FARMINGTON, Maine — When the leaders of the Franklin Community Health Network considered joining a larger hospital system two years ago, local control was a significant concern.
Franklin, the parent organization for Franklin Memorial Hospital, was small and independent, and beloved for that. If it joined one of the big guys, it would no longer be in charge of its own destiny.
On the other hand, that destiny would probably be a lot brighter with a larger system’s money and clout. Without it, many feared the area’s only hospital would close.
Ultimately, Franklin leaders overwhelmingly agreed in 2014 to join MaineHealth, the state’s largest health care organization and parent of Maine Medical Center in Portland. Community members largely supported the decision. The state gave its OK.
Franklin would have to give up some freedom, but the bigger hospital group promised both a better financial future and local governance and leadership. MaineHealth would be the parent, but Franklin would still, essentially, rule its own little world.
Two years later, MaineHealth is talking about consolidating all members under a single authority — a move that would likely eliminate that local control Franklin leaders considered so essential when they joined.
Franklin leaders and community members say they understand the reasons behind the proposal — it’s more efficient, could save money, will create a single, coherent system that will move in the same direction and better respond to rapid changes in health care — but they have concerns.
“I think it probably raises everybody’s eyebrows a little bit. It wouldn’t be human nature if it didn’t,” said Clinton Boothby, chairman of the Franklin Community Health Network’s board of directors. “It raises a concern for people. The question for us, though, has to be: Is it a concern and you stop there, or is it an opportunity?”
His board members have not made up their minds.
“We are very cautious about, you know, what are we giving up and what can we protect for the community?” Boothby said.
Currently, MaineHealth works with the members, including Franklin, to set budget parameters, and it approves budgets after local boards do. So while MaineHealth has considerable input, it does not tell the Franklin County health system how or where to spend that money.
Franklin — the parent organization for NorthStar ambulance service, Evergreen Behavioral Services, the Healthy Community Coalition of Greater Franklin County and a number of doctors’ offices, in addition to the 65-bed Farmington hospital — controls spending, hiring and firing, and where and when its doctors practice, among other things.
All of that would likely fall to a single MaineHealth authority, if the proposal is approved.
Quality assurance and credentialing or privileging of doctors would likely remain at the local level.
Franklin isn’t the only area system that would be affected. Western Maine Health, parent of Stephens Memorial Hospital in Norway and a number of medical practices, also would have to give up local authority.
“I think this is a trend for the future,” said David Kumaki, a member of the MaineHealth board and a doctor at Oxford Hills Internal Medicine, which was bought by Western Maine Health several years ago. “Just as it’s harder and harder to be an independent physician not directly associated with a hospital, it’s harder and harder for a small hospital not to be associated with a bigger system.”
He said he’s “cautiously optimistic” about the possible change and believes it could lead to better patient care and coordination.
“Any time you enter into something like this, there’s always a question of building trust. That’s where I think people have difficulty. If you don’t have trust, it’s not going to work, or work well,” he said.
MaineHealth has had time to build that trust with Western Maine Health. The Norway-based system joined in 1999.
Franklin joined just two years ago, making it the newest MaineHealth member. Local control was such a big deal that then-CEO Rebecca Arsenault told Maine licensing and regulatory officials that local governance and leadership were as essential to Franklin’s future as specialty medicine and improving the health of people living in the area.
But Franklin hasn’t fared better since then. It’s still losing millions of dollars per year and earlier this year eliminated 40 positions, 22 through layoffs. Recently, its safety grade dropped from an A to a C, turning it from one of Maine’s highest-rated hospitals into one of its lowest in six months.
Some community members say they’re concerned about giving away power over Franklin, but they also think it may be necessary.
“For the future, this may be the thing we have to do,” said Sen. Tom Saviello, R-Wilton. “I don’t have enough information to base that decision on yet. … I’m just optimistic that this keeps our hospital here and keeps it so it can provide the services that people have come to expect.”
Because the consolidation proposal is still in the very early stages, it is unclear how a single authority run by a single board would work.
MaineHealth CEO Bill Caron said current discussions would give Maine Medical Center 50 percent of board seats and all other members 50 percent.
Maine Med, he said, represents 75 to 80 percent of MaineHealth assets and about 90 to 95 percent of its profitability.
“I see that as a tremendous message to our rural communities that this isn’t about controlling health care from Portland,” Caron said.
“If we were were in a for-profit discussion talking about merging entities like this, in a for-profit conversation, Maine Med would be getting 80 percent of the control of the board. They’ve not gone that way,” he added. “What Maine Med’s board is very much in tune with is this is sustaining all of our communities, not just in Portland, and it’s coming up with a governance model that’s going to sustain all of our communities.”
Caron said he understands why the Franklin community, in particular, may be rankled by losing their local control.
“[Local control] was what we told them. That was what they heard. That was what they wanted,” he said. “I have to acknowledge that having this conversation two, two-and-a-half years later is very difficult.”
Health Community Coalition board member Scott Landry is, like many others, reserving judgment. For now.
“I’m waiting to see how it all works out,” he said.
At the same time, he feels resigned.