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.


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.”

Podiatry care when you need it most

Emily Wheeler certainly didn’t want an injury so late in her pregnancy but was glad for the care she received

This article was published in Gifford’s Fall 2014 Update Community Newsletter.

Dr. Samantha HarrisEight months into her pregnancy, Emily Wheeler of Corinth didn’t expect to need a podiatrist.

But the unlikely happened. The day after her baby shower on a routine walk out her front door, she fell down her steps. Her first concern was for her baby and she rushed to Gifford’s Birthing Center for monitoring. Only after determining that her baby was fine did she go upstairs to the Emergency Department to have what she suspected was a broken ankle X-rayed.

She followed up with Gifford podiatrist Dr. Samantha Harris of the Gifford Health Center at Berlin. Dr. Harris confirmed Emily’s worry. Her ankle was fractured. She spent the last weeks of her pregnancy in an air cast and wheelchair.

Emily had never heard of Dr. Harris before. She is new to Gifford, but Emily was familiar with the Berlin health center. She was already going there for her prenatal care with Gifford’s midwives. Now she had another reason to go.

“She was really quick with the diagnosis and quick to give treatment,” says Emily, praising her new podiatrist. “The office there has been really great and Dr. Harris has been available.”

Emily delivered a healthy, 10-pound baby boy in August. Days later she headed back to Gifford Health Center at Berlin to get back on her feet once again and – now for a third reason – to have Owen’s first check-up.

About the health center
The Gifford Health Center at Berlin, located off Airport Road, offers a full spectrum of care, including family and internal medicine, help with infectious diseases, midwifery, neurology, orthopedics, urology, and podiatry.

About Dr. Harris
Dr. Harris joined Gifford in July from a practice in her native Tennessee. She got her start in medicine as a physical therapist and went on to attend Ohio College of Podiatric Medicine in Independence, Ohio. Her residency in podiatric medicine and surgery at Mercy St. Vincent Medical Center in Toledo followed.

A desire to start farming and produce maple syrup brought her to Vermont, and she found the right fit at Gifford, which is home to four podiatric surgeons working out of Gifford clinics in Randolph, Sharon, and Berlin.

Putting locals to work in Randolph Center

Senior living community progressing

This article was published in Gifford’s Fall 2014 Update Community Newsletter.

Randolph senior living community

When Gifford conceptualized and received all necessary permits to construct a senior living facility in Randolph Center, it was certain that local people would benefit. The region’s seniors would have a local place for nursing home care, independent living, and one day assisted living.

What wasn’t necessarily known when the project went out to bid in the spring, however, was how many other locals might benefit.

Randolph senior living communityThe crew at W.B. Rogers Inc. is a prime example. The local excavation contractor bid for and won the job to do the site work for the first phase of the project.

The project is the biggest in manager Geoff Gilman’s time with the family business, even trumping the eight miles of Bethel roads the company rebuilt immediately following Tropical Storm Irene.

W.B. Rogers Inc. got its start more than 40 years ago in 1968. Today, three generations work with the company, along with plenty of others. With 16 employees, W.B. Rogers brought on extra staff to work on Gifford’s project, which began in May. “We’ve employed quite a few more people,” Gilman said.

“Everybody who works for us lives in Randolph or a surrounding town, so it’s really keeping the income right here in this area,” added Gilman, whose father Charlie owns the business.

As community members pass by the site on Route 66 in Randolph Center, many have been surprised by the amount of equipment on site. Others have been surprised it’s locally owned. W.B. Rogers, which does jobs from the very small to the very large, owns about two dozen pieces of equipment, from excavators to loaders to backhoes to bulldozers to dump trucks.

Randolph senior living communityWith equipment stored in Randolph and an office in Bethel, Gilman notes a local contractor is also the contractor you know. He’s readily available, has built a reputation through his previous work at Gifford and many other local projects, and works hard to do a good job for his community.

“I take pride in my work. I like to see everything look nice. I treat these jobs like they are my own,” Gilman said.

After a long summer in the sun, he’ll also be glad to be done with it. “I was glad to get it. I’ll be glad to finish it,” he said.

