July 2, 2009

Manchester medics cooperating, not merging
Dartmouth Hitchcock and CMC near formal agreement
By Jeff Mucciarone jmucciarone@hippopress.com

Dartmouth Hitchcock Manchester and the Catholic Medical Center have been collaborating for several years now. Officials at both institutions would like to continue that, even expand on it. But to do so, they need to legally formalize an affiliation so they can each and together provide the types of service the community needs, officials said.

The two entities have been working to iron out details on an affiliation — not a merger — for about a year and a half. They went public with a letter of intent in February. They expect to have a formal agreement ready for public review within a few weeks, officials said.

At the moment, the two are working out how to fit the two health care providers together without stepping on the toes of the religious and ethical directives of the Catholic Church, which the Catholic Medical Center (CMC) abides by.

Last week Dartmouth Hitchcock, which is based in Lebanon and also has locations in Concord, Nashua and Keene, announced the formation of a holding company, Dartmouth Hitchcock Health, that would oversee an affiliation between Dartmouth Hitchcock Medical Center and Mary Hitchcock Memorial Hospital in Lebanon. The two are located in the same building but are actually separate entities. The holding company provides the framework to allow other health care providers statewide to join the affiliation, said Dartmouth Hitchcock spokesman Jason Aldous.

Because CMC is duty-bound by the Church, CMC and Dartmouth Hitchcock needed a different framework for affiliating. To make it work, CMC would form its own holding company, Catholic Medical Center Health Care Systems, to oversee the potential affiliation between CMC and Dartmouth Hitchcock. Alyson Pitman Giles, president and CEO of CMC, would serve in the same capacity in the holding company, Giles said.

Giles approached Dartmouth Hitchcock in 2003 initially asking for help with pediatric coverage. That relationship sprung into several other collaborations. It became easier for both medical centers to access specialists. The two worked together to bring the Norris Cotton Cancer Center to Manchester in February 2008.

“Rather than try to compete, close each other down, build new buildings,” Giles said. “Why can’t we collaborate?”

But to do that, they needed a more “legally acceptable integration” that would include governance, finances and management, Giles said. The new CMC holding company would include trustees from both sides, but with the majority from CMC. Dartmouth Hitchcock personnel operating under the holding company would need to abide by the same directives as CMC, Giles said.

Roman Catholic Bishop John McCormack, of the Diocese of Manchester, would need certain reserve powers over the holding company, including authority over bylaws, mission statements, affiliations and appointments to the board and the position of hospital president, which the Union Leader reported and Giles confirmed. Giles said the two sides were still crafting their agreement around McCormack’s reserve powers.

In terms of patient care, Giles said big changes aren’t on the horizon.

“I don’t think you’ll see a change whatsoever in relation to physicians,” Giles said. “It will be pretty much invisible to the patient.”

Giles said there would be more tertiary specialists coming to Manchester that CMC previously may not have had access to.

Some have been particularly interested in the new West Side Neighborhood Health Center, which is on CMC property and is run by CMC but also includes Dartmouth Hitchcock staff. The center includes maternity care, a refugee care center, and now a new adult health care component.

“We’re both committed to the care of the poor,” Giles said, adding that the new health center has already helped deliver babies for 250 mothers without health insurance. “We’re trying to do the right thing and really take care of the six or seven thousand people who would otherwise fall through the cracks.”

Officials have said they hope to have a formal affiliation agreement in place by the end of the year.

What the proposed affiliation between Dartmouth Hitchcock and CMC means for the Elliot Health System in Manchester remains unclear.

Rick Phelps, Elliot executive vice president, said Elliot has spent many years trying to more tightly affiliate with Dartmouth Hitchcock. Phelps said it seems Elliot was looking to affiliate with Dartmouth Hitchcock along much the same lines as CMC is now, the focus being to bring a greater array of services to the Manchester area so patients don’t have to travel so far.

“It is a natural integration,” Phelps said of Elliot and Dartmouth Hitchcock. “I don’t understand why it didn’t work out.”

Elliot agrees that health care reform should include greater integration of services regardless of which institution is providing them. At its core, Elliot supports anything that improves the cost and quality of health care, Phelps said, adding Elliot will continue to look to partner with health care providers that share their vision.

“In terms of end results, I fail to see where Dartmouth Hitchcock’s attempts to affiliate with CMC differs from our attempts under Optima Health,” Phelps said. Elliot and CMC attempted to merge in the 1990s, but the merger ultimately failed.

CMC says the Dartmouth Hitchcock affiliation will be different since there won’t be any relocation or elimination of services.

In regard to Dartmouth Hitchcock Health, Aldous said the holding company allows Dartmouth Hitchcock Medical Center and Mary Hitchcock Memorial Hospital to operate more effectively together. It also provides a framework for future affiliations with other health care providers. Instead of building a new facility to compete with an existing entity, two or more health care providers could lease space or staff to fill a need, Aldous said.

“It allows us to be more comprehensive,” Aldous said.

Given the rural nature of much of New Hampshire, many places don’t have the population base to support full-time specialists. But maybe there is a need for a specialist a day or so per week in a given area. Under this type of framework, a specialist from a medical provider could use space in a Dartmouth Hitchcock building, or vice versa.

“It’s really a paradigm shift,” Aldous said. “We’re still competing in other areas. Is there a way to compete that makes sense for both of us and collaborate in other ways that make sense for everybody?”

“This is very much the first step in the journey,” Aldous said of Dartmouth Hitchcock Health.