Lebanon Hospitals 
To Affiliate

Valley News Staff Writer
Saturday, August 29, 2015
Lebanon — Alice Peck Day Memorial Hospital will become Dartmouth-Hitchcock’s fifth affiliate, should the state approve the agreement the two institutions expect to file in September.

Under the agreement, which was modeled on previous D-H agreements with New London Hospital and Mt. Ascutney Hospital in Windsor, the two entities would work over time to integrate services, particularly in the areas of emergency, in-patient medicine and obstetrical services, according to a joint news release issued Friday.

In the long term, APD would continue to provide pre- and post-natal care, but many births — except for the most routine — would take place at the birthing pavilion at Dartmouth-Hitchcock Medical Center.

About 300 babies annually are born at the community hospital near downtown Lebanon, while 1,117 babies were born at DHMC last year.

“Obstetrics is sort of the heart of our institution; we have to figure out some way to keep it here in a responsible way,” APD President Sue Mooney said in an interview at the 83-year-old hospital on Thursday. “I think it’s got to change, but not completely get out of it all together.”

The affiliation agreement with D-H is necessary for APD’s long-term survival, Mooney said.

The two organizations initially announced they were exploring an affiliation in January 2014.

“It’s difficult for a small organization alone to manage populations or to accept large financial risk because we don’t have the numbers,” Mooney said. “We don’t take care of large populations; we take care of individuals.”

APD serves 95,000 patients annually, while Dartmouth-Hitchcock serves 1.2 million in New England, according to the release.

In the agreement, APD would remain an independent 25-bed hospital and retain its own board of trustees and administrative leadership, Mooney said.

APD’s board already includes representatives from D-H, but the majority of members are community representatives. APD medical staff also will remain independent.

Overall, the agreement would allow Dartmouth-Hitchcock to shift patients who need to be in a hospital but do not need to see the wide variety of specialists available at DHMC to some of the now-underutilized beds at APD.

Dartmouth-Hitchcock President Jim Weinstein said DHMC has to divert up to 100 patients each week to other hospitals because it does not have the beds available , while community hospitals might sit half empty.

“We don’t necessarily want to turn anybody away,” said Weinstein, who spoke with Mooney to Valley News editors and reporters .

D-H’s growing network allows providers to see which facilities have the capacity to properly care for patients with varying needs, Weinstein said.

The purpose of expanding the network is to improve the quality of patient care, improve safety and decrease costs, he said.

Mooney said APD generally fills up 15 beds per day, leaving approximately 10 beds available for transfers from DHMC.

“We need to think about information sharing, teleconsultations, integrated hospitalist services so you make sure that the right medical patient is in the right facility to get the right care,” Mooney said.

Without an affiliation agreement in place, the two organizations do not have the ability to share information, collaborate or consolidate services, she said.

The affiliation would allow the two organizations to share patient records, improving the coordination of patient care, she said.

Both Weinstein and Mooney also said the affiliation was important to help APD capitalize on D-H’s involvement in accountable care organizations, moving away from a traditional fee-for-service payment system to one that rewards medical organizations for better coordinating patient care and keeping them healthy.

Though the two organizations will be integrating some of their services, Weinstein said patients still will have choices.

“Our goal is to help any patient locally, regionally, nationally to get the best care if that’s what they choose,” Weinstein said. “If the best care is at APD for something, (patients) should go there and continue to go there.”

In the case of high-risk pregnancies, Weinstein said, it makes more sense to have births take place at DHMC, where all of the necessary specialists to support a safe delivery and a healthy baby are in place, rather than having to make a transfer via ambulance from APD.

“Patient choice really matters,” Weinstein said. “But, as Sue said, outcomes matter too.”

Mooney, an obstetrician, said APD and other hospital face several challenges in providing high-quality obstetric care.

The reimbursement rates are low and the demands are high, she said.

“To safely deliver babies, you’ve got to have highly trained physicians, midwives, anesthetists, nurses, O.R. technicians ... — you need a deep bench,” she said.

Not only is there a high number of staff needed, but they must be available at all times, she said.

In addition, the region’s overall demographics are such that the number of babies being born in the Upper Valley is low.

“We’re an aging population,” she said. “We’re not seeing a baby boom.”

Former state Rep. Laurie Harding, who is now co-director of the Upper Valley Community Nursing Project, described the affiliation as an “important next step.” She said an affiliation would allow both hospitals to provide more efficient care.

“It’s a perfect opportunity for each to play on where its strengths lie,” she said.

For example, she said, Dartmouth-Hitchcock has a lot to offer in the area of high-tech services for obstetrics, while APD has a lot to offer in terms of community care.

In particular, Harding said, she hoped the agreement would mean that elderly patients who do not desire the intensive care available at DHMC would be able to receive care in a more peaceful setting at APD.

Peter Mason, a retired APD family practice physician who also teaches at Dartmouth College’s Geisel School of Medicine, said he hoped an affiliation would make patients’ transitions between the two hospitals “much more seamless and much more appropriate.”

“I think it’s a win-win situation,” said Mason, who is married to Harding.

Mason, who has delivered babies at both hospitals, said he very much enjoyed attending births in a peaceful setting at APD. On the other hand, he said, there is an increase in the number of babies who are at risk because of mothers’ substance abuse, gestational diabetes or high blood pressure, he said.

In such cases, “it’s wonderful to have a high-risk nursery right there (at DHMC),” he said.

He said it would be appropriate for APD providers to follow their patients to DHMC when necessary for deliveries and vice versa. Some mothers with low-risk pregnancies whose providers are based at DHMC may prefer APD’s quieter setting, he said.

“Those of us who have worked at both understand that there is a role for each institution,” he said. “Ideally, it is a continuity of care and not an ‘either-or’ situation.”

There is some resistance to the proposed changes, at least emotionally, among members of the community, Mooney acknowledged.

“I think there’s a sadness, that people don’t necessarily want to see (obstetrics) change at APD, but I think there’s also a realization that we have an obligation to do this,” she said.

The two institutions plan to file the affiliation agreement with the New Hampshire Department of Justice’s Charitable Trusts Unit and Consumer Protection and Antitrust Bureau next month.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.