This piece is the second in a two-part series on Lincoln County Healthcare. On Friday, July 18, CEO Jim Donovan and Board President Jeff Curtis sat down with the Boothbay Register to answer questions about programs, finances and plans for the coming year. Read part one here at www.boothbayregister.com.

Patients, finances and programs

LincolnHealth CEO Jim Donovan reported that the number of acute hospital patients discharged from LincolnHealth from October 2013 through May 2014 was similar to the previous year. However, LincolnHealth’s outpatient services across the board, except at the new urgent care and wound care centers, are down about 6.5 percent compared to last year. 

“It’s the continuation of a long-term trend for which we are still trying to project a bottom,” Donovan said.

There were about 20 percent fewer patient visits to the emergency department (in Damariscotta) through May compared to both ERs combined last year. Donovan said he suspected the reduction was due, at least in part, to use of the new urgent care facility.

This year LincolnHealth transferred more patients to other facilities, due to the need for a higher level of care and a lack of beds, than in the previous year. About 25 percent more patients were transferred out of the LincolnHealth ER to another facility for a higher level of care: 400 compared to 320 in the same period last year. Almost twice as many acute patients were transferred to another facility from the ER due to a lack of available beds at Miles: 37 versus 20 last year.

LincolnHealth sent 142 patients needing skilled nursing care to facilities outside of Lincoln County and 61 to nursing facilities outside the county (for some this might have been a return to their home facility). Skilled and nursing bed transfer data from previous years are not available for comparison.

One of the program areas the Navigant consultants reviewed was obstetrics and gynecological services at Miles campus. Most of Lincoln County residents’ births occur at Miles but birth rates in Lincoln County are declining overall. The Navigant report projected declining birth rates based on 2008-2010 data, which caused the LCH board to look closely at the long-term sustainability of the LincolnHealth obstetrics program. 

“Following the Navigant report, and given the staff changes the OB/GYN department was undergoing at the time, we set up a 36 month review period during which we would work to rebuild the department with a stronger focus on GYN services along with the basic OB services,” Donovan wrote in an email. “The 24 month interim review report will be produced in August.”

Hospital VP Cindy Wade reported there were 181, 130, and 119 live births at Miles in 2011, 2012 and 2013 and projected 146 births for this year. During the Navigant study period, the yearly number of births ranged from 90 to 123.

At the end of May, LCH posted a $1.7 million loss. Donovan said the budget shortfall is due to the state’s assessment of a full year tax for Miles Memorial Hospital, whereas LCH had budgeted for only one-quarter tax (Miles relinquished its hospital license in October), and to a significant increase in bad debt.

Donovan said bad debt totaled $3 million from October through May, versus $2.1 million during the same period last year. Other Maine hospitals have also reported a significant increase in charity care/bad debt, which has been attributed by some to the state’s decision not to extend Medicaid.

“I believe that (no Medicaid expansion) is part of it, as is the still struggling economy, as is the fact that there are only about 8,000 commercially insured lives in Lincoln County,” Donovan said. “Even in the better economic times, we couldn’t call the local economy robust. Since the recession hit, we have seen tremendous growth in our uncompensated care numbers. The reasons behind this are many and they seem to be getting increasingly complicated.”

In the recent past when facing fiscal shortfalls, LCH cut staff and vacation benefits, but Donovan said there are no plans to do that this fiscal year.

“We do need to make adjustments, but we are between a rock and a hard place,” Donovan said. “Patient volume is down but not enough to affect staffing levels. We are at core staffing now so we are looking at non-salary adjustments.”

Donovan said plans to consolidate LCH billing staff at a new MaineHealth facility in Rockland are still on hold due to the the considerable difficulties MaineHealth encountered in implementing the Epic electronic medical record system.

Presently, Donovan said he expects 10 employees will be relocated to the new Rockland office next April. The remaining LCH Finance Department will continue to be located at the St. Andrews campus.

Donovan said rumors that there would be further consolidation of LincolnHealth with PenBay and Waldo Hospitals were simply rumors. LincolnHealth currently shares some physicians and specialty healthcare services with PenBay due to low numbers of patients and specialists, but Donovan said there are no plans to consolidate staff or facilities.

Although the overall picture is not exactly rosy, Donovan and Board President Jeff Curtis both emphasized the positives on the St. Andrews campus: The new urgent care center is seeing more patients than expected and the expanded new Physical Therapy/Wellness Center at the St. Andrews Campus has been completed.

Donovan said the new Wound Care Center is doing so well that another doctor will be added to the staff in September to meet the growing need.

Donovan said LCH is also reaching out to community members and local businesses more regularly so they can design practical programs to meet the community’s needs.

“We still have a long way to go but we are pleased with how it all is going,” Donovan said.