Nappi Wellness Institute: Improving Healthcare Outcomes for Vulnerable Populations in an Accessible, Supportive Environment

By Daniel K. Brantley

Tuesday, October 25, 2022

Upstate University Hospital’s soon-to-open Nappi Wellness Institute introduces a new era of health care with a suite of patient-centered ambulatory services and provider benefits in one location.

The area shown under construction will transform into a light and bright reception area.

An increasing amount of data indicates an imperative need to improve healthcare equity for vulnerable patient populations — an issue that’s been evident for years — and hospital systems across the country are attempting to level the field. With a $70 million grant from the New York Department of Health, a $75 million bonding opportunity to match funds, and an $8 million naming gift, Upstate University Hospital has been working on a solution, and that work is about to come to fruition.

Scheduled to open in early 2023, the Upstate Nappi Wellness Institute is a five-story, 200,000-square-foot outpatient facility that will integrate multiple primary and specialty health services and a bevy of unique amenities under one roof. The new Institute is expected to remove many of the barriers that send patients to the hospital instead of getting timely, appropriate care in the lowest acuity setting.

As the new Institute gets underway, Upstate University Hospital anticipates fewer unnecessary emergency visits and inpatient stays, ultimately leading to more cost-effective healthcare delivery and improved quality of life for vulnerable community residents. Combined, the benefits offered meet the qualifications of the state’s Delivery System Reform Incentive Payment (DSRIP) program, an initiative aimed at restructuring Medicaid’s healthcare delivery system and reducing unnecessary hospital use by 25% over five years.

“The COVID-19 pandemic catalyzed a transformation in health care that was talked about for a long time but only dabbled in,” says Amy Tucker, MD, MHCM, Chief Medical Officer at Upstate University Hospital. “Fortunately, we’re ahead of the curve with the Institute, which introduces a new model of care focused on wellness.”

Left to right: Amy Tucker, MD, MHCM, Marylin Galimi, Chief Operations Officer, Marisa Desimone, MD, Nancy Daoust, EdD, FACHE, LNHA

“The remodeling of care to focus on wellness is not just promoted at the Institute — it’s embraced. Everything about the building and the services offered centers around helping people stay well, vibrant and functional.”
— Amy Tucker, MD, MHCM, Chief Medical Officer, Upstate University Hospital

Built for Optimal Health

An integrated model of care guided the design and construction of the Nappi Wellness Institute. And following the WELL Building Standard, the Institute’s design and layout will promote the good health of patients, visitors, clinicians and staff alike.

“We wanted to change what people perceive as health care to be proactive and focused on wellness,” says Marylin Galimi, Chief Operations Officer at Upstate University Hospital. “We didn’t want another facility with clinics where you simply come in and wait for an appointment. We wanted to build something that represented the idea of caring for your body and your family.”

WELL Building Standards include the following:

  • Air: The Institute features filters that circulate 100% of outside air throughout the building.
  • Comfort: Convenient break and lactation rooms allow providers to decompress or tend to personal matters in spaces designed with an intentional lack of work-related furniture or equipment.
  • Fitness: The interior of the building has a walking loop that includes stairs, so team members can get some exercise without leaving the grounds.
  • Light: Large windows bring ample natural lighting into waiting areas, which line the perimeter of the Institute. For patient privacy, patient rooms are inside the pathway, and staff members can control the light in these and other interior rooms.
  • Mind: Calming, digital art on walls and earth-tone colors serve to provide a calming environment for all patients. Outdoor seating surrounded by trees and lush gardens, and a meditation labyrinth provide additional on-site havens.
  • Nourishment: Family-style break rooms with large-capacity refrigerators and a café bathed in natural lighting offer patients and staff members wholesome meals featuring fruits, vegetables, lean proteins and whole grains.
  • Water: Hospital-quality water filtration ensures all water sources are properly filtrated. Handwashing stations throughout the Institute allow easy access within and outside of clinical spaces.

As a LEED-certified building, the planet’s health was also considered during its planning and construction. The energy-efficient space encourages recycling all eligible materials and appropriate disposal of debris. Supplies will be purchased locally or regionally when available and appropriate.

Upstate Nappi Longevity Institute Groundbreaking

Easier Access to Primary and Specialty Care Services

The Institute will be home to a variety of primary and specialty care experts that can reach further than any single clinician or specialty could. Before the Institute was established, Upstate University Hospital healthcare services were provided in numerous locations spread throughout the area, each with its own medical directors, nursing and business leadership in place. These healthcare professionals will still retain their governance while working at the Institute, though some will share clinical space. Everyone will work together to provide more efficient, comprehensive patient care.

Patients who visit the Nappi Wellness Institute will have access to:

  • Adult and pediatric medicine
  • Alzheimer’s disease care and research, which is a special focus of the facility (see sidebar)
  • Center for International Health
  • Connect Care/Upstate After Hours
  • Endocrinology
  • Family medicine
  • Geriatric medicine
  • Inclusive health services
  • Integrated care
  • Internal medicine
  • Joslin Diabetes Center
  • Laboratory
  • Osteoporosis care
  • Nutrition counseling
  • Outpatient pharmacy
  • Palliative care
  • Radiology
  • Social work

Should hospitalization or emergency services be necessary, a pedestrian bridge gives immediate access to Upstate University Hospital. The bridge also allows Institute clinicians to follow up with hospitalized patients in a timely manner.

“We want to be of service to the community and I think we can do that with this facility — not just with the building, which is special, but with all of our services coming together in a cohesive, comprehensive way.”
— Nancy Daoust, EdD, FACHE, LNHA, Chief Ambulatory Officer at Upstate University Hospital

Services for Behavioral and Social Well-Being

Behavioral health services will also be available on-site. In the event patients present with behavioral healthcare needs, they can visit each clinic’s on-site behavioral health professional — a valued and much needed development for clinicians. For example, the Joslin Diabetes Center, the largest clinic within the Nappi Wellness Institute, is housed on the fifth floor, and behavioral health is likely to be an important part of care.

