NHHA      What's New

October 12, 2011
In This Issue
Medicaid Proposal Will Limit Patient Services, NHHA Says
Lean Management Topic at Annual Meeting
Deficit Reduction Talks Prompt NHHA Letter to Congressional Delegation
NHHA Names Officers, Trustees
Healthcare Leaders Honored
Health Information Organization Moves Ahead
Four New Executives Join NHHA, FHC
NHHA on Social Media
Quick Links

Find us on Facebook  Follow us on Twitter  View our videos on YouTube

Join Our Mailing List
NHHA Says Medicaid Proposal will Limit Outpatient Hospital Services  

The NH Department of Health & Human Services (DHHS) proposes to limit outpatient hospital services for each Medicaid recipient. The Public Notice and proposed rules state that the current maximum of 12 outpatient hospital visits per year per recipient will be limited to four visits to hospital Emergency Departments and eight visits to non-emergency outpatient hospital settings. Medicaid will not pay for services provided beyond these limits.

DHHS states that the reason for this "reallocation" of the current 12-visit limit is to improve health outcomes by reducing ED visits for non-emergent conditions while encouraging the use of primary care and urgent care centers.  However, there will be exceptions for appropriate emergency medical care beyond the four-visit limit as well as for medical services related to screening exams in the ED.  

For the NHHA, three primary areas of focus include:
  • Primary Care Access: Unless and until every Medicaid patient is guaranteed access to a primary care provider, they are more apt to use hospital EDs for non-emergency care. This will leave hospitals bearing the cost of all Medicaid ED visits beyond the first four.  
  • Definition of Emergency: DHHS does not state how Medicaid will determine whether services provided in the ED qualify for payment.  Therefore, NHHA will request that the final rule describe how NH Medicaid will ensure that payment is made for appropriate care, including screening services, provided in the ED without penalizing the provider and/or the recipient.  
  • Managed Care: NH Medicaid expects to implement a managed care program by July 1, 2012.  NHHA will request whether DHHS intends to repeal this rule once all Medicaid recipients are enrolled in a managed care plan and are provided a primary care medical home and care coordination.

The NHHA will testify at the public hearing on Oct. 21 at 10 a.m. at DHHS headquarters at 129 Pleasant St. in Concord, as well as submit written comments. For those who wish to submit their own written comments, submissions are due on Oct. 31, and should be forwarded to Michael Holt, Rules Coordinator for the DHHS Administrative Rules Unit, 129 Pleasant St., Concord NH 03301 (or via e-mail to michael.holt@dhhs.state.nh.us).
Kaplan Espouses
 Lean Management at NHHA Annual Meeting

Dr. Gary Kaplan
Keynote speaker Dr. Gary Kaplan

Lean management was the focus when Dr. Gary Kaplan, chairman and CEO of the Virginia Mason Medical Center in Seattle, delivered the keynote address at the New Hampshire Hospital Association's 77th Annual Meeting last month. 


"Most places are focused on lean as a quality improvement method or as a process improvement method," he said. "For us it's our management system. It's how we run our entire organization; whether it's the finance department, the IT department, the critical care unit, inpatient services, or primary care. It's a management system. 


"What I do is work on taking out waste," he added, "improving quality and safety at every opportunity. I'm much more focused on that. I'm making sure we have staff engagement to allow that to happen, and focus on execution and results. While those are all things that conventional leaders do, lean has given us a method by which to focus."  


Kaplan's keynote speech was one of many highlights at the annual conference, which also included panel discussions on "Providing Accountable Care in New Hampshire," which was moderated by Mindy Hatton, senior vice president and general counsel with the American Hospital Association; "Lean Management for Hospitals," moderated by Pat Maguire, RN, Senior Kaizen Specialist, MetroWest Medical Center and "The Future of Healthcare Financing," which was directed by Denny Roberge, Executive Director, Revenue Cycle Solutions - MedAssets.  


Rick DiFilipi
Richard de Filippi. PhD

The program also featured an address by Richard de Filippi, PhD, who discussed his experience with Massachusetts' landmark 2006 health care reform legislation. As past Chairman of the Board of Cambridge Health Alliance, he spoke of the challenges that the health care reform law presented to that organization and how the Board dealt with those challenges to ensure that they could continue to meet the needs of their patients and their communities. 

Hospital Association Reaches Out to Congressional Delegation on Deficit Reduction Concerns

In response to proposals that President Obama put before the Joint Select Committee on Deficit Reduction on Sept. 19, NHHA President Steve Ahnen immediately expressed the concerns of the hospital association's members in letters to the New Hampshire Congressional delegation.

