March 17, 2020


This newsletter is intended to update all VMG staff about our current approach to caring during the pandemic. Information in this newsletter is current as of this date. It will change, often, going forward. We will try to publish updates at least three times per week or as the situation requires. We will also post these on the intranet. PLEASE NOTE: This is not a comprehensive summary of all we are doing. There will be further updates on these and other topics. I’m sure there will be more questions and some topics may require a separate “discussion.”


First, thanks for your service and dedication during this very confusing and difficult time. All of us appreciate your efforts to provide care and support to our patients and colleagues.


VMG’s Goals During the Pandemic


We have several overlapping goals that need to be balanced:


1. Care for our communities by taking whatever reasonable measures we can to limit and slow the spread of the virus

2. Care for and comfort our patients in the best way possible, given the limitations of the pandemic

3. Care for and comfort our staff and practitioners and afford whatever protection we reasonably can


Here’s how we are initially trying to meet these goals:


Slow the Spread of the Virus


The first priority is to limit and slow the spread of the virus. As of now, there is no vaccine and no specific treatment. Because of this, we anticipate that the number of infected and sick people will rise over the next few weeks and months. Our healthcare system including hospitals, labs, and providers will get overwhelmed and be short of needed resources if the disease spreads and peaks in a short period of time. If we can slow the spread (what is called “flatten the curve”), the system will deal with high, but hopefully less overwhelming, numbers at any given time.


The main methods of slowing the spread will involve seeing fewer patients in person, doing more phone and virtual visits, and social distancing in the health centers. Other approaches may be identified as we go and some of the information below will have to be modified or elaborated. The methods below are being implemented through April 1. We will reevaluate prior to then.


In Primary Care:

  • We are canceling/postponing all non-essential visits and procedures through April 1 (and we may need to continue beyond April 1)

  • We will continue to see sick patients, as needed, many of these by phone or other telehealth platform

    • We are working on creating separate areas to see patients with respiratory symptoms

    • We are also working on having teams of practitioners and staff who will see respiratory patients

  • We are currently working on special procedures for doing lab and other tests in patient cars, as necessary

  • We are working on maintaining and/or redesigning capabilities for “essential services” such as CSRP, INR/Coumadin management, etc.

  • CSRP patients are being notified that their prescriptions will be sent to pharmacies electronically during the COVID pandemic

  • Patients are being informed by signage in the centers, by portal, and via our web site


Ambulatory Surgical and Procedure Center (ASPC)

  • Massachusetts DPH has ordered ambulatory surgery centers to close until further notice

  • Patients are being notified and staff will either be reassigned, as appropriate, to other duties in the centers or will be taking PTO


Behavioral Health

  • Visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • Practitioners may still see some patients in the office if they decide this is clinically necessary

  • Integrated Behavioral Health will continue to work in primary care seeing patients, as necessary


Physical Therapy

  • Routine visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • We will still see patients in pain, post-ops, and any others identified as necessary by our therapists or primary care practitioners

  • Practitioners will still consult with primary care, as needed


Eye Care

  • Visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • We will still see patients in pain, post-ops, and any others identified as necessary by our optometrists or primary care practitioners

  • Practitioners will still consult with primary care, as needed


Optical Shops

  • Optical shops will be closed to routine business

  • Patients with urgent/emergency needs for prescriptions, glasses, etc. can still be seen



  • Routine visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • We will still see patients, as necessary, as determined by our rheumatologists and/or primary care practitioners

  • Practitioners will still consult with primary care, as needed



  • Routine visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • We will still see patients, as necessary, as determined by our endocrinologists and/or primary care practitioners

  • Practitioners will still consult with primary care, as needed


Diabetes Education/Nutrition

  • Routine visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • Practitioners will still consult with primary care, as needed


Sports Medicine

  • Routine visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • Practitioner will still consult with primary care, as needed



  • Routine visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • We will still see patients in pain, post-ops, and any others identified as necessary by our practitioners

  • Practitioners will still consult with primary care, as needed



  • Mammography and Bone Density appointments are being cancelled or postponed through April 1

  • Mammography and Bone Density staff will be assigned to helping out with other modalities

  • We will remain open to VMG patients for plain films and ultrasound


Procedures are being worked out for implementing all of the above and may change as we find problems or better ways to manage.


Issues about staffing and possible “re-deployment” are also being worked out now and more information will be coming soon.


Social Distancing Measures


Here’s what we are doing to maintain social distancing for those in the health center:


  • We are canceling non-essential meetings and moving most other meetings to conference calls or other virtual meetings

  • We are trying to limit travel between health centers

  • We have moved and reduced reception area furniture (and some meeting rooms) so that chairs are separated appropriately

  • We are in the process of designating certain exam rooms and other areas for those with respiratory symptoms

  • We have placed new markings in reception areas indicating where patients should stand at the right distance

  • We are working on additional methods to offer the best protection to our staff and practitioners and we’ll discuss further as these are developed

  • Signs have been placed on our doors and information posted to our web site and portal, and email messages have been sent, telling patients with fever, cough, shortness of breath to call us instead of walking into our buildings

  • We are investigating ways to triage in patient cars in our parking lots, as possible and indicated

  • We have notified all non-VMG services (e.g., tai chi and yoga instructors) that we are closing their access to our buildings until further notice (with the exception of our tenants)


Moving to Work From Home, Where Possible


We are in the process of identifying VMG functions and staff that can be done “from home” during the pandemic. Managers and supervisors are working out start dates, equipment needs, policies and procedures now.


Staffing During the Pandemic


We recognize that some staff will have to take time to care for children and/or family during the pandemic. Schools and other institutions are closed and child care/sick care may be difficult to arrange. We will work with staff and supervisors to be as flexible as possible in taking care of family needs, without penalty. We will need to move staff around as carefully as possible to make sure we can staff our essential services.


If You Are Sick


We want you to stay at home and take care of yourself.


If You Are Not Sick


The best things you can do to stay well are the ones you have already heard about (a lot): wash your hands before and after any patient contact, before and after eating, before and after the bathroom. Wash for at least 20 seconds. Soap and water are best (more effective than hand sanitizer).


By the way, hand sanitizer is very difficult to get now. In order to preserve what we have, we removed some bottles of hand sanitizer from areas where there is easy access to sinks (soap and water).


There has been some confusion about other Personal Protective Equipment (PPE). Almost all PPE is in very short supply now. We are trying to use only what we absolutely need to perform our functions and to preserve the supply of certain PPE for very high risk areas in the community as well as in VMG (i.e., hospitals).


Routine use of masks is not recommended for staff. Since the virus is mostly spread by droplets, patients with active symptoms should wear a mask. Certain higher risk procedures will require PPE and we will have separate policies and protocols for those uses. You can get further information from Practitioners and Nursing Leaders in your health centers.


Covidquestions email


Thank you for sending your questions and concerns via this email box on our global address list. We are trying to reply as soon as possible but it is taking longer than anticipated because of the volume of messages and the changing information available.


This is an evolving situation. We greatly appreciate all your efforts. We’ll continue to update you on goals, policies and procedures as new information is available.


Please remember this phrase: Be Patient, Be Mindful. It’s going to require a lot of patience in this confusing and trying time. Patience with each other and with ourselves is vital. Be Mindful means be aware of your feelings, your goals, and intentions and how they influence your behavior.


Thanks again for all you do. We’ll get through this together.



Eggplant 3-11-20 Regarding Coronavirus

Valley Medical Group, P.C. Staff Newsletter           Vol XX, Issue 2, 3/11/20


By now, you are all aware of the coronavirus pandemic (according to the World Health Organization, a pandemic is the worldwide spread of a new disease and COVID-19 is now classified as a pandemic illness). Information about the impact of the virus and the disease caused by the virus (COVID-19) is changing daily. While the local impact is not yet severe, we do need to prepare as best we can for the likely spread of the illness and its effects. Here’s what we are doing at this time to keep patients, staff, and our communities as safe as possible.


1. We are closely monitoring the world-wide and local COVID-19 situation. We are following the guidance and recommendations of the CDC and the Massachusetts DPH as well as local public health authorities and we are staying in close touch with our local hospital systems to coordinate care and share ideas and expertise.


2. We have established an “Incident Command Structure” to better organize and coordinate our information flow and prevention and mitigation activities led by Gina Campbell, VMG Incident Commander and our VP for Clinical Operations. All decisions, actions, and communications at VMG related to the pandemic will be coordinated through this structure. The Incident Command Team and Leadership are meeting daily to monitor the changing information and situation and take appropriate actions.


NOTE: (You may not be familiar with the term “incident command.” It’s a term used in healthcare and other industries to designate a structure and communication process to deal with unusual crises. We have used a structure like this before, most recently with the Halloween ice storm of 2011).


3. In order to help slow the spread of the virus, we are notifying patients with symptoms of COVID-19 as identified by the CDC (fever, cough, shortness of breath, flu-like symptoms) NOT to come to the health center. Rather, we’re asking them to call first to speak with triage.

o   Patients are being notified by portal via email blasts, VMG website, and message on hold. There will also be a message on the appointment scheduling page of the portal.

o   We are posting signs on our entrances asking patients who have symptoms NOT to enter the building but to call (number provided) for triage


4. In order to help slow the spread of the virus, we will be requiring staff who have symptoms of flu and/or COVID-19 to stay at home until their symptoms resolve. We’ll have more information about sick leave and the use of PTO and “return to work” policies soon.


5. We are considering work from home policies and capabilities (for those whose jobs are suitable) in the event that we have to close or curtail our activities in the health centers.


6. We are reviewing and revising cleaning and disinfecting procedures at all of our sites and we are appropriately monitoring and providing supplies for cleaning and for personal protection, following the recommendations of the CDC.


7. In order to slow the spread of the virus we are identifying and changing appropriate in-person meetings to conference calls and/or cancelling/postponing meetings. We’ll keep you informed if a meeting you were to attend is cancelled or postponed. For now, all scheduled Brown Bags are cancelled until further notice. (We’ll arrange to round instead).


8. We will be providing appropriate education to staff and patients based on information from authoritative and trusted sources (mainly the CDC and Mass DPH) on a regular basis.


9. There is currently no test available locally for COVID-19.  We have been told that testing will be available in about a two week time frame. We will announce when testing is available as well as the indications and procedures for testing.


10. There is currently no vaccine or specific treatment for COVID-19. The emphasis now is on stopping/slowing the spread of the virus. Practitioners and clinical staff will use clinical judgement as to recommending “stay at home” and supportive treatment and or referral to other more intensive facilities.


11. See the fact sheet links below for the best advice on preventive actions and managing symptomatic patients.



Information and recommendations about how to manage patients in this pandemic is changing on a daily basis. There is also a lot of misinformation being spread out of anxiety and people feeling they “need to do something.” We don’t want to contribute to fear and panic AND we also want to make sure that you and our patients are as accurately informed as possible. We will continue to provide healthcare to our patients and communities with appropriate modifications in processes and services as they become necessary. For right now, the only changes we are making are listed above. More will be coming and we will keep you informed. Please keep an ongoing list of questions raised by patients as well as staff. You will shortly get information on a VMG email address to send these questions for response by our Incident Command structure.


You will have many questions, as will our patients. We will be sending updates with key information as well as the best answers to questions that are raised on a regular basis.


Here is a link to a CDC factsheet about the virus and illness as well as actions to prevent infection and spread:

This link is appropriate to recommend to patients and as a basic source of information for our staff and practitioners.


Some practitioners are getting questions from patients about travel precautions. Here is a link to the CDC factsheet on travel:


One last point: although this is a public health emergency on a population basis, not everyone will get sick and, of those who do get sick, not everyone will get severe illness. Try to stay informed and help patients stay informed. That’s the best way to remain calm and cope, as necessary.


