Preparing and Adapting to a Changing Health-Care Landscape

The following article appeared in our 2014 Annual Report.

building for the future with Gifford Medical Center

A message from Administrator Joe Woodin

FISCAL YEAR 2014 was a transformative one for Gifford as several long-term initiatives came to fruition—efforts that will not only benefit patients but also position Gifford well for the future in an era of health-care reform.

In November 2013, a very excited Senator Bernie Sanders called to say that Gifford had been designated a Federally Qualified Health Center. What we qualified for were federal funds that provide greater access to primary care—including dental and mental-health services—for Medicaid patients and the uninsured. By July, after a lot of hard work by our administrative team, we were ready to start drawing on those funds.

The Gifford Retirement Community now under construction in Randolph Center passed its final regulatory hurdle a month before the senator’s phone call, and ground was broken in the spring. Add to these developments the hospital’s conversion to single-patient rooms and Gifford’s transition to electronic medical records and you can see why we’ve titled this report “Building for the Future.” In the following pages, we discuss the new developments and relate them to the changing health-care landscape.

Last but not least, Gifford “made budget” for the fifteenth year in a row, a feat not replicated by any other hospital in Vermont. Achieving its state-approved operating margin is an indicator of Gifford’s health as a medical center, community organization, and employer, and credit for this achievement goes to the entire staff.

Gifford Welcomes Ob/Gyn Dr. Elisabeth Nigrini

Dr. Elisabeth Negrini

Dr. Elisabeth Negrini

Dr. Elisabeth Nigrini has joined Gifford Health Care, expanding the comprehensive women’s health care team to three Ob/Gyn doctors and four certified nurse midwives.

A native of Pittsburgh, PA, Nigrini discovered early in life that she enjoyed teaching, working with people, and that she had a particular interest in women’s issues. She mentored adolescent girls as an undergraduate at Swarthmore College, was awarded a graduate fellowship in public affairs, and has volunteered with counseling hotlines and in women’s shelters.

In the field of women’s health she found a career that combined her driving interests. “In my third year of medical school I did a rotation in obstetrics and it was so rewarding,” she said. “I found a way to combine medicine with my commitment to public service, mentoring, and working with women.”

Nigrini has worked with underserved women in Tanzania and the United States, and had additional training in maternal-fetal medicine at Johns Hopkins University. She likes helping women through their labor and delivery experience, and most enjoys establishing continuing care relationships with her Ob/Gyn patients.

“Working with women’s health has an educational component that I enjoy because I feel I can have an impact,” said Nigrini. “People are willing to make changes when facing transitional periods. A woman may quit smoking when pregnant, or be more open to information about lifestyle changes—these things can impact an entire family.”

The move to Randolph is an especially good fit for Nigrini and her family. Her husband, Andy Erickson, MD, is also working at Gifford and they both wanted to practice medicine in a hospital where they could establish ongoing relationships with their patients. They also wanted to raise their two young daughters in a small community where they could enjoy the outdoors.

Board-certified by the American Board of Obstetrics and Gynecology, Nigrini brings a set of skills and experience that enhance the comprehensive approach of Gifford’s women’s care services, particularly for women with complicated or higher risk pregnancies. She is currently accepting new patients. Call her at Gifford Ob/Gyn & Midwifery at (802) 728-2401.

DeHart Exhibit at Gifford Medical Center’s Art Gallery

“Expressions and Demeanors—Wildlife or Human?”

DeHart art exhibit

“Exuberance,” by Rochester photographer Barb Madsen DeHart

In the year since her last popular exhibit in the Gifford Gallery, Rochester VT photographer Barb Madsen DeHart has collected new photographs while travelling in Africa, The Galapagos, and Wapusk National Park in Manitoba, Canada.

The pieces in the current exhibit, “Expressions and Demeanors—Wildlife or Human?” reflect a change in her objective as a photographer.

“I’m no longer pursuing just ‘photo ops,’ to capture shots of wonderful creatures,” she said. “Rather my focus is on glimpsing how wildlife inadvertently presents itself to the outside world, recognizing their expressions and demeanors as interpreted, in this case, by me.”

The exhibit features 28 portraits—of Polar, Spirit, and Kodiak bears; penguins; fur seals; lions; elephants; and walrus—with a whimsical caption describing what each might be thinking.

One of the photographs, “Polar Bear Mom and Cub,” was selected to be a National Wildlife Federation holiday card for 2015. It is one in a series that shows a mother and her 3-month-old cub emerging from their den in spring.

