Wentworth-Douglass Hospital
(603) 742-5252
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Notice to Patients
Governing Body and Committees

Notice to Patients

Some Medicare Fee-for-Service beneficiaries affiliated with Wentworth-Douglass Physician practices, Concord Hospital Medical Group, Elliot Physician Network, and Foundation Medical Partners may have received the information below regarding their providers' participation in an ACO. For more information please contact your provider's office or call 1-800-Medicare.

Frequently Asked Questions

Notice to Patient
Wentworth-Douglass Health System is participating in an Accountable Care Organization.

Your Wentworth-Douglass Physician practice provider is Participating in a New Care Coordination Program
Wentworth-Douglass Physician practice provider has chosen to participate in a Medicare Accountable Care Organization (ACO).

We're Working to Improve Your Care
An ACO is a group of doctors and other health care providers working together with Medicare to give you quality service and care. The goal of an ACO is for your doctors to communicate closely with your other healthcare providers to deliver high-quality care and meet your unique individual needs and preferences. The ACO may be rewarded for providing you with high quality, more coordinated care.

You Can Still See Any Doctor or Go To Any Hospital
Your Medicare benefits are not changing, and you will still receive your benefits through Original Medicare. This isn't a Medicare Advantage plan or an HMO plan. You still have the right to use any doctor or hospital who accepts Medicare, at any time. We may continue to recommend that you see particular doctors for your specific health needs, but it’s always your choice about what doctors you use or hospitals you visit.

You Control Your Personal Information
To help us give you the right care in the right place at the right time, on September 26, 2012, Medicare plans to start sharing certain health information with us about your care. This information will include things like visits to the doctor or hospital, medical conditions, and prescriptions you’ve had in the past and moving forward. Having this information will help us and your other health care providers participating in our ACO give you high-quality care, because we’ll have the most up-to-date information about your health.

Your privacy is very important to us, and you control the use of your personal health information. Like Medicare, we have important safeguards in place to make sure all your medical information is safe.

You Can Choose to Not Share Your Health Information
If you choose, you can ask Medicare not to share your personal health information with us by doing one of these things:

  • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  • Complete and Sign the “Declining to Share Personal Health Information” form in your doctor’s office.

If you want to ask Medicare not to share your information with us, you should take one of the two steps described above. Even after Medicare begins to share your information with us, you may always ask Medicare to stop this informationsharing in the future.

Please note, however, that Medicare will not share any information about alcohol or drug treatment without express written permission. If you have received such treatment, it is important that we understand all of your health needs in order to allow the healthcare providers that treat you to coordinate your care. To give this permission, complete the “Consent for the Release of Confidential Alcohol or Drug Treatment Information” form and give it to us or mail it to the address indicated on the form. If you have received such treatment, consenting to allow Medicare to share this information about you with us will not change who you go to for alcohol or drug abuse prevention, treatment or recovery supports, but will help us provide better health care for you. You may withdraw your consent to share this information at any time either in writing or over the phone if you want Medicare to stop sharing this information.

If you have questions or concerns, you can call your Wentworth-Douglass Physician practice provider or bring it up next time
you’re in their office. You can also visit www.medicare.gov/acos.html or call 1-800-MEDICARE and tell the operator
you are asking about ACOs (TTY users should call 1-877-486-2048).


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Wentworth-Douglass Hospital
789 Central Avenue, Dover, NH 03820
Phone: (603) 742-5252
Toll free: 1 (877) 201-7100