One of the questions that is often asked about the proposed Boothbay Region Health Center is, “Will you provide emergency services?” The short answer to the question is, “No.”

When LincolnHealth closed the hospital at the St. Andrews Campus in Boothbay Harbor in October 2013, there was great concern about the loss of access to 24-hour emergency services on the Boothbay peninsula. People living in the Boothbay Region were and continue to be concerned about the long travel time to access emergency services in Damariscotta or Brunswick.

During the Certificate of Need re-consideration process, some of those opposing the hospital closure proposed converting the hospital facility in Boothbay Harbor into a free-standing emergency department. There is provision for such facilities in Maine law and Medicare regulations and one such facility does exist in Waterville as part of the MaineGeneral Health System. But a free-standing emergency department requires a state license, must be affiliated with an inpatient hospital such as Miles or Mid Coast, and would have to go through the Certificate-of-Need review and approval process. MaineHealth and LincolnHealth are not interested in that and the state regulators said at the time St. Andrews Hospital was closing that they would not recommend such a facility. So a free-standing emergency department in Boothbay is not going to happen under LincolnHealth.

If you are having an emergency medical problem at any time, call 9-1-1. The Boothbay Region Ambulance Service is an excellent advanced paramedic service and they have beefed-up their service capability.

However, there is a longer answer to a question that is not so often asked, “Do we need access to an emergency department on the peninsula?” Studies have repeatedly demonstrated that perhaps as many as half of emergency department and urgent care center visits are unnecessary. These unnecessary emergency visits are for what are called Ambulatory Care Sensitive Conditions. These are medical issues that could more effectively be treated in a primary care setting at much less expense. The recently released Community Health Needs Assessment reports that Maine has more than the national average number of unnecessary emergency department visits and inpatient hospital admissions.

If half of the visits to the urgent care center visits are considered to be for Ambulatory Care Sensitive Conditions, why is this the case?

There are probably a number of reasons for the persistence of this problem. One may be that patients have no ongoing relationship with a primary care provider and are using the hospital emergency department or urgent care service as their primary care source. There is often a long wait for a scheduled appointment at the Family Care Center. Another may be that primary care physicians are unwilling to provide the needed after hours access for patients. If a patient calls a primary care doctor after normal office hours, the easy answer may be, “Go to the emergency room.” Perhaps uninsured patients rely on “free care” from hospital emergency departments. Or patients find that “normal office hours” are inconvenient due to schedule conflicts with work or childcare.

The sad fact is that many patients do not realize that the episodic care they get at the hospital emergency room or urgent care center is not good care. That care tends to focus only on the specific presenting complaint rather than on other underlying or complicating conditions and follow-up care may be poor or nonexistent. And using the emergency room or urgent care center is unnecessarily expensive. This is particularly true when Urgent Care Centers are staffed with ER qualified physicians and nurses and are burdened with the so-called facility fee to cover the corporate health system's overhead cost.

So, how can we do better? In our plan, we propose to provide easy access to good comprehensive primary care through:

1. Extended regular office hours

2. Same day appointments (within 24 hours of a call)

3. Walk-in service without an appointment

4. After hours access by means of an effective on-call service without unnecessary referral to the hospital emergency department

Building a new community health center seems like a daunting task. However, when something is worthwhile and fills a need, our great community pulls together to make it happen. Just witness our wonderful Community Center breaking down social isolation.

For more info and related news go to our website: www.boothbayhealthcare.org.

Does this sound good to you? Are we missing anything? Since we are still in the planning stages there’s time to get more input from the people of the Boothbay region. We want to hear from you. What do you want from your community health center?

Please contact us: info@boothbayhealthcare.org. Like us on Facebook. www.facebook.com/boothbayhealthcare.org/

We need your help. Watch your mailbox in May for our capital fund appeal. We cannot do this without the support of the community.

For more information contact Gerald Homer, 633-5203, or go to: http://boothbayhealthcare.org/contact-us-2/