DECH board votes against critical access plan

MACHIAS – The Down East Community Hospital board of trustees has voted against pursuing a critical access designation, but will review that decision at the end of March if the hospital cannot meet its 2002 budget.

DECH announced the decision Thursday in a letter to hospital corporators and employees.

Chief Executive Officer Philo Hall said the trustees met Monday and unanimously accepted the planning and development committee’s recommendation that the hospital not seek critical access designation at this time.

Hall said physicians and hospital staff will have to work hard to meet the constraints of the 2002 budget. The draft budget is $20,745,000 – just four-tenths of a percent higher than the 2001 budget, he said.

The planning committee’s recommendation comes after weeks of opposition to the proposed change by hospital staff and members of the community who turned out in force for public meetings on the critical access proposal.

Driving that opposition was the fear that downsizing DECH to meet the requirements of critical access would result in medical specialists leaving the area and the hospital having to send patients as far as Bangor when beds were full.

DECH announced earlier this fall that the hospital was considering the critical access designation because the 36-bed hospital lost $300,000 in the first nine months of 2001.

By changing to critical access, DECH would have been eligible for increased payments from Medicaid and Medicare for the 38 percent of the hospital’s patients who are covered by the programs.

The change to critical access would have required the hospital to limit its acute care beds to 15 with an average stay of 96 hours. DECH’s average occupancy rate is now just under 15 beds a day, and the average length of stay is 3.75 days

Carolyn Foster, chairman of the hospital’s planning committee, said the committee decided not to recommend critical access designation because of the concerns expressed by the medical staff, community members, area employers and hospital board members.

“We listened very carefully to what was said at the public meetings, in editorials, phone calls and letters,” Foster said Thursday. “What we heard loudly and clearly was that the community really cares about this hospital. We see this as an opportunity to work together, and we’re committed to going forward.”

The committee’s recommendation against pursuing critical access designation is dependent on whether DECH can meet its 2002 budget. If the hospital fails to achieve that budget during the next six months, the planning committee recommends that DECH seek critical access designation.

The planning committee also recommended: that the board clearly charge the medical staff and management to achieve the cost reductions, efficiencies and quality improvement initiatives upon which the budget is founded; that management study ways to reduce labor costs; and that the hospital seek an expedited state approval for up to 10 swing beds to facilitate case management and reduce the average length of stay.

Swing beds, which would be used for skilled nursing care when a patient no longer needed acute care, also were part of the DECH plan for a change to critical access.

Hall said, though, that the addition of swing beds to the current operation will allow the hospital to be reimbursed for patients who need the services of a nursing home when no nursing home beds are available. Without swing beds, that patient would be in an acute care bed, he said.

Hall said the hospital already has cut 15 staff positions at the hospital, but has accomplished that by not filling a position when someone leaves or by transferring staff to another position when their position has been eliminated. The hospital will have to cut another five positions by the end of March to meet the 2002 budget and is trying to determine how to do that, he said.

“We’ve gotten down to where we have to be very careful,” Hall said. “We’ll continue to work that way because we want to continue to be loyal to people who are loyal to us.”

Hall said the task now is for hospital staff and management to find enough efficiencies to get the cost of services down below the payment the hospital receives for the service.

Dr. David Rioux, a board member and one of the most outspoken physicians to oppose the proposal to move to critical access, said Friday that he is happy the planning committee heard and responded to the concerns of hospital staff and the community.

“It is going to take a major effort to make this hospital work, and I think it needs a lot of community support and input so we won’t have to consider critical access again in six months,” he said.