BANGOR, Maine — Since July 2006, state employees have had a financial incentive to seek health care at Maine’s best-performing hospitals. Here’s the deal: Services delivered at one of the state’s “preferred” hospitals are not subject to the employee’s annual deductible, reducing what patients must pay out of their own pockets.
The list of preferred hospitals is updated twice each year by the Maine State Employee Health Commission, based on data compiled by the Portland-based nonprofit organization Maine Health Management Coalition. The new list is expected by the end of this week.
Five hospitals have consistently have made the state employee grade over the past five years: Mercy Hospital in Portland, Eastern Maine Medical Center in Bangor, Mid Coast Hospital in Brunswick, Miles Memorial Hospital in Damariscotta and Mayo Regional Hospital in Dover-Foxcroft.
Hospitals are ranked according to their performance in specific clinical areas, their patient safety and infection prevention records, and patient satisfaction.
Dr. James Raczek, vice president and chief medical officer at EMMC, said Wednesday that the hospital’s consistently high performance reflects a teamwork approach to improving the quality of care at the 400-bed facility.
Being designated a preferred hospital for state employees is significant to EMMC’s bottom line, he said, particularly because so many other patients seen there are covered by Medicare or Medicaid. Those public programs typically pay less than what it costs to provide care, he said. EMMC also provides discounted or free care to patients with no coverage at all, he said.
“Any time you can attract patients who still have private insurance to your facility because it is a preferred place to receive quality care, that’s a good thing,” Raczek said. “You cannot continue to operate without those patients, and it’s been shown that this kind of tiering does influence patient choice.”
With more than 34,000 employees and dependents, the self-insured state of Maine represents one of the largest purchasers of health care in the state. It has a clear incentive to improve the health of its employees and hold down the cost of the care they need.
“We had two objectives,” said Frank Johnson, director of the government’s Division of Employee Health and Benefits, which has driven the tiering system and the deductible waiver. “One was to increase hospital transparency, which has certainly happened. The other was to give hospitals the business case for investing in patient safety and medical quality.”
Information reported to the Maine Health Management Coalition is provided voluntarily. Johnson said the number of hospitals reporting clinical, safety and patient satisfaction data has risen over time, partly in response to complaints from state employees who found their local hospitals excluded from the top tier because they hadn’t chosen to participate. Now, he said, all 36 of Maine’s acute-care hospitals participate, and about 20 make the “preferred” list.
Beginning in August, Johnson said, the Maine State Employee Health Commission will add a new variable to its ranking of Maine hospitals: the price of certain common procedures. Hospital charges across the state vary considerably, he said, with some procedures costing 50 percent more — or even more than that — at some facilities than at others.
“We’d like to see that gap close significantly,” he said. Steering Maine state employees to hospitals that provide high-quality care at a competitive price is one way to increase efficiency throughout the system, he said.