by Joyce Marcel
Popular, some say inspirational — and very tall — Thomas A Dee got into the field of hospital administration when academia barely recognized it as a profession. By the time he was 26, he was running two small hospitals in upstate New York. Now at 67 and the height of his career, he runs the tiny juggernaut that is Southwestern Vermont Health Care (SVHC) and is currently getting it ready to merge with Dartmouth Hitchcock Medical Center.
Southwestern Vermont Medical Center (SVMC) is a nonprofit hospital that serves 70,000 people in Bennington and Windham Counties in Vermont, eastern Rensselaer and Washington Counties in New York, and northern Berkshire County in Massachusetts. Its parent corporation is SVHC. Dee is CEO of both.
“And under that you have different entities,” Dee cheerfully explained. “So we have nursing homes. We have a regional cancer center. We have a foundation dedicated to fundraising. We have a medical group practice.”
The hospital is well-lauded. It is one of only three hospitals in New England — and one of only of 28 hospitals worldwide — to have achieved five consecutive designations as a Magnet Center for Nursing Excellence.
The award signifies that it is an excellent place for nurses to work; as a result, while other medical facilities have had to depend on expensive traveling nurses to keep their staff rosters filled, SVMC has no trouble attracting and keeping a devoted and creative nursing staff.
The hospital was named the 2020 recipient of the American Hospital Association's Rural Hospital Leadership Award. It has won the highest possible ratings from the Centers for Medicare and Medicaid Services for its renal dialysis team. For the past eight years, SVMC has also been named one of this magazine's “Best Places to Work in Vermont.”
Photo: Pamela M. Duchene, PhD, APRN Vice President of Patient Care Services and Chief Nursing Officer with Thomas A. Dee, FACHE President and CEO. Photo: Baldwin Photography.
Dee, a former basketball player in college who stands at 6'6”, definitely has a talent for rebounding. He is earnest, funny, accessible, and easy to talk to. He is open and appears to be without a shred of the arrogance famously found in the men of his profession.
Those who know Dee best seem to love him as well as his leadership skills. For example, the head of the SVHC board, Kathy Fisher, said he was “inspirational.”
“He is dedicated beyond words and committed to the mission of the hospital,” Fisher said. “He lives and breathes providing top quality health care. It is remarkable to see a leader like him every day, day after day, and really focusing on what's best for our patients, our staff, our community. And I don't even know how to say it. It's quite remarkable.”
Michael Del Trecco is the president and CEO of the Vermont Association of Hospitals and Health Systems, a nonprofit advocacy organization. He met Dee just after he was hired at SVHC, and knew he was a man to be trusted.
“He instantly made an impression on me,” Del Trecco said. “I knew he was someone that I could count on. He leads by example, and that's something that is truly admirable. It's not easy to lead and run a hospital. But Tom's always unwavering integrity, and I would say ethical standards, serve as a guidepost for all of us to look up to. Tom is an incredible collaborator, innovator, and a dedicated leader who deeply cares about the health and well-being of his patients, community and caregivers, as well as the people that work at SVHC.”
Jim Brown, the president of the Bank of Bennington, calls Dee “an incredible leader.”
“He sincerely cares how all decisions will affect employees, patients, and the future of the health care system,” Brown said. “Bennington is fortunate that the hospital hired Tom. His commitment goes beyond the health care system and its employees. He looks for opportunities where the hospital and the community can all benefit. He has made a tremendous difference since coming here in 2009.”
Bennington Town Manager Stuart Hurd simply loves the guy.
“He certainly brought a great deal of enthusiasm and personality to the job,” Hurd said. “He's very easy to get along with. He's very tall. He's got an easy-going way about him. He's not at all overly formal, and you would expect that in a hospital administrator. When he came to Bennington, he worked his way into the community. He became part of the community through the hospital system. Healthcare has become even more a part of the community than it used to be. Before Tom came, it was always kind of a hospital on the hill, which was very nice to have, I grant you that. But now it's much, much more.”