“The interactions and expressions of new mom and ‘newbie’ made me forget the anxiety I felt as my camera froze, my tripod and camera blew over, and as I vainly tried to de-ice my camera lens, viewfinders, and goggles!” DeHart said.

DeHart has exhibited at the Chandler Art Gallery in Randolph, VT; Compass Arts in Brandon, VT; and at the Annual Photo Show and the Member’s Show, both in Waitsfield, Vermont.

This exhibit is free and open to the public, and will be displayed through May 6, 2015. The gallery is located just inside the hospital’s main entrance at 44 S, Main St. (Route 12) in Randolph. Call Gifford at (802) 728-7000 for more information.

Gifford’s Twin River Health Center Welcomes Susan Tubens, PA-C

Susan Tubens, PA-C

Susan Tubens, PA-C

Susan Tubens, PA-C, has joined Twin River Health Center’s team, adding primary care to their patient-centered urology and OB/Gyn practices.

In 27 years as a physician assistant, Tubens has cared for patients with medical needs ranging from trauma to ongoing primary care. She and her husband, Gifford Obstetrician/ Gynecologist Sean Tubens, moved from Florida to Bethel, Vermont, after searching for a small and friendly community where they could practice medicine and enjoy the outdoors.

Primary care is a special interest of Tubens, who notes that an ongoing relationship with a provider who knows a patient’s health care goals and history can help them stay healthy. A strong believer in preventative medicine, she looks forward to caring for families in the White River community.

Tubens is currently seeing patients at the Twin River Health Center on North Main Street in White River Junction. Call 728-2777 to schedule an appointment today.

Primary Care Gets a Boost

The following article appeared in our 2014 Annual Report.

primary care in Randolph VT

Family nurse practitioner Christina Harlow shares a laugh with Mary Williams of Randolph Center during a recent visit.

A family unable to afford dental care. An uninsured mother-to-be. A loved one suffering from depression. These are some of the people who will be helped by Gifford’s new status as a Federally Qualified Health Center.

The memo to staff was dated November 7, 2013, and sprinkled with exclamation points. It came from administrator Joseph Woodin and was entitled “A Must Read!” The message: Gifford had just been named a Federally Qualified Health Center (FQHC)—an event that Woodin characterized as “some of the biggest news I have ever shared with staff since working at Gifford!”

Gifford's primary care

Christina Harlow consults with family medicine physician Dr. Marcus Coxon.

The FQHC designation is a coveted one, opening the gate to a stream of federal dollars for primary care. The funding comes from the Health Resources and Services Administration (HRSA), the primary federal agency for improving access to health-care services for people who are uninsured, isolated, or medically vulnerable. Of particular interest to Gifford: support for dental care and mental health services for Medicaid patients and the uninsured.

“This assistance from the federal government allows us to develop programs for dentistry, psychiatry, and mental health that are hugely important for the community,” says Medical Director of the Hospital and Medicine Divisions Dr. Martin Johns. “It also allows us to place a bigger focus on primary care. It means we can take better care of our Medicaid patients, offering them services that we couldn’t before because of finances, and that’s huge.

“We’re finding out almost weekly that we can offer things to patients that we didn’t even know about, let alone have the capacity to apply for. The designation was designed to help small groups of physicians serving in rural communities. Our mission has always been that.” Gifford's mission To qualify for FQHC status, a community health center must be open to all, regardless of ability to pay. It must offer a sliding fee scale with discounts based on patient family size and income in accordance with federal poverty guidelines. The federal money is intended to offset these obligations.

Over the past year, Gifford has laid the groundwork necessary to begin drawing on those funds. Among the steps: conducting a search for a psychiatrist to join the medical staff, working out agreements with area dentists to provide care to Medicaid patients, and completing a transition to electronic medical records.

“HRSA is really concerned that they make these health centers as feasible as possible,” says VP of Finance Jeff Hebert, “so there’s a lot of grant opportunity that impacts our financial stability. We get support every year as long as we keep up with the requirements.

“Probably the biggest benefit is that we get bigger reimbursement for our Medicaid patients. Reimbursement is cost-based, and not fee-based, so instead of paying a percentage of the fee for x, y, and z, the government looks at how much it costs to provide those services. It’s a better reimbursement methodology for Medicaid.” Other perks of the designation are: insurance coverage for primary care physicians and relief from staggering medical-school debt, a powerful recruitment incentive.

IF IT WALKS LIKE A DUCK

Dr. Marcus Coxon

The new FQHC designation allows primary care physicians like Dr. Marcus Coxon (left) to offer Gifford patients increased access to mental and dental health services.

