Over the past two decades, technology has been advancing to the point outpatient care is replacing inpatient care, said LincolnHealth President and CEO Jim Donovan. However, new technology is expensive and is more present in larger hospitals and urban settings.

On Sept. 10, Donovan gave a presentation to Boothbay Harbor selectmen and the public on LincolnHealth's role, four trends in healthcare, and the MaineHealth merger. He explained that LincolnHealth functions on three fronts: Outpatient care, senior living and long-term care, and hospital. Together, they employ about 1,000 people.

Technology can range from large, room size equipment down to the pills we put in our mouth, but all technology has one thing in common, said Donovan: It is expensive and rural healthcare systems are having trouble keeping up with it.

Donovan said about two-thirds of LincolnHealth's gross revenue of about $100 million is from Medicare and Medicaid.

“Both pay us less than what it costs to actually provide care, so essentially two-thirds of our care starts off at less than cost so we have to try to make up that elsewhere. And with the realities of the demographics of Lincoln County, which we all know, that is very difficult.”

Workforce shortages are also a problem for Lincoln County Healthcare, said Donovan. While 41 percent of the MaineHealth workforce is 50 years or older, about 23 percent of nurses employed by LincolnHealth are 60 years or older. While Lincoln County and Maine as a whole are having difficulty attracting a new and young workforce, healthcare education programs are experiencing retirements and shortages that make it difficult to “grow our own,” said Donovan.

A workforce shortage means a reduction in access to care and services, and an increase in expensive contract labor. To combat these issues, MaineHealth is creating programs to train certified nursing assistants and registered nurses, as well as the Maine Medical Center teaching partnership with Tufts University School of Medicine, Donovan said.

The last trend Donovan presented is the cooperation or regionalization of systems, an approach that lets systems leverage resources and share costs and efficiencies. In 1997, St. Andrews Hospital was the first to join MaineHealth with Miles Hospital following suit six months later, said Donovan. There are now 15 hospitals in MaineHealth, a system that now boasts it is the third strongest behind Mass General and Yale New Haven.

“This merger is about leveraging that strength more than we have been in the past,” said Donovan. “That financial strength translates into about $2.5 billion a year in revenue across the system, using it in such a way that benefits all of the MaineHealth system more equally than it has in the past …”

About a dozen audience members aired their grievance with how St. Andrews Hospital, once an inpatient campus providing overnight care, was dismantled into an 8 a.m. to 8 p.m. urgent care center, an outpatient campus.

“The last time you folks came to us and said 'Oh, this is going to be great for our community, we're going to come in and … take care of the whole Lincoln County area,' a month and a half later we lost our hospital,” said Corey Tibbetts. “ … Now we have an urgent care center and you can only get sick from 8 to 8. So, now you tell me what guarantee we have that if we go along with this we're even going to have an urgent care center?”

Donovan said the licensed hospital which is LincolnHealth includes the St. Andrews campus and the Miles campus. Tibbetts clarified, it is still just a campus, not a hospital.

“We've got to change our mindset of what hospital means,“ said Donovan. “'Hospital' no longer means people lying in beds … We're moving away from that, we have been, and it has nothing to do with the decisions we've made in Lincoln County. It's just the nature of the evolution of healthcare … It's just the way the world is moving and we have to move with it.”

The two-year process for LincolnHealth and all MaineHealth hospitals to merge under the umbrella of the MaineHealth system will conclude on Jan. 1, 2019.

Pending a vote by the board, Fire Chief Nick Upham announced the town would get a new fire truck.

“Over the past several years as I've been chief, I've actually had members of my department saying, 'We'd like to get a new truck …' Well, I sit there and I tell them we don't need a new truck and everything's working that we have out there.”

Upham said that over the last few years, Engine 3 has been proving his assessment wrong. Engine 3, a rescue truck and one of the main pumpers for mutual aid, has been having many breakdowns and failures.

“It's nickel and diming us, basically. Every time we go to use the truck, there is something wrong with it, it's broken down … A nice embarrassing moment was during a parade for the firemen's convention last year. The truck broke down right in the middle of the road with a transmission issue and we couldn't get it to move …”

Upham said that shortly after having the transmission fixed, it broke again on the way to a motor vehicle accident. Costs for repair in 2017 totaled over $10,000, almost the entire repair and maintenance budget, which put off repairs on some of the other trucks, he said.

The proposed truck is an Emergency One Incorporated (E-One) 4x4 e-MAX pumper. The truck will be a custom build allowing Upham and his crew to make it into a three-in-one pump truck equipped with rescue and forestry equipment.

The total cost of the new truck is $425,000, but an Engine 3 trade-in will credit the town with $20,000. The fire truck investment reserve account – $30,000 set aside every year, said financial officer Julia Latter – will cover $396,862.75, nearly the entire cost. Upham said the remaining $8,137.25 will come out of the department's equipment budget account.

The order will take E-One about 10 months to complete since the custom trucks are built from the ground up, said Upham. In two motions, the board voted unanimously to buy the fire truck and transfer funds from the fire truck reserve account for payment.

William Brewer CPA presented the town audit offering positive feedback on a relatively strong fiscal year for the town. Assessed at nearly $6.9 million in taxes, the town put only $52,000 in real estate to lien which works out to less than one percent. Over $560,000 in five accounts was saved for various projects including the fire truck, fireworks and the footbridge, said Brewer, who attributes part of the good year to solid investment and an increase in revenue from excise taxes. Latter said , year to date, town revenue is $3,791,567 and expenses are $1,377,539. Accounts payable are $379,566.58 and the bank balance is $4,768,921.07.

In a brief update on the Sept. 4 Boothbay-Boothbay Harbor joint workshop on broadband access on the peninsula, Board Chair Wendy Wolf asked that if anyone is interested in becoming a member of a new regional broadband committee, to contact town staff by phone, email, or by stopping into the office. Wolf said both Boothbay and Boothbay Harbor are hoping to convene the group relatively quickly.

Selectman Mike Tomko gave a brief update on the Boothbay Lights committee. It has a kickoff meeting for businesses at 5 p.m. Wednesday, Sept. 12 at the Opera House. Tomko said the group is proving to be highly organized and motivated, and that aside from the kickoff meeting, the committee meets every first Friday of the month at 8 a.m. at the Boothbay town office.

Wolf also announced the Boothbay Region Water District will meet on Thursday, Sept. 20 at the Southport town office about water rate increases scheduled to take place on Jan. 1, 2019. The legal notice on the BRWD site shows an overall revenue increase of 33 percent.

The next selectmen’s meeting is at 7 p.m. Monday, Sept. 24 in the town office.