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.”

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

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.

Dr. Lou DiNicola Honored By the Vermont Medical Society

Dr. Lou DiNicola

Dr. Lou DiNicola with award and scroll

Randolph pediatrician and former president of the American Academy of Pediatrics Vermont Chapter, Louis DiNicola, M.D., received the Green Mountain Pediatrician Award on Friday, November 14 at the chapter’s annual meeting in Montpelier.

Surrounded by approximately 50 of his Vermont colleagues, Dr. DiNicola was acknowledged for over 38 years of service as a Gifford pediatrician. The award is given annually to an outstanding pediatrician for their dedication and contribution to children’s health in the state.

“I was very surprised,” Dr. DiNicola said. “It humbles me when I am recognized. I do what I love; this is what makes me tick.”

The award was presented by long-time friend and colleague, Dr. Kim Aakre of Springfield. In addition to a plaque, she presented a 7-foot handwritten scroll, describing what makes Dr. DiNicola special. The scroll added even more emotion to the event.

DiNicola shared, “I lost a longtime neighbor and friend earlier in the day. This handmade gift has helped fill that hole in my heart; the timing was perfect.”

Project Independence receives welcome donation from Hannaford

Gift to support purchase of groceries

Hannaford donation to Project Independence

Pictured from left: Hannaford store manager Jeannette Segale, Project Independence chef Pam, participants Paul, Diana, John and Project Independence executive director Dee Rollins.

Hannaford Supermarket in South Barre recently presented Project Independence with a much welcomed donation. Totaling $1,500 in gift certificates, the gift will be used to offset the cost of groceries for the program which provides a daily breakfast, lunch and snack for roughly 38 participants.

The supermarket chain, which operates in five northeast states, continually supports regional and local non-profit organizations. Recently six of Vermont’s fourteen Hannaford stores conducted a milk drive in conjunction with the Vermont Foodbank. When store manager Jeannette Segale asked her department managers what non-profit the South Barre store should contribute to, the adult day program was at the top of their list.

“We have so much respect for what Project Independence does, for the care they give our elders. We wanted to recognize that,” says Seagle. “We’re always looking for a way to give back to the community.”

For a company whose core business is food, their involvement with the adult day program is one of mutual support. The two have shared a long and satisfying relationship, with the program purchasing the bulk of their groceries from the supermarket, many of which are funded through the center’s Adopt-a-Grocery Week program. Started in 2013, the program is a fundraising effort in which donors can sponsor an entire week’s worth of groceries. Since its inception, it has raised over $7,000 to defray the cost of food.

“Hannaford has been a partner of Project Independence for many years and many of our participant’s families shop there,” says Project Independence director Dee Rollins. “Hannaford truly understands the needs of our elders and supports us with all their hearts in providing the services our participants receive. We are very thankful for their support.”

Partnerships such as the one with Hannaford, along with the Vermont Foodbank, ensure the center maintains its commitment to providing healthy, fresh and delicious home style meals for their participants.

Rollins also noted that Hannaford is not only an excellent partner when it comes to feeding their participants; they are supportive of the program as a whole. Recently they shared with Rollins how they’re just as excited about the recent merger with Gifford as Project Independence is. It’s a merger that secures the future of the organization’s continued care of area elders.

For more information on the Adopt-a-Grocery Week program, please call Project Independence at (802) 476-3630.

Gifford and Project Independence merger official

Two organizations solidify commitment
to the care of area seniors

Dee Rollins and Linda Minsinger

Project Independence executive director Dee Rollins joins ribbons with Linda Minsinger, Executive Director of Gifford Retirement Community.

On September 30th, Project Independence and Gifford Retirement Community, part of Gifford Health Care in Randolph, officially merged in a ceremony and celebration held at the Barre-based adult day program.

The ribbon joining ceremony was attended by representatives from both organizations, participants and their families, dignitaries, and special guests, including Project Independence founder Lindsey Wade.

