By Steve Ahnen
Special to The Monitor

CONCORD - Rep. Marilinda Garcia's recent guest column in The Monitor, "Hospital Plan Improves Business Climate," misses the mark on a number of fronts. Her legislation, HB 1642, would create a special exemption from laws to which all other hospitals in New Hampshire must adhere. How does giving preferential treatment to some at the expense of others improve the business climate for all hospitals in New Hampshire?

Remember, the budget that was adopted back in June that cut over $250 million in Medicaid payments to hospitals has resulted in the loss of over 1,200 jobs in hospitals across New Hampshire and limits on access to services for Medicaid patients. But Rep. Garcia's bill would only serve to make matters worse for New Hampshire's existing hospitals.

HB 1642 would allow a for-profit, out-of-state company to build a "destination" cancer hospital in New Hampshire without first going through the state's certificate of need (CON) process. And not only would it grant this regulatory "free pass" to an out-of-state firm, the Cancer Treatment Centers of America (CTCA), Rep. Garcia's bill also seeks to shield this new facility from paying what every other hospital in New Hampshire has to pay, the Medicaid Enhancement Tax (MET). It is interesting to note that in every other state where CTCA operates a hospital that has a similar Medicaid provider assessment like we have here in New Hampshire, they pay it. So, if they can pay Medicaid provider assessments in other states, why can't they pay the MET here in New Hampshire?

The state's existing CON process is far from perfect, but it serves an important purpose in New Hampshire – to ensure that any new institutional health care services are offered in a manner which avoids unnecessary duplication, contains or reduces increases in the cost of delivering services, and promotes the rational allocation of health care resources in the state. The pioneering work led by Jack Wennberg, MD and Elliott Fisher, MD at The Dartmouth Institute, has shown that health care does not function in the traditional market sense. In fact, this research has shown that increased capacity in health care – more hospitals and imaging centers, for example – leads to higher utilization and ultimately higher costs.

In recent testimony before the House Health, Human Services and Elderly Affairs (HHS) Committee, Dr. Fisher noted that we should strengthen, not abandon, New Hampshire's CON process as we move towards innovative, new payment models that will help bring about the right kind of market forces in health care. We agree that the existing CON process should be strengthened and we will work with legislators in both the House and Senate over the coming weeks and months to do just that.

But the most egregious aspect this effort to bring a new cancer hospital to New Hampshire is the assertion that it will not treat Medicaid patients. In testimony before the House HHS Committee, the president of one of the CTCA facilities in Philadelphia, John McNeil, said that they do not intend to treat Medicaid patients because Medicaid does not cover the cost of caring for those patients. He's absolutely right. But, don't Medicaid patients suffering from cancer deserve the same level of health care that all others do?

Mr. McNeil went on to say that their hospital couldn't be all things to all people. But that's exactly what he wants the rest of New Hampshire's hospitals to be. New Hampshire's hospitals treat all patients without regard to their ability to pay. Refusing to treat Medicaid patients is simply the wrong policy for New Hampshire and it must be unequivocally rejected.

New Hampshire has some of the region's and this nation's leading oncology providers, including the Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, the Payson Center for Cancer Care at Concord Hospital, Elliot Regional Cancer Center, New Hampshire Oncology Hematology, Exeter Hospital for Cancer Care, Frisbie's Center for Cancer Care at Frisbie Memorial Hospital, Portsmouth Regional Hospital Hematology and Oncology Center, The Oncology Center at St. Joseph Hospital, Nashua Regional Cancer Center, Seacoast Cancer Center at Wentworth-Douglass Hospital, The Memorial Hospital/Maine Medical Center, The Lahey Center for Oncology and Hematology at Parkland Medical Center, Dana-Farber/New Hampshire Oncology-Hematology, and the numerous providers just to our south in Boston. The Norris Cotton Cancer Center is one of only 40 cancer centers in the country to have earned the National Cancer Institute's Comprehensive Cancer Center designation.

These providers work hard to collaborate and partner with one another to improve care and best serve the patients and communities of New Hampshire who depend on them. They provide comprehensive, patient-centered care to those fighting cancer, not to mention the groundbreaking research they do to find ways to cure this dreaded disease. It would appear that this new cancer center and those who support it would seek isolation from the rest of the health care provider community in New Hampshire. That is totally inconsistent with the kind of collaborative culture that exists here in New Hampshire, one that studies show produces higher quality health care.

In addition to New Hampshire's hospitals, a broad cross-section of the health care and business communities have spoken out against this legislation. I would encourage those who support this legislation to sit down with hospital and health care leaders in our state to discuss ways they can help create a climate that supports the important work they do in New Hampshire in caring for patients suffering from cancer or any other disease. Let's build on the foundation of the high quality health care system that already exists here in New Hampshire.