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Upstate University Hospital: A Regional and National Leader in Healthcare Innovation

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By Elizabeth Landry

As Central New York’s only academic medical center, Upstate University Hospital is paving the way for much of the region’s healthcare needs. In fact, many of the hospital’s programs and facilities are blazing new trails of innovation, regionally and often nationally, as well.

“We think a lot like a private enterprise, even though we’re public, and that has helped us think innovatively and do well financially,” explained Robert J. Corona, DO, CPE, MBA, FCAP, FASCP who has served as CEO of Upstate University Hospital since 2018. Dr. Corona has been associated with Upstate in various capacities for over 30 years, completing his residency and fellowship at the hospital in the 1980s, serving as an educator periodically, becoming Chair of the Pathology Department in 2012, and serving as Chief Innovation Officer shortly after.

For Dr. Corona, continuing to lead the way in innovation is a core strength of Upstate, and his vision of innovation in health care encompasses new ways of incorporating machines, software, programs and buildings. “We need to be state of the art as a teaching hospital to be able to provide our trainees with the best technology and the latest innovations, so they can see how high-quality care is delivered,” he said.

Technological Innovations at the Forefront

Perhaps one of the most visible avenues in which Upstate utilizes cutting edge technology within its healthcare system is the use of drones and robots, which have combined to become the Autonomous Machines Department. Upstate began using drones around 2013, when Dr. Corona was the Chair of Pathology, but this technology has ramped up since he became CEO. The drones, which can fly over 40 trips per day, save the  organization time and costs by transporting medications and specimens for testing through the air rather than relying on couriers on the ground. Upstate is well on its way to reaching the goal of flying the drones between all its institutions. In addition to the time and cost savings, the innovative technology has also led to increased efficiency and satisfaction of patients.

“We use drones in our ‘Meds to Beds’ program, which means when you’re in the hospital and you get discharged, we provide you with your discharge medication so that you don’t have to go to the pharmacy. The order goes over to the retail pharmacy across from Community Hospital and then the drone flies the medication over to the hospital and we give it to patients when they’re discharged,” Dr. Corona said. Robots, the other piece that forms the Autonomous Machines Department, became part of the organization’s operations to help with staffing shortages, Dr. Corona explained.

“I worked with an engineer and found out that nurses spent 

about a third of their day chasing down supplies, moving food, picking up things in the cafeteria, bringing things to the lab, bringing sheets and any kind of supply, which is really not having nurses work to the top of their license. So, we ended up getting over a dozen robots that now deliver supplies and food.”

Dr. Corona added that such use of these machines has put Upstate at the forefront of healthcare technology not only regionally, but nationally. “I don’t know of any other institution that has a combined program of robotics and drones in an autonomous machines group,” he said. 

Another milestone of technological innovation at Upstate has been the recent opening of the Throughput Operations Center. A sort of central command center for the organization located in the former Telergy Building off Carrier Circle, the center features 22 live-feed monitors and 28 computer stations
that provide hospital officials with a real-time view of operations, including capacity demands, bed census, open beds, COVID information and patient transport status. The center is aimed at reducing bottlenecks, streamlining patient flow, and improving patient outcomes across the hospital network. Dr. Corona explained how the center is helping with capacity challenges and may even grow to include external healthcare organizations.

“We’ve had preliminary discussions with the Department of Health to see if we could coordinate with hospitals that have capacity and we would help them manage the patients if needed,” he said. “We’ve had interest in what I call a ‘virtual hospital system,’ where the Throughput Center would see all the participating facilities and help manage and balance the load.”

New Programs Directly Benefitting Providers

Upstate is one of only a handful of academic medical centers to offer a new Hospital Administration Leadership and Management Fellowship accredited by the Accreditation Council for Graduate Medical Education, or ACGME. This fellowship provides the opportunity for physicians to gain certification in this field.

“The physicians will spend time learning finance, operations, physician management and other skills leading to board certification in healthcare leadership,” explained Dr. Corona. Another significant, yet very different way Upstate is investing in innovations that directly benefit healthcare providers is through a recent safety initiative called “Respect and Heal,” a collaborative effort with other local healthcare entities. It was proposed by Dr. Corona after he and other regional CEOs wanted to address violence against healthcare workers.

“We are united in zero tolerance for abuse and are committed to sharing best practices to end harassment and assaults. We held a half day conference last year, which was standing room only, and we are moving to a full-day conference this year to share innovations and research,” said Dr. Corona. Upstate took on the role of coordinating and hosting the conference, which is offered to staff and leadership at the dozen hospitals that have committed to the principles of Respect and Heal.

Widespread Innovations in Healthcare Facilities

The team at Upstate has been on the forefront of innovative facilities and buildings for several years, with structures like the Upstate Nappi Wellness Institute, a building that’s been both LEED certified, signifying its sustainability, and Well certified, related to its eco friendly status. The building’s beautiful design is what Dr. Corona described as “friendly to the human experience.”

Another innovative space that has been approved is a new pathology building that will be built next to the Upstate Bone & Joint Center on Fly Road in East Syracuse. Dr. Corona elaborated on how pathology has become more innovative at Upstate over time, and why the new building is needed.

“When I returned to Upstate as the pathology chair after 16 years in the industry, I had experience in digital imaging and developing medical products,” he said. “The new facility
is going to leverage recent research in digital pathology, molecular diagnostics, applications of AI relevant to diagnostics, and quantum computing.”