W.B. Rogers will be on-site on the property until the ground freezes, finishing some grading and building an access road and then return in the spring for final grading and seeding.

The first phase of the project, which is the reconstruction of Gifford’s 30-bed Menig Extended Care Facility nursing home on the site, is expected to be done by May 2015.

The project began this May. Since then, water and sewer lines, drainage pipes, fire hydrants, light pole bases, and power have all gone in. Concrete has been placed, walls have gone up, and the site is getting ready for a winter of interior work.

Once complete, nursing home residents will move from their current home at Gifford to the new nursing home. The current facility will then be renovated into new industry-standard private inpatient rooms.

Later phases of the senior living community call for first 40 independent living units and then more independent living units and assisted living units to follow.

For Gifford, employing local contractors like W.B. Rogers means supporting not just seniors but the local workforce.

“Gifford is successful when our community is successful. It’s a partnership, and we do try very hard to be a good community partner,” said Gifford Director of Facilities Doug Pfohl.


This article was published in Gifford’s Fall 2014 Update Community Newsletter.

Gifford givingEach year, we ask our friends to consider supporting Gifford. As a nonprofit community hospital, Gifford truly appreciates your gifts. With your support, we are able to provide high quality patient experiences.

But did you know there are other ways to support the hospital that could be more beneficial for you? Gifford has planned giving options that help the medical center while also providing for your financial future. Including Gifford in your will, for example, means you’re leaving a lasting legacy. A charitable gift annuity means you will receive a fixed income for life.

Gifford is a stable, growing organization with a strong infrastructure; in other words, we’re a safe investment. When it comes to charitable gift annuities, the hospital has set aside assets to secure our promise to pay the annuity, and your return is not affected by market volatility.

There are many ways to invest in your community medical center. Please consult with your financial advisor and interested family members about these options before making a gift. It would be my pleasure to provide you more details with absolutely no obligation from you. Please call me at 728-2380 to begin the discussion.

It’s our job here at Gifford to provide the best care possible to patients. It’s my job to help support that outstanding care by connecting community members like you with Gifford. For many, it will be a friendship of shared values and financial security that will last for years to come.

I look forward to beginning that friendship with you.

~ Ashley Lincoln, Director of Development

State-of-the-art gait analysis system is only one in Vermont

This article was published in Gifford’s Fall 2014 Update Community Newsletter.

Gifford gait analysis systemIn his 50-year career, Sharon Health Center podiatrist Dr. Rob Rinaldi was always pretty certain that his gait analysis skills were spot on.

In his early years in private practice in Connecticut, he analyzed an athlete’s gait through observation. Next came a high-speed Nikon camera. Dr. Rinaldi would take pictures, develop the images, and study them for what the industry calls foot strike and toe off.

A video camera followed, and then most recently the Sharon Health Center had a treadmill, video camera, and monitor set-up. “I really thought we were cutting-edge,” says Dr. Rinaldi.

That is, until the clinic purchased a Noraxon MyoPressure Lab – a state-of-the-art gait and movement performance system – as part of its recent renovations and expansion.

Now providers at the Sharon clinic are using the new technology to diagnose problems, come up with treatment plans, and improve patient outcomes.

The new system includes a treadmill with a force plate that can analyze pressure, show that on a monitor, and immediately print out those results, showing where someone is putting pressure on his or her feet both walking and running, and with and without shoes.

It has two video cameras that can show live images on a computer monitor or be recorded. The health center is also using its original camera, meaning three video cameras are really at work monitoring gaits. And it has a surface EMG to measure muscle activation patterns throughout the body.

Gifford is the only hospital in Vermont with the technology. In fact, one would have to drive to Boston’s Children’s Hospital in Waltham, Mass., or to White Plains, N.Y., to find the closest other such systems.

Dr. Rinaldi is using the new technology for every sports analysis and for individuals at risk of falling. The health center’s other providers – including podiatrists, chiropractors, and sports medicine physicians – are using it as well to look at muscles, joint angles, alignment, and to train athletes.

The results of the Noraxon analysis lead to treatment plans, including sharing information with in-house physical therapists.

“We’ve always felt our success was based on a team approach. Now we’re able to quantify and graphically share information (among the team),” Dr. Rinaldi says.