“Diabetes is often a chronic, lifelong condition that carries a heavy mental health burden for many patients,” says Marisa Desimone, MD, Associate Medical Director of the Joslin Diabetes Center. “Beyond diabetes, lots of people are struggling after spending two and a half years facing the worldwide stressors of the pandemic and other issues.”

The Institute also will provide educational spaces for well-being classes, nutrition counseling, cooking lessons, community lectures and other health and wellness learning opportunities. As equity in health care takes center stage, social determinants of health have become a major focus. According to Dr. Tucker, population health factors guided the creation of the Institute and its services, including drop-off, valet parking and covered bus stops across the street. Upstate Ambassadors will personally greet patients at the door and arrange for an escort to take them to appointments if needed.

“Those touches are a big deal,” Dr. Tucker says. “For vulnerable patients, these can make the difference between coming to a healthcare appointment and not being able to do so.”

Sam and Carol Nappi are joined by family members as well as by Upstate University Hospital President Mantosh Dewan, MD; Eileen Pezzi, MPH, Upstate Foundation; and David Amberg, PhD, Upstate Research, as they paid a recent visit to tour the building while it’s under construction. The gift from Sam and Carol Nappi — the largest ever received by the Upstate Foundation and Upstate Medical University — will be used to expand the building’s services related to neurosciences, including a focus on Alzheimer’s disease. The Nappi Longevity Institute is named in recognition of the couple’s philanthropy.

Feedback Matters

Though population health inspired the Institute, those who will be working there played major roles in ensuring it also met provider needs. Hundreds of individuals assisted in the development of the Institute, including a physician advisory committee which worked alongside nurses, business and marketing executives, hospital administration, security personnel, and more.

The physician advisory committee’s influence is evident in the exam rooms. When physician leaders examined the desks designed for exam rooms, they agreed they were aesthetically pleasing but immediately recognized they weren’t functional. That physician feedback helped the architects create an updated plan featuring large, half-moon-shaped desks that allow clinicians to face patients while talking to them. Additionally, computer screens mounted on the desks move easily to meet the specific ergonomic needs of different providers.

In the geriatric clinic, physicians recommended table height adjustments to make it easy for wheelchairs to fit underneath. Plans to develop mobile workstations in the pediatric area changed when providers noted the potential risk for children climbing on and damaging them.

“Patient care comes first — 100% — always will. [You] can’t go into health care without that outlook. It has to come first.”
— Marisa Desimone, MD, Associate Medical Director, Joslin Diabetes Center at the Nappi Wellness Institute

Technology Upgrades

To ensure continuum of care between providers at the Nappi Wellness Institute and other Upstate locations, all services tie into the Epic electronic medical record system. In place for years, this connectivity allows providers to communicate seamlessly with one another and grants patients access to their health information and appointments via MyChart.

The Institute plans to leverage additional Epic functionality to benefit all users.

“The Institute represents the clinic of the future,” says Nancy Daoust, EdD, FACHE, LNHA, Chief Ambulatory Officer at Upstate University Hospital. “We’ve had great talks with Epic, and we hope to be a beta test site for them to test upcoming Epic functionalities.”

In addition to Epic, real-time location scheduling (RTLS) technology will remedy any scheduling and patient-flow issues. With RTLS, clinicians on one floor can identify available equipment and exam space on another to make use of them as needed. These and other high-tech functionalities will enhance the physical proximity providers experience at the Institute.

“Being in the same building will facilitate even closer collaboration when we pass one another in the hallway, garage or elevator,” Dr. Desimone says. This opens the door for clinicians to “strike up a conversation and brainstorm how to meet a patient’s needs.”

Prepared for Growth

The Nappi Wellness Institute is presently large enough to meet a variety of health needs in the community, but Upstate administrators also had the foresight to plan for growth. The Institute currently has five floors but can accommodate an additional three stories if clinicians, administrators and other team members see a need.

“We want to decant all ambulatory services out of the hospital, which is cramped for space,” Dr. Daoust says. “Doing this presents us the rare opportunity to scope out incoming practice needs and ensure they have more space that allows them to grow further in the future. Think about the impact we can have on a real-time basis instead of a patient having to wait in the ED.”

To ensure the appropriate allocation of areas within the hospital and stand-alone clinics, Dr. Daoust and others are closely monitoring department communications so they can successfully meet future requirements and build on their success.

“By making services accessible and convenient, co-located in a one-stop shop and affordable, we’re positioned to move the needle on our community’s health,” Dr. Tucker says. “The services we offer will be robust, in addition to a very nice experience for patients who go to the Institute, and for the clinicians and staff who practice there. We’ll have a model that is welcoming and easy for referring providers as well.”

A Naming Gift of Lasting Impact

The naming gift from Sam and Carol Nappi will be used to provide services related to the neurosciences inside the new Nappi Wellness Institute, including a special focus on Alzheimer’s disease. The Nappi Wellness Institute is named in recognition of the couple’s philanthropy.

“The Nappi’s support, with its focus on Alzheimer’s disease and brain health, is a down payment on creating healthy futures for all of us as we age,” says Sharon Brangman, MD, Distinguished Service Professor and Chair of Geriatric Medicine at Upstate University Hospital, and a former president of the American Geriatrics Society.

“Sam and I want to continue our commitment to Central New York in both deed and funding,” Carol Nappi says. “We will work with Upstate Medical University to build a world-class facility, assemble a renowned medical team and fund groundbreaking research.”

