Illustration by Molly Oburn Fedarko

OLDER, WISER, AND STRONGER Maine is ideally situated to accommodate the wave of new,
active retirees. By Joshua F. Moore

BANDING TOGETHER Maine’s local hospitals are increasingly discovering there’s strength in numbers. By Jeff Clark

THE HOSPITALS OF MAINE If you’re thinking about retiring to Maine, you can be fairly well assured of finding top-notch medical care wherever you settle.

Older, Wiser, and Stronger

Maine is ideally situated to accommodate the wave of new, active retirees.

By Joshua F. Moore

Caution: Reading only the numbers about Maine’s aging population could be dangerous to your health. Live births have been declining in the Pine Tree State since the early 1960s, coinciding with a rise in the state’s median age during the same time period, up from 29.5 to a seasoned 41.2 years old today. Maine now has the grayest population in the country, and the trend doesn’t show any sign of changing. In fact, the portion of the state’s population between sixty-five and seventy-four years old is expected to rise 97 percent between 1999 and 2025, according to the Maine Development Foundation.

But before those statistics send you into cardiac arrest, consider this: the retirees of the future will bear little resemblance to the senior citizens of today, experts say. “I just read a story today that said, on average, the elderly feel thirteen years younger than their chronological age,” remarks Lenard W. Kaye, director of the UMaine Center on Aging. He is certain the 76 million Baby Boomers who are beginning to enter retirement will remain active well into their seventies and eighties, during which time they will be vital members of their communities through civic boards, cultural organizations, and physical activity-oriented memberships. “These are not rocking chair elders, these are elders who are fast on their feet,” Kaye says. “You’ll find them at the health club pumping iron or sitting on town councils.”

Maine, whose fiercely independent population has always been reluctant to enter institutional living, is particularly well suited to handle this new group of seniors. The state’s hospitals are among the best in New England and are continually seeking out new affiliations and partnerships to better serve their constituents. The percentage of older Mainers living in nursing home is close to 4 percent, below the national average, more proof that the Pine Tree State is committed to keeping retirees in their homes as long as possible. “We’re ahead of the curve when it comes to the plans that have been set into place to handle the needs of older adults,” Kaye says. “Maine is seen as an innovative, forward-thinking state in terms of the policies that have been established around older adults.”

Banding Together
Maine’s local hospitals are increasingly discovering there’s strength in numbers. This is good news for residents of small towns and others looking to retire far from the state’s urban centers.

By Jeff Clark

For more than a century Waldo County General Hospital has defended its independence so fiercely that until a few years ago it wouldn’t even join the Maine Hospital Association. Over the past two decades it has earned a reputation as a lean, well-managed institution, one of the few hospitals in the state to consistently end the year in the black. Its employee turnover is half the state average, and its patient care and services have long been considered top-notch. In an era when hospitals are facing more financial, technological, and regulatory demands than ever, Waldo County General stands out as a strong, independent community hospital.

So why did the hospital’s board of directors last summer vote unanimously to join MaineHealth, the corporate parent of Maine Medical Center in Portland? In September the hospital’s incorporators added their own overwhelming support for the proposal. By early this year Waldo County General, founded in 1901, will become part of the largest healthcare system in the state.

Prodded by rising costs, pushed by market trends, and overwhelmed by laggardly government reimbursements, formerly independent community hospitals all over the state are abandoning their stand-alone status in favor of sheltering under the umbrellas of larger organizations. In the last year Parkview Adventist Medical Center in Brunswick agreed to become part of Central Maine Healthcare in Lewiston, and Southern Maine Medical Center in Biddeford joined Maine Healthcare as a full member. In all, twenty-three of Maine’s thirty-nine hospitals are now part of systems centered on the state’s three tertiary-care hospitals — Maine Med, Eastern Maine Medical Center in Bangor, and Central Maine Medical Center in Lewiston.

