The hospital changed its status to a Critical Care Access (CCA) facility a few years ago and some of the full-time nursing home beds were phased out. Also, some regular, unused hospital beds were converted to "swing beds" which could be used for either facility on a short-term basis.

Nevertheless, C.A. Dean's budget projections for the current fiscal year were off the mark for several reasons:

There was an $800,000 difference between what the hospital expected in Medicare and Medicaid reimbursement and what it actually received in the last fiscal year. Since 1998, the percentage of C.A. Dean patients on Medicare or Medicaid has climbed from 58 percent to 66 percent. "Even commercial insurance company payments are lower. When you see a bill that calls for an 80-20 percent split, don't assume that the hospital gets the whole 80 percent. The insurance companies always negotiate for a lower rate," Marshall explained.

C.A. Dean wrote off $450,000 in bad debts and charity care last year. Marshall conceded that this was a "significant amount for a hospital this size." But she said that the hospital has a moral obligation to provide services, regardless of the patient's ability to pay. "Some people can't even make the co-payments on insurance claims," said the CEO.

The hospital is currently short four registered nurses and two certified nurses' aides. So they have to use contract employees to cover shifts and the cost can be as high as two to two-and-a-half times the salary of a staff member.

To help offset the budget shortfall, Marshall said that three employees have been laid off recently, some open positions have remained unfilled and some have been consolidated. Other workers have either accepted or asked for part-time status, said Marshall, while some left for better positions or jobs closer to their home. "While our turnover rate is higher than I'd like it to be, it's still relatively low compared to the number of employees we have," said Marshall. The hospital has 150 full and part-time workers, making it Greenville's largest employer.

The hospital is also grappling with the possibility of losing two doctors by the end of the summer, although one potential replacement was interviewed last week and two more have appointments later this month, Marshall said. "We hope to be making an offer to one of them very soon."

Dr. Joseph Moriarty is leaving Aug. 16 to return to his home in Minnesota and Dr. Debra Nathan, who came to Greenville from Maryland two years ago, may be departing at the end of the summer. "Dr. Nathan hasn't given her formal notice, although she indicated that she would also like to relocate closer to her home," said Marshall.

C.A. Dean joins a long list of rural Maine hospitals that are being squeezed by a combination of low Medicare and Medicaid reimbursements, high operating costs and a shortage of qualified help.

Blue Hill Memorial Hospital, Calais Regional Hospital, Mount Desert Island Hospital and Millinocket Regional Hospital are all applying for CCA status.

A few weeks ago Franklin Memorial Hospital in Farmington announced that it's facing a shortfall of up to $4 million in its $42 million operating budget. Hospital CEO Richard Batt told the Central Maine Morning Sentinel that he blames the financial crunch on inadequate Medicare and Medicaid reimbursements, a growing number of uninsured patients and the rising cost of health care.

But C.A. Dean is still solidly planning for the future, said Marshall. The hospital's $2 million capital campaign is still on track, although donations are lagging behind, so the actual groundbreaking has been pushed back until 2003. So far, just under $1 million has been pledged but in order to break ground, C.A. Dean will have to have $1 million actually sitting in the bank, said the CEO. "September 11th had a big impact," she added. "A lot of donations that would have gone to the capital campaign went to the disaster relief fund. This isn't unusual. It's happened all over the country."

Meanwhile, Marshall said that C.A. Dean is trying to "get the word out" about services available at the hospital that the general public may not be aware of. For example, services like diagnostic tests and physical therapy can be done locally even if the patient has an out-of-town health care provider. "People need to realize that we need patient volume and support from the community to help us get through this problem and look to the future. We're all in this together," said Marshall.
"This content originally appeared as a copyrighted article in the Moosehead Messenger and is used here with permission."