Thanks for your attention and service during this public health emergency.






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COVID-19 Update

COVID-19: Update for Valley Medical Group as of March 9, 2020
VMG Preparedness 
A core group of leaders are meeting daily, staying current with information regarding COVID-19 as it is available from the Centers for Disease Control, the World Health Organization and the Massachusetts Department of Public Health.  The group is reviewing plans and addressing identified needs. 

COVID-19 Massachusetts Situation
As of today there is one officially documented case and 28 suspected cases. 

Massachusetts is prepared for this potential outbreak. Massachusetts public health are engaging in daily communications with the CDC, US Health and Human Services, and other federal and regional agencies to make sure they are sharing latest guidance and recommendations.

In addition VMG community partners are sharing information, so we may all work together

Take Preventive Measures to Protect Yourself, Our Patients and Colleagues
There are proactive steps that everyone can take to help prevent the spread of any infection including COVID-19:

  • Wash your hands with soap and water often (for at least 20 seconds). You may also use an alcohol-based hand sanitizer;

  • Avoid touching your face, eyes or mouth with unwashed hands;

  • Clean your work area with disinfectant regularly; 

  • Avoid close contact with people who are sick, and keep your distance from others if you are sick; 

  • Cover your mouth and nose with a tissue when coughing or sneezing. Throw the tissue away, and then wash or sanitize your hands. If a tissue is not available, cough or sneeze into your upper sleeve;

  • Avoid shaking hands even in a business setting.

If you are Sick
If you experience a fever of 100° or above OR you have a lower fever combined with respiratory illness (ex: new cough, shortness of breath, sore throat, runny nose), you should stay home from work or leave work (after notifying your manager). 
If you need to seek medical attention, consider calling your healthcare providers office to discuss your health care needs before scheduling and appointment or visiting an Emergency Room.

Thank you
Gina Campbell RN, MSN
Vice President, Clinical Operations

Smoking Cessation Clinical Champions Update

Summary of 2019 HIPAA Violations

Asthma Clinical Champions Update

Special Projects Year in Review

Quality Goals 2019 Results and Plans for 2020

February 6, 2020

There was much progress made in 2019 towards improving patient care and outcomes in the measures that VMG set as a priority.  These priority measures include:  Blood Pressure control for Hypertension and Diabetes patients, HgbA1c control in Diabetes patients, Smoking Cessation Counseling, and increasing cancer screenings for Breast Cancer, Colorectal Cancer, and Cervical Cancer.  The gains that we realized were truly a team effort,  from the outreach and reception staff making sure patients are aware of what visits, diagnostic  tests and preventative services they are due for, and booking those appointments at check out and by phone, lab staff making sure that all appropriate labs are obtained when patients are seen, radiology departments providing same day mammography and clinical support staff and providers identifying patients who need services and coordinating for them to have those services that day or in the future.  The blood pressure clinics were fully operational in Family Practice departments allowing patients to have timely re-measurement and intervention, and most likely directly contributing to the overall improved Blood Pressure control seen in 2019 from 2018.   As you will see by the results below, while we didn’t reach our global goals, we made significant progress and at the local level, health centers did achieve specific goals for measures.   As 2020 begins, VMG will continue to prioritize the same measures for patient care outcomes, and build on the gains that were made in 2019.  The goals and stretch goals will remain the same as well.   Thank you to all staff and providers for your dedication and care to VMG’s patients.

Thank you, Amy Rice Quality Manager

2019 Novel Coronavirus

February 3, 2020

The Centers for Disease Control and Prevention (CDC) is closely monitoring an outbreak of respiratory illness caused by a novel (new) coronavirus first identified in Wuhan, Hubei Province, China. Chinese authorities identified the new coronavirus, which has resulted in thousands of confirmed cases in China, including cases outside Wuhan City. Additional cases have been identified in a growing number of international locations and the United States.  The most current recommendations for healthcare professionals may be found at the link below, including the algorithm for identifying and assessing for the Coronavirus.


Information is being shared with VMG leaders, clinical and reception staff to be prepared for questions from our patients.


Flowchart to Identify and Assess 2019 Novel Coronavirus

Link to the CDC site:


Gina Campbell, MSN, RN

Vice President, Clinical Operations

Safety Corner - Safety in the Workplace

Welcome Medicopy!

We are pleased to announce the transition to a new chart release vendor, MediCopy. Effective 1/15/2020 VMG will no longer be using Chartrequest.   Patients and requestors will use the retrieval service MediCopy.  There will be a link on the VMG website that patients can use to navigate directly to the MediCopy platform to request records.  As always, we can still accept VMG releases as well as releases from outside providers/requestors to be processed.  Health Information staff will be available to all Health Centers in the coming weeks to provide training and answer questions as needed during this transition.


Thank you,

Lauryn Stafford HI Coordinator

RAF (Risk Adjustment Factor) Champions Update

Smoking Cessation Champions Update

Hyperlipidemia Clinical Champions Update

Team Based Care at VMG

As a recap to our  discussions  at October’s Brown Bag Meetings,  VMG began to look at a new model of primary care back in the spring of 2018. It was called Team Based Care and we liked what we saw.  We were already working in teams but this new version seemed to allow practitioners to focus even more on the clinical needs of the patient with less time spent on documentation. It also allowed clinical staff to “be in the room” with patients while they worked with their practitioners and thus better connected clinical staff to patients’ needs and concerns. Finally,  it allowed all team members to “work at the top of their job descriptions,” making sure that we were capturing information we needed and addressing  the needs of patients that might have gotten lost before.


In the end, our reasons for embracing Team Based Care were these: 

·        improve our patients' experience

·        better connect staff to our patients

·        address practitioner fatigue and potential burnout by providing more support and time to connect with patients

And do all these things while improving our quality metrics and keeping the initiative budget-neutral. 


There is now a link to view the video that was shown at the Brown Bag Meetings on the Intranet page.  The link can be found on the right hand side of the intranet page.  Many thanks to Athena for partnering with VMG, to produce this video on VMG’s experience with implementing the Team Based Care model.

Hypertension Clinical Champions Update

Diabetes Clinical Champions Update

Asthma Clinical Champions Update

Flu Shots for Staff

Monday  October 7, 2019

Good Day!

As the next flu season begins, Valley Medical Group is ready to launch its campaign to support vaccination of all members of our health care team this week, starting October 7th.  The Centers for Disease Control recommends the annual flu vaccine as the first and best way to protect against influenza.  Receiving the vaccine is the best way to protect you, your family, your colleagues and our patients.

Each center will have flu vaccine available for all staff and providers.  Dedicated times will be established to offer vaccines, and for those who are unable to obtain the vaccine, the opportunity to complete the declination form.

Vaccination completed  by October 31st is ideal.

This year all those who receive their vaccination by December 1, 2019, will have their named entered in a raffle for a prize to be named later. There will be one raffle prize per center.

While we will not require those who don’t get vaccinated to wear a mask during flu season, we do want you to know that, as a healthcare provider, we feel a responsibility to our patients and communities to get ourselves vaccinated to stop the spread of a potentially life-threatening disease. Thanks for your cooperation in this public health effort.

Additional Information Available:

Flu Vaccine Information Sheet (attached)

If you have any questions, do not hesitate to contact me and/or your supervisor/manager.

Thank you.

Gina Campbell, MSN, RN

Vice President, Clinical Operations

Congestive Heart Failure Clinical Champions Update

Oxygen Ordering Update

As you have seen in Martha’s most recent newsletter, there is a new template for “Oxygen Order” in the PE section of exam notes under procedures. This template covers all required data per CMS to expedite your orders and hopefully avoid the repeated requests for more information. It has been embedded into the encounter as it is also required to send in a visit note with all this data.


ALL blanks and dropdown menus MUST be completed; you may also free text as needed. This is not more information than practitioners were providing before; it’s just more efficient. It also provides all the info needed for the paperwork that the clinical staff fill out for the suppliers.














In addition, if patients are on O2, it is recommended that this be added to the problem list as well as to the med list. This creates more accurate reporting within VMG and also when patient data is sent to other facilities.






Please let me know if there are any issues with the template, or if any orders are returned as incomplete, so Martha and I can discuss corrections. It is our hope that this will be time-saving. It is also our plan to create these types of templates for other DME ordering (hospital beds, wheelchairs, CPAP) and for face-to-face encounters. Please also let me know if you think of others that would be helpful to you.

Stephanie Pick

RAF (Risk Adjustment Factor) Clinical Champions Update

Smoking Cessation Clinical Champions Update

Hyperlipidemia Clinical Champions Update

VMG Intranet Page Changes

Maybe you have noticed that the Intranet Page has had some changes lately?  In an effort to make important information accessible to everyone no matter what role they fulfill at VMG, we have made some improvements to the Intranet Page.   You will notice that the different areas on the screen now have their own heading and that more content has been added to both the Quick Links and the Important Information Links.   You may have noticed that over the last month or two the main area of the page (now labeled Valley Medical Blog) has had new content posted more frequently than we have experienced in the past.   This has all been done to make the Intranet page more appealing and the information easily accessible and current.

There is also a new process for requesting information to be added or updated on the Intranet page.   There is a fillable document that can be downloaded right from the Quicklinks (Intranet Content Request Form) and then emailed to   Blog posts will be guaranteed a minimum of 1 week as featured content before new content will be posted.  Ideally content will be changed at least every 2 weeks.   So if you have content to update/change or add please use the form and email it to us!


Thank you,

Amy Rice and Scott Ackley

Your VMG Intranet Admin Team  

Hypertension Clinical Champions Update

Consult Orders Workflow

As you may recall, we’ve been working on ways to improve the Consult Orders workflow.  Rather than having literally hundreds of orders fall unnecessarily into Follow-Up, we’re limiting these to those that are clinically most important. 


EFFEECTIVE IMMEDIATELY all Consult Orders for specialty and diagnostic care will be un-alarmed by default.  That is, if the order is unfilled, it will NOT have any follow up.  In order to alarm these orders, please choose one of the Order Sets I have created (see the list below).  Alternatively, you can ALWAYS alarm an Consult Order you feel should be followed-up on. 


As a reminder, “Followed Up” means a member of the Referrals Team will:

  •         Retrieve the document from PVIX or Physician Gateway OR

  •         Contact patient to determine if they kept the appointment OR

  •         Contact the specialist to obtain the Report/Result OR

  •         Notify the ordering practitioner that the order remains unfulfilled


The order sets I’ve created (that are all pre-alarmed) are:

  •        Cardiology (Pedi and Adult)

  •        Interventional Cardiology

  •        Diagnostic Mammography

  •        Hematology (Pedi and Adult)

  •        Hematology/Oncology (Pedi and Adult)

  •        Pulmonology (Pedi and Adult)

  •        Rheumatology (Pedi and Adult)

  •        Uro-gynecology

  •        Urology (Pedi and Adult)

  •        Vascular


These order sets are by way of trying to identify types of orders that are likely to require follow-up.  It is, however, up to the ordering practitioner to ensure that important consult orders are alarmed.


As always, please feel free to contact me with any questions.  Martha

Diabetes Clinical Champions Update

Asthma Clinical Champions Update

Measles Public Health Fact Sheet

Link to whole downloadable document here

Summary of 2018 HIPAA Violations

Now that we have closed out 2018, I wanted to summarize the HIPAA Investigations that occurred this past year.  VMG completed 14 investigations of reported HIPAA violations (as compared to 12 in 2017).  Of these investigations, 13 were determined to be HIPAA violations.  These 13 incidents were reviewed with all staff involved, and notifications were made in writing or by phone to the patients affected and each incident was reported to the US Department of Health and Human Services Office of Civil Rights via their on line Breach Notification reporting system.   Below is a summary of the incidents:

Breakdown of 2018 HIPAA violations by center

AMC    6

EHC     1

GHC    4

NHC    2

Breakdown of 2018 HIPAA violations by department

ASPC    1


AMC Lab 2

AMC Endo 1

EHC FP    1


GHC Reception   2

NHC FP   2

Breakdown of 2018 HIPAA violations by circumstance

Unauthorized access to chart by staff member     2

Demographics/guarantor /mailing address not updated in patient record   2

Mailed/gave out lab results, RX, documents to wrong patient due to similar/same name   2

Mailed or gave out lab results, RX, documents to wrong patient due to other clerical error   5

Left phone message or faxed info to incorrect numbers   2


As we start 2019, please remember that each of us at VMG is responsible to safeguard and protect our patient’s healthcare information.     

