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Accelerated Recovery Without Opioid Risks: How New York Surgeon Andrew Wickline Reinvented the Joint Replacement Experience

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By Elesa Swirgsdin

Friday, June 17, 2022

Andrew Wickline, MD, is raising the bar on total knee and hip replacements with game-changing protocols that minimize the need for pain medications while maximizing results.

Andrew Wickline, MD, Nicole Urbanke, RN, Jodi Pearsall, RN, Kristin Thayer, ST, Stevana Hanna, ST, Dana Siriano, RN, Paul Crescenzi, CRNA
 

Total knee and total hip replacements typically lead to painful recovery periods filled with difficult physical therapy sessions. Not only does this deter some patients from getting a procedure that can vastly improve their quality of life, but it also raises the risk of patients developing an opioid dependency after surgery.

Andrew Wickline, MD, an orthopedic joint replacement specialist at Genesee Orthopedics & Plastic Surgery in New Hartford, located about 50 miles east of Syracuse, has proven this troubling trend doesn’t have to continue. After developing Therapy-Free Total Knee Replacement, a program that virtually eliminates the need for traditional physical therapy following a joint replacement, Dr. Wickline published the lowest opioid use rates in the country for this type of procedure, with high patient satisfaction and positive long-term outcomes.

His groundbreaking protocols have also led to the lowest patient costs and the lowest complication rate in the state of New York, even among patients with a high number of comorbidities.

Responding to Patient Needs

“At the end of the day, a huge part of a doctor’s job is customer service,” Dr. Wickline says. “I asked my patients, what can I do better? The answers made me think about why we do such aggressive physical therapy after joint replacements, and if there could be a better way. That was the inspiration for developing my therapy-free program.”

Many patients told Dr. Wickline that the joint replacement surgery itself wasn’t a bad experience, but the physical therapy prescribed during recovery was nearly unbearable, especially for total knee replacements.

“I heard things like, ‘I hate therapy. It was absolutely terrible.’ Or ‘My mom won’t go back to do the other knee because she doesn’t want to go through therapy again,’” Dr. Wickline says. “I started looking at what we could do differently.”

Some patients also had to travel long distances for physical therapy, which presented a significant obstacle to a successful recovery. After developing an at-home therapy plan for these patients, Dr. Wickline found that they experienced less pain, better range of motion, and a faster overall recovery than those who followed a traditional, intensive inpatient physical therapy program. This success has been seen with patients from Pakistan, southeast Asia, Canada, the Caribbean, Texas, North Carolina, New Jersey, Maine and Pennsylvania.

 Andrew Wickline, MD

Siobhan Fitzgerald, RN, BSN, Nurse Administrator

Apex Surgical Center

Exceeding Expectations

Dr. Wickline began using a home-therapy method for all of his patients combined with a comprehensive education and optimization plan. The results showed not only an easier recovery, but patients needed drastically fewer narcotics for pain relief following surgery. In 2020, he published the results of his new study, in the Journal of Orthopaedic Experience & Innovation. It involved 386 patients who had total knee replacement. During a 12-week period, 86.3% of patients needed 10 or fewer opioid pills, while 18.9% used zero opioids.

Dr. Wickline’s results are 16 times less than the national average and five times less than the next best published opioid reduction paper from Mayo Clinic.

“I saw a new study that said the average across the country is 1,200 morphine milligram equivalents for the three-month period after total joint replacement,” Dr. Wickline says. “That’s around 160 oxycodone 5mg pills for 90 days — compared to 10 pills or less with my protocol. There is still a disconnect, and we need better opioid stewardship in New York and across the country.”

In 2021, more than 107,000 people in the United States died from opioid-related overdoses. According to some studies, between 8% and 12% of people who are prescribed opioids for pain after joint replacement may develop an addiction.

Dr. Wickline’s approach replaces the typical 90-minute physical therapy sessions three times a week with four simple 8-minute exercises once an hour. Using elevation and ice after the exercises also keeps swelling down, which further decreases pain.

“If you sprain your ankle badly, you’re not going to do a 90-minute workout three times a week,” he says. “It turns out that you don’t need to do aggressive, tortuous therapy if you control swelling. Formal therapy is best used to fine tune recovery at five to six weeks after surgery.”

More than 85% of patients in Dr. Wickline’s study did not need formal physical therapy, leading to an average personal savings of $720 in therapy copays and more than $3,000 savings to insurers. In addition, 64% of patients in the study went home the day of surgery and 91% were discharged within 23 hours. Currently, 95% of patients go home the same day their joint was replaced.

Patients who follow the program also experience significantly fewer complications.

“Our readmission rate is 1.2%. That is markedly lower than results published by some big institutions,” Dr. Wickline says. “That’s also where cost is kept down. If you get readmitted for a fracture, suddenly the cost for that patient has gone up dramatically. According to Medicare cost data, I have the lowest 90-day cost in the state, even though my patients have a higher number of medical issues.”

Contributing Success Factors

Dr. Wickline is among a small percentage of surgeons in the country performing tourniquet-free knee replacements. This practice lowers the risk of blood clots by 19%. It also reduces pain and infection risk and improves incision healing.

In addition, Dr. Wickline is the only site in New York offering personalized kinematic alignment and medial pivot knee replacement. It restores each patient’s normal anatomy of the knee and provides knee motion that most closely resembles that of the native join — without painful ligament releases that increase swelling.

Improving nutrition with branched-chain amino acid protein supplementation and specific anti-inflammatory diet changes also plays a significant role in an accelerated recovery program.

Lastly, Iovera cryoablation, a temporary freezing treatment around the knee, provides patients with three months of post-op pain reduction.

Total Hip Replacement Results

Dr. Wickline delivers similarly impressive results for patients undergoing total hip replacement. In 2020, he published another study in the Journal of Orthopaedic Experience & Innovation reporting the results of a six-week long study following 207 patients after their hip replacement. About 97% of these patients required 10 opioid pills or less, with the average being 3.5 pills per patient in the six weeks following surgery. Patients followed a home-therapy protocol and 95% were able to skip formal physical therapy at six weeks. He has used the muscle sparing anterior hip approach since 2007.

Preparing Patients for Success

Comprehensive patient education is a critical component of Dr. Wickline’s program.

“No one prepares for the Super Bowl the day before the game. They prepare for weeks ahead of time,” he says. “It’s the same with joint replacement.”

Dr. Wickline has written two separate patient books for knee and hip replacements, each about 65 pages long. The goal of the books — now in their 13th edition — is to help patients succeed with proper preparation prior to surgery. The books cover topics like nutrition, getting the living space ready, and what to expect every step of the way before and after surgery, as well as during recovery.

“They answer pretty much every question that a patient has asked over the last 20,000 plus surgeries,” Dr. Wickline says. “They are extremely comprehensive.”

The books are designed to be read at certain intervals prior to surgery, so that patients can, for example, change their diet four weeks before the procedure to set themselves up for a successful recovery. An app is currently in development for patients who prefer watching videos more than reading.

Ongoing Research

Dr. Wickline continues to study opportunities to optimize recovery protocols. His research focuses on the correlation between swelling and pain and is a main focus of his current research.

“The more you control swelling, the better the joint feels,” he says. “We’re doing 3D optical scanning where we’re looking at several different infection control protocols to see if they reduce swelling. We’re also performing bioimpedance testing to look at how much fluid is in the leg before and after surgery. It’s about creating a normative baseline so we can start adding or subtracting different things from the protocol to see what improves or worsens swelling.”

