Combination of Dartmouth-Hitchcock, CMC subject of public forums this week
Oct. 5—Public forums begin this week about the proposed partnership between Catholic Medical Center and Dartmouth-Hitchcock Health.
Hearings are scheduled for Peterborough and Manchester this week, and Wolfeboro next week, over the proposed "combination" of GraniteOne Health, the parent organization of CMC, with Dartmouth-Hitchcock Health, the largest health-care organization in New Hampshire and the state's largest private employer.
The proposal, first announced in late 2019, is the third attempt in 27 years for Catholic Medical Center in Manchester to partner with a larger health care organization. CMC and Dartmouth-Hitchcock officials say it would help them better compete with out-of-state providers.
State law requires the Charitable Trust Unit in the New Hampshire Department of Justice to review any proposed transactions between the hospitals and issue a report. According to the Charitable Trust Unit website, the unit must issue a report by Oct. 15, just three days after the Wolfeboro hearing.
Here are six things to keep in mind about the proposal.
Name game
Hospital officials have tried to come up with a name that would correctly describe the relationship but also win favor with the public. In 1994, CMC and cross-town rival Elliot Hospital merged into a single organization, Optima Health.
Six years later, the merger dissolved over issues that included conflicts related to abortion and other health care procedures prohibited by Catholic doctrine.
Forum schedule
What: Public forums on the proposed partnership between Catholic Medical Center and Dartmouth-Hitchcock Health
When: 4 p.m. Wednesday at the Hilltop Golf Course, Peterborough; 6:30 p.m. Thursday at West High School, Manchester; 6 p.m. Oct. 12 at Kingswood Regional High School, Wolfeboro.
Participation: Space will be limited, and everyone will be required to wear masks. Remote viewing is an option, and anyone who wants to participate should register ahead of time at doj.nh.gov/charitable-trusts.
In 2009, CMC and Dartmouth-Hitchcock Medical Center proposed an "affiliation" that would create a single entity but give CMC the ability to control health care in its hospital and clinics. Then-Attorney General Michael Delaney rejected the plan, saying it was an "acquisition."
Both organizations term the current proposal a "combination," with local hospital boards remaining intact and having control over their restricted assets. While all sorts of measuring sticks can be used, Dartmouth-Hitchcock Health's flagship hospital is a little more than three times larger than the CMC hospital, as judged by reported 2019 revenues.
When the two organizations announced the deal, they said the combination would "build on years of successful community engagement and clinical collaboration" and provide "seamlessly integrated" care that is high quality and lower cost than that of out-of-state providers.
The new organization would be known as Dartmouth-Hitchcock Health GraniteOne.
It's bigger this time Both organizations have grown since the affiliation was last attempted. The CMC organization (GraniteOne) includes Monadnock Community Hospital in Peterborough and Huggins Hospital in Wolfeboro, as well as physician practices.
Dartmouth-Hitchcock Health includes clinics and hospitals in Manchester, New London, Keene and Vermont, as well as the flagship medical center in Lebanon.
According to an independent analysis of the deal by the UMass Chan Medical School, the new organization would control 35% of the acute care beds in New Hampshire and represents 42% of total hospital revenue in the state.
With that market power comes some concerns, according to a fact sheet produced by UMass Chan.
Anyone in Carroll County whose health network did not include the combined organization would have to travel a long distance for care. Also, some of the smaller facilities may face higher administrative costs and may have to spend on their infrastructure to align their administration with the system.
A different pope
The 1994 merger and the 2009 proposed affiliation took place under popes who proclaimed strong anti-abortion and pro-life messages: John Paul II and Benedict XVI.
Pope Francis focuses more on issues such as climate change, poverty, wealth distribution, education and health care, which allow humans to flourish, said Rev. Liam Bergin, who teaches theology at Boston College.
"He's not saying abortion is not important. He's talking about interconnectedness," Bergin said.
Bishop Peter Libasci, who was not bishop of Manchester when the previous CMC affiliation was proposed, has issued a declaration of no objection, which would allow it to proceed. The bishop would make final decisions regarding the Catholic mission and identity of the hospital.
Health care workers in the CMC region — which includes Manchester, Peterborough and Wolfeboro — will be trained about Catholic health care rules. Dartmouth-Hitchcock would not allow abortions or in-vitro fertilizations at its Manchester locations, according to the Diocese of Manchester. And clinics in the Manchester area will post disclosures about Catholic health care in waiting rooms or exam rooms.
Also, the new organization will perform an annual audit on the Catholic health care rules and their compliance.
Meanwhile, Dartmouth-Hitchcock said it provides comprehensive health care for women, including abortions in a limited number of instances.
The New Hampshire Right to Life opposes the combination.
"We are calling upon CMC to return to its stated core value, especially as it relates to unborn persons," reads a statement on the website.
Pluses for both
CMC estimates that annual debt payments on a delayed $200 million expansion will drop by $188,000 a year if the combination is approved. GraniteOne would reduce debt payments by $650,000 a year once the combination takes place and debt is refinanced, according to answers the organization supplied to the Charitable Trust Unit.
Meanwhile, Dartmouth-Hitchcock Health, the state's only academic medical center, would get what it needs — patients. UMass Chan notes the combination would support D-HH by "providing enough patients to sustain the most specialized clinical services and research activities."
Impact on medical bills
Both organizations say the combination should provide lower hospital bills for patients who now travel to Massachusetts for health care.
In submissions to the Charitable Trust Unit, they note that an average, standardized inpatient stay at Mass General and Brigham and Women's in Boston exceeds $31,000, nearly twice that of CMC ($16,600) and about a third higher than Dartmouth-Hitchcock ($21,000).
However, the price advantage evaporates for those who don't go out-of-state for health care. According to the UMass Chan study, rates that Dartmouth-Hitchcock charges the uninsured and the three largest insurers in the state are 10% higher than the state median in nearly all categories. They are only lower than the median for one category: outpatient tests and procedures for Harvard-Pilgrim Health Care.
GraniteOne charges are much more mixed, with some exceeding the median and some lower.
In response to Charitable Trust Unit questions, the hospitals say that their pricing is much different from for-profit companies, which can pass cost savings on to customers. After the combination, the organizations hope to move to risk-based or value-based contracting, which offers shared savings and cost reductions, they said.
The hospitals expect health care will improve through better service in rural communities; improved efforts in behavioral health and substance abuse treatment; better treatment for chronic conditions such as diabetes, asthma, and obesity; and the ability to address social issues that affect health such as education, nutrition, food security and preventive care.
Other things to know
The two previous deals were scuttled by Democratic attorneys general Philip McLaughlin and Michael Delaney. The oversight for the current decision is in the hands of the current attorney general, Republican appointee John Formella.
Formella's late mother, Nancy Formella, was a nurse who held many high-ranking positions at Dartmouth-Hitchcock, including president of Mary Hitchcock Hospital and co-president of Dartmouth-Hitchcock Clinic.
John Formella has not recused himself from the case. The assistant director of the Charitable Trust Unit is Diane Quinlan, the former chancellor of the Diocese of Manchester. She has recused herself from the case.
Formella's Consumer Protection Unit and the Federal Trade Commission must also review the proposal. Those reviews are not public and have not been completed.
Officials have already received 100 written comments on the proposal.
