Hospitals say proposed DHHS cuts would hurt care, patients [Sun Journal, Lewiston, Maine]

Jan. 21--LEWISTON -- A day after the CEO of St. Mary's Regional Medical Center told Gov. Paul LePage that proposed cuts to the Department of Health and Human Services was a "nuke approach" that would leave thousands of Mainers without health insurance, hospital leaders across the state echoed that concern.

They believe the cuts would cost them millions of dollars and force uninsured patients to the one place that must take them: the emergency room.

"If you want to cut 65,000 people off the MaineCare rolls, that's fine. But you can't ignore that those 65,000 people are still going to be sick," said Mike Koziol, chief financial officer for MaineGeneral Medical Center in Augusta and Waterville.

LePage appeared at Lewiston Regional Technical Center's Green Ladle restaurant on Thursday as part of his Capitol for a Day event. Near the end of the 90-minute question-and-answer session, St. Mary's CEO Lee Myles took the microphone. He thanked the governor for attempting to repay the state's old debt to the hospitals and acknowledged the tough economic time the state was facing. But he had some pointed criticism for LePage's controversial cuts to DHHS.

"This isn't just a fiscal issue," he told LePage. "It's a moral issue."

A day after that event, Myles stood by his comments -- both the positive ones regarding LePage and the negative ones regarding the governor's DHHS plan.

"I don't have the solution," Myles said. "I'm not in his world. I just know what it's going to take for this organization to continue its mission and to take care of the most vulnerable in the community."

No one wins when hospitals' financial viability is potentially threatened, he said.

"I think the governor's legitimately concerned that, from his standpoint, we have somewhat of a welfare state," Myles said. "My concern is, if he thinks we have a welfare state now, what's going to happen if all the cuts go through? Where are the people going to go who might not have a residence? Are we going to have more homeless people? Are we going to have clogged-up emergency departments because no systems are in place to get them care elsewhere?"

The governor's proposed budget includes cutting health care for childless adults; eliminating reimbursement for independent providers of elderly and mental health care; cutting health coverage for about 20,000 parents with children covered by MaineCare; cutting dental, occupational and physical therapy, adult family care and other services. In all, about 65,000 people would be removed from the MaineCare system. The proposal also limits some services for the people who remain, including a cap on the number of times a patient can be admitted to a hospital.

About 21 percent of St. Mary's patients are on MaineCare. It's one of the highest levels in the state. Myles believes the proposed cuts will cost his hospital system $4.3 million in 2012 and $6.6 million in 2013 because MaineCare patients removed from the system won't have insurance and likely won't be able to pay for their medical care on their own.

He believes some patients will stop getting care, while others will go to the emergency room, either to deal with minor problems that could have been handled in a doctor's office or to deal with major issues that might have been prevented if they'd gone to a doctor earlier. Federal law prohibits emergency rooms from turning away patients who can't pay.

Nearby, Central Maine HealthCare, which runs three hospitals and oversees 350 medical providers, has a similarly high level of MaineCare patients. Hospital officials there believe they could lose up to $10 million a year. That's on top of the $51 million they say the state owes for unpaid MaineCare bills, as well as additional cuts they're facing in federal Medicare reimbursements.

"We can't continually absorb all these different cuts and then provide the care at the same time. We can't do it," said Chuck Gill, spokesman for the hospital group.

At one end of the spectrum, MaineHealth in Portland, which includes Maine Medical Center and is the largest hospital system in the state, expects to lose about $20 million a year. On the other end, Norway'sWestern Maine Health expects to lose about $2 million. Even though it's a much smaller amount, the president of the small hospital system says it's not money it can afford to lose.

The hospital group expects to have a $1.4 million bottom line -- what's left after it pays its bills. A $2 million loss would leave it in the hole by $600,000.

"It would force us to really look at the services we deliver," said President Tim Churchill.

He wasn't alone. Leaders at several Maine hospitals said Friday that they would have to seriously consider cutting services and employees if the proposed cuts go through.

"There's got to be a better way," Gill said of the proposed cuts.

Although some hospital leaders admitted they didn't have a solution to the state's budget problems, others suggested raising taxes on tobacco and sugary drinks. They also suggested turning MaineCare into a managed care system, which they believe would make the system more efficient and would encourage patients to get preventive care, rather than more expensive treatment later on.

"It's providing the right care at the right place at the right time," said Kate Fullam Harris, senior director of government and employer relations at MaineHealth.

Legislators are considering the governor's proposed cuts. In a news release, the governor's office said LePage met Friday with legislative leadership to discuss the proposal and the governor's request that it be addressed quickly. It said the governor expects to have a resolution by Feb. 1.

"We had a positive conversation this morning about the dangers of delay and I think we're moving in the right direction," LePage said in the statement. "However, in order to solve this budget crisis, we cannot use gimmicks to fill the hole. There will be difficult decisions made, and if we are to bring our welfare system to a manageable level that Maine can afford, we must make the necessary structural changes."

The governor's office did not return phone calls or emails seeking comment for this story.

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