Dartmouth-Hitchcock (D-H)

Mary Hitchcock Memorial Hospital (mhmh) is an acute and tertiary care teaching Hospital located in lebanon, new hampshire. Mhmh provides a broad range of patient services and health-related community services, consistent with its role as a major teaching Hospital, a tertiary care referral Hospital, and as a prospective payment system Hospital (as defined by cms). Mhmh provides a full range of services in both acute and critical medicine, surgery, psychiatry and rehabilitation for infants, children and adults. During fy 2022, mhmh provided 134,900 acute patient days of inpatient service and had 25,200 total acute care discharges, while mhmh's emergency room was open to the public 24 hours per day, 7 days per week and had 29,743 discharges. Dartmouth-hitchcock clinic (dhc) provides the physician staff for the Hospital and the sophistication essential for the development of the Hospital as the largest and only teaching Hospital in new hampshire and the designation by the federal government as a rural referral center for northern new england. The shared mission of mhmh and dhc is to advance health through research, education, clinical practice, and community partnerships, providing each person the best care, in the right place, at the right time, every time. Consistent with this mission and in partnership with dhc, mhmh provides high-quality, cost-effective, comprehensive, and integrated health care to individuals, families, and the communities it serves, regardless of a patient's ability to pay. Through formal affiliations and other clinical collaborations, mhmh also seeks to partner with other area health care providers to improve the health status of the region. The jack byrne center for palliative & hospice care coordinates mhmh's clinical, educational, and research efforts and visiting nurse alliances around the region to offer much-needed end-of-life care for patients in a clinical setting that meets the needs of patients and their families. Mhmh also continues to build its tele-medicine program to provide care across its rural region and in particular to make specialist consultation and care available to critical access and community hospitals. This allows caregivers at remote locations to access specialists at mhmh and dhc and to bring them "virtually" to the patient's bedside. Mhmh's connected care center for tele-health in lebanon offers a 24/7 team of physicians, pharmacists, and nurses supporting the following acute care tele-health service lines: tele-emergency, tele-pharmacy, tele-neurology, tele-icu, tele-psychiatry, and tele-neonatology; outpatient tele-urgent care 7 days/week; and outpatient virtual visits in pediatrics and more than 30 specialty services to patients in 17 clinical locations along with patient homes. Mhmh served as one of the lead organizations in the state-wide, federally funded delivery system reform incentive program (dsrip) from 2016-2021. This nh program was funded from 2016-2020 but grant funding was able to be carried over for an additional year of interventions and all work was completed by 31st of december, 2021. Dartmouth-hitchcock clinic and cheshire medical center co-sponsored the development of an integrated delivery network which brought health systems, community mental health centers, and social service organizations together to collaborate on improving health for medicaid beneficiaries with mental health diseases and/or substance use disorders. While dsrip funding has now expired, this work laid the foundation for ongoing programming and in august 2021, mhmh was awarded a hrsa grant to develop the behavioral workforce in rural new hampshire. Mhmh has also partnered with colby-sawyer college to provide nursing education to both colby-sawyer students and to mhmh staff. Mhmh also sponsors numerous training programs through the workforce readiness institute, a department of mhmh focused on providing training pathways for entry-level staff to gain the necessary education and certifications to move into higher-paying roles. Along with providing flu clinics to bring vaccinations to area communities, mhmh also created a community covid testing and vaccination center during the latter part of fy '20 which remained active throughout fy22. Additionally, mhmh and dhc have served both the state of new hampshire and area communities as "subject matter experts" during the covid pandemic. During fy '20, mhmh commenced construction of a new patient pavilion, expanding its current in-patient capacity at the lebanon campus. (for the previous three years, mhmh has turned away almost 2,500 patients per year because the Hospital was at full capacity during the patients' time of need.) Expected to be completed early in fy '23, the project will cost in excess of $100 million and will expand in-patient capacity to more fully meet the acute-care needs of the region. Mhmh and dhc jointly file an annual community benefits report with the state of new hampshire which outlines the community and charitable benefits mhmh and dhc provide. The most recent community benefits report is available by request. Financial assistance (formerly called "charity care") represents services provided to patients who cannot afford health care services due to inadequate financial resources which result from being uninsured or underinsured. For the year ended june 30, 2022, mhmh provided financial assistance to 15,142 patients in the amount of $18,315,700 as measured by gross charges. The cost of providing this care for the year ended june 30, 2021 was $15,768,823. Mhmh also routinely provides services to medicaid patients at reimbursement levels that are below the cost of the care provided. The community health activities noted include the cost or value of several different types of programs including the cost of community-based education, health fairs, health screenings, support groups, and programs and materials that promote wellness and prevent illness. Examples of these types of efforts include partnering with the healthy eating active living nh initiative, the women's health resource center, and smoking prevention and cessation. This category of support also includes financial contributions and the contribution of time and services to community programs, hospitals and agencies. Mhmh also provides a significant amount of uncompensated care to its patients that is reported as provision for bad debt, which is not included in the amounts reported above. During the year ended june 30, 2022, the Hospital reported a provision for bad debt of $58,192,436.

As a component of new hampshire's only integrated academic medical center, Mary Hitchcock Memorial Hospital (mhmh) provides the geisel school of medicine at dartmouth (gsm) support for physicians' unpaid teaching time as part of its community benefit initiatives. This support consists of the time physicians spend providing clinical supervision and education for residents and medical students. In addition, the Hospital provides in-kind support for research and other grants representing costs in excess of awards for numerous grant-funded health research and service initiatives awarded to dartmouth-hitchcock clinic (dhc) and gsm. Other community benefit initiatives include subsidizing the costs of providing medical and clinical education to professionals across new hampshire, Vermont and beyond as well as uncompensated costs of academic and medical research activities.