Community Divided over Proposed Dartmouth, Catholic Medical Center Deal

The proposed affiliation between CMC and Dartmouth’s Manchester clinic has raised a number of thorny ethical, financial and legal questions.

And it’s raised the hackles of many local residents.

Dozens of audience members sported blue ‘Save CMC” stickers.

They resurrected the slogan from a fight ten years ago over a failed merger with Manchester’s Eliot Hospital.

Opponents of this affiliation say they want to save CMC’s identity, autonomy and mission as a Catholic community hospital.

Manchester resident Lorraine Petit sees CMC as an integral part of her parish.

"Our founding sisters were grey nuns. Without them, we wouldn’t have a CMC. They were Catholic through and through. They were the ones that got us going. We have to stay Catholic because it’s meant to be Catholic."

The difficulties of combining a Catholic and a secular institution are many.

The two organizations want to affiliate for a variety of overt and not-so-obvious reasons.

Officials say they want to provide more and better care to the Manchester population, in particular to the underserved.

But some inside CMC say that the real reason is so both health care providers can better compete for limited health care dollars.

"I’m sure you all know that the health care system is very tenuous these days. We all read in the papers that hospitals are losing money, going under, running million dollar deficits."

That’s Rich Torossian, who directs a CMC lab.

He says reductions in Medicaid and Medicare reimbursements threaten the viability of community hospitals, including CMC.

The solution, he says, is to bring new patients – and therefore new revenue – into the hospital.

"You have to bring more patients into the system. This is what this affiliation does. It brings more patients into the system and it helps CMC be strong and vibrant… The affiliation, the purpose of this whole thing to save CMC, that’s the reason why we’re doing it."

Southern New Hampshire hospitals have a hard time attracting new patients, because most local areas have their own hospitals.

This deal will bring more Dartmouth doctors – especially specialists like neurosurgeons and oncologists – into Manchester.

And, as several physicians testified, having more specialty care in Manchester will mean very sick patients will no longer have to go to Boston.

And it will mean that CMC will be able to attract more patients from outside Manchester.

Alison Pitman Giles is CMC’s CEO.

"When the bigger things happen and they need to be in the cath lab or they need to have open heart surgery, they don’t hesitate to travel when it’s their heart. Or their brain. But they’re certainly not going to travel because they have a cough."

Furthermore, specialty care is expensive, and so this deal could boost the revenues of both providers.

With new specialists on hand, CMC is also likely to attract at least some patients from the nearby Eliot Hospital.

And so it was not surprising that Eliot representatives raised concerns.

Richard Gustafson is chairman of the Eliot Health System Board of Directors.

"How will this merger enhance patient choice and reduce costs to this community, and how will this merger meet the Federal Trade Commission’s restraint criteria?"

The Federal Trade Commission is reviewing the proposal to make sure the affiliation would not adversely affect the community.

CMC’s Alison Pitman Giles said patients will continue to choose their own health care providers.

But she did not directly address the question of cost.

Some health care observers say that provider consolidation drives up costs.

Giles disagrees.

For routine care, she says:

"People won’t go past a tollbooth to go to a hospital. So we’re not going to start monopolizing southern NH and having them all come to Catholic medical center."

Still, that’s one of the questions that the Federal Trade Commission -- and the New Hampshire Attorney General -- are both looking into.

CMC and Dartmouth expect a response from the FTC in a couple of months.

CMC and Dartmouth have scheduled a forum in Lebanon October 7 and another in Manchester in November.

For NHPR News, I’m EG.