Updated as of July 22, 2019

What is the “The Seacoast Healthcare Initiative?”

The Seacoast Healthcare Initiative is an awareness campaign to describe the proposed affiliation among Exeter Health Resources, Wentworth-Douglass Hospital and Massachusetts General Hospital which would create a new, Seacoast, NH-based, not-for-profit healthcare network for the Seacoast Region.

The affiliation agreement, which centers on combining the strengths of our three organizations in a way that would enable us to integrate clinical care, share resources, increase efficiency and bring more services to the NH Seacoast, has been submitted to regulatory officials, and we are currently engaged in the federal and state regulatory review process.   


The Seacoast Healthcare Initiative aims to engage and educate our communities about our proposed affiliation agreement – which calls for the formation of a new, New Hampshire based, regional, not-for-profit entity that will serve as the parent of both Exeter Health Resources and Wentworth-Douglass Hospital and will be part of the Massachusetts General Hospital family.  Once approved, each hospital is expected to keep its own identity, and a name for the newly formed regional entity will be announced. 

The collaboration of these three mission-driven organizations is just beginning and the Seacoast Healthcare Initiative is just our way of keeping you informed about how this plan will evolve and, once approved, improve the healthcare of the NH Seacoast in a substantial and impactful way.

In the coming weeks and months, we will continue to engage in an active conversation with members of the Seacoast community to provide additional information, details and answers to important questions and concerns. This important initiative is meant to create an on-going public awareness and community dialogue about our intention to create an integrated, sustainable healthcare delivery system for Seacoast residents.  It is vitally important that members of the communities we serve be invited to participate in the regulatory process that we believe will result in our ability to deliver world-class healthcare right here at home in the Seacoast. 

Will Exeter Hospital and Wentworth Douglass Hospital remain not-for- profit and continue to invest in our local communities?

Exeter Health Resources, Wentworth-Douglass Hospital, and Mass General Hospital will remain not-for-profit organizations.  

As not-for-profit organizations, any excess of revenue over expenses stays in the community and is used to reinvest in equipment, facilities and new programs and services to benefit the community.

Our investments in community benefits, including financial assistance/charity care, community benefits funding, and support for civic organizations and community services, will remain a top priority. The proposed affiliation provides the sustainability necessary to ensure Seacoast residents have access to local high-quality care.  

How will this directly affect my care if I am currently a patient at Exeter Hospital or Wentworth-Douglass Hospital?

Incorporating the best practices and safety initiatives provided by Mass General, local healthcare will improve. Our local care teams will still be here to support your healthcare needs. This proposed affiliation will expand and enhance care that Seacoast region patients can receive close to home. With the support of Mass General, we can bring services such as more advanced care in orthopedics and joint care, obstetrics and neonatal care, cardiovascular services, behavioral health and substance use disorder treatment.  A great example of this would be the possible development of a Level II Special Care Nursery to care for newborns needing advanced care.  These services would not be cost-effective for stand-alone community hospitals to provide.  
In short, our common goal is to deliver even higher quality care, enhanced access and value in the delivery of expanded services and the promotion of community wellness in an ever-changing healthcare environment.

Who will be responsible for running the hospitals if the transaction is approved?

The plan is for Exeter Health Resources and Wentworth-Douglass to both become part of a new non-profit corporate entity with board oversight from both organizations and representation from Mass General. The new entity would be part of the Mass General family.  This will allow Exeter Health Resources and Wentworth-Douglass to work closely together under common governance.

Will I need to go to Mass General in Boston for all specialized care?  Will more of that care be brought here to our community?

This proposed affiliation was developed to bring additional advanced services closer to home for you and your family.  We know, however, that at times you may need specialized care that is not available locally or is more suitable for a larger system such as Mass General to provide.  This initiative will provide a seamless transition from Exeter and Wentworth-Douglass to Mass General and back should you need care that only an academic medical center can provide.
Mass General is the original and largest teaching hospital of Harvard Medical School and nearly all of Mass General’s physicians are faculty members of the medical school. Mass General offers sophisticated diagnostic and therapeutic care in virtually every specialty and subspecialty of medicine and surgery and also conducts the largest hospital-based clinical research program in the world.