Amy Rice RN, BSN   Quality Improvement Manager and Electronic Security Officer

New Athena button on Patient Portal

Starting Monday 1/28, Athena has a new button for our patients to log into the patient portal. This new type of sign on will allow patients to access patient portals from other providers that use Athena. Please assure patients that this an authorized change. They do not have to make any changes to their sign on credentials.

Special Projects Year in Review

The start of a new year is a natural time to share how we are doing on several initiatives we work on together. Here is some 2018 data for you:


CCM (Chronic Care Management)

CCM claims

2017       7020      

2018       8260       18 % increase

This increase is due to staff and providers using the Dulcian timer more consistently to account for the time they spend taking care of CCM patients. All your individual minutes add up in the collective, and significantly strengthen this program.


Medicare patients with CCM consent documentation complete

12/2017                79%

12/2018                84%        5% increase

This increase is due to the teamwork involved in getting the consent forms from reception - to intake - to provider discussion, and back to reception to complete the documentation which makes the Dulcian timers pop. Of over 12,000 Medicare patients, more than 10,000 have completed the consent process.


ACP (Advance Care Planning)

New data since documentation discrepancies were cleaned up:

20.7% of FP patients 18+ have HCP on file

24.6% of FP patients 65+ have HCP on file

15.5% of FP patients 65+ have MOLST on file

This is a great starting place for the ACP Committee to begin its new work which you will be hearing more about this year. All patients 18 and more can be encouraged to complete a Health Care Proxy form which names who they want to speak for them about their medical care if they are unable to speak for themselves.


ACP claims

2017       408

2018       461         13% increase

These claims are for ACP discussions that are 16 minutes or more. The ACP Committee will be looking at how to best support providers around how and when to have these important discussions. Inservices are being planned for the coming year that will cover a wide range of topics from beginning conversations to more complex decision-making in light of serious illness.


TCMS (Transitional Care Management Services)

TCMS claims

2017       974

2018       1472       51% increase

TCMS is the complex care that is provided to patients after an inpatient stay. This very significant increase is a testament to the increased communication between everyone who is active in this initiative. Patients receive comprehensive phone calls after a discharge; staff and providers give more time and provide more complex care. This is acknowledged by insurance companies in the form of increased reimbursement for visits coded as TCMS.


Home Health Certifications and Re-certifications

Cert claims

2017       912

2018       1133       24% increase

Another significant increase which is due to providers sending their patients’ reviewed home health care plans to the billing department to be scanned, faxed, and billed.


DRS (Diabetic Retinal Screening)

GHC started scanning in January                               6-7% increase in QM

NHC started scanning in June                                    10% increase in QM       

EHC started adding appt notes in September        2% increase in QM

DRS is an incredible tool to help patients who have diabetes, but are not getting to annual eye exams, to be screened while they are already in the office. When patients are identified as having findings of concern, they are called by nursing to strongly encourage follow up care. It is through the teamwork involved to make these referrals for the scans that can help prevent or treat potential vision impairment or loss. The intention is to bring this to all 4 centers over time.


I am incredibly proud to be part of this work that highlights the care provided to VMG patients, and very pleased to share the progress that has been made. These initiatives are collaborative efforts; they succeed because of all of you working together.


Thank you for all your hard work to achieve this significant measure of success. Please let me know should you have any questions or need any additional support for yourself, your staff, or your department, for any of these programs.


Stephanie  Pick

Dance Related Physical Therapy At Valley Medical Group

Special Projects Update

March 2018


Diabetic Retinal Screening in Family Practice

Retinal screening started at GHC 8 weeks ago at the end of January. There are designated nurses who have been trained to perform this procedure as part of an office visit for patients with diabetes who have not had their annual eye exam. Dr Merlin in Eye Care has been providing the interpretation of the retinal scans. The system to support retinal scanning is now working very smoothly. To date, 20 screenings have been performed and a few patients have had positive findings for retinopathy, choroidal degeneration, or glaucoma. These patients have been notified, and it has been recommended they have a complete comprehensive eye exam due to the positive findings. 


Digital Retinal Screening will be coming to the other family practices, as well as to the endo department, over the next few months.


Advance Care Planning (ACP)

The ACP Committee has been on hiatus for the past year but reconvened recently to complete a grant proposal with Harvard Pilgrim Health to further the work that was begun. We will hear next month if this has been approved.  In the meantime, the committee members are motivated to meet again to advance the mission of preparing patients to make important care decisions.



We use our visit summaries as our required care plans. We are working to assure that we are compliant with all the CMS regulations about this. Providers: please look for email from me soon sharing important guidelines to support your documentation and care planning.

Special Projects Update

January 2018


A new year seems a good time to reflect on some of our achievements over the past year. I know when new initiatives begin, it may seem overwhelming to learn new protocols and procedures. Here are some positive results I am happy to share with you.


Advance Care Planning: The ACP initiative began in January, 2016 and 168 of these important discussions were billed that year. In 2017, there was an increase to 408 ACP claims.


CCM: As many of you know, CCM did not truly take off until we implemented the Dulcian timer. In 2016, without the timer, we totaled just over 1,200 CCM claims. In 2017, we increased to over 7,000. We were not live in all 4 centers until the beginning of May, so there is every reason to anticipate even stronger performance in 2018.


Home Health Certifications: This initiative began in January, 2017 to claim revenue for reviewing home health care orders for patients under VNA care. Per quarter, we increased from 97 to 206 to 284 to 325, for a total of 912 claims for the year.


Thank you for the attention you have paid to these initiatives and for the diligence you bring to your work to provide best care for our patients and to support the mission of VMG.

Summary of 2017 HIPAA Violations

Now that we have closed out 2017, I wanted to summarize the HIPAA Investigations that occurred this past year.  VMG completed 12 investigations of reported HIPAA violations (as compared to 19 in 2016).  Of these investigations, 5 were determined to be HIPAA violations.  These 5 incidents were reviewed with all staff involved, and notifications were made in writing or by phone to the patients affected and each incident was reported to the US Department of Health and Human Services Office of Civil Rights via their on line Breach Notification reporting system.   Below is a summary of the incidents:

Breakdown of 2017 HIPAA violations by center

AMC   2

GHC   3

Breakdown of 2017 HIPAA violations by department


AMC Endo 1


GHC Reception   2

Breakdown of 2017 HIPAA violations by circumstance

Linked incorrect patient to portal access     2

Discussed confidential information with patient in public areas   1

Mailed lab results to wrong patient due to similar/same name   1

Mailed lab results to wrong patient due to other clerical error   1


As we start 2018, please remember that each of us at VMG is responsible to safeguard and protect our patient’s healthcare information.     

Amy Rice RN, BSN   Quality Improvement Manager and Electronic Security Officer

Special Projects Update

December 2017


Chronic Care Management (CCM): Advance Care Coding

Have you noticed there are some patients you spend a lot of time working for while the CCM timer is running? Up until recently, we billed CCM the same for anyone who reached a minimum of 20 minutes in a month. However, Medicare created new codes to account for the time spent if we reach 60 or 90 minutes (and more, in 30 minute increments). So in the past couple of months, we have started to use these new codes—nothing different for staff and providers to do; this is coded by the CCM biller. VMG is now beginning to be reimbursed for the extensive time you spend on some of our most complicated and needy patients. And the reimbursement for these codes is higher, increasing our CCM revenue significantly.


The minutes you are spending are valuable for our patients’ health and to the financial health of VMG. Thank you for the care you provide and for utilizing the timer to account for your efforts.


Shared Medical Appointments (SMAs)

VMG now has SMAs running or being planned in all 4 offices for the 1st time.


Currently we have 3 for Diabetes Management, 2 for weight management, 2 for Healthy Living (the follow up to the weight Managements SMAs), and 1 for chronic pain management. These have generally been well-attended with sometimes up to 15 patients in an appointment. Providers  report enjoying the process and the change of pace.

You can read more or direct patients to read about these on the VMG website  at


While initiating one takes some work, there is a team to help with the logistics. Have  you considered if you would like to be part of facilitating an SMA?

Special Projects Update

October 2017


Diabetic Retinopathy Screening

VMG will be implementing a new screening program this fall. We will be purchasing hand held scanners to be used in family practice to perform retinal screenings for our patients with diabetes who have not had their annual eye exams. As a practice, 55% of our diabetic patients are not in compliance with this quality measure.


This program will be a collaborative effort initially between family practice and the eye care department and then expand to Endocrinology. There will be training provided for designated staff as well as for our optometrists. The exam does not require dilation and is an efficient use of time during an office visit. Results will be read by our optometrists.


I spoke with the nursing manager of a practice using this technology who shared that 8 of their 1st 14 screenings resulted in significant findings, including retinopathy, macular degeneration, glaucoma, and cataracts. These patients were immediately referred for care they would not otherwise have received. I spoke with the optometrists in another practice who said they have been impressed with how this program has increased attention and education on the importance of eye exams to patients who had not previously complied with referrals.


More information will be coming soon about diabetic retinal exams (DRE) in family practice.


LGBTQ Initiative

Glossary: After the inservices last summer, there were requests for a glossary of terms to be available. There is now one posted on the Intranet page with the other LGBTQ links. The committee is also starting work on a patient resource list that will be posted on our website and will also be available in print form to give to patients.


Clinical inservices: Aleah Nesteby from CDH will be providing a one hour inservice in each center over the next couple of months for providers and nurses on LGBTQ health issues. Later this winter, our own Endocrinology Department will facilitate an hour at a primary care meeting specifically on transgender health issues.


September 2017


LGBTQ Initiative

Over the course of the summer, more than 350 VMG staff attended a one hour inservice, Improving the Healthcare Experience for the LGBTQ Community, facilitated by J. Aleah Nesteby, Director of LGBTQ Services at CDH. The remaining staff and all new hires will watch a video of the inservice.

This hour was one part of the LGBTQ initiative at VMG. We have collected suggestions and feedback during 2 community forums and a patient survey, as well as from all of you on the surveys and evaluations you completed. The LGBTQ Workgroup will be discussing this feedback and making recommendations for further steps we can take to assure that we are as welcoming and affirming as we can be to all of our patients.


Advance Care Planning (ACP)

These important conversations are occurring more and more. I last reported 6 months ago that we had increased to 60 of these billable visits for 4th quarter. Since then, the numbers rose to 118 for 1st quarter and 134 for 2nd quarter. Clearly, patients and providers are working together to discuss and plan. We are starting to look at the percentage of older patients who are completing a MOLST and getting it scanned in. Very important to add the date of the MOLST to the social history once added to the EMR so we can gauge this accurately.


Smoking Cessation

Just a quick update: Our count of all patients who are current smokers has now decreased by 3% in the past year. That’s a positive trend to feel very good about! Between the counseling, the CO testing that provides valuable information, the med prescriptions, the classes, and the outreach calls, our patients are making healthier choices.


Home Health Certifications

VMG has now completed the project of reclaiming revenue from last year’s signed Home Health Certifications. This was a tedious process that captured over 500 claims. Now the focus is on the certifications that come in on a daily basis. Since we began in March, we have already billed for 155 of them. The new workflow is for the physician (not NP/PA) to electronically sign the cert and forward to the billing department. The biller then faxes to the appropriate VNA. The claim is held for a month prior to billing so that a TCMS code can be dropped instead if appropriate; we can’t bill both. Thanks to all for creating and utilizing this new protocol.



