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New London Hospital Discusses Potential D-H Affiliation

Newport — The regulatory review of a proposed affiliation between Dartmouth-Hitchcock and New London Hospital could begin as early as next week, moving the two health care providers closer to a partnership they hope will lower costs and better coordinate care for patients in New Hampshire.

Hospital officials said they hope to file their proposal with the state Attorney General’s Office next week, launching a 120-day period during which the state would review the plan and take comments from the public.

If approved, the affiliation would allow the two hospitals to pool some resources, such as sharing billing services and back office functions, as well as expand clinical services and take a more regional approach to caring for patients in the Granite State, hospital officials told an audience of around a dozen people at a public hearing in Newport last night.

The move is aimed at preparing both institutions for a rapidly changing environment for health care, one fraught with uncertainty that is forcing providers to think about more efficient ways of treating patients across a “continuum of care,” said Deanna Howard, vice president of regional development at Dartmouth-Hitchcock.

There is no time to waste in preparing for the new world of health care, she said.

“To get to that new world... we’ve got to get cracking on it,” Howard said. “We think it’s the right thing to do.”

Last night was the second of two public hearings required by the state, with the first held Tuesday in New London. Newport is a key town in New London’s coverage area, accounting for a third of its patient volume. The hospital is expanding a clinic there and the affiliation with Dartmouth-Hitchcock could help New London more easily finance the project, said New London CEO Bruce King.

The next step will be submitting the proposal to the Attorney General’s Office, which will look for anti-trust concerns. Also, because both hospitals are nonprofit organizations, the attorney general’s charitable trust division will get involved to make sure that assets donated to New London stay within the community and don’t get taken over by Dartmouth-Hitchcock.

Hospital officials hope to have the affiliation start July 1, when the new fiscal year begins. Hospital officials hinted that there could be similar partnerships with other institutions in the future.

The proposal is not a merger, Howard said. New London Hospital would remain an independent hospital with its own board and separate financial assets. However, Dartmouth-Hitchcock officials would hold about a third of the seats on New London’s board and be involved in major governance decisions, approve capital and operating budgets, major borrowing and changes in clinical services, among other things.

For New London, the affiliation opens up access to more resources and also helps it prepare for a future that looks increasingly bleak for stand-alone community hospitals, said Anne Holmes, chairwoman of the New London Hospital board.

“We recognize that the environment is changing,” she said. “Free-standing hospitals are pretty much alone in the world and you really need to be part of a system.”

The two boards voted to begin affiliation discussions in the Fall 2011, though ties between the two institutions go back much further.

King, New London’s CEO since 2003, is technically a Dartmouth-Hitchcock employee who is leased back to New London through a management services agreement. Before he was hired at New London, he worked at Dartmouth-Hitchcock for 15 years. New London and Dartmouth-Hitchcock also work together through the New England Alliance for Health, a group of community hospitals, behavioral health centers, and home health care agencies that share knowledge and resources.

This January, New London became the first health care provider in New Hampshire to join Dartmouth-Hitchcock’s Pioneer Accountable Care Organization, an experimental model aimed at improving coordination and lowering the cost of care for Medicare patients.

Anne Nilsen, a Sunapee resident who attended last night’s hearing, was curious about how the ACO would work. If this affiliation functions as hoped, however, she said she had no concerns about the two institutions working more closely together.

“I think it’s a great idea,” she said. “If they accomplish everything they want to accomplish, it will be a good thing.”

There were some questions from the audience about the impact on emergency services, as well as charity care provided to Newport residents. King assured the audience that emergency services would not be harmed, and that the affiliation may allow New London to provide more charity care.

Don Eberly, a New London surgeon who attended last night’s meeting, hoped the affiliation with Dartmouth-Hitchcock would lead to better communication between the two hospitals, particularly when it comes to their electronic health records systems.

The implementation of electronic health records at hospitals, a goal of federal health reform, has been plagued with problems across the nation because the systems that individual providers have chosen are often not compatible with each other. This has made it difficult for hospitals to exchange patient information and coordinate care, for example, which is what electronic health records were supposed to improve.

“The only way we can push to do (improve communication) is through stronger integrations,” Eberly said.

Dartmouth-Hitchcock has pushed for a variety of collaborative partnerships with institutions from around the Twin States and across the nation. These arrangements allow Dartmouth-Hitchcock to share best practices, resources and even staff.

Besides New London, Dartmouth-Hitchcock also has management service agreements with Mt. Ascutney Hospital in Windsor and Valley Regional Hospital in Claremont.

Howard would not say whether Dartmouth-Hitchcock was pursuing affiliations with those hospitals, but left open the possibility.

“We have many conversations with many people,” she said.

Chris Fleisher can be reached at 603-727-3229 or cfleisher@vnews.com.