Dr. Wickline also participates in the geko Cross Therapy Registry for Edema, a clinical trial that collects data on how geko neuromuscular electrostimulation technology affects swelling.

Another research focus area centers on the effectiveness of various non-opioid pain management methods, such as pre-op cryoablation, which Dr. Wickline offers to help reduce post-op pain for up to three months without narcotics. He is involved in a study focusing on how long various pain relief methods last and what is most effective for patients with osteoarthritis.

Prominent Surgeons Adopt New Joint Replacement Protocol

After Andrew Wickline, MD, published his studies on therapy-free joint replacement, orthopedic surgeons around the country, as well as in other parts of the world, began to take a keen interest in his method.

Andrew Wickline, MD

“I was having great success with my total hip and total shoulder patients, but my total knee patients seemed to suffer,” says Chris Mellano, MD, orthopedic surgeon in Manhattan Beach, California. “I commonly heard patients say, ‘I hope I never have to do that again.’ I was searching for a way to make the experience easier and less painful.”

Dr. Mellano came across Dr. Wickline’s study on therapy-free knee replacement — and couldn’t believe what he was reading.

“A large percentage of patients used no narcotics after surgery, which is unheard of in my experience,” he says. “Most also did not require formal outpatient therapy, another astounding accomplishment.”

Dr. Mellano was further shocked to find that the patients in the study were not hand-picked to be ideal patients and instead included people of all ages, including those with multiple comorbidities.

Dr. Mellano decided to visit Dr. Wickline’s practice to observe his protocols firsthand. What he saw validated the published results and inspired him to adapt these new techniques into his own practice.

“The most important factor I learned was exceptional dedication to patient education,” Dr. Mellano says. “Patients went into surgery with a clear understanding of the procedure and how to optimize their outcome. On a surgery day, Dr. Wickline and his team efficiently performed multiple total joint replacements without sacrificing patient care in any way. I left feeling empowered by his example.”

After returning to his practice, Dr. Mellano began implementing many of Dr. Wickline’s protocols, including providing patients with educational guides.

“My results have been transformative,” he says. “The first five patients each took zero narcotics and told me that their outpatient total joint procedure was a wonderful experience.”

Far-Reaching Benefits

Dr. Mellano is not alone in his experience. Michael Engl, MPH, a board member of the elite European Knee Associates, who operates in northern Italy, recently traveled to New York to observe Dr. Wickline’s protocols in action.

“Here in Europe, total joint replacements that allow patients to leave the hospital after a few hours is very uncommon,” he says. “It was almost unbelievable. By visiting Dr. Wickline, I am convinced that the knowledge I gained is as high as that of attending international meetings. It was very inspiring to discuss the differences in our pathways.”

Stephen Howell, MD, knee arthroplasty surgeon at Adventist Health Lodi Memorial in Lodi, California, known for his role in helping develop the kinematic alignment method, was looking for a way to perform outpatient total knee replacements when COVID-19 stopped elective inpatient procedures.

“Since adopting Dr. Wickline’s protocols in July 2020, nearly all of our TKA procedures have been outpatient,” Dr. Howell says. “His pain program works synergistically with the kinematic alignment approach. These techniques complement and potentiate each other.”

Looking to the Future

Dr. Wickline hopes that more surgeons across the country will adopt his unique protocols into their practices to reduce the need for narcotics and improve patient outcomes. Several prominent surgeons have already incorporated his techniques into their own protocols, an encouraging sign (see sidebar on page 8).

“It can be hard to get people convinced because these methods are so different, and change can be scary,” Dr. Wickline says. “But the bottom line is if patients follow the program, they’re going to have great outcomes. The key is getting patients engaged. You just have to give them the winning game plan.”

Dr. Wickline earned the 2020 Excellence in Surgery award at the 9th Annual Excellence in Healthcare Awards presented by the Central New York Business Journal. Visit andrewwicklinemd.com to schedule an appointment. You can also call his personal assistant, Mrs. Lorilynn Szkotak, at 315-738-5069.

The Right Way to Curb Opioid Abuse by Americans

Did you know that your grandma could become addicted to opioids because of a knee replacement? It’s more likely than you might think. Knee replacements — with more than 1 million performed every year — nearly always require opioids for pain control. It’s no surprise that the proportion of older adults seeking treatment for opioid abuse nearly doubled in recent years, particularly as the number of joint replacements increased drastically.

Every pill surgeons order can cause substance abuse. A 10-day opioid supply carries up to a 20% risk of addiction. A 24-hour supply runs a 6% chance of addiction. By getting their wisdom teeth pulled, your teenager — consuming opioids for one day — could develop an addiction. Approximately 80% of heroin addicts first misused prescription narcotics.

I propose a radical solution …

Excerpted from an op-ed in the New York Daily News by orthopedic joint replacement specialist Dr. Andrew Wickline on how to immediately begin reducing opioid addiction. To read the full article, visit nydailynews.com and search for Wickline. Siobhan Fitzgerald, RN, BSN, Nurse Administrator

New York Medical Malpractice Market Trends

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By Jenn Negley

Friday, June 17, 2022

Frequency and severity of claims, social inflation, and tort reform are the key drivers pushing malpractice carriers to seek increases during a hard market or reductions in a soft market.

While New York was slower to transition to the soft market of the past 20 years, the good news is that the same might be true of the significant increases we are now seeing in other states. As reported by the American Medical Association, “Rates that jumped 10% or more between 2020 and 2021 were reported in 12 states.”

See below for those states, listed with the share of comparisons reflecting increases of that size:

  • Illinois: 58.9%
  • West Virginia: 41.7%
  • Missouri: 29.6%
  • Oregon: 20%
  • South Carolina: 16.7%
  • Idaho: 11.1%
  • Kentucky: 7.4%
  • Delaware: 6.7%
  • Washington: 6.7%
  • Michigan: 5.4%
  • Texas: 4.9%
  • Georgia: 3.7%


Jenn Negley

Recent unprecedented trends have upended the predictability carriers rely on to maintain their financial strength. Prior to COVID-19, the number of shock losses rose at an alarming pace due to so-called social inflation in jury awards not seen in previous years. While carriers continued to lower pricing concurrent with the drop in frequency of claims, they had not factored in the drastic increase in payout amounts.

There is now a concern, post-COVID, that there will be a significant increase in the frequency of claims, making reduced rates unsustainable. There is also a belief that because many patients delayed routine tests and treatments during the pandemic, health complications will increase as conditions progress further than what we normally see.

Most states, even in the most competitive markets, are seeing a third straight year of overall rate hikes. New York lags behind due to less competitiveness and its Department of Financial Services, which exerts more stringent control on rate filings.

Admitted carriers like The Doctors Company, a newer entrant to the marketplace that’s still aggressively pursuing market share, reduced their rates at the end of last year in the central region. While the carrier MLMIC has held steady on rates, with some selective increases per specialty, it also filed discounts through risk purchasing groups to maintain a hold on their market share. On the non-admitted risk retention group side, expect to see some increases, but overall, these carriers will look to keep “good” accounts and maintain rate flexibility, unlike admitted carriers.

All of these factors are driving rate increases in other states. In New York, while some downstate regions are the most litigious in the country, Central New York is not immune either, making it a difficult market to navigate.