What a difference a popping timer makes! Everyone in Family Practice and Endocrinology, as well as in the referral department, is now activated in Dulcian, the automated CCM documentation tool. Before we began with Dulcian, the most claims we dropped for CCM in any given month was 169. We are now at about 700, well over a 300% increase! And the work is faster and easier. This program allows us to capture the time we spend taking care of some of our most needy patients.  This has only grown through the teamwork approach you all bring to patient care. Well done!


LGBTQ Healthcare Initiative

VMG has recently been approved by Harvard Pilgrim Healthcare for a grant: “Improving the Healthcare Experience for LGBTQ Patients”. There is a workgroup established, which is meeting monthly, to work on the initiatives as outlined in the grant, including but not limited to:

  • Engaging an outside consultant for training all reception, clinical and provider staff to increase understanding, knowledge and comfort with various issues related to providing more welcoming and affirming healthcare to our patients.

  • Updating bathroom signage for bathrooms to be gender inclusive.

  • Updating general marketing tools online and in-house to present a more diverse population.

  • Modifying EMR (banner, quickview, social history) and health questionnaires to allow for more inclusive, accurate and standardized documentation.

  • Studying preventive measures (mammos, paps, colonoscopies) for transgender patients to determine if there is a healthcare gap that needs to be addressed.

  • There will also be surveys developed for staff and providers before and after training as well as satisfaction surveys for patients.

  • In addition, we will begin planning the follow-up community forum that we committed to last December. This will again be a joint endeavor with HNE.

Smoking Cessation

So here’s a quick stat that validates your efforts. In the last 7 months, our percentage of patients who are documented as smokers has decreased by 2%, roughly 150 fewer smokers. It would seem that the increased CO testing, the focus on counselling, and the addition of a designated cessation specialist offering phone and class support is making a difference. This is important and good work.



Due to sustained interest, effective immediately, the Wednesday afternoon QuittersWin groups will no longer be limited to an 8 week format. This will allow each participant to get the help they need for as long as they need it.

  • More flexible to meet individual patient needs

  • More convenient for providers because there’s always a program available

  • More responsive to the reality of relapses and re-attempts 

To accommodate new participants into the on-going program, first-time attendees will be scheduled to attend a 30 minute orientation session at 3:30 pm on Wednesday, after which they will attend the weekly 4:00-5:00 group for as long as they need to. New participants entering by way of the 3:30 orientation session is vital to their success the flow of the classes.

Please encourage your patients to register when they check out.


Advance Care Planning

  • The ACP Committee has concluded its monthly meetings. This was a wonderful committee that engaged in important discussion and also promoted the significance of this work across the 4 centers during instructional meetings and at primary care meetings. A new encounter plan was developed that includes a template which generates a service charge and also prompts practitioners for the parts of documentation that are required as well as recommended.

  • In 2016, ACP claims per quarter increased from 21 to 32 to 49 to 60. Already for the 1st two months of 2017, 73 claims have been submitted. This is not only good for revenue, but demonstrates the time practitioners are giving to these very important conversations with patients and families.

  • ACP Champions are being named at all centers. Please bring your questions and concerns to them. If there is need for the ACP Committee to reconvene to address specific issues, that is indeed possible.


  • AMC: Jon Schiller

  • EHC: Lauren Schwartz

  • GHC: to be announced

  • NHC: Shersten Killip and Henry Simkin



  • In January, NHC moved into Dulcian, our new CCM documentation system. Since that time, they have significantly increased their billable CCM claims from 64 in December to nearly 200 in February. This automated timer system takes the work out of CCM. There is no longer any need for staff or practitioners to investigate if a patient is CCM eligible. Dulcian does that work.

  • Many thanks to everyone at NHC for being the pilot center that has been so patient as we worked out glitches and made this more efficient and user-friendly for everyone.

  • EHC moved into Dulcian at the beginning of March and we started at AMC this week.  GHC will get to it at the start of April. 1st impressions are very positive. This is far easier and faster than the current CCM order sets.

  • We are now able to capture more of the time that is spent taking care of the more chronically ill patients because this program does not interfere with workflow in the way that adding CCM orders has. Much appreciation for everyone who continues to do this work while waiting for Dulcian to come to you.


Now that we have closed out 2016, I wanted to summarize the HIPAA Violations that occurred this past year at VMG.  There was an increase in investigations/violations reported from 2015.  This may be due to increased awareness of HIPAA laws and regulations by staff and patients.    In 2016 VMG completed 19 investigations of reported HIPAA violations (as compared to 6 in 2015).  Of these investigations, 16 were determined to be HIPAA violations.  These 16 incidents were reviewed with all staff involved, notifications were made in writing to the patients affected and each incident was reported to the US Department of Health and Human Services Office of Civil Rights via their on line Breach Notification reporting system.   Below is a summary of the incidents:

Breakdown of 2016 HIPAA violations by center

AMC   1

GHC   8

NHC   7

Breakdown of 2016 HIPAA violations by department

ASPC    1

Health Information 1


GHC Reception   5

GHC Rheumatology  1


NHC Reception  1

Breakdown of 2016 HIPAA violations by circumstance

Sent records/form to an entity without authorization     2

Mailed/gave patient summary or results to wrong patient due to double sided printing   3

Mailed/gave patient RX /lab results/patient summaries to wrong patient due to similar/same name   4

Mailed/gave to wrong patient due to other clerical error   7


As we start 2017, please remember that each of us at VMG is responsible to safeguard and protect our patient’s healthcare information.    This is complicated by the fast pace and complexity of our workflows, but with continued awareness, education and vigilance, we can all be successful in safe-guarding Protected Health Information.

Amy Rice RN, BSN   Quality Improvement Manager and Electronic Security Officer


December 8, 2016



  • Consent Process: At the end of November, the percentage of Medicare patients with completed CCM consents had risen to 74% from 68% in September. We are giving far fewer forms out per week as we have so much of this completed now.  An average of 80-90% of the forms are returned each week.

  • Orders: Our weekly CCM orders across VMG have increased from an average of 50/wk in August, 115 in Sept, 135 in Oct, to about 200/week in Nov.  Note: orders are not the same as claims. Orders only become billable when they add up to the requisite 20 minutes/pt/month. But this growth shows that more and more of you are starting to “think CCM” when you are doing work for our patients. Each one of you who begins to consistently take this on makes a big difference in the CCM effort. Thank you!


On Tues, December 6, VMG, in partnership with HNE, hosted a community forum to learn more about what is needed to make the healthcare experience most welcoming and affirming for the LGBTQ community. The forum was open to anyone, not just VMG or HNE patients and was meant to inform both groups about what directions we can take to improve our offerings.  Just under 30 non VMG/HNE people attended.


The group was welcomed by Joel Feinman as well as an HNE VP, was moderated  by Pat Griffin, a nationally known advocate for LGBTQ social justice and included Fred Kim, Thomas Kreek, Chris Normandin, and Matt Spitzer as facilitators. The forum was also attended by a good number of other VMG providers and staff.


After the opening comments and context setting, small group discussions took place to focus on pre-determined questions about what makes for a positive health care experience and what gaps exist as well as what resources are needed. The groups also discussed specific issues that arise throughout an office visit and offered suggestions..


This was followed by open discussion and sharing in the larger group where it became clear that follow-up was wanted. We are now in the process of writing up the notes from the discussions and a work group will be formed to review and to make recommendations for action steps to address some of the concerns that were raised. These steps will be posted for the community to see and a plan for how to reconvene will be determined.


This was a very positive and collaborative effort between VMG and HNE and likely only the first of more community forums to come.


The 2016-17 flu season program is in full swing.  As you know, the CDC recommends universal flu immunization.  Not only do we strongly encourage all patients to be immunized, but our employees as well. The most effective way to prevent infection from an influenza virus is through annual influenza vaccination.  The goal is to protect patients, employees, employees’ family members and the community from the flu.  We are administering flu shots to patients at their office visits and holding flu clinics at all of the health centers.  We should continue to strongly encourage every patient who comes in for any type of appointment to receive flu vaccine. 


 We measure the flu immunization rate each week for patients who are seen in the health center.  We started at 48% compliance rate at the beginning of September and have seen this steadily increase.  Last week we were up to 68% - an improvement of over 20% in 2 months. 

This means that 2 out of every 3 patients seen in primary care last week left immunized.  It shows how you are communicating the importance of flu vaccine and administering vaccine consistently to our patients.  Thank you for your continued focus and attention to this.


Again we encourage all employees to be immunized and improve upon last year’s rate, with a goal of 90% this year.    Because we believe this is the right thing to do, and is important to our workforce, families, and communities; we want to remind you that VMG is offering incentives and a challenge for staff to increase our workforce flu immunization rate. 

  • All employees who get immunized will receive a $10.00 gift card when they get their flu shot.  If you obtain your flu shot outside of VMG, just bring in proof of immunization and you will receive your gift card.

  • If VMG reaches the goal of 90% compliance rate by the end of the year, all employees who are eligible for PTO will receive a bonus ½ day off in 2017 (based on what you work).


Currently the employee flu immunization rate is 84%, which is climbing each week.  We will keep you updated regularly to let you know how we are progressing toward the goal.  We will measure this until the last day of December.

  Please seriously consider getting your flu shot if it is not contraindicated for you.  Any RN Team Leader or clinical staff would be happy to administer it! 


November 7-12, 2016

Radiology Techs perform multiple exams each day to help us serve and take care of our community.  From tiny swollen toes in children or a soccer injury to emergent chest x-rays to rule out pneumonia.  They do their best to help with the answers to the diagnosis.  Here at VMG we perform over 9,000 x-rays a year.

Join us as we honor VMG’s Radiology Techs!


VMG has contracted with Tim Sweeney to lead A 2nd  smoking cessation groups at GHC. Tim is Owner and Principal Cessation Specialist at He has been a Tobacco Treatment Specialist for 18 years and has been leading a first class at GHC throughout the summer. He writes:


After 6 meetings we’re seeing success in and out of the classroom… Over half of the participants opted to receive the daily text messages… A handful of patients have made use of the individual phone coaching sessions to augment their classroom experience or to make up for a missed class... I’m impressed by the courage and tenacity of the participants…Most participants have at least reduced their daily number/day significantly. Some have quit completely and most have responded favorably to the carbon monoxide screening (available weekly PRN) as a means of quantifying their progress, even before their quit day…


His new class will meet on 8 Wednesdays, September 28 through November 16, from 4-5 pm in lower level conference room.


Please think about patients to refer into this program. There is room for 15-20 VMG patients. There is no cost to the patient. The schedule is already in place and registration has begun.



The Advance Care Planning Committee has approved an educational posting  that is now on the VMG website for patient review. Please go to the Services link and click on Special Programs. There is information about the Health Care Proxy  and MOLST forms with links to websites where anyone can download the forms in various languages. There is a link to The Conversation Project which provides resources and guides for initiating conversations about advance care wishes. The posting also encourages patients to consider scheduling appointments  to discuss ACP questions and concerns with their providers. Of course, these discussions can occur at any visit but must be documented as at least 16 minutes within a 30 minute appointment time to be billable.. There is a flyer in the works as well.



VMG has contracted with Tim Sweeney to lead 2 smoking cessation groups at GHC. Tim is Owner and Principal Cessation Specialist at He has been a Tobacco Treatment Specialist for 18 years in inpatient medical, inpatient psychiatric, outpatient behavioral health, work place and other community settings. Tim has also worked for over 10 years in behavioral health at Athol Hospital.


