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TABLE TALK: M.D.-M.B.A. student Anthony Paravati was quoted recently in Healthcare Finance News as saying that he "looked for a school with an integrated M.D.-M.B.A. program" so he'd understand management matters. "I didn't want to . . . not have a seat at the table," he said.

DRUG-GIST: Drs. Steven Woloshin and Lisa Schwartz, longtime members of the DMS faculty, had an op-ed essay in the July 4 New York Times, making the case for the FDA to require information in an easy-to-read format on prescription medications regarding how well the drugs work.

FLEET-ING MOMENT: It was exactly 20 years ago, as of October 5, that DHMC moved its clinical operations from Hanover, N.H., to its new campus in Lebanon. A fleet of moving vans, dozens of ambulances, and three custom-built mobile ICUs moved 228 patients in one day.

CMI Offers a Case in Point

Making the case

See a chart of the case mix index at various medical centers
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A little-known number called case mix index (CMI) may actually serve as a good case in point for DHMC's capabilities and strengths. CMI is a measurement that reflects the diversity, clinical complexity, and need for resources among the patient population at a given hospital. A hospital with a high CMI has more varied cases, sicker patients, and more equipment and other services—which all translate into higher Medicare reimbursements. CMI is based on a system that organizes patients into hundreds of so-called diagnosis- related groups.

For FY10, DHMC's CMI was 2.13, which was in the top 3% nationally—96th out of 3,594 hospitals. DHMC's CMI is even higher than Massachusetts General Hospital's (1.87) and the Mayo Clinic's (1.82). According to Robin Kilfeather-Mackey, DHMC's chief financial officer, it's not that hospitals strive for a high CMI, but that DHMC (pictured above) is the main referral hospital for the whole region, and its CMI reflects that fact. "Our case mix index shows that we treat the sickest patients in our state," she says.


CULTURE WAR: The New Hampshire Department of Health and Human Services' annual report on healthcare-associated infections (HAIs) found that, compared national data, HAIs were 64% lower than expected at DHMC and 39% lower statewide.

GROWTH FACTOR: For the first time this past summer, DHMC made 30 garden plots available to employees on land next to the Medical Center. A shared rototiller and soil preparation were supplied thanks to a grant from the Healthy Eating Active Living (HEAL) Partnership.

BODYWORK: Dr. Eugene Nattie, a DMS physiologist, was on a team of researchers that reported enhanced understanding of the role that serotonin plays in regulating basic bodily functions. The work may lead to better tools against such disorders as sudden infant death syndrome.

High-Concept Construction

An increased role for primary-care physicians. Flexible space that can be reconfigured as medical needs change. Those are a couple of the concepts behind D-H Heater Road (pictured at right), a 102,750-square-foot ambulatory-care facility now under construction. It's about a mile from DHMC, where inpatient occupancy is nearly 100% five days a week; the new space will address this problem by moving some outpatient services off-site.

It will also provide more appropriate space than currently exists. The family medicine service, for example, is among those that will relocate to D-H Heater Road, where there will be room to offer more integrated, interdisciplinary care for patients and their families. Other services moving to the new facility, which is slated to open in the fall of 2012, include dermatology and sleep disorders.

Another construction project under way, this one at DHMC, is the Advanced Surgery Center, to be used mostly for research. It will offer intraoperative MRI and computed tomography in the same suite, making it the only such facility of its kind in the U.S. It is expected to be completed in 2013.


AIRWORTHY: Two members of the DMS faculty, Drs. Ira Byock and Elliott Fisher, are among the featured experts in Consider the Conversation: A Documentary on a Taboo Subject. The film, about end-of-life issues, is being aired on public TV stations nationwide.

APP-LAUSE!: The National Center for PTSD (Post Traumatic Stress Disorder), based at the Dartmouth-affiliated White River Junction, Vt., VA Medical Center, developed a mobile phone app (Google "PTSD Coach mobile app") to help PTSD patients manage symptoms anytime, anywhere.

NORTHBOUND: Two medical students from Haiti migrated north for the summer, to Dartmouth—where they took classes and shadowed DH physicians in the ob-gyn and emergency departments—as part of an ongoing exchange between Dartmouth and the Caribbean island nation.

If you'd like to offer feedback about this article, we'd welcome getting your comments at DartMed@Dartmouth.edu.

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