Hurd was especially delighted when, a few years ago, the hospital bid for — and won — the former campus of the bankrupt Southern Vermont College, whose 371 acres are adjacent to the hospital grounds. The future of the property was in peril, he said.
Photo: Thomas A. Dee, FACHE President and CEO. Photo: Baldwin Photography.
“When the hospital bought the property, it meant that the ownership would stay with a responsible party in the community,” Hurd said. “They paid a substantial amount of money to acquire the property, which consists of a former estate. It has a 1900s stone mansion, dormitories, a cafeteria, and a large gymnasium and fitness center. It has a system of trails that are open to the community. It's a unique property and one that we were concerned would not sell quickly.”
Although the hospital did not have plans to hold on to the property indefinitely, it certainly proved useful during COVID.
“They used the gymnasium for a vaccination and testing center, which worked to their advantage as well as the community's advantage,” Hurd said. “I can't tell you how many thousands of people use that facility during the pandemic to get vaccinated or to get tested. It was really very welcome for this region to have that facility. That's the kind of thing that the hospital has done under Tom Dee's leadership.”
The hospital now has a potential buyer for all but seven acres of the property, which it will keep for expansion.
“It's adjacent to our campus, and over time, we obviously are expanding our services and capabilities,” said Fisher. “The ability to have a piece of land next to us was very important. But it was also important for the community to make sure the use of that land fits in with community goals and objectives.”
The potential buyers plan to redevelop the property into a five-star resort.
“They're going to invest between $40 million and $50 million of cash into this thing, and it's going to employ about 150 people,” Dee said. “And it's going to be a centerpiece of our whole redevelopment. We're trying to create plans that make the Bennington area a destination, not a bypass county. We think this will be a major reason for people to come into the area.”
The sale will not involve a profit for the hospital, but Dee would not disclose the numbers because of a confidentiality clause in the negotiations. The potential developers are now going through the permitting process.
“In the spring of 2024, we hope to have a closing on that, and they will become the new owners,” Dee said. “We'll get back the money that we put into it. They'll have a great community asset. And by the way, there's about 240 acres of it that will forever remain green trails open to the community.”
Another of Dee's real estate initiatives was instrumental in helping to restore downtown Bennington.
“The hospital system invested in what's called the Putnam Block,” Hurd said. “The block consisted of, I think, three or four historic structures, right at the four corners here in Bennington, at the intersections of Routes 7 and 9. Several other structures, including Greenberg's Hardware Store, were on the property. When Mr. Greenberg passed, the property went on the market. And there again, these were very, very difficult properties to renovate because three of the four are historic, so they're potentially national registered properties or they're already on the National Register. You can't do a lot of things there.”
Photo: Bread Loaf Corp. recently completed construction on the Putnam Block in downtown Bennington in 2021. Provided photos.
The hospital joined with the Bank of Bennington, Bennington College and several private investors to purchase, restore and renovate the properties in three phases. The first phase, involving the cornerstone Putnam Block itself, has been completed; people are living there.
“They're moving slowly towards Phase Two,” Hurd said. “And again the healthcare system is participating. They are planning to bring some medical facilities downtown, with a walk-in clinic and perhaps a dialysis unit. Right now, for a serious dialysis treatment, you have to go to Pittsfield, Mass. So in a nutshell, Tom cares about Bennington. He has brought camaraderie through the healthcare system to the community of Bennington. We're very happy that he's here.”
David Newell, the former chair of the former Southern Vermont College, served on the hospital's board of directors before Dee was hired in 2009. He praised Dee's interpersonal skills.
“At the time the hospital hired Tom, it had, maybe for the first time in its history, a bit of a deficit,” Newell told me. “When Tom came aboard, he immediately surrounded himself with some pretty talented people. They were able to take care of the deficit early on.”
According to Dee, the hospital had been losing between $6.5 million or $7 million each year.
“That was one of the major needs, to turn around the finances,” Dee said. “And we were fortunate to be able to do that.”