The first group will be a weekly class on Mondays from 4-5 pm in the 2nd floor large conference room from July 11 through August 29. The second will be in the fall, dates to be determined.


Please think about patients to refer into this program. There is room for 15 VMG patients. There is no cost to the patient. Reception has already created the schedule so registration can start now.



Firebird 5K














This past Saturday a group of VMG folks came out to participate in the Firebird 5K. It was hot but we all had fun walking and running as we showed our support for The Recover Project and addiction awareness.

It was a great community event! Thanks for being there.


- Meghan Gump



New Tai Chi Class


Starting Thursday, April 28th, there will be a new Tai Chi class offered at the Amherst office from 6-7 pm. There is currently a Tai Chi class in Easthampton on Mondays as well as a yoga class in Greenfield on Mondays.


These classes are offered at no cost to VMG patients who have chronic pain or other underlying chronic conditions. The Tai Chi teacher, Janet Aalfs, has shared that VMG patients are experiencing reduction in pain and stress as well as increased balance, flexibility, coordination and sense of well-being.


Please think to recommend patients if appropriate. They can call any VMG office to sign up.. Registration is now open.


Smoking Cessation Committee Updates


Carol J. Anderson, NP  and John Novo LMFT will be offering a free class to smokers entitled “New Treatments and Ways to Stop Smoking”.  This will be a 6 week course starting April 11th from 6-7:30 PM at Amherst Medical Center.  Patients can call 256-8561 to sign up.  Fliers about the classes should be available at every health center. 


Clinical Guidelines for Smoking Cessation are now available in Athena which includes pharmacology recommendations.  In addition, resource providers are being recruited at each health center who will receive training from Ann Esrick PA and Carol J .Anderson, NP.  Please read upcoming e-mails.  New handouts for patients are also available now in the “Print Forms” section. 



Substance abuse resource in MA


 Dr. Potee and John Novo will be going to primary care meetings in each of the health centers to talk about outpatient alcohol detox beginning today at NHC. One of the things they want to provide is information on accessing community services. Below you will find a link to a site where one can search for substance abuse treatment resources in MA by typing in the type of treatment needed (detox, outpatient, residential) and which area of the state you are in. It is easy to use and seems to generate a comprehensive list of services. We are sharing it here with everyone at VMG since it is a resource that might be helpful to any of us and our families.


Here is the link:


How to Configure for Athena


Click Configure Browser

















Click Clear Cache (1). A dialogue box will pop up saying Cache cleared, hit ok (2). Click Update Settings under the Browser Settings (3). You want to see “Your browser settings currently adhere to the supported configuration for athenaNet” under the Browser Settings. If it already says this, then you won’t see an Update Settings button. Close all browsers by clicking the X in the upper right hand corner and re-open.























Sports and Exercise Medicine at Valley Medical Group


Valley Medical Group Sports and Exercise Medicine provides diagnosis and treatment of any sports or exercise related injury or pain.  We work with competitive and recreational athletes as well as other active individuals to maintain or improve their health.


We treat athletes at the high school, collegiate, and professional levels along with other active individuals with exercise related injury or discomfort.  A strong emphasis is placed on functional rehabilitation and non-operative interventions in an effort to return athletes and others to their desired sport or activity. 


For athletes, care is tailored to their specific needs taking into consideration training and competition schedules.  We offer complete sports related concussion care with individualized treatment plans.  We can also assist with difficult return-to-play or medical clearance decisions, pre-participation physical examinations, injury prevention counseling, and sports nutrition or supplement recommendations.


Our team will coordinate care with physical therapists, athletics trainers, and coaches to optimize care and ensure rapid return to activity.  Ultrasound is available for injury diagnosis and guiding therapeutic injections when necessary. 


You can find more information about the Sports Medicine Physicians on our Internet Site here. Greg Murphy is the current Physician.




Tobacco Cessation Efforts at VMG




Tobacco use is the leading preventable cause of death in the United States today and is projected to be the leading cause of death in the world by 2020. Tobacco dependence is a chronic condition: Smokers often make multiple quit attempts over time and co-morbidities to this addiction are numerous. Treating tobacco dependence is a complex task, which requires participation by all health care team members.   Valley Medical Group has several initiatives underway to help our patients address their Tobacco Dependence:  counseling and providing educational literature on smoking, its effects on health status, cessation strategies and programs including prescribing nicotine replacement medications, Carbon Monoxide monitoring at office visits, referrals to quit programs, and offering smoking cessation classes at VMG by a trained Tobacco Treatment Specialist (Ann Esrick, PA-C).   


In addition to these resources, VMG applied for and received funding from Harvard Pilgrim Healthcare Quality Grants to provide Nurse follow up for smoking cessation patients.   Since April 1st, 2015 Leah Esrick, RAF RN has been piloting this new initiative with AMC Family Practice Team 1.   The clinical support staff and providers have screened patients for tobacco use during visits, and then referred patients to the Smoking Cessation nurse for follow up contact.  The Smoking Cessation nurse then contacted the patients and provided patient-centered counseling (incorporating motivational interviewing) with care coordination to meet patient-driven goals in smoking cessation.  Here are the results, compiled between April 1st and June 23rd 2015: 




25 patients have screened into program 


13 (52%) patients have participated with the smoking cessation nurse (Goal= 60%)


Quit attempts:


7 of the 13 patients (54%) participating have had quit attempts (Goal= 50%)


Quit attempt =24 hours or more of tobacco cessation


Overall, this has been a very successful pilot. We will continue to build on this by spreading the initiative to the rest of VMG by the end of this year.   Additionally, in the fall, Leah Esrick and Carol Anderson, NP will be attending training to become Tobacco Treatment Specialists.    This will enable VMG to provide more resources for quitting smoking to our patients who are Tobacco dependent.




Colorectal Cancer Screening (CRC)




I wanted to share with you a story about a patient who received a stool collection kit from reception when she checked in. She is 65, had never had a colonoscopy, no symptoms of digestive problems so did not really think this screening was necessary for her. Also – too embarrassed to consider this test.


She brought the kit into the room, the medical assistant advised her to talk with me about the contents of the bag – what the test was about.


I discussed the fact that colorectal (CRC) is the second leading cancer killer in the US after lung cancer. The best screening test is colonoscopy but if she did not want to do that just yet I recommended a screening test to see if any blood was present in her stool. She thought that was “gross” but agreed to collect the samples. I did share about a 51 year old friend who had CRC discovered on her first colonoscopy and was now in remission, and then I shared that my aunt and nephew had both died from CRC.


The tests showed blood in her stool and she came back in to discuss the results. She reluctantly agreed to go for the colonoscopy and could identify a neighbor who would take her. The neighbor had had a colonoscopy herself and was encouraging this pt to also be screened.

She had her colonoscopy and had 8 adenomatous (precancerous) polyps removed.  If left there, these polyps had a high likelihood of becoming malignant.


This story highlights a few things:

The importance of screening

The role of reception in giving the “bags” to anyone who is overdue for CRC screening

The role of medical assistants in encouraging patients to talk with their providers

The role of providers in finding a way to discuss this health issue in a way a person can hear it and sense the importance.


The role of the lab in sending out kits when we receive the report that the pt chose not to schedule their colonoscopy.

The role of us as friends, neighbors, family members to be screened ourselves and then to encourage others to be screened – not with scare tactics but instead with “I had it done, yeah the prep is not so easy but it is only a short time and the test itself was painless.”


Let’s move COLORECTCAL CANCER down on the list of cancer killers.

Early detection saves lives and we all have a role.


Chris Normandin, NP NHC Provider Team Leader





Behavioral Health Integration: The ACE Study




How much do difficult experiences growing up affect our health as adults? According to theAdverse Childhood Experience Study (ACE), adverse childhood events greatly increase risk for a variety of health problems. From 1995-1997 patients at Kaiser Permanente in California filled out detailed confidential surveys on childhood maltreatment, family dysfunction and current health [...]



How much do difficult experiences growing up affect our health as adults? According to theAdverse Childhood Experience Study (ACE), adverse childhood events greatly increase risk for a variety of health problems. From 1995-1997 patients at Kaiser Permanente in California filled out detailed confidential surveys on childhood maltreatment, family dysfunction and current health behaviors as part of a study conducted by Kaiser and the CDC. The study has been following those 17,000 original patient’s health outcomes to determine whether or not there is increased illness and destructive health related behaviors for patients suffering more trauma and disruption in childhood. They used a brief “yes or no” questionnaire asking if the person had experienced childhood abuse, neglect, parental mental illness, family disruption and substance abuse. A “yes” answer scores “1″. The Ace score is the total number for all questions range from “0″ or no adverse events with a maximum of “10″. You can find the survey here.  As you might expect, the higher the ACE score the more illness suffered throughout the lifespan, not just in childhood.


The study is ongoing and is being replicated in other countries but the data is indicating that childhood trauma and family dysfunction contributes to health behavior related problems like smoking, early pregnancy, ischemic heart disease, COPD, depression, hepatitis, STDs, liver disease and substance abuse. You will notice that all of these illnesses involve unhealthy behaviors like

smoking and drinking excessively.


What does this have to do with VMG and BH integration with primary care? A lot. Most simply put, our mission is to help our patients and families live better, longer. We can only do this if we help patients with behavioral health needs and assist in making healthier choices. Many patients in primary care have unmet behavioral health problems but they are not willing or able to seek behavioral health treatment. Integrated care brings the behavioral health expertise right into primary care. Dr. Walsh-Rother has been providing this care at GHC. We think that her work has helped us more effectively address the problems identified in the Ace Study.


Making healthy choices is hard for all of us. The ACE study reminds us that there are many factors that affect how well or poorly patients manage their health. It is a fundamental goal of the patient centered medical home  to take care of the “whole patient”. We believe that offering integrated care is a key component in keeping our patients healthy. Take a look at the ACE study website.

More on Integrated Behavioral Health Care later…

John Novo, M.Ed., LMFT, CDAC II, LADC





Suicide Assessment and Prevention For All Providers




Recently, while gathering vitals at my primary care doctor’s office, the nurse quickly asked me, “Are you feeling down lately? Hopeless, helpless, worthless?” As a psychologist I thought, “Oh, someone has implemented Beck depression screenings into primary care!” As I moved on through the week, the article about how 83% of individuals receive health services [...]



Recently, while gathering vitals at my primary care doctor’s office, the nurse quickly asked me, “Are you feeling down lately? Hopeless, helpless, worthless?” As a psychologist I thought, “Oh, someone has implemented Beck depression screenings into primary care!” As I moved on through the week, the article about how 83% of individuals receive health services within a year before a completed suicide was circulated in our office. Half of these people did not have a mental health diagnosis. And half of all of these patients made it to a medical visit within the past four weeks of their death. You can read that study here if you have not already done so:

While this is alarming, keep in mind, even for psychiatrists doing a full evaluation, the ability to predict suicide completion is very difficult. It is not based only on symptoms in one visit. Suicides are statistically rare while thinking about suicide (suicidal ideation) is much more common. Still, whenever there is a concern that a patient might be suicidal healthcare providers need to collect as much information as possible when assessing a patient’s risk for self-harm. For primary care, it may be connecting the patient to behavioral health providers more readily, consultation with a behavioral health provider and more closely monitoring the patient. The article above points out that accurate assessment of psychiatric illness significantly improves prediction of suicide risk. Since patients who committed suicide did not have psychiatric diagnoses and had often been seen in primary care within one month of their death it is important to improve screening and intervention in primary care, as well as behavioral health.


This  puts the responsibility of mental health screening into the forum of ‘health screening’ and is a good step toward reducing the number of deaths by suicide, which is a goal of the NIH this year.


