Cental Maine Healthcare plans to build a $14.2 million outpatient surgery center near its existing Topsham Care Center. Credit: Courtesy of Central Maine Healthcare

Central Maine Healthcare has asked for state approval to build a $14.2 million ambulatory surgery center in Topsham that will offer lower-priced orthopedic and other services than hospitals.

The Lewiston-based healthcare system said it expects to start operating the planned 20,00o-square-foot center at the end of 2021 following regulatory approval and to hire 16 staff initially. Doctors will work at the center but be based at their own practice or a hospital.

Ambulatory surgery centers are becoming more common in the health care landscape. Hospitals have struggled with high costs and fewer elective surgery patients, especially during the coronavirus pandemic. The new centers are expected to bring new business, offering procedures that cost less than if they were performed in a hospital. Patients could see out-of-pocket expenses halved for certain procedures.

Central Maine Healthcare, which furloughed about 10 percent of its 3,200 employees in April, said it expects the centers to be a strong new revenue stream. The system said the plan for the new center was in discussion before the pandemic began.

“The centers have a tight focus without the typical overhead cost of a large medical center,” said Jeff Brickman, CEO of Central Maine Healthcare. “Given our environment where [hospitals] all being affected by the pandemic, we’re seeing health care become more of a pocketbook issue.”

He said he expects the center to be profitable within several years and that the hospital’s outpatient surgeries will increase by 11 percent in the next two years. The new center won’t take away income from the hospital’s surgical services, he said, because those are increasingly handling more complicated surgeries.

The healthcare system includes Central Maine Medical Center, Bridgton Hospital, Rumford Hospital, outpatient clinics and doctors’ offices. Central Maine Healthcare already has one outpatient surgery center in Auburn in a collaboration with Central Maine Orthopedics.

The proposed center will be located near the hospital group’s Topsham Care Center on Topsham Fair Mall Road. Central Maine Medical Center will provide all of the staffing for services in urology; ear, nose and throat; breast; gastroenterology; and orthopedics. It will have two operating rooms and four procedure rooms.

Central Maine Healthcare filed a letter of intent to build the center with the Maine Department of Health and Human Services on May 8, and plans to file a full certificate of need application by May 30 that will specify why the center is needed in the Topsham-Brunswick area.

Brickman said the closest other ambulatory surgery centers are in Auburn and Portland. The nearest hospital to the proposed center is Mid Coast Hospital in Brunswick.

The hospital will not pay to build the facility. Instead, commercial real estate developer Bateman Partners of Portland will build the facility and lease it to Central Maine Healthcare.

Ambulatory surgery centers can offer surgical procedures at rates 35 percent to 50 percent lower than hospitals, saving the U.S. healthcare system about $40 billion a year, according to research by Bain & Co., a Boston-based consulting firm.

Bain expects the number of such centers to grow 7 percent this year and next year. They already perform more than half of all outpatient surgeries, with orthopedic, spine and cardio procedures increasing the fastest. It said the centers focus on routine, lower-risk procedures in a more convenient setting.

“As a physician, a major concern is the ability of our patients to be able to afford the care that I have recommended,” said Dr. Hector Tarraza, chief of the oncology institute at Central Maine Healthcare. “Over the past two decades of my career I have seen the major shift in surgery from inpatient hospitals to outpatient ambulatory surgery centers.”

He said patients want to be cared for in their own communities. Some patients find hospitals intimidating and scary. The outpatient centers give patients a feeling as though they are going to their doctor’s office, he said.

The average cost for a colonoscopy in Maine at one of the current 16 ambulatory surgery centers in the state is $450, less than half the $975 for the same procedure in a hospital, said Chiara Beckner, director of service line strategy at Central Maine Healthcare. She said out-of-pocket costs for patients for the procedure are also about half at $100 at the outpatient facility.

Brickman said patients also may see the centers as safer than hospitals.

“It is not on a hospital campus where we have very acutely ill patients, several of whom may be suffering from COVID,” he said.