A dissenting report from the Commission to Study Maine Hospitals, which recently concluded its work, provides the state with a means to solve some long-standing disagreements about hospital care. Given the rising costs of health care, the Baldacci administration and the Legislature should use it along with the majority’s report to improve the way hospitals work here.

Both the author of the majority report, former Bath Iron Works CEO Bill Haggett, and a supporter of the minority side, Steven Michaud of the Maine Hospital Association, emphasize the two sides agreed on 14 of the final 20 recommendations. These include expanding electronic medical records, standardizing hospital financial data and setting voluntary cost and margin targets. However, two issues especially in the dissent, written by Scott Bullock, CEO of Maine General Health, and John Welsh, CEO of Rumford Hospital, are worth trying to solve.

The first, predictably, is about cost, and the space between the competing views on the question is enormous. In brief, the majority report says Maine’s hospitals are more costly than the regional average and much more costly than the national one. It relied on work by Dr. Nancy Kane of the Harvard School of Public Health. The minority report says she’s gotten her numbers wrong, and uses figures from the American Hospital Association to show that Maine hospitals are less expensive than those in New England and only a little more than the national average.

Agreeing to disagree isn’t good enough in this case because so many of the problems with health care have cost at their core. For instance, it directly affects the phenomenon of hospitals shifting costs to private insurance because of the level of payment from Medicaid and Medicare. If the hospitals are right, those public programs must reimburse at a higher level; if the majority of the commission is right, hospitals must lower their costs until those public reimbursements become adequate. The policy implications of this are significant.

The state has a couple of options:

It could work with the hospital association to find a new source of hospital cost numbers or it could ask experts to review the work done to date. There’s no debate that Maine insurance premiums are higher than average – finding out why is important.

A second disagreement is over the majority’s call for a statewide hospital consortium, in which purchases are made jointly, protocols are accepted statewide and electronic medical records (EMR) are uniformly accessible. Mr. Michaud of MHA points out that hospitals have formed their own consortiums already and that in some cases, trying to coordinate purchases among 39 hospitals is unwieldy and time-consuming. He agrees that statewide practice standards and EMR are good ideas.

The state’s interest in the other aspects of a consortium is to save consumers money – if MHA or existing hospital consortiums can demonstrate that the savings are already being achieved or are so small that they aren’t worth pursuing, there’s little reason for a statewide group. However, both the state and hospitals ought to have a sense of what else the consortium could achieve.

Maine is nowhere near ready to start closing rural hospitals, as was the feared result of the commission, but it clearly can find savings while improving already commendable quality in its hospitals. Starting with the broad agreement in the commission’s report, it can solve remaining disagreements and move forward together on this crucial part of health care reform.