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After a rough year that saw a regulatory review threaten Medicaid payments at one of its hospitals and citizens challenge the ownership of another hospital, Central Maine Healthcare’s CEO said the Lewiston-based health care group is growing steadily in revenues and patient numbers.
As the health care system began its most recent fiscal year on July 1, 2018, CEO Jeff Brickman faced and then survived three no-confidence votes that same month, one from each of the hospitals in the health care system: Rumford Hospital, Bridgton Hospital and Central Maine Medical Center, one of Lewiston’s largest employers.
Some found Brickman’s management style abrasive, while others did not like policy changes and the new electronic patient records system.
But Brickman, 63, who joined Central Maine Healthcare in September 2016, had experience turning around five other hospital systems in the United States. By July 2018, he already had stemmed much of the red ink that had mired the Lewiston-based hospital group.
He had the board’s backing to continue with plans to add and replace staff, raise wages, update programs, repair dilapidated infrastructure, replace old machinery and expand services. The three hospitals and affiliated medical offices employ a total of 3,132 people.
“Last summer was probably the most difficult period of time in the almost three years worth of transformation [of Central Maine Healthcare],” he said. “We are at full staffing for the senior team for the first time in three years so we can sustain our work. We are through the worst of it and are beginning to look toward the future.”
Brickman said the departures of medical staff and physicians, notably primary care physicians at Bridgton Hospital, caused the number of patients it typically handled to drop below its forecasted levels because there weren’t enough physicians to see patients.
“That was a low point for us and pushed us back a good four to five months [in expected patient numbers],” he said. “It was a destabilizing impact on us. It took until the end of November into December of 2018 to build [staff and patients] back up.”
“We had the perfect storm of a new electronic medical record system, significant changes in operations and we changed from a loose confederation or organizations into a tightly integrated system. The combination of all that created a backlash from some of our medical staff who didn’t see the immediate benefit of all of those significant changes.”
But patient numbers are growing again. Admissions for the last six months of the 2019 fiscal year were up 12 percent over the first six months, while physician visits were up 6.2 percent, he said.
And while he has handled many of the problems he has faced since coming to Central Maine Healthcare in previous hospital system turnarounds, Brickman said what distinguishes the work this time is that all of the issues hit at the same time.
“Typically it takes two to three years for a turnaround. We’re just completing our third year,” Brickman said. “We’re probably taking six to eight months longer than typical turnarounds because of the sheer volume of issues we had to focus on.”
Rebuilding staff, patient numbers
Brickman said he knew he had his work cut out for him to restore staff, calm the community of patients and rebuild the hospital’s reputation. He said the hospital has stabilized and improved each of the past eight months.
“We’re now on a pretty steady pace,” he said. “Since Aug. 1, 2018, we have brought in all of our replacement physicians for Bridgton and a couple other areas across our network. We have made up for some historical deficits in some other specialties and added significant clinical skills in several key programs.”
During the past year, the hospital system hired more than 100 nurses. It also hired 118 providers, doctors, nurse practitioners and physician assistants. That’s more than were hired in the prior two years combined, Brickman said.
The vacancy rate for medical staff has been cut in half to 7 percent over the past year. The total number of medical staff and providers is now back to the level when he started in 2016 at about 350.
The most recent hire is a new chief physician executive, Dr. Jason Krupp, to lead the hospital system’s medical group. He’ll join Aug. 5, filling a vacancy that has been open for a year.
At a time when medical professionals are in short supply, the hospital knew it needed to improve wages to keep and attract staff. Brickman said no one had received a raise in the two years before he arrived.
“In each of the last two fiscal years, we’ve made over $9.2 million in improvements in wages to provide a more competitive wage for our staff,” he said. A third year of wage increases is due in fiscal year 2020, which started on July 1.
“Addressing that issue has put us in a more competitive position to be able to fill vacancies,” he said.
With the new staff, which replaces vacancies and includes additional staff for new services, the hospital system also is seeing higher patient levels.
While the hospital’s financial performance for fiscal 2019 still is being reviewed by auditors, a key metric, days of cash on hand, has met the requirements of the hospital system’s loan agreement for the second year in a row, said John Whitlock, interim chief financial officer. The hospital system has at least 50 days of cash on hand.
When Brickman joined Central Maine Healthcare in the fall of 2016, the hospital already was losing $2 million to $3 million each month and only had 39 days of cash on hand by December 2016.
