MID COAST HEALTH SERVICES, which operates Mid Coast Hospital, pictured above, is vying with a Lewiston-based medical group for management of operations at Parkview Adventist Medical Center. Keeping operations of both hospitals centralized in Brunswick will eliminate redundancy, lower overall health care costs and improve quality of local medical care, according to MCH’s administrators.

MID COAST HEALTH SERVICES, which operates Mid Coast Hospital, pictured above, is vying with a Lewiston-based medical group for management of operations at Parkview Adventist Medical Center. Keeping operations of both hospitals centralized in Brunswick will eliminate redundancy, lower overall health care costs and improve quality of local medical care, according to MCH’s administrators.

BRUNSWICK

Mid Coast Hospital on Wednesday filed its own Certificate of Need application to assume operations at Parkview Adventist Medical Center, challenging an earlier application by Central Maine Healthcare of Lewiston.

Mid Coast’s application calls for the consolidation of health-care services in the area, and an expenditure of $10 million for the creation and endowment of the Parkview Health Trust. The trust would support efforts to provide health and wellness services within the communities served by Mid Coast and Parkview.

The MCH proposal, a 900-page document, examines the issue of need and outlines how — from its point of view — CMHC’s proposal to take over Parkview is unnecessary.

Lois Skillings, president and CEO of Mid Coast Health Services, explained the hospital’s rationale for submitting a competing proposal.

“We are facing a time when rising healthcare costs are breaking the backs of local, state and federal budgets,” Skillings said. “CMHC’s plan will drive up our health-care costs. In essence, their plan shifts resources away from important priorities such as disease prevention, health promotion, and primary care.”

When a certificate of need is filed with the state’s Department of Health and Human Services, it goes through a series of analyses and comment sessions. If the application is complete and if no complications arise, the process will take 90 days, according to Phyllis Powell, assistant director of DHHS’s Licensing and Regulatory Services division.

“Clearly, 90 days is the ideal process, that’s our goal,” Powell said. “We’re generally able to perform analysis in 90 days, if there’s no controversy or not a lot of public comment.”

But everything gets complicated if two or more certificate of need applications are determined to be in competition.

“First, we have to review both applications and weigh whether or not they actually are competing,” Powell said.

If not, each is considered separately. But if so, the process is more deliberate and taken on a case-by-case basis, Powell said.

Mid Coast officials say their CON illustrates why CMHC’s proposal will drive up the cost of health care and trigger “a medical arms race in the Mid-coast community that will ultimately weaken health care in the region and provide no public benefit.” Mid Coast believes that its competing plan is consistent with efforts to reform health care, consolidate services, and reduce the cost of health care to the community by $24.3 million per year.

The CON outlines how to reduce health-care costs by $250 million over the next decade; improve access, coordination, and quality of care; redirect resources toward prevention and population health; and eliminate the significant waste associated with maintaining two acute care facilities.

Parkview’s board of directors already has expressed its approval of CMHC’s plan to assume governing authority.

Skillings described the certificate of need application already filed in late August by Central Maine Medical Center as little more than a “cash-grab,” designed to recoup some $8 million in money already spent by CMHC on Parkview’s behalf. She went on to characterize CMHC’s attempt to manage Parkview as a “hostile take-over.”

“The CMHC plan is predatory, it’s empire-building,” Skillings said. “Parkview doesn’t qualify for critical access status, so CMHC wants to scoop them up.”

Chuck Gill, vice president for public affairs at Central Maine Healthcare, dismissed Skillings’ contentions.

“Parkview decided to join CMHC,” Gill said. “Parkview’s board made the decision. (Mid Coast) can do whatever they want to. It’s definitely not a competing application, because this is about the hospital joining a larger system. It’s fiction.”

The application submitted by the Lewiston hospital group would give it another revenue source and local market share, but wouldn’t do much for the quality of local health care, Skillings said.

Mid Coast officials also contend that maintaining two separate hospitals in the area costs an additional $20 million a year. They further claim that consolidating both Brunswick hospitals would save that money by reducing unused capacity and eliminating duplication of services. The savings wouldn’t be realized with a CMHC-Parkview merger, they say, because there would still be two separate hospitals and emergency departments in Brunswick.

“Health-care costs need to shrink,” Skillings said. “Communities must consolidate, coordinate and come together.”

Jay Mullen, medical director and chief of the department of emergency medicine at Mid Coast, pointed to a shortage of physicians in the area.

“We need to attract them,” Mullen said. “If we lose patients to Lewiston- Auburn, it would hurt.”

Mid Coast officials also say that Central Maine’s proposal will mean that people could find themselves being taken to Lewiston for acute care services that already are available at Mid Coast. The transfer of patient care, they say, also drives up the cost of health care.

Parkview already owes CMMC millions in emergency room personnel and service costs.

“CMHC called them on their loan,” Skillings said.

Gill responded that Skillings “should concentrate on fact, and not fiction.”

Mid Coast has 92 patient beds and 54 of them are in use on a given day or night, for an average daily occupancy of 59 percent, Skillings said. By contrast, only 10 of Parkview’s 55 beds regularly are in use, for an average daily occupancy of 18 percent.

“Excess capacity is a drain on the hospitals’ subsidization, it increases costs and lowers quality of care,” Skillings said. “Those 10 patients who spend the night at Parkview are (an example of) what is costing the state $24 million in duplicated services every year.”

Skillings, whose clinical background is as an emergency room nurse, believes that it is time for the two Brunswick hospitals to heal the long divide and come together.

“As a health-care provider and someone who has lived in this community all my life, I am very sorry about what has happened in the past between Mid Coast and Parkview,” she said. “This is a new opportunity for all of us to look at a very different landscape and a new way of delivering health care.

“Ours is the smallest region in the Northeast trying to support two acute care hospitals, and it makes sense that we would put forth an alternative proposal which calls us to consolidate care so that we are able to maintain highquality, local care,” she continued.

John Morse, chairman of Mid Coast Health Services’ board, offered his perspective.

“Mid Coast is requesting that the state deny CMHC’s Certificate of Need application to provide acute care services outside Lewiston-Auburn, which is its primary service area, through the acquisition of Parkview.

“Mid Coast Health Services clearly demonstrates that there is absolutely no need for two hospitals in the Mid-coast region and our plan outlines how our region could achieve substantial savings and improvement to the health and wellbeing of the people who live and work in this area.”

When the application was sent by courier to Augusta on Wednesday, the clock started ticking on the state’s review process.

First up will be public notice of the filing, followed by an informational hearing that also is open to the public. Fifteen calendar days of open comment follow before the record of public access is closed for initial analysis by DHHS’s Unit of Planning, Development and Quality.

Public hearings are held either nearby the applicant’s place of origin or in Augusta, at the DHHS offices. Location depends both on available meeting space and the subject of the application.

After that, a technical assistance meeting either will be scheduled or waived, and the public record will reopen for 10 more business days while preliminary analysis of the application is done. Then the public record closes again, unit analysis is finalized, and a briefing memo and recommendation is sent to Commissioner Mary Mayhew, who will make the final decision and draft a letter informing the applicant of the state’s decision.

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