Central Maine Cancer Center gets initial DHHS approval

Courtesy / Central Maine Healthcare Central Maine Healthcare's $38 million cancer center, planned for its Lewiston Central Maine Medical Center campus, has received prelimiary certificate of need approval from DHHS.

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By Maureen Milliken

State regulators have given conditional initial approval to the Central Maine Cancer Center, Central Maine Healthcare's planned $38 million project that would centralize and upgrade cancer services on its Lewiston campus.

The certificate of need unit of the state’s Department of Health and Human Services announced preliminary approval this week. The application still needs approval from DHHS Commissioner Jeanne Lambrew. If approved, CMH plans to break ground on the 50,000-square-foot cancer care center by fall, with the center opening before 2022.

The certificate of need was filed in November and the cancer center plan was officially announced in December by Central Maine Healthcare. The center would combine a number of oncology functions that are spread across the CMMC campus into one place. CMH officials said it will provide more convenient, centralized access to outpatient oncology services, along with needed facility and equipment updates.

“Our patients will receive cutting-edge care in one central location,” Jeffrey L. Brickman, CEO and president of Central Maine Healthcare, said in a Wednesday news release. “The Cancer Center will provide the convenient access to care we are committed to offering.”

Brickman said that the center will house brand-new equipment, including new linear accelerators critical for radiation therapy. It will also be home to the Central Maine Cancer Institute, providing multispecialty, team-based care.

DHHS findings

DHHS, in its review, determined the health care system has demonstrated:

It's able to provide the proposed services at the proper standard of care.
It can support the economic feasibility of the center in light of the rates it expects to charge for services provided.
Its ability to operate the project in accordance with existing and reasonably anticipated future changes in federal, state and local licensure and other applicable rules.
That there is a public need, including addressing specific health problems and needs in the area; will have a positive impact on the health status indicators of the population, will be accessible to all area residents and will provide demonstrable improvements in quality and outcome measures.
Proposed services are consistent with economic development of health facilities and health resources for the state as demonstrated by the impact of the project on total health care expenditures, after taking into account costs and benefits and the competing demands in the area and statewide for available resources; the availability of state money to cover any increase in state costs associated with the project's services; the likelihood that more effective, more accessible or less costly alternative technologies or methods of service delivery may become available.
The project ensures high-quality outcomes and does not negatively affect the quality of care delivered by existing service providers.
The project does not result in inappropriate increases in service utilization, according to the principles of evidence-based medicine adopted by the Maine Quality Forum.

The one condition on the certificate is that, in order to monitor CMH' s financial position, the health care service has to provide a copy of its audited financial statements annually, starting when the certificate of need is approved and extending to three years after the center is completed.

The Dempsey Center, which provides services for cancer patients, supports the CMH cancer center, writing to DHHS: “The [Central Maine Cancer Center] would offer central Mainers another reason to get the highest quality of care close to where they live and work.”

'A daunting task'

The cancer center will be built next to the Main Street entrance of the CMMC campus where there's now a parking lot. As the hospital has grown in the more than a century it's been in its Lewiston downtown location, its oncology services have been located where there was room across the sprawling campus, separating radiation oncology, medical oncology and surgeons. Meanwhile, radiation therapy equipment cannot be replaced in its current location — in one of the oldest buildings at the hospital.

"When you put yourself in the place of people with cancer, put yourself in their shoes, it's a daunting task" to navigate the campus cancer care units, Brickman said at a public information session about the center in January. He said the distance patience had to walk between different units covered roughly three football fields, he said.

At the same time, cancer incidence in Maine has increased, and Androscoggin County remains one of the areas with the highest occurrence of cancer in the state, and Maine has one of the highest cancer rates in the country. While the region is a "hot spot for oncology," the health care system hasn't had the facilities to keep care local, Brickman said. "We need to be relevant."

The center will be developed by Bateman Partners LLC, of Portland, and leased to CMH. Bateman has also developed the health care system's Topsham urgent care center, and another one opening this month on Sabattus Street in Lewiston.

As written in the certificate of need review, the health care system negotiated a ground lease for a minimum of 50 years, a medical office space lease including an initial term of 20 years with an option for CMH to buy, fixed rent in years one through five, and 2.5% annual increases beginning in year six.

The option factors in a construction cost of $300 a square foot and a lease rate of $26.62 a square foot, which is about $13 less per square foot than what had initially been offered by development consultant if the system were not to involve a third-party developer.

"Much of the savings between the two development options was rooted in the fact that the general contractor and multiple sub-contractors working with the selected developer are based locally, and the developer is not funded by a publicly traded [real estate investment trust], but rather by a mixture of private equity and conventional banking loans, which allow for more favorable financing terms to directly impact the operating finances of the project and sustainable viability of the entire program," the application said.