Panel discusses LincolnHealth, MaineHealth merger

Fri, 07/28/2017 - 8:45am

MaineHealth and LincolnHealth hosted a public forum at the Boothbay Harbor Congregational Church on Wednesday, July 25. The panel featured Bill Logan, LincolnHealth chairman, board of trustees; Jim Donovan, LincolnHealth president and CEO; Dr. Russ Mack, LincolnHealth CMO, board of trustees; and Bill Caron, MaineHealth President. The pending merger is one facet of a larger plan to unify health systems across Maine and a small part of New Hampshire.

“If you think about the way the system is structured, we’re really not an independent organization,” said Logan.

LincolnHealth’s current relationship with MaineHealth as a member healthcare system has one significant difference to what it would look if they unify. While MaineHealth reserves the power to approve or disapprove a variety of actions and requests — like budgets, marketing and strategic plans, election of trustees, appointment of CEOs, significant debt encumbrances, property sales, program elimination and bylaw changes — LincolnHealth has no access to resources outside its own, independent system.

“(LincolnHealth) is really not a standalone organization though it may feel like it sometimes,” said Logan. He said LincolnHealth’s budget is somewhat volatile. “Sometimes it makes its budget and sometimes it doesn’t.”

According to information provided at the forum, it has become difficult for periphery systems like LincolnHealth to climb out of the hole or stay afloat, for a couple of reasons. With the state having blocked Medicaid expansions, what would once have been reimbursements from the state are now footed by the hospital or clinic. More serious, and lucrative, needs like surgeries are being taken to larger hospitals with more means, technology and personnel.

However, there are certain drawbacks to unifying, according to Logan.

“You lose that local control, you lose that local feeling, you might lose the innovation that one can get by having different entities that want to try different ways… If we’re going to do this, how are we going to maintain the local feeling at the same time of being part of a large system?”

Responding to a Boothbay Harbor resident’s question about what would be gained and lost in the merger, Donovan said: “We can’t answer that, now. That will be in future planning. In many respects, the forces that are driving us now are going to continue regardless of unification. We are going to have to respond to those changes and the way providers are trained. We realize there are potential drawbacks in the service here, but that exists today. I believe the potential loss of services may become less of an issue if we go forward with this because of the financial strength of the organization.”

Mack added that when deciding on the priorities for the hospital, two things are taken into consideration — determining if those services are of use or interest to the community and whether the quality and cost are sustainable. Mack maintained that with unification, the financial aspects will be easier to manage and the need to contract out certain services will diminish.

A Somerville man expressed his concern over what LincolnHealth would get out of the unification. Bill Caron explained that, financially, a care center like LincolnHealth St. Andrews Campus has to be able to turn a three percent profit so that enough can be collected for things like renovations and upgrades years down the road.

This means anytime that mark is missed, it puts services and upkeep at risk. With the unification, a care center like St. Andrews Campus may only be expected to attain a one or two percent profit whereas a larger center like MaineHealth may be expected to turn a five percent profit. Unification allows capital and resources to be moved or granted from a central point, and shortfalls can be covered.

Asked what Maine Medical Center in Portland gets out of the deal,  Caron said: “It does start with altruism. It starts with the board at Maine Medical Center saying ‘this is not about Maine Medical Center, this is about providing great care to 1.1 million people in 12 counties. That having been said… the first thing that’s in it for Maine Medical Center is… (fulfilling the need) for strong community hospitals, a strong community network where great primary and secondary care is being provided because that’s where it is appropriate to provide it.”

Caron said MMC cannot provide care to 12 counties. “The final more practical thing is Maine Medical Center couldn’t provide all of the services that are required across our region. It’s physically not possible. Maine Medical Center doesn’t provide care in rural areas as well as our community hospitals provide. They don’t know how to provide it like rural providers do.

“Jim, I believe you said in the past that if we did not go forward and unify that LincolnHealth would cease to exist in— six months?”

“The more I think about it, it’s probably true.”

If the unification goes through, the new system will be online Jan. 1, 2019. When the board changes on the official start date for the merger, it will likely look much the same, Caron said.