When Christina DiNicola, MD, FAAP started practicing in Gifford’s Pediatrics department this spring, she returned to work next to the mentor she had “job shadowed” before heading off to Stanford University in the fall of 1994. Today that mentor, Dr. Lou DiNicola, is not only her colleague but her father-in-law.
“I always knew I wanted to practice medicine, but that long-ago summer with Lou confirmed that I wanted to work in Pediatrics,” she said. “Last fall, I was about to sign into a partnership that would mean committing to living in Philadelphia when the Gifford position opened up, but we knew this was the right move for our family. I felt like I was coming home!”
DiNicola has worked in a range of communities (including suburban New Jersey, inner city Philadelphia, rural Appalachia, and on a Navajo reservation in Arizona), and with several national organizations including the National Multiple Sclerosis Society and Families USA. She was director of the Integrative Pediatrics program at the Thomas Jefferson University and Hospital in Philadelphia, and founder and medical coordinator of the Reach Out and Read Program at South Philadelphia Pediatrics.
After that summer internship in Randolph, she attended Stanford University and graduated with a BA in human biology (concentration in Children, Family & Public Policy). She received a certificate of completion in the Children & Society Curriculum from the Stanford Center on Adolescence, and earned her medical doctorate degree at the University of Medicine and Dentistry-Robert Wood Johnson Medical School. Her residency training in pediatrics was at The Children’s Hospital of Philadelphia, and she is board certified in pediatrics.
DiNicola says she brings a personalized, yet evidence-based approach to her practice, and stresses building healthy habits early on to prevent disease and mental health issues later in life. She especially enjoys helping families understand the direct connection between mental and physical wellbeing, and to use self-relaxation techniques like deep breathing, yoga, progressive muscle relaxation, or other mind/body techniques that can help with anxiety, depression, or sleep issues. She prefers using a team oriented approach in partnership with families to create the best health outcomes for her patients.
When the DiNicola family’s moving van arrived in Randolph on April 1, 2015, the “meant-to-be” nature of her new position was highlighted by the fact that the chance encounter that connected her to Gifford and her subsequent career in Pediatrics had occurred on April 1st exactly 21 years ago.
Christina DiNicola was visiting a friend when she met Damian DiNicola on April Fool’s Day in the Randolph High School parking lot in 1994. She returned home to New Jersey with a prom date, and the two have been together ever since.
The following article appeared in our 2014 Annual Report.
Flashback 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.
“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.”
The following article appeared in our 2014 Annual Report.
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!”
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.” 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
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.”
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.”
Family nurse practitioner Jeff Lourie has brought his passion for primary care to the Gifford Health Center at Berlin.
A Cape Elizabeth, Maine, native, Lourie attended The Evergreen State College in Olympia, Wash., earning his bachelor’s degree in organic chemistry. He went on to work in a research lab studying organic chemical synthesis before discovering that what he really wanted to do was help people – hands on.
He became a certified nursing assistant in his native Maine, and then went on to pursue his family nurse practitioner degree at the University of Southern Maine in Portland.
From there he was certain of his career path: rural, primary care.
“It’s where you can really make a difference,” he says of primary care, noting that difference comes in the bonds formed with whole families. “When you see two, three, four generations of families, you really get to understand why things happen.”
Lourie worked for three years at a rural family practice in Wilton, Maine, before moving with his wife, Emily, to her native Vermont in 2013. The couple moved to Barre and Lourie went to work at Berlin Family Practice as a practitioner for Fletcher Allen Health Care.
This month he joined the Gifford Health Center at Berlin, part of Gifford Health Care in Randolph.
In Berlin, Lourie works with family nurse practitioner Tara Meyer in providing primary care at the multi-specialty health center located just off Airport Road.
Board certified by the American Academy of Nurse Practitioners, Lourie is a member of the American Nurses Association, the American Association of Nurse Practitioners, and is on the board of The Vermont Nurse Practitioners Association.
He brings clinical interests in diabetes management, weight loss, preventative care, and pediatrics to the health center. He is also a certified medical examiner for those seeking a commercial driver’s license.
As a primary care provider, Lourie sees his role in part as a motivator and in part as an advocate for patient goals.
“My goal is to partner with patients,” he says. “I want to work on the issues that they want to work on.”
Lourie is seeing new patients of all ages. Call him at the Gifford Health Center at Berlin at (802) 229-2325.
This article appeared in our Fall 2013 Update Community Newsletter.
Pediatrician Dr. Pam Udomprasert with a young patient
Family health center now meeting even more of community’s needs for care
Pediatrician Dr. Pam Udomprasert joins the family medicine team at the Gifford Health Center at Berlin beginning this October.
