The LincolnHealth Board of Trustees, along with boards of trustees at organizations throughout the MaineHealth system, have spent the last eight months discussing a possible system-wide reorganization that would align local organizations and their boards under a system-wide board of trustees and a unified financial structure.
In a series of board votes at the entities that make up Northern New England’s largest health-care system, MaineHealth members have decided to take this conversation to the communities they serve.
The proposal under discussion would create a single, system-wide governing body for MaineHealth. It would also leave in place local boards that would retain significant responsibility for the hospital services and other care delivered in local communities, as well as a defined role in budgeting, planning, and the hiring of key executives.
In recent years, the inability to deploy resources across the system has become a significant problem for MaineHealth’s community hospitals, which are under increasing financial pressure because of changes in the way health care is being delivered. Relatively simple procedures are moving into outpatient settings, while complex care is migrating to regional medical centers that can afford expensive new technologies used by highly specialized providers.
The result is that much of the revenue from surgeries and other procedures that sustained community hospitals in the past is no longer available to them, and many community providers are struggling. Those that aren’t losing money are typically small hospitals like LincolnHealth that are designated as “critical access” by the federal government. While critical access status makes smaller facilities eligible for more favorable Medicare reimbursement, their financial position has also recently eroded.
“The good news,” said Bill Caron, president of MaineHealth, “is that, overall, MaineHealth is in strong financial shape. We believe that MaineHealth is positioned, as a system, to deliver the right care in the right place at the right time for all our patients.”
Still, while unifying MaineHealth members under a single budget overseen by a system board of trustees has the potential to strengthen local health services and help preserve community hospitals, the proposal has stirred debate within MaineHealth’s member boards. The conversation over the past eight months has focused on striking a balance between creating a unified financial and operational structure that can better support community health systems like LincolnHealth and retaining local identity and input.
Board members have discussed a range of concerns, including diminished local input into decisions affecting local services; having local voices become lost as part of a large, bureaucratic system; and how to balance the benefits of reducing variations in care with the benefits of local innovation.
The governance model under consideration tries to address these and other concerns. It would include local oversight of care quality and the credentialing of physicians and other providers, a continued relationship with local donors, a defined role in the budget and planning process for local boards, and local oversight of community health initiatives.
The proposal also guarantees local representation on the system board for at least the first five years. Still, it does cede ultimate authority to the system board as MaineHealth’s governing body. However, it requires any significant changes in local services be approved by 67 percent of the system board’s members.
“This idea deserves the attention and input from the communities we serve,” said LincolnHealth Board of Trustees Chair Bill Logan. “We want anyone who is interested to understand this proposal, both the pros and the cons. We want to know what our communities think.”
Throughout the summer, LincolnHealth administrators, trustees, and clinical leaders will meet with individuals and community groups to explain the unification proposal and gather feedback. Public forums are scheduled for 4-6 p.m. July 12 at The 1812 Farm in Bristol Mills, and 10:30 a.m. to 12:30 p.m. July 26 at the Congregational Church of Boothbay Harbor.
For more information about MaineHealth’s unification dialogue, go to mainehealth.org/about/unification.