The Gifford model is an unusual one: a community health center with satellite clinics and a small hospital at its hub. As such, it provides both primary and critical care to a rural population. It would thus seem eligible for both FQHC funding and the benefits it receives as a Critical Access Hospital, a designation conferred in 2001. But would the feds see it that way?

The FQHC “duck test” was a laborious application process that involved many hospital departments and years of preparation, followed by months of waiting. With acceptance, Gifford the health center became the “parent” of Gifford the hospital—one of only three FQHC/CAHs in the country.

“Our primary-care services—which include internal medicine, family practice, pediatrics, and ob-gyn—are all part of that community health center parent,” explains Woodin.

“The concurrent designation is tremendous for us,” says Johns. “It enables us to provide the most possible benefit to the community while being a small hospital, and it protects us from a lot of the changes going around the state and the region with regard to accountable care: As an FQHC, we cannot be purchased by or absorbed by a larger organization.”

“I look at health-care reform as being primary-care focused,” says Hebert. “It’s that primary-care provider who keeps you healthy and works with you to make sure you as a patient are getting what you need. If you’re prompting that patient to come in for a physical, and to develop healthy behaviors, you’re going to keep that patient a lot healthier at a manageable level than a model that doesn’t focus on primary care. I use myself as an example of what not to do: I only go to a health-care provider when I get to the point when I’m ready to go into the hospital and that’s an extremely expensive proposition. It’s not as efficient, and you as a patient aren’t as satisfied because you’re looking at a long recovery time. By making Gifford Health Care the parent of our organization, we’ve set ourselves up for the future, and I feel we’re in a really good place.”

After eight months of administrative work, Gifford was ready to start drawing on its new funds. The first bill went out in July. “It’s probably going to take most of 2015 to really understand all the levers and dynamics,” says Woodin.

“My thanks and appreciation go out to the staff behind the scenes who made this happen. It was a huge amount of work, and yet strategically, it positions us well, given health-care reform both in the state of Vermont and nationally. It helps us to have the right focus again around primary care, taking care of Medicaid and the uninsured, and looking to build from there.”

Gifford’s Dr. Rob Rinaldi Honored

Podiatrist/sports medicine advocate celebrated for His 12 years at Sharon Health Center

Dr. Rob Rinaldi

Dr. Rinaldi

Gifford staff gathered on March 25 to celebrate podiatrist Dr. Rob Rinaldi’s 12 years of service to an expanding community of athletes, and to wish him well as he transitions to new roles in the organization.

The party featured a cake shaped like a foot, lots of foot jokes, and heartfelt stories about Rinaldi’s many contributions and roles at Gifford: as generous mentor, sports medicine advocate, surgeon, and the force behind the very successful Sharon Health Center and sports medicine clinic.

“I flunked the first time I retired!” Rinaldi quipped, explaining that he missed seeing patients when he left a thriving Connecticut practice and retired to his farm in Chelsea in 2000. So when Gifford Administrator Joe Woodin approached him about expanding sports medicine at Gifford, he was receptive: “I didn’t want to sound too anxious, so I said yes!”

Rinaldi helped design the first phase of the Sharon Health Center, which opened in 2005. By 2008 a 2,200 square foot expansion was added to accommodate the thriving sports medicine clinic, and a final planned 2,600 square foot expansion was added in 2014.

Today, athletes come from all over the Upper Valley to the center, which includes a physical therapy gym space; x-ray technology and mounted flat screens for reviewing radiological exams; physical therapy treatment rooms; and a state-of- the-art gait analysis system. The sports medicine team includes: Michael Chamberland, DC (chiropractic/sports medicine); Paul Smith, DPM (podiatry/sports medicine); Nat Harlow, DO; and Peter Loescher, MD (sports medicine); and a team of physical therapists.

“Rob brought years of business experience to the creation of Sharon Health Center,” Woodin said. “But he also brought his pride in what he does, and his entrepreneurial spirit to Gifford.”

The stories Rinaldi’s colleagues told described a generous and compassionate mentor: “Rob was the voice of wisdom, the one people came to when facing some sort of challenge,” said Vice President of Surgery Rebecca O’Berry.

Although he will no longer be seeing patients, Rinaldi will continue to serve on administrative committees at Gifford, and will work with residents at the new Menig Nursing Home when it opens this spring in Randolph Center.

Gifford Positioned for Changing Health Care Landscape

109th Annual Meeting celebrates forward-looking growth in programs and facility

Joe Woodin

Administrator Joe Woodin answers questions during Gifford Medical Center’s 109th Annual Meeting.

