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High-Ranking D-H Executive Resigns

  • John Birkmeyer (Dartmouth-Hitchcock photograph)



Valley News Staff Writer
Wednesday, October 05, 2016

Lebanon — A top executive who found himself at the center of recent upheaval at Dartmouth-Hitchcock has resigned after a two-year tenure.

John D. Birkmeyer, executive vice president for integrated delivery systems and chief academic officer at the Lebanon-based hospital and clinic system, will leave his post next week, Chief Executive James Weinstein said in a Tuesday morning email to the D-H community.

Weinstein’s email provided few details about the reasons for Birkmeyer’s departure.

“As our health system continues to evolve to meet the health and health care needs of the people and communities we serve, change is an inevitable part of that process,” he wrote.

Some of the organizational changes in which Birkmeyer played a visible role did not go smoothly.

He was on the front lines of management at D-H when it absorbed hundreds of employees in clinical research and the Psychiatry Department after Dartmouth College restructured its Geisel School of Medicine. The transition led to several dozen layoffs; concerns about the effects on the salaries, benefits and housing of some employees; and a dispute that led to the departure of several Dartmouth psychiatric workers at the state psychiatric hospital in Concord.

Birkmeyer also recently met with some primary care doctors to explain the potential imposition of time standards that some saw as a retreat from a multi-year effort to reduce costs and improve care by giving those doctors more flexibility and greater responsibility for keeping patients healthy.

In response to a message seeking comment, Birkmeyer said: “It was an honor to help lead clinical and academic affairs at D-H these last couple years, but this was the right time for us to go in different directions.”

Ed Merrens, D-H’s chief medical officer, will assume Birkmeyer’s “clinical and operational responsibilities on an interim basis as we seek to align our goals as a health system with the most effective and efficient leadership and operational structure possible,” Weinstein wrote in his email.

In recent weeks, Weinstein and D-H officials have attempted to address a $23 million deficit that appeared unexpectedly in the final quarter of the fiscal year that ended June 30. They have estimated that fixing the budget will require laying off as many as 460 employees, and also have begun a review of clinical programs throughout a health system that includes the medical center in Lebanon and clinics in New Hampshire and Vermont.

D-H leaders have promised to release detailed plans about layoffs and other measures by the middle of this month.

A particular challenge facing D-H is how to support the breadth of basic scientific and clinical research needed to obtain outside financial support including from the National Institutes of Health, according to Marc Ernstoff, a former Dartmouth professor who now is the senior vice president for clinical research and chairman of the medicine department at the University of Buffalo Roswell Park Cancer Institute.

“Dartmouth is not alone,” Ernstoff said. “The (United States’) academic medical centers are all struggling to find the right mix of research and clinical activity.”

Such challenges have sometimes hurt physician morale and led to departures, according to some observers.

A year ago, in a note to “D-H Boards of Trustees and colleagues across the Dartmouth-Hitchcock system,” Weinstein cited “our inability to manage physician departures in key surgical areas” as a contributor to “key performance shortfalls” in the fiscal year that ended June 30, 2015.

The system’s chief medical officer and about a dozen service line leaders overseeing physicians report to Birkmeyer, according to an organizational chart included in a February Certificate of Need filing by D-H with the Green Mountain Care Board.

Birkmeyer’s resignation is just the latest departure of a high-ranking D-H official.

In July, Robin Kilfeather-Mackey left her position as D-H’s chief financial officer, saying she intended to enroll in graduate school to study environmental sciences.

Kilfeather-Mackey did not respond to a message seeking comment on Tuesday.

Mark Israel left his post as director of the Norris Cotton Cancer Center at the end of September. Israel reported to Birkmeyer, according to the organizational chart. Israel did not respond to a request for comment.

News of Birkmeyer’s departure came a little more than two years after D-H’s announcement, in July 2014, that he had left an endowed position at the University of Michigan to take a newly created position at D-H and work closely with Weinstein.

Birkmeyer started work in September 2014. In that abbreviated work year, Birkmeyer’s D-H compensation package totaled $297,000. During the preceding school year, his salary as a professor at the University of Michigan was $220,000, according to the website UMSalary.info.

During a decade at Michigan, Birkmeyer headed up the university’s Center for Healthcare Outcomes and Policy and directed the Michigan Value Collaborative, a joint undertaking between Blue Cross Blue Shield of Michigan and leaders of 54 hospitals.

In 1989, Birkmeyer came to Dartmouth for a residency, or graduate medical training, in surgery. Over the next 15 years, he was chief of surgery at the VA Medical Center in White River Junction and chief of general surgery at D-H and contributed to the Dartmouth Atlas of Health Care.

The atlas uses Medicare data to document regional variations in health care costs and outcomes. Its findings have served as an evidentiary foundation for the Dartmouth Institute for Health Policy and Clinical Practice, which has challenged the existing fee-for-service arrangements that critics say encourage doctors to increase the volume of care rather than improve the quality of outcomes and the health of the population. Weinstein was the institute director before taking the helm at D-H.

In the private sector, Birkmeyer founded and is a director and chief scientific officer of ArborMetrix, an Ann Arbor, Mich., company that developed a cloud-based platform that “enables health systems, hospitals, accountable care organizations and quality improvement collaboratives to engage physicians in optimizing clinical quality and reducing costs.”

ArborMetrix has raised up to $14.5 million in three securities offerings to wealthy or sophisticated investors since 2013, according to filings with the U.S. Securities and Exchange Commission.

Birkmeyer also served as a scientific advisor to the Leapfrog Group, a nonprofit organization that rates hospitals for safety and the quality of their care.

Rick Jurgens can be reached at rjurgens@vnews.com or 603-727-3229.