After hiring a strong team of people, Dee focused on “the block and tackling of running a business and making sure that we were able to bill correctly and collect money and get our expenses down lower. It was kind of focused on all aspects of the operation. And with a very talented team of people and in a great medical staff, I think we've been able to keep ourselves solid. We've had margins every year of between two percent and four percent. That's kind of the sweet spot for us.”
Dee's work did not go unnoticed.
“All of us, myself included, were immediately impressed with what a great CEO he was,” Newell said. “He had excellent interpersonal skills, great communication skills, and he was great at dealing with employees. He immediately made a pretty big difference in the community. The hospital is pretty important to us. It's the biggest employer by far here in Bennington. And thanks to Tom's leadership, and some others, too, we've attracted some pretty good doctors. The clinical excellence of the hospital is surprising, considering its size. Some of the smaller hospitals, the stand-by-yourself ones, have had it tough. That we've been able to find ways around that is due to Tom's vision and leadership as the hospital CEO.”
The SVHC board is extremely happy with Dee said Fisher.
“Southwestern Vermont Health Care is incredibly lucky to have found Tom Dee to lead the hospital,” Fisher said. “The numbers speak for themselves. In a very difficult time for health care, obviously, due to the pandemic, we've done very well for our patients and our community. Our financial metrics are quality metrics. And it's all because of the leadership of Tom and the people he's hired in his leadership team, and the people that have worked there for a long time.”
Leadership starts at the top, Fisher said.
“And he's just made such a difference,” she said. “And he did it at a time when morale in the healthcare industry is really important because for so long, the challenges have been so significant. I think we all expected after the pandemic that everything would be easy. But with inflation and the ongoing shortage of healthcare providers, it's been a tougher time than anyone would have expected. And under the leadership of Tom and his team, we've been able to fulfill our mission.”
During the pandemic, Dee and his team just rolled up their sleeves and started working, Fisher said.
“The pandemic really illustrated the power of leadership,” she said. “As you know, during the pandemic, everybody was thrown into doing lots of different things in health care. Tom and his leadership team rolled up their sleeves and worked in the vaccination center. They worked with the doctors. It was showing how important it was to keep going when it was very difficult. I think that the commitment to provide health care is so visible, so tangible, and that really helps everybody continue to stay highly motivated and keep going at a tough time.”
The SVHC budget is currently $200 million. While many rural hospitals are running in the red, SVHC has had 12 consecutive years of running in the black, “The longest run in the state, I think,” Dee said. He credits his board for the hospital's success.
“We have one of the strongest boards I've ever seen in my career,” Dee said. “They are a lot of talented businesspeople who have a lot of savviness in terms of running businesses. They held our feet to the fire. They set expectations and directions and provided assistance where we need it. We've been blessed by having that type of governance. It is so important in terms of running businesses, especially nonprofits, They set the tone and management helps us execute. Incorporate that with a talented group of clinicians, it makes for really a tremendous operation. You don't find it at small hospitals every day.”
SVHC was helped to stay in the black during COVID by a flow of government money. But finances are always challenging, and this year the hospital will probably be in the red, Dee said.
“That's because health care's going through a great amount of turmoil in the post-COVID era, with the impact of that, the impact of inflation, plus workforce challenges,” Dee said.
Approximately 1,400 people are on Dee's payroll, definitely making it the largest employer in Bennington.
“But it's a small health system,” Dee said. “Compared with New York, the scale is very different. But in Vermont, I think we're the 12th or 13th largest employer in the state.”
Newell was the first chair of the Foundation Board, which is separate from the hospital's main board. Dee established the foundation approximately a decade ago.
“The function of the Foundation Board is to manage capital campaigns, manage events to support the hospital, those types of things,” Newell said. “It has been tremendously successful for the hospital over the probably eight to 10 years that has been in existence.”
Currently the foundation is winding down a capital campaign that has so far raised $24 million to transform the Emergency Department and Cancer Center into state-of-the-art facilities. The end goal is $25 million.
