Category: JANUARY – FEBRUARY MD News 2022

Oneida Health and Roswell Park in Oneida: The Best of Both Worlds

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By Becca Taurisano

Tuesday, December 28, 2021

As a member of the Roswell Park Care Network, patients of Oneida Health’s Medical and Radiation Oncology practices receive National Cancer Institute standards of care and a superior patient experience, close to home.

The Oneida Health Medical Oncology and Radiation Oncology team

From its inception, the partnership between Roswell Park Comprehensive Cancer Center and Oneida Health has had a singular mission: provide the highest quality, innovative cancer care in a community setting with an outstanding patient experience. Roswell Park provides the clinical pathways and expertise in diagnosis and treatment while Oneida Health provides a full complement of network services and state-of-the-art technology, in a convenient location. It truly is the best of both worlds for patients.

Dr. Thomas Schwaab, Chief of Strategy, Business Development and Outreach, and Associate Professor of Oncology and Immunology at Roswell Park says, “Roswell is always happy to partner with institutions that are driven to deliver the highest quality of care. We have the same mission as Oneida Health, to make top notch cancer care conveniently accessible to as many New York State residents as possible. If you are a cancer patient, the last thing you want to do is spend time traveling in order to get the best level of care. Having that mindset for the patient is really important to the mission of our partnership.”

Roswell Park is the only National Cancer Institute (NCI) Designated Comprehensive Cancer Center in Upstate New York, and one of three such centers statewide. Dr. Roberto Martinez, Medical Director of Medical Oncology and Hematology and Dr. Maya Mathew, Medical Director of Radiation Oncology are Roswell Park physicians located onsite in Oneida, dedicated to providing their patients with world-class cancer care, in a convenient location. “When care becomes more convenient, that directly affects quality of life and positive patient outcomes. It takes the fear and cost of traveling out of the equation,” says Dr. Martinez. “We offer the same treatment in Oneida as we do in Roswell,” says Dr. Mathew, “It is the Roswell standard of care which patients are getting here at home. If I were the patient, I would not compromise on the standard, so if I can get the same standard of care near my home, why not?”

“The partnership between Roswell Park Comprehensive Cancer Center and Oneida Health has a singular mission: to provide the highest quality, innovative cancer care in a community setting with an outstanding patient experience for those we care for.”
— Gene Morreale, Oneida Health President and CEO

Seamless Connection Between Campuses

Patients at Oneida Health benefit from Roswell Park expertise being delivered to Oneida. If a patient requires a consult from a Roswell Park specialist, Oneida makes the connection with Roswell Park very easy for the patient. Oneida Health facilitates an initial consultation using telemedicine, either from the patient’s home or in-office with the oncologist present. “There is intimate contact between Oneida and Roswell,” says Dr. Martinez. Dr. Schwaab visits Oneida once a month and is in close contact with the oncologists in Oneida. “Roswell Park leadership is involved with this relationship. The physicians we employ are inherently driven to be part of Roswell Park. That comes through in the desire to deliver the right quality of care,” says Dr. Schwaab.

The Medical Oncology practice will double the size of their outpatient facility, the William L. Griffin Medical Oncology Center, from six to twelve outpatient exam rooms, as well as increase the staff work area in 2022. This expansion is made possible by a $500,000 donation from the Dorothy G. Griffin Charitable Foundation. The Griffins previously donated $1 million to the William L. Griffin Medical Oncology Center in 2019 and $1 million to the Dorothy G. Griffin Radiation Oncology Center in 2017. This generous support will make it possible for more patients to be treated at the facility and for staff to work more efficiently and comfortably.

William L. Griffin Medical Oncology Center

Access To Specialized Expertise

A Buffalo-based multi-disciplinary committee of disease-site specialists is available to Dr. Martinez and Dr. Mathew to review their cases and provide insight on a regular basis. The oncologists in Oneida have the ability to present these cases remotely to the team in Buffalo comprised of Roswell Park oncologists, pathologists, and radiologists proficient in treating specific disease-site cancers. “The Oneida patient has the safety and luxury of knowing that a number of highly specialized oncologists have reviewed their case,” says Dr. Schwaab. “It is a huge advantage for the patient because they are getting the expert opinion from Roswell Park cancer specialists. A head and neck radiation oncologist is only treating head and neck cancers, so their expertise is greater,” Dr. Mathew says. Once Dr. Martinez and Dr. Mathew have reported the patient’s case to their respective boards, the committee members will give them feedback and guide them on the best path forward. “We have close contact with the specialists in Buffalo. Cancer care is continuing care. There are bound to be bumps in the road, so that close relationship is important. Our colleagues in Buffalo are always available to consult with us when any issues arise,” says Dr. Martinez.