“We’re encouraged and excited about the 21st century vision the team at Upstate Medical University and the Upstate Foundation have shown in their commitment to medical research and proactive medical care,” Sam Nappi says. “Carol and I look forward to working with them.”

The Nappis have a long history of supporting local causes, focusing much of their philanthropic initiatives on medical research and community medical care. Sam Nappi is founder and chairman of Alliance Energy. Carol Nappi, a former psychiatric therapist at Community General Hospital, now Upstate Community Hospital, is active with numerous local and national charitable organizations. She is a 2000 Jefferson Award winner, a national recognition honoring community and public volunteerism.

Visit upstate.edu/nappi-wellness-institute to learn more about the groundbreaking approach to care at the Nappi Wellness Institute.

Comprehensive Breast Care at Oneida Health

By Becca Taurisano
Tuesday, October 25, 2022

Breast surgeon Mary Ellen Greco, MD, FACS, and Physician Assistant Kristen McNeil bring expertise and a personal touch to Oneida Health’s new breast care subspecialty.

Mary Ellen Greco, MD, FACS, and Kristen McNeil, PA-C joined Oneida Health in February after working together for the last five years in Syracuse. Their arrival launched the new Oneida Health Breast Care service line.

Both from Central New York, the pair says it was a natural next step for them to bring high-quality, comprehensive breast care to a community setting.

Together, Dr. Greco and McNeil provide the complete spectrum of breast care including abnormal imaging findings, known diagnoses of breast cancer, screening for patients with a strong family history of breast cancer, patient-related complaints of a self-detected lump, in-office ultrasound-guided biopsies, surgery, genetic counseling and testing, and benign conditions of the breast.

Built on Experience

A graduate of the SUNY Science Center at Syracuse and fellowship trained in trauma and surgical critical care at the University of Maryland Medical System, Dr. Greco brings over 20 years of medical and surgical breast care experience to Oneida Health. She says at the time she finished her surgical training, there was no breast care specialty.

“As the only female surgeon in the practice, I ended up seeing our breast patients because the patients felt more comfortable with me,” she says. The end result was a career with a sole focus on breast care which Dr. Greco calls both exciting and rewarding.

McNeil spent two years in urgent care and 12 years in family medicine before working with Dr. Greco at her Syracuse office.

“Breast care is a subspecialty that became very important to me,” says McNeil, having lost a close friend to metastatic breast cancer at 31 years old. “It’s my goal to provide patients the piece that [my friend] felt was missing from her care.”

Personalized Care

Patients from Oneida and Rome were being referred to their practice in Syracuse, so it made sense to bring care closer to them.

“Here at Oneida, we have all of the technology and pieces of the puzzle to provide the highest quality of personalized care to our patients,” Dr. Greco says.

Plus, many patients prefer going to Oneida because of the convenience or proximity to family members who can provide support. Continuity of care is the key, says Dr. Greco, noting that she has had some patients for 20 years no matter where her practice is located.

Other members of Dr. Greco’s staff have been with her for 10 years or more and that consistency is important for patients.

Mary Ellen Greco, MD, FACS

“A lot of what we do isn’t surgical — it’s care, education, follow-up and reassurance,” Dr. Greco says. “It makes patients very happy to have consistent people be a part of their health care.”

An essential part of providing personalized care is Oneida Health’s certified nurse navigator, Linda Lyon, CN-BN.

“With a breast cancer diagnosis, we are just one pillar of a patient’s complete care,” McNeil says. “The nurse navigator is critical in holding a patient’s hand every step of the way.”

Lyon helps patients get the necessary support they need, whether it’s financial assistance, transportation, access to social workers or supplemental care. “The nurse navigator is the key to keeping the whole system moving effectively,” Dr. Greco says.

Network of Support

When surgery is required, Dr. Greco’s patients have the advantage of receiving all pre- and post-operative care from Roswell Park, an awarding-winning hospital in Oneida. When other treatment options are needed, patients don’t have to go far.

As a member of the Roswell Park Care Network, Oneida Health Breast Care patients have access to the latest developments in cancer treatment if they require medical or radiation oncology.

“We are very happy to be affiliated with Roswell Park and to collaborate with them in caring for our patients,” Dr. Greco says.

Roswell Park’s expertise can be accessed by Oneida patients quickly and easily, either by on-site providers or by using telemedicine if necessary, eliminating the need to travel to Buffalo in nearly all cases.

The Oneida Health Gorman Imaging Center is essential to breast care in Oneida as well. Patients have access to robust imaging right on campus, such as 3D tomosynthesis, screening sonogram, 3 Tesla MRI, and an advanced PET CT. Dr. Greco and McNeil coordinate biopsies with the Gorman Imaging Center, if it is not something they can do in the office.

According to McNeil, providing convenient access to regular screenings is an essential part of providing comprehensive care.

Kristen A. McNeil, PA-C

“Having convenient access to a facility like Gorman Imaging is really important, so patients can easily get their annual mammograms,” she says.

Dr. Greco agrees and adds, “There are people who are motivated now to get their care because they can go to Oneida. All patients want to have their care close to home.”

A Rapidly Changing Field

Collaborating with other physicians and staying up to date with the latest techniques is essential to providing patients with the best possible care. Breast care is one of the most rapidly changing subspecialties of surgery and medicine, which Dr. Greco finds exciting.

“More than ever, women are very invested in their own health care,” she says. “They come pre-educated with questions and have discussed options with their friends and family. Our team takes great pride in not only discussing their concerns but sharing with them the advanced treatment options, many available right here in Oneida.”

