LincolnHealth President Jim Donovan’s message to hospitals CEOs and executives as he accepted the chairmanship of the Maine Hospital Association Board June 17 was the same one he gives to new employees.

“Those of us who don’t lay hands on patients are here for only one reason, and that is to support those who do,” he said.

As Maine hospitals cope with an aging population, reimbursements that lag the increasing cost of healthcare services and an ever more complex regulatory landscape, it has never been more important to focus on the basics, said Donovan, and at the core of the success of Maine’s hospitals are excellent doctors and nurses and other providers.

Maine hospitals have ranked at or near the top in the nation in quality rankings in recent years. In April, more than 60 percent of Maine hospitals received an A – the highest percentage of any state – from The Leapfrog Group, a non-profit organization that promotes quality and transparency in hospitals.

Behind those scores is a tradition of excellence that goes back more than a century to a time when doctors and nurses worked in hospitals that were little more than converted homes. Quality came from the commitment of those providers, who were often caring for neighbors or friends.

Today, healthcare is in the delicate position of a man with one foot in two canoes, said Donovan.

A drive to lower costs by government insurance providers Medicare and Medicaid is slowly shifting the way hospitals and healthcare systems are paid from a fee-for-service system to a population health system, in which healthcare organizations are paid a lump sum for taking care of the needs of an entire population.

Under that type of system, the financial incentive is to find more ways to keep people well so they do not require the most expensive healthcare services including hospital care and emergency care.

That shift will put more emphasis on primary care, said Donovan, something that has always been a strength of LincolnHealth.

“An organization like us is only as good as its primary care network and we have a great one right now,” said Donovan. “In the future with the emphasis on keeping more people healthy, their role becomes paramount.”

At the same time, as insurance providers increasingly reimburse healthcare systems based on the quality of care they provide, it will also be important that healthcare systems be able to prove they offer good care.

And while LincolnHealth, like other rural healthcare systems, faces many challenges, a culture of providing high quality care has positioned it well.

The death this February of Dr. Frank Avantaggio Jr., was a reminder of the debt owed to Maine providers who spent their entire careers building a culture of quality and safety for patients, said Donovan.

A Harvard educated surgeon, Dr. Avantaggio was for many years the primary and sometimes only general surgeon at Miles Memorial Hospital, now the Miles Campus of LincolnHealth, often on-call 24-hours-day, seven days a week. 

Deeply respected for his skill as a physician and a surgeon and for his devotion to his patients, Dr. Avantaggio was enormously influential in developing a culture of safety and excellence, always insisting that everything be done right for the patient, said Donovan.

The culture of providing excellent care exists today because of the commitment of providers like Dr. Avantaggio, including those that came before him and after him.

“It is important to think about how we got here today and on whose shoulders we are standing on in 2015,” said Donovan.

Today, as LincolnHealth and other rural health systems face very real challenges, he said, its greatest assets is a staff of doctors and nurses and other providers who carry on that tradition.

“There has always been that kind of focus and commitment, handed down from professional to professional,” said Donovan. “Their commitment forms the foundation of all that we do today.”