LEWISTON — Officials from Central Maine Healthcare and Midcoast-Parkview Health battled back and forth Wednesday during a nearly five-hour public hearing on CMHC’s proposal to create a $14 million freestanding, outpatient surgical center in Topsham.

More than two dozen people spoke during the virtual hearing hosted by the Maine Department of Health and Human Services, which will have to give Certificate of Need approval in order for the project to move forward. Almost every speaker was affiliated in some way with either CMHC or Midcoast-Parkview.

CMHC’s case: Its surgical center is needed to expand the range of specialty services in Topsham and to provide local patients with access to high-quality, low-cost procedures. It projects a growing need.

“We believe by advancing our mission . . . we can do our small part to innovate, to create different models of health care that allow our Maine communities to better have affordable care and to be able to thrive and to be able to grow with the level of health care they richly deserve,” Jeff Brickman, CEO of CMHC, testified.

Midcoast-Parkview’s argument: It has an outpatient surgical department that is already doing everything CMHC wants to do and that department is seven miles away from the proposed site. It says there is no need for a new, freestanding center and that it can handle any growth through its own high-quality, low-cost health care. If CMHC moves in on surgery, Midcoast-Parkview leaders say, the Topsham-based health system will have to cut services or raise prices elsewhere in order to stay afloat.

“Today before you is an application for a Certificate of Need, not a certificate of want. This Certificate of Need would allow Central Maine Healthcare to bring back duplicated services to this region of Maine,” said Robert Cundiff, a past Parkview hospital board chair who dealt with CMHC when it was a financial backer for Parkview, the former hospital that is now part of Midcoast-Parkview. “As the former board chair of Parkview Adventist Medical Center, I can assure you that duplicated services with this organization is not the best for our community.”

Lewiston-based CMHC proposed its  20,000-square-foot surgical center in May. It wants to build on Topsham Fair Mall Road, near its Care Center and Maine Urgent Care. The facility would have two operating rooms and four procedure rooms and would handle cancer, orthopedics, gastroenterology, urology, ear, nose and throat, and breast issues. Patients would receive routine surgeries and treatments and would return home the same day without being admitted to a hospital.

Such outpatient surgeries are generally profitable and health systems often look to them as money makers.

Midcoast-Parkview supporters asserted during the public hearing that CMHC wants to build the center so it can send cash back to Lewiston, where CMHC’s flagship hospital, Central Maine Medical Center, has struggled financially in recent years.

CMHC officials did note in their state CON application that “. . .  this project is expected to have a positive contribution margin towards CMHC’s overall operational, fixed and overhead costs, thereby contributing to CMHC’s profitability, liquidity and asset efficiency.”

In an email after the hearing, CMHC spokeswoman Kate Carlisle acknowledged that comment in the application but said the situation is no different for Midcoast-Parkview, which is owned by MaineHealth in Portland.

“The hub and spoke system is similar to that of MaineHealth and I would only mention that MidCoast hospital’s revenues are fully redirected to MaineHealth, of which it is a wholly owned subsidiary,” she said.

Midcoast-Parkview spokeswoman Judith Kelsh denied that, saying in an email after the hearing that “Not a single dollar of revenue flows from Mid Coast-Parkview Health to MaineHealth in Portland. Unlike Central Maine Healthcare, MaineHealth has a strong flagship hospital, which allows us to support care in rural communities across our system.”

While most speakers at the hearing were directly affiliated with one of the health systems, a few were not.

A representative for BIW, one of the area’s largest employers, backed Midcoast-Parkview, saying he feared health care costs would increase in the region if Midcoast-Parkview had to make up for revenue lost to CMHC’s proposed surgical center because there aren’t enough patients to go around.

“The demand for additional capacity does not exist,” said Jon Mason, human resources director for BIW.

He added, “As we endure the numerous impacts of COVID-19 and the uncertainty that it creates, we simply can’t afford anything other than disciplined and rigorous cost control from our health care providers.”

A representative for the Healthcare Purchaser Alliance of Maine, a nonprofit comprised of employers, hospitals, health plans and consumer groups, had the opposite view. He backed CMHC, saying an outpatient surgical center will cut health care costs since surgeries typically cost more in a hospital setting like Midcoast-Parkview’s than they do in a standalone center like CMHC is proposing.

“Patients are no longer able afford even routine care. They’re not filling scripts, they’re not getting their insulin,” CEO Peter Hayes said. “Even a minor visit to a hospital setting or a major invoice can be catastrophic financially.”

DHHS will also accept written comments on the surgical center proposal through Aug. 21.

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