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BY BETTY ADAMS
Staff Writer 10/11/2008

Staff Writer

If you're one of the 40,000 people who have health insurance through the state, expect to pay something rather than nothing for elective procedures at MaineGeneral Medical Center.

The hospital system, which has facilities in Waterville and Augusta, has lost its ranking as a preferred hospital in the state insurance system.

A preferred rank means copays are waived.

"Effective Oct. 1, the plan will require a $100-per-day copay, $300 maximum per calendar year, for hospital admissions and $50 copay for outpatient surgery," Frank Johnson, director of the Division of Employee Health and Benefits for the state, wrote in a memo to a number of state employees.

MaineGeneral Medical Center is appealing the drop in ranking, MaineGeneral Health Executive Vice President Dr. Barbara Crowley said.

Crowley is also a member of the Maine Health Management Coalition that ranks hospitals. The coalition is a group of providers, users and hospitals who work to improve health care in Maine and to keep costs down.

The ranking system is based on performance in patient safety and selected clinical quality. MaineGeneral's score dropped in the areas of heart attack and pneumonia treatment, which cost it a "blue ribbon" from the coalition in the "select clinical quality" category.

Ratings are based on the number of heart attack patients given aspirin at discharge and the percent of pneumonia inpatients given the most appropriate initial antibiotic, numbers obtained through a quality survey set up through the U.S. Department of Health and Human Services. Results are posted on MaineGeneral's Web site at www.mainegeneral.org.

MaineGeneral Medical Center is the hospital arm of MaineGeneral Health and has a total of 287 beds in Augusta and Waterville. It reported 305,134 outpatient visits in 2007.

Crowley said the slips occurred during the last quarter of 2007, a time when the hospital implemented the use of electronic medical records. "In the course of doing something to improve overall quality, we lost some points," Crowley said.

She said the problem was rectified promptly.

Crowley said she spoke this week with the coalition and the state commission on employee benefits, and was told the hospital has a strong case to appeal the ranking.

"The state Employees Health Commission considers MaineGeneral an excellent hospital, and it's unfortunate this had to happen," said Alicia Kellogg, director of the Bureau of Human Resources Maine Department of Administrative & Financial Services. "We expect them to be back in preferred status hopefully soon."

Kellogg said the list of preferred facilities is reviewed every six months.

The state's preferred-facilities list that went into effect Oct. 1 indicates a return to preferred status by Franklin Memorial Hospital in Farmington and Maine Medical Center in Portland, as well as five other Maine hospitals.

Betty Adams -- 621-5631

badams@centralmaine.com

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