As the leaders of two of the largest Upper Valley health care organizations, both of which are members of Dartmouth Health, we want to share some important context missing from the Valley News’ Jan. 22 editorial “Are we now receiving better care?”

The answer to Sunday’s editorial question “Are we now receiving better care?” is, unequivocally, “yes.”

While no health system, regardless of its size or location, has escaped the current healthcare crisis in our country, rural hospitals like ours are especially at risk. A report from the American Hospital Association last fall showed that 136 rural hospitals closed from 2010-2022 … 19 hospitals in 2020 alone. With that in mind, we’d like to correct the assertion that Dartmouth Health has been “swallowing up smaller hospitals and medical practices in the Upper Valley and the wider region.” The leadership of each Dartmouth Health member organization asked to join the system because they saw the need to be part of a larger health system in order to survive over the long term, and meet the needs of their communities. Those leaders saw the future as far back as 2010, the extreme challenges that were facing free-standing critical access hospitals at the time, and those that would arrive on their doorsteps in coming years.

We want to be clear — our communities are better for the decisions those leaders made, long before the pandemic arrived. How are they better? A few examples:

■Since joining the Dartmouth Health system in 2014, DHMC has provided Mt. Ascutney and other member organizations with a number of specialty services, including cardiology, gastroenterology, and general surgery.

■In turn, Mt. Ascutney has provided much-needed inpatient and sub-acute rehabilitation services to patients transitioning through their recovery. That kind of collaboration would have been much more difficult without our formal partnership in Dartmouth Health.

■Our integrated electronic medical record improves coordination of care for patients across the system.

■Dartmouth Health partners with more than 30 hospitals around northern New England, providing telehealth support in a half-dozen specialties, enabling more patients to get their care closer to home.

■As a system, we work to lower costs through group purchasing and refinancing debt, which helps enable small hospitals to sustain and invest in needed clinical services.

■And patients across Dartmouth Health have the benefit of the latest research and clinical trials — and aspect of our care that was instrumental in developing therapies in the early days of the COVID pandemic.

Valley News editorial writers were accurate in pointing out some of the factors that are contributing heavily to challenges facing health systems and providers around the country, and we’re not immune from those issues.

The impact of COVID-19 was not purely clinical. Recovery continues to be a process, and far costlier than anyone could have imagined. Ongoing staffing shortages impacts all sectors of our economy but especially healthcare; economic inflation; supply chain issues; and lingering effects of the pandemic.

Workforce issues have had direct impacts, like recruiting primary care physicians — which limits our ability to accept new patients — and indirect impacts caused by staff shortages at sub-acute facilities like nursing homes and rehabilitation hospitals. Low staffing in those facilities around the region is preventing us from discharging patients safely — taking up beds that are much-needed for higher level care.

Despite all of the challenges we face, we remain fiercely proud of the care we provide and the work our employees — our caregivers — do every day to make our communities around the region a better place.

We are especially proud of our ongoing commitment to community benefits. Despite the financial headwinds we’ve been facing, DHMC and the Dartmouth Hitchcock Clinics collectively spent more than $256 million in fiscal 2021 on community benefits, including nearly $175 million to offset the uncompensated cost of caring for Medicaid patients, and more than $9 million in financial assistance. We committed $44 million on education and research, and another $16 million on other benefits including community health improvement services, medication assistance, and cash and in-kind contributions. Mt. Ascutney contributed nearly $8 million to communities on both sides of the Connecticut River, and across the Dartmouth Health system we contribute nearly $300 million in benefits to communities in New Hampshire and Vermont.

Dartmouth Health and its employees are engaged in improving our communities through efforts like the Vital Communities’ workforce housing initiatives, and a broad range of social service, educational, and cultural organizations.

Dartmouth Health created a Workforce Readiness Institute in 2014 — long before the pandemic arrived — to help fill our needs for allied health positions like pharmacy technicians, surgical techs, medical assistants and phlebotomists. We have deepened our relationship with the nursing program at Colby Sawyer College in New London, helping to widen our pipeline for new nurses and other healthcare professionals.

And, to address some of the root causes of health equity in our region, we introduced our Center for Advancing Rural Health Equity late last year, to address social determinants of health (the non-medical factors that determine health outcomes), giving our communities a stronger foundation of well-being to better navigate this and future public health crises.

America’s health system is in crisis. That’s not news, and it’s long past time for a frank discussion about the state of America’s health system. We are addressing the challenges head-on. It is critical to remember that the healthcare industry — and the world — is a much different place than it was in 2013. And our vision for the health of our region is not a “mirage in the desert, receding farther with each step taken forward.” We still believe it is an attainable goal, but one that is based on a complex series of interactions, dependencies, policy implementation and operational decisions … all of which have been complicated by factors in play today that no one could have imagined 10 years ago.

No single organization can address all of these issues and solve all of these problems alone. Our communities must bolster their efforts to create more affordable housing and childcare to meet the needs of, among others, the healthcare professionals we recruit. There needs to be serious consideration of the ways hospitals are reimbursed, paying at rates closer to the actual cost of caring for all of our patients. And there needs to be stronger action taken on holding the line on ballooning costs to our organizations, from the cost of medications to premium “traveler” labor ... two of the main drivers of our budget challenges.

Despite the unprecedented challenges we face in the rapidly changing world around us, all of our organizations are committed to continuing to provide the best care available for the communities we serve, for years to come.

Susan A. Reeves, EdD, RN, is the Executive Vice President of Dartmouth Hitchcock Medical Center in Lebanon and Chief Nursing Executive for Dartmouth Health.

Joseph L. Perras, MD, is the Chief Executive Officer and Chief Medical Officer at Mt. Ascutney Hospital and Health Center in Windsor.

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