FARMINGTON — Leaders of the MaineHealth system and Franklin Community Health Network met with members of the public Tuesday in Farmington to discuss and gauge support for a proposal to unify the nonprofit health system under a centralized board and fund its member organizations through a single, systemwide budget.

The gathering was one of a series of public information meetings planned across the system this summer in the lead-up to an October vote on the proposal. If its member boards accept the proposal then, the system would move toward unification by January 2019, MaineHealth president Bill Caron said.

“We plan on being in a community dialogue through the end of August. We will then take five or six weeks to reflect on what we heard, make any adjustments that we need to make to the proposed model and then will be back to our boards in October,” Caron said. “And we’ll say to each one of our boards, based on what we’ve heard from communities, do we still think unification is the right thing to do?”

At the meeting Tuesday, the panel argued the current system, in which each of MaineHealth’s 13 member organizations function largely independently from one another, generating their own operating budgets and funding care through their own revenue, is no longer sustainable. With uncertainty in health insurance markets, Congress mulling a repeal, replacement or repair of the Affordable Care Act and declining Medicare and Medicaid reimbursements, smaller hospitals and networks in the MaineHealth system have been unable to generate enough revenue for longterm survival. In the last year, four of seven of the system’s local health care networks lost money, with a fifth falling “well short of budget,” according to a MaineHealth website set up to explain the unification plan.

At issue, the panel said, is Maine’s aging population and a shifting of patients with more complex and expensive services away from rural and local providers toward larger hospitals.

Older Mainers are more likely to be insured under Medicare, which, along with Medicaid, fails to cover the full cost of care, the group said. At the same time, fewer patients are turning to their local hospitals for surgeries and complex medical procedures. In 2015, more than 70 percent of inpatient surgeries took place in only five Maine hospitals, while 20 hospitals, including four MaineHealth members, performed fewer than two inpatient surgeries a day, the group said. Instead, local hospitals and providers are seeing greater demand for primary and secondary care that is not as well compensated by insurance companies.

Maine also chose not to expand access to Medicaid under the Affordable Care Act, leaving hospitals to continue providing charity care to uninsured Mainers. Those combined forces have left rural providers struggling to stay afloat.

“When we looked at unification, it’s all about protecting access to the services that we have in our rural communities,” Caron said.

It was in contemplating these financial realities, and engaging in lengthy talks with MaineHealth representatives, that Clinton Boothby, chairman of the Franklin Community Health Network board of directors, said he came to support the unification plan.

“Americans are independent, but if you look at our history, we’ve also learned at times we need to get together to make things happen,” Boothby said. “This is a little bit like that in health care.”

In his discussions on the plan, Boothby said his primary concern was the loss of local control that would inevitably come as the system consolidated under a centralized board of trustees responsible for all final budgetary and operational decisions. But over eight months of negotiations, Boothby said that the group had developed a model for robust local boards with many of the same powers they have today.

“In the early discussions of this unification, my feeling was that what was being assigned potentially to local boards wasn’t as expansive as in my view it should be,” Boothby said. “But as this discussion has rolled out over the last eight months, those concerns have been raised across the whole system, and I feel like the local concerns will be able to be addressed to the local boards and they’ll have a strong voice to go to the system.”

Under the current proposal, local boards would still be responsible for overseeing the quality of care at their respective facilities, credentialing doctors and other providers, drafting local budgets and operating plans and hiring executives. The proposal also guarantees board representation for each of MaineHealth’s members for the first five years under the new system. After that five-year period, the group said it would strive for “geographic diversity” on the board to ensure that regional perspectives are represented.

In exchange for relinquishing final say in some of its decisions, including budget allocations, the Franklin network stands to gain access to the entirety of the $2.4 billion MaineHealth system. If the network needed to replace equipment or raise salaries, for instance, it would no longer need to rely on its own revenue stream to do so.

Asked about staff salaries and movement between the MaineHealth entities, Caron said that all employees would join under a single MaineHealth system. Compensation or wage increases “would happen consistently across the system” and not be subject to each local entity’s financial performance. That would not translate to uniformity in compensation across the system, Caron said. Registered nurses, for instance, would not receive the same salary across the system, but when salary adjustments were made they would occur systemwide.

In terms of benefits, Caron said most MaineHealth members’ employees already were receiving the same benefits package and the group would continue to work toward a unified retirement program for employees.

The Franklin Community Health Network joined the MaineHealth system in 2014 after a bruising year in which the network lost $7.28 million. The companies announced their intention to merge in December 2013 and received approval from the Department of Health and Human Services in August 2014. In October 2014, the Franklin network became the 13th member of a sprawling system with more than 18,000 employees across Maine and New Hampshire.

At the time of the merger, representatives from the Franklin network said beyond aesthetic tweaks to the network’s logo and marketing materials, most patients would not see changes as a result of the merger. By that point, the network already had been collaborating with MaineHealth affiliates, sending patients to Maine Medical Center for cardiology and cardiovascular care, the Barbara Bush Children’s Hospital at Maine Medical Center for neonatal care and MaineGeneral Health for cancer treatment.

But the network continued to tout its local control, including on its website, where it is still described as “a locally controlled, nonprofit, integrated network of rural health care providers.”

Kate McCormick — 861-9218

kmccormick@centralmaine.com

Twitter: @KateRMcCormick

Copy the Story Link