Facing a potential $10-million loss in Medicaid funding, Dartmouth-Hitchcock Medical Center has asked its 6,500 employees and the general public to lobby against the Medicaid cuts included in New Hampshire Gov. John Lynch's proposed two-year budget. The medical center already loses money each year on Medicaid patients because of the disparity between the actual cost of care and Medicaid reimbursements, according to Frank McDougall, DHMC vice president for government relations.
The hospital sent an e-mail to all employees on March 6, urging them to contact state lawmakers to ask for a reversal of the proposed Medicaid cuts. DHMC also ran advertisements that weekend in five New Hampshire newspapers to persuade the general public to do the same.
The response has been "tremendously supportive," McDougall said.
"It's one thing for me to meet with the governor," he said. "But it's another thing for employees, patients and parents of sick children to advocate for change. That's some powerful stuff."
McDougall and DHMC co-President Nancy Formella met with Lynch on March 6, just three hours after sending the e-mail to hospital employees.
"By the time we got there, he had already been flooded with hundreds of e-mails," McDougall said.
The governor asked Formella and McDougall to create a funding proposal, which they have since drafted and shared with him, McDougall said.
Even without the proposed cuts, DHMC will lose $34 million in unpaid Medicaid reimbursements this year, he said.
"The government has been underpaying us for years," he said. "Back in 2001, we lost $3.1 million, and that number has grown each year since then."
DHMC has already taken steps to alleviate its financial difficulties by delaying employee raises until June, cutting spending on major capital expenditures and putting a "cautious filter" on staff hiring, The Dartmouth previously reported.
"Something else will have to give," if the funding cuts continue, McDougall said.
In the past, the Children's Hospital at Dartmouth, part of DHMC, has shifted the cost of treating Medicaid patients across departments to make up for the deficit, but Dartmouth Medical School professor Paul Merguerian, interim director of CHaD, said he worries this will no longer be sufficient.
A preliminary proposal to restore the proposed Medicaid funding to be cut from CHaD, which McDougall said was about $7 million, has been approved by a subcommittee of the New Hampshire House of Representatives Finance Committee, according to McDougall.
"I think the grassroots campaign was very helpful in getting some focus on the importance of CHaD to the rest of the state." he said.
The full Finance Committee must still approve the plan, after which it must pass in the state House of Representatives and the state Senate.
"If we continue to run a deficit, we will have to make some difficult decisions and cut programs," he said.
The Medicaid cuts have affected DHMC more than other hospitals in the state because DHMC sees the largest proportion of patients with Medicaid of any New Hampshire hospital, McDougall said. It is also the second largest Medicaid provider for Vermont residents.
Both Merguerian and McDougall emphasized that the hospital wishes to continue its policy of accepting all patients, regardless of whether they have adequate insurance.
"We don't turn any patients away because they're under-insured or uninsured completely, and we want to be able to keep it that way, but cuts like these put that mission of ours at risk," McDougall said.
Merguerian, who opposed the Medicaid cuts in a March 9 speech at a public hearing in Salem, N.H., said in an interview with The Dartmouth that DHMC and CHaD will be disproportionately affected by the cuts.
"We understand that New Hampshire, just like any other state in the nation, is going through some financial difficulties and that we should all pitch in," Merguerian said in an interview with The Dartmouth.
McDougall said that DHMC will suffer more than other hospitals.
"The governor is saying that everyone has to share the pain in these hard economic times, but we're sharing the pain in a disproportionate way due to the high volume of Medicaid patients we see," he said. "The volume of Medicaid patients we're seeing is going up at the same time our Medicaid funding is decreasing, which just doesn't make sense."
Formella and Lynch were unavailable for comment by press time.