Oneida Health has implemented a local tumor board in Oneida who serves as an extension of the multi-disciplinary board in Buffalo. This board involves Dr. Martinez and Dr. Mathew as well as Oneida surgeons, radiologists, pathologists, and primary care physicians. The purpose of an Oneida-based tumor board is to elevate the level of care being provided at the local level.


In a recent survey conducted by Oneida Health Radiation Oncology, patients ranked their satisfaction 9.86 out of 10 upon treatment completion.

Focus On Quality

Roswell Park is an internationally recognized brand known for comprehensive cancer care. There are multiple mechanisms built into the relationship between Buffalo and Oneida to ensure continuity of the quality of care associated with the Roswell brand, no matter where it is delivered. Dr. Martinez and Dr. Mathew follow Roswell Park clinical pathways, or preferred treatment for each particular kind of cancer, bringing that in-depth cancer-specific experience to patients in Oneida. These clinical pathways can be reviewed remotely by Roswell Park which ensures the doctors are following best practices. The review process provides continuous opportunities for improvement. “It is the Roswell standard of care that we adopt here in Oneida,” says Dr. Mathew, “The physics team from Roswell’s main campus reviews all our radiation plans to make sure the quality checks are in place before the patient gets treatment. They do weekly checks which is the standard for all Roswell patients whether in Buffalo or Oneida.”

Sterile Compounding is completed by specialty-trained pharmacists and technicians on site at the
William L. Griffin Medical Oncology Center. Providing future opportunities for clinical trials to be delivered in Oneida.
 

Keeping Care Local

Oneida Health is known for providing award-winning patient safety and patient experience to the communities they serve. “We strive to give state-of-the-art medicine in a community setting,” says Dr. Martinez. The goal is to continue that small community touch, no matter how much they grow, with a focus on keeping patients local. “Modern cancer care is intricate and well-orchestrated in that a patient may need chemotherapy, radiation therapy, specialized imaging, biopsy, molecular pathology, surgery or genetic screening. If these disciplines don’t reside under the same roof, it can take a long time to develop a treatment plan. When a patient makes their way through the doors at Oneida Health Medical Oncology, they have access to all of that without leaving the campus,” says Dr. Schwaab.

We have a great team here. When you give the best care and a great patient experience, patients will be satisfied.”
— Dr. Maya Mathew, Medical Director of Radiation Oncology

Investment In Technology

The expert medical opinions you get from Roswell Park are coupled with Oneida Health’s significant investment in technology. Using an onsite CT simulator, the Radiation Oncology team uses advanced imaging techniques and software to deliver precise dosages while taking every measure to minimize the exposure to healthy tissue.

In some cases, Dr. Mathew can also take advantage of other imaging modalities including a new PET/CT and 3 Tesla MRI to fuse images for more invasive tumors. Radiation therapists use a TrueBeam linear accelerator to generate and deliver precise targeted treatment to treat cancer. “We are using the most modern equipment available in the region,” says Dr. Mathew.

Oneida Health has designed a network of specialists, services, and technology,
including da Vinci Robotic Surgery (established in 2012), to support quality cancer care treatment in Oneida.
 

Personal Interaction With Staff

Personal interaction with the oncology staff is a big part of patient care and ensuring positive outcomes. “Cancer is a life-changing diagnosis. The life of a cancer patient is fraught with difficulties, so it is important to have a personal touch. It makes this disease less dehumanizing. If they can touch someone, tell their stories, and ask their questions, that makes their experience much less difficult,” says Dr. Martinez. “When you are getting radiation treatment, you require compassion and empathy. Every person’s attitude is different toward cancer and cancer treatment. We try to put ourselves in the patient’s shoes. We are making sure that everyone is getting high-quality tailored treatment, as well as that personal care from us,” says Dr. Mathew.

Oneida Health provides contact with a nurse navigator from the very beginning of a patient’s cancer journey. The nurse navigator is available to coordinate appointments, answer questions, identify patient needs, and provide financial counseling. Often the nurse navigator is there just to listen. “The nurse navigator is very important,” says Martinez, “Cancer is a journey and there can be very complicated treatment plans. They are the advocate and champion of the patient, and essential to their care.” The nurse navigator is the glue that keeps it all together, bridging the gap between offices, providers, campuses, and even family members. For a patient who has other social and financial issues, the nurse navigator provides the support that might not otherwise be available, forming a close bond with the patient and their family.

Dr. Martinez and Dr. Mathew are readily available to referring physicians whenever questions about a patient’s treatment may arise. “Communication is essential. A lot of the doctors have my cell phone so they will contact me frequently. It is important to stay in touch,” says Dr. Martinez. “If there is any concern to be discussed with the patient’s primary care and other physicians, I do not hesitate to pick up the phone,” says Dr. Mathew.

