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Working together for a healthy health care system

Senate Bill SB 308, a bill I supported, has moved on to the House. This bill would allow hospitals to form cooperative agreements that include sharing revenues. Some critics have argued this will stifle competition, and damage our smaller hospitals. I disagree.

It is clear that our health care delivery system is undergoing major transformation. Aging populations, high tech advances, changes in reimbursement policies, the emergence of alternative service providers all have huge impacts. And, the pressure to control health care cost is paramount to survival.

Let me tell you about the hospital in the town where I grew up. Four weeks ago, the people of North Adams, Mass., awoke to the news that their local hospital, North Adams Regional, was a good, busy hospital with an emergency room that treated over 20,000 people and operating rooms that performed 2,200 surgeries every year. But the rapidly evolving economics of health care forced the hospital into financial peril and bankruptcy.

The hit to the local region’s economy of losing their hospital will be devastating: $96.4 million a year will disappear, 530 people are losing their jobs, and another 230 jobs in related businesses will soon be gone.

North Adams looks very similar to many New Hampshire communities. That should concern us because North Adams may be the canary in the coal mine. I have spent my career as a nurse witnessing these changes first hand, and they have left me concerned, not just for the future of small, rural hospitals, but for all of our providers. The simple reality is that hospitals will need to innovate and become more creative in the coming years or many will go the way of North Adams Hospital — especially the smaller, rural ones that are so vulnerable to emerging financial pressures.

New Hampshire should not just sit idly by. Rather, we must take initiative in helping our hospitals find ways to survive and thrive. That is why I supported SB 308. The bill creates a process for the state to review and oversee collaborations and efficiency initiatives among hospitals and other providers that could help them stay viable so patients have access to high-quality care within their community. Why is this helpful? Increasingly, health care professionals are trying to figure out how to work together on prevention and early intervention; how they can combine their respective strengths, locations and patient populations; and whether they can enter business arrangements to reach the maximum populations possible. SB 308 would help that process. The bill requires our Attorney General’s Office to look at new innovations and relationships, and then make sure that they balance competition with the potential benefits of overall improvement in health delivery, efficiency and access to services. To me, this just makes sense. As the closure of North Adams shows, the pressure on our providers is mounting. New ways of delivering services are coming, whether we like it or not. Hospitals are going to have to try new things and see what works best to serve local populations and stay afloat. Our state has a compelling interest in reviewing new collaborations and initiatives, both to ensure that they protect access and affordability of health care, and because hospitals are vital economic engines in our communities.

Critics of the bill say it substitutes state review for the more thorough federal antitrust review. However, the Attorney General’s Office testified that the state approach is not a substitute for the federal. Rather, it creates the possibility that the state take the first crack at deciding whether certain arrangements among providers make sense. And after all, wouldn’t we prefer to keep these decisions closer to home whenever we can, rather than having Washington decide all the time?

At the end of the day, this bill is about the possibility of a New Hampshire-based solution to rapid change in the economics of health care. Ultimately, we all want access to the best possible care, for that care to be close and affordable, and for our providers to meet our needs, delivering the best care at the lowest cost. SB 308 is one step toward that goal.

Peggy Gilmour represents Senate District 12, which includes Mason, Greenville, New Ipswich and Rindge.

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