Letters From Our Readers
Christina J. Maguire, Charles Sidman
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Ensuring Fair Medicare Advantage Reimbursement for Rural Hospitals
Christina J. Maguire, President & CEO, Mount Desert Island Hospital
Rural hospitals are the backbone of healthcare in communities like ours. At Mount Desert Island Hospital, we serve patients who rely on us for emergency care, preventive services, and chronic disease management. As a Critical Access Hospital (CAH), we provide a safety net for a population that depends on Medicare and Medicare Advantage for their healthcare needs. Yet, an alarming financial disparity is threatening the sustainability of rural hospitals across the country—one that must be addressed if we are to continue providing high-quality care to our communities.
Medicare Advantage, a growing alternative to traditional Medicare, has reshaped the way seniors receive healthcare. While these plans often promise greater flexibility and benefits, they also introduce restrictive payment policies that undermine rural hospitals’ financial stability. Unlike traditional Medicare, which reimburses CAHs on a cost-based system, Medicare Advantage plans frequently deny or delay payments, impose lower reimbursement rates, and increase administrative burdens. These disparities are more than bureaucratic inconveniences—they are existential threats to rural healthcare providers like Mount Desert Island Hospital.
The Financial Reality for Rural Hospitals
As a designated CAH, our hospital receives cost-based reimbursement from Medicare to ensure we can sustain operations and continue serving our community. However, the exclusion of Medicare Advantage beneficiaries from this calculation creates an artificial financial gap. Medicare Advantage enrollees now represent a significant portion of our Medicare population—more than 50% in some areas. As this trend continues, rural hospitals face mounting shortfalls that threaten our ability to remain viable.
The solution is clear: The Centers for Medicare & Medicaid Services (CMS) must adjust its reimbursement policies to treat Medicare Advantage patient days the same as traditional Medicare patient days in CAH cost reports. This simple change would ensure fair, cost-based reimbursement and help sustain essential healthcare services in rural communities.
A Precedent for Change
This is not an unprecedented request. Since 2014, federally qualified health centers (FQHCs) have received supplemental payments to offset the financial strain caused by Medicare Advantage reimbursement disparities. If this policy adjustment is necessary for FQHCs, why should Critical Access Hospitals be treated differently? Our role in providing healthcare access is just as vital, and the financial challenges we face are just as urgent.
A Call to Action for Lawmakers
Policymakers must recognize the impact of Medicare Advantage reimbursement disparities on rural hospitals. We urge Congress to pass legislation like S. 803, the Save Rural Hospitals Act, which seeks to correct this issue by ensuring equitable reimbursement for CAHs. Addressing this financial imbalance is not just a matter of hospital sustainability—it is a matter of patient access, quality of care, and the long-term health of rural communities.
At Mount Desert Island Hospital, we are committed to delivering exceptional care to our patients. But we cannot do it alone. We need our lawmakers to stand with us and support the policies necessary to keep rural hospitals strong. The time to act is now—before more rural hospitals are forced to close their doors.
Christina J. Maguire
President & CEO, Mount Desert Island Hospital
To Bo and our Neighbors
I write to express both strong support for and firm disagreement with the recent letter by Bo Jennings in the Mount Desert Islander and the Bar Harbor Story entitled “On an Island.” To start, I could not agree more with his statement that “Bar Harbor, and MDI, is a special place to work and call home.” I chose to be, and remain, here for just this reason.
Second and for similar reasons, we are also a tourist destination. Here the disagreement starts, however, as I believe that being such is not and should not be our overall objective and destiny, any more than Appalachia is just a coal mine and Sarasota a city of the elderly. Despite holier-than-thou generalities such as that we’re-all-in-this-together, there are very real differences in costs and benefits to different parts of Bar Harbor. “Hospitality and tourism” are a legitimate element, but not “the lifeblood of our community” that Bo feels from his personal allegiance and multiple roles in this sector.
Moreover, his view that “Bar Harbor’s businesses, most of whom are owned and operated by year-round residents” is simply not true. The largest, most valuable and most profitable of these are owned by and primarily enrich out-of-staters (albeit many with historical ties to our area.) This impact of non-locals is a modern form of colonialism, that historically as well as here today coopts local employees and small beneficiaries for political cover.
