NH Department of Health and Human Services Commissioner believes labor and delivery and behavioral health are not essential services in ruling against Littleton Regional Healthcare

December 10, 2019

Littleton, NH - A written determination from NH Department of Health and Human Services' (DHHS) Commissioner Jeffrey Meyers on December 3 stated that obstetrical and behavioral health services are not essential health services in his ruling to license a new ConvenientMD facility in Littleton under three miles from Littleton Regional Healthcare (LRH). LRH believes the impact determination lacks evidence, did not follow proper procedure and could lead to a reduction in core health services for the greater Littleton region due to projected financial impacts of having duplicate services in such a small community.

"As an independent, comprehensive hospital, we provide high-quality, health services to the region, regardless of the ability to pay. Through our urgent care center, we provide all of the same services that ConvenientMD provides at the same cost, yet we don't turn people away because we are a non-profit critical access hospital. Revenues from urgent care services help us subsidize other critical healthcare services that we offer. Having duplicate services just down the street will have an adverse effect on our ability to provide our full range of health services," said LRH President and CEO Robert Nutter.

In 2016, the State Legislature implemented a statute (NH RSA 151:4) to protect Critical Access Hospitals 1) to require public notice by the licensure applicant if it plans to locate within fifteen (15) miles of a Critical Access Hospital; 2) to allow any person or CAH to object to such a licensure application; 3) to require the Commissioner of DHHS to thoroughly weigh the potential adverse impact of any proposed urgent care center on the Critical Access Hospital; and to determine that there will be no material adverse effect on essential health services in the service area of the Critical Access Hospital prior to issuing a license to such entity.

The impact determination was provided to LRH at 9 pm on December 3, hours after a ribbon cutting ceremony. On the morning of December 4, DHHS issued the license, just a few hours before an injunction hearing on the issue. This was the second written determination provided by the commissioner, who was asked by the Attorney General's office to do a second review after questions arose about the postings for public comment. It comes just three days before the commissioner's retirement date.

LRH was not the only provider expressing concern about the process. Ammononoosuc Community Health Services, a Federally Qualified Health Center that also serves people in the North Country at all income levels, also filed a detailed objection with DHHS.

"We are confident that everyone in the medical community believes that women's and behavioral health are essential, yet this illogical and immoral decision could eventually have an adverse effect on health services in the North Country. We plan to fight the DHHS determination all the way to the Supreme Court so we can ensure that women can count on receiving quality care in our region," Nutter said.

The impact determination states that "the Department requires quantifiable evidence that the essential health services would become unavailable or difficult to access in the service area. However, state statutes do not require "quantifiable evidence." To demonstrate impact, LRH submitted extensive statistics and data in its objection demonstrating why essential health services would be impacted -- with some being discontinued, such as obstetrical and behavioral health. In the determination, the Commissioner states that the information provided by LRH is "conjecture and attenuated at best."

"We engaged a leading accounting firm to conduct this review and analysis of the projected impact. However, since this is a projection of future impact, it's impossible to submit proof. While we believe competition is generally good, this situation assumes a for-profit entity that provides very specific services is the same as a nonprofit critical access hospital. This is clearly not the case. Our missions are different and having robust, cost competitive urgent care services provides the revenue to offer services that we subsidize, including essential obstetrical and behavioral health. We do not believe that due diligence occurred and will be pursuing other avenues to address the adverse impacts for the community related to this decision," Nutter said.

The analysis done by the firm projected a $3.2 million annual impact to LRH. For comparison purposes, Net operating loss to run obstetrics and behavioral health services were a $1.6 million annual expense for the fiscal year ending September 30, 2019.

Littleton has a population of just under 6,000 people. The other towns where ConvenientMD currently has locations in NH include Bedford, Concord, Dover, Exeter/Stratham, Keene, Merrimack, Nashua, Portsmouth and Windham/Salem. Populations in these communities range from 22,000 to 89,000 - nearly 4 to 15 times the population of Littleton.

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