In her Jan. 4 column, “Looming doctor shortage demands action,” Rebecca Sacchetti outlined an issue of great concern to hospitals — the difficulty Maine has in attracting physicians to the state.
Maine’s 36 hospitals employ most of the physicians in Maine; best estimates are that 75% of physicians practicing in Maine are employees of hospitals.
As such, attracting and retaining high-quality physicians is a constant challenge for the Maine Hospital Association’s members. Hospitals in Maine compete with hospitals across the country for physicians. We know that once we can get doctors to Maine, they will love it as much as we do and will want to stay and practice and raise their families in our magnificent state.
But we have to get them here first.
While Maine’s total number of physicians is in line with recommended levels, as Sacchetti noted, they are not evenly disbursed throughout the state. Rural areas tend to have a more difficult time attracting doctors.
Many hospitals rely on temporary placements (so-called “locums” or “travelers”) far too often because it is so challenging to hire full-time staff. This both drives up health care costs, as locums are quite expensive, and leads to a lack of continuity in care.
Sachetti went on to challenge state and federal leaders to take some action to alleviate the problem and, at a minimum, not make it worse.
We’re happy to note that the Maine Legislature did take a couple of actions in 2019 that will help rural Maine with this issue.
First, Medicaid expansion has provided health insurance coverage to thousands of Mainers who were previously uninsured.
Maine’s hospitals are non-profit and provide millions of dollars worth of free care to uninsured Mainers each year. This is a burden because hospitals try to generate enough revenue to pay for their doctors and nurses.
Furthermore, this burden is too often shifted by hospitals onto local businesses in Maine via commercial insurance premiums. Expanding Medicaid has several positive ripple effects that should help hospitals afford the physicians.
In addition, the Legislature, largely led by Senate President Troy Jackson, D-Allagash, took the issue of rural physicians head on and sponsored a bill for hospitals that will also help.
The new law increases Medicaid reimbursement rates for physician services. For years, Maine set reimbursement rates for physicians at below the cost of providing care — it was written right into the MaineCare policy manual. That has now changed and MaineCare (Maine’s Medicaid program) will cover its own costs for doctors practicing at rural hospitals in Maine. Maine hospitals won’t make money on the treatment they provide to patients on MaineCare, but at least they won’t lose money.
Furthermore, many hospitals provide tuition reimbursement benefits to doctors and nurses as a way to attract caregivers to Maine. This costs hospitals a lot of money each year. A wrinkle with tuition reimbursement is that the state imposes an income tax on those benefits, so 5% of every dollar hospitals provide in tuition reimbursement is handed over to the state as taxes. Sen. Jackson’s legislation now waives that tax bill for physicians practicing in rural hospitals.
Finally, there are many rural health clinics in Maine, some operated by hospitals, some not, that have not had an adjustment to their pay rates in years. The new law provides these vital community health clinics with a badly needed adjustment.
We agree with Sacchetti that doing good is always appreciated but not doing harm is sometimes even more important. As she noted, there is legislation being debated that could have the government set prices for medical care in the private market (the government already sets prices in Medicaid and Medicare). That would be bad for Maine and the rest of the country.
Despite the challenges they face, Maine hospitals provide residents of this state excellent care. According to the most recent Leapfrog Hospital Safety Grade, Maine had the highest percentage of “A”-rated hospitals of any state in the nation.
We want to once again thank Sen. Jackson for his leadership last year on behalf of rural hospitals and physicians. Every year there are many worthy causes competing for scarce state resources at the Legislature and Sen. Jackson and his staff fought tooth and nail to see that this important legislation was enacted. Thank you.
Steven Michaud is president of the Maine Hospital Association in Augusta.
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