The North Country is the sickest, poorest, oldest and most sparsely populated part of NH. Any one of these things would be a challenge to efficiently and effectively delivering health care, but taken as a whole they provide an enormous hurdle. That’s why the North Country’s four hospitals are considering an affiliation to better serve area residents.
The main goal of the proposed affiliation is to provide quality, local, accessible care to patients. A letter of intent has been signed by all four hospitals—Androscoggin Valley Hospital in Berlin, Littleton Regional Healthcare in Littleton, Upper Connecticut Valley Hospital in Colebrook and Weeks Medical Center in Lancaster—but the final details have not been decided.
Androscoggin Valley Hospital CEO Russell Keene says the affiliation is a proactive move to help the four hospitals deal with the barrage of changes occurring in the health care system and the unique challenges small rural hospitals face. These include the proliferation of accountable care organizations and risk-based contracts (a shift from fee-for-service to payments based on quality of care, which can lead to reduced reimbursements), the challenges of negotiating reimbursement rates with insurers as a small hospital (larger organizations have the numbers to negotiate better rates) and new requirements of the Affordable Care Act to manage care for a defined regional population (a size that could be the same as or bigger than the total North Country population). In addition, one of the four hospitals operated in the red in 2014 and a second was on the brink.
Keene says the proposed structure involves a parent nonprofit corporation with board members from all four hospitals. While the four hospitals will remain autonomous and keep their own programs, boards and financial structures, Keene says there will be some consolidation of administrative duties to reduce costs and provide better health care access. The exact details of what functions will be consolidated under the parent company and how many employees the parent company would have has not been determined. The new parent organization is anticipated to form in 2015.
This affiliation proposal follows a trend between NH hospitals in the past year. The reasons are often the same: Small hospitals face challenges with new payment models based on large patient populations, and decreased payments from Medicare and Medicaid. Last year, New London Hospital in New London affiliated with Dartmouth-Hitchcock Health Care in Lebanon. New London remains autonomous but integrated some of its governance, clinical services and administrative functions with Dartmouth-Hitchcock. Also last year, Memorial Hospital in North Conway affiliated with the MaineHealth System. And St. Joseph Hospital in Nashua expanded an existing affiliation agreement with Leahy Health in Massachusetts. Under the agreement, St. Joseph serves as a preferred medical provider for patients needing specialty care Leahy does not offer in NH.
Keene says the North Country hospitals have a history of working together. Two years, the three Coos County hospitals affiliated, with Androscoggin Valley and Weeks assuming management of Upper Connecticut Valley through a newly formed LLC (Littleton Regional Healthcare is based in Grafton County). The LLC provides a chief administrative officer for Upper Connecticut Valley. All three hospitals also share a home health care network. “The success of this initiative has led us to conclude that with Littleton’s capacity coming into the mix, we can do some long-lasting positive things,” Keene says.
To learn more about the proposed affiliation, visit northcountryhealth.org.
Current Issue - May 2024