One patient per hospital room is good medicine. Here’s why…
The following article appeared in our 2014 Annual Report.
Semi-private rooms offer little privacy or space for patients, their families and hospital staff. Private patient rooms will alleviate the overcrowding that is typical of shared rooms.
The reality of a shared hospital room is that you don’t get to choose your roommate.
“We do our best to match up personalities and scenarios and illnesses and infection issues,” says Alison White, vice president of the hospital division, “but there are things like having a roommate who is a night owl and you like to be in bed by 7:30. If we need a bed and your room happens to be that one empty bed, you get who you get.”
The new reality at Gifford is that every hospital patient will soon have a room of their own as part of a construction project that received its final okay in October 2013. In spring 2015, when 30-bed Menig Extended Care moves to Randolph Center, the hospital will begin converting the vacated wing. The number of rooms for hospital patients will double while the number of hospital beds—25—remains the same, a ratio that guarantees maximum comfort and safety. The renovations are also an opportunity to open up ceilings, replace old systems, and improve energy efficiency.
“When patients are recovering from surgery or from illness, they want what they want,” says Rebecca O’Berry, vice president of operations and the surgical division.
“Sharing a room with somebody else just doesn’t work for most patients. From the surgeon’s point of view, if I’ve just replaced your total hip, the last thing I want is for you to be in a room with someone who might be brewing an infection.”
White names several other factors, besides the risk of infection, that have helped make private rooms the standard in hospitals today. Among them:
Faster healing: Studies show that patients who are in private rooms need less pain medication because they’re in a more soothing environment. If your roommate has IV pumps that are going off, or the nurse has to check your neighbor every one or two hours—which is very common—the lights go on, the blood pressure machine goes off, the nurse has to speak with the person in the bed next to you. With private rooms, all that is removed.
Ease of movement: Our rooms were built before the current technology existed. IV poles didn’t exist. We now have people with two or three pumps. With today’s technology there’s no room to move around. When you have two of everything—two chairs, two overbed tables, two wastebaskets—it creates an obstacle course.
Better doctor-patient communication: As professionals, we don’t always get the whole story because the patient doesn’t want to be overheard by his neighbor.
Patient satisfaction: Larger rooms, each with a bathroom, will give patients additional privacy and enhance the patient experience. It’s a win-win for everybody.
Roger Clapp and JoEllen Calderara from March of Dimes in Vermont, receive check from Ellen Fox, RN, and Kim Summers, Birthing Center assistant nurse manager. The check was for $505 in employee donations to Blue Jeans for Babies day, and Gifford’s sponsorship of the CVT March for Babies in May.
More than 100 Gifford Medical Center employees raised $505 for the March of Dimes by wearing “Blue Jeans for Babies” to work on Friday, March 20, 2015.
Each March the Randolph medical center and its outlying health clinics participate in the fund-raiser, which allows employees who donate $5 to the March of Dimes to wear jeans to work for the day. The March of Dimes is the nation’s leading non-profit organization for pregnancy and baby health. It raises funds through a variety of events to help prevent birth defects, premature births, and infant mortality.
Roger Clapp, executive director of the March of Dimes in Vermont, thanked hospital employees for their participation in the fund-raiser and – as a medical center with a renowned Birthing Center – for their work toward healthy births.
“The March of Dimes recognizes the care and commitment to excellence among the Gifford team that contributes to Vermont’s national lead in preventing premature birth. We’re particularly thankful to be able to reinvest the staff’s fund-raising proceeds to give every baby in Vermont a healthier start,” Clapp said.
Gifford Birthing Center Assistant Nurse Manager Karen Summers and RN Ellen Fox presented the check to Clapp and Jo Ellen Calderara of March of Dimes in Vermont.
Gifford is also a sponsor of the Central Vermont March for Babies walk on Sunday, May 3, 2015 at Montpelier High School. Sign-up online at www.marchforbabies.org or by calling 802-560-3239.
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.
Members of our Gifford family were recognized at the Employee Awards Banquet on October 18 at Vermont Technical College for their years of service. (Employees are recognized in five-year increments.)
Congratulations to these individuals and thank you to all for your dedication and service.
Rebecca Jo Ward
Susan Tubens, PA-C, has joined Twin River Health Center’s team, adding primary care to their patient-centered urology and OB/Gyn practices.
In 27 years as a physician assistant, Tubens has cared for patients with medical needs ranging from trauma to ongoing primary care. She and her husband, Gifford Obstetrician/ Gynecologist Sean Tubens, moved from Florida to Bethel, Vermont, after searching for a small and friendly community where they could practice medicine and enjoy the outdoors.
Primary care is a special interest of Tubens, who notes that an ongoing relationship with a provider who knows a patient’s health care goals and history can help them stay healthy. A strong believer in preventative medicine, she looks forward to caring for families in the White River community.
Tubens is currently seeing patients at the Twin River Health Center on North Main Street in White River Junction. Call 728-2777 to schedule an appointment today.