What’s next is a suicide prevention screening that will be developed by NIMH for primary care providers to use on interval visits, with the goal to reduce suicides by 20 percent in the next five years.  Here is what we can do to help our patients in the meantime:

The single most important thing a provider can do in assessing and mobilizing a patient to safety, if there is a risk of suicide, is connect with their patient. Your relationship with that patient, however brief, in that moment, can make an impact that communicates care, warmth, support and hope, all in one interaction. Rating scales, check lists, contracts for safety and promises are all used in various settings but their prediction rate is very limited.  These tools are most useful  in tandem with a treatment team that the patient trusts.


In general, any presentation of a patient with mood instability, impulsiveness and a hopeless outlook deserves careful investigation by the clinician.  Presence or absence of each factor is not as important as the combination and intensity of these factors at that time in that person’s life.  Direct questions do not increase a patient’s risk of self harm and actually come as a relief if the person has been thinking about suicide. Deciding with the patient, if any of the factors which are distressing to them can be changed, even to bring temporary relief, may be a life or death intervention.


From Psychiatry Online, a recent training module indicates: 

“Past history, family history, and demographic characteristics are examples of non-modifiable factors. Financial difficulties or unemployment can also be difficult to modify, at least in the short term. While immutable factors are important to identify, they cannot be the focus of intervention. Rather, to decrease a patient’s suicide risk, the treatment should attempt to mitigate or strengthen those risk and protective factors that can be modified [I]. For example, the psychiatrist may attend to patient safety, address associated psychological or social problems and stressors, augment social support networks, and treat associated psychiatric disorders (such as mood disorders, psychotic disorders, substance use disorders, and personality disorders) or symptoms (such as severe anxiety, agitation, or insomnia).”


To summarize, although prediction of death by suicide is a daunting task for all healthcare providers, brief intervention  can  help the patient make life saving changes and choose to use available supports for relief and comfort until long term problems can be addressed. The relationship with the patient and careful questioning is more effective than rating scales or safety contracts. Routinely ask about suicidal thoughts and follow-up with further questions if the patient expresses suicidal thoughts or intentions. Your warm, caring attention can save lives.


Thank you,

Dr. Bridgette Sacco-Laurens





March 18, 2020                                                                                                  Issue # 2


I hope you and your families are well. I know it’s a confusing time. Here is today’s update.


Hand Washing and Social Distancing


I know you’ve heard this a million times by now. Hand Washing is our best defense. We should all be washing our hands with soap and water for at least 20 seconds before and after every patient visit, before and after eating, before and after bathroom visits. AND after using a device such as a keyboard, computer, cell phone, etc. (I know that this is difficult to remember because of strong habits and because of how frequently we use our devices but the more we do it, even if not every time, the better off we are). You can use hand sanitizer (60% alcohol or greater) but soap and water is preferred and more effective.


Social Distancing is also a “best practice” defense against the spread of the virus and slowing its progress through our population. We are committed to doing as much as we reasonably can to observe social distancing.


Yesterday’s update (which is now on the intranet page) provided information on steps we are taking in the health center. We have made progress on many of those steps already (moving patients from in-person to virtual visits, “red lines” taped in reception areas, reception area and conference room chairs moved, etc.). Additional steps will be necessary and taken. If you are in a meeting with multiple staff, please try to observe a 4-6 foot distance between participants. We are moving many meetings to conference call/video platforms.


We are working on some modifications to our facilities and work flows to protect staff and patients from possible viral spread. As discussed yesterday, we’re moving ahead with finding a way to segregate respiratory illness patients from others (separate entrance, separate team of practitioners and staff, parking lot “holds” until asked to enter and escorted entry and exit via as isolated walk as possible). We are looking for ways to place additional protection in the form of a barrier of some sort at reception areas which do not have Plexiglas fronts.


Outside our Health Centers, I want to encourage you to also observe social distancing. Although we want to be with our friends and family (especially in crises like these), its best to follow the CDC and WHO recommendations including:


  • travel as little as possible, even locally

  • avoid gatherings

  • avoid unnecessary meetings and social events

  • avoid contact with people who are coming from/visiting from areas where the pandemic is most active

  • wash your hands (and have family wash their hands) before and after contacts

  • clean and sanitize high touch areas frequently

  • If you cough, cough into your elbow. If you sneeze, use a tissue and throw it into the trash

  • if you are sick with respiratory symptoms of concern (cough, fever, shortness of breath), stay home and isolate from others in your household as much as possible. If your symptoms are worsening, contact your primary care practitioner


Work From Home Initiative


In keeping with our efforts at social distancing, we are in the process of (and have already made some progress with) deciding on functions that can be done outside of VMG with staff working from home. The Management Team has developed a Work from Home Agreement for those staff that we ask to work from home. Staff will be paid as if they were in the health centers under these Agreements. We may ask staff to take on some functions and tasks not normally part of their jobs, but within their skill levels.


If You Need to Care for Children or Family Members Due to School Closures or Illness, our usual sick time policies apply. We hope you will be able to make arrangements for child care. If you can’t, you will first use PTO and, if necessary, unpaid leave. We are following the talk in the state and federal government to see if any additional help is being authorized, but right now we have not heard anything definitive.


If you get sick, you will use PTO/Sick Time as usual. We will have answers to questions raised about return to work protocols and the possibility of quarantine due to COVID-19 in the next few days.


As of right now, we are not encouraging staff to take unpaid leave. With the exception of staff we are asking to work from home, we believe we have enough work to do so that would be unnecessary now. That situation might change and we’ll keep you informed.




Because of the unprecedented nature of this virus, the federal and state governments, CMS and the Division of Insurance have loosened the restrictions on the use of telehealth and billing for telehealth services with patients. We are encouraging the use of virtual visits by telehealth platforms and services (for video visits) and, if video is not available, the telephone. We’ll be gathering information on which methods seem to work best and provide feedback to practitioners and staff as we get it.


Thank you again for all you do for our patients, communities, and each other.




March 19, 2020                                                                                                  Issue # 3


We are just a few days into the escalation of the pandemic and the work to care for patients affected by the pandemic. While there are lots of things we are not yet clear on, there are a few things that are very clear:


1. it’s not easy to keep up with the information about the virus and the pandemic and the measures being taken to keep our patients and ourselves well.

2. This is emotional work, with ups and downs daily and sometimes hourly.

3. Your work, our work, is more important than ever. We will have, and we are having, a real impact on patients’ lives. As this goes on, I have no doubt that we will be saving lives. And, that’s why we are in healthcare, right?


I want you to know that no matter how confusing and emotional the work gets, we appreciate what you are doing for our patients and communities. As this pandemic goes on, as the impact of the disease increases before it eventually wanes, we will have to learn new skills and tasks, stay focused, be patient and support each other through this.

The Latest at VMG


We have created separate work areas and entrances for patients with respiratory symptoms. This is important as we want to reduce the risk of spreading the virus to others in the Health Centers.


We have worked to come up with procedures to draw perform tests for patients in their cars in our parking lots. This is also a measure to prevent spread.


We have messages to patients going out by portal and email informing them that we are there for them with virtual visits, and for some, with precautions, for sick visits as well.


Tim Sweeney, our Smoking Cessation Counselor, has switched his meetings/groups to all virtual visits.


We still do need staff to work in the health centers, though some of you may be asked to take on other tasks, as necessary. We are also continuing to work through the policies and procedures for Work from Home to meet the needs of our social distancing efforts to slow the spread of the virus. Some staff has already been moved to work from home for identified tasks from their own department or other “new work” (for example, tasks that are important to our quality and service efforts). We have also asked staff in high risk groups (related to age and possible underlying health conditions) to work from home. We’ll have more information on this soon. If we’ve asked you to work from home, we’ll have you sign a Work From Home Agreement which list the requirements and the contact you will need to maintain with your department and supervisor. If we ask you to work from home, your pay will be just as it was in the Health Center. We will also re-evaluate all of these efforts as April 1 approaches.


Once again, I hope you and your families are well. Remember to be patient, be mindful, and wash your hands (a lot).




Friday, March 20, 2020                                                                                                                                                                                                   Issue #4


With all the talk, press, TV, radio, rumor, about COVID-19, it remains difficult to keep perspective on this illness and how it will affect us as a company, a staff of healthcare workers, as parents, partners, spouses, etc. I know it’s hard to be patient and to take a breath with all the concern. Keeping perspective is hard but helpful. Here are a few key things to remember, as of now, as we try to keep perspective:


  • The illness will be with us for some time; at least 6 to 18 months

  • We will all know someone, or be someone, who has the virus

  • Not everybody with the virus will be symptomatic (at least, not right away)

  • Once symptomatic, most cases of the virus will be mild and people will make a full recovery within two weeks (the estimates are 80-95%, so far)

  • Some cases may be severe and these will usually be in people age 70 or older with significant medical problmes or people age 60 and older with significant underlying illness like diabetes, lung disease, and heart disease and even many of the hospitalized patients will recover well

  • As you know, there have been deaths associated with the illness but there have been no deaths for people under the age of 20 and even for people over 60 the death rate is still very small


The more we know, the better we are prepared for the months ahead. Information will change and we will keep each other informed. It’s important to remember why we are here: to help patients stay well and to comfort and treat patients when sick. We will save lives by sticking to this mission. We will need to continue to support and comfort each other as we go.


We have taken all the reasonable measures we can take so far to keep ourselves, our staff, and our patients as safe as possible. Personal protection starts with frequent hand-washing and sanitizing our areas.


Social distancing will help slow the spread of the virus and the illness for our patients and staff. But the main point of social distancing is to slow the spread of the virus and illness and preserve our health care system so it is not swamped by an abrupt spike in cases that outnumber our medical and hospital resources. This is what is meant by “flatten the curve.” That’s why we are seeing the non-critical cases in our centers. Every case we triage as appropriate for us to see preserves an ER visit, hospital bed (and scarce PPE) for those who most need it: mainly the very sick and the elderly with underlying conditions.


So far, our methods for social distancing are the ones you’ve heard of:  maintaining a distance of 6 feet from others, directing patients with non-urgent conditions to visits by telehealth triage, evaluations and virtual visits, and directing patients with respiratory symptoms on a different route through the health center, having respiratory symptom teams to triage and treat those patients, and having “non-essential staff” (those staff not immediately needed to organize and provide care) work from home.


Earlier today you got an email with the EMR Newsletter from Martha describing “Working from home: what we are doing and why.” I know there have been questions about this and the Newsletter should help answer those.


During this COVID-19 pandemic, other industries are beginning to retool and ask staff to do new things. A few of the major airlines are now carrying freight in what used to be passenger planes (because many fewer passengers are flying). Leading designers of clothing are now beginning to make surgical masks and gowns (without their expensive logos, I hope). Distilleries are now making hand sanitizer (hand sanitizer is, after all, almost all alcohol). We’re going to see a lot of that which will both produce medical products that are scarce and preserve jobs.


As you know, we’ll be asking some staff to start performing other necessary duties now that most of our visits are converted to virtual. It’s a way of continuing to be able to provide needed care to patients and preserving our business for the long term once the pandemic subsides.


Progress at VMG


Just in the last few days we have:


  • Markedly increased the number of virtual visits with patients

  • Designed and implemented a Respiratory Symptom Triage Evaluation Team (“Respiratory Unit”) at AMC, GHC, and NHC

  • Arranged to have scrubs for staff and practitioners on those teams so they can change clothes before going home

  • Changed our messages and signage for patients about how we are focusing our services

  • Begun to cross train staff to take on other necessary tasks

  • Continued our social distancing initiative

  • Placed barriers and/or markings in reception to create greater distance between patients and reception staff

  • Practiced and completed a few lab draws in patient cars preparing for more to come


This is just a brief list. There will be more.


Once again, thank you for all you are doing to keep our communities safer. Please have a good weekend. “See you” on Monday.




