“We are part of a health system,” Blank said. “We share that community responsibility.”
Providing health care to the community must be balanced with paying for that care. In this area, the administrators would admit they have concerns.
MCMH posted a loss of $6 million as of the fiscal year that ended June 30, Therrien said. With the affiliation with EMHS, the hospital is now on a fiscal year that begins Oct. 1.
The fiscal year for MDI Hospital ends in April. The hospital is in the midst of what Blank describes as a “$2-million turnaround” and expects to end the year “in the black.”
Ronan said his hospital has a “solid bottom line” and, as of the fiscal year ending Sept. 30, is showing a profit.
Hospitals are struggling financially for a variety of reasons including one that seems counterintuitive. Preventative care, early diagnosis and health education are replacing the traditional care model of treating chronic diseases. As beneficial as that is to patients and society as a whole, the hospitals are losing a source of revenue derived from in-patient care.
“There’s a focus on keeping people healthy and managing their chronic diseases,” Blank said. “The challenge we have is no one pays for that.”
Insurance companies increasingly are seeing the value in prevention.
“We’re starting to see a shift in payment models,” Therrien said.
Another contributor to financial shortfalls is the state’s unwillingness to expand Medicaid under the Affordable Care Act. Hospital administrators say the Governor’s vetoes of legislative attempts to do so are cheating Maine hospitals out of money they sorely need.
“We need to access federal dollars our state is sending to Washington that we’re not getting back,” Blank said. “We’re sending the money and leaving it there.”
Even with the financial challenges, the county’s hospitals seem to be providing excellent care, as shown in surveys of patients. BHMH is one of six hospitals in the state and one of 98 in the country to be recognized for quality care by the Leapfrog Group. MDI Hospital received a similar recognition, a five-star Medicaid rating.