“We're pretty close to hitting that goal, which will be transformative for the hospital in that it completely reorganizes it and rehabs the emergency department,” Newell said. “And as matter of fact, that's going to be open in June. I'm going to the ribbon cutting. It will greatly improve patient flow and the care that folks get in the emergency department. What's still under construction are some other improvements, including the Cancer Center at the hospital. So that's pretty exciting for everybody.”
Photo: Rendering of the SVHC's Emergency Department and Cancer Center. Courtesy photo.
Early Life
Dee was born in Pittsburgh and raised in communities all over New York State.
“My father was in the retail industry,” Dee said. “He ran Sears stores, mostly in New York State. So we moved around a lot. But we were mostly in the in the Hudson Valley, upstate New York Region.”
Dee is the youngest of five children; his mother was a homemaker.
Dee's father was a hard-working, salt-of-the-earth kind of guy who taught him old school lessons.
“He said, 'Listen, you'll get out of it what you put into it,'” Dee said. “He was never a wealthy man. But he was very big on education. We went through the diocesan school system, from kindergarten to high school to college. We all worked. And all the kids are college-educated.”
Dee always had a job as a youngster. And some of those jobs were — how to say it? — maybe a bit odd.
“I worked a lot on actual farms, tell you the truth, which was tough,” Dee said. “There were days where I did 500 bales of hay. That's when I was young and strong. I did a lot of horse work on farms. I was a grave digger, too. I worked at a cemetery. I was 17 and our local church had a cemetery. They needed someone to do it, so I did. I also did industrial cleaning as a young kid. I worked for a cleaning company that would go in and do some nasty jobs. Not murder sites, though. I was also a security officer. I used to work the midnight shift at a large factory in the Albany area. I did that through college too. So I worked a lot of different jobs.”
Dee went to Xavier University in Cincinnati, Ohio. Given his height, it is not surprising he did those four years on a basketball scholarship.
But Dee also studied business administration under the guidance of his future father-in-law, the father of “my only date my entire life,” Dee said.
“She was my girlfriend, and then she was my wife,” Dee said. “We started dating in my senior year in high school. And her father was a health care CEO, a hospital CEO for his entire career. And he had one of the longest tenures of hospital CEOs in New York State history. I think he was the CEO of a hospital for 45 years. He was a mentor for me.”
His future father-in-law did not see a future in basketball.
“He said, 'Basketball is great, but I don't think you're going to the NBA,'” Dee said. “'So you'd better come up with a game plan.' He said, 'You should consider healthcare administration.' He was a very big promoter of the field, which was, at the time, kind of a new field. Healthcare administration, hospital administration, really started in the 1950s in terms of getting your master's degree in it. Of course, he got one from Columbia University. And as I went through college and was looking for opportunities, he was the one who kept pushing me to take a look at it.”
At the time, Xavier University had one of the top health care administration programs in the country. So Dee decided “to give it a shot.”
He has a master’s in health care administration (MHA), also from Xavier.
After he graduated, Dee did a two year residency program at Vassar Brothers Hospital, now called Vassar Medical Center, a 350-bed, acute care hospital in Poughkeepsie, N.Y.
When he finished the program they hired him as an administrative assistant for support services. He was on his way.
In Poughkeepsie
It may be hard to believe, but by the time Dee was 26 he was CEO of two small hospitals in the Vassar system.
“First I had responsibilities for materials management, for housekeeping, for food service, food safety and security,” Dee said. “And a number of shipping and receiving areas. It was a non-clinical entry level job. It was really my first time in hospitals. Then, within a year or so, I started to take on clinical services — radiology, respiratory therapy, physical therapy, physical rehab. So I quickly got into both support services and clinical.”
Within three years he was a contract administrator for two smaller hospitals that Vassar took over.
“I ended up running two different hospitals as CEO at a pretty young age,” he said. “I had administrative accountability for the operations of those areas. Budget control, planning, working with the physicians and medical directors of each of those services. So partnering with the doctors in terms of developing and expanding those type of services.”
From the beginning, Dee liked the work.
