Declining Volume and Need to Maintain Medical Standards Make St. Andrews Changes Necessary

Last Thursday Lincoln County Healthcare officially announced that the St. Andrews Hospital Emergency Department will become an Urgent Care Center in April. With that transition, St. Andrews will no longer officially be a hospital and will not offer inpatient services.

Those changes, particularly the loss of 50 jobs that will take place in the coming months, are painful, but we believe they are also necessary. Lincoln County Healthcare was created to provide high quality, affordable and accessible care. We are confident that by consolidating emergency and surgical services and expanding primary care, we can improve care in the Boothbay peninsula and make it more affordable.

Ambulance crews in the Boothbay area will need to drive further to the nearest emergency department, but when they arrive, patients will have access to a team of physicians and nurses. These include on-call specialists, such as surgeons, pediatricians, hospitalists and anesthesiologists, who can provide the care necessary for complex cases.

Less serious cases (over 82 percent of patients at the current St. Andrews Emergency Department do not require emergency care), including most fractures and lacerations, can be treated at the Urgent Care Center that will take the place of the Emergency Department. The Urgent Care Center will be open 8 a.m. to 8 p.m. in the summer and 8 a.m. to 6 p.m. in the winter.

While there will no longer be a 24-hour emergency department in Boothbay Harbor, the Urgent Care Center will meet the needs of the vast majority of patients and will provide care that is both more affordable and sustainable.

Changes driven by volumeOver the years, fewer and fewer people from the Boothbay area have chosen to receive their care at St. Andrews Hospital. Roughly 20 percent of the people in the towns surrounding the hospital now get their care from St. Andrews. This is consistent with a national trend in which emergency department and inpatient use at rural hospitals has fallen across the country.

The number of surgeries performed at St. Andrews dropped by about two thirds between 2007 and 2011, from 920 to 304. The number of emergency department visits dropped by more than 20 percent from around 4700 to 3700.

When volume declines, costs increase. In addition, decreased patient visits necessitates a smaller team of providers who have less opportunity to maintain their procedural skills. By consolidating services, we can offer access to high quality care that is affordable. Reducing costs will also allow us to invest more in primary care services as we shift to a new model of care delivery that we believe will not only be more affordable but will better serve the community by putting more resources to work keeping people well.

Change is never easy, but by making difficult choices now, we can make a transition to an affordable medical system that is accessible in the Boothbay area and offers the excellent care our community needs and deserves. If we wait too long, our chance to choose our future will disappear.Changing medical needsSmall hospitals like St. Andrews were founded when transportation was difficult and providers were generalists and able manage the various facets of a less complex medical system.

Now the situation is reversed. People can choose among several nearby hospitals and they are exercising that right. At the same time, trends in medical care, including the need to invest in extremely expensive equipment and to recruit teams of specialists, make it difficult for rural hospitals to offer specialty services that are competitive with larger urban medical centers.

Thirty years ago, the emergency room physician was normally a family doctor who was on call. Today, emergency departments are staffed by teams of doctors and nurses with specialized training who are themselves backed up by other specialists, including surgeons, radiologists and anesthesiologists.

The St. Andrews Emergency Department is currently staffed by very well trained doctors and nurses. However, St. Andrews Hospital does not have access to the on-call specialists in Boothbay Harbor who are often necessary for more complex cases.

Surgery has also changed. Twenty years ago, most surgeries were “open” – performed via a large incision that allowed direct access to the part of the body that was the focus of the procedure.

Now most surgeries are laparoscopic, preformed through a small incision through which a tiny camera and other remote tools are inserted. Laparoscopic surgery requires a shorter stay (often no stay) in the hospital and results in less discomfort, fewer complications and a shorter recovery time.

However, it also requires more expensive and technologically advanced equipment as well as a team of people with the skills to operate and maintain that equipment, and like sports teams, the surgical team must practice together often to maintain peak efficiency. A healthier futureWhile rural hospitals like St. Andrews face real challenges offering some specialty services, a St. Andrews Healthcare Center can play a vital role in improving the health of its community through primary care and wellness services.

Like emergency medicine and surgery, primary care is also becoming more team-oriented. While primary care practices have historically consisted mostly of doctors working with support staff, a new model of care called a patient centered medical home includes a variety of specialties, including advance practice nurses, educators and counselors, all working together to keep patients as healthy as possible.

In future years, Lincoln Medical Partners practices like Boothbay Harbor’s Family Care Center will adopt this new model, offering patients, greater flexibility in scheduling appointments and a broader array of services.

As we move toward this goal, we will also work harder to keep our community better informed about developments within Lincoln County Healthcare and how they may affect our communities.

(Dr. Garth Miller, MD, is Medical Director for Surgery for Lincoln Medical Partners and a member of the Lincoln County Healthcare Board of Trustees. He has practiced general and laparoscopic surgery and gastrointestinal medicine in Lincoln County since 1991. After many years in solo, private practice, Dr. Miller joined Lincoln Medical Partners General Surgery in 2009. He is married to Holly Miller, Hospice Coordinator at Miles/St. Andrews Home Health Agency. They live in Edgecomb. Together they have eight children.)