"The President's proposals will impact all sectors of healthcare," Ahnen explained, "including major changes to Critical Access Hospitals (CAHs), rehabilitation hospitals, nursing homes and home health agencies. We are very concerned that Medicare and Medicaid funding to hospitals is at serious risk.

"Specifically, the President's proposals would cut indirect medical education payments by 10 percent, change cost reimbursements to Critical Access Hospitals, revert back to an old reimbursement policy for physical rehabilitation hospitals and deny CAH status to hospitals that are located within a 10-mile radius of another facility. For hospitals in New Hampshire, these proposals are very troubling.

"Hospitals understand the economic realities facing our nation and the State of New Hampshire," Ahnen added, "but these cuts will come on top of the more than $250 million in Medicaid cuts adopted as part of our State budget.

"We all agree that the current state of the healthcare delivery system is unsustainable, but continuous cuts of this magnitude will have a debilitating effect on our ability to plan for effective change that is needed for a viable future for hospitals and the patients we serve. And, in light of what's happening right here in New Hampshire with dramatic cuts in Medicaid reimbursement to hospitals, this is clearly not a time to add to that burden."

Executives from the NHHA have already met personally with staff aides representing all four members of the State's Congressional delegation, and productive talks are continuing.



New Officers, Trustees named by NH Hospital Association


The member institutions of the New Hampshire Hospital Association elected officers and trustees for its Board at its annual meeting, with Nancy Formella, President of Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock in Lebanon, elected Chairman of the Board of Trustees.


Anne Jamieson, CEO of Portsmouth Regional Hospital was elected Vice Chair, while Art Nichols, President of The Cheshire Medical Center in Keene was elected Secretary-Treasurer of the Association. Newly elected trustees include:


  • Peter Gosline, CEO of Monadnock Community Hospital, Peterborough;
  • Henry Lipman, Executive Vice President of LRGHealthcare, Laconia;
  • Scott McKinnon, CEO, The Memorial Hospital, North Conway; and
  • David Ross, CEO of St. Joseph Hospital, Nashua.

Four trustees re-elected for additional two-year terms are:

  • Scott Howe, CEO, Weeks Medical Center, Lancaster;
  • Bruce King, CEO, New London Hospital, New London;
  • Rick Phelps, MD, Executive Vice President and Chief Operating Officer of Elliot Hospital, Manchester; and
  • Warren West, CEO, Littleton Regional Hospital, Littleton.



Healthcare Leaders Honored by NH Hospital Association


Outstanding leaders in health care were recently honored during the New Hampshire Hospital Association's (NHHA) annual meeting. 

Wendy Gladstone
NHHA President Steve Ahnen presented the James A. Hamilton Founder's Award to Wendy Gladstone, MD.
Wendy Gladstone, MD, of Exeter Hospital received the James A. Hamilton Founder's Award, the New Hampshire Hospital Association's highest honor which is presented only as appropriate for outstanding service to health care on behalf of the people of New Hampshire.


Dr. Gladstone has been a long-time advocate for children and families since she began her medical practice in 1978. She was medical director of Seacare, a non-profit organization that provides assistance to local families who cannot afford health insurance. She also serves as chairperson of the NH CARE network - comprised of physicians and nurse practitioners who provide medical services to NH children. She also authored the section of the New Hampshire Attorney General's protocol for the medical evaluation of child abuse and neglect.


Frank McDougall, vice president of government relations at Dartmouth-Hitchcock Medical Center, received the Leslie A. Smith President's Award, bestowed upon an individual who has made an exceptional contribution to the NHHA.

Mr. McDougall is a vocal participant in NHHA's Advocacy Task Force, which deals with a range of legislative issues. He shares his technical expertise and his political savvy in support of all hospitals in New Hampshire both at the federal and state levels.

Wayne Granquist, a member of the board of Dartmouth-Hitchcock Medical Center in Lebanon, was recognized for his exemplary performance in hospital governance with the Outstanding Trustee of the Year Award. Mr. Granquist is described as a visionary leader, collaborator, expert negotiator and tireless advocate for Dartmouth-Hitchcock Medical Center. During his 11-year tenure as a trustee, he demonstrated a steadfast commitment to the organization's vision to achieve the healthiest population possible.

The Cheshire Medical Center received the first ever Healthy Eating Active Living (HEAL) Award. This new award was created to recognize a Hospital Association member organization that has demonstrated significant progress in making the healthy choice the easy choice for its employees, patients and the community.

Cheshire Medical Center was cited for re-thinking and reforming the links between and health and health care delivery, and demonstrating a sustained commitment to healthy eating and active living.