Another recent facilities development at Upstate is a plan to build an annex which will include a new Emergency Department and a new Burn Unit. The team at Upstate is also exploring the development of a cellular therapy center reflecting recent innovations in

 stem cell technology.

The Upstate Cancer Center at Verona is unique due to the organization’s collaboration with the Oneida Nation, a relationship that Dr. Corona explained is one of the first of its kind.

“To the best of our knowledge, this is the first collaboration where a public New York state hospital has worked with a native nation to build a health facility. It’s been a wonderful relationship – they’ve been amazing to work with.”

Providing Cutting-Edge, High-Quality Care
The Verona Cancer Center is one of Upstate’s several cancer centers, with other locations in Syracuse, Oswego, Auburn and at Community Hospital. These widespread resources reflect Dr. Corona’s focus on providing healthcare where people in the community need it most.

“I see us as having a responsibility to grow and provide state-of-the-art care locally for our community, so people don’t have to leave the area for exceptional cancer care, cardiac care or stroke care. We have an obligation to really drive outstanding quality, and to incorporate the most relevant tools and approaches to do so.”

For Dr. Corona and the team at Upstate, that’s what innovation is all about. 

The new Upstate Throughput Center features 22 live-feed monitors and 28 computer stations that provide hospital officials with a real-time view of operations, including capacity demands, bed census, open beds, and patient transport status to streamline care.

Research and Teaching: What Sets Upstate Apart

The two pillars of Upstate University Hospital that perhaps most distinguish the organization from other hospitals in the region are research and teaching. These components stem from the hospital’s role in the overarching Upstate Medical University. Academic medical universities like Upstate include a medical school and a research enterprise as part of their core mission, along with patient care.

Every research project at Upstate is focused on finding cures and improving human health. Current research initiatives and projects include tumor cell invasion and immunotherapy for treating cancer, exploring the genetic bases of neurological and psychiatric disorders, and utilizing AI and machine learning for advancements in pathology diagnoses. Patients benefit from access to clinical trials, and every patient at the Upstate Cancer Center is assessed for their potential to participate in a clinical trial.

Focusing on education, Upstate’s role as a teaching hospital ranges from faculty educating third- and fourth year students on their clerkship rotations, to medical residents and fellows arriving for their training, to offering continuing medical education and grand rounds that are open to area physicians.

Agility In Recruitment In Health Settings

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BY KATHRYN RUSCITTO, ADVISOR

During Covid I watched a hospital in Florida implement a variety of new positions based on specific tasks. From the basic welcome to a room with detailed instructions done by a patient tech to a full assessment being done remotely by a nurse.. The goal being to reduce clinical time at the bedside from tasks that paraprofessionals and professionals could accomplish rather than the bedside nurse. It worked well.

More recently some hospitals are using remote Nurses to support community based nurses. Access to experts in Diabetes, Wound Care and cardiac care are active across the country. When done with care and training, it gives nurses specialized back up they might not have immediate access to on a local level. 

Agility during times of workforce stress is working for many organizations. Placing an emphasis on innovation is key for health leaders. The strategic issues confronting healthcare feed into the workforce shortages.

Rising costs, lower reimbursements, financial
implications from value based care, cybersecurity, and introduction of new technologies like AI are all contributing to high turnover rates.

Many health care employers are opening new points of access for existing employees to increase education and training . In addition they are working with community colleges and job transition programs as people see layoffs in other areas to transition to health training programs. From military transitions, to immigrants these recruitment paths are helping.

Recently I met an Administrator, Rosemarie Tamunday- Casanova, from Right Accord, who has recruited nurses from the Philippines. We discussed that foreign born recruitment has and is being done primarily in acute settings. We pondered whether surgery centers and private offices might also be an option for these nurses.

Finally, the use of AI and digital strategies to reach broader audiences and make your organization known is essential in recruitment. There is no question that agility in essential in and professionals recruitment. There are successes and best practices evolving if we are open to their adoption.

Background:
https://www.hhs.gov/health are/workforce/recruit- train retain/index.html#get-grant

https://www.aha.org/aha center-health-innovation- market-scan/2022-12-06 how-build-yourfuture-workforce-pipeline

https://magazine.hcahealthc re.com/people/career- and development/creating workforce-solutions- and-advancing-healthcare professionals/

https://www.nga.org/public tions/preparing- the-next generation-of-the-healthcare workforce-state-strategies-for-recruitment-and-retention/

https://www.kornferry.com/ bout-us/events-webinars/talent-acquisition-trends-2025

Kathryn Ruscitto, Advisor, can be reached at linkedin.com/in/kathrynrusci to or at krusct@gmail.com

Help Me… HELP YOU.

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by Jenn Negley, Vice President, Risk Strategies Company

Throughout my career, I have often had those thoughts in my head while trying to assist medical groups or individual physicians resistant to working with an agent or broker. While some skepticism is warranted, and we acknowledge that any industry has both positive and negative aspects, there are specific factors to consider in medical malpractice insurance that can increase the likelihood of achieving positive results. How can you determine the professionalism of an agent you are working with, such as myself, and help us assist you effectively?

Several factors should be considered, starting with an individual’s approach and the carrier and policy solutions they recommend. In most instances, these factors have significant consequences and can help you determine if this is an individual you should work with.

