All-Staff Meeting Wednesday & Thursday
Gifford gathers as a team every month, and it’s that time again! We’ll meet Wednesday at noon in a hybrid format and again virtually Thursday morning.
Before we meet, I have a question for you: Have you noticed how much of the recent news about health care feels negative? Everywhere you look, there seems to be a steady stream of discouraging headlines—both locally and nationally. That sense of uncertainty has felt especially close to home since the Oliver Wyman report, which impacted Gifford’s reputation and cast a shadow over our presence in the community. When you add in the ongoing concerns from the Green Mountain Care Board and rumors about significant Medicaid cuts, it can all feel pretty overwhelming.
That’s why I’m starting this All-Staff Meeting with some good news—yes, it’s true—and sharing my thoughts on why it’s worth sticking with Gifford. Most importantly, I want to hear from you: what are you hearing out there? And how are you feeling about the work we’re doing together?
Looking forward to connecting soon.
Michael
Always Ask The Question
April 1, 2025
Good Morning, Gifford!
I had a great Monday. I enjoy writing the Monday Morning Memo and sharing it with all of you. Also, I attended a legislative breakfast yesterday morning. I had the opportunity to meet local legislators and community members, all of whom expressed support for Gifford and shared concerns about Vermont’s healthcare system. There’s a shared understanding that we need to create a more affordable, sustainable system—one that ensures patients are seen at the right place and time (which isn’t always UVM or Dartmouth). Topics discussed included education funding, housing, climate change, income inequality, and support for vulnerable Vermonters. I’m grateful that the House passed a budget to increase FQHC rates and invest in primary care. Now, let’s see to it that the Senate follows suit.
On another note, I want to promote a culture of transparency at Gifford, which means addressing your questions. At the all-staff meeting, there was a question about therapy billing—whether Gifford failed to bill $2 million in therapy claims. I promised to answer the question in a blog post. After looking into it, our CFO, Cheyenne Holland, confirmed this isn’t the case. There was some confusion about what happens when claims fail to “drop.”
The issue was that many claims got stuck in our claims scrubber (the software that checks claims for errors) and required manual updates. This did not result in $2 million in lost revenue. We’re working to fix the issue, which includes staff training and education. Kudos to both our finance and frontline staff for their efforts. Our informatics team has confirmed that there is no $2 million backlog in the claims scrubber at all, never mind for rehab services. Do we still face challenges with billing? Yes, we certainly do. And, we will fix these issues. Yet, the rehab issue did not result in the claimed loss. Keep your good questions coming. I’m always happy to answer!
Vermont’s Best Kept Secret?
March 19, 2025
Gifford offers an exceptional range of care, and while patients may have to wait months for appointments elsewhere, we can typically see people much more quickly. Our team is actively working to raise awareness about the services we provide. Recently, Dr. White visited Central Vermont Medical Center, and marketing materials have been shared with other FQHCs. Today, a delegation from Dartmouth visited our main campus, and the visit went very well! The Dartmouth team was not fully aware of the full extent of our services, but after seeing us in action, they now feel more confident and comfortable referring patients here. This visit builds upon the work we have done to transfer patients over the past few months. Kudos to everyone who helped today!
Similarly, we have begun similar conversations with Blue Cross Blue Shield, urging them to partner with us to identify opportunities where their members can get high quality care more quickly and at a lower price than other facilities. Getting patients to the right care at the right time at the right price is hugely important to Vermont’s health care system. I believe that Gifford is well positioned to be an integral part of Vermont’s health care system. The more people know about Gifford, the better we will do. We will continue our efforts to share the Gifford story, which may very well be Vermont’s best-kept health care secret.
Rural Healthcare Facing Financial Difficulties
March 13, 2025
I’m back on the blog after a brief delay due to technical issues.
Today, I want to discuss recent news coverage about healthcare in Vermont. A few weeks ago, VTDigger highlighted the precarious state of Federally Qualified Health Centers in the state. Yesterday, WCAX covered a Green Mountain Care Board meeting regarding the financial performance of hospitals during the previous fiscal year. These stories confirm what we already know: rural healthcare is facing serious financial difficulties, Vermont’s healthcare system is under significant strain, and the past two fiscal years at Gifford were challenging. This is not new information. I’ve been transparent about our financial performance for a reason—so that no one is caught off guard by news stories about us.
