This article was published in our 2015 Annual Report.
Drs. Lou DiNicola and Christina DiNicola
In 1976 Pediatrician Lou DiNicola came to Randolph for an interview shortly after completing his residency. The first provider he met wore jeans and a flannel shirt, and he knew right then he was at an unusual organization.
“I spent the night at the CEO’s house—it really was a community hospital!” he said. “I wanted to work in Vermont, and I wanted to care for kids, not just see them and send them on to a larger medical center. I took the position.”
Forty years later, DiNicola is still practicing in Randolph (he also saw families in the Rochester clinic until 1992), and he has become a passionate and respected advocate for children’s health, helping to shape state legislation on a range of issues.
The organization has grown (there are now six community health centers), and you see fewer flannel shirts, but the feel of a “real community hospital” remains. The local Rotary Club holds morning meetings in the cafeteria, where at lunch the staff mingles with neighbors who come for great locally-sourced food; there are no reserved spaces for VIPs in the parking lot; and the computerized staff email directory is still arranged alphabetically by an employee’s first name.
In a small community everyone’s lives are intertwined. We care for people who repair our cars, teach our children, attend our church, or manage the store where we buy groceries. The lines that separate hospital from community, caregiver from patient, and even family from co-worker are less distinct.
“Everything that happens in the community —a town fire, school events, Hurricane Irene—comes into our office as well. I have patients now who are the grandchildren of patients I saw years ago,” said Dr. Lou DiNicola. “I live less than three miles from work; clearly this is my home.”
For Dr. Lou DiNicola the connection goes even deeper: Pediatrician Dr. Christina DiNicola spent a summer jobshadowing him before heading off to Stanford University in fall of 1994. Today her former mentor is both a colleague and her father-in-law.
“I wanted to live in the same community I worked in, to have the same accountability to community as to family,” said Christina, who came from a larger practice in Philadelphia last spring. “People care about each other, and about life outside work. There’s a special kind of familiarity this way. The people I see in the office I also see in my community—just in different roles.”
Both Dr. DiNicolas say this blurred line between their work and community roles brings relevance to their work, and shapes the way they deliver care. When something they do has a positive impact, they can see how lives are changed.
“In previous positions I was part of a team of rotating doctors,” said Christina. “My work in the clinic here is especially satisfying to me because I can follow up directly with patients and build ongoing relationships with families.”
Dr. Lou DiNicola says the opportunity for connection and community still attracts new providers. Another draw also endures, something he recognized when he visited years ago, and that is Gifford’s focus on quality. This ensures that the technology and expertise needed for direct patient care is available locally—most patients aren’t sent elsewhere after diagnosis. We do everything we can to treat our patients in the community setting.
“Today medical students are most often trained to be specialists at larger medical centers. Those who want to do more personalized care, and to see a wide range of cases, come to rural medicine,” he said. “I value my ongoing relationships with people in the community, but I also take satisfaction in being there for people who have come a long way for care. People from all over choose to have their babies at Gifford and helping them with the birthing process, whether routine or complicated, has also always been a rewarding experience. We have the best of both worlds at Gifford!”
Ellen Bando, PA-C has joined Gifford’s Pediatrics team, bringing 15 years of experience with pediatric and adolescent patients.
She most recently worked at the Winslow Indian Health Care Center in AZ, where she spent 5 years as part of a medical team providing outpatient care for Native American patients, and working a mobile medical van that brought preventive and screening services to remote communities on the Navajo Reservation.
Bando knew when she graduated from college that she wanted to help underserved rural communities, and first worked in hospital administration.
“I was disturbed by the inequality I saw in access to medical care, and decided that I wanted to make a difference by taking care of patients directly,” said Bando. “I began as a lab technician, and then at age 30 decided to train to be a physician assistant.”