The consolidation trend raises issues of local control, the future viability of small hospitals, and the structure of the healthcare network in Maine. But for potential retirees looking to move to the Pine Tree State, it also promises a new safety net.

Not so long ago providing local health care was not an overly complicated business. Community hospitals could get by with a run-of-the-mill X-ray department and a diagnostic laboratory just a couple of steps above the local high school’s chemistry lab. Government-funded programs like Medicaid (for low-income patients) and Medicare (for the elderly) underwrote only a small percentage of patients.

Today’s high-tech imaging machines are multi-million-dollar behemoths that often require an expansion project to house them. More than 20 percent of Mainers now qualify for Mainecare, and the state has the oldest population in the country. Meanwhile, the search for qualified medical personnel verges on desperate, especially in more remote areas. The Maine Hospital Association estimates that the state needs at least 230 additional physicians alone. Even the state’s tertiary-care facilities, hospitals that provide highly specialized medical care in state-of-the-art facilities, are scrambling for medical personnel.

“For what’s coming at us in the very near future, the realities of what’s happening today, [consolidation] was the only logical choice for us,” says Mark Biscone, Waldo County General’s executive director for the past twenty-five years. Once a keen defender of the hospital’s independence and an architect of its financial health, Biscone today says the decision to join MaineHealth “is timely, very timely.” He expects the hospital to save at least a million dollars a year in operational costs in areas ranging from accounting to information services, as well as another $500,000 in capital costs. “We’re saving $350,000 on one piece of imaging equipment alone,” Biscone notes, “because MaineHealth is buying several of them and getting a discount.”

At least half a dozen hospitals in Maine “are in really serious financial situations,” he notes, although he declines to name them. The state of Maine owes hospitals $300 million in Mainecare billings for the 2005-2007 fiscal years alone, according to the Maine Hospital Association, including $6.6 million to Waldo County General. At the current rate of payments, the hospital bill for an infant born under Mainecare today won’t be paid by the state until the child starts kindergarten.

“We could have stayed independent, but it was becoming apparent that it was more prudent for everyone to pull in the same direction inside the industry,” Biscone says. “Now, with that decision just a few months behind us, I can’t believe the rest of the hospitals in Maine won’t be moving quickly to align themselves with one system or another.”

Multi-hospital systems aren’t new in Maine — both Eastern Maine Health Systems and Central Maine Healthcare date back to 1982 — but they have grown rapidly in this decade. “We put our system together in the mid-1990s,” explains MaineHealth CEO Bill Caron, “and went through a relatively stable period into the early 2000s. Now we’re in a growth period again.”

Financial pressures are driving much of the new consolidation efforts. “Some hospitals have significant cash flow problems,” notes Caron, “but the bigger issue I see is access to capital. More hospitals are employing their own physicians, which means they have to build medical office buildings. Others are looking to finance additions and expansions. And the opportunity to save money through consolidating overhead expenses is very attractive.”

Although details differ among Maine’s three systems, essentially member hospitals retain large amounts of local control, with their own boards of trustees and incorporators. Donations and existing trusts remain with the local hospital. Typically each member hospital has a seat on the central board, while the overall system CEO sits as an ex officio member of each member’s local board. Any financial decision over a certain amount — $250,000 in the case of Maine Health — needs central board approval, as does each hospital’s annual budget.

“MaineHealth has about a dozen or so ‘reserved powers,’ where the local board has to make the decision in conjunction with MaineHealth,” Caron explains. “One of those is the hiring and firing of the local hospital’s CEO, for example. If a new executive is needed, the local board drives the search process and comes up with a short list of candidates, and then we mutually decide on the final choice.”

M. Michelle Hood, president and CEO of Eastern Maine Health Systems, acknowledges that loss of local control and the possible downsizing of the local hospital in favor of the central tertiary care facility are high among the fears she has to address when hospitals consider joining her organization. “We’re very faithful to the expectation that we will deliver health care as close to the patient’s home as possible as long as we can get an acceptable result,” she says. “We don’t funnel patients to the tertiary hospital. We don’t have room to do that, for one.”

