Guiding the Future of Rural Health Care

The following article appeared in our 2014 Annual Report.

Gifford volunteers

Back (left to right) Linda Morse, Peter Nowlan, Sheila Jacobs, Paul Kendall, Matt Considine, and Lincoln Clark. Front: Jody Richards, Barbara Rochat, Gus Meyer, Dr. Ellamarie Russo-DeMara, Randy Garner, Sue Sherman, Joe Woodin, Carol Bushey, and Linda Chugkowski. Not pictured: Bill Baumann, Fred Newhall, and Bob Wright.

Volunteer board leads Gifford with vision, passion and energy

2014 was a year of great excitement for Gifford, as several projects moved from the planning stage into actual implementation. Our FQHC status, new senior living community, and the much-needed upgrade for inpatient rooms are all visible signs of Gifford’s readiness for quality community care in a larger landscape of changing healthcare reform.

Each of these accomplishments was built on years of behind-the-scenes planning. None of them would have been possible without the dedicated work of our 16 volunteer board members, who last year alone collectively gave more than 2,500 hours of their time to meetings and subcommittee activities. Board members bring passion and energy to the challenge of balancing the work that translates our mission (providing access to high-quality care to all we serve) with anticipating and planning for future healthcare needs.

“Gifford is woven into the fabric of this community. For more than 100 years generations have had the benefit of local access to quality care,” says board secretary Robert Wright, who was born at Gifford and now lives in Brookfield. “Gifford has been able to maintain that identity and also grow with the times, attracting highly skilled people and successfully investing in the equipment and facilities needed to provide the quality of care that people expect.”

Board members are recruited from across the community and have worked in various businesses and civic organizations. This diverse perspective keeps Gifford’s vision grounded in the community it serves, with a distinctive small town commitment to quality.

Board work is demanding, but members say learning about the hospital and participating in decisions that will shape the future of healthcare in their community is rewarding.

“It is by far the most rewarding volunteer activity that I have ever done,” says Randolph resident Randy Garner. “Gifford has shown me the model of being an actively engaged board member, and seeing the results of the board’s actions is extremely gratifying.”

Others want to give back to their community: “I joined the board because Gifford is community focused, a small town hospital that provides excellent healthcare and uses the latest technology,” says Northfield resident Linda Chugkowski. “I feel proud and privileged to be promoting the hospital during these troubled health care times.”

The job description for a Gifford board member might read: part planner, policy-maker, visionary, realist, promoter, cheerleader, and community advocate. It requires the ability to bring a pragmatist’s eye to sustaining robust primary care and a visionary’s openness to future possibilities. When asked what makes the institution unique, you’ll get the clear answer of a realist:

“Gifford is unique in that they are a small Critical Access Hospital and FQHC facility with niches that they do better than anyone else, like primary care, podiatry and sports medicine,” says Brookfield resident Carol Bushey. “They will never compete with the large hospital, but they will continue to do what they do better than anyone long into the future.”

But new possibilities and future community roles for Gifford are always part of the planning:

“I am excited to see the direction Gifford is going with the senior living community and hope that this continues to all levels so Randolph will have a place where folks can comfortably live out their lives,” says Garner. “Gifford will continue to be on the forefront of quality care with a small town feel.”

15 Years Financially Stable

Working together to achieve not only a healthy community, but a healthy company

The following article appeared in our 2014 Annual Report.

Gifford budget

Gifford staff pose with VP of Finance Jeff Hebert (center left) and Administrator Joe Woodin (center right) to celebrate achieving budget.

In a feat not replicated by any other hospital in Vermont, Gifford achieved its state-approved operating margin for the 15th straight year, closing the 2014 fiscal year books with a three percent margin.

As a fiscally stable medical center, community organization, and employer, Gifford has been able to consistently provide care and services without facing cuts and uncertainty.

This achievement is especially remarkable this year, given the many healthcare changes and an equally challenging economic climate.

“By managing our expenses and the budget process, we’ve once again met our state-approved operating margin goals,” said Jeff Hebert, vice president of finance.
“Consistently maintaining a steady operating margin — the money the medical center makes above expenses — is an indicator of an organization’s fiscal health and allows us to continue to invest in new clinical programs, equipment, staff, and facilities.”