She received a master of Medical Science from the Emory University School of Medicine Physician Assistant Program, completing rotations in pediatrics, family medicine, ob/gyn, inpatient and outpatient internal medicine, emergency medicine, and surgery. She also completed elective clinical service in rheumatology, newborn medicine, and pediatrics, and worked on the Navajo Reservation.
An NCCPA-certified physician assistant, Bando has provided a wide spectrum of primary care services to children and their families, and she has a special interest in pediatric and adolescent care. Other clinical interests include pediatric obesity, adolescent health, and cross-cultural medicine.
Bando practiced at Upper Valley Pediatrics in Bradford VT before accepting her most recent position in Arizona. Wanting to be closer to family in Hartford, VT, she began to look for a position in a rural Vermont community where she could settle with her family. The position at Gifford was a good fit, and she has already purchased a home nearby.
“Patient-centered care is the heart of medicine—I’ve always practiced in a small community where people can get to know you and you can get to know them,” says Bando. “My work with Navajos taught me to be a good listener. I listen to what my patients say and then try to be their advocate.”
To schedule an appointment, please call 802-728-2777.
The following article appeared in our 2014 Annual Report.
Gifford completes its upgrade to electronic medical records (EMR). Throughout the year, Gifford primary care and specialty care outpatient practices moved from paper to electronic records as part of a federal initiative.
Gifford and the White River Valley Chamber of Commerce collaborate to hold the only local candidates’ debate for Senate and House of Representatives candidates.
Gifford employee Teresa Bradley and her niece, Krista Warner, once again hold a bowling tournament in memory of Teresa’s mom and Krista’s grandmother, Ruth Brown. Money raised supports Gifford’s Woman to Woman Fund and brings awareness to the importance of mammograms.
Gifford announces it has met its state-approved operating margin for the 15th consecutive year.
Gifford loses one of the greatest heroes of our time, Major Melvin McLaughlin. Affectionately known as “the Major” and “Major Mac,” he spent the last 40 years volunteering at the hospital, encouraging staff and patients with words of love and friendship. He will be greatly missed, but never forgotten.
Hannaford Supermarket in South Barre presented Project Independence with a gift certificate worth $1,500. The gift is used to offset the cost of groceries for the program which provides a daily breakfast, lunch, and snack for roughly 38 participants. When the store manager asked staff which nonprofit they should contribute to, the adult day program was at the top of their list.
Pediatrician Dr. Lou DiNicola receives the Green Mountain Pediatrician Award from the American Academy of Pediatrics Vermont Chapter. He was acknowledged for over 38 years of service as a Gifford pediatrician. Along with a plaque, Dr. DiNicola was presented a 7-foot-long handwritten scroll describing what makes him special.
Gifford once again invests $40,000 into the regional economy through the Gifford Gift Certificate program.
Oral exams, medical screenings, and wellness and health access resources
No insurance, high deductibles, or lack of a primary care provider keeps many from getting medical care until they find themselves in an emergency room with a serious problem.
Gifford Health Care in Randolph is sponsoring a free Dental and Medical Health Access Day on Thursday, June 11, 2015 from 8 a.m. to 4 p.m., with free medical and dental health screenings and information about community resources that can help with access to care.
We know that regular primary care can help people manage many chronic conditions, and that dealing with health issues before they become serious can prevent expensive hospital visits. Research has linked gum disease and poor dental health to increased rates of heart disease, premature birth and low birth weights, osteoporosis, and other health problems.
On Dental and Medical Health Access Day, two local dentists (Dr. John Lansky and Dr. Chris Wilson) will give free oral exams, and Gifford primary care providers and pediatricians will provide free health screenings for registered participants. (Call 728-2781 to schedule an appointment.)
A day-long wellness fair, open to the general public, will offer information on preventative health programs and resources to help with access to medical and dental care, including:
Diabetes and diet
Vermont Blueprint for Health
Healthier Living Workshops
Other community resources
Refreshments will be served, and there will be a raffle for registered participants.
For more information, or to register for a free medical screening and oral exam, call Casey Booth at 802-728-2781.
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.