What will happen to my doctor?  Will I be able to continue to receive care as I do now through my doctor’s office and the various locations for hospital services?

This initiative is not about replacing the excellent care Exeter Hospital and Wentworth Douglass Hospital now provide.  This is about enhancing the care we provide; and keeping more specialized care local for you. 
 
What about insurance?  Will my insurance still be accepted at Exeter Hospital?

Exeter Hospital has contracts with insurers and these will remain in place.  Exeter Hospital and Wentworth Douglass Hospital plan to continue to contract with regional and national health insurance plans as individual hospitals, so there should be no changes that impact patients and their coverage through their insurance plans.  Federal and state insurance programs also contract with us as individual providers.
Mass General accepts most New Hampshire insurance plans and following the transaction with Wentworth-Douglass in 2017, accepts New Hampshire Medicaid as well. 
 
Will any services be leaving the community?

There are no plans to move existing services from the Seacoast.  In fact, we plan to expand high level services using the strengths of each institution to provide excellent care for the community for years to come. 
At Wentworth-Douglass, services have not been reduced or eliminated.  Instead, services have been enhanced and expanded, including cardiovascular services, behavioral health and neurology services.

Some say the cost of healthcare increases when hospitals merge.  Is that true? 

Every healthcare merger and acquisition is different.  In this case, we can point to the success of Wentworth-Douglass joining the Mass General family in 2017.  Wentworth-Douglass saw favorable cost savings in group purchasing and shared services.  This has allowed Wentworth-Douglass to invest in services and programs to bring more care to the local communities.  Understanding that healthcare is expensive, Wentworth-Douglass continues to invest in lower cost services in the community – such as the availability of urgent care and walk-in primary care locations as an alternative to the higher cost of visiting an emergency department. 

Keeping more care local, so that patients do not need to travel outside of the community for advanced care also supports a more cost-effective and convenient model of care for patients.

We believe that the proposed affiliation – in partnership with insurance plans, employers and patients –can help reduce the overall health care spend in New Hampshire without compromising the level of care or our local economic impact.

  • Increased investment in lower cost, consumer friendly alternative delivery sites like ambulatory services, urgent care and telemedicine
  • Avoidance of costly and duplicative services that are inappropriate for the size of the population of combined abutting service areas
  • Savings in supply, pharmacy and technology costs due to enhanced purchasing scale
  • More economically sustainable physician services (shared specialist and call coverage)
  • Significant increase in population health competencies and capabilities
  • Integrated medical records that help avoid duplicative medical testing and improve outcomes
  • Efficient sharing of administrative overhead when possible
  • Expanding clinical services to bring care back to NH (stroke patients, level II nursery patients, specialized surgical patients)
  • Allows each organization to attract, recruit and retain the highest quality staff to NH, keeping care in-state.
  • Support growth in care access and quality locally in ways that drive better care and an economic benefit for the greater seacoast
  • Unlike for-profit health care providers, we provide services regardless of an individual’s ability to pay.
  • Part of the reasoning for the proposed affiliation is to help two not-for-profit, community-based, Seacoast Region health systems gain critical operational efficiencies so that they can continue to provide broad access to high-quality care in the Seacoast Region while maintaining jobs and sustaining their positive economic impact.


Will any programs or services available at Mass General be expanded here to the Seacoast?

There are already several programs available. Since Wentworth-Douglass joined the Mass General family advanced programs, with the support of Mass General physicians and administration, are available in cardiology (A-fib), epilepsy, neurology, advanced cancer care and more.  Exeter also has a long-standing clinical affiliation with Mass General and offers medical and radiation oncology services with Mass General Providers onsite at Exeter as well as tele-stroke care.  With Exeter Hospital joining the family, the ability to offer expanded programs and services will continue to grow. 

What has been the impact of Wentworth-Douglass joining the Mass General family in 2017?

