New Hampshire
Massachusetts doctors opt for New Hampshire imaging centers – Valley News
This past summer, one of Dr. Amy Boutwell’s patients needed an imaging test done, but Lahey Hospital and Medical Center, which is down the road from her practice in the Boston suburb of Lexington, Mass., told her it would be a five-month wait.
“And I said, ‘Gosh, there’s got to be a better way,’” Boutwell said. “The question that came to my mind was, ‘Isn’t there some sort of independent imaging center where I don’t have to send her through the big, expensive, and busy health care system?’”
Her search turned up nothing nearby in Massachusetts. But located 30 miles north, just over the state line in Nashua, she found Tellica Imaging. She learned the newly opened independent imaging center could take her patient the next day and at a much lower cost. It worked out so well, she began sending more patients there. Boutwell’s status as an independent doctor made it possible. Doctors working in big health systems, she said, typically send patients to the imaging facilities within their own system.
“We live in Metro Boston. We’re used to using large health care systems,” Boutwell said. “This patient might have said, ‘I know and trust the health care infrastructure of Massachusetts,’ but instead, I think it’s really telling in this day and age, patients want access. They want transparency around pricing. They want easy and convenient. Of course, we need to know that the quality is going to be high and trustworthy. But for me as a doctor, and for my patient, in this case, we both were really compelled by, ‘It’s quick and it’s easy and it’s inexpensive,’ so let’s go to New Hampshire.”
For the longest time, Boutwell was perplexed as to why she couldn’t find centers like Tellica closer to her.
“I just thought, how’s it possible here in the medical mecca of the world, I don’t have an independent imaging center?” Boutwell said. “And I didn’t really know why.”
Many point to a primary culprit: “certificate of need” laws, which require health care providers to seek permission from state regulators for any new services they’d like to provide.
Under the laws, providers must prove to regulators that any new proposed services are necessary. Certificate of need laws also allow would-be competitors to weigh in and contest applications by arguing they already offer the service and, as such, a new provider is unnecessary.
The laws have been in place in some states since the 1960s, but the 1974 National Health Planning and Resources Development Act mandated every state institute them. Proponents believed the laws would restrain health care costs, increase quality, and provide better access to care for traditionally underserved communities. However, many experts in the field argue they’ve done the opposite. Congress repealed its federal certificate of need mandate in 1986, but 35 states, including Massachusetts, still have the laws on the books, according to the National Academy for State Health Policy. The laws vary based on what types of care are subject to the laws and how the process works.
New Hampshire is the only New England state without certificate of need laws.
Dr. Jeffrey Gold, a direct primary care physician in Salem, Mass., is another Bay State doctor who sends patients to independent New Hampshire imaging centers. He said Derry Imaging, which is roughly 45 miles away from his practice, might charge around $700 for an MRI. However, Gold said that at one of the large health systems in Massachusetts, such as Mass General Brigham, “you’re shooting a dart in the wind.” He said a patient won’t know exactly what they’re being charged until after the MRI is complete. In some cases, Gold said, once insurance and the health system finish negotiating the patient could be asked to pay roughly $1,500 (while insurance pays another $1,500).
Gold provides a unique type of care called direct primary care, where patients pay a monthly fee out-of-pocket for unlimited access to his services. He said this allows him more time with patients and to consider patients’ costs, among other things. He often advises patients to go to independent imaging centers in New Hampshire, even if their insurance won’t cover it, because paying Derry Imaging out-of-pocket is often cheaper for patients with high-deductible insurance policies. Though he notes he can sometimes get good prices at private orthopedic centers for some services, those facilities are increasingly being purchased by larger health systems.
In Massachusetts, Gold argues certificate of need laws have constrained the free market because when big health systems like Lahey and Mass General already offer imaging, it makes it harder for smaller providers to prove their services are needed. However, New Hampshire repealed its certificate of need laws in 2016 and so this phenomena hasn’t occurred here.
