MCMH Regains Tier 1 Status

ELLSWORTH — In the race for preferred hospital status, there is no prize for coming in second.

Thus Maine Coast Memorial Hospital in Ellsworth and Blue Hill Memorial Hospital welcomed the news that the Maine State Employee Health Commission has moved both hospitals from a Tier 2 ranking to Tier 1.

The promotion is significant because the state of Maine provides incentives to employees to utilize Tier 1 hospitals. For example, a University of Maine System employee will have a $10 copay for in-patient services at a Tier 1 hospital; the copay is $100 if that employee goes to a Tier 2 hospital. So, beyond being a source of pride, Tier 1 status is good for business.

Though significant and cause for satisfaction, the improved rankings come — literally — with an asterisk. MCMH and Blue Hill Memorial are among 10 Maine hospitals on the new Tier 1 list with an asterisk after their names.

The asterisk, according to the state, “denotes hospitals that did not reach the minimum score to become preferred but have engaged in a pilot project with the State Employee Health Commission. As part of this agreement, these hospitals will be considered preferred.”

Regarding the asterisk, Roraff said, “I think that there have been major changes taking place. We had been anticipating that our quality indicator would take place, with or without” the pilot project status. “We are confident we would have achieved the Tier 1 status. I wasn’t aware that had put us over the top because we had paid particular attention to the requirements and metrics used. “We were confident we were going to achieve that status.”

In February, when MCMH and Blue Hill learned of their Tier 2 rankings, the administration at each set about improving.

Charlie Therrien, president and CEO at Maine Coast Memorial, said Tuesday that the hospital went to work on quality and cost-control goals.

With Roraff , Therrien noted that the Tier 1 status, despite the asterisk, was earned and based on performance.

Leadership positions were assigned to certain doctors and nurses to bring about efficiency, best practices, communication and collaboration. Processes were standardized and systems were put in place to monitor the improvements.

“Everyone realized the importance” of gaining Tier 1, Therrien said.

On the cost side, rates were not raised and, in some cases, were lowered. Contracts with Anthem and Aetna were altered to allow those insurers to reimburse at a lower rate. It meant “less money coming in,” Therrien said.

Less money coming in required the administration to “manage labor costs” more closely and ensure that staffing balanced patient volume. Though there have been no layoff s, he said, some employees are working fewer hours.

Greg Roraff , president and CEO of Blue Hill Memorial Hospital, said some of the initiatives the hospital implemented are making a difference, such as computerized physician order entry and calling every patient seen in the emergency room after they go home.

“The single most important factor is our relationship with the Eastern Maine Health Care System,” he said. “So many of our initiatives are really driven by and initiated by EMHS.”

One example, said Roraff , is an initiative called “zero defects” where the hospital has strategies in place to eliminate medication errors.

“Th is is an initiative that was started at EMHS and that the member hospitals have all taken to heart and included in our strategic plans,” he said.

“Also, we’ve become so much more focused on our patients and what we can do to improve the quality and safety of their care,” Roraff said.

Bill Swain, public affairs officer for Mount Desert Island (MDI) Hospital, whose ranking dropped from Tier 1 to Tier 2, said nine of the hospitals that were rated Tier 1 were granted that status due to their participation in the pilot project with the State Employee Health Commission.

“We were not approached to be part of that pilot,” Swain said. “We don’t have many people covered by the state employee health plan that are within our service area.”

He said the State Employee Health Commission would have to delineate why MDI Hospital was bumped from its Tier 1 status, but did say the formula and methodology for calculating the score has changed since last year.