“Thirty five to 60 days of cash on hand is a healthy number for Maine hospitals,” said David Winslow, vice president of financial policy for the Maine Hospital Association. He said the amount of cash on hand varies depending on the size of the hospital.
Losses for the hospital system have continued to decrease. While Brickman would not comment on whether the hospital system would be profitable in its most recent fiscal year, he did say it was not profitable the year before.
He does expect top-line revenue of $500 million in the recent fiscal year to rise $30 million this fiscal year, which ends June 30, 2020.
Brickman said the hospital system has invested between $5 million and $8 million to improve clinical programs in the past year.
“While we were struggling and seeing some of our patient volumes challenged, we kept our eye on where we wanted to go, made those investments and had the backing of our board,” he said.
That includes putting money into the cancer, cardiology and surgical programs. The hospital system replaced one bariatric surgeon who left with two who he said have more contemporary skill sets. It also added a new trauma leader, a general surgeon, head and neck physicians, surgical oncologists and new plastic surgeons.
Brickman said it made its first investment in an ambulatory surgery center in partnership with Central Maine Orthopedics in Auburn. That will allow patients to get lower cost, same-day joint replacements, he said.
“Many specific investments in surgical programs have given us significant growth in our ability to treat patients as a regional center with specialized surgical cases,” he said.
Another new service added reconstructive plastic surgery for women with breast cancer.
Brickman said the hospital system’s Topsham urgent care center has set new levels of patient activity each month since it opened in September 2018.
“That [the Topsham] volume has increased so much that we’re getting ready to launch our second urgent care center in the Lewiston-Auburn area later this fall,” he said. “And we have plans for several others that we will be adding to provide patient access to basic care.”
He said the Topsham care center has worked so well in the midcoast that the hospital system is looking for other services to add in the area. It also has a partnership in Topsham with New England Cancer Specialists, and low-cost radiology and outpatient laboratory services in collaboration with Shield HealthCare and Quest Laboratories, respectively.
Putting out fires
In February, Central Maine Healthcare added a walk-in clinic in north Bridgton staffed by nurse practitioners overseen by a family practice physician. Two family practice physicians had left Bridgton Hospital, making it difficult for the hospital system to service all the patients. Brickman said it has filled the gap with the new clinic.
In April, Peter Wright took over as the new president of both Bridgton and Rumford hospitals.
Wright joined the hospital just as a citizens group, protesting the loss of doctors and citing concerns over the future of Bridgton Hospital, petitioned local selectboards and others to shift control of the hospital from Central Maine Healthcare to MaineHealth or another entity.
The citizens, who call themselves the Pondicherry Group, sent letters to the selectboards in the 13 Lakes Region towns that Bridgton Hospital serves, including Bridgton and Harrison, asking them to support what it called an initiative to improve the quality of and access to health care in the Lakes Region, which is about 30 miles northwest of Portland. The group also has presented its case before the selectboards.
Brickman said Wright has been meeting with chambers of commerce, selectboards and other public entities in the hospital’s service area to talk about and address issues with the hospital.
At the same time. the citizens group launched its challenge, the largest of the three Central Maine Healthcare hospitals, Central Maine Medical Center, received letters in February and April from the regulatory Centers for Medicare and Medicaid Services warning it to comply with standard procedures and protocols for patient care or face the possibility of losing federal reimbursements.
In correspondence with the hospital, the federal agency detailed problems with how one patient with a spinal fracture lost motor function after being propped up in bed due to poor communications between a doctor and nurse. Another patient left after the severity of a heart problem was not identified quickly.
Central Maine Medical Center did correct problems cited by the federal agency, which in June said the hospital complies with safety and quality requirements.
Brickman said initial publicity over the incident did cause some patients to call and ask if the hospital would remain in business. But he said the issues did not cause a major dip in patient activity.
“At the end of the day, if our patients [had been] concerned or lost confidence in our ability to provide care, we would not be seeing this rebounding in their activity and acceptance of our programs,” he said.
While he acknowledges the hospital system still has a way to go, including continued investments to upgrade buildings, he’s enjoying the stabilization of operations over the past eight months.
“We invested in programs, improved wages, gotten key leaders in place and that pulled us through the tough times in the first four to five months of the fiscal year that just ended,” he said. “And it’s given us the momentum we have been enjoying over the last seven to eight months.”