A Message from the Medical Staff President Dr. Ellamarie Russo-DeMara

The following article appeared in our 2014 Annual Report.

Medical Staff President Dr. Ellamarie Russo-DeMara

Medical Staff President Dr. Ellamarie Russo-DeMara

As president of the Medical Staff I have witnessed firsthand the hard work and dedication not only of our medical team, but of all those behind the scenes who make Gifford a place where patients are a priority.

With economic and healthcare issues front and center in our daily news, it’s reassuring to work for an organization that is fiscally stable without sacrificing quality of care. I know I speak for the entire health care team when I say how fortunate we are to have our new FQHC designation, which will allow us to provide much needed dental and mental health services to our community.

Gifford continues to lead the way in its vision for the future of providing quality care for our community. At the forefront of that vision is the creation of a new Senior Living Community, where our seniors can be cared for in a home-like setting.

As part of this process we are fortunate to be able to “rejuvenate” our existing space into private, more comfortable rooms that will allow us to improve the efficiency and quality of the care we offer our patients.

It has been an exciting year of planning and creating new ways to provide access to the high-quality care we offer through all stages of life—from newborn through to nursing home resident.

A Vision for the Future: Meeting Tomorrow’s Health Care Needs

A message from Development Director Ashley Lincoln

Ashley Lincoln

Above: Ashley Lincoln, Development Director, and Vision for the Future Campaign Committee members Dr. Lou DiNicola (Co-chair), Linda Chugkowski, and Lincoln Clark (Co-chair) at the site of Gifford’s new Morgan Orchards Senior Living Community.

Since outreach began, a little over 18 months ago, many generous donors have stepped up to pledge $3 million for Gifford’s “Vision for the Future” campaign.

This $5 million capital campaign will support patient room upgrades and a new senior living community, improvements that will help us continue to provide the best possible community health care for years to come.

This impressive early support—from members of the business community, Gifford’s volunteer board of Trustees and Directors, former trustees, medical staff, employees, the Gifford Medical Center Auxiliary—is already having an impact.

The beautiful new Menig building that you’ve watched growing in Randolph Center will open in May as an anchor for the new Morgan Orchards Senior Living Community. Soon after, renovation of the vacated hospital wing begins, creating 25 new single-patient rooms that will improve patient privacy, allow state-of-the-art technology to be brought to the bedside, and create an environment that promotes and speeds the healing process.

Humbled and energized by this wonderful start, I can now officially announce that our “silent phase” ended on Saturday, March 7, with the public launch of our “Vision for the Future” campaign at the medical center’s 109th Annual Meeting of Corporators.

Over the years our community has generously supported Gifford through many evolutions. Moving forward we will need everyone’s help to raise the remaining $2 million by the end of 2015. Our goal of $5 million may seem lofty, but this campaign will help us address unprecedented challenges and opportunities in health care.

Providing quality medical care in the hospital and our nine community health centers is central to our mission. We care for patients locally, eliminating the need to travel—sometimes over mountains, often in treacherous winter conditions. Over the years we have invested in state-of-the-art technology, retained high quality staff, and adopted a hospitalist model that helps us care for sicker patients. Modernizing our patient rooms is a next step in improving patient comfort and providing the best care.

A real community concern is a lack of living and care options for our seniors. As our friends and neighbors age and are looking to downsize, we want them to stay where they have grown up, worked, raised their family, and built relationships. Each individual is a piece of our community quilt: when one leaves, it starts to fray.

Your support for this project will help us sustain our community’s health—and protect our “community quilt”—with the very best care, from birth through old age, for another 110 years.

Space that Speeds the Healing Process

One patient per hospital room is good medicine. Here’s why…

The following article appeared in our 2014 Annual Report.

individual hospital rooms

Semi-private rooms offer little privacy or space for patients, their families and
hospital staff. Private patient rooms will alleviate the overcrowding that is typical of shared rooms.