We understand what needs to be done to improve Gifford’s finances over the next two years. Our goals are clear: we need to ensure Vermonters know we are here to provide excellent care, reduce expenses wherever possible, recruit talented individuals to join our team, and continuously improve all aspects of our work within Meditech. Progress is being made on all fronts. The real challenge lies in the persistence required to succeed.
Rural healthcare is certainly under threat, but that threat can be mitigated through careful, deliberate action. We’ve already taken steps to strengthen our organization, and we will continue to do so. The financial results presented by the Green Mountain Care Board reflect the year prior to my arrival. Every day since then has reinforced my confidence that we can meet the challenges ahead. Step by step, we are committed to ensuring Gifford’s success.
If you have any questions, I’m happy to answer them.
Michael
Listening to Your Voice
Feb. 10, 2025
Health care is going through a challenging time, both locally and nationally, but there are timeless skills that will help us navigate these times as an organization. Listening and learning are two of the most important skills we can lean on to improve Gifford.
Last week, Gifford’s Growth Team launched a survey to better understand how our team members utilize the diverse medical services we offer. Many of us are both team members and Gifford patients, and your insights are crucial. Your feedback will help us enhance the patient experience and support our efforts to improve patient loyalty and retention.
Please take a few minutes to complete the survey by Friday, Feb. 14. Your responses are confidential, and you can share your honest opinions here: Your Gifford Health Care Experience Survey. So far, we’ve received 138 responses—can we reach 200? I believe we can!
Michael
The Week Ahead (Federal Focus)
Feb. 7, 2025
We are ending another busy week. There’s a lot of news emerging from Washington, and it can be difficult to keep up with it all. I frequently receive questions about whether the Gifford administration is monitoring these changes. The answer is yes. While Gifford is not a political organization and serves everyone equally, we remain attentive to how decisions in Washington and Montpelier impact our patients, community, and organization. I’ll provide more details on our response to federal changes next week, but here are a few key updates for now.
Federal Funding Freeze
So far, Gifford has not been affected financially by the changes at the federal level. The funding freeze that the Trump administration announced last week is currently on hold due to litigation, and we are drawing down money from our grants as usual.
Executive Orders
Health centers across the United States received notice that, effective immediately, HRSA grant funds cannot be used for activities conflicting with four recent Executive Orders (EOs). These EOs address gender-affirming care and diversity, equity, and inclusion in various ways. We’re working with other hospitals, health centers, trade groups, our congressional delegation, and attorneys to assess the impact. Some key questions we’re evaluating include:
- Are the EOs legal?
- Do they affect already awarded grants?
- What actions are required?
- How do they align with our current services and grant applications?
We have not made any changes yet as we continue to assess the legal landscape amid ongoing litigation. We’ll share a plan next week.
Immigration
There’s growing discussion about how to respond if ICE shows up at a clinic. Vermont’s health centers met earlier this week, and Vermont’s hospitals gathered today to discuss appropriate responses. I am vetting a checklist for our clinics describing exactly how we would deal with this event.
These issues are quite weighty. Yet, there is never a bad time for calm, assertive leadership. Our patients and teammates rely upon us to be steady when things are tough. No different here. I will share more news next week.
Michael
Issues Near and Far
Jan. 30, 2025
At Gifford, we’re committed to supporting people at every stage of life, including during retirement. Last week, I shared exciting news: Gifford is partnering with Distinctive Living to manage the 49 apartments at Strode. This partnership marks a significant step forward—and this week, the process continued as the Distinctive Living team flew into Vermont to meet with our Strode residents and staff.
The overall feedback from both the residents and our hardworking team was positive. The meetings were candid and transparent, with a clear focus on open communication. I joined the Distinctive Living team for a panel discussion with residents, spending over 90 minutes discussing their concerns and answering questions. It was an invaluable opportunity to clear the air and ensure everyone was on the same page as we prepare for the changes taking effect Feb. 1.
Before leaving Strode, I took a moment to admire the breathtaking view of the Green Mountains in the distance (see picture above). It served as a powerful reminder of the incredible beauty of this place and why so many of us choose to live and work here.
