Decision to join Northern Light Health the right decision for Mayo Regional Hospital

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I have been a family physician living and practicing in Dover-Foxcroft for over 25 years. I have lived in Piscataquis County nearly half of my life. This is my home. Mayo Regional Hospital is my hospital. My daughter was born here. My mother and mother-in-law each died here. I get my personal care here. Every day I am proud to say that I am a part of the Mayo team. I write now to tell why I think that the time is right for Mayo to move forward with its merger with Northern Light Health as has been proposed by our board of directors.

For many of Mayo’s 41 years the conditions in the community were good for growth and promoted the financial stability of the hospital. The leadership teams were prudent and saved money they earned to build the hospital’s reserves. The factors that led to that past success no longer exist. The years of positive budgets and resource accumulation for Mayo, and for nearly every small and rural hospital in Maine and the rest of the country are over. Our reserves have supported the hospital for the last eight years with deficit budgets. We cannot continue to spend more than we earn every year without dramatic changes.

In 1993 Piscataquis County was a thriving manufacturing hub. We had five major employers in the region providing robust employment, supporting young families, and providing strong insurance support for health costs. We had a very active woods industry and were geographically located between major paper mill towns, where many of our men and women worked. Over the years Dexter Shoe, Moosehead, Pride and the paper mills all became victims of global economic changes and closed. Only Hardwood Products and Duvaltex remain, now joined by Pleasant River Lumber.

As opportunity for employment decreased many young families relocated. This has caused the population of the county to decline. Schools have closed in every district. The median age of our population has risen and is now the highest in the state. We now have many patients who live with a high burden of chronic disease, live on limited incomes and can’t afford to pay for their care. Even those who work and have employer-sponsored health insurance have found their out-of-pocket costs rising annually with higher deductibles and copayments for every element of their health care. Hard working families who work for local employers often qualify for our charity care programs to “cover” the cost of their responsibilities for their health expenses. Our charity care is not funded by any outside sources — it is a straight write-off of income from our bottom line.

When my family moved to Dover-Foxcroft in 1993 I became the first physician to be directly employed by the hospital. Together we started Dover-Foxcroft Family Medicine and built it into the largest primary care practice in Piscataquis County. Although employed doctors were new to Mayo then: since that time every physician except one who has moved to the community has come as an employee. The hospital is responsible for the operation and support of Dover-Foxcroft Family Medicine, Dexter Internal Medicine, Dexter Family Practice, Corinth Medical Associates, Milo Family Practice, Mayo Women’s Health, Mayo Psychiatry and Counseling, Mayo Surgical Associates and Mayo Orthopedics. Maintaining each of these practice sites and recruiting and retaining all of the physicians, physician assistants, nurse practitioners and counselors who work in those practices requires a commitment to the practices and the communities they serve. This requires a strong hospital system to provide that support. Without a strong hospital: those clinics would not be able to maintain their staffing. Most would close. The reimbursements offered to private practice physicians by Medicare and Medicaid are too low to cover the cost of running a practice. Most practitioners, removed from the support for their practice that hospital employment provides, would relocate to other communities where they can practice, pay off their student loans and meet the needs of their families.

Mayo Regional Hospital (and Mayo Memorial Hospital before it) has, since the 1940s, been here to serve the health needs of the communities it serves. Northern Light Health, and its predecessor Eastern Maine Health Systems, has been active in Piscataquis County doing the same things since the 1990s. We overlap in service territory. We collaborate now in oncology services, pharmacy support, materials purchasing, emergency psychiatry care, obstetrical and newborn care and education, cardiology, pulmonology and imaging storage and archiving. We are both committed to the present and future health of the residents and the communities of the region.

As we look to the future and engage even more in improving the health of an entire population: we need to align our resources and work together to do this. Our county is too small to support competing health networks. By joining together, we can harness the power of a larger organization, with experience across the entire state, to provide up-to-date modern facilities to the entire region in a sustainable fashion so that the people who live, play, and work here can rest assured that when they need care it will be available to them. They will know that their practitioners are supported with the tools they need to guide them in prevention and wellness. Mayo will gain the power of a larger entity advocating on their behalf with policy makers and payers to bring fairness and equity to our region. Alone: we simply don’t have the resources to do that in 2019 and beyond. As a part of a larger system: we will.

There are those out there who do not share my vision for an aligned future. “Just tax the communities to keep the hospital open,” they say. I’ve lived in Piscataquis County long enough to know how tax increases are viewed by my neighbors. We can’t tax ourselves into prosperity. It just does not work. Even if we had the money (from taxes or another source): there are too many regulatory demands in 2019 for a small hospital to succeed as an independent entity. That is why nationally so many independent hospitals are choosing one of two paths: align with a larger regional entity or close. I know which path I want my hospital to take. I ask you to support our board as they continue the hard work they have been doing for five years to make this path to our successful future a reality and to support the merger between Mayo Regional Hospital and Northern Light Health. Northern Light has been a very good partner in the negotiations to build this merger plan.

They have listened to the people of the region and made many changes to their initial proposals, guaranteeing support for many critical services we now provide for many years to come.

There are those who don’t support this merger because they fear “change.” “We don’t want anything to change at Mayo.” That is a nice sentiment, but in every aspect of our lives change is a constant presence. The pace of change in healthcare in the past 10 years has been accelerating. No one can predict what health care will look like in 10 years, but I can guarantee that it will be different than it is today. Change is inevitable. The real question should be “what resources are available to help you use change to build a strong future”? Let’s make decisions that put us on the driving side of change, not the reacting side.

If you enjoy living, working, and playing in the Maine Highlands I challenge you to list what essential qualities you feel we need to be a thriving region. We need great schools. We’ve got them. We need passionate people committed to making their towns better. We’ve got them. We need small farmers supported by local consumers, growing our own sustainable food sources. We’ve got them. We need outstanding recreational opportunities — and have some of the best in the world. We need to know we live in a safe area—with good fire and law enforcement protection. We’ve got that. Fresh water…. clean air …. the arts … got all of that. High on any list: we need high quality health care close to home. This is a watershed moment for health care in the region — we either go forward together or we fall down in our isolation. The choice is ours. Please let your elected officials — at the town, county, and state levels — know how much you want to preserve and sustain the health care access we have now! Join me in supporting this merger. It’s the right thing to do.

Dr. McDermott is a family physician who lives and practices in Dover-Foxcroft. Originally from a small-town very much like Dover-Foxcroft in the North Woods of New York State, he now is the medical director at Mayo Regional Hospital. He is a past president of the Maine Medical Association, the Medical Staff of Mayo Regional Hospital and the Kiwanis Club of Dover-Foxcroft.

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