Dartmouth-Hitchcock, Valley Regional leaders take questions about proposed affiliation

Sep. 9—If all goes to plan, Claremont's Valley Regional Hospital could be a subsidiary of Dartmouth Health in less than a year.

As the hospital groups prepare to submit a proposal for affiliation to the state Attorney General's Office, the CEOs of both hospitals answered questions from the public on Thursday during a hearing in Claremont.

Dartmouth Health CEO Joanne Conroy and Valley Regional CEO Jocelyn Caple said they thought the affiliation would help stabilize Valley Regional, enable the small Claremont hospital to offer more services staffed by doctors on loan from Dartmouth Hitchcock, and create opportunities for staff to get more training and move around the larger Dartmouth Health system.

But the proposal to affiliate faces a major hurdle. The deal must be approved by the state Department of Justice, which denied Dartmouth's effort earlier this year to combine with GraniteOne, the parent company of Manchester's Catholic Medical Center. A report from the Charitable Trusts Unit of the Department of Justice found the deal would have hurt competition in the health care market, and denied the deal.

Asked Thursday about how the Valley Regional Hospital affiliation would avoid the same finding and the same fate, Dartmouth Health CEO Joanne Conroy said small, rural hospitals face a different set of challenges.

"In rural America, it's not necessarily about competition," Conroy said. "Nobody's fighting us for business in rural New Hampshire and Vermont. It's about creating a sustainable rural health system."

Small hospitals have found themselves under financial pressure, especially in parts of the country where the population is aging. More than 130 rural hospitals around the country have closed around the country since 2010, and many more have stopped offering services like mental health care, and maternity care. Those factors contributed to the 2020 bankruptcy of LRGHealthcare, the parent company of Lakes Region General Hospital in Laconia and Franklin Hospital before they were sold to Concord Hospital last year.

"We want to keep these rural hospitals in our network strong, thriving and sustainable," Conroy said.

Mt. Ascutney Hospital in Windsor, Vt., became a Dartmouth affiliate almost eight years ago. The Vermont hospital's CEO and chief medical office Joseph Perras said the Dartmouth affiliation had indeed stabilized Mt. Ascutney.

"You don't have that worry about the lights going off, or paying your vendors," Perras said during Thursday evening's hearing. "You can think a little bit further down the road."

In addition to a little more financial stability, Valley Regional Health CEO Jocelyn Caple said she hoped to see the affiliation bring services like behavioral health treatment and substance use treatment in Claremont, adding to the Dartmouth-provided services like cancer care that Valley Regional already offers patients.

The benefit for Dartmouth, Conroy explained, is maintaining a local network of hospitals that can treat patients with less-severe conditions, preserving Dartmouth-Hitchcock's capacity for the most serious care. Where Dartmouth is nearly always at full capacity, Conroy said, Caple said the 25-bed Valley Regional often only has 15 patients.

Caring for patients at Valley Regional could also help control costs, Conroy said, because it's generally less expensive than caring for patients at the academic medical center.

"Never enough talent"

The affiliation was pitched as another way to help recruit and retain health care workers and other staff for the smaller Valley Regional Hospital.

"There's never enough talent to go around," Caple said.

The Dartmouth affiliation can provide more advanced training for Valley staff, a closer connection to the nursing school at Colby-Sawyer College and the opportunity to get paid to pursue more advanced certifications, and a more defined career path for health care workers who want to move to a busy academic hospital, working on more acute patients in a more intense environment.

Doctors might also be drawn to Valley if they have the opportunity to teach Dartmouth's medical students and residents, Conroy said.

And having a hub in Claremont, where housing is somewhat more affordable than in Lebanon and Hanover, could help too.

Conroy said she did not think the merger would mean less competition for staff — workers will still have plenty of options both in health care and in other fields.

"All of us have nurses that drive long distances to work at our facilities," Conroy said, and it's fairly common for health care providers to commute to other parts of northern New England or into Boston. When pay goes up in Boston, Conroy said, she sees the impact in the Upper Valley.

Workers in other sectors, like food and environmental services, or in more entry-level positions, are seeing rising pay outside of health care, she said, so Dartmouth Health has to keep pay competitive. The health care group raised its starting pay to $17 per hour in October 2021.

"We have to stay ahead of the market," Conroy said, to be competitive on pay for people who could find less-stressful jobs outside of health care.