Oneida Health has become an imaging destination with new investments in state-of-the-art imaging technology
including a 3-Tesla MRI, Advanced PET/CT (pictured), and 3D Mammography.
 

Advancing The Approach

There are many planned improvements to optimize the integration between Buffalo and Oneida in the future. “The Oneida cancer service line continues to grow, and there is always room for recruiting highly qualified and very driven physicians,” says Dr. Schwaab. Patient volumes are up 30% this past year and Oneida anticipates the growth will continue in the coming years. They plan to add a second medical oncologist and additional ancillary staff to support this growth. Plans are in place to open a survivorship center and to expand the cancer screening program, as well as opening clinical trials.

With the significant resources of Roswell Park delivered locally in Oneida, referring physicians can have the peace of mind that their patients will receive the best possible patient care. “Referring physicians want to know that their patients are receiving high-quality care in a timely manner,” says Dr. Schwaab. “This is all about the patient, who has a dire diagnosis and the last thing they want to do is worry about getting their cancer treatment. Cancer treatment is really time-sensitive so you need to make sure chemotherapy and radiation are delivered in a timely manner. Delivering that care right in the patient’s hometown, that is what this is all about.”

For more information about cancer care in Oneida, visit oneidacancer.org.

Medicare: Choice or Complexity

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By Kathryn Ruscitto, Advisor

Tuesday, December 28, 2021

Recently we have seen select physician groups and hospitals saying no to certain Medicare plans. Reimbursement and access barriers for patients are often cited as the tipping points for providers exiting the networks.

For consumers, the complexity of choosing between a traditional Medicare plan and a Medicare Advantage Plan — combined with the rejection of certain plans by providers — further adds to the frustration felt by many patients.

Each year, in late fall, consumers are allowed to switch healthcare plans and are flooded with print and electronic marketing from insurers offering a variety of enticements and coverage options. New enrollees to Medicare must consider and sign up immediately or incur future penalties. Consumers switching between Original Medicare and an Advantage Plan must carefully consider what options they gain or lose. Additionally, people who travel and live in different places face another set of complexities.

There is no point at which patients and providers are connected in this conversation other than knowing whether the insurer being considered is in the network. Yet when choosing a policy, understanding how a physician functions within the plan or providers are paid is at the core of Medicare.

Kathryn Ruscitto, Advisor

Peering Up Ahead

Health2047, a Silicon Valley subsidiary of the AMA, aims to transform health care at the system level and sees continued reimbursement for telehealth as key to moving toward a value-based payment arrangement, which has been an important lesson learned over the past two years. The AMA ponders:

  • How much are payers willing to reimburse on a fee-for-service basis?
  • How much will the industry adopt value-based payment?

Costco recently launched a service for its members to help them better understand their Medicare choices — which is what brought me to this subject. For all its complexity, Medicare is a unique program that offers a great deal of choice, and as the population ages, will continue to be a primary payer for providers, who should understand the importance of the educated consumer. Perhaps the best contribution we all can make as employers and providers is helping to promote the services and programs that support consumers in making informed Medicare choices.

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

Resources for Consumers

  1. National Council on Aging | ncoa.org
  2. AARP | AARP.com
  3. Medicare Compare Analyzer | medicare.gov

Key Updates to the Medicare Physician Fee Schedule for 2022

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By Sarah Steinmann

Tuesday, December 28, 2021

The Centers for Medicare & Medicaid Services released a final rule in November, implementing policy changes to medicare payments in 2022.

 

CMS is updating its policies and billing practices to better reflect the role non-physician practitioners (NPPs) have in providing care in the facility setting. The changes do not apply to physician offices because the incident-to-billing policies already in place in that setting reflect the significant role NPPs play in patient care. A selection of the policy changes, which take effect Jan. 1, 2022, are summarized below.

Split Evaluation and Management Visits

Split (or shared) evaluation and management (E/M) visits are now defined as an E/M visit in the facility setting (e.g., a hospital or skilled nursing facility) when such visit is performed in part by a physician and in part by an NPP who are members of the same group, such as being employed by the same employer.

Only the physician or NPP who performs the “substantive portion” of the split (or shared) visit may bill for the visit. Beginning in 2023, “substantive portion” will be defined as more than half of the total time spent by the physician and NPP performing the split (or shared) visit.

Medical groups will undoubtedly face administrative challenges in efficiently and effectively recording the time spent by each physician and NPP during a split (or shared) E/M visit. Therefore, CMS has designated 2022 as a transition year, in which a broader definition of substantive portion will be used with the exception of critical care visits, which will use more than half the total time definition.


Sarah Steinmann

The 2022 definition of “substantive portion” is either more than half of the total time of the visit or a complete performance of any of the three key components of an E/M visit (history, physical exam and medical decision-making). This broader definition should give medical groups sufficient time to develop and implement procedures to ensure accurate tracking of physicians’ and NPPs’ time.

