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Ayotte suggests AVH as North Country veterans hospital


BERLIN – U.S. Senator Kelly Ayotte has raised the possibility of Androscoggin Valley Hospital providing in-patient hospital care to North Country veterans through a contract with the federal Department of Veterans Affairs.
In a meeting with AVH officials Wednesday, Ayotte noted that New Hampshire is the only state in the country without a full-service veterans hospital. The senator said she and U.S. Senator Jeanne Shaheen have filed legislation that would provide for a veterans hospital but said passage will be challenging in today's financial climate in Washington. Ayotte said even if the current legislation passes, it will still take time to get a hospital built.
In the meantime, Ayotte said North Country veterans who require hospitalization at a veterans hospital have access and transportation issues. The nearest veterans hospitals are in White River Junction, Vt., and Boston.
Ayotte asked AVH CEO Russell Keene and Hospitalist Dr. John McDowell if the hospital would be interested in a contract to provide in-patient care to veterans in the northern section of the state. She said the Veterans Administration has a contract with Concord Hospital for a certain number of beds. She said AVH could be the North Country facility for in-patient care for veterans.
"I think about veterans in the area being able to come here," Ayotte said.
"We'd very much love to be a partner in that," responded Keene. "We've asked in the past," he said.
Keen assured Ayotte that the hospital has the capacity to enter into such an agreement with the Veterans Administration.
The two AVH officials told Ayotte maintaining the hospital's critical access hospital status is important to the financial well being of the facility.
"It's really critical to us," Keene said.
The program, started in 1997, is designed to help small rural hospitals stay operating by providing a higher Medicare reimbursement rate. McDowell said last fall Shaheen warned the hospital there was some talk about eliminating the entire program.
Ayotte said she was not aware of any move to eliminate the program but said there has been talk of modifying or reducing it. She said she will use her position on the Senate budget committee to ask about the program.
Keene said the hospital is also struggling with the impact of sequestration which he estimated will cost AVH $500,000. He said the uncertainty of the Congressional action made it difficult for the hospital to plan for it.
Ayotte said the two percent Medicare Provider reimbursement cut that took effect April 1, as part of sequestration was not even discussed.
The state's junior senator said she voted against sequestration because she did not think "it was a sensible way to do things". But she said sequestration will probably stand unless Congress and President Obama come up with a large fiscal deal. Ayotte noted the Senate and House have both developed budgets that represent two different visions. Noting that she was one of a dozen Republican senators invited to dinner with the President Obama, Ayotte said she is glad to see Obama taking more of a role in trying to bring the parties together. She said the discussion at the dinner was finding a way to reach common ground.
McDowell said his patients and the public are frustrated by the disfunctionality of Washington. Ayotte said there is a path forward if the two parties can work together. She said there are choices that need to be made now or face a future of reduced choices. She noted the debt is now almost $17 trillion and a one percent increase in the interest rate will add almost a trillion dollars to the total.
"All of us need to be willing to work across the aisle," she said.
Keene took a few minutes to give Ayotte some statistics about the hospital. With 425 employees, he said AVH is the biggest employer in Coos County. In 2010, it was voted one of the best places to work in the state and for the second consecutive year has made the list of top 100 critical access hospitals in the country.
In partnership with Weeks Memorial Hospital and Upper Connecticut Valley Hospital, the three hospitals have worked together and done what Keene called some "amazing things". Keene also took time to introduce Ayotte to the hospital's cardiologist, Dr. Daniel Van Buren.

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