“Dr. Pam,” as patients affectionately know her, is a graduate of SUNY Downstate College of Medicine in Brooklyn and completed her three-year residency at the University of Connecticut School of Medicine and Connecticut Children’s Medical Center in Hartford.
She worked in Connecticut before joining Gifford and moving with her family to Randolph in 2011.
Board certified by the American Board of Pediatrics and the National Board of Medical Examiners, she is a member of the American Academy of Pediatrics and the Academy of Breastfeeding Medicine. She has a special interest in lactation support as well as asthma and allergies.
Personable and responsive, Dr. Pam continues to see patients in Randolph part of the week. In Berlin, she joins family nurse practitioners Sheri Brown and Tara Meyer as well as internal medicine physician/infection control practitioner Dr. Jim Currie.
The diverse team is available to care for all of your primary care needs, from birth through end-of-life.
The clinic is also home to Gifford’s remarkable team of certified nurse-midwives providing prenatal and well-woman care, neurologist Dr. Robin Schwartz, orthopedist Dr. Stephanie Landvater and podiatrist Dr. Kevin McNamara.
To schedule an appointment with Dr. Pam or another member of the Berlin team, call 229-2325.
The following was featured in our 2012 Annual Report.
Our effectiveness as a medical home has grown this year with the expansion of health care teams and our collaboration with the Vermont Blueprint for Health. But at the heart of these teams are Gifford’s long-established primary care practices. In each of our health team locations, we have providers and support staff whose relationships with the community run deep.
Take Starr Strong, for example. For 19 years, Starr has committed herself to the people of Chelsea – first under the mentorship of Dr. Brewster Martin and now as a mentor in her own right.
With humility and compassion, family physician Dr. Ken Borie has cared for the people of Randolph for 32 years. The humanity he brings to medicine is an example for all, including the many medical students who he guides through the family medicine portion of their clinical studies.
And Dr. Lou DiNicola, a local pediatrician for 36 years, has been among the foremost leaders in this state when it comes to children, advocating at every turn for their health, safety, and welfare.
Those of us enjoying long-standing relationships with Gifford and with our central Vermont community consider ourselves fortunate to know and work with these practitioners and their support teams. Such stability, and depth, builds our medical homes into more effective tools for helping our patients.
~ Marcus Coxon
Medical Staff President & family physician
The following article was published in our 2012 Annual Report.
Above left – One of Gifford’s newer providers, internal medicine physician Dr. Cristine Maloney, lives in Randolph and brings special training in palliative care to Gifford’s already robust advanced illness care program. Here she is pictured with patient David Wark of West Topsham. Above right – Emergency Department physician and clinical director Dr. Saul Nurok joined Gifford in 2010. Here he is shown with patient George Carr of Bethel.
Gifford is fortunate to have many long-serving health care providers, but the medical center would not be successful without the providers who have joined Gifford in more recent years.
Lured in part by the stability and quality provided by the very individuals highlighted in this year’s report, Gifford has welcomed new providers in almost every area of medicine.
For example, joining long-time pediatricians Dr. Lou DiNicola and Dr. Elizabeth Jewett, who have both been at Gifford for 36 years, are Dr. Joe Pelletier, now with Gifford for 10 years, and Dr. Pam Udomprasert, who joined more recently in 2011.
“Joe is now the cornerstone of pediatrics here,” says Dr. DiNicola.
At the Chelsea Health Center, long-time U.S. Navy family physician Dr. Brian Sargent joined physician assistant Starr Strong in practice in 2008. “I am especially appreciative of Brian,” Starr states, “and his commitment to the folks of this valley and the joy he takes in developing relationships in this unique place.”
In Bethel, family nurse practitioner and former emergency department nurse Emily LeVan joined long-time family physicians Dr. Mark Seymour and Dr. Terry Cantlin just this year. “Emily brings her wealth of emergency room experience and a firm commitment to primary care. She also has a strong tie to the area, working with her husband and family running a local farm,” Medicine Division Medical Director Dr. Josh Plavin says.
In the Emergency Department, Drs. Steven Fisher, Josh White, and Saul Nurok have filled the shoes of long-term physicians like Dr. Lucy Wollaeger, who retired from full-time work in 2012 after 21 years at Gifford.
“Often people’s first opinion of the hospital is through the emergency room, and Steve, Saul, and Josh are amazing,” Dr. Ken Borie, a family physician at Gifford for 32 years, says.