“I didn't want to be focused on making widgets,” he said. “I wanted to be focused on helping people, providing services and having an impact. And all those things came from my father-in-law, who was passionate about creating services that would help the community.”
After Poughkeepsie, Dee moved to Kingston, where he became president and CEO of the 222-bed Catholic Benedictine Hospital.
“I was the first lay administrator for a Catholic health care system,” Dee said. “And I was there for 17 years. And then we went into merging several hospitals together and I moved to Bennington and the Southwestern Vermont Medical Center.”
Financial Challenges
Dee's career has been in the nonprofit hospital world, where the financial challenges are many.
“Trying to balance the needs of the communities — sometimes underserved communities — with a business that is challenged by reimbursements and challenged by the payer mix is always difficult,” Dee said. “Sometimes you have indigent folks who just don't have the funds. So it's always challenging, but it's certainly invigorating. It's never easy to balance the needs of everyone and make the finances work. “
There are multiple reasons why SVHC may be in the red this year. But the biggest reason is that “the world has changed,” Dee said.
“We've gone through a very difficult time of inflationary expenses that have hit us hard,” Dee said. “Every line item, literally. I've been in health care administration for over 40 years, and I've never seen where you had every line item going over budget in terms of cost. It's remarkable — in a negative way.”
Personnel costs have jumped, as well.
“We've had to go way above our budgets over the years in terms of our salaries, because we have to keep people here,” Dee said. “And that's been a big challenge. Expenses have gone up double digits, and reimbursements have certainly not gone to double digits. It's much less than that. So when you don't have a big margin in the first place, it doesn't take much to reach a tipping point. And certainly, we've had a tipping point in terms of our expenses and our need to try to balance everything.”
Dee and his staff are working on a plan for 2024.
“We're showing progress and we will be back into positive operations, we believe, in 2024,” Dee said. “But it's not without a lot of hard work. Our entire team is working on this right now — to get ourselves back to where we need to be, which is at that sweet spot of a 2 percent to 4 percent margin. That's where we need to be to be sustainable long term.”
One of the biggest challenges facing all hospitals today is insurer reimbursements.
“The entire state has a very high percentage of people who are either on Medicaid or on Medicare,” Dee said. “If they're on Medicaid, they're probably indigent. In our case, 70 to 78 percent, I believe, of our revenue is Medicare and Medicaid. That's a very high percent. When I came from New York, it was nowhere near those numbers. But those are governmental insurers who typically pay less than cost for care. So if you have a high percent of Medicare and Medicaid patients, you're going to be financially challenged. Then the people who are on commercial insurance end up paying a higher percent, because you have what's called a cost shift. Hospitals have to make it up somewhere.”
SVHC is part of a paradigm shift happening in the field of medical reimbursement.
“We're trying to move away from a fee-for-service model, where providers, hospitals and doctors get paid for doing more work,” Dee said. “We're trying to move towards a model where they get paid for keeping people well. It's called Value Care, where you're rewarded based on how well you care for people and how well you try to keep them healthy.”
It is a challenging transition, especially when your patient base is elderly and needs more care.
“As you get older, you're going to have more chronic illnesses,” Dee said. That's what makes this very challenging. And I think at times it penalizes the communities who have an older population. We're not Seattle, Washington, where you have a bunch of young tech people. It's hard to make the transition away from fee-for-service.”
Another spanner in the works is drug addiction.
“The whole drug and substance abuse problems are also wreaking havoc on our system,” Dee said. “The number of addicted people who are coming into Vermont is a very high number. And it brings with it drug trafficking. The rise of fentanyl use and the rise of other illegal drugs coming into Vermont, a lot of it coming from New York City, is impacting our population. We're in constant dialogue with the Health Department and the police department, trying to work on this problem. It's having a negative impact on the overall health status of our community. We're opening up substance abuse centers to try to deal with this. It's a very significant problem that's not going away. And it's impacting a greater percentage of our population.”
Dealing With COVID
At a time when COVID was a new disease that no one knew how to treat, SVMC received the first case of COVID in the state.
