We are living in uncertain and chaotic times. In my 35 years as a physician in Dover-Foxcroft, I have seen many changes in medicine and in the region. I have seen Mayo Regional Hospital become a respected community hospital in the 1990s capable of handling most emergencies — including patients on ventilators, major surgical and medical emergencies and heart attacks — only to become in recent years a “ critical access hospital” to survive.
The emergency room has grown from seeing 10 to 15 people a day to a fully staffed ER serving more than 900 patients a month. I have watched the evolution of hospitalists, intensivists, nocturnists, emergency physicians and outpatient-only clinicians, as well as the explosion of mid-level practitioners. I have seen the advent of “medical homes” and “nurse navigators.”
Our hospital is one of the pillars of our community. It is our largest employer, providing more than 500 skilled, well-paying jobs. It is an essential institution for growth in the local economy, attracting businesses and families.
But the hospital is in danger, and we should be alarmed and ready to take action. In the past several years, there have been numerous cuts in funding because of cuts to Medicaid eligibility, as well as reimbursement at the state level and the governor’s failure to accept money to expand Medicaid. Medicare also has reduced payments to critical access hospitals, creating further budgetary pressures. As local mills and large businesses shut down, the privately insured population has declined, leaving a bigger uninsured population in need of medical care. Mayo Hospital does not turn anyone away from its ER because of lack of insurance. It provides $3 million of free care each year to uninsured patients.
With the recent cuts in reimbursements, Mayo has trimmed all the “fat” from its budget. It has cut unnecessary staff, overhead, procedures and expenses. And even with these cuts, Leapfrog Group, a national hospital quality assessment program, recently recognized Mayo for its outstanding safety record and care. What remains is absolutely essential to maintaining the services our community enjoys. Any further cuts in reimbursements will result in job losses and cuts in desirable and valuable programs.
The governor’s proposal to remove another 18,000 people from MaineCare, the state’s version of Medicaid, may sound appealing to taxpayers, but it will shift the cost of medical care for needy low-income people to communities and hospitals, potentially resulting in devastating cuts in services for all people in our region. Not only will people still show up in Mayo’s ER for care, but they will be sicker and more costly to treat. More care will be shifted to specialists in Bangor, resulting in increased travel time and expenses and loss of work time.
Ultimately, the dominoes will begin to fall, and our hospital will have to reduce staff. These proposed MaineCare cuts will cost Mayo more than $1.1 million in fiscal year 2018 alone. This is not the change we want to see in rural Maine.
The Republican-led effort to repeal the Affordable Care Act also will severely impact our community health and our state. Not only will many middle income people lose the only medical insurance they can afford, but even people covered under employer plans risk losing coverage for pre-existing conditions and coverage for children up to the age of 26. Women may also lose the protection of the Affordable Care Act requiring that insurance plans may not charge higher premiums for women. Medicare recipients will lose the coverage required by the Affordable Care Act for the “ donut hole” gap in payments for medications, resulting in potentially thousands of dollars of out of pocket costs for people over age 65. This loss of coverage will not only worsen the health of people in our community and leave hundreds of middle income people in a frightening dilemma, but it will also increase free care demanded of the hospital.
I urge my state legislators, congressional representatives and neighbors to think carefully about cutting more people from even the most basic insurance. It may seem like a good plan to reduce government costs, but the unintended consequences are going to haunt us all.
Lesley Fernow is an internist and geriatrician who now practices house call medicine. She has been a member of the Mayo Regional Hospital medical staff for 37 years. She lives in Dover-Foxcroft.