Malpractice insurance is a highly specialized market with significant financial implications. If you have an agent pitching you other coverages and adding malpractice insurance at the last minute, I would be wary. Sticking with someone who focuses on medical malpractice insurance is always best; not only will you benefit from their knowledge, but it often impacts the carriers they have access to, which leads us to the second item to keep an eye out for. If an agent is pushing one carrier, this is always a red flag. The most qualified agent should be able to provide you with multiple alternatives, giving you a nonbiased view of what is available. Another consideration is whether the carrier has an A rating from A.M. Best. In the insurance world, it is advisable to avoid lesser-rated companies, and I would not rely on ratings from any rating agency other than A.M. Best, which is the gold standard.

The type of policy an agent pushes might also be a cause for concern. If an agent is asking you to change your coverage type from occurrence to claims made to save money, they are doing you a disservice. While this will generate savings in the first 2 to 3 years, the scheduled premium increases will bring you back to your original cost and possibly more. In group settings, you will often have to amend employment contracts to address who is responsible for tail costs when a provider leaves your group. If your practice ever sells, most buyers will likely require you to purchase a tail for the entire group, and the cost can range from 100% to 200% of your current premium.

When working with a specialty broker, you also gain the advantage of a service team that knows how to navigate the processes for each carrier because of the volume of business they place. With that volume, you typically have a dedicated underwriting team that builds strong relationships, allowing for more collaborative efforts to provide solutions that would not usually be available. In competitive markets, this could result in increased savings, and in a challenging market, it could limit rate increases. Don’t be fooled into assuming that large-name brokerages are the best solutions. Typically, it comes down to the volume that a particular office does, not what the brokerage does as a whole, and again circles back to the question of whether they specialize in this coverage. 

We are all too aware of the financial stress healthcare is under. Still, there are professionals readily available to serve as an honest partner in alleviating those pressures in a way that protects your longterm security and meets your needs. I hope these market insights, in a small way, help you in your future endeavors. r practice, and your patients, depend on it. 

For more information, please contact Jenn Negley, Vice President, Risk Strategies Company at 267-251-2233 or JNegley@ Risk Strategies.com.

Dr. Hadley Narins Fills a Gap in Patient Care with a Focus on Quality of Life

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By Bari Faye Dean

Hadley Narins, M.D., never set out to become a specialist in  female urology, but as she progressed through her medical training, she saw a significant gap in care. “Nearly 50 percent of the patients coming in were women, yet so few urologists were specializing in female pelvic health,” the board-certified, fellowship trained urologist said. When she was a medical student, she didn’t see any women residents in urology, making the field feel male-dominated. But instead of being deterred, she found an opportunity to make a difference.

Although she initially considered a focus on general urology and cancer, her experiences in training opened her eyes to the pressing need for female pelvic health specialists. “Few men want to focus on female urology,” she explains. “Most gravitate toward prostate and kidney cancer.”

Dr. Narins earned her medical degree from Thomas Jefferson Medical College in Philadelphia, then completed a General Surgery internship and Urology Residency at SUNY Buffalo, finishing in 2017.

Practicing since 2018 at Associated Medical Professionals of New York, Dr. Narins specializes in treating women suffering from voiding dysfunction and pelvic organ prolapse and reconstructive surgery with minimally invasive techniques, including robotic sacrocolpopexy.

Transforming Lives, One Surgery at a Time
Urologic surgeries for women might not be lifesaving—but they are life-changing. “The most rewarding part of my job is meeting with a patient post operatively and seeing how happy they are,” Dr. Narins said. “Many experience almost immediate relief.”

Her practice serves a vast region, extending from the Canadian border to the rural areas of Central New York. “There is a huge need for specialists like me in Syracuse,” she said. “We all need to clone ourselves two or three times to meet the demand, especially as the Baby Boomer generation ages.”

While many of her patients are women who have had children, some experience significant pelvic floor disorders despite never giving birth. In addition to primary surgeries, she performs revision surgeries for patients who have experienced recurrence or complications following prior treatments. She conducts robotic surgeries at Crouse Hospital, where she played a key role in developing the Female Urology and Pelvic Reconstruction program. Routinely, she performs many procedures at Intrepid Lane Ambulatory Surgery Center, the facility owned by her practice.

A Patient-Centered Approach
Dr. Narins prioritizes building relationships with her patients. “I want to take care of them clinically, but I also want to know who they are as people,” she said. “What’s important to them? What is their family life like? I genuinely care about my patients and want them to feel heard and valued.”

Her team includes a physician assistant, nurse practitioner and dedicated nurse, ensuring patients receive comprehensive, evidencebased care. “We stay up to date with the latest literature and make sure our patients not only get the best clinical outcome but also feel supported throughout their journey.”

Life Beyond the Operating Room
Outside of work, Dr. Narins leads a full life with her husband and three children, ages 8, 5 and 2. Married in 2016, she credits her husband —a stay-at-home dad—with keeping their household running smoothly. “He does all the cooking,” she said, laughing.

Gardening is her sanctuary. “Work is work. I get a lot of gratification from it, but it’s stressful. When I’m in my garden, I’m physically working hard, but my mind is in a calm, contemplative state,” she said, noting she even starts her  mornings in the garden before heading to surgery.

Her family grows tomatoes, cucumbers, green beans, eggplant, okra, Swiss chard, and squash, with the children eagerly picking their favorites to eat raw. “They can identify so many different flowers,” Dr. Narins said. “When the weather is nice, I come home from work, change out of my scrubs, and we stay outside until the mosquitoes come out.”