Hood, who has worked in hospital administration from Georgia to Montana, says Maine’s system of independent nonprofit hospitals isn’t unusual, although its lack of for-profit medical centers is. “There’s an even stronger trend toward consolidation outside Maine,” she adds.

Waldo County General’s Biscone says his board paid close attention to protecting the hospital’s current and future level of the service. “MaineHealth can’t change or close a service here without our board’s approval,” he notes. And Belfast is too far away from Portland to worry about patients being funneled to Maine Medical Center.

Waldo County General studied offers from both MaineHealth and the much closer, Brewer-based Eastern Maine Health Systems. MaineHealth was favored for its philosophy of a highly localized corporate management, Biscone says. “In the spectrum of management, from the tight, top-down style to a loose, decentralized system of control, we definitely fall at the decentralized end of the scale,” Caron notes. “But you need a very strong local board of trustees for that to work.”

If current trends are any indication, healthcare networks are developing into vertically integrated health provider systems, offering literally cradle to grave care. Besides its seven member hospitals, for example, Eastern Maine Health Systems includes physician group practices, specialty medical services, home health programs, nursing homes, and retirement communities. It even owns its own ambulance service. It’s almost as if a regionally based single-provider medical care system is developing without government involvement.

Some of those assets came as existing affiliates of member hospitals. Others were acquired as part of corporate strategy, particularly during the administration of Eastern Maine Health System’s former CEO, Norm Ledwin, who built much of the current network during his fourteen-year tenure. Today, Hood says, “we’re not in the mode of looking for acquisitions; we’re in the mode of forming collaborative efforts.”

Hood notes that Maine is unusual for having a sparse and fragmented public health infrastructure compared to other states. “It’s the sort of service you typically see elsewhere in county health departments,” she notes. “In Maine that responsibility has largely fallen on the shoulders of local hospitals, with varying results.” One effect of consolidation, she says, is a more uniform and widespread approach to public health issues, such as wellness programs, mental health care, and substance abuse efforts.

Consolidation also allows member hospitals to cooperate on projects that they could never have undertaken individually. For example, Biscone notes that Waldo County General, Penobscot Bay Medical Center in Rockport, and Miles Health Care in Damariscotta, as members and affiliates of MaineHealth, could jointly create a cancer treatment center in the midcoast area that none of them would have attempted alone.

Three years ago, Governor John Baldacci’s Commission to Study Maine Hospitals created a furor within the state’s medical community when its draft report recommended that all of the state’s medical facilities be forced into one of three centralized systems [Down East, December 2004]. Mary Mayhew of the Maine Hospital Association, which led the public criticism of the proposal, says the current consolidation trend shows that state coercion wasn’t needed. “Hospitals made the case that there already were all kinds of incentives for collaboration and affiliations within hospital systems,” she points out.

“It was happening and is happening without state government directing and overseeing the process, and it’s happening in a much more organic, sensible manner.”

Caron and Hood predict that most if not all of Maine’s hospitals will be part of a larger system within the near future. “I think independent community hospitals will be much more open to having a relationship with one of the tertiary hospitals,” Hood says.

Among those that don’t, “I think it’s very probable you’ll see more hospitals merge or even close,” Biscone says. “Given the alternatives, this is a no-brainer.”