Dr. Greco uses advanced surgical practices such as oncoplastic closure for more cosmetic healing, and sentinel lymph node biopsy after neoadjuvant chemotherapy, to help reduce lymphedema complications. She is hoping to soon have plastic surgery available at Oneida Health to do simultaneous mastectomies and reconstruction, eliminating the need for patients to travel.

New Developments

“In order to be a specialist, you have to stay on top of all of those changes and be aware of the most current recommendations and standards of care,” Dr. Greco says.

She and McNeil work closely with medical oncology and radiation oncology to for treatment planning, as chemotherapy and radiation therapy indications continue to change and evolve.

Determining which patients qualify for genetic testing is changing too. Anyone with a history of breast cancer is now eligible for genetic testing, a change from what was recommended three years ago.

“We are happy to see those patients, counsel them and test them,” Dr. Greco says.

Oneida Health Breast Care Staff: Jayme Lohr, Dawn Leduc LPN, Karisa Zuke, Linda Lyon RN, Kim Sabatino LPN, Mary Ellen Greco, MD, FACS, and Kristen McNeil, PA-C

Gun Violence in Central New York

By Kathryn Ruscitto

Tuesday, October 25, 2022

It’s time to focus on solutions.

Every morning, as I read the news, there’s more and more reported gun violence. I’ve been reading — but not acting — for far too long, and I have to ask myself why. Gun violence is getting worse and more violent, and everyone involved suffers from this epidemic: the shooter, the victim, the families and the community members lost to death or incarceration.

In August, Syracuse police reported a 35% increase in those injured or killed by gunfire over the last year, from 81 individuals to 110. 

Many of these deaths were among teenagers, and nationally, gun violence is now the leading cause of childhood death. The issue — which has become a political football — is clearly based on fact: Guns are causing deaths.

What are we going to do to reverse this trend? Many other public health threats, from smoking to driving under the influence to COVID-19, have prompted research and program interventions. They may have taken time, but slowly, progress was made and public health improved.

Many experts are concluding, similar to how infant mortality rates are viewed, that we have a deep societal problem on our hands, one that requires us to look closely at the social determinants feeding this crisis. Inherent racism in our systems, a proliferation and lack of controls on firearms, poverty, and lack of programming and resources for children are certainly factors.

Standing Up To Do Something

This epidemic needs a different kind of partnership to break through to faster results. Engaging the communities and the leaders closest to the problems, and listening to their recommendations for investment, often referred to as place-based decision-making, would help.

What is somewhat hopeful is the call to action building across the healthcare community with research, funding and best practice innovations.

Michael Dowling, CEO of Northwell Health, launched an initiative this summer called The Gun Violence Prevention Learning Collaborative for Health Systems and Hospitals, and 1,000 healthcare organizations and clinicians have joined the effort.

“This is about protecting people’s health. This is about protecting kids’ lives,” Dowling says. “Have some courage. Stand up and do something. Put the interest of the community in the center of what you think about each and every day.”

We each can contribute in ways that move the conversation forward. Discuss the issue with your family and social and professional organizations. Support funding for research and programming that keep children engaged and safe. Understand the social determinants and attitudes we can change in health care.

This issue won’t get better with hope alone. It requires outrage and action, as Dowling reminds the healthcare community.

“Our job is to save lives and protect people from illness and death,” he says. “Gun violence is not an issue on the outside — it’s a central public health issue for us. Every single hospital leader in the United States should be standing up and screaming about what an abomination this is.”


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

Leading the Way in Robotic-Assisted Surgery

By Becca Taurisano
Tuesday, October 25, 2022

Crouse Hospital’s robotic-assisted surgery program is the largest and most successful in Central New York, thanks to the collective expertise and support of the surgeons participating in the program.

Kenneth Cooper, DO, (right) and Jeffrey DeSimone, MD, with the da Vinci Robot
 

Since it started in 2008, the robotic-assisted surgery program at Crouse Hospital has grown to include seven robotic platforms, with six da Vinci XI systems and the latest addition of a da Vinci Single Port (SP) system, the only one in Central New York. The program’s surgeons have completed over 14,000 procedures in the areas of general, bariatric, colorectal, thoracic surgery, GYN oncology, gynecology, and urology. Crouse’s commitment to the success of the program ensures the region’s largest multispecialty robotics surgery program will continue to flourish, enhancing the patient experience and benefiting the community as a whole.

Kenneth Cooper, DO, and Jeffrey DeSimone, MD, use the robotic platform to perform gastric bypass and sleeve gastrectomy bariatric surgery. When the da Vinci XI, a four-arm robotics system, was released in 2014, Dr. Cooper says it was a game changer compared to laparoscopic surgeries.

“There are a lot of options in this community for surgery of all kinds, including bariatric, but Crouse is clearly the leader in Central New York in robotic cases and that makes the difference.”
— Kenneth Cooper, DO

“The robotic-assisted technology provided patients with a less invasive surgical experience, and made it more comfortable for surgeons,” Dr. Cooper says, citing the physical challenges surgeons have when working on patients with an elevated body mass index (BMI). The da Vinci XI allows Drs. Cooper and DeSimone to perform bariatric procedures in ways they could not do laparoscopically.

“We didn’t think we could improve upon laparoscopic surgery, but the data we have collected has shown that robotic surgery is an excellent option for our patients,” Dr. Cooper says.

Incision sizes with the robot are similar to laparoscopic incisions, but patients recover faster and have shorter hospital stays. In addition, robotic-assisted surgery significantly reduces the need for postoperative narcotics among bariatric surgery patients, who are able to return to work faster with fewer incision issues requiring wound care.

“We were a Center of Excellence three times over before robotics, so we didn’t think we could improve on our excellent outcomes, but we did,” Dr. Cooper says.