Many of her patients are gardeners, too, allowing her to foster an unexpected but meaningful connection. “It’s a common passion. When I talk to my patients, I see them as people, not just cases. And I think that makes a difference.”

Certificate Of Need Coming For Private Equity?

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By: Marc Beckman and Ben Goldberg

New York State is poised for a significant shift in healthcare oversight with the amendments to the state’s Disclosure of Material Transactions law proposed in Governor Kathy Hochul’s FY 2026 Executive Budget. Previously, with the introduction of PHL Article 45- A, which took effect on August 1, 2023, the New York State Department of Health (“DOH”) was authorized to scrutinize healthcare transactions taking place in New York State. These legislative changes are designed to further regulatory scrutiny over healthcare transactions, aiming to curb rising costs and ensure market stability.

Governor Hochul’s proposed legislation introduces the Cost Market Impact Review (“CMIR”), a framework modeled after similar regulatory mechanisms in states like Massachusetts. The CMIR would empower state regulators to assess healthcare transactions, particularly those involving consolidations, mergers, and acquisitions, to evaluate their potential impact on cost, access, and competition. One change that should be immediately noted is the extension of the required notice of a “material transaction” provided to DOH, which was 30 days under the PHL Article 45- A, and would be increased to 60 days.

Among the components of the CMIR are pre-transaction review, assessment of market impacts, and enforcement measures. During the pre transaction review, healthcare entities engaging in significant transactions will be required to submit documentation for state review. If the “material transaction” will increase a healthcare entity’s gross in state revenue by $25 million or more, notice will have to be provided to the New York State Department of Health (“DOH”) and documentation submitted to the DOH for review. Material transactions include but are not limited to mergers, acquisitions, assignments, sales, other conveyances of assets, voting securities, and membership or partnership interests. It is also important to note that material transactions include contracts, if they increase the revenue by $25 million or more, and entities like managed services organizations that provide administrative services to healthcare entities, even if they don’t provide healthcare services themselves. The $25 million will be based on a 12 month lookback period. This is somewhat straightforward if the transaction is a single transaction. However, should there be a series of related transactions, the revenues associated with each of the transactions will be added together to determine the total impact on New York’s healthcare markets.

Since the intent of the review is to analyze whether a proposed transaction could lead to increased prices, reduced competition, or diminished healthcare access, the notice given to New York’s DOH will include, among other things:

• the names of the parties conducting the transaction and their current addresses,

• copies of any definitive agreements governing the terms of the material transaction, including pre- and post-closing conditions, in-state revenue from practice or operating locations in New York,

• plans to reduce or eliminate services and/or participation in specific plan networks,

• a brief description of the nature and purpose of the proposed transaction

• the anticipated impact of the material transaction on cost quality, access, health equity, and competition in the market locations where the transaction is taking place.

When a transaction is found to have negative cost or market implications, regulators may impose conditions or even prevent the transaction from proceeding.

Key Proposed Amendments Include:

Lowered Reporting Thresholds:
More transactions subject to mandatory disclosure, ensuring greater regulatory oversight.

Expanded Scope: Nonprofit and for-profit healthcare entities, including physician groups and private equity backed organizations, will face increased scrutiny.

Stronger Enforcement Mechanisms:
The state may impose penalties for non-compliance and require additional corrective actions from healthcare organizations.

Potential Impact on Healthcare Providers and Patients
The implementation of PHL Article 45-A and the proposed amendments to the Disclosure  of Material Transactions law could significantly reshape the healthcare landscape in New York State. Providers facing increased regulatory oversight may slow down consolidation efforts, leading to more rigorous due diligence before executing transactions. While enhanced scrutiny could help prevent monopolistic practices and cost increases, among the concerns for patients is that providers may delay or abandon transactions that could improve healthcare access and efficiency.

With heightened scrutiny regarding these transactions, private equity firms and large health systems may face more barriers to market entry and expansion, altering investment strategies in the state’s healthcare sector. Reading the changes to the Disclosure of Material Transactions law generously, it appears the intent behind Hochul’s proposed regulatory reforms is to ensure healthcare transactions do not compromise affordability, access, or market competitiveness. While these measures align with broader national efforts to curb healthcare costs, their implementation will require careful balancing to prevent unintended consequences.

Stakeholders in the healthcare industry should prepare for increased regulatory compliance obligations. As with similar frameworks used to analyze business transactions—such as antitrust statutes and certificate-of-need applications—it is uncertain how forcefully New York will enforce these new CMIR assessments if they are passed by the legislature. Furthermore, it remains unclear what appetite the DOH will have for prohibiting or limiting such transactions.

However, whether or not the DOH takes an aggressive stance if Governor Hochul’s proposals become law, healthcare entities will still need to comply with the submission of notice and the concomitant documents to DOH and should prepare accordingly.

If you have questions pertaining to the proposed legislation and how it may impact you, please reach out to Marc S. Beckman (mbeckman@lippes.com), Benjamin W. Goldberg (bgoldberg@ lippes.com) or a member of the Lippes Mathias Health Care Practice Team.

Nephrology Associates Of Syracuse, PC:Remaining Dedicated to Superior Kidney Carein a Dynamic Medical Landscape

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By: Elizabeth Landry

In the post-Covid-19 pandemic world, healthcare continues to evolve with new challenges and innovations alike. Nephrology Associates of Syracuse, PC (NAS) has been on the forefront of the treatment and management of kidney disease in Central New York for more than 45 years and remains dedicated to addressing challenges in healthcare head on while also utilizing the latest in medical technology.