“What I have found is my outcomes seem to be better,” he says. In some instances, he’s also offering more conservative treatments to surgery.

The Sharon Health Center is a renowned, multi-discipline sports medicine practice located off Route 14 in Sharon. Call the center at 763-8000.

Ob/gyn team provides comprehensive care — and now total laparoscopic hysterectomies

This article was published in Gifford’s Fall 2014 Update Community Newsletter.

Gifford ob/gyn teamGifford’s women’s health team has grown to include two new ob/gyns.

Dr. Sean Tubens and Dr. Melissa Scalera have joined gynecologist Dr. Ellamarie Russo-DeMara, as well as Gifford’s certified nurse-midwife team, in caring for women.

Dr. Sean Tubens
Dr. Tubens is a native of Baltimore who joined the U.S. Marines out of high school. He went on to work in his father’s trade – as a hairdresser – before illness took his parents’ lives just months apart. Dr. Tubens found himself wanting to do more and pursued a career in medicine.

He attended Towson University in Baltimore, graduating magna cum laude in just three years while working full-time. He went on to Ross University School of Medicine in Dominica in the West Indies and New Jersey and completed his ob/gyn residency at Bayfront Medical Center in St. Petersburg, Fla. During his residency, he worked exclusively on high risk pregnancies and performing gynecologic

His work at Bayfront earned him recognitions for excellence in laparoscopic surgery, excellence in reproductive endocrinology and as outstanding resident teacher of the year.

When it came time to look for a job, Dr. Tubens looked for a warm and friendly community where he and his wife could settle with their two huskies.

He has found that in Vermont and at Gifford.

“People are so welcoming. They smile. That’s very attractive,” said Dr. Tubens. “We hope we can spend the rest of our lives here.”

Dr. Melissa Scalera
A native of New Jersey, Dr. Scalera was the first person in her immediate family to go to college. She earned her bachelor’s degree in psychology from Williams College located just three miles south of Vermont in Williamstown, Mass. She worked at a direct marketing company that made and sold leather books before deciding that she wanted a change.

“I want to be a doctor,” she decided, quit her job, and moved in with her parents. With no science classes to her credit, she did two years of post-baccalaureate studies in the pre-medical curriculum at nearby Seton Hall University in South Orange, N.J., before attending the New Jersey School of Medicine at the University of Medicine and Dentistry in Newark. She went on to residency at Albany Medical Center in nearby New York.

Since then she has worked for 13 years as an ob/gyn physician in Washington, Texas, Oregon, Pennsylvania, New Zealand, and North Carolina. A love of snow and skiing has brought her and her family to Vermont, and to Gifford.

“Gifford,” she says, is “a really fantastic match for me.”

A new team
Dr. Scalera brings a love of all things ob/gyn to the practice. Dr. Tubens is a new resource in high-risk pregnancies, gynecologic surgery as well as office procedures. Specifically, Dr. Tubens offers urogynecology procedures for uterine prolapse, bladder and rectal prolapse, and urinary incontinence. He also performs total laparoscopic hysterectomies – something not previously offered at Gifford.

Dr. Tubens and Dr. Scalera are currently working exclusively in Randolph. Their skills meld nicely with Dr. Russo-DeMara, who focuses on gynecologic and menopause care. Dr. Russo-DeMara works out of Gifford’s Bethel and White River Junction practices. Joining them are Gifford’s midwifery team, which focus on prenatal care and births as well as well-woman care in Randolph and Berlin.

“This new team is providing comprehensive women’s health medical and surgical services, from contraception to menopause management and everything in between,” explained Alison White, Gifford vice president of patient care services.

A Spoonful of Thanks: Message from the Development Director

The following is an excerpt from our 2013 Annual Report: A Recipe for Success.

spoonful of thanksGifford’s is a story steeped in tradition, and one that has only grown more positive in recent years. As director of fund-raising efforts, telling that story of a small hospital making it and improving year after year despite the odds is such a privilege.

In 2013, that is even more true. We’re celebrating another year of major achievements, including “making” budget, earning Federally Qualified Health Center status allowing us to soon provide enhanced primary care to the community and receiving all approvals needed to move forward with the construction of a Senior Living Community in Randolph Center and private inpatient rooms at Gifford.

