Eastern Maine Medical Center in Bangor has announced a plan to eliminate 100 full-time positions through an offer of early retirement packages. The hospital says the cuts are due to a lack of MaineCare reimbursements and shorter hospital stays. Other hospitals throughout the state report the same problems, but have not yet been prompted to cut staff.

Officials at Eastern Maine Medical Center say it isn't entirely bad news that over the past year, the hospital is seeing fewer patients and therefore needs a smaller staff.

"We think that that's in part due to some successes actually to better manager chronic illness in the outpatient settings," says EMMC spokeswoman Jill McDonald. "So in our primary care medical homes, for example, we have care managers who are working with people who have chronic illnesses like diabetes or congestive heart failure -- those are people who, if they're not managed closely, their conditions can put them in the hospital on a regular basis."

McDonald says care management on the inpatient side has also reduced the average length of hospital stays. "We have a situation where you reduce length of stay, you reduce the need for inpatient care, you have empty beds. And right now we're experiencing patient volumes that really don't support the level of staffing that we have."

McDonald says EMMC's plan is to offer employees who are nearing retirement age incentives to retire now, but she says layoffs will be considered if necessary.

Along with the decline in patients, McDonald says a recent cut of $4.6 million in revenues from Maine's Medicaid program, MaineCare, has hurt the hospitals finances. Central Maine Medical Center in Lewiston is also feeling that pain.

"There's millions of dollars owed to hospitals and there's not a cogent plan at this time to pay those bills," says Chuck Gill, vice president of public affairs at CMMC. He says while Maine hopsitals continue to see patients every day, the amount owed to them by MaineCare continues to grow.

"In the case of our hospital system, it's growing at about $1.4 million a month. That's the difference between what we're getting paid and what will actually be owed to us. That's a problem we hope the legislators will address."

Gill says Central Maine Medical Center has seen a slight dip in the number of inpatients over the past six months but a rise in the number of outpatient procedures, putting the hospital at budget. And Gill says there is no talk of layoffs or early retirement offers.

Maine Hospital Association President Steve Michaud says the situation will force hospitals to reduce their staffs at some point. "It has to affect our workforce. More than half of our expenses are labor. It's got to come from somewhere so it's not suprising that it's impacting the workforce."

Michaud says that over the past year, nearly one quarter of Maine hospitals have laid off employees, costing the state's economy some 300 jobs. Michaud says more cuts are on the horizon.

"The state of the Maine budget is critically in play here," he says. "If the cuts go through as proposed, to hospitals, we're looking at between what happened in the last legislative session on top of this legislative session, that could be $80 million, 12 percent reduction in Medicaid payments. That's going to hit the workforce and that's exactly what you don't want to do in this kind of an economy."

With one eye on Augusta, hospital officials are also looking toward Washington. Judith West is vice president of human resources at Maine Medical Center in Portland. West says while layoffs have been avoided, there are still concerns that low Medicare payments are exacerbating the problem of outstanding MaineCare bills.

West says Maine hospitals deserve recognition for providing high-quality care at costs lower than most states. "We are really a very cost-effective healthcare structure. And that's been identified -- that we're very prudent and we're fairly cost effective compared to some other areas of the country. Our hope continues to be, as you look at health care reform, that we don't get penalized because other states may not have been as cost-effective."

The hospitals say that another reason they're seeing fewer inpatients is that many Mainers are either putting off or cancelling elective surgeries and other procedures, for financial reasons.