Surgeons have greater control with the da Vinci XI technology, allowing them to toggle between the four arms, which include surgical instruments and a camera. “You can see detail you couldn’t see otherwise,” Dr. Cooper says. “That allows us to visualize much more clearly, especially in patients with a large amount of intra-abdominal tissue.”

The robotic instruments can be rotated like a human wrist in multiple planes, allowing surgeons to operate in tight spaces and use both hands with complete dexterity. The instruments themselves are high-tech and smaller in size, which reduces the potential for complications and bleeding. The technology allows surgeons to perform procedures faster and with more efficiency.

“Anything that is an advantage for me as a surgeon is going to translate into an improvement for our patients,” says Dr. DeSimone.

Introducing robotics technology into the operating room has changed the skill set needed for the surgical team. Every member of the team must be able to prepare for next steps before the surgeon performs them, streamlining the entire process. Dr. DeSimone refers to this process as a highly choreographed dance. Highly-skilled personnel that possess the knowledge of the robotic platform and equipment are essential to ensuring a case is completed quickly and efficiently.

 

The Robotic-Assisted Surgeons at Crouse Hospital

Bariatric
Kenneth Cooper, MD
Jeffrey DeSimone, MD
Taewan Kim, MD

Colorectal
James Berry, MD
David Nesbitt, MD
John Nicholson, MD

Cardiopulmonary Thoracic
Michael Archer, MD
Mark Crye, MD
Jason Wallen, MD

General
Akbar Ahmed, MD
Benjamin Sadowitz, MD
James Sartori, MD

Urology
David Albala, MD
Po Lam, MD
Hadley Narins, MD
Nedim Ruhotina, MD
Harvey Sauer, MD

Gynecology
Stephen Brown, MD
Nikole Bucsek, MD
Catherine Fiori, MD
Myron Luthringer, MD
Navpriya Oberoi, MD
Byuong Ryu, MD

OB/GYN Oncology
Rinki Agarwal, MD
Douglas Bunn, MD
Mary Cunningham, MD
Allison Roy, MD

“We heavily rely on other individuals to do their part so we can provide the safest care for our patients. It is truly a team approach and we are very efficient with the use of our time,” says Dr. DeSimone.

“The hospital’s commitment to robotic surgery is visionary.”
— Jeffrey DeSimone, MD

Po Lam, MD, (left) and team
 

Urology surgeon Po Lam, MD, performs prostatectomies using the da Vinci SP (Single Port) robot, which has a single arm, or port. Originally, the SP unit was mostly utilized by teaching hospitals to refine surgical techniques done with multiport systems.

“The SP platform puts Crouse in a very unique position, as it is the only system of its kind in Central New York,” Dr. Lam says.

In addition to the change from multiple ports to one port, the instrumentation with the SP system is more flexible. Dr. Lam explains that the flexibility of the instrumentation and the camera allows the surgeon to work in tight spaces they could not access before.

“It allows for an innovative way to do the same surgery in a more confined space,” says Dr. Lam. “With the availability of the SP, there’s no reason to perform prostate surgery any other way.”

For Dr. Lam’s patients, there are numerous benefits to having robotic-assisted surgery with the da Vinci SP.

“We can reduce the risk of damage to the intestines or large blood vessels and avoid scar tissue that may exist due to a patient’s prior abdominal surgeries.”

The positioning of the patient is different with the SP robot as well. During a laparoscopic prostatectomy, a patient is placed with their head down and feet up, creating potential issues to maintain proper breathing during anesthesia. By eliminating this positioning during robotic surgery, patients have fewer issues and faster recovery.

“The real impetus to do this is that it’s ultimately better for our patients,” says Dr. Lam

“The ability to enter the body through a single, small incision helps surgeons perform procedures in a less invasive way, helping to reduce trauma and discomfort to the patient.”
— Po Lam, MD

From the beginning of the robotics program in 2008, Crouse has been the regional leader in the field of robotics surgery, ensuring that their surgeons have the resources they need to be on the cutting edge.

“To their credit, Crouse leadership understood the advantages of robotic surgery early on and has done a great job of nurturing the program,” Dr. DeSimone says. Bariatric patients require special equipment and furnishings to accommodate their size and Crouse provided them with everything they need on their own floor, making an overnight stay in the hospital more comfortable. “We have never been faced with a lack of institutional support,” Dr. Cooper says.

A Higher Level of Care that is Female by Design

Women’s health is deeply rooted in the history of St. Joseph’s Health. Saint Marianne Cope, a visionary in hospital management, opened the hospital in 1869 and welcomed everyone regardless of gender, religion, nationality or financial situation.

Today, the Women and Infant Services at St. Joseph’s Health includes award-winning breast care, gynecology and maternity services designed to provide the most comprehensive women’s care in one service line. As the only Baby-Friendly hospital in Central New York, St. Joseph’s is recognized for gold standard guidelines for breast feeding education and support established by the WHO and UNICEF. St. Joseph’s NICU was the first in the region when it opened 50 years ago, and is a two-time winner of the Guardian of Excellence award for Neonatal Intensive Care Patient Experience by Press Ganey. And St. Joseph’s Health was awarded the BlueCross BlueShield Blue Distinction Center for Maternity Care. The organization’s highly qualified, respected and dedicated female physicians share the same passion as St. Joseph’s founders.

Suchitra Kavety, MD, a board-certified OB-GYN and Syracuse native, says 2020 was a year unlike any other in her two-decade career.


Suchitra Kavety, MD

“St. Joseph’s is incredibly supportive of women physicians,” Dr. Kavety says. “Thanks to support from my fellow physicians, staff and patients who trusted us to come in for exams and treatments, we were able to bounce back during the pandemic.”

Dr. Kavety’s practice followed strict cleaning protocols and rearranged rooms for social distancing, but also offered virtual options for patients who were unable or unready to visit places in-person.