It Is Never Tenable to Leave Savings on the Table

As a buyer, it’s important to keep an eye on a carrier’s financials due to the stressors this market creates. It’s also important to engage the market and take advantage of potential savings while it is available. Working with an experienced professional who specializes in malpractice insurance allows you to test the market and avoid costly mistakes. Working with an insurance broker who has a deep understanding and insight into each carrier’s appetite and rate history is key.

While New York is in some ways less dynamic, it can be very difficult to navigate without strong carrier relationships across multiple companies. Be sure to reach out to a specialist before your renewal, even if it is only to review your current policy and confirm you are receiving all the new discounts available.

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

Jenn will be at the NY MGMA convention in Verona June 29–July 1.

Patient-Centered Care

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By Kathy Ruscitto, Advisor

Friday, June 17, 2022

We have made many advancements in health care these days. Whether this involves staffing, healthcare delivery and access, or new technology and a growing sophistication with vaccines, all of these milestones benefit the patient.

Patient-centered care has emerged as the preferred healthcare framework for providing services that are effective and produce the best outcomes. Patient-centered care is more than listening and engaging the patient in their care. It also involves developing processes and making administrative decisions that improve the overall patient experience — from how a reception area is designed and how patient data is analyzed to education and communication about a diagnosis and even how a bill is explained. Most importantly, patient- or people-centered care means how the elements of the care team and social determinants are connected across time, place and discipline. That collaboration is what is so important to patients.

Connecting the Dots

We have developed a high level of specialized clinical expertise, but often the parts don’t connect. A patient with MS sees a neurologist for falls, an orthopedic surgeon for joint pain and a primary care physician for general concerns. Without some way to integrate all of this care, the patient is often left navigating a system they don’t entirely understand.

Kathy Ruscitto, Advisor

Health care must be evidence-based and patient-centered, which can be a complicated balancing act. But if the clinician understands the standards of care and how to effectively communicate them, the patient feels listened to and can better address all of their needs with the provider.

The World Health Organization has commenced a worldwide initiative to introduce patient-centered approaches in every country, meaning patient-centered care is now internationally accepted as a best practice framework.

However, to every clinician, every practice and every organization, the words patient-centered care may take on a different meaning. For example, clinical approaches to diagnosing and treating Lyme disease differ between the Infectious Disease Society of America and the International Lyme and Associated Diseases Society. The patient-centered approach calls for any clinician to listen to where the patient is with symptoms and offer care that considers all approaches.

The Institute of Medicine defines patient-centered care as: “Providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” It starts with listening deeply to the challenges and needs of every patient, particularly of those with chronic conditions.

Patient-centered care helps set up a collaborative dynamic that meets patients’ needs. When done well, it’s a win for clinicians, a win for patients and a win for payers because this care model improves health outcomes.

Finally, and probably worthy of another discussion itself, how can we use technology to create virtual care teams around chronic conditions and improve our care plans?

Resources

  1. Institute for Patient and Family Centered Care (ipfcc.org/)
  2. Patient Engagement HIT (patientengagementhit.com/news/what-does-patient-centered-care-truly-mean)

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

St. Joseph’s Health: Empowered, Engaged and Resilient

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By Robin Overbay

Thursday, April 14, 2022

The pandemic caused unimaginable challenges for healthcare systems across the world. In central New York, St. Joseph’s Health was up to the task.

Measures taken prior to the pandemic and meaningful adjustments made in response to COVID-19 set St. Joseph’s Health up for success and enabled them to maintain capacity and serve their community during one of the most difficult times in healthcare’s modern history.

Fostering a team approach and shared governance set the precedence of unity by allowing nurses and other staff to share concerns which would then be addressed to improve patient safety, optimize positive outcomes, ensure job satisfaction, and elevate the overall experience of patients and their families. Working this way throughout the pandemic also brought the St. Joseph’s Health team closer together, which measurably improved resiliency among staff, something still evident in the recovery phase following the initial and subsequent COVID-19 surges.

“Our nursing team here is absolutely wonderful and comfortable with the ever-changing landscape, and they are able to effectively care for and support our community,” says Jamie M. Kabanuk, DNP, MSN, RN, NEA-BC, Chief Nursing Officer at St. Joseph’s Health.

Raising the Bar for Clinical Excellence

Kabanuk believes promoting employee engagement and empowerment — in tangible ways — can directly improve patient safety and outcomes.

“We promote a shared decision-making platform here at St. Joseph’s Health, and we use our shared governance committee and our unit practice committees to elevate the voice of our bedside colleagues,” Kabanuk says, noting how this approach allows for faster and better identification of issues so changes can be made to improve patient care and experience. This approach also empowers the clinical team because they know their input is heard, valued and taken seriously.

“Our Unit Practice Council (UPC) is right down at a unit level, including our licensed staff and unlicensed staff, ancillary staff and manager/leadership staff, to be a part of bringing the unit’s voice to the higher-ups,” adds Helen “Melba” James, MHA, RN, Interim Director, Capacity Management Center at St. Joseph’s Health.

St. Joseph’s Health uses a tiered huddle approach to make it happen. First, the UPC will meet and bring ideas to their managers and leadership. Leadership then huddles and passes this information to directors at another tier level, then it travels to administrators, and on to VPs. Messages heard during the initial UPCs are also heard by practice administrators, the CEO, finance officers and human resources.

“So, it really goes all the way to the top,” James says. “Now, when those concerns are communicated and employees start to see changes, they realize they are a big voice — not a little voice — in this organization, and that there is a whole team behind them at different layers and at different levels of administration willing to help them.”

Kabanuk says shared governance was exemplified when a bedside colleague expressed the need for a designated discharge nurse who could provide support and one-on-one attention to patients during the discharge process. Assisting patients during this process was often time-consuming for staff and sometimes confusing for patients. The administrators listened and decided to provide this new service — tangible proof that they responded to the concerns of their clinicians — which improved satisfaction for both patients and staff.

“We were the ones who were holding this pandemic at bay. I told staff, ‘One day students will read about you in their epidemiology books and learn from how we conquered and overcame — so take pride in knowing that in a way, you have sealed your identity in history.”
— Yuri Pashchuk, MSN, RN, CCRN-k, Clinical Director of Medical and Surgical Services, Critical Care and Careflight at St. Joseph’s Health

Recognition and Positive Reinforcement

Celebrating staff accomplishments — in a profession where burnout and compassion fatigue pose a real threat to healthcare systems — can go a long way toward boosting morale. Positive reinforcement also incentivizes and recognizes nurses who help make the organization successful, which translates to improved patient outcomes and satisfaction.

One of the important ways St. Joseph’s Health honors its staff is to give awards:

  • The DAISY Award honors nurses who go “above-and-beyond” to provide quality, compassionate care to their patients. Nurses can be nominated by patients and/or their families, and by their colleagues.
  • The Good Catch Award, a lapel pin featuring a baseball and catcher’s mitt, gives recognition to team members who identify and bring forward issues that could risk patient safety or quality before an adverse event occurs.
  • The Sister Patricia Ann Award, named after one of the founding nuns at St. Joseph’s Health, recognizes team members who display tremendous healthcare leadership.
  • The Spirit of St. Joseph’s Award is given to those who exemplify the hospital’s values and mission.

When Rewarding Reaps Rewards

Providing a consistent show of appreciation and respect across departments may also have something to do with the acknowledgments the hospital routinely receives for clinical excellence.

“St. Joseph’s has always been a leader in quality and outcomes with Leapfrog designations, the U.S. News & World Report Best Regional Hospital designation, Magnet designation, and the Beacon awards — the highest awards for clinical excellence in critical care — for both of our critical care units,” says Yuri Pashchuk, MSN, RN, CCRN-k, Clinical Director of Medical and Surgical Services, Critical Care and Careflight at St. Joseph’s Health.