The merger comes after years of struggle for the independent adult care program, Vermont’s oldest, which faced flood recovery efforts in 2011 in addition to other facility issues and financial woes.

“It is very hard in these changing times in health care for a stand-alone nonprofit to make ends meet,” says Project Independence executive director Dee Rollins. “Merging with Gifford allows us to be off the island with more supports and resources so we can grow our services for our elders and caregivers. Gifford is the right and best partner Project Independence could imagine.”

While still responsible for their own bottom line and fundraising efforts, Project Independence now has the resources and backing of the financially stable Gifford to help maintain ongoing services.

Joe Woodin, Dee Rollins and Steve Koenemann

Gifford CEO Joe Woodin officially welcomes Project Independence to the Gifford family, shaking hands with board president Steve Koenemann and executive director Dee Rollins.

And the center is already experiencing the benefits of being part of a larger organization through savings in expenses and access to a wider range of resources.

For example, Project Independence is now able to utilize purchase point buying for a savings on supplies and groceries while also benefiting from the services of established Gifford departments such as billing, payroll, human resources, marketing, and others.

For Gifford, the merge is an opportunity to expand on its commitment to the region’s seniors. Already home to an award-winning nursing home and a successful adult day program located in Bethel, Gifford has a strong foundation in caring for the aging.

It’s a foundation they are building upon with the creation of a senior living community in Randolph Center. This new community will include a nursing home, assisted living and independent living units.

Construction on the campus began this past spring with work focusing on infrastructure and the building of a new Menig Extended Care facility, the 30-bed nursing home currently connected to the main hospital.

Current Menig residents are expected to transition to the new facility when construction is completed in the spring of 2015, a time that will also see the ground breaking of the first independent living facility.

Gifford’s Record of Success Continues for 15th Straight Year

Randolph hospital ‘makes’ budget, operating margin

Gifford 2014 budget

President Joseph Woodin and CFO Jeff Hebert announce via video that Gifford closed the books with a 3.2% margin for the 2014 fiscal year.

In a feat that has not been replicated by any other hospital in Vermont, Gifford Medical Center announced that it has achieved its state-approved operating margin for the 15th straight year, by managing its expenses and the budget process.

In a “reality TV” video announcement sent to staff on Monday, November 3, President Joseph Woodin and CFO Jeff Hebert announced what auditors have confirmed – Gifford closed the books with a 3.2% margin for the 2014 fiscal year.

“This is all thanks to the hard work and dedication of our staff,” said Woodin. “Without their diligent focus, always trying to manage quality and costs, we would not be able to have accomplished this.”

An operating margin is the money the medical center makes above expenses – needed to reinvest in programs, staff and facilities. Sixteen years ago, Gifford ended the fiscal year with a negative 16% margin ($2.9 million loss), after having lost money 4 out of 5 years. At that time, the future of the hospital was uncertain, with some state officials even asking if the hospital should be closed.

Today, Gifford is known as one of the most successful and innovative hospital and health care organizations in New England. They are designated a CAH (Critical Access Hospital), as well as an FQHC (Federally Qualified Health Center); one of only three in the nation to carry that dual designation. They also operate a nursing home (Menig) that is rated one of the top 1% in U.S., and are currently constructing the first phase of a five-phase senior living community in Randolph Center, VT.

Consistently achieving the operating margin can be an indicator of an organization’s success. Despite record shortfalls in revenue for Vermont hospitals, including Gifford, Woodin noted the medical center was able to make up for revenue shortfalls through managing expenses and due to support from federal programs like 340B, a drug pricing program that in part generates revenue when Gifford patients fill non-generic, non-narcotic prescriptions at participating pharmacies.

“This news is exciting for Gifford and for the community,” said Woodin. “It is an indicator of Gifford’s health as a medical center, community organization, and employer. Primarily it means we’re stable, and we’re able to provide consistent care and services without facing cuts and uncertainty.”

The achievement is especially remarkable within the current economic climate and amid so many changes in health care, hospital officials also noted.