Control of Valley Regional a chief concern at hearing on Dartmouth Health affiliation

By NORA DOYLE-BURR

Valley News Staff Writer

Published: 05-23-2023 10:05 PM

CLAREMONT — Attendees at a recent public hearing on a proposed union between Dartmouth Health and Valley Regional Hospital had a fundamental question: Should an affiliation occur, who would make decisions about the Claremont hospital’s future?

“After the affiliation happens, does Valley Regional cease to have control?” asked Rebecca Mackenzie, a clinical social worker who practices in Claremont and Windsor, during last Thursday’s public hearing at the Claremont Savings Bank Community Center. It was organized the Charitable Trusts Unit of the New Hampshire Attorney General’s Office, and about 50 people attended.

If approved, the affiliation, which the organizations announced they would pursue last year, would bring Valley Regional, a critical access hospital with 21 staffed beds and 350 employees, under the umbrella of Dartmouth Health, which employs 13,000 people and includes Dartmouth Hitchcock Medical Center in Lebanon, four other hospitals, a visiting nurse organization and clinics in both the Twin States.

The hospital has operated independently in Claremont since the 1890s, but has faced repeated financial struggles in recent decades amid changes in the health care industry.

As proposed, DH would be the sole corporate member of Valley Regional, with a controlling interest in the organization. Valley Regional and Mt. Ascutney Hospital and Health Center in Windsor would be led by a shared leadership team and by mostly the same board members comprising one-third each of representatives from the three organizations.

In response to Mackenzie’s question, Dr. Joanne Conroy, DH’s CEO, said that should Valley Regional come under DH’s umbrella, its purpose would remain largely the same and local leaders would retain responsibility for managing day-to-day operations.

“They’re the team that wakes up every day (and) makes sure the lights are on (and) patients are being cared for well,” Conroy said.

Still, Katharine London, a principal at ForHealth Consulting at UMass Chan Medical School, who conducted a review of the transaction and presented her findings at the hearing, said she was puzzled by the proposed structure of the two boards for Mt. Ascutney and Valley Regional, which mirror each other except that the medical staff president for each hospital would only sit on that hospital’s board.

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“It doesn’t really make a lot of sense to me,” she said. She speculated that, perhaps, this was intended to be a “transitional model” and that the two hospitals will eventually share a board.

In that case, “will this board’s attention be diluted?” she asked. It could be that DH might decide to consolidate different services at one campus rather than the other. She also said that the combined board might have less of a focus on the concerns of people in Claremont.

But in a Friday email, Audra Burns, a DH spokesperson, said the mirror board model is not intended to be temporary.

“We believe this structure will foster greater coordination and integration of services to better serve the needs of each community,” Burns wrote.

Should Valley Regional join DH, Cottage Hospital in Woodsville would be the last hospital on the New Hampshire side of the Upper Valley to retain its independence.

In spite of some concerns that Valley Regional might lose its autonomy if it joins the larger system, most of those gathered on Thursday acknowledged that there are fewer and fewer independent hospitals in New Hampshire and around the country as market forces drive consolidation. Some in the audience also expressed hope that the affiliation might result in greater access to mental health and addiction treatment in Claremont, which DH and Valley Regional have listed among the benefits of affiliation.

About 30% of the current attendees of the Moms in Recovery program that DH operates on Mechanic Street in Lebanon come from Claremont, where Valley Regional is located, Conroy said.

“We are committed, first of all, to expanding substance use disorder (treatment) access points in this community,” she said during the hearing.

Dan Wargo, director of TLC Recovery Programs, said that telehealth has its place, but for people struggling with substance misuse, who may be prone to losing their cellphones or have trouble finding a space for a private session, in-person treatment is often best.

Wargo asked if there were “further conversations about providing more in-person (behavioral health treatment) at Valley Regional as you are doing at Dartmouth.”

Conroy responded that DH is always looking for more mental health providers, but that its ability to expand is “limited by our ability to recruit and place people.”

She noted that DH is using providers other than physicians to care for patients in some circumstances, such as advanced practice nurse practitioners to manage panels at New Hampshire Hospital in Concord, where DH provides care through a contract with the state.

Other advantages to Valley Regional of joining a larger system would be improving its long-term financial stability; allowing it to streamline administrative functions; allowing it to expand services such as behavioral health care, oncology, general surgery, orthopedics, inpatient and primary care; and improving benefits such as retirement plans for employees, said London, the consultant.

Based on a comparison of current costs at Valley Regional and the DH-affiliated Alice Peck Day Memorial Hospital in Lebanon and New London Hospital, London said she doesn’t expect the proposed transaction would result increased costs at Valley Regional.

“I would be very surprised if you saw big jumps,” she said.

Dr. Joseph Perras, CEO of Mt. Ascutney, credited his hospital’s relationship with DH with helping bring stability to its finances and enabling it to provide some types of specialty care in Windsor. He noted that his hospital regularly receives high marks for quality and it would share best practices with Valley Regional should the affiliation move forward.

“I only see an upside for Valley Regional,” he said.

London echoed Perras’ view on at least one point, saying if the affiliation goes through there’s a “good chance that quality will improve significantly.”

The Charitable Trusts Unit will continue to accept public comments on the transaction through May 31 via email at: charitabletrustsunit@doj.nh.gov, or by mail to: Director of Charitable Trusts, Department of Justice, 33 Capitol St., Concord, NH 03301.

Because Mt. Ascutney is in Vermont, the transaction also will require approval from the Vermont Attorney General’s Office.

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

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