Pashchuk says Magnet-designated hospitals offer not only improved patient safety and lower patient mortality rates but also job satisfaction and more options for personal development and growth.

“All of those [designations] translate to a culture that we have developed over the years, where we set a high bar for ourselves,” Pashchuk says. “Those who have stuck with us understand that and they rise to that level and encourage others to do the same.”

“Our nurses have a voice. Our staff has a voice. Our nutritional service members have a voice. It’s not just that we focus on our licensed nurses, but we know that in order for this whole organization to work well, we must hear the voice of everyone from every department. We try to be an all-inclusive culture to improve our community.”
— Helen “Melba” James, MHA, RN, Interim Director, Capacity Management Center at St. Joseph’s Health

An Enduring Alliance Moves Beyond the Pandemic

Staff shortages and burnout aren’t new to healthcare systems, but these problems have grown exponentially in recent years. According to ECRI, an independent non-profit healthcare quality and safety organization, the top two patient safety concerns of 2022 are staffing shortages and the effect the pandemic has on a healthcare worker’s mental health.

St. Joseph’s Health recognized the growing threat and moved quickly to employ policies and procedures that would improve patient outcomes, including taking good care of its team. Prior to the pandemic, St. Joseph’s Health already had some systems in place to reduce the duration of hospital stays and nosocomial conditions, ensure adequate community support on discharge, and reduce the risk of readmissions. However, when the pandemic hit, more adjustments were made, including:

  • Introducing a new patient care tech position that enabled members without a formal healthcare education to receive in-house training to assist and reduce the burden on current staff
  • Redeploying staff from other departments that were seeing lower than usual patient volume into areas that needed more support
  • Using allied health colleagues to augment some of the work that would typically fall on their nurses

“Different executive orders brought all kinds of changes to health care,” Pashchuk says. “We needed to be agile and adapt quickly, and we needed to make sure that our staff had enough time to process that.”

Administration showed their support to frontline healthcare workers early, and it wasn’t uncommon to see the CEO, Chief Medical Officer or Chief Financial Officer rounding on these clinical units, including the COVID-19 unit.

“When we started seeing some of the first waves, it was a very scary time and we needed to be able to be very close at the elbow with our staff to make sure they knew we were in this together, no matter what level of leadership you were in,” Pashchuk says.

The C-suite donned the proper PPE and joined staff in solidarity to make sure they were visible, and that frontline staff had access to top leadership as close to real time as possible.

“Instead of coming to work in suits, we were coming to work in scrubs,” James says, adding that St. Joseph’s Health also introduced a manager-on-call initiative to share the burden more evenly. “Instead of you getting called to come in and me getting called on the weekend, how about I’m just on call for my unit and you for your unit.”

James says the change strengthened the leadership infrastructure and allowed for more uninterrupted downtime and recovery for staff members who greatly needed it.

“We definitely proved that we have each other’s backs,” she asserts. “Our managers have never been stronger, and our clinical managers continue to lean on each other to this day.”

St. Joseph’s Health administrative RN coordinators, whom James calls the unsung heroes throughout the pandemic, carried not only their own personal stress, but the stress of the staff, and that of the patients and patients’ families.

Pashchuk says he’s proud St. Joseph’s Health was prepared to help when COVID-19 cases were climbing, adding that their success was supported by a lot of hard work and processes they implemented years prior to the pandemic.

“That was something that the Department of Health and New York State watched very closely because our colleagues were at capacity,” Pashchuk says about other facilities. “St. Joseph’s was full but was able to maintain capacity and keep their doors open to serve the community for COVID-19 and other medical needs. We took a lot of pride in that, but that wasn’t something that was as obvious or as evident outside of these walls.

“Being a nurse at St. Joseph’s Health is not like being a nurse anywhere else in our community. I joined health care at St. Joseph’s health because I believe nursing can make a difference in people’s lives. We will continue to make decisions together and support the movement forward in our nursing journey.”
— Jamie M. Kabanuk, DNP, MSN, RN, NEA-BC, Chief Nursing Officer at St. Joseph’s Health

Recovery Support

St. Joseph’s Health paid close attention to staff needs and responded with a variety of support, such as adjusting policies to ensure adequate staffing and access to medical supplies. They also implemented resilience rounding for team members who were under more intense stress due to COVID-19 surges.

“Our colleagues are very dedicated to the care of the patients, often putting the care of the community over their own care, and we want to be able to support them in the programs that we are able to provide here at St. Joseph’s Health,” Kabanuk says.

St. Joseph’s Health also has a diverse employee assistance program that provides mental health services including group therapy sessions, individual counseling and psychiatric services. As a Catholic institution, St. Joseph’s Health chaplains and interfaith colleagues are available to talk and pray with staff, provide grief counseling and other support services.

At the end of the day, nurses and other team members at St. Joseph’s knew their community needed them, and they were ready to look the viral enemy in the eye during this pseudo-wartime scenario.

“They rallied around each other and knew, if not us, then who? Who is going to step up and help our community? These were our family members, our neighbors,” Pashchuk says. “Our nurses have been some of our biggest champions and leaders through not only COVID-19, but all challenges where we continue to see improvement.”

Visit jobs.sjhsyr.org for more information on joining the St. Joseph’s Health nursing team.

Crouse Health’s Addiction Treatment Center Expands Access to Services and Improves Patient Outcomes

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By Becca Taurisano

Thursday, April 14, 2022

 

Since 1963, Crouse Health has been a leader in addiction treatment services for Central New York and was the first provider in the area to offer methadone maintenance for the treatment of opioid use disorders. Now Crouse is leading the way again with a new two-story, 42,000 square- foot outpatient treatment center in Syracuse. The Bill and Sandra Pomeroy Treatment Center opened its doors in June 2021 at 2775 Erie Boulevard East and allows Crouse to expand the integration of medical services with a holistic, uplifting and healing environment that will lead to improved treatment and recovery outcomes for patients.

“One of our main goals with the new location was to expand access to services and increase outpatient capacity in a welcoming, safe and nurturing environment,” says Tolani Ajagbe, MD, Medical Director for Crouse’s Addiction Treatment Services, adding that the facility’s increased square footage will enable Crouse to provide treatment and recovery services for an additional 300-plus patients annually.

As the U.S. opioid crisis was exploding during the late 2010s, Crouse realized it was outgrowing its previous treatment center. Monika Taylor, Director of Addiction Treatment Services at Crouse, says, “We were bursting at the seams. It was apparent we needed a larger space to treat the needs of the community.”

In 2017, Crouse secured funding from the New York State Department of Health to build the new center, but then it was a matter of finding a location. Despite the growing awareness surrounding the opioid crisis, there is still a stigma attached to addiction and some communities were reluctant to have a treatment center close by. After a push to increase community awareness, the Erie Boulevard location became available and Crouse was able to build the center from the ground up, which was important to achieving their vision for the completed project. Working with architecture firm King and King, Taylor says they were able to design a space that is welcoming, fosters diversity and is free of stigma.

“The patient experience was front and center to the design,” she says. “We want our patients to feel uplifted when they walk in the door. [The new center] sends a message to people that you matter. You are someone who deserves to be here.”

