June 21, 2018
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EMMC overburdened by proposed state budget cuts

By Dr. James Raczek, Special to the BDN

Recently, I had the privilege of sharing some frank and direct conversation with state legislators regarding the proposed cut to Maine’s hospital-employed physicians. As Eastern Maine Medical Center’s vice president and chief medical officer, I make sure that EMMC has the physician work force to provide specialty medical services for the northern two-thirds of Maine. That responsibility is weighing heavily on me as I contemplate the risks involved if the state withdraws substantial financial support for hospital-based physicians through MaineCare.

MaineCare reimbursement is already poor. Private practice physicians usually limit the number of MaineCare patients they see, because they can’t afford to provide significant amounts of care they won’t be paid for. That’s one of the reasons private practice physicians who care for a large MaineCare population have become hospital-employed. EMMC employs about half of its medical staff — 32 practices in all. The burden of these proposed cuts will be heavier on EMMC than any other hospital in Maine. The state’s estimated impact on EMMC is $4.9 million.

Hospital employed physicians see a disproportionate share of MaineCare patients, because hospitals don’t limit the number of MaineCare patients they will see. For example, more than 60 percent of the patients who see our hospital-employed OB-GYN physician are covered by MaineCare — at least four times more than her colleagues in private practice. She can afford to do that only because she draws a hospital salary. The losses must be absorbed by EMMC. If we don’t absorb that loss, where would those patients go?

More than half of the primary care physicians in Maine are hospital-employed, many at critical access hospitals in our region. These practices will suffer immeasurable harm if the cuts go through. Primary care physicians are paid by the patient visit. There’s no reimbursement for implementing an electronic medical record, completing insurance forms, reviewing lab results and X-rays, consulting with specialists, calling patients, families, nursing homes, or home health agencies, or many other duties of care management. Without this coordination of care, however, the costs of medical care rise with the unnecessary duplication of tests, inappropriate use of specialists, etc.

EMMC provides tertiary, or specialty, medical services for northern, eastern and central Maine. We are the region’s patient care safety net. Twelve of Maine’s 15 critical access hospitals depend on us for adult, pediatric, and neonatal critical care. Often EMMC is the only hospital in the region that offers the services that a patient may need. Providing the safety net requires a significant physician work force. If EMMC loses the kind of dollars we are talking about, it may jeopardize our ability to maintain the safety net. There is no other hospital in the state that is able to assume that role for our region.

EMMC pursues its mission of service with great passion and determination. Still, there must be a limit to the cost of that dedication. For several years now hospitals have borne the burden of the state’s budget shortfalls on our shoulders. The state already owes hospitals $400 million for care already provided to MaineCare patients — this is not underpayment; this is no payment at all. EMMC alone is owed $73 million for MaineCare patients dating back to 2005. Is this not enough of a contribution to the state’s financial problems? Hospitals should not have to “give more financial support” to the state to balance its supplemental budget.

The state’s Health and Human Services commissioner told legislators that the proposed cuts would have minimal to little impact on the health care of MaineCare patients. I disagree. Before drawing a conclusion that the proposed cuts will not affect the health of Maine residents and will not affect hospital operations, the state should have asked us. To my knowledge that did not happen.

I have a proposal. It involves collaborative dialogue. I believe there are a number of health care leaders in the state who would be happy to work together with the Legislature and state planners to come up with a plan that would not only lower costs, but also improve care.

Dr. James Raczek is the chief medical officer at Eastern Maine Medical Center.

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