December 17, 2018
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Why one of Maine’s largest hospitals is cutting diabetes care

Troy R. Bennett | BDN
Troy R. Bennett | BDN
MaineGeneral Medical Center in Augusta, shown here before its opening in 2013, recently announced it will discontinue endocrinology services, affecting some 4,000 patients.

About 4,000 Mainers with diabetes will have to look elsewhere for their care, after the state’s third-largest hospital, MaineGeneral Medical Center in Augusta, announced last week that it will discontinue endocrinology services.

Endocrinology includes the management of disorders affecting glands and hormones, including thyroid disease, pituitary disease and others, but diabetes is by far the most common. Diabetes is one of the most pervasive diseases in Maine and the nation.

“We know there’s a big need for diabetes management in the community,” MaineGeneral Health CEO Chuck Hays said in an interview Monday. But that need can’t be met sustainably when hospital revenues aren’t enough to offset costs, he said.

“Even as a nonprofit … we need to make enough money to remain financially viable,” he said.

According to data from the U.S. Centers for Disease Control and Prevention, about 137,4000 Mainers have diabetes, a chronic illness that can be life-threatening even with early diagnosis and aggressive management. An estimated 9,000 new cases are diagnosed here each year.

Type 1 diabetes is an autoimmune disorder that often develops in early childhood, while type 2 is more often a complication of long-term inactivity and obesity. In both cases, the pancreas is unable to produce the insulin needed to metabolize foods, potentially resulting in organ failure, circulatory impairment and other serious problems.

MaineGeneral Medical Center, which opened in 2013, will still provide diabetes education, including diet and medication management, as well as caring for diabetes that develops during pregnancy. But acute endocrinology services will no longer be available after April 27.

The endocrinology team, including one board-certified doctor, two nurse practitioners and five support staff, will lose their positions, although some have already accepted new jobs, Hays said. About 4,000 patients received letters about two weeks ago advising them of the change and referring them to their primary care providers for guidance.

The program costs about $1.4 million per year to run and has lost about $500,000 each year since it opened five years ago. With revenue streams dwindling across all services, Hays said the hospital is unable to keep propping up the program.

About 60 percent of MaineGeneral’s patients are covered by either Medicare, a program for older Americans, or by the state’s Medicaid program, known as MaineCare, which covers low-income individuals. Both programs have cut payments in recent years, Hays said, while the cost of providing care, including staff salaries, physical infrastructure, technology and drugs, continues to rise.

Private insurers use their clout to negotiate lower payments as well, Hays noted, while some patients at MaineGeneral have no insurance coverage and may be unable to pay for their care. The result, he said, is an operating margin that has in many years dipped well below the 3 percent margin Maine’s nonprofit hospitals aim for.

“We’ve done a lot of hard work to find efficiencies and lower expenses,” he said, “and we remain committed to providing essential services to the community.”

But while hospitals traditionally use revenues from more lucrative services such as cardiac and orthopedic procedures to offset losses in other areas, Hays said diminishing revenues from those services are no longer able to prop up areas that lose money.

According to a financial report recently released by the Maine Hospital Association, in 2016, MaineGeneral Medical Center’s profit margin was 0.5 percent, up from minus 6.15 percent the year before. The report shows that between lower reimbursements, uncompensated care, rising costs and a state tax on hospital revenues, about half of Maine’s 33 acute-care hospitals operate in the red in any given year.

The hospital association report states that Maine hospitals have absorbed a total of $416 million in Medicare reductions since 2010, related to a variety of changes. Maine is also among the states where Medicaid expansion under the provisions of the Affordable Care Act has not yet been implemented. As a result of these and other factors, Maine hospitals have absorbed a $132 million reduction in Medicaid payments since 2010, according to the report.

Jeff Austin, a spokesman for the hospital association, said Maine hospitals have been adjusting to revenue losses for years while struggling to provide essential care to the communities they serve.

“They dip into reserves, freeze wages and take away benefits,” he said, “but at some point [this trend] hurts services.”

MaineGeneral has provided patients affected by the change with a list of other endocrinology providers in the state, including in Bangor and Portland.

A statement from Maine Medical Center in Portland said the hospital’s endocrinology program is “an important specialty program” and that it is “continually evaluating ways we can best serve the needs of patients in our communities.”

At Eastern Maine Medical Center in Bangor, Senior Vice President Dr. James Jarvis said the difficult decision at MaineGeneral showcases the concerns of all Maine hospitals.

So far, he said, EMMC has not had to pare down medical services as important as endocrinology and diabetes care.

“We’re fortunate not to be in that position,” he said.

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