“I want people to know when you go to Crouse you will not be judged; you will be treated with kindness and care beyond anything you’d ever expect. I have never seen anyone pour their heart and soul into this like they do. They want to see you succeed.”
— Greg Collins, Pomeroy Treatment Center patient recovering from addiction

Creating a Comfortable, Supportive Atmosphere

The Bill and Sandra Pomeroy Treatment Center incorporates unique features that communicate a message of hope to patients. Crouse included thoughtful details in the building’s design, like a glassed-in courtyard in the center of the building to let in natural light, inspirational quotes suggested by staff displayed on artwork and colorful glass windows to enhance the space.

In addition to designated areas for individual and group counseling, the center has a life skills laboratory with computers where vocational counselors can help patients with resume writing. There’s also an on-site fully functional kitchen and laundry facilities. Staff can teach meal preparation and laundry skills to patients who need them, particularly for those whose substance use started at an early age. A sensory room is used for meditation or a nursing mother by dimming the lights and playing soothing music.

Activity therapists can use an outdoor courtyard for movement, and planters are available outside for patients to grow vegetables in the summer.

For patients who have lost their basic living needs due to substance use, a clothing closet is available for them to access everyday wear or business clothing for an upcoming interview. A shower room was developed after speaking with existing patients who explained that some people seeking treatment are living on the streets and may not feel comfortable showering at a shelter.

“These features help our patients feel better about themselves,” says Taylor. “It helps with their dignity.”

Responding to the Pandemic

At any given time, the Pomeroy Treatment Center cares for as many as 1,300 patients, with the capacity to see 300 more. Dr. Ajagbe says he is seeing an uptick in patients seeking treatment, due to the COVID-19 pandemic.

“COVID measures meant to keep us safe impacted addiction like isolation, high stress and economic hardship. Some people self-medicated during this time,” Dr. Ajagbe says. “A direct effect was the huge spike of opioid deaths during COVID.”

In 2017, there were 70,000 deaths in the United States as a result of opioid overdose and 93,000 opioid overdose deaths in 2020. In the 12-month period ending in April 2021, 100,000 people died from opioid use.

“We continue to see the effects in Onondaga County,” Dr. Ajagbe says. “We lost 156 people from opioids in 2020 and 2021 is on pace to be higher than that. More people are trying to access care every day.”

About 50% of the patients at the Pomeroy Treatment Center are being treated for opioid use and the other 50% are seeking help for addictions to alcohol, marijuana, crack cocaine and other substances.

Dr. Ajagbe says the patients that come to the treatment center now are medically sicker, largely due to fentanyl and other substances used in drugs today. Some are also suffering from mental health issues, another side effect of the pandemic.

“We are seeing an increase in mental health issues — depression, anxiety, PTSD, trauma — because of lack of interpersonal interactions,” he says. “The substances people are using are spiked with synthetics and fentanyl that are causing damage in the brain and mental health.”

The Pomeroy Treatment Center can usually address all of their patient’s health issues in one location, whether they need medication to support treatment such as methadone, suboxone or vivitrol, medical treatment from their providers on staff, or mental health treatment.

“If a patient has a cough or sore throat, they can be seen by our medical staff,” Taylor says. “Some patients may not have a primary care provider or their doctor may be treating them differently because of their addiction. Being able to address those issues here is a plus to their overall treatment outcomes.”

Part of the mission of the Pomeroy Treatment Center is to destigmatize addiction.

“A large part of our population worldwide still sees addiction as a moral failure, rather than a chronic disease of the brain,” Dr. Ajagbe says. “Addiction is no different than other chronic diseases like hypertension, diabetes, asthma, Parkinson’s disease, multiple sclerosis, etc. They go through periods of remission and periods where they relapse. Our responsibility is to help them stabilize again.”

Dr. Ajagbe says only 10% to 12% of people with substance use disorders are in treatment and the rest are either unable to admit they need help or do not know how to access care. Dr. Ajagbe believes education about addiction is key, as well as providing 24/7 access to individuals seeking treatment.

The Pomeroy Treatment Center is open seven days a week: Monday through Thursday, 7:30 a.m.–1:30 p.m.; Friday, 5:30 a.m.–4:30 p.m.; Saturday/Sunday, 7 –10 a.m.

CRA Medical Imaging: On the Cutting Edge

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By Martha Conway

Thursday, April 14, 2022

Facilities tout state-of-the-art medical imaging technologies

Nicole Taylor, DO, reads patient files
 

Exciting things are happening in the field of medical imaging, and CRA Medical Imaging is leading the pack. One of the largest diagnostic imaging practices in Central New York, CRA Medical Imaging’s radiologists boast more than 20 years’ experience in the field and proudly deliver the highest level of care to patients with skill sets in specialty areas such as neuroradiology, breast imaging, nuclear medicine, interventional procedures, body imaging and musculoskeletal imaging.

Most of the time, they do it first.

“We strive to stay ahead of the curve, providing the most advanced imaging techniques,” says Medical Director Nicole Taylor, DO. “For example, we were the first in the area to offer PSMA scans and are continuously exploring the newest imaging techniques.”

Clinical quality and service to patients and referring providers are top priorities for the practice, a dynamic that has led CRA to establish locations in Syracuse, Auburn, Fulton and Oswego, where diagnostic testing including ultrasound, x-ray, MRI (magnetic resonance imaging), CT (computed tomography), PET (positron emission tomography)/CT, nuclear medicine, 3D digital mammography and interventional radiology are performed in a friendly, efficient environment.

“What really makes CRA special is the high quality of care that we provide,” Taylor says. “Long before I came to this group, I had heard about CRA’s reputation for providing great service to its patients and providers. Now that I’m a partner here, I see this every day. Taking good care of people is our top priority.”

Taking the lead in PSMA PET-CT

One of the cutting-edge technologies CRA offers is prostate-specific membrane antigen (PSMA) PET-CT. Approved by the Food and Drug Administration Dec. 1, 2020, the radioactive tracer gallium (ga) 68 PSMA-11 may be used in PET imaging not only in men with prostate cancer, but also in men who have been successfully treated for prostate cancer but who are suspected of having had their cancer return due to elevated PSA levels.

“Physicians should refer their patients to CRA because any of our specialized radiologists are only a phone call away,” Taylor says. “We believe that imaging is collaborative, particularly in complex disease processes, and especially when taking care of cancer patients.”

The National Institute of Health’s National Cancer Institute reported in 2020 that PSMA PET-CT accurately detected prostate cancer spread in a large clinical trial conducted in Australia. For some men with prostate cancer, the trial suggests PSMA PET-CT is a more effective approach than traditional imaging modalities ­— such as CT scans and bone scans — to detect metastases to other parts of the body (cancer.gov/news-events/cancer-currents-blog/2020/prostate-cancer-psma-pet-ct-metastasis).


Phillips Vereos PET/CT Scanner

According to Michael Hofman, MBBS, FRACP, FAANMS, professor of Nuclear Medicine at the Peter MacCallum Cancer Centre in Melbourne, as reported in the March 22, 2020, edition of The Lancet, “…use of PSMA PET-CT was more likely than the standard approach to change the strategy doctors used to treat the cancer…” Hofman says the trial results build on evidence from other studies that PSMA PET-CT is more likely to detect metastases than conventional approaches; early and more accurate test results mean more efficient and effective treatment.

Making diagnostic testing accessible to at-risk patients

CRA Medical Imaging CEO Mary Ann Drumm says the ACR reports that recent changes to the reimbursement rules for low-dose CT lung screening scans are expected to make screenings more accessible to more patients.