Wentworth-Douglass has seen tremendous positive outcomes since joining the Mass General family. From a clinical perspective it has helped with:

  • Recruitment of top physician leadership in behavioral health. For example, Dr. Fuad Khan has a joint appointment with Mass General Psychiatry and will be participating in Mass General clinics and educational sessions. 
  • In cardiology, Wentworth-Douglass worked collaboratively to develop a new Electrophysiology Program (EP) with Mass General EP physicians on-site in Dover and Portsmouth; and to develop clinical training for the Wentworth-Douglass cath lab team. Together Wentworth-Douglass and Mass General are collaboratively developing sub-specialty programs for heart failure and women’s heart health.
  • Wentworth-Douglass has developed a more comprehensive Neuroscience Program here in the Seacoast with expanded emergent Tele-Neurology services to include additional differentials beyond Stroke (e.g., status epilepticus and cord compression); Wentworth-Douglass has a Mass General epilepsy specialist providing an epilepsy clinic in Dover; and is working to establish an epilepsy monitoring unit at Wentworth-Douglass in collaboration with Mass General.  Further it has started a Neuropsychology Program Clinic in Dover with Mass General provider Cathy Leveroni and has started work on a Traumatic Brain Injury Program as well.
  • From a service perspective, Mass General has collaborated with Wentworth-Douglass to provide advisory/quality reviews of clinical service areas to promote positive outcomes and best practices; to provide CMEs and grand rounds to educate clinical staff; and to provide input into strategic planning to look at the future necessary services and how to make care more robust closer to home, and when necessary, seamless transition to Mass General for tertiary level services.


Is this proposed affiliation a good thing for the economy or will jobs and investment move out of state?

This is a great thing for the economy. The proposed affiliation will help to sustain the services of two of the Seacoast’s highest regarded not-for-profit community hospitals.  This initiative creates jobs – in fact Wentworth-Douglass has employed more than 300 new staff members since joining in 2017. This Initiative helps to recruit and retain staff from our community to work in the place they live. This Initiative keeps donations local and sustains ongoing community investments in the Seacoast.

Who will decide if this Initiative or transaction moves forward?

The community-based Boards of Trustees at Exeter, Wentworth-Douglass and Massachusetts General Hospital have all voted to approve this affiliation.  Notice of the proposed transaction was submitted on May 23, 2019 for federal and state regulatory review, which must be completed before it moves forward.  

What will happen to all the dollars that the local hospitals contribute to our communities for uninsured and under-insured people?

The proposed affiliation will strengthen contributions to our community.  Our investment in community benefits including charity care and support for community, social service and civic organizations remain a top priority and we will continue to invest in solutions to address the needs in our communities – including support for mental health, treatment for substance use disorder, transportation, access to care, and other identified needs.
As not-for-profit health care organizations, we share a commitment to provide financial assistance and both Wentworth-Douglass and Exeter Health Resources provide 100% coverage for individuals and families whose incomes are 200% or less of the federal poverty guidelines who live in our service area and meet additional requirements.
In fiscal year 2018, together Exeter Hospital and Wentworth-Douglass provided over $110 million in unreimbursed care to patients insured by government programs (Medicare/Medicaid), to uninsured and underinsured patients and in direct grants to other community benefit programs and services to communities in the areas served.

What about the charitable and community programs the hospitals have always supported?

Wentworth-Douglass and Exeter each have a long history of financially supporting local organizations in the Seacoast Region.  Each will remain a valued community partner to many community initiatives and organizations and will continue to support efforts that are aligned with each hospital’s mission and vision.  
Exeter will continue to provide the communities it serves with its Community Impact Grant Program that provides nearly $1 million annually to local not-for-profit community organizations.

I made a donation to my New Hampshire hospital.  Will my gift go to Boston? 

No.  Donor intent will be followed. If donors wish to make a philanthropic gift to Exeter, their intent will be honored and the funds will stay local.  The same is true if donors wish to make a philanthropic gift to Wentworth-Douglass. Their intent will be honored and the gift will also stay local.  We believe that donors will see the value of the combined, regional health network and continue their generous support.

Is it your expectation that after this affiliation is approved the individual hospitals will still have the same purpose and mission as when they were first started?

Yes.  The mission of each of our hospitals will continue to be to improve the health and wellness of the communities we serve.  This Initiative will only strengthen that ability.  Coming together will help us strengthen, enhance and grow clinical services and programs to better meet the needs of our communities for generations to come.

Will either Wentworth-Douglass or Exeter Hospital discontinue any services?

