BENNINGTON - Going to see a Dartmouth-Hitchcock physician no longer means two hours in a car for residents of southwestern Vermont and nearby communities, such as Hoosick Falls, N.Y. and Williamstown, Mass. On July 1, Southwestern Vermont Medical Center's employed physicians became part of Dartmouth-Hitchcock, which employs nearly 1,000 physicians across New Hampshire and in other parts of Vermont.

"I am pleased and excited to announce that the physicians in our multispecialty medical group are now part of Dartmouth-Hitchcock," explained Thomas A. Dee, president and CEO of Southwestern Vermont Health Care (SVHC), the parent organization for Southwestern Vermont Medical Center (SVMC). "This agreement paves the way for expanded access to physicians in our area and improved recruitment of new physicians."

Dee added that the agreement also will expand SVMC's quality improvement efforts. "SVMC has an outstanding quality improvement record. Dartmouth-Hitchcock is a national leader in quality improvement research. The affiliation will leverage the quality improvement strengths of each organization to drive health care quality in our community to a new, higher level."

The agreement also positions both institutions for coming changes in health care reform. Most reform proposals in Vermont or at the federal level will shift the way for which health care is paid. At present, physicians and hospitals are paid for each office visit or each treatment. That creates incentives for

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doctors and hospitals to see more patients or provide more treatments. Future payment schemes instead may create incentives for keeping people healthy. For example, a health care institution may be paid a set amount per year to care for the number of people it serves.

"Health care reform makes collaboration between physicians, community hospitals, and academic medical centers more important than ever before," explained Dr. James Weinstein, chief executive officer and president of Dartmouth-Hitchcock. "As health care shifts toward managing the health of a population, organizations will need to be broad, diverse, and well-connected to succeed."

The agreement is the culmination of about a year of work at the health system to determine which academic medical center would make the best partner. The agreement itself is straightforward. The roughly 70 physicians employed by SVMC will become employees of Dartmouth-Hitchcock Putnam Physicians, an arm of Dartmouth-Hitchcock.

Instead of employing doctors itself, SVMC will purchase physician services from Dartmouth-Hitchcock. The physicians will continue to work in their same positions and locations within SVMC, only as Dartmouth-Hitchcock employees.

Although the physicians and a few clinical staff members will be employed by Dartmouth-Hitchcock, SVMC will continue to operate the medical practices themselves. The buildings, nursing staff, billing and office personnel, and other employees also will remain with SVMC.

To ensure collaboration, the two organizations have created a joint operating council that includes representatives of SVMC's and Dartmouth-Hitchcock's management and physician leaders. The group meets regularly to discuss strategic planning, collaboration, and improving quality and efficiency across the multispecialty physician practice.

"This is not a merger or a takeover," explained Dee. "No assets or cash are changing hands. SVMC will continue to operate our medical practices. The major difference patients may notice is that the doctor they're seeing is now a part of Dartmouth-Hitchcock."