“Prior to the changes made by CMS, there was less than a 15% uptake rate for lung cancer screening in general, so we are definitely interested in raising awareness about the availability of low-dose CT scans,” Drumm says. “The goal of screening is to detect disease at its earliest and most treatable stage of lung cancer, particularly in asymptomatic individuals who have a high risk of developing lung cancer.”

She says lung cancer is the leading cause of cancer-related deaths in the United States, and worldwide about 85% of lung cancer deaths occur in current or former cigarette smokers.

In the Feb. 10 edition of the ACR’s Radiology Business, Marty Stempniak wrote that CMS’s final decision drops the eligible age for Medicare beneficiaries to receive lifesaving screenings by dropping the eligibility age from 55 to 50 years old and reducing the tobacco smoking history threshold from at least 30 pack-years to 20. These changes broaden lung cancer screening access for at-risk people.

It is predicted the move will improve health outcomes through earlier detection and close the gap in outcomes disparities, particularly among women, Black men and rural residents, according to Debra Dyer, MD, Chair of the ACR Lung Cancer Screening Steering Committee.

In the March 11 Health Imaging article by Dave Fornell, ACR Principal Economic Policy Analyst Alicia Blakey noted the benefits if expanding screening for lung cancer.

“These changes will expand lung cancer screening to underserved populations, such as African American women and people who do not have a long history of smoking,” Blakey says. “It is now recommended that patients younger than age 55 get screened by Medicare. When we think of Medicare, we think of age 65 and older, but there actually are growing millions of Americans who could benefit from this screening update due to disability status and end-stage renal cancer patients.”

Blakey says 3,593 facilities performed 866,954 LDCT lung screening exams in 2021 alone.

Valerie Brown, CRA Nuclear Medicine Technologist
 

Firefighter Cancer Screening Program

Drumm said cancer also is a leading cause of death among firefighters. Research suggests this population is high-risk for certain types of cancers compared to the general population, as fire settings can contain various hazardous substances, including carcinogenic chemicals from the fires themselves and — in some cases — from the foam used to extinguish fires.

The American Cancer Society and International Association of Firefighters have partnered in an initiative for early diagnosis and cancer treatment for firefighters, and CRA Medical Imaging has teamed up with Hematology Oncology Associates of Central New York and Crouse Hospital to hold local screening centers biannually for firefighters. The slogan is “Get screened as if your life depends on it, because it does.”

CRA Medical Imaging philosophy

CRA Medical Imaging is committed to investing in the latest technologies and regulations and working with referring providers for prompt results and follow-up care.

“Our staff is experienced, welcoming and kind,” Taylor says. “Patients can trust that their exams will be read by sub-specialized board-certified radiologists. We use the latest techniques to cut scan time and maximize patient comfort and satisfaction.”

Their facilities are American College of Radiology-accredited in mammography, CT, nuclear medicine and PET/CT, providing patients a higher standard of imaging quality, care and radiation dose protection.

The Future of Medical Imaging

Those in the imaging field know it holds incredible potential.

“Artificial intelligence is particularly interesting,” Taylor says. “There is still a very important and necessary human aspect of radiologic interpretation, but as technology grows and imaging examinations become more and more important in the diagnosis and treatment of diseases, AI will become an important adjunct to enhance disease detection.”


GE NM 830 Nuclear Medicine System

Taylor said she is proud to tell people she’s a physician at CRA Medical Imaging.

“We often are the first ones in the area to offer certain exams,” Taylor says. “We offer free lung cancer screening to at-risk patients who otherwise wouldn’t have access, and we have become one of the top groups in the world for PET brain imaging in dementia research.”

For more information about CRA Medical Imaging, call 315-234-7600 or visit craimaging.com. For more information about firefighter screening, visit crouse.org/firefighter/ or contact Marianne Kokosenski at 315-472-7504 x. 1349 or mkokosenski@hoacny.com.

New York State Proposed Executive Budget and the Section 18 Excess

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By Jennifer Negley, Vice President, Risk Strategies Company

Thursday, April 14, 2022

The trend toward shifting cost to the individual physician is almost guaranteed to continue.

To no one’s surprise, this year’s 2021–22 New York State Proposed Executive Budget comes with another attack on the Section 18 excess. The last few budget cycles, however, saw the focus move from eliminating the excess altogether — something the hospital lobby has stringently argued against — to shifting the coverage cost to individual physicians. While originally enacted to help hospitalists avoid financial losses due to their “deep pocket” status, it has subsequently become a budget nightmare.

While necessary at inception due to the extremely litigious environment in New York, Section 18 has been chronically underfunded, risking the viability of the program all together. In 2013, steps were taken to reduce the number of physicians receiving the “free” excess. Hospitals were given a proportion of slots based on the number of the previous year’s participants. Those physicians newly applying would need to remain on a waiting list until slots opened from physicians who did not reapply from the previous year.

While this did achieve some reduction in the number of individuals obtaining coverage it did little to shrink the cost within the state’s budget. Fast-forward to last year when it was proposed that physicians pay for half of the coverage cost, which received little pushback from the hospital lobby since the all-important limits would remain in play. With COVID-19 raging on, creating a tremendous financial strain, it was eventually dropped as an undue burden during a continuing healthcare crisis. Proposing this during a pandemic is evidence of how eager those in Albany are to eliminate this cost from the state’s budget.

The latest iteration in this year’s budget requires physicians to front the cost. As noted in MLMIC’s The Albany Report, “The Governor proposes to require Section 18-eligible physicians and dentists to pay the entire premium for excess medical professional liability (MPL) coverage and then be reimbursed by the state for their up-front payment in two equal installments, the first to be paid one year after the policy period began (July 1, 2023) with the second installment reimbursement payment made a year later (July 1, 2024).”

With this split, reimbursement practices will constantly be in the negative, getting only half of the 2022 cost back when having to pay for 2023’s premiums. Most practices would find this financially untenable. To put this in perspective, a radiologist in the Syracuse area’s excess cost is approximately $1,258 annually and an OB/GYN would pay an additional $13,884.

While not every hospital requires excess coverage, physicians at hospitals that do or ones who simply want the additional financial protection these limits afford need to keep an eye on these proposals. The trend toward shifting cost to the individual physician is almost guaranteed to continue for future budgets.

It is vital for physicians or practice leaders to stay informed and advocate. Please be sure to reach out to your carrier partners, local medical societies, or a specialist like myself, who are all deeply embedded in the New York market as trusted sources for information. Know we are available to offer the knowledge you need to protect your practice and support future endeavors.

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

Jennifer Negley, Vice President, Risk Strategies Company

Risk Strategies, National Health Care malpractice team by the numbers:

  • Supports over 6,000 clients representing over $90,000,000 in physician premiums
  • Representing every major medical malpractice insurance carrier in the market. In New York, we represent MLMIC, EmPro(PRI), The Doctors Company (TDC), HIC, MedPro RRG, Coverys RRG, ProAssurance RRG, TDC RRG, AMS RRG
  • Specialists with over 25 years’ experience in medical malpractice insurance
  • Programs designed for independent physicians and self-insured programs as well as large practices and hospitals

Helping Refugees in Need: Info for Clinicians in Central New York

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By Kathryn Ruscitto, Advisor

Thursday, April 14, 2022

As we watch the faces of mothers and children fleeing war on the news, we must assume some may come to our community. Over the last decade, 7,369 refugees have arrived in Central New York from Africa, the Middle East, Burma, Afghanistan, Nepal and other locations.

