MEDICAL DOLLARS AND SENSE

A state panel’s recommended denial of a major addition to Eastern Maine Medical Center highlights a disconnect between the state’s health plan, which focuses on reducing health care costs, primarily through preventive measures, and the medical reality that as small rural hospitals shrink regional hospitals such as EMMC must grow. This conflict won’t be resolved through the rejection or approval of building projects, rather it requires a realistic assessment – by both regulators and hospital officials – of Maine’s health care needs, how they are met and what that really costs.

While EMMC clearly needed to provide more data and commit to more assessments to show the $250 million addition is needed, the state is in the odd position of criticizing the hospital for doing what the state has generally said it wants. There has been a strong push, in part through the state health plan, to transform smaller, rural hospitals into critical care facilities that send patients who need specialized treatment and longer hospital stays to EMMC. In part to accommodate patients from these hospitals, EMMC has sought to add more beds, operating rooms and improve the emergency department in a new eight-story tower it proposes to build.

Last month, the state’s certificate of need unit, which must approve most major medical facility projects, recommended that the EMMC plan be disapproved. It rightly found that the hospital’s claims that the new facilities would improve patient outcomes, which was not supported by any data or descriptions of how such improvements would be measured, was inadequate. EMMC also failed to explain how building new and improved facilities would not simply encourage more use of them, therefore driving up health care costs.

The hospital recently filed additional information to address these concerns.

The role of EMMC in a regional health care system is a larger issue. “While hospitals in the region are committed to continuing to provide their local communities with the first line of medical care, they depend on EMMC for the more specialized services, which we can provide by consolidating that care in Bangor,” the hospital wrote in its application.

Because of space constraints at EMMC, critically ill patients at rural hospitals too often can’t be transferred to the Bangor hospital or are forced to wait dangerous hours before being accepted; some die and others develop problems that will remain expensive to treat in the long run. The solution to such a problem is to improve and enlarge facilities either in Bangor or at each of the smaller hospitals, which have downsized and are no longer equipped to handle patients with complex medical needs. Doing so in Bangor makes much more sense. Further, ensuring EMMC has up-to-date facilities – its operating rooms are 30 years old – will help the hospital attract and retain high-quality physicians, another benefit to patients in the region.

A recent report found that health care spending in Maine is well above the national average with worse than average outcomes. A major problem is that Maine has more medical infrastructure and equipment, per capita, than other states.

The certificate of need process offers a way to address this problem by reviewing hospital equipment purchases and building expenditures. The process could be improved by allowing for a fuller conversation about the need for a project, with the possibility of revising a proposal based on state input, rather than simply facing approval or denial, which means a three-year wait (and the associated construction cost inflation) before reapplying for a similar project.

In the end, the process must recognize that to reduce duplicate expenditures it will have to approve investments by comprehensive care hospitals such as EMMC.