Sunday, April 20, 2014
A plan to merge southern Maine’s two largest cardiology practices with Maine Medical Center is on hold because of concerns about reduced competition and antitrust challenges.
The merger would be one of the biggest examples in Maine of a trend that is transforming the nation’s medical industry as private-practice physicians trade their independence for a salary from the hospitals where they do much of their work. And it is sparking debate about whether competition or consolidation is the best way to deliver care and contain costs in the post-reform business of health care.
Under the plan, MaineHealth, owner of Maine Medical Center, would hire the 40 cardiologists now with Maine Cardiology Associates, which is based in South Portland, and Cardiovascular Consultants of Maine, based in Scarborough. The doctors would continue to see patients at their existing offices with the same medical and support staffs, although MaineHealth would buy the offices and equipment.
MaineHealth and the physician groups asked for a change in state law that would protect the deal from antitrust challenges if they can show it is in the public interest – for example, that it preserves access to high-quality heart care.
That effort failed in the closing days of the legislative session, however, and it’s unclear whether MaineHealth and the cardiologists will move ahead and risk legal challenges, or wait and try again when the Legislature reconvenes next winter.
“We’re assessing our different opportunities to move forward. We’re still fully committed to our integration,” said Mark Harris, spokesman for MaineHealth, a nonprofit that owns seven Maine hospitals and several other health care organizations. “It would be in our best interest and in the best interest of the state, as well.”
Mercy Hospital in Portland and Central Maine Medical Center in Lewiston have objected to the change in state law. Officials with those hospitals also say the merger would effectively give Maine Medical Center a monopoly in cardiac medicine that could harm competitors and patients.
Both the Federal Trade Commission and the Maine Attorney General’s Office have been monitoring the plan because competition – at least in theory – leads to better services and lower prices, and the deal could threaten that.
Neither agency, however, would comment on the legal issues around the merger.
“I’m very interested to find out what they’re going to do, but right now the ball’s in their court,” said Christina Moylan, an assistant attorney general.
The cardiologists in the two local offices now typically work as staff physicians at both Maine Medical Center and Mercy Hospital. Both Portland hospitals provide care for heart patients, although most acute care and surgery is done at the much larger Maine Medical Center.
MaineHealth and the cardiologists have assured Mercy and other Maine hospitals that the doctors would continue treating patients in all the same hospitals that they do now. But that hasn’t erased the concerns.
“Essentially, all the practicing cardiologists we rely on for emergency care, patient consultation (and) primary care” would become employees of another hospital, said Eileen Skinner, president and chief executive officer of Mercy Health Systems, owner of Mercy Hospital.
“For all of that to be consolidated into one organization or service would not only not give us choice, but it would not give the consumer choice, either.”
Skinner said there is a potential, over time, that the lack of competition could raise costs.
“They say they’d still be on staff (at Mercy), but I think it has to do with what their allegiance is at the end of the day,” she said. “It’s sort of this big question mark.”
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