Refugees come with special health needs. The Department of Health and Human Services states, “Refugees may face a wide variety of acute or chronic health issues. Examples include infectious diseases such as tuberculosis or intestinal parasites, chronic illnesses such as diabetes or hypertension, and mental health issues such as post-traumatic stress disorder or depression.”

Refugees contribute to our communities in so many ways and need our healthcare systems to help them as they find their new paths. There are many area businesses who have built their workforce from these new residents. Providing good health care to refugees means so much more than providing an interpreter service. It means understanding what services are available in our community and being part of the fabric of support they receive. In addition, understanding their culture and what they have experienced in their former countries and how they perceive and understand your plan of care will impact outcomes.


Kathryn Ruscitto, Advisor

The American Academy of Family Physicians has taken a strong advocacy position on behalf of refugees and produced materials — “Building Capacity to Care for Refugees” which offers a variety of checklists and codes — to help healthcare facilities during this time.” (See resources below.)

Others may receive support through community based organizations such as The Center for New Americans at IRC, Catholic Charities Refugee Resettlement Program, Hopeprint in Syracuse and the Refugee Health Clinic at Upstate University Health Care Center.

Andrea Shaw, MD, leads the Upstate team and spoke to me about the things she has found important in her work to assess and treat refugees. “I spend as much time as I can up front, building trust, which builds better outcomes,” she says. “Many come to this country without having experienced or lived in a culture with a functioning health system. The local not-for-profits and religious organizations provide a bridge between health care and help to guide refugees to achieve good health outcomes.” I asked her what advice she would offer other clinicians as they treat refugees. “Keep an open mind and ear to what is going on in their life,” she says. “The social complexity and vulnerability they are facing impacts their health. Know what diseases come from the area they lived in, and know that many have had a lifetime of chronic stress.”

The World Health Organization calls for us to make health systems more accessible and responsive to refugees and migrants and says that means, “providing quality and affordable health coverage as well as social protection for all refugees and migrants regardless of their legal status; making health systems culturally and linguistically sensitive to address the communication barrier; ensuring health care workers are well-equipped and experienced to diagnose and manage common infections and diseases; working better across different sectors that deal with migrant health; and improving collection of data on refugee and migrant health.”


Andrea Shaw, MD and Alyssa Purday MS4 (medical student)
Photo credit: William Mueller

We have been supporting refugees and migrants for many years in this community, and recent events remind us how important access to health care will be in their early days. Is your office accessible? More importantly, what is your level of preparation and collaboration with community-based organizations? Below are some resources to support your teams.

Resources:

  1. aafp.org/fpm/2017/0700/p21.html#fpm20170700p21-bt2
  2. interfaithworkscny.org/programs/center-for-new-americans-2-3-2
  3. hopeprint.org
  4. ccoc.us/services/stability-services
  5. refugeeandimmigrant.org
  6. otda.ny.gov/programs/bria/documents/population-report.pdf
  7. upstate.edu/news/articles/2021/2021-11-18-refugeeclinic.php

Legal Issues in Operating a med-spa in New York State

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By Andrew M. Knoll, MD, JD, Cohen Compagni Beckman Appler & Knoll, PLLC

Thursday, April 14, 2022

Med-spas have garnered significant interest among physicians in recent years. It is an opportunity to earn extra money outside of the constraints of third-party payers, as well as performing a service that can be enjoyable and satisfying.

There is no legal definition of a med-spa. It is commonly thought of as a cosmetic practice that provides treatments typically offered at lay spas (e.g., skin peels) as well as treatments that are considered medical procedures (e.g., Botox and fillers).

Offering Spa Services in a Medical Practice

By far, the easiest model from a regulatory perspective is for the physician to provide cosmetic procedures within their practice. Procedures would be performed by the physician, or when appropriate, delegated to qualified individuals (discussed further below).

Andrew M. Knoll, MD, JD, Cohen Compagni Beckman Appler & Knoll, PLLC

However, there are two important caveats to consider if a physician plans to open a med-spa within his or her practice. First, if not a dermatologist or plastic surgeon, consult with your malpractice insurance carrier to ensure coverage. Typically, the carrier will require documentation of training before underwriting the practice. Second, always treat the encounter as a medical procedure and keep medical progress notes. Regulators from the Office of Medical Conduct (OPMC), for example, will likely not waive the requirement to maintain an accurate record, even if the treatment is legally permissible to be performed by a layperson.

Scope of Practice Issues

Just because the spa services are being offered within a medical practice does not mean the physician can delegate any procedure to anyone. Medical spa services all fall within the scope of practice of a physician, NP or PA. With a PA, the supervising physician must be qualified to perform the procedure.

A common question is what the scope of practice for a registered nurse is. (There is little utility in using an LPN because she would have to be in line-of-sight supervision of an RN or MD). The general rule is that nurses execute patient-specific orders. However, the ordering provider must first examine the patient — so-called “standing orders” do not qualify. Following an examination and order, the Nursing Board states the following falls within a nurse’s scope of practice:

  • Injections (e.g., Botox, fillers)
  • Non-ablative lasers
  • Phototherapy
  • Superficial skin peels

Micro-needling and PDO threading fall outside of a nurse’s scope of practice.

Aestheticians are licensed by the Department of State, not Education, and legally are no different than a medical assistant. They can perform laser hair removal simply because the practice remains unregulated in New York. Like MAs, they cannot perform invasive procedures. They also cannot hire a licensed professional to perform procedures. A common misconception is the idea that an aesthetician can hire a “medical director,” who performs or supervises the procedure and splits the fee with the aesthetician. That is impermissible in New York.

So what does this mean in practical terms? While New York has not explicitly given guidance in this area, other states have, and have used the stratum corneum layer of the skin as the defining boundary between medical and nonmedical procedures. Accordingly, it is both reasonable and defensible to use this boundary to delineate the scope of practice for an aesthetician in New York, which would permit treatments such as superficial chemical peels but not micro-needling.

Prohibition Against the Corporate Practice of Medicine and the PC/MSO Model

New York follows the Corporate Practice of Medicine (CPOM) doctrine, which prohibits a layperson or business entity from owning or operating a medical practice. This prohibition also includes splitting fees with a medical practice, which is defined to include any business arrangement where compensation is based on a percentage of collections.

A common business setup that complies with CPOM is based on the professional corporation/management services organization (PC/MSO) model. In the PC/MSO model, the MSO, which may be owned by a layperson such as an aesthetician, provides business services, such as space, support services, administrative services, billing, lay employees, etc. to the PC. The PC hires the licensed professionals and administers the medical services.

Consider the following hypothetical: Aesthetics, LLC wants to offer med-spa services. It cannot simply hire a medical director and give Botox under its corporate umbrella, so it contracts with John Doe, MD, PC, and PC intends to use an NP to perform the medical services. The parties enter a written contract whereby, for a fair market fee, the PC will utilize the space and provide administrative assistance to Aesthetics. This fee will not be based on the PC profits or a percentage of collections. There will be signage and statements on Aesthetics’ literature and website that all medical procedures are performed by the PC.

Next, the client/patient comes to Aesthetics and asks for laser hair removal (non-medical), a superficial chemical peel (non-medical) and Botox (medical). Aesthetics’ aesthetician performs the laser hair removal and chemical peel. The PC’s NP injects the Botox. The total bill is $2,000, with the Botox procedure costing $600. Aesthetics collects the $2,000, PC invoices Aesthetics for the $600 and Aesthetics electronically transfers the $600 to PC. This is an oversimplification of the arrangement and an individual wishing to enter such an arrangement should consult counsel because, as the old saying goes, the devil is in the details. This is none truer than in the highly regulated world of health care.