Indeed, analysis from the Mercatus Center, a think tank based at George Mason University, estimated in 2020 that Massachusetts nonhospital providers would’ve likely performed 80,388 MRIs annually if the state had no certificate of need laws as opposed to the 58,960 it did perform. The organization also estimated that without certificate of need laws, nonhospital providers would’ve performed 758 PET scans as opposed to 420. The researchers found no statistically significant change for hospital providers, suggesting the laws could be protecting hospitals from competition. The analysis estimated that, across all services subject to certificate of need laws, annual health care spending would’ve fallen $320 per capita without the laws.
“Neither theory nor evidence suggest that CON (certificate of need) laws work as advertised,” researcher Matthew Mitchell wrote in a 2024 report in the academic journal Inquiry. “While advocates for the regulation have offered several rationales for its continuance, the balance of evidence suggests that the rules protect incumbent providers from competition at the expense of patients, payors, and would-be competitors.”
In New England, this has created an interesting dynamic. Patients in southern New Hampshire often travel to the Boston area for treatment at larger hospitals. However, as costs and wait times rise in Massachusetts, doctors say it makes sense to go the opposite direction for certain services. Boutwell said the “cost of care in Massachusetts and access to care in Massachusetts is at an all time high and an all time low.”
“This is not a story of people who can’t afford care going to New Hampshire,” she said. “With the classic cycle of people from the north coming into Boston, you might think, ‘Well, maybe people who are price sensitive will be people who don’t have access, you know, people who don’t have the money.’ But in this case, we’ve got all the benefits of who we are, and we’re making an educated choice to say, ‘You know what? Let’s go to New Hampshire.’”
Mass General and Lahey declined to comment.
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New Hampshire
N.H. lawmakers to vote on increasing tolls, civil rights, and k-12 education – The Boston Globe
One proposal (Senate Bill 627) would generate more than $53 million per year in estimated revenue for turnpike projects by essentially doubling what certain cars pay on the state’s toll roads.
The cash fare for Hampton’s main toll booth on Interstate 95, for example, would jump from $2 to $4 for cars and pickup trucks. The toll wouldn’t increase at all for motorists who use New Hampshire’s E-ZPass transponders.
“Surrounding states already have the same in-state discount structure in place,” Democratic Representative Martin Jack of Nashua wrote on behalf of a House committee that unanimously recommended the bill.
A potential hitch: Governor Kelly Ayotte. She’s expressed opposition to the whole toll-hiking idea, and proven she’s not afraid to use her veto pen.
Modifying civil rights standard
Another proposal (Senate Bill 464) would add a few words to the state’s Civil Rights Act. Instead of addressing conduct that is merely “motivated by” a legally protected characteristic, the proposed revision would address conduct that is “substantially motivated by hostility towards the victim’s” protected characteristic (such as their race, color, religion, national origin, ancestry, sexual orientation, sex, gender identity, or disability).
The prime sponsor, Republican Senator Daryl Abbas, an attorney, testified the change was small and aligned with the law’s intent. But the attorney who oversees the Civil Rights Unit at the New Hampshire Department of Justice, Sean Locke, testified in opposition, saying the proposal could reduce protections, especially since the meaning of “substantially” is somewhat vague.
The House is also weighing a proposed amendment that would add a few more words than Abbas’s version, potentially narrowing the Civil Rights Act’s applicability a bit further.
Open enrollment for K-12 schools
A third proposal up for a vote on Thursday (Senate Bill 101) would make every K-12 public school in New Hampshire an “open enrollment” school. That way, students could freely choose to transfer to a district other than the one where they live.
The proposed policy is controversial, partly because of how schools are funded. Districts rely mostly on local property taxes to cover their costs, as the state government chips in relatively little, and property tax rates vary widely from one community to the next. That generates concern about who will foot the bill when a student transfers.
In light of those concerns, Republicans are offering a compromise amendment to SB 101 that would require the state to provide more money per pupil that a district receives via open enrollment, as the New Hampshire Bulletin reported. Democrats are offering their own amendment to establish a study commission on this topic, rather than adopt the proposed policy now.
Lawmakers have until May 14 to take action on the bills that came from the other chamber, though they have until June 4 to iron out any discrepancies.
Amanda Gokee of the Globe staff contributed to this report.
This story appears in Globe NH | Morning Report, a free email newsletter focused on New Hampshire, including great coverage from the Boston Globe and links to interesting articles elsewhere. Sign up here.