The medical record must also identify the individuals who performed the visit and must be signed by the physician or NPP who performed the substantive portion of the visit. Split (or shared) E/M visits can be reported for both new and established patients, and for initial and subsequent visits and prolonged services. A modifier to identify split (or shared) E/M visits must also be added to the claim. The modifier is intended to inform future CMS policy and ensure medical practice compliance with the new regulation.

Physician Assistant (PA) Billing

As required by Section 403 of the Consolidated Appropriations Act, CMS updated the requirements for PA billing and payment. Previously, Medicare could only pay a PA’s employer or contractor for services rendered by the PA. Beginning in January, PAs can bill Medicare directly and reassign payments for professional services.

This change aligns PA billing practices under Medicare with those of other NPPs like nurse practitioners and clinical nurse specialists who can bill Medicare and be paid directly for their services. This new policy may require practices to change their Medicare enrollment process for PAs. For example, PAs may need to complete enrollment forms to reassign payment for their services to their employer.

Practices should be mindful that while a PA can now bill Medicare directly, their services are only covered when furnished in accordance with state law, including any supervision requirements, and within the PA’s scope of practice.

Sarah Steinmann is an associate at CCBLaw, a boutique law firm focused on providing counsel to physicians and other healthcare professionals. She can be reached at 315-477-6232 or ssteinmann@ccblaw.com.

Dr. Wilson is Named CMO of Auburn Community Hospital

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It was virtually preordained that Michael G. Wilson, MD, was going to be an orthopedic surgeon.

“My father and grandfather were both orthopedic surgeons, and I was introduced to life in a hospital as a teenager when my father noticed me sitting around on a summer day,” Dr. Wilson recalls. “He told me to meet him at the hospital the next morning at 6:30 a.m. and I found myself in the basement, cleaning and wrapping instruments to be used in surgery. I continued to work a variety of hospital jobs every vacation through high school and college.”

Dr. Wilson has come a long way from that basement. Effective Dec. 1, 2021, he became Chief Medical Officer (CMO) of Auburn Community Hospital (ACH), replacing Paul Fu, MD, who accepted a position at a medical facility near Boston.

“We are thrilled to have Dr. Wilson as our new Chief Medical Officer,” says ACH President and CEO Scott Berlucchi. “Dr. Wilson not only has excellent clinical skills as an orthopedic surgeon but has excellent management experience.”

Dr. Wilson has been on staff at ACH since May of 2020, serving as deputy CMO. He is a surgeon at Auburn Orthopedic Specialists with a focus on traumatic injuries and complete care of foot and ankle injuries.

A native of California, Dr. Wilson attended medical school and completed his orthopedic surgery residency at Los Angeles County USC Medical Center where he also met his wife Donna, a nurse. The two have been married for 37 years and have two sons, Caleb and Ben.

Dr. Wilson practiced in Boston for 25 years, completing a fellowship in adult orthopedic reconstruction at Brigham and Women’s Hospital and Boston Children’s Hospital, an experience he calls “inspirational, challenging and intimidating.”

He also served as Chief of Orthopedic Surgery at the West Roxbury Veteran’s Hospital and the Faulkner Hospital, also in Boston. In 1995, he founded the Harvard Fellowship in Orthopedic Foot and Ankle Surgery and, as an assistant professor of Orthopedic Surgery, taught dozens of fellows and hundreds of residents at Harvard Medical School.

Prior to joining ACH, Dr. Wilson was the Chair of the Surgery Governance Committee at Cayuga Medical Center in Ithaca for eight years.

As CMO, Dr. Wilson will be responsible for overseeing the medical operations of the hospital, including credentialing, physician practice evaluation, recruiting new medical staff, examining clinical operations, identifying ways to improve efficiency and ensuring quality and safety. He will also continue to practice as an orthopedic surgeon.

Dr. Wilson said it is an honor to accept the position of CMO.

“For me, CMO means commitment to the quality of medical services we provide, while working to ensure the success of the physicians and affiliate providers,” he says. “This is a great place to work and I hope that I can contribute to the growth and excellence of Auburn Community Hospital.”

A Second Dream Achieved

A California native, Michael G. Wilson, MD, earned an advanced degree in wine making and long dreamed of having his own winery like those he visited in Sonoma and Napa.

He realized that dream in 2014, when he and his wife Donna purchased a farm on the eastern shore of Cayuga Lake and established Bright Leaf Vineyard. Today, the vineyard produces 3,500 cases of premium wine that is fermented in large stainless steel tanks and aged in French oak.

Dr. Wilson calls his winery the perfect counterpart to the indoor, artificially lit environment of the hospital, with plenty of fresh air, singing birds and wide-open lake views.

For more information, visit brightleafvinyard.com.