In 2014, moving forward on our Senior Living Community and private patient rooms will become a major focus for the Development Office, Development Committee and our new Campaign Steering Committee.

These committees are comprised of hardworking volunteers. The project has already generated much excitement from both donors and from community members hoping to one day make this community home.

Over time, the Senior Living Community will include the Menig Extended Care Facility nursing home, independent living units and assisted living units. This vision allows our friends and neighbors to age in place rather than leaving their community for similar housing.

Constructing the nursing home, building infrastructure for the entire community and creating private inpatient rooms, however, will take community support. This support is already being demonstrated among the Gifford community, including our Auxiliary, Board and Medical Staff, and soon will be an exciting public campaign where community members can help make this project a reality through financial investments.

Ours is a community that supports its hospital and patients. We continue to have remarkable success each year with our annual fund and once again we have raised a record amount in support of end-of-life care through the Last Mile Ride – our charity motorcycle ride held each year on the third Saturday in August. Participants, volunteers and local business sponsors make this event possible and so positive for our hospital and community. We look forward to continuing and growing this (now) Randolph tradition in 2014.

As always, there are many ways to support Gifford – as a donor, as a patient, as an employee and as a volunteer both at the medical center and through the Auxiliary. I welcome your inquiries on how you can become involved in our story of success and in bettering patients’ lives.

~ Ashley Lincoln, Director of Development

A Bowl Full of Teamwork: Message from the Medical Staff President

The following is an excerpt from our 2013 Annual Report: A Recipe for Success.

Ellamarie Russo-DeMara, DO

Ellamarie Russo-DeMara, DO

As health care providers, doctors, nurse practitioners, and physician assistants are often who patients think of and look to when they need care.

In medicine, we’ve long known, however, that it is not an individual providing your care, but a team. From those working hard to keep our facilities clean and well-maintained, to those ordering the supplies needed for an office procedure or surgery, to those scheduling your appointments and answering your calls, it takes everyone doing their job well to ensure that you get the care you expect.

At Gifford, we are fortunate to have an outstanding team that takes its role of providing your care one step further. Here, we’re not just caring for your illness, but for you as a person. As someone who is privileged enough to work at Gifford, I am afforded opportunities to see this special brand of care first-hand. And yet, it often goes unrecognized because it happens so quietly, so seamlessly and with so little fanfare

In this year’s Annual Report, you get a special glimpse at just a bit of what quietly makes Gifford so special. It’s countless acts of kindness by selfless individuals all committed to you. Separately, these efforts are remarkable. Together, they tell a story – a story of a medical center and medical team that takes caring far outside of the exam room to the community, home, and family.

~ Ellamarie Russo-DeMara, DO, Medical Staff President and Gynecologist


“Gifford is in the final phase of the Sharon Health Center addition. Sharon has become renowned throughout Vermont and beyond for excellence in sports medicine. This addition is driven by patient demand for care as more and more athletes and weekend warriors seek help from our outstanding team of podiatrists, chiropractors and sports medicine providers.”

~ Dr. Ovleto Ciccarelli, Surgery Division Medical Director



President - Ellamarie Russo-DeMara, DO
Vice President - Joseph Pelletier, MD
Secretary - Nicolas Benoit, DPM
Past President - Marcus Coxon, MD
Surgical Division Medical Director - Ovleto Ciccarelli, MD
Hospital Division Medical Director - Martin Johns, MD
Medicine Division Medical Director, Peer Review Committee Chair - Joshua Plavin, MD, MPH
Credentials Committee Chair - Mark Seymour, DO
Administrator - Joseph Woodin

Patient and Giving Statistics

The following is an excerpt from our 2013 Annual Report: A Recipe for Success.
Gifford financial giving 2013

Categories of giving by type

Each year Gifford is fortunate to receive generous gifts from our friends. Gifts are made to benefit specific purposes, such as technology or services, or to the general fund. The Last Mile Ride, which raises money for end-of-life care, continues to grow in popularity and benefits patients and their families. The pie chart shows the donations – all of which are greatly appreciated.

Gifford financial giving