March 23, 2020                                                                                   Issue #5


In order to slow the spread of the virus, Governor Baker has ordered all non-essential businesses in the state of Massachusetts to close beginning tomorrow at noon until noon on April 7. He is also directing the Department of Public Health to issue a “stay-at-home” advisory to limit all unnecessary activities, especially for those over 70. VMG is an essential business because continuing to provide healthcare services is essential to the public’s health, safety and welfare. For these reasons, we are staying open, though we have, in the space of the last 10 days, essentially redesigned a lot of what we do (more of that below).

Essential and Non-Essential


You’ve probably heard a lot about “essential” and “non-essential” employees. Whichever category your work is in, these terms do not mean that your work is not important to VMG. The terms are only used to designate which employees must report to our place of business to work during this public health emergency. Essential employees are those who are needed at the health center to allow us to continue to provide care to patients. These employees include, but may not be limited to, practitioners, nurses, medical assistants, phlebotomists, radiology staff, medical technologists, receptionists, custodians, couriers and most members of our leadership team.


At VMG we have been actively working to move our non-essential employees (as well as some of our essential employees who can be spared because we have reduced the number of patients we’re seeing in our health centers) out of the office in order to implement and maximize social distancing as a means of slowing the spread of the virus. However, not all of our patient care and work can be performed from home.


It’s important to remember that as we see more patients in the health centers (either because we are seeing more illness or because, in the future, we are returning to normal volumes) we will be moving employees who have been sent home to return to the office so that we can continue to provide needed services to our patients.


Recent Changes


Because of the growing spread of the virus, every patient contact involves a risk- benefit decision. For younger patients, if they visit the health center without urgent need, it increases the risk for practitioners and staff. For older patients if their need is not urgent we increase their risk. We need to make sure that bringing a patient in for a visit will urgently make a difference in their health so as to be worth the risk.


For this reason, we are now seeing almost all patients by Telemedicine; virtual visits by Zoom, Doxy, other platforms or, in some cases, by telephone. The only exceptions are urgent patients who have been through triage and were told to be seen in person by triage nurses or practitioners. All normal, routine follow-ups, wellness visits, and physicals, routine labs and routine radiology are not being seen in the health centers. This is to reduce risk to other patients and staff and to slow the spread of the virus by social distancing. We are seeing urgent patients with respiratory symptoms in our designated spaces in the health centers by our designated teams.


Based on some new recommendations, we are now asking all practitioners and clinical staff in direct patient contact to be wearing masks.


New Federal FMLA and Other Benefit Changes


We have not yet finalized all the information coming from Congress and the federal government but we are aware of some changes to FMLA and other programs because of the pandemic. These will create some safeguards for both well and sick employees going forward. We’ll have more to say about these before the end of the week.

Anyone Feeling Stress?


Now that’s a stupid question. Here are some ideas:


  •          If you are spending a lot of time on social or other media watching the news or listening to people talking about the pandemic, stop! Listen to music, read a comic book, try a new recipe, talk with a friend, hang out with a pet, etc.

  •          Connect with others. There is a new word: “social closening.” Talk with friends and family, actually talk, by phone or by video (zoom, face time, etc.). Talking with others helps. And, try making sure that you are also talking about things other than the pandemic. Set a goal to talk with others at least once a day.

  •          Mindfulness. If you don’t have a method you are fond of or never tried it, use one of the free apps like Calm or Headspace. You can get these on your phone or on the web. Or just google mindfulness for other ideas.

  •          Exercise. Go for a walk, stretch, whatever your favorite is, do it often. It doesn’t have to be intense to get some benefit.


Here’s a quote: “The only thing more contagious than a virus is hope.”                                   

                  Admiral William McRaven


There’s been a lot of change at VMG and in our communities these last several days. There will be a lot more in the coming days and weeks. Believe in each other, take care of each other, and, that Hope thing. We will get through this.


Thanks again for all you do.




March 24, 2020                                                                                                  Issue #6


One of my all-time favorite movies is Nobody’s Fool based on a Richard Russo book about friendship, family, distress and adaptation (I’m happy to lend a copy of the book or the movie). Toward the end the lead character is trying to comfort his work mate of many years after an intense conversation about how their lives have changed and the work mate says “you know what I wish?” “I wish we could go back to working together like we used to.” I’m sure many of us are thinking that about now.

But I have two thoughts about that. First, although this is all intense and at times difficult and we are all, of necessity, social distancing, we will rely on each other, do our best to stay connected to each other and our patients, and we will adapt. Let’s keep track of what we are learning about our work and ourselves. Be Patient, Be Mindful.

Second, I think we are all learning something about confronting our fears and worries, courage and inspiration in hard times. Here’s a link to an article in Monday’s NY Times by Don Berwick. We’re in the midst of a lot of change and it’s sometimes hard to see where we are going and it can be hard to see our values in action. But they are there. Take a look:®i_id=3975868720200323

Changes at VMG

  • To better protect our patients and ourselves, beginning tomorrow, we will have a system in place to control access to our health centers for patients, staff, and practitioners. Please read the emails sent today by Gina Campbell and by Mary Mitchel for new procedures

  • We are continuing to see primary care and our specialty departments accelerate the use of virtual visits with patients. These allow us to continue to provide care to our patients. But they also allow us to stay in touch with our patients. Patients really appreciate this and I have to think it’s also good for us as staff and clinicians

  • There is a lot of work going on “behind the scenes” (the folks you don’t see every day that are not patient-facing) to allow all this to happen. Operations Coordinators, IT, Billing, HR, Facilities, Couriers, Payroll, Finance, Health Information, Informatics, and others (I hope I didn’t leave anyone out) are working to enable the work of Reception and the Clinical staff and practitioners

  • Many staff have taken on new tasks as these have been identified to “fill in” until we can figure out new work processes


Thanks again for all you are doing. It’s appreciated.




March 25, 2020                                                                                                                                                                                                  Issue # 7


I was just writing (last night) to an old friend (formerly a leader in healthcare in Kaiser Permanente, now retired). We were sharing family stories and developments and then we turned to talking about how our world has changed. And, how quickly! Just two weeks ago, we had plans to visit our kids in other cities, plans for travel, plans for meeting up for dinner, movies, etc. And now we are both essentially hunkered down, doing what we can do, and a lot of …. waiting to see what will happen and trying to plan for a return to some kind of normalcy in the future.

As to a return to some kind of normalcy, despite what some are saying at the top of our government, most of us believe that we have not yet seen the peak of this pandemic in our country and certainly not in our local communities or region. You probably saw the reports of what is happening in the metro New York and New Jersey area. That wave of illness and the preceding infections are probably coming here a few weeks following the peaks in metro New York. There will be no return to normalcy until months after that. I say this not to create fear and anxiety but to make sure we all are connected to what appears to be reality. If we can connect to reality, we can find ways to deal with it as best we can. We can have expectations. We can adjust as necessary. We can come together, share our experiences (even virtually), and we can cope. We need to be able to trust. And trust is based on being told the truth and sharing reality as it exists.

We will continue social distancing as much as possible. That’s the main tool we have now to slow the spread of the virus, gain time for the healthcare system to be ready to treat patients in greater volumes than we had planned, and, eventually, find some treatments that work and a vaccine.

You’ve already seen, and are participating in, what social distancing means at VMG. We’ll be announcing other measures and other procedures as we go based on evidence, best practice, and what we learn from other organizations, other regions of the country, and other nations.


New Federal Programs and Regulations for Emergency Sick Leave and FMLA

You’ll be getting some information from Human Resources on these new federal programs that will provide some greater security and comfort for sick leave for employees as well as caring for family members. The laws have been passed but the rules and regulations for implementing them are still being developed and getting clarified. HR will have that information for us as soon as it is clear. For now, just know that it is coming and please DO NOT call HR as they are very busy working to get this information ready.

Once shared, there will also be information about how you can ask questions and access the benefit, if necessary.


Current Changes at VMG


As you know, we are now screening all staff and patients upon entry to the building. We are taking temps and asking screening questions about possible symptoms. Entry to the building is dependent on these procedures.

Masks for All Staff and Providers upon Building Entry

Beginning Thursday, March 26, all staff and practitioners will be asked to wear a surgical mask upon entry to the health centers. The mask will be provided, one per day, by the staff doing temps and screening at the entrances. The purpose is to avoid the possible spread of the virus from asymptomatic individuals to others in the building.


I want to thank Val Felton, Amy Rice, and others who have worked on acquiring enough inventory of these scarce supplies.


It’s hard for me to believe, but I’m seeing the beginning of a whole new scam industry centered on people’s fears about the coronavirus and COVID-19. We’ve seen scams related to services to prevent and treat the disease, testing for the virus (there are NO mobile testing centers), financial scams to “protect” people from possible costs, and even hackers into telehealth platforms. If you see something that looks suspicious or too good to be true, pause and check it further. Don’t buy it.

Ongoing Planning for our Immediate Future

We are working proactively to anticipate how the scope of our work may change as the pandemic increases in our region. Everything from inventory of medical and business supplies, ideas for changing the shape of urgent care, processes for continuing to provide childhood and adult immunizations, drawing labs inside and outside the building for chronic disease management, further controlling access to the buildings, and collaborating with our community colleagues and more will need to be reexamined for best practice and optimal functioning for managing the pandemic as well as our “usual work” in caring for people.

You’ll hear more about all of this as we make decisions and confirm what we can do in the near future.

Thank you once again for your caring for our patients, our communities, and each other.




March 26, 2020                                                                                                                                                                                                  Issue # 8


I was at a virtual get-together with a group of friends and neighbors yesterday evening. All are in the midst of coping with businesses that are at risk, uncertainty and confusion about their health and healthcare in the face of the virus, and doing the best they can to stay in touch with friends and family.

This is literally a world-wide crisis as well as a national crisis. New Orleans (one of my favorite places) is now an epi-center and trying to cope. The reality of the scope and massive disorganization caused by the pandemic is hard to fathom. You’ve seen pictures of empty streets and public places all over the world (which, in a way, is a good thing as people take the need for social distancing seriously or maybe it’s more out of anxiety). We’re not at all certain about “where the bottom” is and how long it will take to get there. So, we will keep on coping as best we can, adopt best practices and adapt our work based on evidence as it exists, and good sense where there is no evidence. And, I’m saying this again: we’ll get through this together at VMG and in our region, country and world.

And what are our tools (for now)? Mostly, right now, it’s hand-washing, masking, and social distancing! In the future we’ll have some treatments and a vaccine but that’s at least months away.

Recent Changes at VMG

We’ve changed our approach to the use of masks, as you already know. All staff are now given a mask to use for the day when they enter the health center. FOR PATIENTS: only patients with fever, cough, and those proceeding to care in our respiratory symptoms unit are being masked at this time. We do have adequate supplies of surgical masks for now.

VMG Lab Changes

As I think you all know, our lab is a central part of our Group for clinical and financial goals and also for patient convenience and engagement (patients love not having to go someplace else to get excellent lab service). Due to the pandemic, we’ve had to change how we do lab business.

Please see Matt Spitzer’s email from this morning for more details. Basically, for now, we’ve stopped all routine testing to reduce the risk of exposure to patients and staff. We will still do urgent labs, as identified by our practitioners. And we have the ability to do urgent “car draws,” as necessary (thanks to all of you involved in that process for making that possible).

We are doing only a very limited number of COVID-19 tests (we only have about 20 kits) and they are only done with the request and approval of the primary care team leaders. We are relying on the public health and hospital systems (as they come on line) to do acute and population screening for now.

As we believe that the flu season is “essentially over,” we are not doing flu (or strep) testing now except in rare circumstances (and then only in cars by our respiratory teams). Again, we want to avoid exposure risks for patients and staff.

Emphasis on Filling Our Schedules with Virtual Visits (VV)

We still have patients with needs and we still have to keep our revenue streams as much as we can. Many of our patients have appreciated our Virtual Visits (by video as well as by phone) both for their clinical value and for their ability to ease patients’ concerns and keep them connected with us.