MaineHealth (Maine Medical Center) (1996)
Members:
Maine Medical Center, Portland
Miles Health Center (aka Miles Memorial Hospital), Damariscotta
St. Andrews Hospital, Boothbay Harbor
Spring Harbor Hospital, South Portland
Stephens Memorial Hospital, Norway
Southern Maine Medical Center, Biddeford
Waldo County General Hospital, Belfast

Affiliates:
MaineGeneral Health, Augusta, Waterville
Midcoast Health Services, Brunswick (Midcoast Hospital)
Penobscot Bay Medical Center, Rockport
St. Mary’s Regional Medical Center, Lewiston
Joint Venture:
New England Rehabilitation Hospital, Portland
Eastern Maine Health Systems (Eastern Maine Medical Center) (1982)
Members:
Acadia Hospital, Bangor
Aroostook Medical Center,
Presque Isle
Blue Hill Memorial Hospital
C.A. Dean Memorial Hospital, Greenville
Eastern Maine Medical Center, Bangor
Inland Hospital, Waterville
Sebasticook Valley Hospital, Pittsfield

Central Maine Healthcare (Central Maine Medical Center) (1982)
Members:
Central Maine Medical Center, Lewiston
Parkview Hospital, Brunswick
Rumford Hospital, Rumford
Bridgton Hospital, Bridgton

The Hospitals of Maine
If you’re thinking about retiring to Maine, you can be fairly well assured of finding top-notch medical care wherever you settle. In addition to the major medical centers of Portland, Lewiston, and Bangor, dozens of excellent smaller facilities dot the state.

Augusta
MaineGeneral Medical Center
6 East Chestnut St., Augusta, ME 04330, 207-626-1000, 126 acute care beds, www.mainegeneral.org

Bangor
Acadia Hospital
268 Stillwater Ave., Bangor, ME 04402-0422, 207-973-6100, 100 acute care beds, acadiahospital.org

Eastern Maine Medical Center
489 State St., Bangor, ME 04401, 207-973-7000, 411 acute care beds, www.emmc.org

St. Joseph Hospital
360 Broadway, Bangor, ME 04401, 207-262-1000, 82 acute care beds, www.stjoseph-me.org

Bar Harbor
Mount Desert Island Hospital
10 Wayman Lane, Bar Harbor, ME 04609, 25 acute care beds, 207-288-5081, www.mdihospital.org

Belfast
Waldo County General Hospital
118 Northport Ave., P.O. Box 287, Belfast, ME 04915, 207-338-2500, 25 acute care beds, www.wchi.com

Blue Hill
Blue Hill Memorial Hospital
Water St., Blue Hill, ME 04614, 207-374-2836, 25 acute care beds, www.bhmh.org

Biddeford
Southern Maine Medical Center
1 Medical Center Drive, Biddeford, ME 04005, 207-283-7000, 150 acute care beds, www.smmc.org

Boothbay Harbor
St. Andrews Hospital
6 St. Andrews Drive, Boothbay Harbor, ME 04538, 207-633-2121, 20 acute care beds, www.standrewshealthcare.org

Bridgton
Bridgton Hospital
10 Hospital Drive (off South High St.), Bridgton, ME 04009, 207-647-6000,
16 acute care beds, www.bridgtonhospital.org

Brunswick
Mid Coast Hospital
123 Medical Center Drive, Brunswick, ME 04011, 207-729-0181, 73 acute care beds, www.midcoasthealth.com

Parkview Adventist Medical Center
329 Maine St., Brunswick, ME 04011, 207-373-2000, 55 acute care beds, www.parkviewamc.org

Calais
Calais Regional Hospital
24 Hospital Lane, Calais, ME 04619, 207-454-7521, 25 acute care beds, www.calaishospital.com

Caribou
Cary Medical Center
163 Van Buren Rd., Caribou, ME 04736, 207-498-3111, 65 acute care beds, www.carymedicalcenter.org

Damariscotta
Miles Memorial Hospital
35 Miles St., Damariscotta, ME 04543, 207-563-1234, 38 acute care beds, www.mileshealthcare.org

Dover-Foxcroft
Mayo Regional Hospital
897 West Main St., Dover-Foxcroft, ME 04426, 207-564-4342, 46 acute care beds, www.mayohospital.com

Ellsworth
Maine Coast Memorial Hospital
50 Union St., Ellsworth, ME 04605, 207-664-5311, 64 acute care beds, www.mcmhospital.org