We currently serve two separate service areas.  Our intention remains to enhance services and quality care available to patients and visitors in the communities we serve.

Is Mass General “taking over” southern NH/Maine?

No. Mass General has always cared for patients from across the globe – including here in New Hampshire. Mass General continues to look for ways to strengthen and broaden collaborations in these neighboring areas as part of our shared goal of delivering top-notch, cost-effective care. This long-standing commitment can be seen in our work with Wentworth-Douglass Hospital to create a tele-stroke program that allows our teams to quickly evaluate, diagnose and treat patients, and in our relationship with Exeter Hospital where our world-renowned cancer specialists provide comprehensive medical and radiation oncology and hematology services. These successful clinical offerings are just two of many in our local region that allow us to combine our expertise and talents to help meet and care for patients where they are.
In both cases, it was the NH hospitals that reached out to Mass General to discuss a possible affiliation because they believed it was the best option for ensuring sustainability and supporting their ongoing missions.

Is Mass General planning to construct a new building to create more space for New Hampshire patients to be brought to downtown Boston?

Mass General has announced plans to create a new clinical building that will help alleviate already existing current capacity constraints at its main campus in Boston. The hospital’s Emergency Department is at – or near – capacity on a daily basis. The proposed new building would include approximately 450 single-bed inpatient rooms located on the top six floors of two parallel towers. The building – with an expected net increase of between 100 and 200 inpatient beds – will enhance patient privacy, help meet the growing demands for quality health care and enable the hospital to decommission outmoded space in older facilities and convert some double inpatient rooms into single rooms.

Will this new affiliation draw patients out of the Seacoast to Mass General?   If it is determined medically necessary for care to be provided in Boston, will the patient eventually resume with their local provider?
The future goal- as one system- has always been to keep more patients local to NH whenever possible, while being able to provide coordinated care through shared electronic medical records, care coordination efforts and bringing more Mass General subspecialists into the Seacoast to see patients locally rather than having to go out of state or out of their healthcare system where their primary care providers and medical history exist.
In addition, for patients who must go to Mass General for more advanced or specific care, Wentworth-Douglass has been working with Mass General to get these patients back to the local community for rehabilitation and routine care needs once they are able.
Exeter Hospital’s Center for Cancer Care has had a longstanding clinical affiliation with Mass General’s Cancer Center. Our clinical affiliation, now in its 10th year, has enabled local Seacoast residents the opportunity to receive world class cancer care right here in their own community. The Mass General Cancer Center clinicians provide patient care locally, offering new and innovative technologies and treatments on-site to Seacoast patients. Our collective goal is to provide comprehensive enhanced care locally within the Seacoast Region.

Does the Care New England news have any bearing on this affiliation?

No, the affiliation conversations between Partners HealthCare, Brigham Health and Care New England that had taken place in Rhode Island are separate from those underway in New Hampshire. The discussions between Massachusetts General Hospital, Wentworth-Douglass Hospital and Exeter Health Resources are continuing through the regulatory review process. Wentworth-Douglass became part of the MGH family two years ago and given the longstanding clinical relationships with Exeter, a deeper relationship with that hospital would enhance care for all residents of the Seacoast Region.

Will the public be able to have any input on the proposed affiliation?

The public absolutely can provide input – either informally or formally.  Part of the regulatory process includes holding public hearings in both Exeter and Dover where regulatory officials will be present.  We are awaiting word from the NH Attorney General’s office as to the date and time of each hearing, but we expect it to be late summer, 2019. 

I assumed that Exeter Hospital was in good financial condition.  Why must they do this?  Why does it need to happen now?
 Nationally the conditions that smaller community hospitals are faced with are consistently becoming more challenging with aging populations, expenses growing faster than revenue, the need for significant investments in technology and infrastructure etc. To continue to succeed we must change and by doing this now when we’re in a position of strength we can expand and ensure local high quality healthcare for the Seacoast Region for generations to come.

What happens if regulators in Concord decide to oppose this transaction?
It is critically important that this affiliation goes forward to ensure the sustainability of the local high quality care delivered right here in the Seacoast Region as well as our positive economic impact to the communities we serve.