“We could do virtual visits with a patient and her family, and it’s also helpful for postpartum patients,” Dr. Kavety says. “Patients didn’t need to leave home for me to walk through medications or other medical needs.”

As we emerge from the pandemic, Dr. Kavety says women — who seem to have been affected more than anyone else during COVID-19 through increased demands from work and at home — need to focus on themselves.

“Women, in general, don’t prioritize themselves. But self-care is extremely important because most women put their health behind everyone else’s,” Dr. Kavety says. “Women tend to prioritize others in their family, at work, and in their community above their own needs. Medical services such as routine gynecological exams are important elements of self-care that should be prioritized.”

St. Joseph’s award-winning Breast Care and Surgery Program is nationally recognized for its exceptional outcomes, making St. Joseph’s Health the breast care leader in Central New York.

Kara Kort, MD, has performed thousands of surgeries in more than 20 years of breast care.

Kara Kort, MD

“St. Joseph’s Health has one of the highest volumes of breast surgeries in our region,” she says. “Experience and knowledge are what makes the St. Joseph’s breast care team one of the best in the nation.”

While COVID-19 impacted many healthcare services, Dr. Kort says appointments for screenings did not significantly drop.

“When it comes to breast cancer, there really hasn’t been that big of a difference in patient volume,” Dr. Kort says. “The fear of cancer makes people anxious and upset more than the virus.”

Dr. Kort was glad to see patients keeping appointments, but emphasized that screenings and mammograms should always be top of mind for all women.

“One in eight women will get breast cancer. That’s a very high and upsetting number,” Dr. Kort says. “We’ve treated many patients with breast cancer or other related issues, and we’ve seen amazing outcomes. We understand the physical and emotional aspects, and we’re here to help people take charge of their health and navigate this disease.”

Beata Belfield, MD, is trained in minimally invasive surgeries and advocates the many benefits of these types of procedures. Minimally invasive means smaller incisions, faster recovery and quicker back-to-work time.

She is also the only local surgeon with the most up-to-date training in the latest complex abdominal wall repair training. She was called into the operating room one weekend night to treat a patient who was suffering from a hernia and needed emergency surgery. With the help of her colleagues, Dr. Belfield was able to jump in and perform minimally invasive surgery that same night and the patient was able to go home the next day.

Dr. Belfield believes this procedure will become much more common in the near future.

Nelly Kazzaz, MD, a cardiologist with more than 15 years of experience, considers it an honor and privilege to serve her community. As a board member of the American Heart Association’s Central New York chapter, Dr. Kazzaz speaks regularly at St. Joseph’s Health Community Outreach programs.


Beata Belfield, MD

Nelly Kazzaz, MD
 

“Seeing a cardiologist can be a very stressful event,” Dr. Kazzaz says. “When they approach us as a person — a nonmedical professional — during an event, they are much more comfortable and willing to share and ask questions.”

This kind of community outreach has helped to prevent heart attacks, strokes and other heart-related diseases.

During the height of the pandemic, Dr. Kazzaz turned to telemedicine to see some patients, but virtual visits were still difficult for the high-risk population.

“It’s difficult to not be able to see a swollen leg or not use electrons when a patient complains about having chest pains,” she says.

With more people being vaccinated daily, Dr. Kazzaz stresses the importance of routine doctor’s visits and paying attention to your heart. She also urges women to pay extra close attention to their hearts because of the additional stress caused by the pandemic.

“Women are affected the most by the pandemic,” Dr. Kazzaz says. “If you’re working from home, you may also be a mother, a cook, a teacher, etc. We do everything for other people and forget ourselves.”

These extraordinary physicians and surgeons are part of a much larger team at St. Joseph’s Health, where women’s health care is female by design. They understand the unique needs and challenges for women, offer the latest innovative programs and procedures, and are on the forefront of new developments in women’s health care.

Risk Assessment In Health Care

There are two skill sets under taught and undervalued among leadership teams: risk assessment and crisis management. A good risk assessment reduces the need for crisis management.

Often compartmentalized to an emergency manager, the fundamental responsibility for assessing and planning for risk rests with board members and leadership teams.

Assessing risks and hazards for health and patient safety, cyber security, facilities, programs, finances , reputation, compliance and integrity should be an annual agenda item for board members and other leadership. What are our priorities? Who could be harmed? Do we understand where our focus would improve the benefits and outcomes of this work? Everything has risk, but the opportunity in a risk assessment is to prioritize what can have meaningful risk reduction.

It’s a great area to use as a test case for a team. What keeps us up at night? How do we prioritize and prepare? In a crisis, do we have all the tools and plans to function? I have written a simulation for teams available on LinkedIn.com/kathrynruscitto. If you have engaged in this work, have your suppliers and subcontractors?

The coronavirus gave many teams the opportunity to experience in real time the lack of pandemic risk assessment and planning in our supply chain. This experience not only heightened our awareness about the vulnerabilities in our organizations but, more importantly, in our partners. We recognized how interdependent we are and the importance of asking those partners if they are also engaging in assessing risk.

Defense contractors and insurers maintain risk plans and have adopted good processes around input for these plans. In addition to the board or leader providing direction, they must engage input from all stakeholders in the organization. Those closest to the process best understand the vulnerabilities.

Kimberly Townsend, President and CEO of Loretto, states that her board created a risk management committee and has found the experience important.

“Our Board is using a board led committee to work with our leadership team to evaluate all aspects of our facilities and operations,” Townsend says.

Consider assessing your areas of risk and planning for the next crisis.


You can reach out to Kathryn Ruscitto on LinkedIn or via email at krusct@gmail.com.