The reality of a shared hospital room is that you don’t get to choose your roommate.

“We do our best to match up personalities and scenarios and illnesses and infection issues,” says Alison White, vice president of the hospital division, “but there are things like having a roommate who is a night owl and you like to be in bed by 7:30. If we need a bed and your room happens to be that one empty bed, you get who you get.”

The new reality at Gifford is that every hospital patient will soon have a room of their own as part of a construction project that received its final okay in October 2013. In spring 2015, when 30-bed Menig Extended Care moves to Randolph Center, the hospital will begin converting the vacated wing. The number of rooms for hospital patients will double while the number of hospital beds—25—remains the same, a ratio that guarantees maximum comfort and safety. The renovations are also an opportunity to open up ceilings, replace old systems, and improve energy efficiency.

“When patients are recovering from surgery or from illness, they want what they want,” says Rebecca O’Berry, vice president of operations and the surgical division.

“Sharing a room with somebody else just doesn’t work for most patients. From the surgeon’s point of view, if I’ve just replaced your total hip, the last thing I want is for you to be in a room with someone who might be brewing an infection.”

White names several other factors, besides the risk of infection, that have helped make private rooms the standard in hospitals today. Among them:

Faster healing: Studies show that patients who are in private rooms need less pain medication because they’re in a more soothing environment. If your roommate has IV pumps that are going off, or the nurse has to check your neighbor every one or two hours—which is very common—the lights go on, the blood pressure machine goes off, the nurse has to speak with the person in the bed next to you. With private rooms, all that is removed.

Ease of movement: Our rooms were built before the current technology existed. IV poles didn’t exist. We now have people with two or three pumps. With today’s technology there’s no room to move around. When you have two of everything—two chairs, two overbed tables, two wastebaskets—it creates an obstacle course.

Better doctor-patient communication: As professionals, we don’t always get the whole story because the patient doesn’t want to be overheard by his neighbor.

Patient satisfaction: Larger rooms, each with a bathroom, will give patients additional privacy and enhance the patient experience. It’s a win-win for everybody.

A Message from Board Chair Gus Meyer

The following article appeared in our 2014 Annual Report.

Gifford Board Chair Gus Meyer

Board Chair Gus Meyer

What a momentous year it’s been! Things we had been planning for years came to fruition in 2014. Even as these fundamental changes in our organization have taken place, Gifford has maintained its remarkable fiscal stability and continued our steady growth in the proficiency, professionalism, and breadth of service that we provide.

In 2015, we anticipate completion of the nursing home, renovation of the space that Menig now occupies, expansion of mental health and dental services associated with the FQHC, and full implementation of the EMR, along with ongoing commitment to fiscal responsibility and improvement in quality of care.

These accomplishments are all the more amazing because they have been achieved in a very uncertain health care environment. While Governor Shumlin has suspended planning for single payer health care, many other aspects of health care reform continue. For example, accountable care organizations are now in development, with the goal of changing from fee-for-service to covered lives reimbursement.

How these changes get implemented will have profound impact on how medical decisions are made, as well as how and where care is delivered. In the coming year, as we pursue the internal strands mentioned above, we will also maintain our active involvement in the health care reform planning process, working to ensure that Gifford’s patients continue to have the highest quality, locally provided health care possible.

Going Digital

The following article appeared in our 2014 Annual Report.

converting to electronic medical recordsFlashback to March 2014. Gifford’s switch to electronic medical records, the industry standard, has been in the works for a couple of years. The challenge: To complete the transition before spring 2015, when government penalties are due to kick in. For the shift to occur, providers—doctors and other medical professionals—will have to learn to use the system. This learning will be put to the test in front of patients. A prevailing sentiment: “I was really hoping I’d retire before we got around to doing this.”

“EMR came out of the Affordable Care Act as a sort of a mandate for us,” says Gifford Administrator Joe Woodin. “We had some electronic files and file management in the past, as many hospitals do, but now there’s a clear mandate of completing that loop, and the government has given us economic incentives to do it, as well as economic penalties if we don’t. So like every other hospital in the country, we’ve been passionately working on this for a couple of years.”

