Good Medicine

Daria Mason has put the last 30 years to good use in the service of the people of central Vermont

by Virginia Lindauer Simmon

photoDaria Mason is heading for retirement in June after 30 years at Central Vermont Medical Center in Berlin. For the last 10 years, she has been president and CEO of the corporation, which owns Central Vermont Hospital, Woodridge Nursing Home and Central Vermont Medical Center Group Practices, serving a population of 66,000.

Daria Mason laughs as she tells the story of how she ended up running a medical center. At first blush, it seems the most natural thing in the world for her to work in medicine. Her father is a retired physician and her mother was a nurse — “but she obviously didn’t practice after having seven children!” Mason exclaims.

She grew up in New York and graduated from Fordham University with a degree in French literature. Her older brother was doing a general surgical rotation in Montreal, and Mason moved up there planning to get a graduate degree in French literature and teach. 

“As an American, I had to have landed-immigrant status and a job,” she says. “I had always worked every summer at the local hospital, so I signed up at a hospital to be unit coordinator — a glorified ward clerk. Six months later, they made me unit manager, and in another six months, department head. That’s when I said, ‘Boy, I’m really enjoying administration,’ and signed up for a graduate degree in institutional administration.”

Mason’s brother was taking flying lessons at the time and persuaded her to try flying, too. Their instructor was a guy named Jim Mason who was stationed at Plattsburgh Air Force Base and giving flying instruction at Clinton County Airport. It was 1973. By 1976, she and Jim were married.

Moving to Vermont was a conscious choice. “We used to fly over to this little airport here in Berlin for lunch,” says Mason. “We loved the bird’s-eye view of Vermont. When Jim got out of the Air Force, we thought we would like to live here, especially in terms of raising a family.”

Jim had plans to join the FAA as a flight controller, and Mason wrote to hospitals in Vermont about work. “The one that was hiring was Central Vermont,” she says.

In 1977, she went to work for Joel Walker, the president and CEO, as an assistant to help him with special projects such as certificate of need applications and risk-management functions, including the safety committee. “After a little while, it became, I guess, clear to him that he wanted to give me more responsibilities,” she says, with a modesty typical of her approach when discussing herself.

It was an exciting time, she says, when she started at Central Vermont. The medical center, created from the merging of two hospitals — Heaton in Montpelier and Barre City in Barre —in 1968, had built a regional facility and turned the older hospitals into nursing homes in the 1970s. It was unusual for the times to have nursing homes associated with a medical center.

One thing led to another, and pretty soon, she  was receiving increasing assignments on the acute-care side of things. In 1980, she worked on the certificate of need to expand the emergency room, because, she says, “believe it or not, then you didn’t have the emergency room physicians we have today. It was the beginning of when we began to recognize services other than traditional inpatient services.” These included the lab, the pharmacy, acute-care administration and the psych unit.

photoCVMC’s clinical laboratory and pathology department were accredited in January by the Commission on Laboratory Accreditation of the College of American Pathologists. Pictured in the hospital’s new lab are Brian Travis, M.D. (left), a pathologist, and Ray McLeod, lab director.

When the long-term care administrator retired, her boss said he wanted her to obtain her nursing home administration license and run the nursing home. “So I did,” she says. 

By the 1990s, Mason had helped bring the two nursing home programs into one new, state-of-the-art nursing home, Woodridge, on the campus.

“So there’s about 10 years of acute care,” she says, summarizing, “10 years of long-term/acute-care experience, and then 10 years ago, when Philo Hall [who had succeeded Walker in 1988] resigned, the board of trustees asked me to help out for the summer, because I had been here for so many years and had so much exposure.” By fall, the board made it permanent.

The year before, Central Vermont had joined the 10-member Dartmouth-Hitchcock Alliance after considering both Dartmouth and Fletcher Allen Health Care. “Fletcher Allen was going through its own evolution, and Dartmouth had some other affiliations, and we found it a cultural fit,” says Mason, adding that Central Vermont continues to have patient partnerships with Fletcher Allen.

Joining Dartmouth brought in several hundred thousand dollars a year in savings, realized from lower interest rates for debt and more access to malpractice insurance at a stabilized rate.

“The low-hanging fruit in the 1990s was the financial benefit,” Mason continues, “but now, 10 years later, we’re talking about how do we access some of the clinical benefits, looking at how do we perform better on patient outcomes.