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.”
Podiatrist/sports medicine advocate celebrated for His 12 years at Sharon Health Center
Gifford staff gathered on March 25 to celebrate podiatrist Dr. Rob Rinaldi’s 12 years of service to an expanding community of athletes, and to wish him well as he transitions to new roles in the organization.
The party featured a cake shaped like a foot, lots of foot jokes, and heartfelt stories about Rinaldi’s many contributions and roles at Gifford: as generous mentor, sports medicine advocate, surgeon, and the force behind the very successful Sharon Health Center and sports medicine clinic.
“I flunked the first time I retired!” Rinaldi quipped, explaining that he missed seeing patients when he left a thriving Connecticut practice and retired to his farm in Chelsea in 2000. So when Gifford Administrator Joe Woodin approached him about expanding sports medicine at Gifford, he was receptive: “I didn’t want to sound too anxious, so I said yes!”
Rinaldi helped design the first phase of the Sharon Health Center, which opened in 2005. By 2008 a 2,200 square foot expansion was added to accommodate the thriving sports medicine clinic, and a final planned 2,600 square foot expansion was added in 2014.
Today, athletes come from all over the Upper Valley to the center, which includes a physical therapy gym space; x-ray technology and mounted flat screens for reviewing radiological exams; physical therapy treatment rooms; and a state-of- the-art gait analysis system. The sports medicine team includes: Michael Chamberland, DC (chiropractic/sports medicine); Paul Smith, DPM (podiatry/sports medicine); Nat Harlow, DO; and Peter Loescher, MD (sports medicine); and a team of physical therapists.
“Rob brought years of business experience to the creation of Sharon Health Center,” Woodin said. “But he also brought his pride in what he does, and his entrepreneurial spirit to Gifford.”
The stories Rinaldi’s colleagues told described a generous and compassionate mentor: “Rob was the voice of wisdom, the one people came to when facing some sort of challenge,” said Vice President of Surgery Rebecca O’Berry.
Although he will no longer be seeing patients, Rinaldi will continue to serve on administrative committees at Gifford, and will work with residents at the new Menig Nursing Home when it opens this spring in Randolph Center.
Eighteen photographs by Randolph artist Christopher J. Fuhrmeister are currently on display at Gifford Medical Center’s art gallery in an exhibit that will run through April 1, 2015.
Fuhrmeister was given a Kodak Brownie camera when he was 12 and bought his first 35mm camera while in high school, working on features for his yearbook and as a newspaper sports photographer. He was a general photographer for his college paper, and later worked as a reporter/photographer for the St. Johnsbury Caledonian Record.
For many years he worked as an emergency management communications officer and then a telecommunications coordinator for the Vermont Public Safety Headquarters in Waterbury. When he retired in 2006, he switched from conventional film to digital photography.
While most of his photographs are of Vermont scenes, he was born in Maine and has a soft spot for lighthouses. This display is taken from his collection of photographs of lighthouses that he has visited in the eastern United States.
This exhibit is free and open to the public, and will be displayed through April 1, 2015. The gallery is located just inside the hospital’s main entrance at 44 S, Main St. (Route 12) in Randolph. Call Gifford at (802) 728-7000 for more information.
Facilities crew: Josh Doolittle, Bruce Jacobs, Stu Standish, Tom Maylin, Dennis McLaughlin, Frank Landry, and Patrick Giordano
It’s official: Vermont set a record for the coldest February. Since the year began, we’ve had storms and below-zero temperatures made even more brutal by gusting wind.
As we trek from warm cars into a warm building each workday, we’re thankful for the folks who keep Gifford’s sidewalks and parking lots cleared and safe for travel.
Patrick Giordano, facilities supervisor, says he’s seen snowier years, but this one has been challenging because it has been so consistently snowing.
This hard-working crew uses three tractors—one with a brush cleaner, one with a blower, and one with a bucket—as well as muscle and lots of shovels to keep entrances and pathways cleared for patients and staff.
Even if it’s only snowing lightly, someone is out shoveling to keep snow off the entrance circle, Emergency Room entrance, loading dock, and day care entrances, as well as all walkways. So the continuous snowfall has meant lots and lots of man hours for the facilities crew.
So far this year the snow piles have been cleared five times, and 320 dump truck loads of snow have been hauled away. The crew has spread 110 tons of salt to keep the lots and walkways safe.
Snow and cold brings lots of behind-the-scenes tasks as well: Gifford’s roofs must be shoveled off, and any roof snow that slides off on its own, blocking stairs or fire exits, has to be shoveled so that exits are kept clear. There have been hydraulic and electrical motor failures, a flat tire on the bobcat used to load salt, and broken chains on the snowplow—often at the most inconvenient times.
Gifford’s staff is grateful to this crew, which has endured bone-chilling temperatures when not getting soaked by ice and pelting snow.
“We’ve definitely had a lot of baked goods delivered to us this year, which is great!” says Giordano. “We all really appreciate that.”
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.”