When we think of doctors, we think of clipboards and script pads and cheap ballpoint pens. We think of scrawly handwriting. With the shift to EMR, doctors who were used to scribbling notes on charts and sending them to medical transcriptionists were being asked to give up those tools and plug in the data electronically. VP of Finance Jeff Hebert likens the task to mastering Excel when you’ve been doing spreadsheets by hand for years.

“To add more complexity,” says Hebert, “the product was a brand-new one for our hospital vendor; they redesigned it and we were the first to be going live with it. So in addition to my Excel analogy going on with our providers, CPSI was introducing us to a product that they weren’t that familiar with because they had just created it.” Across the health-care system, a piecemeal electronic infrastructure that lacks standardization—unlike, say, the banking system—did nothing to make the task easier.

By March, pediatrics was trained and ready to go. The first wave of physicians began walking into exam rooms hugging their new laptops. Office visits slowed.

Gifford's electronic medical records

“A lot of organizations have found that transitioning to EMR affects their productivity and some of their morale,” says Woodin. “It asks a lot of the providers and the patients. The challenge would be equivalent to going metric or if you were asked to speak a different language.”

Over the summer, primary care joined the campaign. Neurology, surgery, and other specialists stepped up in the fall.

Meanwhile, providers and patients were starting to experience the benefits of the new system.

“Electronic medical records will allow our organization to be fully integrated across the continuum of care, from inpatient to outpatient to pharmacy—the whole thing. And it’s going to allow us to better care for you. If you walk into the ER and you’re a patient in our Bethel clinic, the ER can pull up your record from this morning—it’s already there,” says Rebecca O’Berry, vice president of operations and the surgical division.

“So if you’re a poor historian—meaning, for instance, that you can’t remember what pills you take or whether you’ve had your gall bladder out—or you just know that you saw somebody today and you still don’t feel well, they can pull it up, whereas before we had nothing. If it’s seven o’clock at night, you can’t call Bethel and say, ‘Hey, I need you to pull this record and read to me what happened.’ There’s no delay, no lag time waiting for dictation. For somebody who has had care and needs more care within the next day or two of their last visit, everything’s there, and that’s the beauty of it.”

By the end of the year, providers were settling into their new routine and at least some of the kinks had been worked out of the new system.

“We’ve done a good job,” said Woodin. “We’re working through it. There are always improvements to be made.”

Recognizing Employee Commitment

Annual Employee Awards

The following article appeared in our 2014 Annual Report.

Members of our Gifford family were recognized at the Employee Awards Banquet on October 18 at Vermont Technical College for their years of service. (Employees are recognized in five-year increments.)

Congratulations to these individuals and thank you to all for your dedication and service.

annual Gifford employee awards

5 YEARS
Diane Alves
Teresa Bradley
Amy Chiriatti
Eric Christensen
James Currie
Tammy Dempsey
Lyle Farnham
David Gehlbach
Tammy Gerdes
Marjorie Gewirz
Thom Goodwin
Lindsay Haupt
Cathy Jacques
Thomas Maylin
Megan McKinstry
Loretta Miller
Michael Minchin
Susan Moore
Megan O’Brien
Martha Palmer
Heather Pejouhy
Rella Rice
Matthew Shangraw
Paul Smith
Meghan Sperry
Debra Stender
Thomas Young

10 YEARS
Lori Barrett
Jamie Cushman
Amy Danley-White
Jennifer Davis
Nancy Davoll
Cynthia Legacy
Patricia Manning
Rhonda Schumann
Rebecca Jo Ward
Lisa Young

15 YEARS
Kathrine Benson
Sadie Lyford
Shelley McDonald
Kathleen Paglia
Dessa Rogers
David Sanville
Linda Sprague
Joseph Woodin
Carol Young

20 YEARS
Kenneth Borie
Louis DiNicola
Milton Fowler
Betsy Hannah
Jean Keyes
Cheryl McRae
David Pattison

25 YEARS
Dawn Beriau
Karin Olson
Renee Pedersen
Kathi Pratt

40 YEARS
Judith Santamore

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.

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.”