A Step Forward, a Step Back: Reaction Mixed to D-H Announcement

  • Dartmouth-Hitchcock Medical Center seen from the air during a 20-minute scenic flight over Lebanon on Saturday, Dec. 9, 2017, from the Lebanon Municipal Airport in West Lebanon, N.H. (Valley News - Charles Hatcher) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Charles Hatcher

Valley News Staff Writer
Published: 1/26/2019 10:21:10 PM
Modified: 1/30/2019 11:05:28 AM

Lebanon — Dartmouth-Hitchcock’s plans to combine forces with the health system containing the Manchester-based Catholic Medical Center are just the latest in a string of hospital mergers around the country.

Reactions were mixed to Thursday’s news of the planned creation of a new health system, Dartmouth-Hitchcock Health GraniteOne — which would include the 396-bed Dartmouth-Hitchcock Medical Center in Lebanon, the 330-bed Catholic Medical Center and six other smaller hospitals currently under the umbrella of either Health or GraniteOne Health, which in addition to CMC includes Huggins Hospital in Wolfeboro, N.H. and Monadnock Community Hospital in Peterborough, N.H.

Some saw the proposal, which the two systems have outlined in a nonbinding letter of intent, a logical step as hospitals seek to shore up resources in a competitive market, while others saw it as further evidence that health care is not treated as a public good, but as a commodity. Still others wondered if the philosophies of a secular organization and a Catholic one would be aligned.

In outlining their plan on Thursday, D-H Health CEO Joanne Conroy and GraniteOne CEO Joseph Pepe said that by working together, they will be able to increase patients’ access to services, find cost efficiencies and increase their borrowing power for new construction projects.

“The patients should expect more options (and) more choices,” Pepe said. “Better access to high quality, better-coordinated care through(out) New Hampshire.”

D-H officials said they are calling the proposed agreement — which requires approval by the bishop of Manchester, as well as the two systems’ boards, and state and federal regulators — a “combination,” not a merger.

“This combination is not a classic merger because each member of the combined system will survive, maintain its unique identity and mission, and be governed by a local board of trustees and managed by local leadership,” D-H general counsel John Kacavas wrote in an email on Thursday.

Financially, such collaborations — whatever form they take — are necessary as the health care industry evolves, said Mark Bonica, an assistant professor of health management and policy at the University of New Hampshire.

“The consolidation of hospitals is necessary not just in New Hampshire but nationally because (of) the changing nature of health care delivery, particularly as we move toward value-based care,” Bonica said.

As part of that shift, hospitals are increasingly reimbursed on a per-patient basis for keeping people healthy, rather than in the traditional fee-for-service model.

Potential clinical benefits include increasing access to specialty care through telemedicine services and physician sharing, Bonica said. In addition, the hospitals’ collaboration might also include back-end resource sharing, such as data analysis.

“I think it’s necessary if we want to keep the institutions around,” he said.

Given the region’s aging demographics, relatively low reimbursements from insurers and high acuity of need for care, state Rep. Sharon Nordgren, D-Hanover, said she hopes the new system will increase the level of care small hospitals are able to provide close to people’s homes, leaving beds at the larger hospitals for the sickest individuals.

“I think the services that will be available will be of great value to the patients,” said Nordgren, who sits on the House Finance Committee.

She was, however, uncertain about the cost.

The effects of mergers on patients are usually mixed, said Dr. Vikas Saini, president of the Lown Institute, a progressive health care think tank in the Boston area. While patients may have better access to some specialty services, they may be paying more for them.

Around the country, as hospital systems have grown, so has their market share, Saini said. With increased market share, systems can demand higher prices, he said.

“It hasn’t brought down costs,” Saini said.

The move by D-H and GraniteOne also comes as Massachusetts-based Partners Healthcare, which includes some of Boston’s most illustrious teaching hospitals, also is angling for more market share in New Hampshire.

For some, news of D-H’s plans to “combine” with Catholic Medical Center, drew questions about the compatibility of a secular health system with a Catholic hospital. A similar merger attempt about a decade ago was thwarted, at least in part, by concerns related to reproductive services.

State Rep. Susan Almy, D-Lebanon, said she would seek assurances from D-H officials that the agreement would protect the ability of D-H providers to perform abortions and she would be looking to understand whether Catholic Medical Center would respect patients’ do not resuscitate orders.

“I’d want to make sure that those things — and anything else that I haven’t thought of — is carefully spelled out in the agreement,” Almy said.

In contrast, David Umbaugh, chairman of the New Hampshire Right to Life Political Action Committee, and anti-abortion group, said in an email that he worries the partnership “could weaken Catholic Medical Center’s commitment to protecting all patients’ lives, from conception to natural death.”

“NHRTL will be closely monitoring the terms of this proposal, looking only to ensure Catholic Medical Center remains a place where life is revered above all else,” Umbaugh wrote.

Under the proposal, the Bishop of Manchester would retain his role in overseeing the types of services that Catholic Medical Center provides.

“I am impressed with the deliberate discussions that have taken place thus far and I believe that this combined system would strengthen Catholic Medical Center’s ability to care for the suffering and sick in our community, while at the same time maintaining the integrity of its Catholic identity,” the Rev. Peter Libasci, bishop of Manchester, said in Thursday’s news release announcing the combination.

The nearest competition in southern New Hampshire, the newly formed SolutionHealth, a combination involving health systems that oversee Elliot Hospital in Manchester and Southern New Hampshire Medical Center in Nashua, did not seem threatened by Thursday’s announcement.

In his response to the news, Greg Baxter, president of Elliot Health, said that he didn’t expect any immediate change in the way health care is delivered in the state.

“Having just been through the process, there is a lot of work ahead of them to complete due diligence alone,” Baxter said in an emailed statement. “We respect the fact that they are making this effort, but we don’t foresee an impact at this time. As for SolutionHealth and our work with Southern New Hampshire Health, we remain focused on expanding access to services to improve the health of people in our region.”

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

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