Gov. Chris Sununu signed a bill in late July that will increase scrutiny of health care mergers, such as the proposed combination of the parent organizations of Lebanon’s Dartmouth-Hitchcock Medical Center and Manchester’s Catholic Medical Center.
Under the new law, House Bill 552, the director of the New Hampshire Charitable Trusts Unit has specific authority to ask merging health care organizations how the transaction will affect the community’s “access to quality and affordable physical and mental health care services.”
It also increases the time the director has to review these proposed transactions and requires more than one public hearing on the proposals.
“Anytime New Hampshire’s health care providers merge or affiliate, it only makes sense for the state to ensure that these transactions will benefit patients; especially those needing mental health or (substance use disorder) services,” Sununu wrote in a statement on July 29 after he signed the bill. “House Bill 552 provides the State with the ability to examine these arrangements to ensure that they result in lower costs to patients with a higher quality of care.”
The legislation, sponsored by state Rep. David Luneau, D-Hopkinton, aims to clarify the director of Charitable Trusts Unit’s ability to ask these questions after the parent organizations for two hospitals in southern New Hampshire, Elliot Hospital and Southern New Hampshire Medical Center, objected to when current Charitable Trusts Director Tom Donovan asked them during a review of the merger that led to the creation of SolutionHealth last year.
Though Elliot and Southern New Hampshire responded to the questions in spite of their objection, health care advocates in the state hope the new law will avoid such objections in the future.
“Especially given the fact that a lot of the hospitals are now the hubs of the hub and spoke model for the opioid treatment to deal with the opioid crisis ... if the hospitals aren’t willing to answer questions, what does that mean for the hub and spoke model?” said Holly Stevens, health policy coordinator for the Concord-based New Futures, a health care advocacy group that supported HB 552.
The question of how the Charitable Trusts Unit reviews these transactions is under scrutiny because health care mergers have become more commonplace in New Hampshire and nationally. At the same time, their value to consumers has been brought into question. For example, an analysis conducted by the Nicholas C. Petris Center at the University of California at Berkeley for the New York Times last year found that mergers have the effect of eliminating competition, which allows prices to rise.
“Even though the hospitals say when they merge costs will go down (that’s) not what the research is showing,” Stevens said.
Though the law is a relatively minor tweak to an existing statute that outlines the director’s responsibilities in reviewing such transactions, Luneau said, “It’s more than window dressing.”
This ability is essential, he said, to ensuring that the public interest in these nonprofits is represented.
“This is in the public trust,” Luneau said. The “shareholders are the taxpayers of New Hampshire.”
Elliot and Southern New Hampshire said, through spokeswoman Susanna Fier, that they support the fundamental principles behind HB 552. But they also said they don’t see a problem with the review they went through to create their combined system.
“We have welcomed the opportunity to provide all of the information asked of us by the Director of Charitable Trusts relating to our combination relationship,” Fier wrote in an email. “We have every reason to believe that the Director has been satisfied with our submissions to date as no further inquiry has been made since our comprehensive and transparent responses to each of his questions. In fact, he has stated that we have met the statutory requirements.”
For their part, even though the New Hampshire Hospital Association and some of its members including Dartmouth-Hitchcock opposed the bill as it was initially proposed, they said last Wednesday that they came around to support it.
“Whether under existing law or as revised by HB 552, we will continue to satisfy the requirements that govern our efforts to combine with other health systems for the advancement of health and healthcare in New Hampshire,” D-H spokesman Rick Adams said in an email.
By way of example, Adams pointed to D-H’s role in the hub and spoke model known as Doorway-NH to address addiction issues and to efforts to integrate mental health care into primary care.
“We have long been engaged in behavioral health solutions, statewide,” he said.
D-H and GraniteOne Health, the parent organization that includes Catholic Medical Center, announced their intent to combine efforts last January. They plan to file with the Charitable Trusts Unit in the fall, Adams said.