Stephen Jordan, MD, of New London Hospital was presented with the Medical Staff Award for outstanding service to hospital and community. The honor is bestowed upon a medical staff member from an NHHA member institution whose professional performance has strengthened the cooperation between the hospital and the medical staff, and who brings credit to the institution and the community. Dr. Jordan is a 28-year member of the medical staff at New London Hospital. He has served several terms as the Chair of Medicine and the President of Medical Staff and has also served on the hospital board of trustees for five years. Dr. Jordan consistently strives to understand the different work experiences between newly hired physicians and those who began practicing medicine many years ago.



NH-HIO LogoHealth Information Organization Moves to Implementation Phase  


The New Hampshire Health Information Organization (NH-HIO) - the product of a $5.5 million federal grant to the Department of Health and Human Services for the New Hampshire Health Information Exchange Planning and Implementation Project (HIEPI) - has moved into its implementation phase.


According to Kathy Bizarro, Executive Vice President of the NHHA, the move was made possible when House Bill 489 was passed by the NH General Court, which officially formed the NH-HIO. The bill outlined the governance structure and established the organization as a "public instrumentality" (similar to NH Healthy Kids). The board has two hospital representatives - one each from CAH and large hospital - plus several other healthcare organizations, six legislators and three at-large members. The NHHA and several hospital representatives participated in the drafting of the bill language and were supportive of the bill.


The first organizational meeting for the NH-HIO was held on August 30, and it has since established its board officers. Future board meetings have been scheduled with meetings set up for twice a month for several months.


The NH-HIO is being formed as a 501(c)3 organization and will hire an executive director and issue a request for proposals for a technical vendor to support the establishment of health information exchange. Several other organizational milestones are under development.


The long-range goal is that the NH-HIO will take over all aspects of the federal grant requirements from the NH DHHS and become the State Designated Entity (SDE) for New Hampshire should it meet all of its organizational milestones.


Work group meetings are on-going, and the NHHA continues to work closely with the hospital CIO group to share on-going progress of the NH-HIO and to solicit input and feedback.



Four New Executives Join Hospital Association and Foundation for  

Healthy Communities


The New Hampshire Hospital Association and the Foundation for Healthy Communities have added four new staff members. They include:

  •   John Clayton of Manchester, who has joined the NHHA and Foundation as Vice President for Communications. John was an award-winning reporter and columnist for the New Hampshire Union Leader and the long-time host of "New Hampshire Crossroads" on New Hampshire Public Television. He had previously served as Associate Dean of College Relations at New Hampshire College and as a public relations specialist with Nashua Memorial Hospital. He is also the author of seven books about Manchester and New Hampshire.
  •  Anne Diefendorf of Concord will serve the FHC as its new Associate Executive Director/Vice President for Quality & Patient Safety. Anne began her hospital career as a clinical dietician after graduating summa cum laude from UNH. She earned her MS in Clinical Evaluative Sciences from Dartmouth College in 2000. Anne is actively engaged in the NH Health Care Quality Assurance Commission and other quality initiatives of the Foundation. She most recently served as the Director of Quality Performance at Concord Hospital.
  •  Greg Vasse of New London has been named Director of the Rural Quality Improvement Network for the FHC. Greg previously served as Senior Vice President for American Red Cross blood services in Washington, D.C. where he had oversight responsibility for regulatory and operations issues for 19 Regional Blood Centers in the Midwest and Western United States. He also served as Regional Chief Operating Officer in the Henry Ford Health System in Michigan and was formerly Chief Executive Officer of the Henry Ford Cottage Hospital in Grosse Pointe Farms, Michigan.
  • Noreen Cremin of Penacook has assumed the duties of Program and Grants Manager for the FHC. Her previous experience includes 10 years as office manager with New Futures, a nonprofit advocacy organization committed to reducing alcohol and other drug problems in New Hampshire, and to improve access to treatment. She also worked on child welfare issues with Casey Family Services in Concord.

"The addition of these four individuals will bring an exciting new dynamic to the work of both the Hospital Association and the Foundation for Healthy Communities," said NHHA President Steve Ahnen. "As we have often stated, the NHHA mission is to provide leadership through advocacy, education and information in support of its member hospitals and health care delivery systems, and these new staff members can only help them to deliver high quality health care to the patients and communities they serve."


 NHHA on Social Media 


 Follow us on Twitter 


Find us on Facebook  View our videos on YouTube 


These tools are a valuable addition to traditional media in supporting our hospitals' messages.  Join us in spreading the word by following us, liking us, and viewing us.


Currently on YouTube: Steve Ahnen's message  about how the state's budget will have a negative impact on hospitals and patients in New Hampshire.