High percentage of Medicare & Medicaid patients weighing on LRGHealthcare's ability to stay in the black

LACONIA — When LRGHeathcare announced this week that it was shedding 58 full-time employees, Ken Merrifield, the mayor of Franklin, was quick, online, to place the blame on "Obamacare" and he was at once echoed by Congreressman Frank Guinta.

However, in seeking to score political points both apparently overlooked pressures at work across both the entire state and the Lakes Region that are weighing on hospitals in general and LRGHealthcare in particular.

In January, the New Hampshire Hospital Association reported that while the operating margins of hospitals nationwide rose to 5.7 percent in 2015 those of their not-for-profit counterparts in New Hampshire fell to less than half that at 1.9 percent. LRGHealthcare posted an even lower operating margin of 1.2 percent for its fiscal year 2014, the last reported.

The association pointed to two major factors bearing on the financial performance of hospitals: reduced Medicare and Medicaid reimbursements and lower reimbursement rates from private insurers.

Medicaid reimbursement rates in New Hampshire are the lowest among the 50 states. And while, nationwide, hospitals lose on average about 14 cents on the dollar treating Medicare patients, in New Hampshire the average loss more than doubles to 30 cents on the dollar. Moreover, since the population of the state is aging rapidly, the rising share of Medicare patients will add to the losses.

As private health insurers began offering plans that offset high premiums with high deductibles and co-pays, insurers seeking to enhance the competitiveness of their products and patients bearing a greater share of their health care expenses have begun exerting downward pressure on hospital charges. At the same time, when patients are unable to pay their high deductibles, hospitals are left with bad debt.

These pressures weigh particularly heavily on LRGHealthcare. In 2014, 11.4 percent of the population of the Winnipesaukee Public Health Region was living at or below the federal poverty level compared to 8.7 percent in the state as a whole. In the region 17.4 percent of the children younger than 17 were living in poverty compared to 11.1 percent in the state as a whole.

Among the patients served by LRGHealthcare 14.4 percent were enrolled in Medicaid and 18.4 in Medicare, compared to 10.7 percent and 15.2 percent in the state. For 2014, LRGHeathcare reported that the cost of caring for Medicaid and Medicare patients exceed reimbursement payments by $17.6 million and $14.7 million respectively. Meanwhile, the organization absorbed $1.4 million in uncollected debt and provide $1.8 million in charitable care.

Meanwhile, the population of Belknap County, which represents much area served by LRGHealthcare, is among the most rapidly aging in the state. with a median age of 45.5, the third highest among the 10 counties. Only two counties had a greater proportion of people aged 65 and older in 2010 and by 2030 that share is projected to top 37 percent, exceeded only by the 49 percent of seniors in Carroll County.

As the population ages, the demand for health care increases. But, at the same time, as people age and retire they drop their private health insurance and enroll in Medicare. As result, the hospitals are treating a growing volume of patients but receiving less reimbursement — between a third and two-thirds less according to the treatment and procedure — for doing so.

Not surprisingly the New Hampshire Hospital Association called the present moment "a precarious point in time for hospitals."

Dr. Robert Evans named interim CEO at LRGHealthcare

LACONIA — The Board of Trustees of LRGHeathcare has appointed Dr. Robert Evans, an anesthesiologist who has been with the organization since 1991, as interim president and chief executive officer.

Evans succeeds Seth Warren who after serving for six months tendered his resignation for undisclosed personal reasons last month.

Apart from his clinical experience, Evans has served on a variety of committees overseeing both medical staff and hospital administration since 1994. He joined the board of trustees in 1995 and has chaired its Finance and Investment Committee since 1999.

In addition to his medical degree from the School of Medicine at Tufts University, Evans, a native of Rochester, earned a Bachelor of Science degree in business administration at the University of New Hampshire.

