Process For Proposed LRH-Dartmouth Health Affiliation Extended

LITTLETON — Nearly a year after a public presentation was held for the proposed affiliation between Littleton Regional Healthcare and Dartmouth Health, the process, originally anticipated to have the needed state approval by mid-year, has been extended at the hospitals’ request.

Meanwhile, Dartmouth Health has experienced a recent $63.5 million deficit, and LRH has received a one-star rating from the Centers for Medicare and Medicaid Services (CMS), making LRH the only one-star hospital in New Hampshire for 2026.

Hospital officials addressed both as they gave their perspectives on the delayed affiliation, which ultimately must be approved by the New Hampshire Attorney General’s Charitable Trusts Unit, which also weighed in on the status.

Proposed Affiliation

In October at the Littleton hospital, Dartmouth Health and LRH officials held a community listening session, where Bob Nutter, president and CEO of LRH, and Joanne Conroy, president and CEO of Dartmouth Health (DH), presented what they said are benefits of an affiliation and LRH partnering with a larger healthcare system and becoming a member hospital of DH.

After affiliation, LRH would keep its independence, name, board of directors, money, mission, employees, physicians, and local donations, they said.

The benefits of LRH becoming a member hospital of DH, they said, are greater efficiencies and cost savings; greater purchasing power for equipment, insurance, and other expenses; shared doctors; improved employee recruitment and retention; continued investments in people, facilities and technology; maintenance of current programs and services; care kept closer to home; and better ability for LRH to navigate a continually changing healthcare landscape.

The partnership would also make LRH, as a rural hospital facing periods of financial and other challenges faced by all rural hospitals, more sustainable for generations to come, said Nutter and Conroy.

At the listening session, Nutter said that in the past 15 years almost 150 independent rural hospitals across the nation have closed as they encountered challenges ranging from recruitment and retention to investments.

In New Hampshire, major shifts in healthcare during the last few decades have led more hospitals to form or join systems, he said.

At the session, Ashley Garrison, chair of LRH’s board of trustees, said LRH is approaching the affiliation from a position of strength to ensure that it is set up to serve future generations of Littleton area residents.

In early 2023, four years after LRH withdrew from its affiliation with North Country Healthcare, the LRH board and administration began evaluating the benefits of partnering with a larger healthcare system.

In September, after a two-year study of various affiliation models, LRH’s board announced that a letter of intent had been signed with DH, its preferred partner, which oversees Dartmouth Hitchcock Medical Center (DHMC), a cancer center, children’s health, school of medicine, and nursing, rehabilitation, hospice, and personal healthcare services.

To date, DH has as members nine community hospitals and 30 clinics in New Hampshire and Vermont.

Next Steps

In June, the Valley News, citing a DH bondholder filing in May, reported that DH had a deficit of $63.5 million, largely driven by weather-related closures in February that reduced patient revenues, along with higher medication and labor costs.

While operating revenues increased by 8 percent, expenses spiked nearly 11 percent.

The deficit comes after two years of DH operating in the black. The last deficit, of $20 million, was in early 2025, before it was reversed.

DH is implementing a financial resiliency plan at DHMC to reduce costs and increase patient access, and has made gains to increase patient volumes and reduce different expenses, said DH representatives.

On Friday, Michael Garrity, spokesman for the New Hampshire Department of Justice, provided a response on behalf of the New Hampshire Attorney General’s Charitable Trusts Unit (CTU) about the status of the affiliation, for which the state could now issue a decision in late 2026.

“RSA 7:19-b, IV provides that CTU is to conduct its review and make its determination in a period not to exceed 180 days after receipt of notice,” he said. “CTU’s review period can be extended by agreement of the parties. Littleton filed the notice of transaction with CTU on April 20, 2026. CTU is aware of Dartmouth Health’s reported financial deficit. The parties have proposed an extension of CTU’s review period for six months, which is amenable to CTU.”

Audra Burns, spokesperson for DH, was asked about the status of DH’s financial resiliency plan, if the deficit led to the affiliation extension or was a factor, how DH will ensure that LRH patients are protected after affiliation, and if there are any concerns about LRH’s recent CMS one-star rating.

“Dartmouth Health (DH) and Littleton Regional Healthcare (LRH) have mutually agreed to a temporary six-month pause in the proceedings related to the affiliation agreement between the two organizations,” she said on Friday. “Both remain committed to LRH joining the DH system and are confident this brief pause will provide the opportunity for Dartmouth Health to focus on strengthening financial resilience.

“Healthcare organizations across the country are facing industry-wide challenges, including reimbursement pressures, inflation, and rising costs that continue to outpace revenue growth,” said Burns. “Taking time to address these issues through DH’s improvement work is essential to ensuring our long-term ability to provide high-quality care to the communities we serve.”

Nutter offered LRH’s perspective on the affiliation, including any concerns about DH’s deficit and how LRH will ensure patient care is maintained after LRH becomes a DH member hospital.

“Both remain committed to LRH joining the DH system and are confident that this brief pause will provide Dartmouth Health with the opportunity to focus on its improvement work,” he said.

LRH is aware that DH has implemented a financial resiliency plan at DHMC in response to short-term financial challenges stemming from reimbursement issues, inflation, and higher expenses, he said.

“LRH leadership continues to maintain constant communication with Dartmouth Health leadership and is confident that these current challenges will not affect the overall plans for the affiliation between our two organizations,” said Nutter.

He spoke of the continuity of care.

“LRH’s Board of Trustees began our partnership search with our patients’ and community’s best interests in mind, and they have been at the forefront of every decision throughout the affiliation process,” said Nutter. “Our Board is confident that Dartmouth Health remains the right partner for our organization. DH’s improvement work speaks to their commitment to addressing these issues and is essential to ensuring our long-term ability to provide high-quality care to the communities we serve.”

One benefit of joining a larger health system is the support each individual member receives, he said.

“I would encourage everyone to learn more about our proposed affiliation and its guiding principles by visiting our website or by reviewing the documents publicly available on the New Hampshire Department of Justice’s website,” said Nutter.

CMS Rating

Each year, CMS issues ratings of hospitals across the nation using five criteria: mortality, safety, patient experience, readmission rates, and timely and effective care.

The ratings, using 46 hospital quality measures, range from one star at the lowest to five stars at the highest.

In 2026, following CMS’s May update, there were 199 hospitals with one star and 384 hospitals with five stars.

Nutter spoke of LRH’s one-star rating for 2026.

“In late 2022, we implemented a new electronic health record system,” he said. “We faced conversion challenges that continued through 2024. Data that directly impacts our CMS Star Rating was also affected by these challenges. An independent, external audit confirmed that inaccurate and incomplete numbers were ultimately reported and used in the rating algorithm. Our Board Quality Committee meets regularly to review data and reporting to ensure we maintain the high-quality care our community deserves.”