Resources to Use

Websites

Podcasts

Listening, Learning and Responding to Disparities in Health Care

By Kathryn Ruscitto

Monday, November 2, 2020

I am not sure I realized what white privilege meant until I sat in a room of diverse women several years ago.

As we went around the table and discussed our careers, I listened to issues that I had not encountered. When the evening was over, I left asking myself how I could use my position and advantage to open more doors and help advance the careers of diverse women. That was a lesson I wished I had learned earlier in my career.

There were times I would ask board committees I was on or at events I was part of to recruit more diverse candidates for board positions or honors. Some organizations listened and acted, others did not.

Many years ago, I was also involved with setting policies that involved choosing a location for senior housing or clinics without asking myself if underserved populations could access the facilities. Later in my career, when those questions were asked, it resulted in better access and funding awards to benefit all communities.

The past several months of public discourse have helped me understand what my Black friends tried to tell me, how my own discomfort prevented me from recognizing the racism they faced every day and the pain that resulted for their families.

Those of us who have worked and are working in health care cannot let the disparities that exist in access and treatment to continue. The data is clear. According to the Centers for Disease Control and Prevention:

  • Diabetes among white adults is 7.5 %
  • Diabetes among Black adults is 11.7 %
  • Diabetes among Hispanic adults is 12.5%

These same disparities exist in breast cancer, Lyme disease , heart failure and maternal outcomes. Funding for research and treatment for chronic diseases must have a priority to reverse these trends. Our voices in our associations’ legislative agendas should advocate for this focus.

This period in our country demands we acknowledge we have a lot of learning and change to initiate, followed by action plans. I’ve stopped asking my BIPOC friends what to do. It’s time to figure out what I have to do to be a better colleague, friend and neighbor.

We all have opportunities to move this discussion forward by asking in our own spheres of influence:

  • Are our boards reflecting diversity?
  • Are our executive teams diverse?
  • Are our providers culturally sensitive?
  • Are our staff trained to be welcoming and culturally sensitive?

If the answer is no to any of the above, then, we must decide what are we doing to mentor, train and hold ourselves and our teams accountable for progress. It’s up to all of us to lead on these issues.

Resources Available

There are great resources available to help on this journey.

  • healthypeople.gov
  • ama-assn.org
  • Health Disparities Toolkit
  • Unequal Treatment, Institute of Medicine
  • Just Medicine: A Cure for Racial Inequality in American Health Care
  • Health Disparities in the United States

Loretto Partners with Clarity Clinical Research to test new COVID-19 drug for seniors

Loretto took early action at the start of the pandemic to protect our community’s most vulnerable population — an effort that resulted in less than 1% of residents testing positive for the virus.

Now looking forward to future protection against COVID-19, Clarity Clinical Research is working with Loretto to launch a clinical trial with an investigational treatment for people who were exposed (or potentially exposed) to COVID-19 to test the medication’s ability to reduce the risk of becoming infected for those living in long term care facilities.

The drug is a post-exposure prophylactic and the active ingredient, Nitazoxanide, is already approved by the FDA for acute viral respiratory illnesses.

“Nitazoxanide has been used to treat an estimated 400 million people worldwide. This means we already know the safety performance and side effects of this drug,” says Lisa Sonneborn, MA, LMHC, Site Director for Clarity Clinical Research. Clarity Clinical Research in East Syracuse is one of only two sites statewide leading this study.

“The benefit of this study is that it only requires one person to test positive for COVID-19,because that allows Clarity Clinical Research to open up participation in this trial with all residents at the facility who may have been exposed to the individual who tested positive,” says Julie Sheedy, Chief Marketing & Engagement Officer at Loretto. “Eligibility does not require every participant to test positive for COVID-19.”

The study is being offered exclusively to qualifying Loretto residents at The Bernardine, Sedgwick Heights, Buckley Landing, and The Nottingham.

“Residents at these facilities tend to have the highest levels of independence and can meet the study’s requirements, including making medical decisions and diary keeping,” Sheedy says.

This is one of many studies the clinical research company in East Syracuse offers. Clarity has been a leader in Alzheimer’s and dementia research, focusing on evaluating treatments to slow or stop the progression of memory loss. The research clinic has found new and innovative ways to continue enrolling patients into Alzheimer’s trials despite the challenges caused by COVID-19. Using telehealth and virtual memory screening, Clarity has long supported national trials in the search for a cure for Alzheimer’s disease.

In addition to partnering with Clarity Clinical Research to offer innovative trials to help prevent the spread of COVID-19, Loretto has also partnered with other companies that offer groundbreaking technology to keep its residents safe and healthy.

Loretto has had a long partnership with ImagineMIC, a health-monitoring device that tracks a person’s vital signs and other important health indicators 24/7. The health data is collected and monitored by a team of physicians and medical staff 24 hours a day. Participants of the telehealth device have access to that team of medical professionals around the clock.

In April, Loretto rolled out MonitorMe, a second-generation health-monitoring device also made by ImagineMIC. To date, close to 100 Loretto residents and program participants have enrolled in these two telehealth programs and the results are overwhelmingly positive.

COVID-19 has certainly changed the way healthcare providers care for patients. Loretto is committed to offering new technology and forging new partnerships, while Clarity Clinical Research continues to be on the cutting edge of offering innovative studies that benefit our community. Their individual efforts and their partnership will help keep our most vulnerable population safe and healthy.

Innovation in Health Care

by Kathryn Ruscitto

Monday, June 29, 2020

We clearly have a long way to go to get past this virus. So many challenges, and so many thanks for all front line clinicians and staff who have gotten us this far.

There are some bright spots of innovation emerging from the chaos. As with any period of complexity, we are also presented with great opportunities for change.