Farmington
Franklin Memorial Hospital
111 Franklin Health Commons, Farmington, ME 04938, 207-779-2555, 70 acute care beds, www.fchn.org

Fort Kent
Northern Maine Medical Center
194 East Main St., Fort Kent, ME 04743, 207-834-3155, 49 acute care beds, www.nmmc.org

Greenville
C.A. Dean Memorial Hospital
364 Pritham Ave., Greenville, ME 04441, 207-695-5200, 14 acute care beds, www.cadean.org

Houlton
Houlton Regional Hospital
20 Hartford St., Houlton, ME 04730, 207-532-2900, 25 acute care beds, www.houlton.net/hrh

Lewiston
Central Maine Medical Center
300 Main St., Lewiston, ME 04240, 207-795-0111, 250 acute care beds, www.cmmc.org

St. Mary’s Regional Medical Center
93 Campus Ave., Lewiston, ME 04243-0291, 207-777-8100, 233 acute care beds, www.stmarysmaine.com

Lincoln
Penobscot Valley Hospital
7 Transalpine Rd., P.O. Box 368, Lincoln, ME 04457, 207-794-3321, 25 acute care beds, www.pvhme.org

Machias
Down East Community Hospital
Upper Court St., Machias, ME 04654, 207-255-3356, 25 acute care beds, www.dech.org

Millinocket
Millinocket Regional Hospital
200 Somerset St., Millinocket, ME 04462, 207-723-5161, 25 acute care beds, www.mrhme.org

Norway
Stephens Memorial Hospital
181 Main St., Norway, ME 04268, 207-743-5933, 50 acute care beds, www.wmhcc.org

Pittsfield
Sebasticook Valley Hospital
447 North Main St., Pittsfield, ME 04967, 207-487-5141, 25 critical access beds, sebasticookhospital.org

Portland
New England Rehabilitation
Hospital of Portland
335 Brighton Ave., Unit 201, Portland, ME 04102, 207-775-4000, 100 acute rehab care beds, www.nerhp.org

Maine Medical Center
22 Bramhall St., Portland, ME 04102, 207-662-0111, 606 acute care beds, www.mmc.org

Mercy Hospital
144 State St., Portland, ME 04101, 207-879-3000, 200 acute care beds, www.mercyhospital.com

Presque Isle
Aroostook Medical Center
140 Academy St., Presque Isle, ME 04769, 207-768-4000, 105 acute care beds, www.tamc.org

Rockport
Penobscot Bay Medical Center
6 Glen Cove Drive, Rockport, ME 04856, 207-596-8000, 109 acute care beds, www.penbayhealthcare.org/penbaymedicalcenter

Rumford
Rumford Hospital
420 Franklin St., Rumford, ME 04276, 207-369-1000, 25 acute care beds, www.rumfordhospital.org

Sanford
Goodall Hospital
25 June St., Sanford, ME 04073, 207-324-4310, 58 acute care beds, www.goodallhosp.org

Skowhegan
Redington-Fairview General Hospital
46 Fairview Ave., P.O. Box 468, Skowhegan, ME 04976, 207-474-5121, 65 acute care beds, www.rfgh.net

Waterville
Inland Hospital
200 Kennedy Memorial Drive, Waterville, ME 04901, 207-861-3000, 48 acute care beds, www.inlandhospital.org

MaineGeneral Medical Center
(Seton and Thayer campus),
149 North St., Waterville, ME 04901, 207-872-1000, 161 acute care beds, www.mainegeneral.org

Westbrook
Mercy Westbrook
40 Park Rd., Westbrook, ME 04092, 207-857-8000, 30 acute care beds, www.mercyhospital.com/affiliated/westbrook

Spring Harbor Hospital
123 Andover Rd., Westbrook,
ME 04092, 207-761-2200, 100 acute care beds, www.springharbor.org

York
York Hospital
15 Hospital Drive, York, ME 03909, 207-363-4321, 79 acute care beds, www.yorkhospital.com