Small Clinic Succeeding

Rutland Herald (VT) June 29, 2008
It has digital X-ray technology and an emergency room. There is a physical therapy room and a laboratory where technicians run tests. The clinic's 15-member, full-time staff, including three doctors, two nurses and a nurse-practitioner, are available for 13,000 patient visits a year. But despite its modern equipment, and efficient operation, it's missing something most rural clinics have: a hospital affiliation. How can a medical clinic in the heavily regulated, expensive health care industry operate without a connection to a large hospital with a multi-million dollar budget? Apparently, the answer is, very well. Mountain Valley Medical Clinic was founded by a group of volunteers in 1972 and has remained independent since the clinic opened in 1976. In fact, it is one of the last independent, full-service medical clinics in Vermont, according to its board of directors. Board president Peter Stock says "The fact that we're independent allows us to do things that bigger places either can't do or are slow to do and we can respond to the needs of the providers and the community, like, fast. As a small organization we can make decisions quickly and not have to go through all the channels. We're nimble." While many Vermont hospitals are hurting because they're dependent on the way the state and federal government reimburse them for their Medicare and Medicaid patients at less than the actual cost of medical procedures, Mountain Valley has created other options to make up for the shortfall, according to Stock. Mountain Valley is funded partly through contributions from surrounding towns like Winhall.

At town meeting in March, voters there approved a budget with an appropriation of $2,000 for the clinic, and they have approved budgets with appropriations of $1,650 over the last few years. "One of the strengths of this place because we're independent (is) we have flexibility that we can basically go out to the community and the community is tremendously supportive, has been since the place started up," Stock said. "The idea from the beginning was to provide care without concern for the ability to pay and to not be a government-taxed entity, so over time the communities at town meeting have decided just to vote an annual contribution to the clinic because they know it goes to help some of their people who haven't been able to pay for their care here," said Warren Fuller, treasurer of Mountain Valley's board of directors. Because Mountain Valley accepts all patients regardless of ability to pay, including Medicare and Medicaid patients, and does not receive federal subsidies, it must raise money in other ways. The clinic has an annual golf tournament fundraiser - which brings in about $15,000 - and an annual campaign conducted by mail. Stock said people served by Mountain Valley have always been "very generous." Fuller said the community has donated nearly $200,000 in the past two years. Mountain Valley's annual operating budget is $1.5 million. The board wants to add another doctor to the staff and has begun a new capital campaign to upgrade its 30-year-old building, which is in need of "significant work," Stock said. "In each of our towns, Weston, Peru, Landgrove, the mountains, by far the majority of the property owners that help to support us are vacation owners, yet they support us because they want us to be there when their families are here," he said. Patients and friends of the clinic can also contribute to the clinic's "wish list" of items. Vallario pointed to a special light used for minor surgeries in the emergency room that a patient donated. Paul Harrington, executive vice-president of the Vermont Medical Society, said he believed Mountain Valley's success could be a product of its environment. "That kind of clinic model hasn't really been emulated most recently in Vermont. The difficulty is in fundraising especially because most of the services that receive higher reimbursement are services that you would see in hospitals. So it's more financially challenging but I think it's suitable for Londonderry. I don't think there's really a 'right' model for health care, health care is really local. It's what suits the local community and for them, I think it's a terrific model," he said. With the nearest hospital about 30 miles away in Springfield, Londonderry and its surrounding mountain towns, which include the ski resorts at Bromley and Stratton, the area needed a medical provider that offered an old-fashioned family doctor and then some. The clinic serves people who live in the area year-round. It offers general check-ups, care for patients with chronic conditions and a small emergency room. The wall of crutches in the ER is a testament to its proximity to two ski mountains. Patients who need more medical care are typically sent to Springfield Hospital where Mountain Valley has admitting privileges.

"Patients are also sent to other area hospitals such as Rutland Regional Medical Center or Dartmouth-Hitchcock Medical Center in Lebanon, N.H." Dr. Ronald Vallario, medical director of the clinic, said an on-site laboratory and X-ray machines were added so doctors wouldn't need to send patients to another facility or keep them waiting for test results. Vallario, who came to Mountain Valley in 2005 after 15 years in private practice in New Jersey, said he likes the varied work at the clinic. "I can practice more medicine here, a broader scope of medicine, everything from infants to the elderly. I do more things like minor surgery. In New Jersey, if somebody cut themselves with a chainsaw they would go straight to the emergency room because there is a hospital in every town just about. Here, people come (to Mountain Valley) first and then if we need to, we send them to the hospital," he said. Dr. Roger Fox, whose dry humor has probably put many patients at ease, at first jokes that it's inertia that has kept him at the clinic since before it officially opened, but goes on to admit the "support, it's a little trite to say, is heartwarming." While the independence and remote location of the clinic offer certain advantages, Vallario said it was a "tremendous responsibility" to be "the so-called only game in town." Stock and Fuller said they didn't believe the clinic had ever been approached by a hospital interested in taking over but said they thought such an offer would not be well-received because the clinic's board values Mountain Valley's independence. "What happens in cases where hospitals take over clinics, typically, is that the level of service goes down. We believe there's a value in keeping the level of full-service going and that's one of the reasons our patients are so generous in their contributions." We're fortunate in that everyone on our (10-member) board supports that concept," Stock said. Fuller said he thinks the clinic would be diminished if its current structure changed. "It would be taken over by probably Springfield Hospital, and they would keep a clinic here but all of the work that we do here on site - X-ray, the lab - to make your hour and a half here total, would all be done at the hospital at a margin, in a sense. We would have an office here and medical care but the capacity to serve the community would be quite different," Fuller said. Stock believes what is holding back other communities from using this kind of model is the will. "It seems to me that there aren't a lot of communities out there in the state that are willing to take this bottom up approach like the guys and ladies did who started this place 30 years ago and said, 'We've got to take the bull by the horns and provide good quality health care for our community 'cause we're not gonna get it. Somebody else isn't going to come in and do it for us. We've gotta do it for ourselves.' And they did. That legacy continues today," he said.
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Author: PATRICK McARDLE Staff Writer
LONDONDERRY - The Mountain Valley Medical Clinic is missing something.