Reception (and practitioners and clinical staff) are working to reach out to our patients to schedule Virtual Visits. Health Plans (including Medicare and Medicaid), recognizing the need for social distancing and slowing the spread of the virus, are all beginning to reimburse for most of these.

So we’ve changed our messaging to patients on our web site (and we’re in the process of changing that on the portal as well) and we are actively trying to move all currently scheduled routine and most f/u visits to VV as well as looking back in our schedules to reach out to patients to offer VV if they have no near future visits scheduled.

I just realized that I used the phrase “for now” several times in this update. That’s a new part of our lives and business. A lot will change between now and when this crisis subsides. We’ll have to get, and stay, used to that.


Because of the pandemic most artists and musicians are struggling to stay in touch. I’m a jazz fan. Jazz at Lincoln Center (in NYC) is one of my favorite venues and orchestras (with connections through artists like Wynton Marsalis with New Orleans). Every day they send a new link to what they call an archival concert for streaming these live performances. Without realizing it the last week or so, I go home and click into this more normal world for 30 minutes or so. It “transitions” me out of work and into home and family. So far, it works.

You probably have things like this you can do. I’d urge you to take the time for such a transition.

Once again, try to Be Patient and Be Mindful.

And be well. Thanks,




Friday, March 27, 2020                                                                                                                                                                                   Issue # 9


The weekend approaches. I hope this communication finds you well.

You’ve probably seen the latest news that the virus is continuing to spread with stories out of Michigan and, specifically Detroit. It should be clear that this will not be over anytime soon and that state-by-state efforts at social distancing will need to continue. No one knows what the signs are for “reopening” but they clearly have not been seen yet. So let’s continue to be patient with social distancing measures. We have not seen the peak in the curve of COVID-19 yet.

You may have heard this afternoon that Governor Baker has issued guidance that visitors from outside Massachusetts are instructed to self-quarantine for 14 days effective immediately. The Governor’s advisory specifically exempts healthcare workers; healthcare workers from neighboring states can still come to work in Massachusetts. The order is an effort to slow the spread of the virus that may be “carried” by travelers from other regions of the country.

Martha reminded me that when we hear news of viral spread, testing, new cases found, and illness and death, we often have a gut feeling that the worst is upon us. And the situation is worsening. And we also need to keep perspective. This is called “the denominator problem.” When a report comes in that 25 new cases were found in a town, we naturally think this is a huge problem. We don’t stop to think that this may be due to a number of things including that testing is expanding. And, the denominator: 25 out of how many? In an example we found it was something like 25 out of 20,000 (much less than 1%). That’s a problem but not as big as you might imagine until you know the size of the town. This does not mean that things are good. Only that you need perspective to judge how bad.

Rumors Spread as Easily as Viruses in Times of Crisis and Fear

With all the confusion and uncertainty in our communities, you may hear rumors about what’s happening here at VMG. We have heard rumors about VMG closing (UNTRUE) and AMC closing (also UNTRUE). It is true that some other non-VMG specialty practices have reduced their size of closed for now. That’s not true here.

We will keep you up to date about VMG. That’s one of the purposes of this newsletter.

VMG is Open

During the first few weeks of learning about the pandemic locally, we were freezing schedules, cancelling routine appointments, and we did close the surgical center at AMC (due to an order from the Department of Public Health closing all ambulatory surgery centers across the state). We wanted to move as many appointments as possible from our buildings (to observe social distancing) to virtual visits.

We are continuing to convert in-person visits to Virtual Visits (VV) and Reception is going through schedules to do that. We are also going through lists of previously cancelled appointments to offer VV. We will continue to see patients with respiratory symptoms after triage by our nursing staff and practitioners in our respiratory teams and we will also see other patients (non-respiratory) with urgent needs for visits when that is necessary.

VMG is Open to New Patients

Not only are we open to our patients but we are also accepting new patients. These appointments will be by Virtual Visits. New patients are welcome at all our centers. Primary care is getting to be more scarce and primary care will be needed now and as the pandemic resolves even more than before. So it’s important to know that we will see new patients. Our website and Facebook page have been updated with this information.

Guidance on Emergency Sick Leave and FMLA: Families First Coronavirus Response Act

Lisa sent all staff information about the Families First Coronavirus Response Act earlier today. This is the result of new federal legislation offering additional resources and protections for employees.  The information describes the benefits as well as the qualification for benefits. Please contact HR (via the new ) email address for questions.

From the New York Times: What You Can Do About Coronavirus Right Now

The Times has made coronavirus coverage available free to anyone. Here’s an article on steps you can take around your home and much more to try to keep safe. The embedded instructional videos are also very good.

I hope everyone will enjoy the weekend. Go outside if it’s nice (and maybe even if it’s rainy, if you enjoy that sort of thing). Keep perspective, keep connected and be well. And thanks again for the incredible things you do.


Be Patient. Be Mindful.


Monday, March 30, 2020                                                                                                   Issue # 10


Happy National Physician Day to all of our physicians! And, more generally, Happy VMG Practitioner and Staff Day. This healthcare crisis could not be managed without all of you. You are all appreciated.

We are now beginning the fourth week of our operations under COVID conditions. I know it seems both like an eternity and also just the beginning. There is already a lot of change and there will be a lot more coming before we return to a new, normal state. This is an evolving situation so what we say today may have to change as conditions change. The Governor’s office said today that the peak in Massachusetts is now expected in the middle of April, but we don’t know. We’ll have to remain ready.

What has not changed is the following: wash your hands, don’t touch your face, continue to social distance but do find ways to stay in touch with family and friends.

Social Distancing Efforts Continue

The Federal Government has advised continuing social distancing through April. I think these efforts will need to continue several months after that. But for now, we will continue our social distancing efforts in keeping with national and state policy.

Work From Home Agreements

In keeping with the above, all current work from home agreements will now be continued through the end of April (according to the conditions in those agreements and assuming we have work for those working from home). However, please keep in mind that as conditions change, we may need to recall staff to work in the centers.

Certain Services Remain Closed or Limited to Reduce the Possibility of Spread

Our surgical center in Amherst remains closed by Department of Public Health order until further notice. Most staff has been reassigned and patients are being cancelled and rescheduled for after July 1, at this time.

At this time, we’re providing only urgent and necessary services in Radiology and Lab as determined by practitioners and medical staff. All routine imaging such as mammography remains unavailable. Lab patients have been cancelled though mid-April. We’re seeing about rebooking after April 30 but we will still need to find a way to see patients who need lab draws. More to come on this later.

Access for Our Patients in the COVID World

We still need to provide access to care for our patients for all the usual reasons. Right now, because of COVID, we are avoiding scheduling visits in the health centers unless practitioners decide otherwise. We are doing Virtual Visits (VV) so reception staff continues rescheduling in person visits to VV.

Triage telephone volume is growing. We are working on moving some of those triage calls to VV with practitioners as a means of preserving triage availability and keeping our schedules filled. Triage will take calls and, where appropriate, offer and schedule a VV with a practitioner.

Keeping Patients Out of the ER (Where Appropriate)

We expect that at some point soon, our local ER’s may be overwhelmed (we’re not NYC but we have fewer ER resources). It’s important for us to do what we can to keep patients who don’t need to be there, out of the ER. So again, we’ll offer urgent care and VV to those patients we think are appropriate. We want to do our part to keep the ER and Hospitals available for more critical patients.


Over the weekend, I heard someone say that “the delivery man is not the enemy; he’s a hero.” This was in response to questions about whether it was safe to get food (or anything else) delivered. It’s a reminder to keep perspective and to also appreciate those who are out in the community, day after day, doing what they can to keep us fed, supplied, and meet our needs.

Thanks again to all of you for stepping up in this public health emergency.




Tuesday, March 31, 2020                                                                               Issue # 11


I wish we could all go back to a time when most of us didn’t know what “PPE” meant. But we can’t.

The news on TV remains difficult to watch. The concerns of front-line healthcare and first responders, the lack of necessary supplies and ICU beds, and of course the numbers of reported cases and deaths. We may want to ignore it all, but it’s hard. Reminders are everywhere (work, grocery stores, the UPS guy, etc.).

Our brains are usually able to compartmentalize difficult information and emotions and a certain amount of that may be necessary. But since we are in healthcare, we all have stories about how our patients, colleagues, and families are doing. We do our best work by relating to patients and their situations. It’s important to go on but it’s also just as important not to succumb to “compassion fatigue.”

So if you get to the point where you feel “a cloud” over your caring and concern for others and their situations, make sure to find someone to talk with, take a break, stretch, walk, and give yourself a chance to breathe and recharge. It happens to all of us. Remember to Be Patient and Be Mindful. You can also contact HR for information on the Employee Assistance Program.

Local Situation

Unlike the metro areas of NY and Boston, we may be a bit protected by our geography and lower population densities. But that does not mean we won’t see the effects of this epidemic here. We are seeing some cases in all of our communities of patients with confirmed COVID as well as presumed. Our hospitals are gearing up but are not yet overwhelmed. The ERs, for the most part, are functioning well. They are not yet overwhelmed. As of today, the state still expects the peak of the pandemic to reach Massachusetts by mid to late April.

We are doing what we can, as you probably know, to preserve the capacity and capabilities of our hospitals and ERs by seeing our own urgent patients as much as we can. Also, it’s important to remember that keeping in touch with our patients by Virtual Visits helps to provide needed medical advice and calm anxieties and perhaps prevent an unnecessary ER visit.

Updates from our Specialty Departments

During the “early” part of our pandemic work, we’ve been necessarily focused on primary care and our workflows in primary care. This week, Gina, Martha and I began to meet with our specialty departments to stay in touch, learn more about their work and needs, and make sure we could get information out to VMG about what they are already doing and what they can do for our patients and our staff. I’ll try to update on each department over the next several issues of this newsletter.

I’ll begin with some information on Physical Therapy. All of our therapists are working from home though there is someone in the buildings on a daily basis or close by and on-call for any urgent needs that they can help with. They have geared up to do scheduled Virtual Visits by audio/video or telephone and their schedules reflect those changes.

Here’s some more detailed information:


·    Scheduled virtual Physical Therapy appointments are available from all VMG Health Centers. These are provided through an internet video application, easily accessed by a hyperlink sent via email to patients by Reception staff. Virtual appointments are also available by telephone, which are also scheduled by Reception staff.  


·      Virtual Physical Therapy evaluations may include:

o   A detailed injury and medical history

o   Postural, mobility, gait, and balance assessment

o   Range of motion and strength assessment

o   Neurological assessment

o   Special tests and measures

o   Home safety assessment

o   Discussion of findings, establishing goals, and determining treatment plan.


·      Virtual Physical Therapy treatments may include:

o   Selfcare training, e.g. RICE, activity limitations, etc.

o   Postural awareness training

o   Stretching and strengthening training

o   Mobility, gait, and balance training

o   Soft tissue/fascial mobilization training

o   Vertigo, BPPV CRM training

o   Other specialized treatments

o   Review and progression of written home exercise program.


·      Virtual Physical Therapy treatments do not provide:

o   Manual therapy treatments

o   Mechanical spinal traction

o   Clinical modalities


·      Advantages of virtual Physical Therapy:

o   Decreased Covid-19 exposure risk

o   Access to treatment for patients with shelter in place or quarantine restrictions

o   Therapists are available for questions via the patient portal or email as needed between visits

Thanks to Jeffrey Reed and the PT department for the information above. Please consider sending patients to virtual PT and contact a PT Team Member for any questions about suitability for treatment.


Once again, thanks to all of you for stepping up in this public health emergency. Wash your hands, don’t touch your face, and observe social distancing.

And, Be patient; Be Mindful.