LEWISTON — Last year, Central Maine Healthcare sent out inquiries to five health care organizations asking whether any would consider taking CMHC on as a member, drawing CMHC and its affiliated hospitals and physicians’ offices under their respective umbrellas.

None accepted the overture, including neighboring St. Mary’s Health System, part of the Covenant Health Systems.

Central Maine Medical Center, the cornerstone of CMHC, was incorporated in 1888 as Central Maine General Hospital and always has been an independent hospital.

The CMHC inquiry was sent out in letters as a request for interest in affiliation, asking the five entities to each respond with their position regarding investing their capital in Central Maine Health Care’s service area and to “describe your vision for inclusion.”

The request for interest included 15 other questions concerning how the addressee might further develop tertiary care at CMHC, including cardiac and trauma services, how it views doctor-hospital employment relationships and to describe its commitment to developing value-based business models for patient populations, which are more cost-conscious and patient-centric than current health care delivery models, among other things.

CMHC, which includes CMMC, Rumford Hospital and Bridgton Hospital, was seeking what it called a fully-integrated relationship, and asked how the health care entities that it contacted might view “existing management at CMHC, their prospective roles and reporting relationships within your organization” if an affiliation were developed.

There was no similar question about existing staff.

Chuck Gill, vice president of public affairs for CMHC, declined to answer specific questions about what prompted the request for interest and what kind of formal relationship CMHC had hoped for, calling the request an “exploration.”

He said CMHC officials held discussions with some of the people it contacted, and said “right now in health care, it’s important for organizations to work together because it’s a very changing environment around the country.

“I think everyone would like to have higher quality, lower cost and greater access to health care,” Gill said, and that the informal and formal relationships that health care organizations develop with various hospitals helps respond to that patient demand.

For instance, according to Gill, CMHC has a professional clinical relationship with Massachusetts General Hospital, sending patients there for advanced cancer treatment and for some neurological care. When patients return home, Mass General doctors continue working with them, and “patients like it because they have access to world-class cancer care” while being treated closer to their families.

There is no formal financial relationship between CMHC and the Boston hospital.

CMHC also has a clinical relationship with St. Mary’s Regional Medical Center — part of St. Mary’s Health Systems it contacted through the request for information — working with and educating the community about familial hypercholesterolemia, a genetic disorder that causes grossly high levels of cholesterol in people of French Canadian descent.

CMHC also has a working relationship with Eastern Maine Health Care — another organization included in the request for information — through their jointly-owned LifeFlight ambulance service.

Even though nothing came of the request for interest, Gill said “we are always willing to collaborate with other health care organizations to improve the health of our communities, lower cost and improve care.”

Lee Myles, president of St. Mary’s Health Systems, confirmed that he had some discussions with CMHC, and that he and others at St. Mary’s “take it seriously when anybody in the community asks us to discuss ways to better provide services in the community,” including how to improve care.

However, according to Russ Donahue, director of marketing for SMHS, Myles said “we signed a confidentiality agreement with them and we need to honor that.”

MaineHealth President Bill Caron did not sign that agreement, and provided the Sun Journal with a copy of the request for information after CMHC declined to do so.

Asked whether the exploration of partnering with more profitable health care providers had anything to do with Central Maine Medical Center’s financial losses over the past six years, Gill declined to say. He acknowledged that FY 2013 was a “tough year,” and said the fiscal year ending next Monday, June 30, will be far better than previous years because CMMC has increased the number of surgeries and recruited new doctors to its staff over the past 12 months.

In FY 2013, according to the Maine Health Data Organization’s preliminary figures, CMMC’s excess of revenue over expenses, which is how hospitals define revenue or loss, reflected a loss of nearly $13 million. The year before, MHDO figures show losses at CMMC at $3.1 million. In 2011, the loss was $9.2 million and, in 2010, the recorded loss was $4.6 million.

Over the same time period, that’s a far greater loss than any of Maine’s largest hospitals, which include Maine Medical Center, Eastern Maine Medical Center and Maine General Medical Center (see accompanying chart).

Bridgton Hospital, which is part of CMHC, reported no loss over the same time frame and Rumford Hospital reported more revenue than loss.

In its formal response to CMHC’s request for interest to Portland-based MaineHealth, Caron declined interest in any partnership and suggested that CMHC and St. Mary’s consider consolidation instead.

MaineHealth already has a working relationship with St. Mary’s and in his letter, Caron told CMHC that MaineHealth is committed to continuing that relationship.

Caron also expressed interest in participating in any discussion that would further a CMHC and SMHS consolidation.

Caron said Monday that MaineHealth never received any response from CMHC about that suggestion.

Suzanne Spruce, the chief communications officer for EMHS, confirmed that Eastern Maine responded to CMHC’s request, but declined to answer specific questions about whether the two entered into discussions.

“We’ve had a very long and good relationship with Central Maine,” through LifeFlight, Spruce said, “and we’re working together on advancing mutual goals of population health” in their respective care networks.

Spruce said that, like other hospitals, EMHS believes that when hospitals work together, patients benefit.

According to Gill, CMHC remains an independent organization and that its request for interest was an exploration of what other organizations might be willing to do with CMHC “and what that could mean.”

CMHC maintains an administrative management agreement with Parkview Adventist Medical Center, helping the Brunswick hospital with backroom services, including financial and clerical work.

In 2012, CMHC filed a controversial certificate of need application with the Department of Health and Human Services’ Licensing and Regulatory Services division to take over Parkview, but withdrew that application last September.

CMHC has also enjoyed a close working relationship with Franklin Memorial Hospital in Farmington, most notably for cardiac care and prevention services, because CMMC is the closest tertiary hospital.

A joint application by MaineHealth and Franklin Community Health Network for the Farmington hospital to become a member of MaineHealth received a preliminary recommendation of state officials last month, and the steps for MaineHealth to merge with the Farmington hospital are underway.

According to Gill, affiliations between hospitals is routine across the country, and a review of Certificate of Need applications shows that’s true in Maine, including successful applications by MaineHealth to purchase Waldo County Healthcare in Belfast and Southern Maine Health Care in Biddeford.

MaineHealth also owns Maine Medical Center in Portland, Pen Bay Healthcare in Rockport, Lincoln County Healthcare in Boothbay Harbor and Damariscotta, Miles Memorial Hospital in Damariscotta and Western Maine Health in Norway, which includes Stephens Memorial Hospital and other facilities. 

Eastern Maine HealthCare’s member hospitals include Eastern Maine Medical Center in Bangor, Mercy Hospital in Portland, Blue Hill Memorial Hospital, C.A. Dean Memorial Hospital in Greenville, Inland Hospital in Waterville and other medical facilities.

jmeyer@sunjournal.com