“But we were geared up for it,” Dee said. “We got ready for COVID early on. We created an incident command center at the hospital. When we got the first case — and I wish it was the last — there were a lot of questions. We were having lots of meetings with other states, lots of meetings with our national associations, just trying to educate ourselves. We were all kind of reading from the same training book at the same time.”
Having the Southern Vermont College campus on which to set up a testing and vaccination center helped enormously.
“People came from multiple states, not just from a tri-state area, but from multiple states,” Dee said. “They came because it was a very efficiently run center. We got results back in literally hours. It worked out very well for us.”
Another thing that greatly helped SVMC during COVID was its stable nursing staff.
“We're one of the few hospitals that have not been using a lot of traveling staff,” Dee said. “We made a decision to try to focus on our internal staff and to readjust salaries and create special pay arrangements to keep our people here. And by and large, it was a choice that worked.”
For example, Dee cited the work of chief nursing officer, Pamela Duchene.
“She has her doctorate degree in Advanced Nursing Practice,” Dee said. “Yet she would go and work on the floor, taking care of patients. She and the associate nurses, nurses, and leadership, all working side by side doing direct bedside care. That's a testimony to their focus on patient care. And it helped the staff fill in spots where there were shortages.”
Management was doing that in other areas of the hospital, too.
“Everyone was jumping on board helping out,” Dee said. “Our clinical management team was working on the floors,” Dee said. “That's really a testimony to them — working with their staff directly. And I think it sends a message that we're all in this together.”
Staff burnout was a huge hospital problem during COVID, and SVHC was no exception.
“People got tired, and it was hard,” Dee said. “And you can only do that for so long. But in certain respects, they're still doing it right now. They're still helping out in areas. Not as much because we don't have as much COVID. But at the time, it was everyone pitching in. I think that's kind of the philosophy that we have here. And I think it shows why we're a magnet hospital. It's a sign of the culture that's been created here over the years, even before I got here. And it carries over into all areas of the hospital, because you can't be a magnet hospital just by having great nurses. You need to have great support areas, great support departments, and we have that.”
This kind of cooperation has led to a new way of looking at staffing.
“We're going to try and make adjustments on compensation to keep people here,” Dee said. “But we're also going to have more and more management working side by side with their employees. I think that worked well for us. It doesn't work everywhere, but at our organization, by and large, it did.”
Right now the entire country is suffering from a shortage of medical personnel; SVHC is no different.
“There's a big shortage of nursing care across the country,” Dee said. “And we need more. We're recruiting. But I think we tried to be innovative and do things that allow us to attract more and more nurses here. For example, we have self-governance. In our different departments in nursing, the nursing team members sit down together with management. They come up with ways that make our nursing operations better, more sustainable, more efficient. They have a higher focus on quality, a higher focus on patients, and they're right at the table working with us to come up with ideas and plans to make us a better organization, and make us more attractive for people to come and work here and stay here.”
Nursing loss is not the only problem. The need for family health care providers is also at a crisis level.
“Certainly we have a fair number of primary care physicians, but we're concerned because they're aging out,” Dee said. “Overall, our medical staff is at a pretty young age. I think the average age is in the mid-40s, which is pretty good. But that's not the case for family medicine doctors, who tend to be older. Over the next five or six years, we're going to see a significant number of physicians retiring, so we need to fill those positions. And that's why we're trying to make plans that will allow us to do that.”
Growing The Dartmouth Connection
Creating a pipeline for doctors is just one of many reasons that SVHC is affiliating — if that's the right word — with Dartmouth-Hitchcock Medical Center in Hanover, NH, a good two-hour drive over a mountain range. There are no questions about the high standard of care that Dartmouth, a teaching hospital, provides, but autonomy issues are a concern.
According to board chair Fisher, this is a combination of merger and affiliation.
“We become a member hospital in the Dartmouth health system,” Fisher said. “So we absolutely will become part of Dartmouth. And they'll have other hospitals who are member hospitals. The benefit to our community is that Dartmouth will help us grow and expand our services to the local community. We want to provide more care locally, as opposed to having many of our patients go to Albany or Dartmouth or Burlington.”