Anesthesiologist Dr. Dennis Henzig, a 20-year veteran of Gifford, has been joined by Drs. Jon-Richard Knoff in 2007 and Nazek Shabayek in 2012. Both of Gifford’s orthopedists, Dr. Stephanie Landvater and Dr. Bess Brackett, have come to Gifford within the last decade as Dr. Bill Minsinger prepared to retire.
Hospitalist medicine is a newer specialty. Consequently, it melds newer doctors and mid-level providers with experienced ones who have transitioned from another area of medicine, such as family care. Gifford’s certified nurse-midwifery team additionally melds newer and more experienced members. Ob/gyn physicians Dr. Anne Galante and Dr. Dina Levin have both joined Dr. Brent Burgee, a 27-year veteran of Gifford, and experienced gynecologist Dr. Ellamarie Russo-DeMara.
The most recent addition in the Randolph primary care office is family physician Dr. Barbara Lazar. “Barb brings a wealth of experience, particularly in geriatrics, and is an extremely competent and kind provider. She is an excellent long-term fit for our community-focused practice,” adds Dr. Plavin, who is also among those providers who have committed themselves to the community.
Most of Gifford’s newer providers – of which there are many more – are from the immediate area or have made it their home, raising children here and engrossing themselves in the community in a variety of ways.
Together – even as health care changes and recruitment, particularly of primary care physicians, becomes more and more challenging – they are carrying on the tradition of neighbors helping neighbors and of high-quality, accessible care in our communities.
Above left: Family physician Barbara Lazar joined Gifford in 2012, bringing a background in geriatric care. Above right – Certified nurse midwife Donna Butler, pictured here with a patient and her baby, only joined Gifford in 2010, but this Vermont native has more than 25 years of experience.
Dr. Robert Smith returns to Northeast after 21 years in U.S. Army
Dr. Robert Smith
A native of New Jersey, pediatrician Dr. Robert Smith is returning to the Northeast after 21 years spent as a U.S. Army doctor in Texas, Germany and Afghanistan.
Dr. Smith has joined Gifford Medical Center’s Randolph pediatric practice, bringing his decades of experience, commitment to continuity of care and warm sense of humor to Vermont families.
A graduate of Drew University in Madison, N.J., Dr. Smith went on to earn his master’s degree from the University of Vermont and then his doctor of osteopathic medicine from the University of New England College of Osteopathic Medicine in Biddeford, Maine. His pediatric internship and residency were at Tripler Army Medical Center in Honolulu.
Joining the Army helped provide scholarship money for Dr. Smith, then a young husband and father, to attend medical school and also allowed him to serve his country while seeing some of the world. He started his career in Texas and then moved to Germany in 1998, serving the majority of his career there as the head of pediatrics departments, primary care offices and health clinics at various U.S. military bases.
His most recent position was as chief of the Department of Pediatrics at the U.S. Army MEDDAC (Medical Department Activity) in Heidelberg, Germany and as a pediatric consultant to Europe Regional Medical Command.
From 2010-2011, he was in Kandahar, serving as a brigade surgeon. It was actually during down time in Afghanistan that Dr. Smith shopped for and bought his current home in Vermont.
He had maintained residency in Vermont since first going to college here in the 1980s and hoped to return upon his military retirement. That came just this month. He left Germany on July 1 and started at Gifford a week later on July 8.
“It’s a friendly hospital. It’s a great area,” says Dr. Smith with excitement over being able to practice medicine in a small community where he can build relationships with his young patients and their families.
Dr. Smith describes his style as warm and trusting. “The best compliment I’ve ever had is a child who said ‘Mommy, this guy is funny.’”
That humor leads to children being comfortable receiving care.
Dr. Smith provides care to children from birth through adolescents. Of special interest is ADHD, asthma, infectious disease and sports medicine or sports injuries, he notes.
Dr. Smith is board certified by the American Board of Pediatrics. He is a fellow with the American Academy of Pediatrics and a member of the American Osteopathic Association. He has garnered many awards throughout his career, including the Bronze Star Medal in 2011, an Order of Military Medical Merit in 2004, the American Academy of Pediatrics’ Young Outstanding Uniformed Staff Pediatrician Award in 2002, multiple Meritorious Service Medals, the Army Commendation Medal, three Army Achievement Medals and much more.
Dr. Smith lives in Fayston. He and wife Rosemarie have four children, two daughters who are married, a third in nursing school and a 10-year-old son. In his free time, Dr. Smith enjoys the outdoors, including downhill skiing, gardening, camping and hiking.
He is now accepting new patients. Call him at Gifford pediatrics at (802) 728-2420.