Sunday, March 9, 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.”
Central Maine Medical Center and Maine Medical Center have been rivals in the cardiac care market, and the merger also would involve cardiologists who work with patients at the Lewiston hospital. Maine Cardiology has a medical office three blocks from Central Maine Med, for example.
“It is a very big deal when you have about 40 cardiologists decide to merge and then join one hospital system,” said Chuck Gill, spokesman for Central Maine Healthcare, owner of the hospital.
“When your employer is also the largest cardiac provider in northern New England, there would be, I think, a tendency to refer to your employer,” Gill said. “We definitely believe there would be less choice over time.”
Mark Harris, the MaineHealth spokesman, said the deal is really in the best interest of patients. Southern Maine could see a decline in access to high-quality heart care if the merger doesn’t happen, he said.
Private-practice doctors are seeing a decline in payments through Medicare and Medicaid, and that’s especially significant in Maine because a relatively high percentage of Mainers are covered through the government insurance programs, he said.
At the same time, hospitals in other parts of the country are acquiring cardiology practices and constantly recruiting doctors from less lucrative markets, such as Maine, he said. That could pose a big problem in Maine because the state will need more heart doctors to take care of its aging population.
“We want to recruit more high-quality doctors,” Harris said. The merger would allow the physicians to earn salaries that aren’t dependent on what kind of insurance a patient has, he said. “By joining MaineHealth, they join a much larger organization that can weather some of the smaller economic storms.”
The merger also will improve the coordination of care, according to Harris. “The health care reform legislation is actually asking hospitals and physician providers to work closer together and integrate.”
Dr. John Love, a longtime cardiologist with Cardiovascular Consultants of Maine, said the doctors also see the merger as the best way to maintain cardiac care in the future.
The system of family physicians running their own businesses and competing for patients has been replaced by larger networks of specialized high-tech medicine and public insurance programs that effectively set prices, he said.
“We realize that the old culture and model … just doesn’t work any more,” Love said. “What we need to do is develop a system that provides the best care to the most people for the least amount of money.”
The consolidation planned here is similar to models that have proven successful in other cities, he said.
“If we can’t find a way for the cardiologists and hospitals to integrate, we will fall well behind those kinds of centers that can do that,” Love said.
Staff Writer John Richardson can be contacted at 791-6324 or at: