Many readers have a stake in the success of Blue Hill Memorial Hospital. Many have questions about the proposed affiliation between Blue Hill Memorial Hospital (BHMH) and Eastern Maine Healthcare Systems (EMHS). BHMH is deciding if it should become a member hospital of EMHS. We intend to consider this issue with input from the communities served by BHMH. Our goal is open communication: straight forward answers to any questions you want to ask. Here are some questions we have been asked already.

1. Why is BHMH considering becoming a member hospital?
In three words: quality, access, and economics. The primary reason we are considering this partnership is the potential for improving the quality of care we offer to the community. The second reason is the potential for increasing access to health services close to home. The third reason is to improve our economic stability.

To survive in the future, we will need clinical, financial, political, technological and human resources. Increasing expectations of clinical quality, continuity of care, and the need for shared information systems will require small hospitals to obtain significant resources from some larger entity.

The economics of health care are likely to become more challenging with time, forcing efficiencies that can only be obtained by significant sharing of costs and services with other hospitals.

2. Will BHMH employees lose their jobs?
No. Layoffs are primarily caused by poor financial performance and economic instability. We've made great progress in the last year to improve our financial position. However, we are still fiscally vulnerable. An affiliation with EMHS should increase our financial stability.

3. If BHMH becomes an EMHS member hospital, can it retain its small hospital culture?
Yes. Bangor will always be 45 miles from Blue Hill. We serve different communities. BHMH is dedicated to providing primary and selected specialty healthcare of outstanding quality, caring for our patients with respect and compassion, and improving the health of the communities we serve. EMHS seeks to provide "… a well-organized network of local health care providers who together offer high quality, cost-effective services to their communities." Each organization has different but complementary missions. Keeping our mission is of critical importance to us.

4. What will happen to BHMH's assets?
Ownership and control of BHMH's endowment, investments, buildings, and equipment will remain local. Our endowment has grown due to the generosity of many contributors and we will always honor their commitment and legacy to this hospital. Both parties in this discussion have agreed from the beginning that control of our endowment and investments will be kept local as will all funds raised through BHMH's development efforts.

5. What does it mean to be a "member hospital?"
In 1993, BHMH became a clinical affiliate of Eastern Maine Medical Center in Bangor. We agreed to cooperate in the care of patients using both our facilities. In 1997, BHMH became a strategic affiliate of EMHS, which provided for cooperation in clinical programs and sharing of administrative resources. In 2004, we are considering becoming a member hospital of EMHS. Other member hospitals in the system include The Acadia Hospital, The Aroostook Medical Center, Charles A. Dean Memorial Hospital and Nursing Home, Eastern Maine Medical Center, Inland Hospital, and Sebasticook Valley Hospital.

EMHS member hospitals have their own boards of directors and are accountable for all local hospital operations. Four important areas of governance responsibilities are shared between EMHS and member organizations. We call these the "3 B's and a C." Member hospitals define their own bylaws, create their own budgets, and elect their own boards. These actions are subject to approval by the EMHS Board of Directors. The member hospital CEO is selected by the CEO of EMHS in collaboration with the member hospital board.

The EMHS Board of Directors itself is composed of trustees from throughout the nine counties served by EMHS. The reason EMHS approval of certain actions is required is to assure that all the hospitals within EMHS qualify under IRS regulations as a single economic unit. This designation allows the member hospitals in the system to obtain the benefits that come from acting as a single entity, which I outline below in response to other questions.

6. Realistically, where do you think we can cut costs by becoming an EMHS member hospital?
Three big areas come immediately to mind: information systems, employee benefits, and the cost of borrowing money. We borrowed over $1 million two years ago to purchase our hospital information system. When the time comes to replace it, we will be able to get a better system at less cost through EMHS. Each year, we go shopping for health benefits as an employer of 300 people. . If instead we shopped as an EMHS member hospital employing 5,000 people, we would get a better deal. Finally, our cost of debt would be reduced with the lower interest rates available to a large financially successful healthcare system. These cost savings not only will make us more economically viable, they will reduce the cost of healthcare to the community.

Q: Why would EMHS be interested in BHMH? What's in it for them?

A – EMHS' interest in BHMH doesn't make any sense at all if you are looking for them to act only in their financial interest. If you are willing to ascribe positive motives to EMHS, then their interest in BHMH makes a lot of sense.

EMHS could find a more lucrative partner than BHMH – the third-smallest hospital in Maine, operated at a loss in 77 of its 80 years. EMMC gets most Blue Hill-area referrals anyway, so it is reasonable to wonder why EMHS would bother to affiliate with BHMH. EMHS's interest in BHMH cannot be explained by financial motivation. EMHS's interest can be explained by a focus on mission. The EMHS mission is, "…to create a network of local health care providers who together offer high quality, cost-effective services to their communities." BHMH is a better fit to accomplish that EMHS mission than other hospitals in this region. Another explanation for EMHS's interest is our historical relationship, which goes back many decades. Dr. Bliss was a completed his internship at Bangor General Hospital in 1915. We have records of administrative and clinical agreements as far back as 1968. In 1993, BHMH became a clinical affiliate and in 1997 a strategic affiliate of EMHS. To increase our affiliation seems a natural historical progression.

7. How would becoming a member of EMHS affect BHMH's cooperative ventures with the other hospitals in Hancock County, especially Maine Coast Memorial Hospital (MCMH)?
We have an excellent relationship with MCMH. We share in educational activities and public health programs. Our joint recruitment of a general surgeon has been successful and we are currently working together to recruit an ear, nose and throat surgeon to Hancock County. If BHMH became a member hospital of EMHS, the Hancock County hospitals would continue to have many common interests because of our proximity.

8. If the affiliation doesn't work out, can BHMH back out of the deal?
The affiliation agreement will provide a window of opportunity for either party to withdraw from the affiliation. However, if we decide to affiliate, we will do so with the intention of making our relationship permanent.

In conclusion: We will keep the personal touch that comes with our small hospital culture. But we also want to tap into system resources such as better information systems, clinical care guidelines, career ladders, and training opportunities (like having our staff occasionally rotate through EMMC to be exposed to situations we see rarely here). Also, if the affiliation makes us stronger financially, we will face less pressure to reduce our costs in ways that harm quality, access, or patient satisfaction.

Our goal will always be to provide healthcare of outstanding quality and personal attention...close to home.