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.”

Gifford Receives 2015 Business Excellence in Sustainability Award from White River Valley Chamber of Commerce

Emma Schumann and Ashley Lincoln

Emma Schumann, executive director of the White River Valley Chamber of Commerce (left) with Ashley Lincoln, director of Gifford’s development and public relations.

On February 6, Gifford received the 2015 Business Excellence in Sustainability award from the White River Valley Chamber of Commerce.

This award recognizes remarkable efforts to sustain and support the communities of the White River Valley, and was given to Gifford for its holiday gift certificate program.

The program, which distributes gift certificates redeemable at local businesses, allows Gifford to thank employees for their dedication and hard work while contributing to the economic health of the community it serves. Historically, within three weeks in December, Gifford employees spend nearly $40,000 at locally owned community businesses from Chelsea to Rochester, Sharon to Barre, and towns in between.

“For 14 years I have had the privilege of organizing this program, and I can honestly say that it is one of the more rewarding parts of my job. Some Gifford staff members have cried when they received their gift certificates,” said Ashley Lincoln, director of Development and Public Relations at Gifford. “Over the years many business owners have also told me how much Gifford’s support has meant to them during the slow winter months.”

Community has always been important to Gifford. Along with the gift certificate program, the medical center offers scholarships and grants each year to support area businesses and schools; during the growing and harvest season meals include produce from local farmers; and careful consideration of the community needs is considered when planning projects like the new senior living community being developed in Randolph Center.

Lincoln adds, “Nourishing and building healthy, sustainable communities ensures that we will be able to continue to provide quality local care for years to come.”

Levesque Grant Now Available

Phil Levesque

Phil Levesque

Gifford is now accepting applicants for the Philip D. Levesque Memorial Community Award.

The $1,000 grant is given annually to an agency or organization involved in arts, health, community development, education or the environment in Gifford’s service area in recognition of Levesque’s commitment to the White River Valley.

The award has been awarded to a variety of organizations including: Orange County Parent Child Center; Quin Town Senior Center; Rochester, Hancock & Granville Food Shelf; South Royalton’s School Recycle Compost and Volunteer Program; Bluebird Recovery Program; Kimball Library; Bethel’s Playground Project; Chelsea’s Little League Field; Rochester’s Chamber Music Society; Royalton Memorial Library; Tunbridge Library; White River Craft Center; Safeline, Interfaith Caregivers; the Chelsea Family Center and the Granville Volunteer Fire Department.

Community organizations are encouraged to apply. Applications are due by Monday, February 16th. Click here to download the grant application.

The announcement of the 2015 grant recipient will be made at Gifford’s Annual Meeting on March 7th.

Gifford Scores above National Average on Infant Feeding Practices

Performs better than 84 percent of national facilities with similar number of births

first New Year's babyGifford Medical Center ranks above the national average for infant feeding practices in maternity care settings, according to the most recent Centers for Disease Control and Prevention’s (CDC) survey of Maternity Practices in Infant Nutrition and Care (mPINC).

Gifford scored 91 of 100 points, performing better than 84 percent of facilities nationwide with a similar number of births per year (less than 250). Across Vermont, the average mPINC score was 88; the national average score was 75.

“Gifford has always been a leader in providing women’s and obstetrics services and supporting moms and babies,” said Alison B. White, vice president of Patient Care Services at Gifford. “This report reflects the excellent care programs embedded in our pregnancy and maternity care, which create an environment that promotes and supports health and nutrition practices.”

Nationally 2,666 facilities providing maternity services responded to the 2013 mPINC survey (83 percent).The survey evaluates participating facilities in seven dimensions of care, a group of interventions that improve breastfeeding outcomes:

  • Labor and delivery care
  • Postpartum care
  • Breastfeeding assistance and contact between mother and infant
  • Facility discharge care
  • Staff training
  • Structural/organizational aspects of care delivery

For more information on the mPINC survey visit: http://www.cdc.gov/breastfeeding/data/mpinc/index.htm.

