By Stephanie Grinnell

Staff Writer

Maine hospitals saw a “precipitous drop-off in patients” during November and December, said Maine Hospital Association President Steven Michaud. 

Since then, the 39 hospitals that are members of the association have seen a bounce back or a flattening of patient numbers but a “substantial” increase in uncompensated care, which is health care provided to patients who don’t have insurance and can’t pay, he said.

“We have seen in many cases across the state double digit increases [in the amount of uncompensated care]. That has the most significant and ongoing impact,” Michaud said. “Hospitals are cutting expenses and cutting them rapidly.”

Nationally, an April 2009 American Hospital Association study determined there has been a significant increase in uncompensated care and emergency room visits as well as patients covered by Medicare, the national insurance program for low income families. The study showed nine out of 10 hospitals have adjusted budgets or reduced staff because of reduced income and increased expenses due to uncompensated care.

Local hospitals reflect the state trend in terms of patient numbers and uncompensated care. Southern Maine Medical Center in Biddeford is seeing an increase in patients, while national numbers show a decrease of up to 7 percent, President and CEO Ed McGeachey said.

“We’re surprisingly busy. Nationally, that’s not what other hospitals are seeing,” Community Relations Director Sue Hadiaris said.

While an increase in volume may seem like good news, McGeachey said most of the increase has come in the form of uncompensated care.

SMMC staff began planning for spending decreases during winter when the budget projected a shortfall of more than $2.5 million. Hadiaris said the hospital budgeted $15 million for uncompensated care last year, but that amount was not enough for the nearly 30 percent increase in patients being seen in private doctor’s offices and the emergency department. A few years ago, budgeted uncompensated care was between $7 million and $8 million, Hadiaris said. 

“My take is that it is still going to be a while before we see improvement in the economy,” McGeachey said. “And these are people who are not accustomed to not having insurance. They don’t know how to navigate the health care system. We’re working on educating the community to get care they need.”

McGeachey said a pamphlet outlining health care options is being created for distribution to patients. The hospital also employs counselors to assist patients with payment options, he said. 

Senior executives at the hospital took a voluntary pay cut immediately and cost cutting measures were taken to balance this year’s budget, McGeachey said. At the end of the hospital’s fiscal year, the changes led to a balanced budget and staff members were returned one sick day of two given up previously, Hadiaris said. 

Conversely, Goodall Hospital in Sanford has seen a patient decrease, which, in part, led to staff cuts, President Darlene Stromstad said. Goodall has also seen an increase in uncompensated care but overall patient numbers have steadily decreased for months, she said. A major income source for Goodall, state-sponsored insurance MaineCare payments are far behind schedule, leading to additional budgeting difficulties. Previously, Stromstad said Goodall Hospital was owed more than $11 million for MaineCare reimbursements between 2006 and 2009. Michaud said hospitals are owed more than $420 million for reimbursements from 2005 to now, but said Gov. John Baldacci has a plan to use $102 million of federal stimulus money to leverage matching federal funds to pay $370 million of the reimbursements by the end of the year.

Michaud said the budget approved during a late night session Monday includes money to reimburse hospitals for delayed MaineCare payments. 

“The state is getting some money out the door right now,” he said. “But it’s not a windfall, it’s an unpaid bill.”

McGeachey said the SMMC patient base consists of fewer MaineCare patients than Goodall, though MaineCare payments to SMMC are behind as well. He said SMMC serves an older population that is covered by Medicare.

Stromstad said fewer patients means it is easier to schedule appointments, which could improve people’s health.

“We do see a higher level of stress in our patients than past years,” she said. “And stress leads to more aches and pains.”

Stromstad said there was a short “bump” in patient numbers during the recent H1N1 “swine flu” outbreak, which Goodall staff dealt with by establishing a hotline for questions. She said more people came to the emergency department as well, but said she does not anticipate an increase in patient numbers in the near future. 

Those who can’t afford medical care are not turned away from hospitals, but other alternatives, including free clinics, are available as well. Leavitt’s Mill Free Health Care in Bar Mills is open to people who do not have insurance coverage. The clinic also is seeing an increase in patient volume, leading to increased hours of staff availability, nurse Patsy Leavitt said.

The patient demographic has shifted from college students and older patients to include middle class workers who have recently lost jobs, Leavitt said. 

“It’s a new experience for them to be uninsured,” she said. “It’s a little different slice of the population.” 

Leavitt said she does not have concrete numbers to show an increase in patients but estimated an up to 20 percent increase in recent months. She said the center has extended hours because of the increase. 

Leavitt’s Mill Free Health Care opened five years ago, and moved to a new location this month at 63 Main St. in Bar Mills. Leavitt said the increase in patients began before the move to the new building. One age bracket that has not increased at Leavitt’s Mill is children younger than 21, Leavitt said. 

“Even though children are welcome here, we haven’t had an increase,” she said. “But that’s always been our experience.” 

Leavitt said her theory is children have access to more health care programs than adults and are healthier overall. 

Staff writer Stephanie Grinnell can be reached at 282-4337 ext. 220. Staff writer David Harry contributed to this story.