At the practice’s main office located on Buckley Road in Syracuse and at several satellite offices located in nearby communities, NAS offers access to high-quality, specialized kidney care when 

patients are referred by their primary care provider. The office’s five dedicated physician owners and seven advanced practitioners are all experts in the field of kidney care, working with patients one-on-one to deliver 

personalized care for each individual. The team also provides hospital care at Crouse Hospital and St. Joseph’s Hospital Health Center in Syracuse, offers hemodialysis care at six locations in Onondaga County, and facilitates home hemodialysis and peritoneal dialysis at the DaVita and Fresenius Dialysis home/PD centers.

The team at NAS works collaboratively to ensure patients receive superior nephrology care, while actively participating in programs and medical enhancements that make managing kidney disease more efficient for patients, help lower overall costs, and that are aimed at decreasing hospitalizations. Although keeping all factors in balance can be a challenge, the NAS team is confidently rising to the occasion and continues to demonstrate a strong commitment to excellence in the field of kidney care.

CATCHING KIDNEY DISEASE – Early is Critical

For many years, NAS has worked to educate patients about kidney disease – in fact, the practice’s vision statement specifically includes “efforts to increase awareness and early detection.” Kidney disease is often described as a “silent killer” and many of the physical symptoms of the disease aren’t recognized by the general population until the disease has severely progressed, unfortunately, as nephrologist Philip Ondocin, MD, who joined the practice in 2002, explained.

“Patients won’t know they have kidney disease unless their blood or urine is checked,” Dr. Ondocin said. “Oftentimes, people just equate kidney function with urine output. Patients will tell us they’re making a lot of urine, but even still they may not be clearing toxins. So, it’s only through a physician or provider visit with blood work and urine tests that we can identify how well the kidneys are functioning. Kidney disease is largely asymptomatic until it’s very late, so people need to be screened.”

Along with screening for kidney function, primary care referrals to NAS are also imperative in catching kidney disease before it progresses. The NAS providers have strong relationships with local referring physicians and providers, and they encourage all patients who have learned of a potential risk for kidney disease to heed new-patient referrals and not delay meeting with a nephrologist to determine an individualized kidney care plan.

To make the referral process more efficient and help ensure new patients can be seen as soon as possible, NAS has partnered with Phreesia, a vendor partner, which provides an online dedicated new patient referral toll-free fax line and online new referral submission form. NAS nephrologist Antoine Azar, MD, who’s been with the practice since 2016, described how these tools that help streamline new referrals are complemented by the strong communication between office staff and providers to help ensure patients are seen in a timely manner and with urgency that matches the severity of their kidney health concerns.

“Phreesia is a tool that helps with rapid review of new referrals, but our front office staff is also educated about knowing when to check with providers if they notice something is off with the referral,” explained Dr. Azar. “They know that if they see a referral with higher creatinine, which means worse kidney function, they need to check with a physician. Every day in the office there’s a physician available they can confer with. We always try to risk stratify the referrals, so for more stable patients we can usually see them within a few weeks, but for more urgent referrals we can usually see patients within a week.”

Dr. Azar added that the practice is also careful not to accept referrals for patients who don’t currently need to be seen by a nephrologist. “Sometimes we’ll find that a patient may need to be seen by a urologist or a vascular surgeon instead, so in those cases we’re honest with the patient that they were referred to us by mistake. We try to avoid unnecessary referrals in order to save patients time and money, and we make sure to communicate back to their primary care office, so they understand, too,” he said.

VALUE-BASED CARE FOR INCREASED QUALITY AND COST-SAVINGS

One of the biggest challenges facing all physicians who provide care to Medicare and Medicare Advantage patients, in both primary care and specialty care, is the continued decline of the Medicare Physician Fee Schedule.

In looking at data from 2013 – 2023, the Consumer Price Index increased by 29.3% from 2013 to 2023. Inflation adjusted, per-visit Medicare Physician Fee Schedule payments decreased by 12.2% for outpatient office visits and 19.1% for inpatient visits from 2013 to 2023. Adjusted for inflation, national health expenditures increased by 33.9% for physician services from 2013 to 2021. In comparison, Medicare Physician Fee Schedule payments over the same time period, 2013 to 2021, increased by 1.3% for outpatient office visits but decreased by 10.6% for inpatient visits.1 Dr. Ondocin highlighted how the practice works together to face this challenge, which often leads to rising expenses for operations, clinical supplies and more.

“The Medicare fee schedule changes every year and there’s not much we can do about that. Some physician groups like the American Medical Association lobby for adjustments, but it’s really out of our control. Anne Zaccheo, our practice director, is very good at making sure our office runs as lean as possible, which helps sustain our practice considering these challenges. We’re also fortunate to stay in private practice because we’re autonomous and we can care for patients the way we prefer. We still do 20-minute follow up visits and onehour consultations. So, we feel we can maintain the quality of our practice even with the challenges,” stated Dr. Ondocin.

Another way the practice aims to save on costs while still providing high-quality health care to patients is by engaging in several value-based care (VBC) initiatives. NAS has contracted with both KidneyLink and Excellus BlueCross BlueShield REACH Kidney Care, two VBC offerings which seek to prevent unplanned trips to emergency departments and hospitals. While KidneyLink is for patients with traditional Medicare Part B who have stage 4 or 5 chronic kidney disease and those on dialysis, REACH is for Excellus members in Medicare, Medicaid, commercial and those self-insured employers who opt to include the program in their annual benefit offerings.