In a prepared statement Scott Clarenbach, chairman of the board, said that "Dr. Evans' business and medical education, along with his extensive experience with LRGHealthcare's clinical operations and financial performance, make him the right choice for this interim position. Along with the board and senior team," he continued, "his insight and assessment of our organization's processes and financial turnaround will be vital as make the transition to a new CEO."

For his part, Evans said in a prepared statement, "I'm honored to be selected to lead LRGHealthcare through this transition. My experience in multiple realms of health care operations has afforded me the ability to review things from all perspectives and I look forward to doing just that in my new role."

Evans will assume his new responsibilities on Monday, April 4.

A park near you

By Adam Drapcho

The Lakes Region saw temperatures in the 70s on Friday, after a warm and sunny day on Thursday. Looking for a way to enjoy these early tastes of springtime weather? The Lakes Region is dotted with public parks, including some unfamiliar to people who live nearby or drive past them every day.

Asked to name a public park in the Lakes Region, many people would reference Ellacoya State Park — and for good reason. Ellacoya, easily accessed from Route 11 as it passes through Gilford, is the only state park on Lake Winnipesaukee, and boasts a long, sandy beach with views across the lake and of the mountains to the north.

Ellacoya is one of only two state parks with an RV campground. It also has bathroom facilities and a pavilion available for reservation. Ellacoya sees about 33,000 visitors each year, most of whom will pay $5 per person during its operating season, which starts on May 28. However, just because the park is not officially open, doesn't mean it's off-limits. There's no staffing or amenities, but visitors are able to park on the side of the road and walk into the park to enjoy the beach, picnic areas and open spaces.

Not nearly as well-known as Ellacoya, but just one town away, is Ahern State Park, accessed in Laconia off of Parade Road. This 128-acre parcel was once part of the Laconia State School property, and became a state park in 1994.

Ahern, despite its low profile, has two prime features. The first is a network of trails that ranges from broad and flat, well-suited to walking or jogging in the warm weather, or snowshoeing or skiing in the winter. Criss-crossing the land encircled by the broad trails are single-track paths to challenge mountain bikers.

The system of trails makes Ahern a favorite for local dog owners to take their pet for a walk. Pets are permitted on the trails but not on the beach, which is Ahern's best-kept secret.

Ahern State Park abuts Lake Winnisquam, and boasts 3,500 feet of shoreline on the water body's northeastern shore. Much of the trail system explores the shoreline, including two rocky outlooks and a sandy beach, a quieter alternative than the more populated Ellacoya or Weirs Beach.

Other state parks in the Lakes Region include Wentworth State Park, on Lake Wentworth in Wolfeboro, Endicott Rock at Weirs Beach, Wellington State Park on Newfound Lake in Bristol, White Lake State Park in Tamworth, and Livermore Falls Recreation Area in Holderness. For more about these and other state parks, visit www.nhstateparks.org.

There are many more public areas to explore beyond the state parks, though, such as Waukewan Highlands Community Park, a town-managed and conserved parcel located in Meredith, off Route 106.

Waukewan Highlands is the kind of park that hundreds of people drive past everyday without realizing what they're passing by. The park features four trails, totaling 3.1 miles, and each trail leads either to or from Hart's Pond.

The pond at the center of the park is a reservoir that, until 31 years ago, served as a public water supply. Still standing in the pond is a 120 year-old pump house. On the bank of the reservoir is a picnic table, as well as a notebook, inviting visitors to leave a message.

A variety of ow-impact uses are permitted in Waukewan Highlands, such as hiking and mountain biking. A recent visit proved that the park is, like Ahern, a favorite for dogs and their owners, as the trails are wide and well-marked as they pass through a varied topography and a mixture of tree stands. Those interested to learn more should pick up a pamphlet from the green mailbox at the trailhead; numbered entries contain insights into the park that correspond with certain points along the trails.

These represent just a sampling of local parks. Across the region, drivers pass small gravel parking lots with kiosks containing trail information, perhaps its time to see where those trails lead.