The hospital was struggling in the face of a $3 million loss due to a variety of factors, including the economy, the state’s failure to expand Medicaid coverage under the Affordable Care Act and an increase in uncompensated care, which is a category that combines charity or free care and bad debts that hospitals have billed to patients but have been unable to collect.
But the solution made by the critical access hospital to close down its long-term care unit has helped them “see the light at the end of the tunnel,” Moakler said, and resulted in no loss of jobs or nursing home beds in the community for the hospital.
The move leaves just two hospitals in the state that have open long-term care units in their hospitals, according to Becky Schnur, director of communications for the Maine Hospital Association. They are at Maine Coast Memorial Hospital in Ellsworth and Lincoln County Health Care in Boothbay Harbor.
At the same time, Schnur noted, 18 hospitals across Maine run continuing care facilities for patients that provide extended care outside their hospital facilities.
Maine General Health at Augusta’s Gray Birch facility, for instance, provides long-term nursing care for individuals who require a longer stay in the facility and who need extensive help with their activities of daily life. There also are such facilities that provide Alzheimer’s care, rehabilitation care and skilled nursing care.
Moakler said that closing the facility, when administrators and the board looked at the financials, was a “no brainer.”
The unit was licensed for 26 patients and when the hospital was at its busiest was usually full, but in 2013 was down to an average of 17 patients, he said.
“We looked at our finances and saw that long-term care was a pretty significant financial drain on the hospital,” he said. “But when the hospital was in its heyday, the other side of the hospital was making up for it. But that could not happen when there was a $3 million loss.”
Moakler said the spike in uncompensated care was particularly hard-hitting, as the CEO said he could recall years not long ago when that figure was “one million.”
“Our plan to turn it around was to bring our outpatient rehab, which was located at a physical location outside the hospital, back inside the hospital,” he said.
At the same time, the hospital transferred the rights to its nursing home beds to Madigan Estates, an 86-bed skilled and long-term care facility, which expanded to take on new patients.
Using early retirement and transferring nurses to other positions within the hospital, none of the 15 nurses on long-term care lost their jobs.
Moakler said that the hospital also trimmed down its administrative staff from seven positions to four.
He also is proud of a move that he said he and other independent hospitals around the state have made. Moakler said Houlton Regional Hospital has joined forces with Cary Medical Center in Caribou, St. Joseph’s Hospital in Bangor, Northern Maine General in Fort Kent and Mount Desert Island Hospital in Bar Harbor to form the Maine Rural Health Collaborative. They share efficiencies and best practices while working to preserve and offer the best care to patients.
At this point, Moakler estimated, Houlton Regional Hospital is about two years away from recovery.
“We are on the right road,” he said. “This fiscal year, we are still budgeting about a $200,000 loss,” Moakler said. “But it is nowhere near where we were back in 2013, facing a $3 million loss. Now, we can see light at the end of the tunnel. We are not where we need to be yet, and we are still digging out of that hole, but we are getting better.”