Why We Voted to Adopt Unification with MaineHealth – A Decision by Our Local Board for Our Community

By Laura Jawitz & Scott McKinnon

We’d like to acknowledge some of the community feedback we’ve received in the last few weeks on our decision to adopt the proposal to unify with MaineHealth. We know many of you have questions and we want to provide you with some additional information.

We’d like to start by emphasizing that our board has always worked with the best interests of our community in mind. That’s because we are local community members ourselves. Many of our trustees have lived, worked, and raised families here for decades. Four trustees are providers at Memorial, three practicing, one a long-time family practitioner now in an administrative role. Some are local business owners and entrepreneurs. Others are retirees who are volunteering their time and expertise in the interest of supporting their new hometown hospital. We live in local towns including Albany, Bartlett, Conway, Glen, Intervale, Jackson, Madison and North Conway. As with all non-profits, the current list of trustees is available on public filings such as Form 990, and on our website, www.memorialhospitalnh.org.

In addition to being Trustees for Memorial, our board members are committed volunteers and board members for other Valley organizations including the MWV Economic Council, OLLI at Granite State College, White Mountain Community Health Center, MWV Chamber of Commerce, Habitat for Humanity, the New England Ski Museum, local churches and many others. So it was disheartening to read letters to the editor in this newspaper recently claiming that our board was anything but a local board of local citizens addressing the health needs of our community. MaineHealth CEO Bill Caron, who sits on the boards of all member organizations, is the only non-local trustee, and he was not a party to the unification vote.

Under the proposal approved by our board and now the rest of the members of MaineHealth, under unification, our local board will continue to participate in the development of local budgets and strategic plans, and we’ll oversee care quality and safety and the provision of credentials to medical staff. We will do this jointly with our partners at MaineHealth, which like Memorial is a nonprofit organization. Significantly, this proposal to unify calls for all local foundation money we have accumulated at Memorial Hospital to be spent on priorities here in our community. The majority of those funds will be expended prior to unification taking full effect.

It is true that under unification, the MaineHealth Board of Trustees will have final governing authority over the entire system, including Memorial Hospital. That is why we spent many months researching this proposal and, along with other MaineHealth members, creating a governance model that safeguards local care and gives us input on many decisions.

But there are still additional steps to be taken to ensure the protection of the hospital’s mission. That’s why the New Hampshire Charitable Trust division of the state Attorney General’s Office will review our proposal to unify with MaineHealth. That review, lasting 120 days will include a local public hearing and will commence in early 2018. That review will take place after our board has crafted and voted on detailed language to make sure our charitable mission here in the Valley will continue to be supported. That is another unique step that our board has taken as we continue to advocate for our local community.

It is important that everyone understands that we did not make this decision lightly, and did so after more than a year of conversation with our internal and external stakeholders. This included a widely publicized and well attended community forum on October 11, where 170 residents freely asked questions of a panel of board members and MaineHealth CEO Bill Caron for more than three hours.

We feel we went above and beyond the due diligence required, including hiring an outside healthcare consultant and our own attorney to represent us in negotiations with MaineHealth.

It is important to remember that our hospital has been a part of the MaineHealth System since 2013. In the period leading up to the signing of that agreement, the board researched options for hospital system affiliations, culminating with the selection of MaineHealth as the best and most logical partner for this relationship. Notably, they considered potential affiliations with Dartmouth Hitchcock Hospital, other Maine hospital systems and the smaller group of hospitals that today comprise North Country Health Consortium. They concluded that being a part of MaineHealth and enhancing our access to its Portland flagship, Maine Medical Center, would provide the best care for our patients.

At this time, we are in a binding agreement with MaineHealth. Accordingly, the only option before the Board at this time is whether to proceed with unification or not. We did, however, revisit other affiliation options when considering unification, assessing those options again evaluating the pros and cons of each. That process reaffirmed the conclusions that led to our joining MaineHealth in the first place.

Our predominant medical center partner is in Portland. The vast majority of our referrals go to Maine Medical Center – a fact that was true before we joined MaineHealth and one that remains true today. While we could achieve some scale and leverage shared services as a member of the North Country Health Consortium, Memorial Hospital as part of MaineHealth is able to avail itself of the specialists and services found at a world-class tertiary care center like Maine Medical Center. Our relationship with MaineHealth in recent years has resulted in sustaining and strengthening local specialist care, including oncology, endocrinology, sleep medicine and cardiology by sharing providers with other MaineHealth members.

Now that all other MaineHealth members have voted to unify, if we chose not to do so, we would be an outlier in the system and not in a position to gain the full benefits provided to other members.

We decided that staying with MaineHealth is what is best for our patients and also concluded that, on a practical basis, staying with MaineHealth meant supporting this new governance model.

Another option would have been to open discussions to leave MaineHealth entirely and go back to being an independent entity. The problem there is that the world that once supported local, independent hospitals no longer exists. One need only look across the hospital landscape in New Hampshire to see that – few if any non-affiliated hospitals remain. Pulling out of MaineHealth would have profound financial implications for Memorial Hospital, affecting everything from our purchasing power to our bond rating.

The reality is, health care is changing at a rapid pace. Indeed, this change has proven unsettling to many of our stakeholders, notably providers on the front lines. And it is fair to say that the idea of changing our governance model on top of everything else that is changing doesn’t sit well with some. And when patients see their own doctors frustrated and concerned, it is frustrating and concerning to them as well. That is an understandable reaction.

Still, our board has an obligation to stay ahead of trends that could threaten our ability to provide the best care as close to home as possible. After carefully considering all the options, we have concluded that remaining a full partner in a world-class healthcare system was the best way to do that. While there may be those that disagree with that conclusion, claiming a lack of local input or thoroughness of this board’s efforts is neither fair nor factual. We believe unification will best preserve our hospital and the community’s access to it.

Laura Jawitz is chair of the Memorial Hospital Board of Trustees; Scott McKinnon is an ex-officio member of the Board of Trustees, and President & CEO of Memorial Hospital

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