Steven Porter can be reached at steven.porter@globe.com. Follow him @reporterporter.
Boston MedFlight often touches down at the scene of some of the worst tragedies in New England – where minutes can mean life or death for a victim. The critical care transport operation is now expanding with a new base in New Hampshire.
The organization is hosting an open house at the new Manchester location on Thursday.
Boston MedFlight flies a critical care transport paramedic and nurse on every flight. Jaik Hanley-McCarthy says their helicopters and ground vehicles are equipped to handle just about any emergency medical procedure.
“Anything that can be done in the ICU,” explained Hanley-McCarthy. “We have a mobile lab so we can draw blood and run labs in real time.”
Boston MedFlight now has five bases across the region.
“Having a base in Manchester just expands this Boston-level care even further north to the more remote areas of the state,” said Hanley-McCarthy.
Boston MedFlight operates as a network of bases and some of the locations are staffed 24 hours.
Chief Executive Officer Maura Hughes says the nonprofit operation survives on public and private donations.
“We provide about $7 million in free care every year to patients,” said Hughes. “Not every hospital can be everything to every patient. We’re really the glue that keeps the health care system together.”
Heather Young says her daughter, Teighan, is still alive because she was flown for a critical assessment and procedure after falling off a truck and hitting her head.
“She should not be driving and walking and talking and all the things she’s doing as quickly as she is,” said Young.
Teighan just turned 18 and plans to go to college to study the medical field.
“I want to be a nurse and help other people,” she said.
It’s stories like this that keep the men and women who work Boston MedFlight focused on their mission.
“I think we just go call by call and try to do the best we can,” said Hanley-McCarthy. “I think when we stop and truly think about it, I think that weight is pretty heavy.”
Boston MedFlight also has a yearly reunion where patients and the team get together here in Bedford to meet and check in on their progress. It really shows you how connected they are to the people they help.
New Hampshire
Hiker who set out in warm spring weather found dead after snowstorm in New Hampshire mountains
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A Massachusetts hiker who set out in warm spring weather was found dead deep in New Hampshire’s White Mountains after a snowstorm dumped several inches of snow in the area, authorities said.
Kent Wood, 61, of West Roxbury, was discovered Tuesday evening on a remote section of the Kinsman Pond Trail in Franconia Notch, about 5.5 miles from his vehicle, according to New Hampshire Fish and Game.
Wood had driven to Franconia Notch on April 17 for a weekend camping and hiking trip, and set out on a hike the next morning in warm, clear weather, officials said. Family and friends last heard from him Saturday afternoon.
When he failed to return or make contact for two days, officials said relatives reported him missing Tuesday morning, prompting a large-scale search.
HIKER IDENTIFIED, POPULAR TRAIL CLOSED AFTER DEADLY FALL A UTAH’S ZION NATIONAL PARK
An aerial view of Franconia Notch State Park in New Hampshire, where a hiker was found dead on Tuesday. (Joseph Sohm/Universal Images Group, File)
Rescuers quickly learned Wood had packed for mild conditions, not the three to five inches of snow that fell in the area between Sunday and Monday.
Fog hovers over a narrow road through Franconia Notch in the White Mountain National Forest in New Hampshire on Dec. 27, 2021. (Andrew Lichtenstein/Corbis)
Search teams from Fish and Game, PEMI Valley Search and Rescue, and the Army National Guard launched a coordinated effort, focusing on the Lonesome Lake and Kinsman Pond areas.
FAMILY’S SPRING BREAK HIKE TURNS INTO LIFE-OR-DEATH RESCUE AFTER PARENT FALLS 70 FEET OFF UTAH CLIFF
Conservation officers located Wood’s body around 7:41 p.m. Tuesday. Crews carried him out overnight, reaching the trailhead shortly after 1 a.m. Wednesday.
Franconia Notch and the Appalachian Trail are seen in New Hampshire on Sept. 21. (Carol M. Highsmith/Buyenlarge/Getty Images)
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Since Friday, six hikers from Massachusetts have been rescued in the White Mountains, Fish and Game said.
Officials are reminding hikers that winter conditions still grip the mountains, with snow, freezing temperatures and rapidly changing weather.
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