This story was originally produced by the Valley News. NHPR is republishing it in partnership with the Granite State News Collaborative.
Signaling that the future of government support for health care is murky, Dartmouth Hitchcock Medical Center and its associated clinics said they are instituting a “hiring pause” in the face of industry “headwinds,” including potential cuts to Medicaid and research funding.
In an email to staff on Friday, Dartmouth Health CEO Joanne Conroy said DHMC and the clinics would “pause making new offers except for direct patient care positions or pre-approved critical roles until all current open positions have been reviewed.”
DH, the largest private employer in New Hampshire, has 1,500 positions listed in its recruitment system and in some cases is advertising for more workers than it has budgeted to pay, Conroy said.
“By being more intentional about where and how we invest in roles, we ensure we continue delivering on our commitments to patients, research and the community,” Conroy said in the email. “The hiring pause is not about halting growth, but about ensuring we are investing in the right roles at the right time to support our mission and future success.”
In April, DH’s trustees approved issuing $416 million in new debt, more than half of which will go toward completing the remaining two floors of the Patient Pavilion which opened two years ago at Dartmouth Hitchcock Medical Center in Lebanon.
DH also is going ahead with plans to build a new medical office building at Valley Regional Hospital in Claremont, according to the third-quarter report to bondholders.
The review of open jobs will be conducted by a newly-formed Position Control Committee, according to Conroy’s email, which did not state how long the process would take.
“Leaders will have conversations with their teams around ongoing performance improvement, a focus on resilience through accelerated and thoughtful decision-making and constant evaluation of how we can all be efficient while always delivering the right care to the right patients at the right time,” Conroy said.
A bill backed by President Donald Trump that was passed by the U.S. House of Representatives and is being debated by the Senate would cut an estimated $800 billion from Medicaid spending over the next decade.
The New Hampshire House also passed a budget that included Medicaid cuts. Though those cuts were restored this month in the version of the budget passed by the state Senate, the two sides still need to hammer out their differences and it’s not clear if state Medicaid cuts are completely off the table.
Additionally, the Trump administration has significantly cut medical research funding, mostly through the National Institutes of Health.
DH receives about $100 million in Medicaid revenue annually, according to the hospital.
Earlier this year officials said that DH received about $18 million from the National Institute of Health for medical research in fiscal year 2024.
Conroy said the Medicaid changes and loss of research funding “could exert a powerful impact on the delivery of health care and scientific research.”
Meanwhile, DH reported a financial loss in the third quarter of its fiscal year, as spending outpaced revenue by nearly $20 million between January and March, according to a report to bondholders.
It was DH’s first quarterly loss since 2023, when it was still emerging from the COVID-19 pandemic.
DH attributed the red ink to “higher than anticipated” employee costs across its system, in addition to the expense of taking over operation of Hampstead Hospital, the state-owned psychiatric facility, earlier this year.
The third quarter results follow what had been a healthy increase in DH’s profit margin over the prior six months.
Even with the loss, DH has posted strong results for the year so far.
Overall from July 1 to March 31, the first three quarters of its fiscal year, DH reported that system-wide revenue was up 15.6% — to $3.1 billion from $2.7 billion compared to last year.
The biggest chunk of the increase — more than half — came from patient service revenue.
Operating “gains” — otherwise known as operating profit — of $37.6 million are more than three times what they were for the same period last year.
DH credited the nine-month gains to a “significant year-over-year increase” in “net patient service revenue,” thanks in part to the addition of Claremont’s Valley Regional Hospital, which joined the DH system last summer.
In the third quarter, DH’s revenue actually rose 12.4% compared to the third quarter last year, to $1 billion from $909 million, according to the report to bondholders.
But expenses increased 14.6%.
As a result, DH saw its operating margin fall into the negative with a $19.7 million loss for the quarter.
Gains at DH were supported by system-wide efficiency improvements and a big boost in DH’s contract and specialty pharmacy business, according to the bondholder report.
With the latest bond offering — some of which was used to refinance existing debt — the system’s total long-term debt increased to nearly $1.5 billion.
As it had in prior quarters, DH’s pharmacy services expansion continued to help its bottom line, powering a 30.3% increase in “other operating revenue.”
DH operates on-site pharmacies within its system and affiliated medical centers, as well as “personalized 24/7 customer support to people with complex medical conditions such as cancer, hepatitis, and infertility,” according to its website.
DH’s other hospitals include Alice Peck Day Memorial Hospital in Lebanon; Cheshire Medical Center in Keene, N.H.; Mt. Ascutney Hospital and Health Center in Windsor; New London Hospital; and Southwestern Vermont Medical Center in Bennington.
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