“These programs focus on patients with advanced kidney disease,”
said Dr. Azar. “So, mainly patients with less than 30% kidney function. We focus on trying to delay progression, delay starting dialysis and delay hospitalizations, which are ways to help save on costs down the road while also ensuring we maintain great care for our patients.”

CONTINUING PROVEN CARE STRATEGIES

Although the practice strives to help patients avoid acute kidney concerns, hospitalizations due to kidney injury and disease do occur. NAS is continuing to prioritize timely, thorough care after a hospitalization, which, as Dr. Azar explained, can help prevent rehospitalizations. 

“Care after a hospitalization is very, very important,” he said. “A lot of patients get discharged with medication changes and instruction changes, but they’re so sick at the time and overwhelmed, they don’t follow through. We try to get every one of our patients who end up in the hospital to come and see us within a week, or a maximum of two weeks, after discharge so we can take their blood pressure, see how they’re doing, check their medications, make sure their labs are steady and make sure their kidneys are tolerating any new medications. There are a lot of cases where we catch something a little earlier and have prevented re hospitalization.” 

Another program NAS is  continuing to offer is Chronic Care Management, also known as Connected Care. Designed to support patients with two or more chronic, life-threatening diseases, this program involves monthly care support through a personalized care manager who reviews medications with patients, makes sure they’re getting their medications refilled, talks to them about weight gain, and much more. Dr. Ondocin shared that the program “is great – it’s kind of like an extension of our practice. All the gathered information is incorporated directly into our electronic health record.”

NEW ADVANCEMENTS TO SUPPORT KIDNEY HEALTH

In addition to continuing these proven programs, the team at NAS is always staying informed on the latest research and innovations in the field of nephrology, such as increased access to home dialysis for patients with acute kidney injury, kidney regeneration technology and policy changes aimed at expanding living donor support for kidney transplants. The practice plans to roll out a new initiative this year called remote patient monitoring (RPM), which provides physicians with real- time, in-home blood pressure and weight status, saving valuable time for patients and physicians alike and helping to prevent emergencies and hospitalizations.

“In nephrology, we manage a lot of hypertension. RPM is the gold standard for managing hypertension in patients,” said Dr. Ondocin. “The blood pressures and weights will be stored with AccuHealth, a new vendor partner, and then shared with us in our electronic health record. So, we’ll actually have real-time home monitoring data for these patients, and we’ll have access to more data points so we can better manage our patients with hypertension.”

While these new ways of managing risk factors and  supporting kidney health are exciting, the team at NAS continues to emphasize screening for kidney health concerns and caring for overall health as the primary ways to 

prevent or slow down the progression of kidney disease. The National Kidney Foundation recommends regular screenings, following a healthy diet, focusing on hydration, taking medications  as directed, managing stress, and exercising as ways that individuals can support their kidney health.

Similarly, for the NAS team, supporting kidney health all comes back to awareness, education, and proactive care.

“We try to educate folks about early detection and prevention of kidney disease, including our referring physicians,” said Dr. Ondocin. “We really try to educate people as much as possible about what their level of kidney dysfunction is, what to look out for, what labs to follow – how to most help themselves. That’s our thing, we just try to keep our patients healthy.” 

1https://pubmed.ncbi.nlm.nih. gov/38262816/

To refer patients to Nephrology Associates of Syracuse, P.C. in Syracuse or a satellite location, visit nephrologysyracuse.com/ contact or call 315-478-3311.

Reset With Nature

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BY KATHRYN RUSCITTO, ADVISOR

It is easy to get stressed from a variety of things.

Sometimes all it takes to reset is by engaging the outdoors. In, “The Fundamentals of Environmental Neurosciences,” is a summary of current research that looks at the relationship between people and their environments. The premise is that urban design must take into account the importance of green space and its impact on the mind and body.

It doesn’t matter where I am when I share that I live part of the time in the Adirondacks, immediately people smile and often share a story of the Adirondacks from their childhood. Recently a customer service agent in another state started singing the jingle from the waterpark in Old Forge over the phone!

A drive to the Adirondacks can reduce anxiety, improve health, mental health, creativity and inspire new ideas.

I am hoping to plant some seeds for a day or an overnight in nature for you and your family.

Wherever you are in eastern or western, New York State, you are close to the most amazing natural resource, the Adirondack Park.

The drive to the Park pulls in views that are soothing and beautiful. A winter visit with a warm fireplace and a great dinner improves sleep and the ability to manage stress. A summer visit and kayak or swim in the many beautiful lakes and rivers, adds to reducing stress during busy office practice months. It might not be possible to take a long vacation, but planning some reset breaks adds to your health.

It requires focus on creating the time on your calendar and some research to decide where. When our daughter was young we called these exploration days, no work, just family time to do something new. Often we chose Adirondack locations such as Moss Lake, Cascade Mountain, Saranac Lake or our favorite, Hemlock Hall. No tv, electronics or cell service. Just peace and quiet.

It’s not just about hiking, although there are some of the best trails anyplace in the US. From Old Forge to Inlet to Long Lake to Saranac, Elizabethtown and Lake George. Unique villages, great small libraries and excellent restaurants. Fishing, biking,camping, or just communing with nature can lead to a healthier sense of well-being.

Here are resources to help your planning!