Nearly 100 community members gathered Saturday night for “Building for the Future,” Gifford Medical Center’s 109th Annual Corporators Meeting.

Reporting on an exciting and transformative year, administrators and board members highlighted the implementation of several long-term initiatives:

  • The new Menig Nursing Home, looking out over the green mountains in Randolph Center, will open—on time and on budget—mid-May 2015.
  • The hospital wing vacated by Menig will be converted into state-of-the-art private patient rooms to offer privacy for provider consultations and family visits, and to accommodate medical technology at the bedside.
  • A new organizational structure, created to reflect Gifford’s new Federal Qualified Health Center designation, will allow Gifford to offer enhanced preventative, dental, and behavioral health services to our patients.

“It’s been an extraordinary year,” Gifford Administrator Joe Woodin stated. “These initiatives strengthen the services we offer our patients and also position Gifford well for the future in an era of healthcare reform.”

Moving forward while making budget for the 15th consecutive year
After presenting the annual hospital report and a brief update on the uncertain state of Vermont’s healthcare policy, Woodin noted that Gifford has maintained ongoing fiscal stability while pushing ahead with these forward-looking initiatives. For the 15th consecutive year Gifford has made budget and achieved its state-approved operating margin. The culmination of years of research and planning, each of these new projects reflect Gifford’s commitment to providing quality community care for years to come.

New $5 million capital campaign launched
Lincoln Clark, board treasurer and co-chair of the “Vision for the Future” campaign, announced the launch of the public phase of the $5 million capital campaign.

“As of tonight this campaign is no longer silent,” Clark told the group. “It has been a remarkable experience—we started two and a half years ago with a vision, research, and a community survey. We decided then to wait until we raised 60 percent before going public, and we’ve exceeded that goal. We hope to reach the campaign’s $5 million goal by December 31st of this year.”

The “Vision for the Future” campaign supports the hospital’s conversion to industry-standard private patient rooms, and the construction of the new Menig Nursing home in Randolph Center. Menig, one of only twelve nursing homes in Vermont to retain a five-star rating from the Centers for Medicare and Medicaid Services, will anchor the new Morgan Orchards Senior Living Community in Randolph Center.

Panel presentation describes a Gifford ready for tomorrow’s healthcare needs
A panel presentation looked at four recently implemented changes that will help Gifford provide for future community healthcare needs:

  • Dr. Martin Johns, medical director for Gifford’s FQHC and hospital division, talked about building the behind-the-scenes administrative structure now in place that will help Gifford provide expanded preventative, dental, and behavioral health services as a Federally Qualified Health Center.
  • Dr. Lou DiNicola, pediatrician, described the challenges staff faced while transitioning to a federally mandated Electronic Medical Record system. Now that the transition is complete, the benefits are clear: greater efficiency and improved patient care.
  • Alison White, vice president of Patient Care Services, talked about how important private patient rooms are for provider consultations, improved patient care, and how they will help bring medical technology to patients’ bedside.
  • Linda Minsinger, executive director for the Gifford Retirement Community, talked about plans for the new Morgan Orchard Senior Living Community in Randolph Center.

Gifford scholarships and awards presented
Bailey Fay was awarded the Dr. Richard J. Barrett Health Professions Scholarship, a $1,000 award for a Gifford employee or an employee’s child pursuing a health care education. Laura Perez, communications director of the Stagecoach Transportation Services, accepted the $1,000 Philip D. Levesque Memorial Community Award, given annually in recognition of his personal commitment to the White River Valley.

Randy Garner

Retiring board member Randy Garner was presented with a gift to honor his 12 years of service at Gifford Medical Center’s 109th Annual Meeting. Vice-President of the board Peter Nowlan looks on.

For the second year of a two-year commitment, the $25,000 William and Mary Markle Community Grant was given to schools in Gifford’s service area to promote exercise and healthy eating and lifestyles.

Board of trustees and directors election and service recognition
During the corporators business meeting, retiring member Randy Garner was presented with a gift to recognize his 12 years of service, and retiring board member Fred Newhall was recognized for his three years of service.

The following slate of new corporators were elected: Brad Atwood (Sharon); Rob and Linda Dimmick (Randolph Center); Dee Montie & Murray Evans (Brookfield); Joan Goldstein (South Royalton); Kelly Green (Randolph); Kate Kennedy (Braintree); Doreen Allen Lane (Berlin); Larry and Susan Trottier (South Royalton); Clay Westbrook (Randolph)

The following were elected officers of the board of directors: Gus Meyer, chair; Peter Nowlan, vice chair; Barbara Rochat, secretary; Lincoln Clark, treasurer.

