A controversial 31‑year management relationship between Calais Regional Hospital (CRH) and Quorum Health Resources has ended. CRH CEO Rodney Boula announced the news in early June. CRH board Chair Ronald McAlpine explains, "As a board we discussed the issue. It was mutually agree upon with Quorum." He adds, "The board made the decision based on the best direction for the hospital."
     Boula and McAlpine would not release any figures that would illustrate financial savings, although the hospital's release states that the new arrangement will provide "an immediate cost savings." CEO Boula and Chief Financial Officer Diane Maheux, formerly Quorum contract employees, are as of June 1 hospital employees. Both came to CRH in 2016.
     The hospital will continue utilizing Quorum with a new three‑year contract for group purchasing, education for board and staff through online resources and "other consulting services on an as‑needed basis." The savings will be felt in the management fee, explains Vice President of Community Relations DeeDee Travis, as well as reductions in vendor costs as the hospital looks to find savings wherever possible.
     Boula and McAlpine declare that some of the cost savings information is proprietary, such as whether or not there were savings in salaries when renegotiated or in other areas where Quorum had received monies. However, the CRH 2015 990 form filed with the IRS lists the top five independent contractors paid more than $100,000. Quorum is listed as receiving just under $900,000. While 2016 figures are available, because of staff changes  including interim CEO and CFO salaries, the amounts paid for Quorum staffing in that year are unclear. In 2015 former CEO and Quorum employee Mike Lally is listed as receiving a salary of $243,000 with additional compensation of $14,000. Former CFO and Quorum employee Nancy Glidden is shown in the 2013 990 to have earned $139,000 with $15,800 in additional compensation. In 2013 Quorum is shown to have received $624,000 in independent contractor compensation. Quorum is a Tennessee‑based health management for‑profit business.
     In response to the announcement, Maureen Hayward, RN and Maine State Nurses Association (MSNA) chief steward at CRH, states, "Today's news shows that what we have been saying all along is true: Quorum takes more from our hospital and our community than it gives. It is long past time that we got rid of Quorum. We wish this had happened long ago, but better late than never."      She adds, "We have a long way to go to rebuild our hospital's relationship to our community. But this is a good first step."
     "We have been fighting Quorum in Calais for decades, so this is great news, and I'm so happy for everyone there," says MSNA President Cokie Giles, RN. "We see how Quorum treats people across the country. How they treat people in Maine is no different." MSNA has noted that since 2004 under Quorum management CRH has ended: the special care unit; many capabilities of the intensive care unit; the ability to admit patients on hemodialysis; the ability to admit pediatric patients; and the ability to admit patients on BIPAP, which is a type of ventilator that helps with breathing.
     The hospital has been facing mounting financial pressures. In 2017 it closed its obstetrics unit. In response, the Calais City Council unanimously passed a vote of "no confidence" in the hospital's board of directors. Since last summer, CRH has closed its cardiac rehab department and also the "Rose Room," an outpatient infusion center serving chemotherapy patients and others. Since then CRH has been working with Down East Community Hospital to bring some of those services to Calais.
"We're in a position, a survival position. We're trying to right the ship and turn it around," says Boula. All service lines are being assessed for whether a service should be modified, eliminated or added, he states. Services need to stand on their own financially. "We're not in a position to take on services that we can't afford."
     McAlpine illustrates some of the challenges small rural hospitals such as CRH face. Sequestration has made cuts that have hit hospitals hard. He explains that where once allowable costs were reimbursed at 101%, that rate is now down to 99%. Medicare bad debt reimbursement has gone from 100% to 66%. He says, "These are all things that go directly to the bottom line." 
     Continuing with the subject, Boula notes that Medicare can go back a number of years for repayments from hospitals and says that hospitals were overpaid and need to reimburse Medicare. The "claw‑backs" cause chaos with budgets and are being felt by hospitals all over Maine. Travis explains, "In 2017, Medicare had open cost reports dating back eight years to 2010, and Mainecare had cost reports dating back 13 years to 2005. These are all potential open and unknown bill amounts. Last year CRH was able to get 2010‑2014 closed by Medicare -- although they keep the right to open any years -- and 2005‑2011 closed by Mainecare. In 2017, CRH paid out over $1.6 million to clear up settlements from many years prior and continues to make payments on these settlements."
     McAlpine expresses his frustration by saying, "People aren't aware." He pauses and adds, "I wish people would call and talk to their senators and congressmen."