The first 120 days by the numbers
People aren't numbers and illness isn't a statistic. When you are sick and need care, or have to find the money to pay for that care, abstract numerical analyses matter little. However, when government officials and hospital administrators look at healthcare, they focus on the numbers, the grand statistical compilation of what has happened to whom, where and for how long and for how much. Humanity gets stripped from the picture in the hope that important trends will emerge, that numbers won't lie.
As the bureaucrats at the Maine Department of Health and Human Services weigh the case for and against the changes instituted at St. Andrews Hospital by Maine Health and Lincoln County Healthcare, they have in their hands, two quite different worldviews.
There's the local worldview, strongly in favor of overturning the changes. This is a story told largely by individuals, rich in human details, personal viewpoints, uniqueness of place and history. It's a story told from the ground floor, by patients, loved ones and caregivers.
The other worldview, espoused by MaineHealth and Lincoln County Healthcare in support of the changes, is an impersonal one. It’s told from the top floor, with reams of data, a broad view of healthcare, and a vision in which St. Andrews is a piece in a larger care-giving machine that provides services to lots of people over a large continuum of need.
While DHHS decides whether healthcare changes at St. Andrews should be allowed to remain, the people of this community have continued to go to St. Andrews for urgent care, to call the ambulance service in emergencies and to need hospital beds. They have also continued to tell the human side of this healthcare story, in letters to the editor, comments to the DHHS and conversations in the supermarket aisles.
Here are how the changes look from a strictly numerical perspective since St. Andrews closed its ER on October 1.
In its first 120 days, the St. Andrews Urgent Care Center treated 865 patients. Of these, 46 patients (5 percent), were transferred by ambulance to a hospital. Sixteen transferred patients ended up at Miles Memorial in Damariscotta, 21 at Mid Coast Hospital in Brunswick and 9 at Maine Medical Center in Portland. The average triage level of patients arriving at the urgent care was around 4, which equates to a person who needs care within 1 to 2 hours.
Since it opened on October 1, the St. Andrews Urgent Care Center has seen, on average, about 7 patients a day. Although lower than the average of about 10 patients per day reported by Dr. Tim Fox in 2011, patient volume at the urgent care is slightly better than predicted.
“Through three months, our volume at 7.6 patients/day is 37 percent higher than we expected and 2.6 percent less than last year's 7.8 patients/day,” LCH CEO Jim Donovan wrote in an email.
In terms of finding a hospital bed in Lincoln County, there are different sources of data to consider. Donovan reported that Miles Memorial, which now has the only inpatient hospital beds in the county and is limited to 25, had an average daily acute inpatient census of 15.3 and an average daily skilled inpatient census of 4.6.
Averages obscure variation, however. Although on average Miles has been under capacity since October 1, patients seeking hospital beds in Lincoln County have been turned away more frequently since St. Andrews inpatient services ended.
Donovan reports that between October 1 and December 31, 22 patients were transferred from Miles emergency department to another hospital because Miles did not have an acute bed available. During the same period last year, Miles ED transferred 15 patients.
Skilled bed services, which bridge the gap from acute care to home care, were offered at St. Andrews Hospital until October 1. Lincoln County Healthcare facilities in Damariscotta and at St. Andrews Village were unable to provide skilled nursing beds for 48 patients who sought skilled beds between October 1 and December 31.
When it comes to numbers, none perhaps compels more than the bottom line. At the end of January, Donovan reported the urgent care center was $21,000 over on expenses, 6.4 percent of its roughly $328,000 expense budget, due to the better than expected volume. This overage is dwarfed by LincolnHealth's, the combined hospital entity, total expenses for the same period of $19 million.
The other bottom line, the personal one, still awaits clarification.
Although LCH has reported costs at the urgent care center are significantly lower than the emergency department, patients report costs that are much higher than anticipated. LCH has promised to provide a clear explanation of how urgent care costs are assessed and how these costs compare to physician's office costs in the near future.
Increased costs to taxpayers for ambulance services for the coming tax year also await definition. Local boards of selectmen will begin review of the 2015 Boothbay Region Ambulance Service budget this week.
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