“In the ’70s, we did long-term care; in the ’80s, we did an expansion more focused on the emergency room and diversifying services, including psychiatry; and in the ’90s, we were looking at a couple of issues:the potential for becoming part of a bigger network and the fact that primary care physicians were becoming more vulnerable and endangered in Vermont — and by the way, they still are,” she says. 

A big problem was the debt hanging over physicians coming out of medical school, making it difficult for them to open independent practices. In order to secure access to primary care, institutions began employing physicians. This year, Central Vermont employs 30 physicians in its nine community-based medical group practices; 127 on-staff physicians have privileges to admit and see patients at the hospital.

photoIn 1996, CVMC became a member of the Dartmouth- Hitchcock Alliance, a cost-saving move that has proved beneficial in other ways. Mary Viens (left), a licensed practical nurse, checks the blood pressure of patient Doris Robinson.

The health care system today is very different from what it was when Mason joined Central Vermont, she says. “We have a system now that was designed for acute, episodic care, so in the 1960s, when Medicare and Medicaid programs and the insurance companies became involved, you had an event, you came in and it was taken care of. Now, thankfully, we’ve had so many advances, we are living a lot longer, but we really haven’t changed the payment principles to reinforce that we now have to look at prevention — screening, chronic disease management, obesity, diabetes, those things.

“We really have to reorient the payment system so doctors can get paid for spending time doing diabetic counseling, working on chronic disease management instead of getting paid for a hospital admission.

“The big gorilla here,” says Mason, “is that Medicare and Medicaid — huge, huge funding sources for all of health care — need to be realigned to promote health and reduce chronic disease.”

The initiative by the Douglas administration to give incentives to reward performance on prevention is a good blueprint, Mason says. “It’s a start, but a drop in the bucket. When physicians are paid to do some of this work, it will change.”

As challenges arise, opportunities present themselves. Central Vermont has filed a certificate of need application for a radiation therapy unit. “We have chemical oncology here, but we don’t have radiation therapy,” says Mason. “People have to travel to Burlington or Lebanon for that. Many of our community members have asked us to have something local.”

“We’ve seen a tremendous need in central Vermont for patients who need radiation treatment,” says John Nicholls, a lawyer with Abare, Nicholls & Associates in Barre and chairman of the Central Vermont Medical Center board of trustees. “I’ve been involved personally with a couple of people who needed radiation and didn’t have a family to drive them. We’ve had to organize carpools, so you take turns driving them to Dartmouth or Fletcher Allen for that five-minute dose of radiation.”

 Other big changes are taking place via a $20.3 million renovation and expansion. The birthing center, where incidentally, Mason’s two daughters were born, is being replaced with modern, family-centered rooms “where everyone can stay — moms, dads, families,” she says. The surgery suite is being replaced and will feature all the latest technology, and a newly renovated and modernized clinical lab and pathology department recently received accreditation. 

The emergency department began using a cutting-edge information system in December, which reduces the time spent at the registration desk by having in-room registration to better protect a patient’s privacy. Nurses use portable carts equipped with computers to record information, and physicians have hand-held computers to enter medical information.

“In the hospital arena,” confirms Mason, “the big news is outpatient care and technology. Over 30 years have passed since this was built as a regional facility, so our renovation project is to greatly increase the outpatient service.”. Acknowledging and responding to the dramatic increase in outpatient visits, and the corresponding decrease in inpatient stays — “a national trend, by the way,” she says — a state-of-the-art ambulatory care center is being constructed and due to open in September. 

By September, Mason might be spending time with Jim at their camp on Peacham Pond or flying a plane over the emerging fall colors. She’s retiring in June. “We’ll still live here in Berlin,” she says. “Our daughters are still in Vermont, and we’ll take a little more time off, because Jim has been an air traffic controller — they work nights and weekends — and he’s retiring at the same time.”

Her family has always been her rudder, she says, adding, “You have to have balance; you can’t be all work.” Still, it’s clear  Mason has had a good run and that she’s still engaged in her career, and especially in Central Vermont Medical Center, as she returns again and again to the importance of serving the 66,000 people who live and work in central Vermont.

“I really would like your readers to know that health care is a very rewarding profession. We want to attract the best and the brightest. Don’t believe all the negatives you hear,” she says, laughing. “And to come every day and make a difference in people’s lives, it’s extremely rewarding. Technology supports the job we do, but where the rubber meets the road is taking care of the people.” •