On a different note, I want to address the recent developments regarding federal grant funds, including the freeze and subsequent unfreeze of grants. Every time the government takes action like this, our Senior Leadership Team is quick to respond, sorting through the details and making sure we are prepared. The freeze started and ended so fast that I did not communicate about it. Rest assured, we are hyper-aware of the federal situation right now. While we are not a political organization, we pay very close attention. We will continue to keep you updated as the federal situation evolves, particularly if federal policy choices attempt to interfere with our relationship with patients.
Stay tuned—we’ll be in touch with more details as things progress.
Michael
When It Rains, It Pours
Jan. 23, 2025
An exciting day in Gifford’s beloved Birthing Center today. We had a pipe burst, raining all over the nurses’ station and eventually much of the floor. Huge kudos to our awesome Birthing Center team, Facilities team members, and Environmental Services group for helping clean up. One thing I love about Gifford is that everyone, including Senior Leadership, helped to clean up the water as fast as possible. Check out the video here.
We are currently on diversion, but our goal is to have the Birthing Center up and running in the next few hours. Thanks to everyone for helping us weather this unusual midday rain shower.
Michael
What’s Up with AHEAD?
Jan. 20, 2025
Last week, the State of Vermont continued its health care reform journey. The governor signed the agreement for Vermont to enter the federal AHEAD Model in Cohort 2, starting January 1, 2027. Friday, the Green Mountain Care Board (GMCB) voted to sign the agreement under very strict conditions, meaning the GMCB will automatically withdraw if its requirements are not met. This whole exercise is meant to bring about a decade long transformation project based on hospital global budgets, purported access to about $130 million a year in funds to invest in the state’s health system overall, and to continue and expand funding for primary care. There is also a commendable focus on health equity.
Overall, the AHEAD model, its parameters and timing as we transition from one federal administration to another, raises many question that currently lack answers. The model’s specific details, including the financial components for each hospital, remain unknown. The details will emerge over time. I’ll be in this conversation with others trying to figure out what it all means.
My advice to the Gifford team? Ignore this noise. The current debate in Montpelier changes nothing right now for Gifford. Our job is to improve our business and finances as rapidly as possible so Gifford can remain independent and return to being financially strong. Let’s keep our eye on the ball—a fitting saying as spring training and baseball season rapidly approaches!
Michael
Who Knows?
Jan. 16, 2025
People often ask what a CEO does each day. Much of the daily decision-making is handled by talented leaders within the organization. I focus on big picture leadership: this includes aligning teams, reviewing data, setting strategy, and engaging with partners. I focus on ethics and accountability as well. But what I really love about each day is (1) our amazing people and (2) the variety of tasks that come with the role.
Here’s a snapshot of my day yesterday, which gives you a sense of how much variety there can be.
- 8 a.m.: Medical Executive Team Meeting, which aligns clinical leaders with administration.
- 9 a.m.: Meet with HR Team and Interim HR Director, Ross Gibson, to discuss HR needs going forward.
- 10 a.m.: Quarterly FQHC team meeting to review grants and regulatory requirements.
- 11 a.m.: Interview with a Nurse Practitioner candidate.
- 11:30 a.m.: Strategy session with attorneys regarding ongoing lawsuits. The lesson here: let’s do the little things right now so we don’t have large legal problems later.
- 12:20 p.m.: Lunch in the cafeteria–enjoyed a 5-star wrap today.
- 1 p.m.: Discuss health care reform on WDEV radio with Copley Hospital CEO Joe Woodin.
- 2 p.m.: Meeting with bankers to review Gifford’s bonds and loans.
- 3:30 p.m.: Weekly Senior Management Team meeting to discuss current and future projects.
- 4:30 p.m.: Readiness meeting for the Maple Mountain Consortium, which is a new rural family medicine residency seeking accreditation.
Between these meetings, I can count on the unexpected—a drop-by or call informing me of an issue that needs my attention—and, like you, have the usual emails and voicemails to return.
And that’s a day.
What do you think? Would love your feedback on this blog post or anything else on your mind. My door is open.
Michael
I think you are doing a great job especially with communication.
Turkey and cheese on a spinach wrap with lettuce, onion, and light mayo. Made to perfection in the cafeteria!
So what kind of wrap was it!?
Thanks for sharing, Michael.
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