Dartmouth Health’s already significant influence in the Vermont healthcare market is expected to grow next year with the addition of Southwestern Vermont Health Care.
The board of the smaller network, which includes a hospital in Bennington and medical clinics in Manchester, Pownal and Wilmington, approved an “integration agreement” in late November that would allow it to become a member of Dartmouth Health, according to a email to the staff of SVHC’s president and chief operating officer, first reported by Bennington Banner.
“Over the next 90 days, the two organizations will meet with state officials and regulators, so that we can formally close the deal,” the email reads.
Dartmouth Health is the parent organization of the Dartmouth Hitchcock Clinic and Mary Hitchcock Memorial Hospital, which form the Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, and more than two dozen other not-for-profit and for-profit entities. These include Mt. Ascutney Hospital in Windsor and other smaller hospitals in New Hampshire in Lebanon, New London and Keene, all of which have joined over the past 15 years.
Dartmouth Health Network is about the same size as UVM Health Network in terms of employees and patients served, but about three-quarters of Dartmouth’s patients come from New Hampshire. It serves a much smaller percentage of Vermont patients than the UVM network, but that could change.
Southwestern Vermont Health Care has worked closely with Dartmouth Hitchcock Medical Center for a decade. Its clinics in Manchester and Wilmington are already called Dartmouth Health clinics. Its cancer center and several other medical departments are already jointly operated by the medical center and doctors in the area are all affiliated with Dartmouth Hitchcock, an academic medical center linked to Dartmouth College’s Geisel School of Medicine.
According to statements from both organizations, further “integration” of Southwestern Vermont Health Center into Dartmouth’s health system would provide several additional benefits to its 75,000 patients. Patients come largely from Bennington and Windham counties in Vermont and Rensselaer County in eastern New York and Berkshire County in northwestern Massachusetts.
In particular, becoming a member of Dartmouth Health would allow Southwestern Vermont Medical Center to become a “regional referral hospital” and integrate with Dartmouth’s electronic medical records platform. The move would allow SVHC to “participate in numerous initiatives such as joint purchasing, expansion of telemedicine services, education and research to name a few,” SVHC’s statement said.
Although the Green Mountain Care Board regulates hospitals, it does not oversee
memberships. The main regulatory hurdle to the integration deal appears to be potentially a review by the Public Protection Division of the Vermont Attorney General’s office.
Because SVMC is a not-for-profit company, such scrutiny would be triggered if the deal involves transferring “all or substantially all” of its assets to another organization, said Lauren Jandl, chief executive. office of the attorney general’s office. The review would only consider whether the transfer is consistent with the nonprofit’s original mission and any restrictions on assets.
SVMC staff declined to comment on the impact of affiliation on its governance and debt structure. The Southern Vermont Medical Center is halfway through a $28 million expansion and upgrade to its emergency department.
New Hampshire law allows the Charitable Trust Unit of its attorney general’s office to conduct a more rigorous review of transfers between nonprofit health care organizations, including considering whether the transaction is in the best interests of the the community served. It was under this standard that the office rejected a deal that would have allowed an affiliation between Manchester Catholic Medical Center and Dartmouth Health earlier this year, saying the affiliation would “adversely impact competition”.
Recent research has consistently shown that consolidation among healthcare providers is linked to increased costs charged to insurers. Americans spend about twice as much on health care per capita as other similarly developed countries.
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