Resources:
The Adirondacks Drives: https://visitadirondacks.com what-todo/ scenic-drives-byways

Views: https://visitadirondacks.com/

Events:
Saranac Lake WInter Carnival
Old Forge Winter Carnival
Raquette Lake Winter CarnivalFrozen Fire
and Lights, Inlet
Wild Lights at the Wild Center

More at https://www.iloveny.com/search/?q=Adirondacks

Restaurants by region
https://www.adirondack.net/ estaurants/all/

Kathryn Ruscitto, Advisor, can be reached at linkedin.com/in/kathrynrusci to or at krusct@gmail.com

Are We Seeing The End Of Private Practice?

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by Jenn Negley, Vice President, Risk Strategies Company

The pressures on healthcare professionals have never been greater. Whether it’s keeping up with evolving regulations, battling prior authorizations, chasing down reimbursements, or managing rising operational costs, maintaining a private practice has become a balancing act for many. It’s no wonder that fewer physicians are running their own practices. In fact, according to the American Medical Association (AMA) Physician Practice Benchmark Survey, only 46% of physicians now deliver care from a fully physician-owned practice.

The personal decision to stay independent

The choice to stay independent is often a deeply personal one, shaped by a variety of factors, such as autonomy, patient focused care, financial pressures, and stress or burnout. Physicians are trained to put patients at the center of care, and for many, the thought of having their practice dictated by non physicians, especially when it comes to patient care decisions or time management, feels untenable.

Concerns about losing control, particularly the fear that financial implications might overshadow the needs of patients often give pause to the idea of transitioning from a small, physicianowned practice to a larger corporate model. At the same time, however, the struggle to keep the doors open amidst declining reimbursements and rising costs is pushing more practices to the brink. As noted by the Medical Group Management Association (MGMA), recent reimbursement cuts have directly impacted the viability of practices that rely on Medicare and Medicaid, which in turn affects their commercial contracts and ability to keep operating. 

The growing burden of business operations 

Most physicians didn’t enter private practice to run a business, they entered to practice medicine and serve their community. But the reality of running a practice requires attention to countless business operations. From hiring and training staff to handling insurance claims and ensuring compliance, many physicians are finding that the administrative burden is taking a toll on their well-being and job satisfaction.

So, what can physicians do to stay independent in the face of these pressures? 

Mitigating the negative aspects of private practice 

One of the keys to success in maintaining a private practice is leveraging available resources and expertise. With increasing complexity and costs, more practices are turning to outsourcing as a way to reduce overhead and free up time for clinical work. Outsourcing areas such as billing, HR compliance, and insurance management can lead to significant savings and help alleviate the burden of administrative tasks. 

For example, working with an insurance specialist can reduce the practice’s overall insurance spend without compromising coverage or incurring additional fees for the service. These types of expert partnerships can help maintain a focus on what matters most — patient care — while ensuring the practice remains financially viable.

Advocacy and the need for legislative change

In addition to operational changes, advocacy at the state and federal levels is critical to the future of private practice. The MGMA has pointed out the dire consequences of reimbursement cuts, particularly for communities that rely on local, independent physicians. Without legislative action, more practices will be forced to close, leaving patients without access to care.

On the bright side, there’s hope on the horizon. Recently, a bipartisan bill, the Medicare Patient Access and Practice Stabilization Act of 2025, was announced with the potential to increase Medicare payments by 6.62%. This bill is backed by over 150 healthcare associations, and it’s a direct result of advocacy efforts by those who understand the critical need for policy change.

Private practice isn’t dead — yet

While challenges abound, the demise of private practice isn’t inevitable. It’ll take a concerted effort from healthcare professionals, associations, and lawmakers to ensure that independent practices  continue to thrive. By staying informed, leveraging expert resources, and advocating for legislative change, we can work together to safeguard the future of private practice.

Take action

If you’re a healthcare professional facing these challenges, don’t navigate this journey alone. Explore the resources offered by organizations like the AMA and the MGMA and consider partnering with experts who can help streamline the business side of your practice. And most importantly, get involved in advocacy efforts that push for the legislative changes we so desperately need. Your practice, and your patients, depend on it.

For more information, please contact Jenn Negley, Vice President, Risk Strategies Company at 267-251-2233 or JNegley@Risk Strategies.com.

 

Quiet Resolve, Big Impact: Denise Baker Drives Change at Syracuse Community Health

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Denise Baker, BSN, RN, CCM, director of Quality Improvement at Syracuse Community Health (SCH), is a leader with a vision for advancing healthcare access and equity. Known for her thoughtful approach and strategic focus, Baker works tirelessly to address barriers that prevent many patients from receiving the care they need.

“Connecting people with resources— healthcare, food, housing, and transportation is essential,” Baker explained. “Our work begins by meeting people where they are and understanding their unique journeys.”

Since joining SCH’s leadership team in 2021, Baker has led initiatives aimed toward reducing health disparities and strengthening SCH as a trusted resource for the Syracuse community. Her efforts reflect one of the health equity goals of SCH to ensure everyone has an opportunity to reach their true health potential.

Syracuse Community Health at a Glance SCH, a federally qualified health center, serves Syracuse and Onondaga County residents through three main locations: 930 South Salina St., 603 Oswego St., and 1938 E. Fayette St. SCH also has three quick care locations, including its newly opened Onondaga Community College location. Eight school-based health centers are located throughout the city of Syracuse. The health system offers a range of specialized services to patients, including: behavioral health, pediatrics, internal and family medicine, dental, podiatry, nutrition counseling, obstetrics, gynecology and more. Walk-in services and support groups, including smoking cessation, grief counseling and parenting, are also available.