Lighthouse Photographs on Display in Gifford’s Art Gallery

Randolph artist Christopher J. Fuhrmeister

Bass Harbor Head Light, Arcadia National Park, ME

Eighteen photographs by Randolph artist Christopher J. Fuhrmeister are currently on display at Gifford Medical Center’s art gallery in an exhibit that will run through April 1, 2015.

Fuhrmeister was given a Kodak Brownie camera when he was 12 and bought his first 35mm camera while in high school, working on features for his yearbook and as a newspaper sports photographer. He was a general photographer for his college paper, and later worked as a reporter/photographer for the St. Johnsbury Caledonian Record.

For many years he worked as an emergency management communications officer and then a telecommunications coordinator for the Vermont Public Safety Headquarters in Waterbury. When he retired in 2006, he switched from conventional film to digital photography.

While most of his photographs are of Vermont scenes, he was born in Maine and has a soft spot for lighthouses. This display is taken from his collection of photographs of lighthouses that he has visited in the eastern United States.

This exhibit is free and open to the public, and will be displayed through April 1, 2015. The gallery is located just inside the hospital’s main entrance at 44 S, Main St. (Route 12) in Randolph. Call Gifford at (802) 728-7000 for more information.

Gifford’s Snow Warriors!

Gifford facilities crew

Facilities crew: Josh Doolittle, Bruce Jacobs, Stu Standish, Tom Maylin, Dennis McLaughlin, Frank Landry, and Patrick Giordano

It’s official: Vermont set a record for the coldest February. Since the year began, we’ve had storms and below-zero temperatures made even more brutal by gusting wind.

As we trek from warm cars into a warm building each workday, we’re thankful for the folks who keep Gifford’s sidewalks and parking lots cleared and safe for travel.

Patrick Giordano, facilities supervisor, says he’s seen snowier years, but this one has been challenging because it has been so consistently snowing.

This hard-working crew uses three tractors—one with a brush cleaner, one with a blower, and one with a bucket—as well as muscle and lots of shovels to keep entrances and pathways cleared for patients and staff.

Even if it’s only snowing lightly, someone is out shoveling to keep snow off the entrance circle, Emergency Room entrance, loading dock, and day care entrances, as well as all walkways. So the continuous snowfall has meant lots and lots of man hours for the facilities crew.

So far this year the snow piles have been cleared five times, and 320 dump truck loads of snow have been hauled away. The crew has spread 110 tons of salt to keep the lots and walkways safe.

Snow and cold brings lots of behind-the-scenes tasks as well: Gifford’s roofs must be shoveled off, and any roof snow that slides off on its own, blocking stairs or fire exits, has to be shoveled so that exits are kept clear. There have been hydraulic and electrical motor failures, a flat tire on the bobcat used to load salt, and broken chains on the snowplow—often at the most inconvenient times.

Gifford’s staff is grateful to this crew, which has endured bone-chilling temperatures when not getting soaked by ice and pelting snow.

“We’ve definitely had a lot of baked goods delivered to us this year, which is great!” says Giordano. “We all really appreciate that.”

Louise Sjobeck and Therapy Dog Jasmine’s Menig Visit

Menig dog therapy

Menig resident Barbara Wright enjoys a visit from Jasmine, a Vermont Therapy dog.

As the sun was lowering on a cold February afternoon, Gifford volunteer Louise Sjobeck and her dog Jasmine walked down a quiet hall toward two Menig residents who were visiting on a bench.

Before she could reach them, a woman in a wheelchair appeared, stretching out her arms to stroke the brown and white Shih Tzu’s silky fur: “What nice ears you have!”

Within minutes more people appeared, filling the space with smiles and stroking hands and conversations: “I love dogs, we used to have two dogs….” “This little doggie is so soft!” “I hope it won’t leak on me—oh, I wouldn’t mind. I‘d just brush it off!”

The visit marked the beginning of a new role for Sjobeck, who had spent nearly a year training and working with five-year-old Jasmine to prepare her for the Therapy Dogs of Vermont certification test. Dogs that are gentle, enjoy being touched, aren’t fearful, and are able to remain calm in new situations are allowed to take the exam, which tests for 48 criteria.

To celebrate their inaugural visit, Jasmine was dressed in a red ruffled dress decorated with Valentine’s Day hearts, bringing some early holiday spirit to Menig.

“I love to see the residents’ faces light up when the pet visits occur,” said Brooks Chapin, director of nursing at Menig. “There is nothing like the unconditional love of a dog.”