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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.
What to Read Next
What employers are getting wrong, and how to fix it before it becomes a claim
New Hampshire’s employment law landscape heading into 2026 may not be dramatically different from last year, but the real risks lie in implementation missteps. From the initial setting of wages, to calculating and distributing wages, employers will likely find a specific statute and/or labor regulation governing the transaction. Failure to follow these detailed wage and hour laws can result in significant back wages and other penalties being imposed by the state or federal Department of Labor following an audit. Fortunately, however, this area of employment law is relatively easy to master, once you are familiar with the basics.
Notice compliance
One of the most common pitfalls for employers in New Hampshire is misunderstanding the wage and hour notice requirements under RSA 275 and the related New Hampshire Department of Labor Administrative Rules.
At the time of hire, employers must notify employees in writing of their rate of pay and the day and place of payment. This notice is traditionally delivered to employees by way of an offer letter or some sort of “New Hire Rate of Pay” form. (A sample form is available from the New Hampshire Department of Labor website.) What surprises most employers, however, is that Lab. 803.03(f)(6) also requires employers to request and obtain their employees’ signatures on this written notification of wages, and employers must keep a copy of the signed written notification of wages on file. Further, employers must notify employees in writing during the course of employment of any changes to wages or day of pay prior to such changes taking effect, and the employer must obtain the employee’s signature on this subsequent notification as well. (See RSA 275:49; Lab. 803.03.)
Employers are further required to notify employees in writing, or through a posted notice maintained in a place accessible to employees, of:
• employment practices and policies with regard to vacation pay, sick leave and other fringe benefits.
• deductions made from the employee’s payroll check, for each period such deductions are made.
• information regarding the deductions allowed from wage payments under state law. (RSA 275:49; Lab. 803.03.)
Policies regarding vacation and sick leave should inform employees whether or not the employer will “cash out” unused time at year end or at the end of employment, and if so, under what terms. Again, if any changes are made to vacation pay, sick leave and other fringe benefits during the course of employment (all of which are considered “wages” under New Hampshire law), employers must request and obtain their employees’ signatures on the written notification of the change, and must keep a copy of the signed form on file. (Lab. 803.03.) Importantly, notification by way of pay stub alone is not sufficient, and, these requirements apply to both increases and decreases in pay.
Two-hour minimum (reporting pay)
Another frequently overlooked obligation is New Hampshire’s two-hour minimum reporting pay requirement. Under RSA 275:43-a, non-exempt employees who report to work but are sent home early must generally be paid for at least two hours. Weather-related closures, client cancellations or operational slowdown days can trigger this rule. Employers should also note that the New Hampshire Department of Labor currently applies this law to remote-based employees. Consequently, employees who “report to work” at an employer’s request from a home office may likewise have a right to two hours of pay, depending on the circumstances.
Salaried vs. hourly employees
Misclassification of employees as exempt from overtime remains a significant source of compliance exposure. The position’s job duties — not the titles or label such as “salaried” — determine whether an employee qualifies for an overtime exemption.
Employers, particularly in nonprofits, health care and small businesses, unintentionally misapply exempt classifications to roles such as administrative staff, office managers, executive assistants, program coordinators or hybrid jobs that involve significant non-exempt tasks. Over time, as organizational needs evolve and employees take on broader responsibilities, job duties can drift outside of an exemption’s scope.
Best practice is to periodically review job descriptions and actual job duties to ensure continued compliance with exemption criteria, particularly following any significant restructuring or job redesigns.
Peg O’Brien is chair of McLane Middleton’s Employment Law Practice Group. She can be reached at margaret.o’brien@mclane.com.
Local News
“Our family wants to know what happened, who did this and why,” said the family of the victim.
A new photo has been released of the victim in a nearly 30-year-long unsolved murder case, in the hope of finding any new potential witnesses in the cold case, New Hampshire officials said.
“Our family wants to know what happened, who did this and why,” the family of Rosalie Miller said in a press release. “We miss her and want to give her peace.”
Miller was last seen on December 8, 1996 at her apartment in Manchester. At the time of her disappearance, Miller had plans on meeting friends in the Auburn, New Hampshire area, officials said.
Her body was found on January 20, 1997 in a partially wooded spot on a residential lot along the Londonderry Turnpike in Auburn, officials said in the release.
The autopsy report declared Miller’s death a homicide by asphyxiation due to ligature strangulation, N.H. officials wrote.
As part of a new effort to garner public help with the case, an “uncirculated” photo of Miller, 36, is being distributed “in hopes it may jog the memory of someone who saw or spoke with her in the winter of 1996,” Attorney General John M. Formella and New Hampshire State Police Colonel Mark B. Hall announced on behalf of the New Hampshire Cold Case Unit in a joint press release.
Investigators are especially hoping to talk to anyone who was in contact with Miller in December of 1996 or anyone “who may have seen her in the vicinity of the Londonderry Turnpike in Auburn during that time,” officials said in the release.
“We are releasing this new photograph today because we believe someone out there has information, perhaps a detail they thought was insignificant at the time, that could be the key to solving this case and bringing justice for Rosalie and those who loved her,” Senior Assistant Attorney General R. Christopher Knowles, New Hampshire Cold Case Unit Chief said in the release.
The New Hampshire Cold Case Unit encourages anyone with any amount of information to contact the group at [email protected] or (603) 271-2663.
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