SCH accepts Medicaid, Medicare and commercial insurance and it offers a sliding fee scale to ensure care remains accessible to all.

Improvements on the Horizon
So, what does a director of Quality Improvement do?

“Quality improvement is a way to drive meaningful change,” she said, noting, “I am always looking at areas to improve.” By analyzing patient data and listening to feedback, Baker and her team have developed impactful programs like the HOPE (Help Our People Eat) Pantry to improve health outcomes.

Committed to Feeding the Hungry
In collaboration with community partners like the Food Bank of Central New York, SCH has distributed more than 2,000 boxes of fresh produce to patients, staff and the community. Boxes of fresh produce are distributed at the main location, on a first come, first served basis on the third Thursday of each month between 1 and 4 p.m.

SCH also works with organizations, such as the Brady Farms, United HealthCare and FLIPA (Forward Leading Independent Provider Association), “to empower patients to make healthier choices for managing chronic conditions like diabetes and hypertension,” Baker explained.

The success of HOPE Pantry has led to the creation of HOPE Med, a program that focuses on providing patients diagnosed with chronic conditions like diabetes and hypertension access to healthier food options tailored to their needs. Patients of the health center who may struggle with access to healthy foods will be eligible to receive additional items from the food pantry. HOPE Med integrates education and resources to empower patients to better manage their health.

“Our goal is to ensure no one has to choose between paying bills and eating well,” Baker said. “These programs go beyond addressing hunger they focus on dignity, empowerment and building healthier lives.”

Through collaboration and innovation, Baker and her team are breaking barriers and setting the foundation for a healthier, more equitable future.

Advances In Cardiac Technology:Diagnosis, Treatment, And Monitoring

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Data from the World Health Organization indicates that cardiovascular diseases (CVDs) are responsible for approximately 17.9 million or 32% of deaths worldwide, necessitating continuous innovation in diagnostic and therapeutic technologies. Recent advances in cardiac technology have significantly improved patient outcomes, with breakthroughs spanning early detection, minimally invasive treatments, and personalized care.

Advancements in Cardiac Imaging: Enhancing Diagnostic Accuracy and Treatment Planning

One of the most significant advancements is the use of Cardiac Magnetic Resonance Imaging (MRI). Cardiac MRI is an essential tool for assessing myocardial viability, scar tissue, and heart chamber functionality. A breakthrough in MRI technology, Late Gadolinium Enhancement (LGE) imaging allows for highly accurate detection of myocardial infarction and fibrosis. This non-invasive imaging modality provides details on heart tissue structure, enabling clinicians to better predict patient outcomes and guide therapy decisions.

Another notable advancement is 3D Echocardiography. Unlike two-dimensional echocardiograms, 3D imagining allows for a more precise evaluation of cardiac morphology, valve function, and hemodynamics. This is especially beneficial when assessing mitral valve diseases and congenital heart defects, facilitating improved surgical planning and postoperative care.

Minimally Invasive Cardiac Interventions: Revolutionizing Treatment, Reducing Recovery Time, and Improving Outcomes

One of the most significant developments in recent years is the evolution of Transcatheter Aortic Valve Replacement (TAVR). TAVR, a procedure in which a catheter replaces a damaged aortic valve without open-heart surgery, has gained widespread acceptance for the treatment of aortic stenosis, particularly in elderly and high-risk patients. Advances in valve design and catheter technology have significantly improved the success rate and reduced the risk of complications, making TAVR an increasingly preferred option over traditional valve replacement surgery.

Similarly, left atrial appendage closure (LAAC) devices, such as the WATCHMAN™ device, offer a minimally invasive solution for stroke prevention in patients with atrial fibrillation. By occluding the left atrial appendage,  thrombus formation is prevented and reduces the risk of stroke, eliminating the need for long-term anticoagulation therapy in certain patients.

The Rise of Digital Health: Wearable Technology and Remote Monitoring

 Wearable devices have become integral to the management of cardiovascular diseases. Technologies such as smartwatches with built-in electrocardiograms (ECGs) can detect arrhythmias, including atrial fibrillation (AF), in real time. Devices like the Apple Watch® and KardiaMobile® capture high-quality ECG readings that can be instantly transmitted to healthcare providers for analysis, allowing for earlier detection of cardiac abnormalities and timely interventions.

Additionally, remote monitoring systems are improving the management of heart failure. Implantable devices, such as Cardiac Resynchronization Therapy CRT) devices and implantable cardioverter-defibrillators (ICDs), can continuously monitor heart function and send data to clinicians for analysis. This allows for personalized adjustments to treatment regimens and early intervention when abnormalities are detected. The use of artificial intelligence (AI) to analyze large datasets from these devices further enhances clinical decision making, making care more proactive and individualized.

The Landscape of the Future

Cardiac technology continues to make tremendous strides, improving the ability to diagnose, treat, and monitor cardiovascular diseases. Advances in imaging techniques along with minimally invasive procedures have revolutionized management of heart disease. Furthermore, wearable technologies and remote monitoring systems are ushering in an era of personalized, continuous care, enabling better management of chronic conditions like heart failure and atrial fibrillation. As technology continues to evolve, these innovations promise to further transform cardiovascular care, improving patient outcomes and quality of life.