The key will be improving the disaster we have seen in supply chain. For any of us who tried to buy masks, gloves or other protective materials for organizations, the fluctuating quality, costs and global fraud involved in obtaining that equipment suggests we need to remold our manufacturing and supply chain. Innovators, please jump in!

We need to examine access to care and the disparities that emerged across urban and rural communities. This means determining how we use data and best practices to better assess and understand these disparities and create a response system for the next pandemic. This also means better systems for addressing vaccine and treatment protocols.

Kathryn Ruscitto

The isolation and fear that has emerged for at-risk elders living at home or in long-term care facilities needs attention. How do we provide better protection and support? Great opportunity exists to apply emergency management algorithms to protecting important community members.

While these trends suggest new opportunities, innovation in health care is already happening on many fronts.

In talking to graduates and startups, I keep stressing this time as an chance to advance bold new ideas and new products. Some examples of promising new startups from the Blackstone LaunchPad powered by Techstars at Syracuse University include:

MedUX: medux-llc.com is an award-winning medical product company based on user-centered design. Its first product is a wearable/portable IV system for people in hospital, infusion center and home infusion settings. This product is also used in emergency first response and military situations, offering patients infusion treatment without being tethered to an IV pole.

PAANI: paanisolutions.com, a venture developed by two female founders, addresses a public health crisis in India, where 163 million people lack access to clean water. Using a traditional sari cloth, they engineered a culturally appropriate filtration system to capture pathogens and particulates.

Visos: visosvr.com is a VR platform specifically for medical applications, working in conjunction with a team of advisors that include leaders in the health industry.

Promptous: promptous.com is led by a team building a digital health innovation venture in the insurtech space. It is a blockchain-powered platform to make access to dental benefits simple, seamless and transparent. Their goal is to help make dental benefits affordable and accessible to the 74 millions who go without dental insurance.

In-Spire: news.syr.edu/blog/2018/04/24/engineering-and-computer-science-students-win-panasci-business-plan-competition-with-wearable-inhaler, is a sleek wristband asthma inhaler developed by two female founders who won the CNY Biotech Accelerator Medical Device Innovation.

SugEx: dailyorange.com/2019/10/su-senior-invents-watch-monitor-glucose-levels-diabetes-diagnosis , a wearable technology to make glucose monitoring easier, was developed by an engineering student and industrial design student (one of whom was unexpectedly diagnosed with juvenile diabetes while in college).

If you have any interest in being a mentor for a promising student startup, head to launchpad.syr.edu. Mentors play a key role in accelerating learning about application in a clinical setting. I’ve served as a mentor for MedUX and have enjoyed watching many a great product be launched.

It’s a challenging time, and if you encounter a student concerned about the future, share the exciting startup ideas that are emerging for health care and the opportunities that they can help to explore.

Kathryn Ruscitto, Advisor, can be reached on LinkedIn at Kathrynruscitto or at krusct@gmail.com.

Daniel Alexander, MD, Joins Auburn Orthopedic Specialists

By Molly English-Bowers

Monday, August 29, 2022

Auburn Orthopedic Specialists (AOS), affiliated with Auburn Community Hospital, has added another orthopedic surgeon to its growing practice. Daniel Alexander, MD, is one of the most respected and accomplished orthopedic surgeons in upstate New York, with 20 years of experience performing more than 20,000 surgeries. Recognized for both his professional achievements and his community service, Dr. Alexander will join AOS in early October.

“I am thrilled to join the team at Auburn Orthopedic Specialists, and to be a part of Auburn Hospital and this community,” says Dr. Alexander, whose specialty is joint replacement surgery. “The medical professionals at AOS have built a first-class orthopedic practice, and I look forward to helping them grow this practice.”

He will join four physicians and three physician assistants with expertise in a variety of fields ranging from hand and wrist surgery to sports medicine and joint replacement.

Dr. Alexander is a leader in ROSA (Robotic Surgical Assistant) total knee arthroplasty and has performed arthroscopic surgeries and treated orthopedic trauma and fracture fixation. A Fellow of the American Academy of Orthopedic Surgeons, he’s at the forefront of orthopedic care and research.

“We are thrilled to have someone of Dr. Alexander’s stature and experience join AOS and the hospital,” says Scott Berlucchi, President and CEO of Auburn Community Hospital. “His experience and desire to stay on top of the latest orthopedic procedures and technology will be a tremendous asset to our community.”

Dr. Alexander will join the physicians at Auburn Orthopedic Specialists’ total joint replacement program and work closely with referring primary care providers and patients to ensure excellence in care from diagnosis to rehabilitation.

“All of the surgeons at AOS are doing remarkable work and I am impressed with the investments Auburn Community Hospital leadership has made in new technology to allow this practice to grow and serve the community,” Dr. Alexander says.

Reaching Residents in Other Ways

Daniel Alexander, MD, has an impressive medical resume, but his community service is also noteworthy, particularly his reach to the underserved. He was instrumental in building the new state-of-the-art emergency department at Newark-Wayne Community Hospital, and is responsible for building a community center in one of Buffalo’s poorest neighborhoods, where he grew up.

Dr. Alexander also helped build a Boys and Girls Club in Geneva, New York, to connect and empower young people to reach their full potential. He currently co-chairs “Boldly Buffalo,” a fundraising campaign to support his alma mater, the University of Buffalo (UB), including the UB medical school. Under his leadership, the campaign will soon meet its goal of raising $1 billion.

Dr. Alexander received his medical degree from the State University of New York at Buffalo and completed his training at Henry Ford Hospital in Detroit, Michigan. He is the founder of Finger Lakes Bone and Joint Center and Open MRI of the Finger Lakes, and was Chair of Orthopedics for Rochester Regional Health eastern region. He will soon depart his current position at Newark Wayne Community Hospital and Clifton Springs Hospital.