October 23, 2013

Maine Voices: 'Cynical mandate for hospital care' could prompt exodus of physicians

Poor Mainers are hurt by limits on where they can be treated as well as by Gov. LePage’s veto of MaineCare expansion funds.

By Douglas Howell, M.D., a Portland gastroenterologist

PORTLAND — Health care in Maine is at an ominous crossroads. Many of us in the health care field fear that under Gov. LePage’s leadership we may be unable to reverse a threatening trend.

about the author

Douglas Howell, M.D., is a Portland gastroenterologist who has practiced at Maine Medical Center for 35 years.

Maine is a proud state. Our people are hardworking, family-oriented, independent and generous. Farmers, fishermen, woodsmen and small businesses are the backbone of our challenged economy.

I chose to come practice here in 1978 in part because we offered only one high level of care to all patients, regardless of their insurance or ability to pay, unlike many larger urban health care systems. Simply put, we could afford this equality because the insured so outnumbered the uninsured that the reimbursement for care was adequate to compensate and retain physicians who wanted to practice and treat our Maine community equally, whether rich, in the middle or poor.

Today, Maine simply cannot afford the premiums that the health care system requires to offset the uninsured. Gov. LePage seems not to comprehend this evolving and escalating reality.

A year ago, Gov. LePage ordered that Mainers covered by MaineCare must receive their outpatient care within hospitals as opposed to ambulatory surgical centers, which are free-standing, non-hospital units where surgical procedures not requiring an overnight hospital stay are performed. This decree was despite much higher cost and, at least at Maine Medical Center, a lack of capacity to accommodate these additional patients.

The strategy was clear: Force costs of care onto the hospitals, restrict access to care and, in the end, withhold payment to the hospitals once again.

In general, care at ambulatory surgical centers is less costly, highly efficient, comfortable and of high quality, as enforced by state inspectors. I personally practice, in part, in an ambulatory surgical center accredited and awarded for its excellence in the fight to prevent colon cancer and other digestive illnesses. As of September 2012, in a pen stroke, the governor denied MaineCare members access to these centers throughout the state.

This cynical mandate for hospital care has proven to be only the harbinger of Gov. LePage’s action in vetoing the expansion of MaineCare to cover an additional 70,000 low-income Mainers.

The Affordable Care Act, in part, aims to provide health care coverage for the uninsured by mandating health care premiums and forwarding some of these funds from the federal treasury to the states to fund this expansion. These needy Mainers would have 100 percent of the cost of this insurance paid by these federally collected funds for three years, and 90 percent paid thereafter.

Maine is among the neediest states and has the most to gain by adoption of this expansion. We stand to lose $350 million over the next three years with no plan to provide care except to force uninsured patients onto hospitals for which the state will be unable to pay.

In May, Richard Petersen, president of MMC, reported a loss of $13.4 million in the previous six months, largely due to rising numbers of uninsured Mainers. He has called for hospital austerity measures including hiring and wage freezes and the cancellation of certain health care programs and has set a goal of reducing our workforce by 400.

The governor’s veto of the MaineCare expansion gravely threatens MMC’s future since we will not turn away the growing uninsured, even with fewer caregivers. The reality is that overwhelming the hospital further prevents his mandated shift of current MaineCare patients to hospital care, hindering their access to preventive care.

During my 35 years of practice at MMC, I have recognized that our physicians are here for the right reasons. In general, we came to provide equal, high-quality care to all, enjoy the wonderful quality of life, raise our families and train and mentor our (your) future physicians.

But doctors are not indentured. Opportunities exist to meet these personal goals throughout our country. Can we attract and keep talented, hardworking and ethical physicians in Maine under this governor’s leadership?

When the exodus of high-quality physicians begins, there will be no recovery. What will Maine be like if our health care system is hollowed out? Will our businesses remain? Will the elderly choose Maine as their place of retirement? The economic impact on our community, our health and well-being, cannot be fully estimated.

Gov. LePage has proposed no plan to deal with this reality. As he has repeatedly demonstrated, his foul language, intimidating behavior and rigid, ideological actions disqualify him to lead us to address these issues. We must ask our Legislature to act to reverse these hurtful and dangerous decisions. We do not have time to await a change in leadership.

— Special to the Press Herald

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