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.”

Family Nurse Practitioner with Doctorate Degree Joins Gifford

Christina Harlow

Christina Harlow

A nurse practitioner with advanced degrees and diverse experience has joined Gifford Health Care’s family practice in Randolph.

Family nurse practitioner Christina Harlow holds a bachelor’s degree in nursing from Colorado Mesa University, a master’s degree in nursing from the University of Arizona College of Nursing in Tucson and a doctor of nursing practice degree from the same institution.

She is board certified by the American Nurses Credentialing Center, a member of the American Nurses Association, and has experience in emergency medicine, psychiatrics and more.

A native of Wisconsin, Harlow’s first career was as a mountain bike guide and a river guide in Utah and West Virginia. During that time, however, Harlow lost a brother to mental illness. Looking to her future, she knew she needed a more stable career. The loss of her brother struck an interest in better understanding depression and anxiety.

She went to nursing school and worked internationally as a volunteer in Honduras and Northern India and in the United States as a psychiatric registered nurse, then in specialty and inpatient care and finally in an emergency room. “I wanted to be more well-rounded, because psych is everywhere,” she says of her diverse experience.

She went on to nurse practitioner school and then took the extra step to earn her doctorate in the field.

She worked as an emergency department nurse practitioner in Colorado and as an adjunct professor at Adam’s State University, before deciding to move to Vermont with her family.

Her husband, Dr. Nathaniel Harlow, grew up in Vermont and wanted to be closer to family here.

The couple both joined Gifford – him as a sports medicine provider at the Sharon Health Center and her as a family medicine nurse practitioner in Randolph, where she is looking forward to getting to know her patients and providing well-rounded care.

“I wanted more than just a passing relationship with my patients,” she notes of her emergency department work. “I am really interested in continuity of care.”

In Harlow, patients will find a highly-educated, compassionate caregiver and open communicator.

“Being a nurse first, I have open communication with my patients. I nurse to my patients,” she says. “I like to focus on health. Your health is your wealth.”

“I also really embrace a holistic perspective,” she says, noting she considers a patient’s emotional and spiritual well-being in addition to more common inquiries about diet and exercise.

Harlow’s specific clinical interests include preventative care, women’s health, holistic care and mental illness. As a family nurse practitioner, she treats all ages as well as both men and women.

In her free time, Harlow – a competitive mountain biker, road cyclist, adventure racer, distance runner and climber – enjoys travel and the outdoors. She and her husband are currently living in Brookfield with their young daughter, Juliana, 1.

Harlow is seeing new patients. Call Gifford’s central scheduling line at 728-2777 to make an appointment with Harlow.

A New Home for All Rehabilitation, Billing

occupational therapist Ann Brunelle

This article was featured in our Spring 2014 Update Community Newsletter.

The Kingwood Health Center in Randolph underwent an expansion in the fall that both improved the Route 66 health center and freed up needed space at Gifford’s downtown campus.

The addition was completed in November and over the winter several Gifford departments made the move to the impressive, new space. Those departments included:

  • Occupational and speech therapies, which joined outpatient physical therapy on the ground floor of Kingwood
  • Billing
  • Accounting

The move of occupational and speech therapies creates a full-spectrum, multidisciplinary rehabilitation center at Kingwood. Added is some gym space, six new exam rooms and improved staff areas.

“Everyone loves the new building,” notes Megan Sault, the rehabilitation department’s operations coordinator.

Having all rehabilitation services in one, convenient location has reduced confusion among patients as to where they should go for their appointment and allows for a collaborative approach to care.

“It’s really great to be so close to team members and share this beautiful facility,” says speech therapist Kathy Carver, who on the day we visited was meeting with patient Terry White of Randolph Center. Terry, who had a stroke, had also seen physical therapy that day, allowing him to make just one trip to Kingwood, and allowing collaboration on Terry’s care.

For others the new location near Interstate 89 is just convenient.

Occupational therapy patient Michael Dempsey of Brookfield was recovering from a broken arm that had left him with shoulder pain. “It’s nice, got a lot of room and is closer to my house. It’s convenient,” Michael remarked.

On the top floor is new office space for accounting as well as billing, or what the medical center calls patient financial services. This is where patients can go to pay their bills or make billing inquiries.

To find the billing office, park in the upper drive and use the door on the left. There are signs inside.

Gifford first bought the Kingwood building in 2007 as an opportunity to expand services. Initially the flat-roofed, dark structure underwent renovations. The new addition seamlessly expanded the structure toward the wood-line.

Also located at the health center are Gifford’s Blueprint Community Health Team, mental health practitioner Cory Gould, the Diabetes Clinic and a private practice dentist, Dr. John Westbrook – all on the top floor.

Call the health center at 728-7100 and listen for options for reaching the various departments.

Health Connections caseworker Michele Packard remains at the main medical center. Michele provides patients help accessing insurance and free care options. (Go in the main entrance at Gifford’s main campus and look for signs to find Michele.)