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D-H, Mt. Ascutney Hospital Announce Formal Partnership

Catherine Scneider, MD, Chief Medical Officer, left, and Niall Rizvi, Physician Hospitalist, check on Plainfield, N.H., resident John C Morse's breathing while checking up on him after a recent surgery at MT. Ascutney Hospital and Health Center in Windsor, Vt., on Jan. 20, 2014. 
Valley News - Sarah Priestap

Catherine Scneider, MD, Chief Medical Officer, left, and Niall Rizvi, Physician Hospitalist, check on Plainfield, N.H., resident John C Morse's breathing while checking up on him after a recent surgery at MT. Ascutney Hospital and Health Center in Windsor, Vt., on Jan. 20, 2014. Valley News - Sarah Priestap Purchase photo reprints »

Windsor — Mt. Ascutney Hospital and Health Center and Dartmouth-Hitchcock have announced a formal partnership designed to streamline care of patients moving between the two institutions and maintaining service offerings in Windsor.

In an interview Monday, officials from both organizations said the agreement will solidify the “collegial” partnerships that the two providers have shared for years.

“Our previous relationships (with Mt. Ascutney), much of them were centered around shared administrative savings ... and we really see this relationship being about improving the care of the patient through better coordination and better partnership through care providers,” said Steve LeBlanc, executive vice president for strategy and network relationships at D-H.

Under the affiliation agreement, which was affirmed by the hospitals’ governing boards pending a due-diligence review, Mt. Ascutney would maintain its own board of trustees and remain an independent not-for-profit community hospital, with 25 general beds and 10 beds in its rehabilitation center. It will also continue to run Ottauquechee Health Center in Woodstock.

At the same time, LeBlanc said, the move will increase communication between the two organizations in a way that allows doctors and nurses to do a “better job of coordinating patient care,” LeBlanc said. Patients should expect “more integrated planning” between clinicians in Windsor and Lebanon.

“It’s been a little bit of a collegial relationship before, where we both had benefits that we brought to each other, but through this now we can work directly through sharing resources,” said Mt. Ascutney CEO Kevin Donovan.

Donovan said there is no discussion under the proposal about workforce consolidation or affecting employee positions.

“There’s no preconceived notion, but we’re not looking to give up the mission or the culture or identity of Mt. Ascutney Hospital,” he said.

Clinicians at Mt. Ascutney and D-H have worked together for years, but the agreement is expected to allow for better coordination. For example, a patient currently might be treated at Dartmouth-Hitchcock until D-H clinicians feel that they have finished their care for her, at which point she might be transported to Mt. Ascutney’s rehabilitation center.

Going forward, D-H and Mt. Ascutney clinicians would work together to determine the best point for the patient to be transferred.

The agreement also would allow Mt. Ascutney to provide clinical services locally that it was unable to fund on its own because of low demand, such as orthopedic services. In the past, it was difficult for Mt. Ascutney to maintain orthopedic services, but going forward, orthopedic surgeons from D-H will visit the Windsor hospital on a regular basis.

“We want to provide care as close to the patient as possible,” LeBlanc said.

Other highlights of shared clinical services will include general surgery, urology and pain management.

Dartmouth-Hitchcock entered a similar agreement with New London Hospital last fall. LeBlanc said building these affiliations is part of the organization’s “broader strategy” moving forward. (D-H also is in early talks with Cheshire Medical Center in Keene, N.H., to explore a similar agreement, said spokesman Mike Barwell.)

Earlier this month, three other large health care providers in New Hampshire joined D-H’s accountable care organization, or ACO, in which providers are encouraged to collaborate rather than compete for patients and are held responsible for keeping them healthy and out of the hospital.

“We do see the payment models changing to be more around the cost of the population that you become responsible for, being able to manage that as quickly and efficiently as possible and meeting quality metrics,” LeBlanc said. “In order to do that, we believe that we have to partner with other organizations … so we see this as just a logical step.”

Part of the savings from the agreement revolve around the data coordination needed for payment systems that hold providers accountable for the total cost of the patient, which is difficult for smaller hospitals like Mt. Ascutney to maintain.

Dartmouth-Hitchcock and Mt. Ascutney officials are targeting a July 1 start date for the agreement. Following recent votes of approval by their governing boards, they’re now engaging in a due-diligence process that should take several months, LeBlanc said.

Donovan said officials likely will have to make a formal presentation to the Green Mountain Care Board, which was created in 2011 to oversee Vermont’s state run health insurance pool, “although exactly what, if any, formal approval is required by them is still being determined,” he said.

Several Green Mountain Care Board members have been supportive during informal conversations, he said.

The New Hampshire Attorney General’s Office does not technically “approve” these affiliations but can choose to raise objections, and has been consulted by D-H.

Maggie Cassidy can be reached at mcassidy@vnews.com or 603-727-3220.