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N.H. wants hospitals near Mass. border

Hopes specialties will lure patients

New Hampshire lawmakers are pushing incentives for so-called destination hospitals to open along the state’s southern border, hoping to build a specialty health care hub that draws patients from Massachusetts.

The effort initially aims to attract a national for-profit hospital chain, Cancer Treatment Centers of America, by eliminating a state review process and exempting it from a tax nonprofit hospitals pay. Sponsors hope to eventually add kidney care, spine surgery, and other specialized services - all drawing business from out of state.

“We’re right on the border of Massachusetts, but we’re also 45 minutes from the Maine border,’’ said House majority leader David J. Bettencourt, a Republican from Salem. “If you look at these specialty destination hospitals, they tend to cluster around one another, so this could create thousands of jobs.’’


That possibility does not sit well with Massachusetts health care leaders.

“I find it very concerning,’’ said Dianne J. Anderson, chief executive of Lawrence General Hospital, which is not far from the New Hampshire state line and operates a cancer care program staffed by doctors from the Commonwealth Hematology-Oncology group. “There’s plenty of capacity for world-class cancer care in this area. This could pull [patient] volume out of our facilities and affect jobs here.’’

Steven Singer, senior vice president at Harvard-affiliated Dana-Farber Cancer Institute in Boston, said, “We’re watching it closely, as are other hospitals in the area.’’

Steward Health Care System, which runs two for-profit community hospitals near the border, views the proposed competition as potentially harmful. “It’s going to destabilize the hospitals in northeastern Massachusetts,’’ said Chris Murphy, spokesman for Steward, based in Boston. “It has the potential to drain insured patients from Massachusetts.’’

A bill already passed by the New Hampshire House of Representatives would repeal the state’s “certificate of need’’ process, which is now required for approval of new hospitals. A second piece of legislation approved by the House asks the federal government to exempt specialty destination hospitals - defined as for-profits with fewer than 50 beds that draw at least 65 percent of their business from out of state - from a Medicaid tax paid by nonprofit hospitals. The money is used to fund care for low-income residents.


“This would make New Hampshire a destination health care state,’’ said Representative Marilinda Garcia, a Salem Republican and chief sponsor of the House bills. “Right now, a lot of people leave our state to go to hospitals in Massachusetts and elsewhere for their serious care.’’

New Hampshire’s Senate is considering legislation that would reform the hospital review process rather than scrapping it, but postponed a vote on the bill scheduled for Wednesday.

Privately, some Massachusetts health care executives concede there may be little they can do to stop New Hampshire from going forward with its plan to create a specialty-hospital region. Brad Puffer, spokesman for the Massachusetts attorney general’s office, which is said to be monitoring the situation, declined to comment.

Even within New Hampshire, however, there is debate over the effort to attract Cancer Treatment Centers of America and other medical care companies.

The New Hampshire Hospital Association, representing mostly nonprofit hospitals that also fear added competition, opposes the House bills. It and other opponents argue the incentives would create an unfair playing field. They note that for-profit specialty hospitals elsewhere often do not accept Medicaid and Medicare, government insurance programs for older and low-income residents, while nonprofits do - even though government insurance sometimes does not cover the entire cost of care.


“It’s a matter of fairness,’’ said Steve Ahnen, president of the association, based in Concord. “We don’t want to see a for-profit cancer center drawing revenue and picking off commercially insured patients from other New Hampshire hospitals.’’

Opponents are particularly troubled by a December trip that Garcia and four co-sponsors of the House legislation made to tour the nearest Cancer Treatment Centers of America hospital, in Philadelphia. The one-day visit - including round-trip flights for the lawmakers - was paid for by the Schaumburg, Ill.-based cancer care company.

“We continue to be amazed and very curious about the House’s infatuation with a bunch of strangers from Philadelphia who they want to give the moon to,’’ said Frank McDougall, vice president at Dartmouth-Hitchcock Medical Center, the largest health care provider in New Hampshire, which owns the Norris Cotton Cancer Center in Lebanon, N.H.

Cancer Treatment Centers has not formally applied to build a hospital in New Hampshire. But a company executive told a New Hampshire legislative committee that the national chain was interested in opening a New England operation if lawmakers eliminated the process to determine need and offered incentives, according to sponsors of the House bill.

Company spokesman Andrew Welhouse said Garcia invited Cancer Treatment Centers to come to New Hampshire after being approached by a patient from Methuen, Mass., who travels to its hospital in Philadelphia for cancer care. “In order to even consider the possibility [of opening a hospital], New Hampshire would need to change their certificate of need process,’’ Welhouse said.


Cancer Treatment Centers, founded in 1988, runs for-profit cancer hospitals in Philadelphia, Zion, Ill.; Tulsa, Okla.; and Goodyear, Ariz., along with an outpatient center in Renton, Wash. It agreed to build a southeastern regional hospital, scheduled to open in August in Newnan, Ga., after state lawmakers there last year approved incentives and a provision to allow out-of-state health care companies to locate in Georgia.

Garcia said the state’s certificate of need process has been poorly managed and is seen as a bureaucratic hurdle to health care businesses interested in coming to the state. She said seeking a federal waiver to the Medicaid tax for specialty destination hospitals is justified because, unlike their nonprofit counterparts, for-profit health care enterprises must pay business and property taxes.

She also defended the all-expense-paid trip to Philadelphia, noting that New Hampshire lawmakers earn only $200 a year for their legislative duties. “We’re the epitome of the citizen legislators,’’ Garcia said. “This was not a trip to Disneyland.’’

Robert Weisman can be reached at weisman@globe.com.