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Dozens of Dartmouth Health staff being shifted to Texas-based billing company

Valley News Staff Writer
Published: 9/24/2022 11:44:56 PM
Modified: 9/24/2022 11:44:07 PM

LEBANON — About 50 employees of Dartmouth Health in Lebanon are slated to become employees of Conifer Health Solutions, a Texas-based company that oversees DH’s billing and collections, starting late next month.

The move, scheduled to take effect Oct. 23, brings DH’s Lebanon location in line with the health system’s other locations that already rely on Conifer employees to serve as front desk staff, providing registration services to patients.

“Managing our registration process under one system allows us to improve our patient experience by providing a consistent experience at every Dartmouth Health location,” Audra Burns, a DH spokeswoman, said in an emailed statement.

In addition to DHMC, DH includes four other hospitals, a visiting nursing organization and several clinics in Vermont and New Hampshire.

Conifer has worked with DH since 2015; now it “will assume responsibility for registration services currently provided through General Ambulatory Services and Radiology at the Lebanon Campus,” Burns said.

The approximately 50 front-line employees affected by the change received a letter dated Sept. 14 informing them of the transition. The employees will be eligible for a $1,000 transition bonus to be paid out the first full pay period after their first six months of employment with Conifer, according to the letter. The offer of employment is contingent on “satisfactory completion of Conifer’s pre-employment screening process.”

An emailed request for comment sent to the media contact listed on Conifer’s website was not returned by deadline.

Conifer, on its website, has a page congratulating DH on a recent award from the Healthcare Financial Management Association, an industry group. In June, DH was one of 27 recipients of a MAP Award, which “recognizes providers that have excelled in meeting industry-standard revenue cycle benchmarks (…), implemented the patient-centered recommendations and best practices (…), focused their efforts on improving price transparency and achieved outstanding patient satisfaction,” according to HFMA’s news release announcing the award winners.

“High-performing revenue cycles design business processes around the consumer’s needs,” HFMA President and CEO Joseph J. Fifer said in the news release. “Kudos to all the 2022 MAP Award winners for putting consumers first.”

Conifer, on its website, celebrates DH’s achievement of 101.9% of its cash collection goal over a five-year partnership with Conifer.

The website explains that DH’s business goals were to enhance revenue cycle operational performance while adding new members to the DH system. Specifically, DH sought to improve cash collections, patient satisfaction and funding for uninsured patients, as well as receive support in integrating the new partners on Epic, DH’s shared electronic medical record.

DH chose Conifer to assume operational management of the revenue cycle and the so-called “Single Business Office” for the entire health system, including physicians, outpatient surgery centers and imaging centers, according to Conifer’s website.

In a June 2019 news release announcing a new “revenue cycle management agreement” with Alice Peck Day Memorial Hospital, a DH member in Lebanon, then-DH CFO Dan Jantzen credited Conifer with “consistently delivering on key performance metrics.”

“Their expertise helps D-HH (DH was previously known as Dartmouth-Hitchcock Health) maintain the firm financial footing to realize our vision for a sustainable health system that will serve New Englanders for generations to come,” Jantzen said in the 2019 release. “As D-HH and APD work to connect people throughout New Hampshire and Vermont to the thriving, integrated care community they expect, we rely on Conifer to deliver the high-quality patient financial experience they deserve.”

The 2019 release said APD was the second DH-member hospital to adopt Conifer for “comprehensive” revenue cycle management services, following Cheshire Medical Center in Keene, which engaged Conifer in 2017.

“The impact of our work extends beyond improved margins, reduced costs and more efficient operations,” Stephen M. Mooney, then-president and CEO of Conifer, said in the 2019 release. “As part of the community, we have also made a commitment to bring the highest quality service to patients and their families whenever and wherever they access care.”

But some DH employees have concerns about Conifer’s increasing role. An Instagram page maintained by a nurse at Dartmouth Hitchcock Medical Center in Lebanon featured a meme including a picture of a bride and groom kissing. The bride is labeled “Conifer” and the groom “DH,” with a woman in the foreground looking grim-faced at the camera, labeled “main desk employees.”

A second picture on the page includes text at the top that reads: “When DH decides to let Conifer buy out all of the registration staff, forcing them to either sign new employment contracts or quit.” Below that text is a picture of former President Donald Trump saying, “This has been the worst trade deal in the history of trade deals, maybe ever.”

Additionally, some patients have struggled with DH and Conifer’s billing practices. A May story by Kaiser Health News featured Sunapee resident Elizabeth Melville, a 59-year-old patient at New London Hospital who faced a $2,185 bill for her second colonoscopy. Her first, nearly six years earlier, cost $0, as required under the preventive services provisions of the Affordable Care Act. The Centers for Medicare & Medicaid Services has said polyps removed during a screening colonoscopy, as Melville had, are considered part of the procedure and shouldn’t affect a patient’s cost-sharing responsibilities.

But it was only after KHN reached out to DH and Conifer regarding Melville’s bill that Conifer told Melville her bill was being reprocessed. Melville’s insurer, Cigna, then told KHN that Melville wouldn’t be responsible for any out-of-pocket costs.

According to the story, Melville’s situation shows that patients ought to check in with their insurance company before a colonoscopy to see what costs they might expect; doctors and hospitals are required to give patients a good faith estimate before a procedure; and patients should read through paperwork they’re required to sign beforehand.

Melville told KHN that the burden placed on patients felt unfair: “I still feel asking anyone who has just prepped for a colonoscopy to process those choices, ask questions and potentially say ‘no thank you’ to the whole thing is not reasonable.”

Nora Doyle-Burr can be reached at or 603-727-3213.

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