Then comes the most recent push in Augusta for a Local Option Lodging Tax (LOLT), that evidently went over (again) like a lead balloon. While it would be great for Bar Harbor to have someone outside solve our internal problems (while not directly costing anyone else anything), it would not similarly help most Maine communities. Is asking Augusta for a selectively beneficial favor, on top of the good fortune of being in Acadia and having the opportunity to be such a tourist magnet and moneymaker in the first place, not like a rich kid requesting further help from those less fortunate? Wouldn’t the moral and responsible stance be to try to balance out unearned good fortune by helping those less favored, rather than asking them for even more assistance? How can anyone dispute that Bar Harbor is more like “Cinderella” and “the belle of the ball” than “in all actuality” the (self-pitying) “chamber maid mopping after our stepsisters”? I regret this LOLT result but am not surprised by it. We are not so self-reliant in that we, like all Mainers, do not depend on the state’s roads, police, social services, etc.
If a knight on shining horse is not going to ride to our rescue, how can we deal with ever more crushing financial woes and constantly rising property taxes? We already have several factors in our favor. First, our local tourist businesses and scientific and educational institutions are better developed than those almost anywhere else. These are not only costs but also strengths and contributors. Second, as a vacation and recreational paradise, we have a large number of property owners who pay a pretty penny in taxes for their less than year-round services, but don’t even get to vote.
So why is there such a large and growing hole in our pockets? My answer is that we lack self-discipline and any sense of constraint. Every one of our municipal expenditures is worthy in itself, but what is missing is an overall sense of reality and limitations. As a community we have given in to this age’s cultural belief that we can and should have everything we want. In essence we put it onto the credit card today, for tomorrow’s citizens to pay the bill! The alternative is to balance our budget now and live within our means. To return to the LOLT, who but the most entitled and self-centered feels that Augusta should “come to our rescue”? We can be masters of our own fate and prioritize what we can afford, or continue to posture, postpone, defer, overspend, hope for Santa Claus and keep running up the bill. Is there any other valid choice and available option?
Charles Sidman
Bar Harbor resident
First, ThankYou to Christine Maguire for her leadership in the MDI Hospital team which provides excellent healthcare to residents and visitors. We are all fortunate to be the beneficiaries. In my experience, every employee examples caring and consideration in their various roles.
Specifically, ThankYou for spotlighting the dangers of Medicare Advantage to participants in its for-profit schemes and threat to every person who relies on hospitals negatively impacted by Medicare Advantage's predatory financial practices.
As all our government programs are being shredded by the Republican mania for privatization, our hospitals are 'the canary in the coal mine' calling attention to the detrimental, dangerous, and even deadly results of privatizing essential and emergency government services.
Medicare Advantage Harm to Patients
Medicare Advantage Myth-Busting – CEPR
"This year, the majority of Americans eligible for Medicare coverage chose to enroll in private Medicare Advantage (MA) plans rather than Traditional Medicare. Insurance companies that run these MA plans spend significant sums of money to blanket seniors with marketing that highlights the supposed advantages of MA like low upfront costs, supplemental coverage, and other unique perks like subsidizing gym memberships. However, the ads leave seniors in the dark on the downsides of MA like heavily restricted networks that damage one’s choice of provider along with dangerous delays and denials of necessary care."
.https://cepr.net/publications/medicare-advantage-myth-busting/.
Medicare Advantage Harm to Hospitals
Rural hospitals across the country are facing severe financial difficulties, and Medicare Advantage plans are exacerbating those challenges, according to an analysis released by the American Hospital Association.
.https://www.chiefhealthcareexecutive.com/view/medicare-advantage-plans-are-hurting-rural-hospitals-report.
Charles you are a man after my own heart and I could not agree more when you say that at the route of Bar Harbor's problem is a near total lack of financial discipline. As my old pal naturalist/philosopher/novelist Edward Abbey once pointed out "We had a good thing in America but got carried away, in a nation devoted to the proposition that too much is not enough we are squandering our inheritance...." Anyone who doubts this should read the excellent book "Amusing Ourselves To Death" by Neil Postman. In Bar Harbor's case we have found the enemy and the enemy is us!