FAQs about the APD and Dartmouth-Hitchcock Integrated Obstetrical Obstetrical Service

Frequently Asked Questions about the Alice Peck Day Memorial Hospital (APD) and Dartmouth-Hitchcock (D-H)  Integrated Obstetrical Service

1. Why is this change being made now?
Integration of our obstetrical services has been one of the key clinical goals of the affiliation between Dartmouth-Hitchcock and Alice Peck Day Memorial Hospital (APD), which took place in March 2016. Since then, APD and Dartmouth-Hitchcock have been working closely to identify how best to integrate these services, to ensure continued access to high quality, personalized, cost-effective care for residents of the Upper Valley. APD, like many other small hospitals across the nation, has faced significant financial and staffing challenges in connection with operating a 24/7 obstetrical service.After careful review and planning, we are now ready to begin implementing our integration plan.

2. What will happen to patients who began their obstetrical care at APD and were planning to deliver at APD’s Birthing Center?
We anticipate deliveries continuing at APD through July 14, 2018.After that date, patients will deliver at Dartmouth-Hitchcock’s Birthing Pavilion.With respect to choice of delivery location, whether a patient delivers at APD (until July 14th) or Dartmouth-Hitchcock depends on a variety of factors related to each patient, including patient preference and medical indications.Because each patient’s situation is unique, we will be speaking with each current APD obstetrical patient about plans for where the patient will deliver. The integration plan envisions that prenatal care and postnatal care will continue to be available for patients on the APD campus after July 14, 2018.

3. Which providers are transitioning to the integrated service?
We anticipate that most of the APD providers (obstetricians and midwives) will choose to be part of this integrated service.  Patients will be contacted directly by their providers about their future plans. A directory of providers for the integrated service will be made publicly available as soon as possible.

4. Will there be any layoffs because of this integration?
Certain positions that supported APD’s obstetrics program will be eliminated.However, we will help all APD employees affected by this transition to find other employment opportunities either at APD, DHMC, or elsewhere in the Dartmouth-Hitchcock system.

5. Are finances driving this integration?
Finances are a part of the reason for the transition, but not the sole reason.   Reimbursement rates for obstetrical services are generally low, and APD currently operates its obstetrics service at a loss of approximately $500,000 annually. Staffing for the obstetrical service at APD has also presented a challenge, reflecting a national trend. Finally, because APD and Dartmouth-Hitchcock Medical Center are only four miles apart, it makes practical sense to combine this service.

6. If a patient has questions about how this service integration will affect her, how can she get information?
We’ve established a hotline for our current obstetrical patients only to call with any questions they might have. Our providers will also be calling all of our patients to answer questions over the phone, and will offer to schedule an appointment to further discuss the transition.

7. Can you provide information about the Community Mothering program?
This program will focus on providing non-clinical support and resources for obstetrical patients in their communities and homes, through a team of community health workers that will make visits to expectant mothers. More details about the program will be released later this spring.

8. What will happen to the beds on the APD Birthing Center?
The beds will be transitioned for use by medical-surgical patients.

9. How was this decision reached?
Please view this joint message joint message from our President and CEO, Dr. Mooney, and the President and CEO of Dartmouth-Hitchcock, Dr. Conroy, explaining the difficult decision to integrate obstetrical care.