{"id":2544,"date":"2011-10-17T14:33:42","date_gmt":"2011-10-17T18:33:42","guid":{"rendered":"http:\/\/stateimpact.npr.org\/new-hampshire\/?p=2544"},"modified":"2011-10-17T14:33:42","modified_gmt":"2011-10-17T18:33:42","slug":"dartmouth-hitchcock-medical-center-starts-the-week-with-100-fewer-employees","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/new-hampshire\/2011\/10\/17\/dartmouth-hitchcock-medical-center-starts-the-week-with-100-fewer-employees\/","title":{"rendered":"Dartmouth-Hitchcock Medical Center Starts The Week With 100 Fewer Employees"},"content":{"rendered":"
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Dartmouth-Hitchcock Medical Center<\/p>

Although Dartmouth-Hitchcock Medical Center hopes the wave of early retirements won't affect patient care, the institution is still taking a hit<\/p><\/div>\n

For most New Hampshire residents, last Friday was the end of a short, post-Columbus Day week.\u00a0 But for 100 employees of Dartmouth-Hitchcock Medical Center<\/a>, last Friday was their last day at work.<\/p>\n

Like most large hospitals in the state, DHMC says changes the legislature made this summer in how the state compensates providers for Medicaid patients has forced it to take extreme measures.\u00a0 Unlike Catholic Medical Center<\/a>, Exeter Hospital<\/a>, Southern New Hampshire Medical Center<\/a>, and others, which laid-off hundreds of workers between them, DHMC went the early retirement route.\u00a0 Dartmouth-Hitchcock spokesman Rick Adams told StateImpact that 735 employees were offered the early retirement option.<\/p>\n

291 workers took it.<\/p>\n

“It’s pretty close to being on target,” Adams said.\u00a0 “We had been told that we could expect anywhere from about 15 to about 40 percent positive response, and that’s sort of an industry average.\u00a0 291 out of 735 is about 40 percent.\u00a0 So it’s pretty close to what we had hoped for.”<\/p>\n

Adams said the people who qualified for early retirement spanned all areas of the institution, “except for doctors and bedside nurses.”\u00a0 Some select employees in highly specialized administrative positions were also not offered early retirement.\u00a0 Other than those exceptions, Adams said workers who were 55 years old and older and had at least five years of vested service in the hospital’s pension plan qualified.\u00a0 He noted that besides the main facility in Lebanon, some employees at DHMC community group clinics in Concord, Manchester, Nashua and Keene took early retirement as well.<\/p>\n

While 100 people left Dartmouth-Hitchcock last Friday, Adams said the other 191 will leave gradually over the next couple of months as they finish grant-funded work and other long-term projects.\u00a0 He told StateImpact that administrators are still crunching numbers to find out how close the hospital is to closing a $100 million budget gap.<\/p>\n

So where did this $100 million come from?<\/p>\n

Here’s how Adams explained it to us: “In FY 2010\u2026we provided about $88 million in care to Medicaid patients.\u00a0 The state reimbursed us $28 million for that care.\u00a0 And so there is a $60 million hole, for starters,” he said.<\/p>\n

“Now…we\u2019re taxed by the state $40 million, and much of that was returned through the Disproportionate Share payment.\u00a0 The legislature, through the budget that was passed effective in July, eliminated the Disproportionate Share payments.\u00a0 So we\u2019re paying in another $40 million.\u00a0 We\u2019re now in a situation where we\u2019re paying more back to the state than we\u2019re getting back in reimbursement.\u00a0 We\u2019re now a net payer to the state, to the tune of $100 million.”<\/p>\n

So what’s this Disproportionate Share payment Adams was talking about?\u00a0 For hospitals all over the state, it’s a huge deal.\u00a0 When the legislature made the decision to cut those payments back to hospitals, reporter Elaine Grant filed a piece for NHPR that explained it this way<\/a>:<\/p>\n

“Picture three buckets of money. The first bucket is a provider tax that the hospitals paid the state. For the sake of simplicity, we\u2019ll say it totaled about $100 million dollars a year.<\/p>\n

The second bucket came from the state treasury and went to the hospitals. The trick is that the buckets had exactly the same amount of money in them.<\/p>\n

And they changed hands every year on October 15th.<\/p>\n

‘We\u2019d get a wire for $37 million, let\u2019s say.’<\/p>\n

That\u2019s Frank McDougall of Dartmouth Hitchcock. Later the same day<\/em>, he says, ‘We\u2019d pay a tax of $37 million.’<\/p>\n

It didn\u2019t cost anybody anything. It didn\u2019t even show up on a hospital\u2019s books.<\/p>\n

Then the state would turn to the federal government and say hey, we just paid the hospitals $100 million dollars to care for needy people. ‘Will Medicaid match it?’<\/p>\n

And every year, the federal government said, ‘sure.’<\/p>\n

And that\u2019s the third bucket of money.<\/p>\n

They sent New Hampshire a 50 percent match.<\/p>\n

The stated<\/em> intention was to have those federal dollars go to the hospitals that had the largest number of poor patients. But a loophole allowed it to go straight to the state treasury instead.<\/p>\n

‘People called it Medicscam, and over 20 years it\u2019s brought in at least 2 billion dollars,’ says Steve Norton, executive director of the New Hampshire Center for Public Policy Studies. ‘It was a big source of revenue for the state, and it really many say, saved the state in the recession of 1990.’<\/p>\n

When HHS commissioner Harry Bird and then-governor Judd Gregg proposed the idea, the hospitals were nervous. They didn\u2019t want to be stuck with the tax if the payment ever disappeared.<\/p>\n

So Bird wrote a letter to the hospital association \u2013 it\u2019s on our Web site — saying we\u2019ll repeal the tax if that ever happens. But that was 20 years ago.”<\/p><\/blockquote>\n

So what hospitals like Dartmouth-Hitchcock feared back in the ’90’s is exactly what happened this summer.\u00a0 They’re supposed to give the state its money, but won’t get anything back.\u00a0 Because that money’s due by the middle of next month, hospitals have been cutting down where they can to raise the needed funds.\u00a0 For DHMC, that’s early retirement.\u00a0 And it’s obvious that the hospitals aren’t happy about this situation.\u00a0 For starters, as we noted in an earlier post, ten of the state’s largest hospitals are suing to get that money back<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

For most New Hampshire residents, last Friday was the end of a short, post-Columbus Day week.\u00a0 But for 100 employees of Dartmouth-Hitchcock Medical Center, last Friday was their last day at work. Like most large hospitals in the state, DHMC says changes the legislature made this summer in how the state compensates providers for Medicaid […]<\/p>\n","protected":false},"author":28,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[51],"tags":[28,511,509,494,512],"acf":[],"_links":{"self":[{"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/posts\/2544"}],"collection":[{"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/users\/28"}],"replies":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/comments?post=2544"}],"version-history":[{"count":3,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/posts\/2544\/revisions"}],"predecessor-version":[{"id":2548,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/posts\/2544\/revisions\/2548"}],"wp:attachment":[{"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/media?parent=2544"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/categories?post=2544"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/tags?post=2544"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}