Peterborough Hospital's Incoming CEO Discusses Priorities

PETERBOROUGH — Monadnock Community Hospital announced earlier this month that its Chief Financial Officer Richard Scheinblum would become the facility's new CEO following Cyndee McGuire's retirement.

Scheinblum, who has been at the Peterborough hospital for 25 years, has 31 years of experience in health care and is scheduled to start as CEO on March 1. He is also on the boards of the Greater Monadnock Collaborative, Monadnock United Way and the N.H. Hospital Association.

He enters his new role at a crucial moment for the 25-bed critical access hospital. The hospital is anticipating a $4 million to $5 million loss for Fiscal Year 2025, $1.5 million to $3 million of which Scheinblum estimates comes from lower reimbursements from Medicare Advantage plans. A critical access hospital is a designation given by the Centers for Medicare and Medicaid Services to rural hospitals with 25 beds or less; these hospitals are reimbursed based on the actual cost of their services instead of fixed Medicare fees that are typically lower than the cost of service. However, this does not extend to Medicare Advantage plans, which are funded federally but managed privately.

Monadnock Community Hospital is also preparing for the impacts of the federal One Big Beautiful Bill Act, which was passed in July. It contains the largest ever cut to Medicaid, as well as a Rural Transformation Fund that the N.H. Department of Health and Human Services says will bring $100 million a year to New Hampshire over a five-year period.

The Sentinel spoke with Scheinblum on Dec. 23 about his hopes in his new leadership position, and how he'll confront the hospital's challenges.

This interview has been edited for length and clarity.

Elijah de Castro: What are some of your goals as the new leader of Monadnock Community Hospital, and what direction do you want to take it in?

Richard Scheinblum: I've been very fortunate in my career [and] in my 25 years at Monadnock [Community Hospital] to work with two excellent CEOs that are my mentors. ... I've really learned some lessons along the way. There's going to be a lot of change coming in health care, especially rural health care, and it's gonna start after the first of the year. I think that things are gonna move at a fairly quick pace. ... Some of it right now, for me, is connecting with folks especially around the Rural [Health] Transformation funds; the state is going to be getting $100 million-plus to transform rural health care. What I've been working on for a year is making sure we have all the proper controls in place. I have a feeling through the RTF, you're going to see a lot more automation in health care, and I want to make sure that we can handle that right, and handle it safely and effectively. If we introduce new tools to assist with patient care, we [need to] understand those tools and make sure that people are educated on those tools.

de Castro: You've been [at MCH] for over 20 years. How are you going to leverage your knowledge that you've built up over the years in the decision making that you make on behalf of the hospital?

Scheinblum: When I started here in 2000 as controller, we had some financial difficulties. Our balance sheet wasn't where it is today, our capital structure at the time really wasn't where it needed to be, and our hospital needed a lot of investment. ... Over time with my experiences at Monadnock [Community Hospital] under the leadership of two excellent CEOs, we've slowly invested in certain things at the hospital like our infrastructure and our building, and we've been very fortunate that the community has been supportive of that. ... Just because of retirement, half my team is going to be new. Making sure that we have a cohesive team is important to me. For me, I just want to continue the path that my mentors have set that have set us up for success. We talk about innovation in health care, and innovation, to me, is just making improvements. Health care in this country has a lot of opportunities for improvement, and that's what we've done at Monadnock [Community Hospital].

de Castro: Monadnock Community Hospital is a critical access hospital. How does being a critical access hospital help the community there, and how does it change how the hospital functions? 

Scheinblum: When we converted to critical access hospital status, that was in December 2004. ... That changed our reimbursement scheme to cost-based reimbursement. We file a Medicare cost report every year that we settle on. When we converted, that was worth about $5 million a year to our community, so it gave us more flexibility. We [had been] a PPS [Prospective Payment Systems] hospital, like many of the larger hospitals that are around us. [But] we don't have the scale of a Dartmouth or a Catholic Medical Center or those places. [Being a critical access hospital] gave us extra reimbursement so we could invest more in services and things like that. With that, there's certain things we have to do like have an emergency room, and we can only have 25 inpatient beds. ... With that said, the whole Medicare Advantage issue, that concerns me. We don't get reimbursed as cost-based [by Medicare Advantage] reimbursement, like traditional Medicare. We have a high Medicare population, and I'm already seeing up to 40 percent Medicare Advantage right now. ... I'm expecting from government reimbursement a 15 percent decrease without intervention for my Medicaid and Medicare reimbursement. ... We're one of the only independent hospitals in the state, so I don't have the scale again to necessarily swallow this [loss] without help. ... You see rural hospitals across the country that have gone out of business, things like that, because of some of these reimbursement challenges and challenges to actually bring care to their communities. I enjoy being independent, and I enjoy the challenge, and I enjoy supporting our staff. I enjoy supporting our community in that capacity. Other places don't have the flexibility that we have because of our relationship with the community.

de Castro: What relationship do you want people in the community to have with Monadnock Community Hospital?

Scheinblum: First of all, we're considered a public trust so we're here for the community. Both the last two CEOs that I've worked for have built deep relationships with the community. I want to continue that. ... I want to have open dialogue and conversations about health care in the community, so that they understand what we do here.

de Castro: What are some of the top community health issues that you have on your mind as you step into this role?

Scheinblum: Number one is mental health. We employ a psychiatrist, we employ a couple nurse practitioners [and] social workers. Many hospitals can't afford to do that. ... I also think that we need to have a conversation about substance abuse. Unfortunately, mental health is not reimbursed very well and there's not a lot of access to it. So I'm hoping to work with my team to continue to build on the foundation that we already have. That's important to me. As our population gets older, chronic disease management [for things] like hypertension. ... Management for things like hypertension and some other chronic diseases, that costs this country a lot of money. ... I'm hoping that we can continue down the path of doing some things around, say, those programs. ... We're one of the only critical access hospitals that does OB [obstetrics], women's services — again, not reimbursed very well, but very vital to the community. ... We've been discussing housing at the board for years, partnering with others to bring more housing for [the] workforce.