June 20, 2018
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EMMC wraps up deal to integrate Bangor cardiology practice

By Jackie Farwell, BDN Staff

BANGOR, Maine — Eastern Maine Medical Center has finalized plans to integrate Northeast Cardiology Associates, the last sizeable private cardiology practice remaining in the state, into the hospital’s heart center.

The deal between EMMC and Northeast, a Bangor physician practice, was reached Monday after about a year of serious negotiations, according to James Raczek, EMMC’s chief medical officer and senior vice president of operations.

The agreement will lead to more coordinated care and give heart patients better access to services, he said Monday.

Northeast Cardiology’s roughly 100 employees, including 17 physicians, are now employed by EMMC. The hospital purchased the practice’s assets, including equipment and supplies, but not Northeast’s building at the Maine Business Enterprise Park, where the practice will remain.

EMMC said it paid fair market value for the assets, but did not disclose the purchase price.

The move comes as the federal government, in an effort to improve health care while lowering costs, increasingly ties shrinking Medicare reimbursements to how efficiently health providers deliver care. Many cardiology practices across the country have joined with hospitals to adapt to that shift, said Robert Hoffmann, executive medical director and lead cardiologist at Northeast Cardiology.

“By us being integrated, we’re going to be able to provide more efficient care, more timely care,” he said.

Across the nation, an increasing numbers of private heart doctors, faced with slashed Medicare payments over the last several years, have sold their practices to hospital systems to stay afloat. Under Medicare’s payment system, hospitals receive more generous reimbursements than individual doctors for some specialty services, including cardiac treatment.

The deals can lead to better care, but also have been criticized for giving hospitals the clout, through controlling most of the cardiac services in a region, to negotiate higher reimbursement from private insurers.

The Maine Attorney General’s Office is monitoring EMMC’s deal with Northeast to ensure that EMMC and nearby St. Joseph Hospital maintain a level playing field in treating cardiac patients, said Linda Conti, who heads the AG’s consumer protection division.

A similar deal announced in 2010 by Portland’s MaineHealth raised concerns about a lack of competition for cardiology care in southern Maine, she said. MaineHealth partnered with two local cardiology practices, but was able to reach an agreement with competitor Mercy Hospital to ensure that the deal didn’t raise prices for treatment or siphon patients away from Mercy to MaineHealth’s Maine Medical Center, she said.

EMMC and St. Joseph are expected to have similar discussions, Conti said.

Unlike EMMC’s plan, much of the concern about MaineHealth’s transaction arose from the fact that the two private practices planned to merge, limiting patients’ choice in cardiac care, Conti said.

“Northeast already has a legal monopoly,” she said.

With Northeast Cardiology’s integration into EMMC, the few cardiologists remaining in the state who don’t work for a hospital system are mostly solo practitioners, said Gordon Smith, executive vice president of Maine Medical Association.

“This would appear to be the last cardiology practice of size in the state to merge into a hospital,” he said.

With the addition of Northeast Cardiology, EMMC doctors and patients will have the flexibility to schedule diagnostic procedures at both locations, which is expected to lead to shorter wait times, Raczek said. Northeast performs diagnostic testing including echocardiograms and exercise stress tests at its office.

At EMMC, where doctors are under pressure to treat and discharge patients as quickly as possible, heart patients sometimes end up waiting for outpatient testing before they can go home, Hoffmann said.

“If our office [can] assist in taking some of the outpatient burden, then the inpatients will get taken care of more quickly and be out of the hospital quickly,” he said. “And the outpatients, for them it’s a bit more convenient” to undergo testing at Northeast.

At EMMC’s heart center, nearly 31,000 adult electrocardiograms, more than 8,600 adult echocardiograms, and almost 5,600 cardiac catheterizations were performed in fiscal year 2012, according to the hospital.

The deal also will help EMMC to recruit new cardiologists, Raczek said.

“Making sure that we have enough cardiologists to meet the demand for our region, so that our referring providers are able to get patients here efficiently when they need cardiac services, whether that’s outpatient evaluation or inpatient evaluation, is something we need to continue to work on and improve,” he said.

Raczek said he foresees a need particularly with outpatient cardiology services.

“Sometimes the waits are longer than we all like,” he said.

EMMC’s backing will give Northeast the resources to visit surrounding hospitals for consultations more frequently, Hoffmann said.

“The patients like that because some of these hospitals are a great distance away; it’s a long way for them to travel,” he said. “They like the idea of being able to see a specialist locally if that’s available to them.”

Cardiology services now staffed by Northeast at St. Joseph Hospital will continue to be available.

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