The Granite State News Collaborative and its partners have undertaken a new series that explores who owns the hospital in your area, how that impacts your health and what kind of care hospitals offer. In addition to hosting “The State We’re In,” Melanie Plenda also serves as executive director of the Granite State News Collaborative, a group of more than 20 news organizations covering every corner of New Hampshire that tells stories that matter. The collaborative and its partners have been working on a new series, called “Critical Condition,” and it looks at the state’s hospitals, exploring how financial conditions impact the care we receive. Here to talk about the series is collaborative editor Jeff Feingold.
This article has been edited for length and clarity.
By Rosemary Ford and Caitlin Agnew
Melanie Plenda:
Jeff, tell our audience about the series and what it will take a look at.
Jeff Feingold:
It started with what's been going on in New Hampshire and all around the country actually — consolidation. In New Hampshire, larger hospital systems have been buying up hospitals over the last 20 years, but even more recently it's been more concentrated.
There used to be 26 independently owned acute care hospitals in New Hampshire, and now there are only five that are not affiliated. The rest are owned by Dartmouth Hitchcock, which has five other hospitals besides Dartmouth Hitchcock Medical Center, and HCA Healthcare, which is a giant for-profit corporation that owns hundreds and hundreds of hospitals and other health facilities around the country. They own four hospitals in New Hampshire. Other hospitals are owned by Beth Israel in Beth Israel Leahy and Mass General as well as Concord Hospital, which owns Laconia, which previously bought Franklin Hospital. So we're in that situation now where there's just more and more concentration of ownership of hospitals.
Melanie Plenda:
Why does it matter who owns a hospital? Or how many hospitals are owned by the same parent company?
Jeff Feingold:
There's a reason that these hospitals are merging. There have been financial problems in healthcare, as I'm sure all the viewers out there understand. The costs involved in health care have gone through the roof, and many hospitals can't really make it on their own anymore. So they find buyers, or buyers find them, and that's why there's consolidation. The consolidation allows them to streamline their services and look for more efficiencies with the goal of lowering costs and things like that. The issue in some cases, the owners are also making decisions to eliminate services at the hospital that they've acquired.
A perfect example is what happened in Rochester with Frisbie Hospital, which was being acquired by HCA. What they did was, after two years, eliminate labor and delivery services. That means that all those patients in need of labor and delivery services or another service that was eliminated have to travel to Portsmouth, which also happens to be an HCA hospital, or another hospital and find a new doctor. They also might have transportation issues, cost issues, because the hospital that they were used to is no longer offering the same services or the services that they require. That can make a big difference in a patient's life.
Melanie Plenda:
How has New Hampshire been affected by these hospital consolidations already?
Jeff Feingold:
That is what the project is about. There was a piece in The Boston Globe not too long ago about how EMTs and other first responders are being trained in labor and delivery techniques up in the North Country, because there's no obstetric care there. As we know, New Hampshire is infamous for having an inadequate transportation system, so it's really difficult for someone who has a lower income, who doesn't have a car, is elderly or is a disabled person to obtain services when a hospital no longer provides those services that they used.
Melanie Plenda:
What does this mean for those seeking health care in the state?
Jeff Feingold:
It's making it more difficult. It also is making it more expensive, because what happens is that when a service is more concentrated in an area, the prices will go up. That's one of the major concerns of people who watch hospital consolidation trends — the cost of health care — and it is continuing to rise even with these supposed synergies, as they say in the business world, the streamlining of these efficiencies.
Another concern is that insurance rates might also rise, because as these hospitals gain more power with the hospital systems they can negotiate rates differently than other hospitals with the insurance companies, and that means it's very hard to just keep track of that kind of stuff.
Melanie Plenda:
What role does the state government play in all this?
Jeff Feingold:
That is a major piece in our series. The initial story was written by Meera Mahadevan on how this whole consolidation thing works. It is an excellent piece — I recommend everybody to read it.
What she found is that one of the things we just don't know enough about is this hospital consolidation phenomenon because the state basically doesn't track this stuff. We used to have a process called a certificate of need process, and we had a Certificate of Need Board, which would approve all major acquisitions of technology, the big-high priced items, expansions and additions to hospitals. But back in 2016, the state eliminated it saying there were issues with the certificate of need process.
But what happened is the state no longer has an entity that keeps track of all that’s going on. What that has left us with is basically all the oversight of health care systems is provided by the attorney general, John Formella.
Melanie Plenda:
How is recent news impacting the series — or is it? For example, the recent cuts to Medicaid.
Jeff Feingold:
Unfortunately, New Hampshire hospitals rely on Medicaid funding because that's a steady flow of income. It's not as much money as they would get from a patient that has commercial insurance or can pay out of pocket, but it's still a steady flow of money.
With Medicaid cuts, that flow of money will be lower, and that'll affect hospital finances once again. What would happen is it may risk putting another hospital in the kind of position where it has to be acquired — or the worst case would be if it has to close — because they don’t have an adequate stream of income. I'd say it's another pitfall for hospital financial people to get through. It's not a good thing. It's a stream of income that is going to be lower, and that's not what the hospitals need right now, especially hospitals on shaky ground.
Melanie Plenda:
What stories have been done so far? What’s coming next?
Jeff Feingold:
The stories that have been done so far are the piece by Meera, and a second piece on the Health Care Consumer Protection Advisory Commission. She did a really thorough look at that, and that actually inspired us to do future stories, such as what's the deal with primary care in New Hampshire? Because a lot of primary care practices have shut down or there's just not enough primary care physicians in New Hampshire to provide for people to make appointments. She's also looking at the state of primary care in New Hampshire and what is basically happening with labor and delivery and other services as they are being cut.
Another piece that's coming up is an article by Paul Cuno Booth, formerly of New Hampshire Public Radio. We're lucky to have him working with us now. He's writing about the demise of that Certificate of Need Board, and, more specifically, what's going on with oversight. How is New Hampshire going to be able to get this information?
Another piece that we're working on is on the role of urgent care facilities, which is really interesting because it turns out because of this shortage of primary care physicians, people are going to urgent care, or they're even encouraged to go to urgent care, for what they used to go to for primary care support. That's a really interesting topic all by itself.
Melanie Plenda:
How can people follow these stories?
Well, they can certainly go to our website and check out our Critical Conditions page. But many of our partners are picking these stories up. I would encourage them to look there because I know that several of them pick up everything we've been writing on this, and just judging by the interest in these they're really eager to publish our work.
It's a story that affects a lot of people. A lot of people are interested and I think that we're coming up with some great information that people will be happy to find out about.
Melanie Plenda:
Interesting! Jeff Feingold, editor with the Granite State News Collaborative, thank you for joining us.
“The State We’re In” is a weekly digital public affairs show produced by NH PBS and The Marlin Fitzwater Center for Communication at Franklin Pierce University. It is shared with partners in the Granite State News Collaborative, of which both organizations are members. For more information, visit collaborativenh.org.