There are great benefits to this merger/affiliation, Fisher said.
“I view the opportunity to be fully affiliated with a teaching hospital as a huge benefit,” Fisher said. “That will really enable us to think about long term sustainability and providing health care in our market. Over time, it's going to be very hard for rural hospitals to build the technology, the artificial intelligence, all the things that you know will be incorporated into healthcare, on their own. So being connected to a teaching hospital will be a real benefit. The immediate focus will be on expanding our local services. We talk about orthopedics and cardiac health, and there are a lot of things we're looking to expand and enhance as part of this merger.”
SVHC will still retain its individuality, Fisher said.
“We will maintain a board, and we will be accountable for our performance,” she said. “But they'll have the ability to leverage the increased knowledge and technology and information that you can get as part of a bigger system.”
Dee started looking for a hospital to affiliate long before COVID; SVHC has had an affiliation with Dartmouth since 2012.
“When we made the decision to affiliate 10 years ago, we went through a full year's process of assessing different potential affiliate partners,” Dee said. “We sent out a request for proposals, and we got a pretty good response. We interviewed all of them, and we had a chance to go to see the different sites. After about a year review that included our board, our medical staff, our leadership administrators, and community members, we chose Dartmouth, because everyone I met was very impressed.”
Dartmouth understands rural medicine, Dee said.
“And that's important,” he said. “A place like Albany Medical Center is a very good organization, but Dartmouth is in a rural area so they get it. Also, a lot of our physicians and providers are graduates of Dartmouth, so there's a historical relationship. Also, Dartmouth understands Vermont. They're the second largest provider of care for Vermont people. (The University of Vermont Medical Center is number one.) So they understand the politics of Vermont. They understand the whole culture of Vermont.”
The relationship has been working well for the last 10 years, Dee said.
It's been a very good relationship,” he said. “We know them and they know us. I mean, there are no secrets anymore. When you're with someone for 10 years, it's almost like courting and then being engaged and getting married. You know each other very well.”
Now SVHC is taking that relationship to the next level.
“In July of this year we will become a member of Dartmouth,” Dee said.
“They will become our new parent corporation. We will work even closer with them. They'll have certain governance responsibilities for us.
The CEO of Dartmouth, Dr Joanne Conroy, will be the CEO of the entire system, but Dee will remain the CEO of SVHC. And there will be no transfer of assets, Dee said.
“We're going to move into their corporate structure,” Dee said. “They will have certain reserved powers over our organization. They'll have the right to approve our budgets. They'll have a right to approve major financing. They'll have the right to approve major new services. And in return, Dartmouth works with us helping to create new programs and services that we could not create on our own.”
For example, for SVHC Dartmouth is investing over $20 million in a new electronic medical record system called EPIC.
Also, Dartmouth is a teaching hospital; it will provide a family practitioner pipeline to SVHC.
“We're looking to join them to do a family medicine training program,” Dee said. “We couldn't do that on our own, as a small institution. Dartmouth has an infrastructure to train physicians. Now we're looking to work with Dartmouth-trained physicians in the Southern Vermont region. That's exciting, and it's an area of big need for us.”
SVHC is a regional cancer center, but Dartmouth has one of the best cancer centers in the country.
“It's what's called a comprehensive cancer center,” Dee said. “And they're working with us to continue to upgrade and to allow more services to be rendered locally here. And they will add additional programs to create clinical drug trials, and add educational aspects for our patients. These are all things that will help people be cared for closer to home.”
Then there is telemedicine, already on-line and performing an important service to Bennington County.
“We have an 11-bed Intensive Care Unit, or ICU,” Dee said. “Every one of our patients is monitored 24/7 by a team from Dartmouth in addition to our team of nurses and hospitalists.”
This adds an extra layer of safety and care.
