Hospital expansions stopped Baldacci: We want best, not most, health care

New spending for hospital construction and equipment will come to a halt under a moratorium issued by Gov. John Baldacci earlier this week.

Through his emergency rule-making powers, the governor imposed a one-year pause to health care projects that require the approval of the state’s Certificate of Need office, a branch of the Department of Human Services. Emergency projects and those for which applications have already been filed are exempt.

Baldacci said the moratorium will allow state planners to change the CON program to get state spending under better control as part of his effort to make health insurance available to every Mainer.

“We want the best, not the most, health care,” Baldacci said.

Baldacci and Trish Riley, the principal architect of Baldacci’s ambitious reform plan, say Maine’s health care system is staggering under the burden of runaway expansion at hospitals and other medical facilities across the state.

In competition for health care dollars, hospitals have built an array of cardiac catheterization labs, magnetic resonance imaging units, ambulatory surgery centers and even whole new facilities in the past few years.

In Bangor, for example, both St. Joseph Hospital and Eastern Maine Medical Center now boast cardiac catheterization laboratories just a few blocks apart, while the neighboring southern Maine cities of Portland and Lewiston compete for cardiac surgery patients.

In his Monday address, Baldacci cited a 1999 study that said the state of Maine had more MRI units than the entire country of Canada.

Make no mistake, says Brad Ronco, an analyst with the Certificate of Need office, that kind of convenience, or duplication, costs Maine plenty.

“Whenever a hospital goes out and spends money [on building projects or equipment], it collects the cost through the health care system,” he said, either through private insurance, Medicaid, Medicare, or tax deductions or other bookkeeping strategies.

It’s the upward spiral of costs that the governor wants to squelch while he and Riley and their health care advisers develop a far-seeing state health plan. Key to that plan, according to Baldacci, is the revision of the Certificate of Need process.

Maine’s CON office came on line under a federal mandate issued by the Nixon administration, along with similar programs in every state. The mandate was repealed under President Ronald Reagan, and now 18 states have abandoned the process altogether, allowing hospitals to operate under a free-market model, in competition with each other and with private physician-owned clinics.

Maine’s CON office has come under frequent fire for approving nearly all of the proposals it receives, and critics claim the system undermines a fair distribution of services while discriminating against free-standing clinics.

But Baldacci wants to strengthen, not eliminate the system. He says CON is an important player in managing Maine’s health care system.

“I don’t think health care should be marketed like used cars, ” he said. “Every Maine citizen, no matter where you live, needs to know you’ll have quality care where and when you need it.”

Baldacci said he wants to restructure the CON process to support an as-yet-to-be-developed statewide health plan that ensures a fair distribution of services throughout the state, whether those services are provided by hospitals or physician groups.

Stephen Michaud, president of the Maine Hospital Association, said he’s heard very little outcry from member hospitals regarding the moratorium. He said the industry strongly supports CON reform.

Michaud said CON should be extended to include the growing number of private-practice physician groups building outpatient surgery centers and other free-standing clinics that compete with hospitals for patient dollars.

Gordon Smith of the Maine Medical Association, which represents most physicians in the state, has long opposed the CON process and has supported legislation to do away with it altogether in Maine. Private medical practices don’t have the financial resources to compete with hospitals in the CON process, Smith said.

Hospitals on Wednesday were still trying to ascertain the impact of the moratorium on their projects. EMMC spokeswoman Jill MacDonald said the hospital has been working for two years or more on a plan to place a six-bed dialysis center at Penobscot Valley Hospital in Lincoln. The hospital has already submitted a letter of intent to the CON office, so the project might not be affected, but MacDonald said the status was still unclear.

The CON office in Augusta was unable to supply complete information on the status of specific projects Wednesday. But some area projects that may go on hold include additional surgical suites at Penobscot Valley Hospital in Lincoln; MRI units at Penobscot Bay Hospital in Rockland and at The Aroostook Medical Center in Presque Isle; and a new hospital building for Calais.