Editor’s note: This commentary is by Richard Slusky, of South Burlington, who was the CEO of Mt. Ascutney Hospital and Health Center in Windsor from 1982 to 2010.
‘The interim CEO of the financially strapped Springfield Hospital says its financial structure is unsustainable and its survival will be ‘virtually impossible’ unless it merges with other hospitals in its region.” VTDigger, Aug. 28
As a former CEO at Mt. Ascutney Hospital and Health Center from 1982-2010 who was involved in a number of merger discussions, I thought it might be interesting for readers to know that efforts to merge these three hospitals, MAHHC, Valley Regional Hospital and Springfield Hospital, began over 50 years ago, and as is now apparent, none of these efforts have succeeded.
I don’t think it’s a secret that, given the presence of Dartmouth-Hitchcock in Lebanon, New Hampshire, there are probably more acute hospital beds than are needed in the Upper Connecticut River Valley of Vermont and New Hampshire. Hospitals serving this region include Alice Peck Day Memorial Hospital in Lebanon, New Hampshire; Mt. Ascutney Hospital and Health Center in Windsor, Vermont; Valley Regional Hospital in Claremont, New Hampshire; and Springfield Hospital in Springfield, Vermont. The four community hospitals serve the towns of Windsor, Claremont, Lebanon and Springfield and a number of small towns that surround them on both sides of the Connecticut River. Three of the four hospitals are currently part of the Dartmouth-Hitchcock alliance, with Springfield being the exception.
Historically, this part of Vermont and New Hampshire was known as the “Precision Valley” because of the presence of large manufacturing companies located in the region. The American Precision Museum in Windsor is an interesting place to explore the history of this region, which gained an international reputation for precision manufacturing.
Unfortunately, manufacturing in this region came to a screeching halt in the mid-1980s when many of these companies lost business to overseas competition and almost all of the manufacturing base in the area was lost. As a result, hospitals became, by default, the largest employers in the towns, and a very significant resource not only for health care, but for the jobs and ultimate survival of the communities they serve.
However, concerns about the number of beds in the region and the duplication and cost of health care services did not begin in the 1980s. As a matter of fact, in the late 1960s regional health care planners received nearly a million dollars in a federal grant (the Abenaki Plan) to study the feasibility of consolidating three aging hospitals, (Windsor Hospital, Claremont General Hospital and Springfield Hospital) into one new facility to be located on Lover’s Lane in Charlestown, New Hampshire. Confidence in the implementation of this plan was so high that several surgical practices serving the hospitals actually bought land adjacent to the proposed site and built professional office buildings to house their medical practices.
Unfortunately for them, and I suppose for the region, community opposition to the idea of closing the three hospitals and relocating them into one facility was so great that the plan had to be scrapped and the new hospital was never built. Although none of the hospitals would have been able to meet current facility standards, each of the communities was determined to keep their local hospital and were unanimously opposed to the regional plan.
As a result, despite opposition from state health planners, in 1972, the Windsor community raised over $800,000 to replace the old wood-framed Windsor Hospital located in the center of town, and built a new building about a mile outside of town on donated state prison land without any federal or state money. A former administrator told me the story about how state health planners were meeting with the Windsor Hospital board to tell them that a new hospital would never be built in Windsor while trucks were rolling down Main Street to the hospital construction site. It’s hard to deny a Vermont community that is determined to have its way.
In the same time period, Claremont General Hospital was modernized and renamed Valley Regional Hospital to better reflect the regional nature of its services, and Springfield Hospital was also updated to better serve its community. With the investment of several millions of dollars in these hospital upgrades, the Abenaki Plan was dead, and the die was cast for the future of health care services in the Upper Valley.
This, however, is far from the end of efforts to merge these hospitals. In 1982, I was hired as the CEO of MAHHC, but just before I officially settled into the position, I was invited to meet with the CEOs of Valley Regional Hospital and Newport (New Hampshire) Hospital to discuss a possible merger of our organizations. The plan was to agree to merge the hospitals as a bulwark against the expansionary plans of Mary Hitchcock Memorial Hospital (now Dartmouth-Hitchcock) for the sake of our collective survival. This was my introduction to hospital relations in the Upper Valley.
When I brought this proposal to the MAHHC board, it was made clear to me that MAHHC had an affiliation agreement with Mary Hitchcock that was working just fine, and that there was no interest in merging with Valley Regional and the other area hospitals. From the board’s perspective, our future was much more secure in a relationship with Mary Hitchcock than in any relationship with the other community hospitals. I should note that this was the case despite the fact that most of our medical staff also had privileges at Valley Regional and vice versa. Clinical collaboration was fine, but administrative collaboration — not so much.
Several years later, I was approached by the CEO of Springfield Hospital about a possible merger, but when I jokingly suggested that I would be honored to have someone like him work for me the discussion quickly ended.
In the late 1990s or early 2000 another attempt to merge the hospitals took place when the three hospital boards agreed to each contribute $50,000 toward a feasibility study with the purpose of evaluating the possibility of consolidating acute hospital services into one centrally located facility. The study would also explore the possibility of repurposing the existing facilities to provide urgent care services, community-based primary care, and other services such as acute rehabilitation, nursing home care, and inpatient mental health services.
The completed study included a plan to construct a modern up-to-date facility which would be centrally located. Among other benefits, this would make it possible for surgeons who were traveling from hospital to hospital and would often be on-call for three hospitals at the same time to have all their services and staff located in one facility. The study also identified significant cost savings in both clinical and administrative services, but would have required significant reductions in staff from each of the hospitals.
A site was identified in New Hampshire just off the Interstate 91 Ascutney exit on farmland adjacent to the Connecticut River. Unfortunately, this plan failed when the CEO and board of Springfield hospital decided that the location was not sufficiently accessible to Springfield residents. I want to be clear that even if Springfield had agreed to the site location, it is far from certain that the other hospitals would have agreed to implement the plan. It was a good excuse which allowed MAHHC and Valley Regional to avoid the same community outcry that greeted the Abenaki plan in the 1960s.
Ironically, the company that conducted the study was a subsidiary of Quorum Health Resources, which employs Michael Halstead, Springfield Hospital’s interim CEO, who is now calling for a merger of the three hospitals with the support of Dartmouth-Hitchcock.
One other attempt during my tenure occurred when the CEO of Valley Regional Hospital announced that she would be retiring and that this might present an opportunity to consider the consolidation of administrative services among the two hospitals. Once again, a consultant was engaged and financial plans and organizational structures were evaluated by the boards, and once again agreement could not be reached.
So, with Springfield Hospital in bankruptcy and in jeopardy of closing, here we are 50 years later, seeking once again to redefine the relationships among these regional hospitals. I suppose it’s worth trying again, but I fear that the cultural and competitive dynamics between the communities, the financial considerations, location of services, and control issues will make it just as hard today as it has been over these many years to make this work. I think ultimately, the key rests with Dartmouth-Hitchcock to determine what leadership it can provide, how much risk it is willing to take and what commitments it can make to ensure, not necessarily the survival of the neighboring hospitals in their current form, but rather that adequate and accessible health care services will continue to be provided to residents of the Upper Valley.
Perhaps this time they will succeed.
