Testimony of the Maine Medical Association
In Opposition to
L.D 1715, An Act to Ensure Rural Patient Populations
Receive Safe and Effective Health Care   

Joint Standing Committee on Health and Human Services
Room 209, Cross State Office Building
Tuesday, January 16, 2018, 1:00 pm 

Good afternoon Senator Brakey, Representative Hymanson, and Members of the Joint Standing Committee on Health and Human Services. I am Peter Michaud, Associate General Counsel for the Maine Medical Association (MMA) and a registered nurse. I live in Readfield, and I am speaking in opposition to LD 1715, An Act to Ensure Rural Patient Populations Receive Safe and Effective Health Care.

The MMA is a professional association representing more than 4,000 physicians, residents, and medical students in Maine whose mission is to support Maine physicians, advance the quality of medicine in Maine, and promote the health of all Maine citizens. We represent physicians from all medical specialties, as well as public health and primary care.

Maine is currently seeing a few significant trends affecting health care. First, Maine people are getting older. A corollary to that trend is that Maine people, particularly in rural areas, are having fewer children. Many MMA members practice in rural areas of Maine, and we as an organization are sensitive to the health care needs of rural areas. But we can’t legislate the geographic distribution of health care needs. Forbidding the modification or closure of certain services in areas of limited need is not the solution to our health care access problems.

Health care today is becoming more complex and more technological. The standard of care for physicians is increasingly requiring more use of expensive, complicated medical devices. In order for hospitals to pay for such equipment, it must be used. We all know, for example, that it makes no sense to spend thousands of dollars on a state-of-the-art generator for a house that only loses power once or twice a year, for a day or two. The same is true of medical equipment…and medical people. It makes no economic sense to have a fully equipped and staffed labor and delivery suite in a community that sees one birth a week. While a multi-million-dollar surgical robot machine may be the best and safest way to perform certain surgeries, it is simply not economically wise to require one in every hospital in Maine. The same is true of sub-specialty physicians…or staff like neurosurgeons or labor and delivery nurses. There must be a critical mass of health care need to justify human and financial expenditure.

Another issue is maintenance of skills. A physician who performs very few of a certain procedure per year will not maintain the same level of skill as a physician who performs several of those procedures per day. It is extremely difficult to attract highly skilled physicians to areas where their skills will fade away from lack of use. Speaking of skills, it is the skilled and experienced hospital board members, physicians, nurses, and administrators, members of the local community, who can best make decisions about hospital operations. This legislative committee is not designed to run a hospital, and you should not be micromanaging hospitals.

LD 1715 would not do what its title suggests: it would not ensure safe and effective health care for patients in rural areas of Maine. Instead, it would impose statewide political criteria on local health care decisions, increase the cost of health care at the local level, and add a massive public process to hospital decision-making.

We respectfully ask you to vote the bill “Ought Not To Pass.” I would be happy to respond to any questions you may have.