“They have a series of board-certified intensivists,” Dee said. “Those are doctors who are trained in intensive care medicine. They have nurses there and they have pharmacists, and a team of people who work with our team of people to closely monitor our patients around the clock. They look at vitals and recommend drug regimen changes. They have consultations with our staff, and they talk to the patients. It's all done on screens.”
Telemedicine is also in the Emergency Room.
“When a patient comes in for emergency care, they hook up them electronically,” Dee said. “Say you come into the emergency room with symptoms of a stroke. Right away, we'll pull up a stroke neurologist, a doctor who specializes in stroke medicine. And the stroke neurologist will do a review of the patient on a telemedicine screen right there.”
This is the future of medicine, Dee said.
“It's a team approach to care,” he said. “It allows you to have a bigger, more robust number of people working together. It's especially the future when you are physically hours away. You can bring care right to the bedside. I think it's going to be a continually growing relationship that will evolve and manifests itself in a lot of new services that the community needs.”
The financing will be complicated. Each hospital still bills insurance for its services, Dee said.
“You're paying them, they're paying you,” he said. “It's all part of us becoming integrated together as we absorb those costs. And I think over time there'll be more and more billings for telemedicine services. I think when COVID was in high gear, the insurance companies allowed for billions of dollars for telemedicine, but it's not universally accepted for billing yet. In the future, it probably will be.”
The Future
SVHC has already expanded into New York and Massachusetts.
“We have small locations right now but we're looking to expand,” Dee said. “In New York, we have a primary care center in Hoosick Falls, and we also are running a nursing home. We have the Center for Nursing and Rehabilitation, and down in Massachusetts we are running an Orthopedic Center. We also have a joint venture on an urgent care center with an another partner in North Adams.”
On the radar is building workforce housing on the seven acres of land that the hospital is retaining from the Southern Vermont College deal.
“That's definitely on our radar screen,” Dee said. “Before the housing crisis hit, the hospital was acquiring single family homes in the town of Bennington to redevelop. We were buying homes and renovating them and selling them back to our employees. And now there's a housing crisis. The amount of available housing stock is very low right now.”
Phase Two of the Putnam Block is happening now.
“It's about a $40 million project,” Dee said. “That will be the construction of a five story building downtown. The main floor will be healthcare services. The second, third and fourth floors will be apartments, and the fifth floor will be condos.”
Between the rampant drug problem and the general mental health problems that have surfaced since COVID, Dee is thinking about constructing a mental health unit.
“We are looking at creating a new service.” Dee said. “We'll do it with the help of Dartmouth. We're going to start to move into mental health services. We haven't done that in the past. We have been primarily a medical and surgical community hospital. But now we're going through a serious discussion at the board level, asking the question, 'Should we move into the realm of also providing mental health services?' This is extremely challenging and expensive. It's hard to find staff and it reimburses poorly. There are a lot of negatives, but the reality is there's a growing community need.”
The hospital has been working with the Vermont Dept. of Mental Health for the past six months, studying the feasibility of the idea. The board will make its decision soon, Dee said.
“And the first one that we're looking at, which is probably maybe one of the toughest we could pick, is to open up an inpatient adolescent mental health program,” Dee said. “These are for kids from 12 to 17. It's a very challenging population. There are very few services in our state. The only one is at the Brattleboro Retreat, and they've downsized the number of beds they have for that service. If we do it, we're gonna need the help of Dartmouth because they have a structure for mental health services.”
With all these high-energy, demanding, serious and exciting projects, it is not surprising that Dee has given very little thought to retiring.
“At some point, I will,” he said. “But right now I'm focused on getting to the finish line with Dartmouth and moving ahead and getting some of these major projects completed. So retirement is not imminent at this point in time.”
Photo: Ronald Zimmerman, Director of Engineering Thomas A. Dee, FACHE President and CEO in front of construction at SVHC. Photo: Greg Nesbit Photography.
Joyce Marcel is a journalist in southern Vermont. In 2017, she was named the best business magazine profile writer in the country by the Alliance of Area Business Publishers. She is married to Randy Holhut, the news editor/acting operations manager of The Commons, a weekly newspaper in Brattleboro.