Gifford’s Birthing Center: For more than 35 years, Gifford’s Birthing Center has been the standard of care for women in Vermont, and today continues to be a leader in family-centered care, obstetrics, and midwifery. For more information call 802-728-2257 or visit http://www.giffordmed.org/BirthingCenter

Local Crafters Donate Quilts for Gifford Babies

Crazy Angel Quilters donate warm, colorful quilts to Gifford’s Birthing Center

Crazy Angels

Left to right: Gifford Birthing Center Assistant Nurse Manager Kim Summers, Crazy Angel quilter Kayla Denny, and Karin Olson, RN

Gifford Medical Center’s youngest patients can leave the hospital wrapped in warmth and vibrant color thanks to a generous donation of 36 baby quilts, lovingly crafted by a group of “Crazy Angels.”

Kayla Denny, of East Bethel, brought two plastic bins filled with beautiful, carefully folded quilts to Gifford’s Birthing Center on January 20, 2015. She explained that the Crazy Angel Quilters— her mother Bobbie Denny, grandmother Gladys Muzzy, and friends Kitty LaClair, and Maggie Corey—have been meeting weekly for over a year to create the donated baby quilts.

“You don’t know how happy it makes us to be able to offer these to families,” Gifford Birthing Center Assistant Nurse Manager Kim Summers told Denny as she and Karin Olson, RN admired the colorful selection of donated quilts.

Denny, a CAT scan technologist at the Dartmouth-Hitchcock Medical Center says she learned to quilt after her mother taught her to sew her own scrub tops for work when she finished her X-ray training. She fell in love with the craft and has been creating beautiful quilts ever since.

Crazy Angel Quilts

Baby Lola Alsup wrapped in a quilt donated by Crazy Angel Quilters

Inspired by Project Linus, a national nonprofit that provides homemade blankets to children in need, the The Crazy Angels wanted to do something for local children. “We all loved to sew and enjoyed sewing together,” said Denny. She estimates that each quilt takes five hours to complete. When not sewing with the Crazy Angels, Denny creates quilts to sell through her business, Sew Many Stitches.

Within hours of the donation, Monica and AJ Alsup of Thetford Center, VT, stood before a bed covered with quilts, trying to choose one for their day-old daughter. The happy family left for home with a sleeping baby Lola, warmly enveloped in playful owls, pink hearts, and polka dots.

Gifford’s Oncology Program Receives American College of Surgeons Accreditation

Renewal marks hospital’s 49th year
of providing local quality cancer care

Commission on Cancer accredited programThe oncology program at Gifford Medical Center has received accreditation from the Commission on Cancer (CoC) of the American College of Surgeons.

Every three years the CoC accreditation program reviews hospital oncology services to ensure that they conform to commission standards and are committed to providing the highest level of quality cancer care (learn more here). After a rigorous evaluation process and on-site performance review, Gifford received accreditation through 2016.

“Our goal is to make sure people know that they can receive the same quality of care offered at larger hospitals close to home, with a support network they know,” said Rebecca O’Berry, vice-president of surgery and operations at Gifford. “The accreditation process is work for our entire oncology team, but it is worth the effort. Battling a cancer diagnosis is hard enough—I’m thankful that we can provide quality cancer care locally and decrease our patient’s travel time during treatment.”

One of smallest hospitals in nation to hold CoC accreditation, Gifford has done so since 1965. Gifford’s oncology services include:

  • Cancer care from experienced oncologist Dr. John Valentine
  • Compassionate and specially certified oncology nurses
  • Lab and diagnostic services
  • Advanced diagnostic technology, including stereotactic breast imaging
  • Patient navigator help with planning options for treatment and to coordinate care
  • Outpatient chemotherapy
  • Preventative cancer screenings
  • Hospital specialists, surgeons, and a robust palliative care program

For more information, visit www.giffordmed.org/Oncology, or call (802) 728-2322.