A more comprehensive version of this article first appeared in the Health Law Journal (2021 Vol. 26, No. 3) published by the New York State Bar Association, One Elk Street, Albany, NY 12207. To learn more about NYSBA, or to become a member of the Health Law Section, visit NYSBA.ORG today.

Auburn Community Hospital: A Tradition of caring for the Finger Lakes community

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While successfully managing pandemic demands, Auburn Community Hospital continues to embrace and support the needs of the Finger Lakes community with ongoing strategic planning, new programs, technology and services.

Auburn Community Hospital
 

The COVID-19 pandemic has placed an immense strain on hospitals throughout the world, and Auburn Community Hospital (ACH), a 99-bed acute care facility, is no exception. However, as ACH continues to aggressively monitor and update its public health safety plans during new surges, it also continues to punch above its weight with steadfast commitment to delivering advanced, high-quality care while investing in new initiatives to support the health and well-being of the Finger Lakes community.

New Investment in a CT Scan Suite

On the Forefront of Technology

As evidence of their commitment to adopting the latest technologies for its community, ACH has received the College of Healthcare Information Management Executives’(CHIME) Digital Health Most Wired Award for the past two years in a row. CHIME’s Digital Health Most Wired award recognizes healthcare organizations that use information technology to elevate the health and care of their communities. In an annual survey, CHIME identified and recognized ACH’s adoption, implementation and use of information technology to improve patient safety and outcomes.

“ACH is extremely proud of the CHIME Digital Health Most Wired Recognition,” Berlucchi says. “Although ACH is a small community hospital, we pride ourselves in delivering amazing care through the use of advanced technologies along with talented doctors and nurses to provide excellent care for our patients and our community. Our Information Technology organization, led by Chris Ryan, is second to none and continues to apply practical technological solutions to improve the care we offer our patients.”

To earn the Digital Health Most Wired award, ACH has started to achieve meaningful clinical and efficiency outcomes by deploying technologies and strategies including cost-of-care analytics and patient portals. ACH has also implemented more advanced technologies, like telehealth, that expand access to care.

“Exciting things are happening at Auburn Community Hospital,” Berlucchi says. “We are making significant investments in new technology, equipment and people.”

Other investments include:

  • A newly established state-of-the-art Women’s Health Center offering advanced, comprehensive breast care, maternity services and more
  • Clorox Total 360 System for efficient, thorough cleaning and disinfection & The Purple Sun UV Disinfection System.
  • Electronic fetal monitoring, which tracks fetal heart rate without a provider present
  • Mako robotic surgical system for precise, minimally invasive joint replacement surgery and faster patient recovery
  • MyoSure Tissue Removal System, which allows physicians to resect abnormal tissue, fibroids and polyps for highly targeted biopsies without incisions for faster recovery

Assessing Needs, Improving Care

Every three years, ACH and the Cayuga County Health Department develop the Community Health Needs Assessment by collecting data and input from friends and neighbors throughout the Finger Lakes area. With this input, ACH can understand and implement or build upon services to improve the health of the community.

Over time, healthcare needs in the Finger Lakes community grow or change, prompting ACH to adjust their healthcare model to support the mental, physical, social and spiritual well-being of Finger Lakes residents. ACH and the Cayuga County Health Department identified priority areas during the most recent Community Health Needs Assessment: Prevent and treat chronic disease, and increase healthcare services for low-income populations. The partners developed specific goals to address these priorities.

Improving access to more affordable healthy foods and encouraging a more active lifestyle is now a top priority for reducing obesity and is being achieved by increasing the availability of fruits and vegetables and creating more access to physical activities.

To help promote Healthy Women, Infants and Children, a New York State Department of Health Prevention Agenda, ACH is working to increase healthcare services for low-income populations. A new Women’s Health Center with health education programs have been established, including:

  • Healthy Moms, Healthy Babies, a program that helps mothers access a wide range of community services that can benefit them and their babies, such as doula services, assistance with transportation, breastfeeding support from certified lactation counselors and in-home nurse visits for first-time mothers
  • Medically Speaking, a series of lectures covering topics such as stroke, cardiovascular health and women’s health and wellness
  • Women’s Health Expo, interactive workshops led by area healthcare providers and a keynote address

Pandemic Protocols in Place

Since the pandemic began, Auburn Community Hospital (ACH) has had a COVID-19 task force in place that meets daily to manage what’s going on with COVID-19 and emerging variants.

“We manage our capacity and staffing regularly — if not hourly — and are in constant contact with the Cayuga County Health Department and other hospitals in the area to manage any spikes in COVID and other health issues,” says Matthew Chadderdon, Vice President of Marketing, Media Relations, Public Affairs and Fund Development at Auburn Community Hospital.

To protect the staff and community, ACH has implemented special emergency protocols and services. Some steps ACH has taken include:

  • Applied existing comprehensive guidelines for infectious diseases to educate and direct employees through disease recognition, infection prevention, treatment, isolation and reporting protocols
  • Created a vaccine clinic for all ACH staff and family, including the Finger Lakes Center for Living nursing home
  • Expanded its COVID-19 testing capacity in coordination with the Cayuga County Health Department
  • Implemented a telemedicine option to improve provider access for patients
  • Implemented health screenings for all staff and outside visitors
  • Limited visitation in an effort to protect patients
  • Provided ample personal protective equipment to staff

“We hope our region sees more vaccinations and less COVID-19, and we will continue to advocate this,” Chadderdon says. “Our leadership team communicates regularly with our medical teams throughout the hospital, as well as all of the local physician practices and the Finger Lakes Center for Living nursing home.”

“We are fully committed to working with our colleagues to successfully implement and evaluate programs, policies and services in our community. We are committed to investing in three main services – Cancer Care, Cardiology, and Orthopedics, all of which are significant needs in our communities,” Berlucchi says. “Together, we will move forward toward improved health and well-being for all.”

Dr. Brian D. Tallerico & the Mako Robot at Auburn Community Hospital.
 

Enhancing Cancer Care

A new partnership with Syracuse-based Upstate Cancer Center at Auburn Community Hospital the only academic medical center in the region, strengthens and supports the expertise of the oncology specialists at ACH. Upstate’s program is ranked in the top 20% in the United States by the American College of Surgeons Commission on Cancer and is the only facility in Central New York accredited by the organization.

“We are able to provide very contemporary cancer care here at Auburn Community Hospital,” says David B. Duggan, MD, MACP, Professor of Medicine at Upstate Medical University and Medical Director of Upstate Cancer Center at ACH. “People feel a strong attachment to the hospital and want to get care here. Our ability to help so they do not have to travel provides a sense of security and comfort.”

Located on the hospital’s first floor, Upstate Cancer Center at ACH offers a spectrum of advanced diagnostic and treatment resources delivered by board-certified physicians and nurses with extensive experience in hematology and oncology.

“We’re very excited about bringing all of the resources of Upstate and an academic medical center to Auburn,” Dr. Duggan says. “The physicians we work with are highly trained and have many years of specialized training.”

“Bringing the Upstate team to Auburn provides that team approach to cancer care that all patients want,” adds Christina Sherman, RN, Director of Cancer Services, Upstate Cancer Center at ACH. “We want second opinions. We want to know what other doctors think. These are doctors who are world-class in their fields of expertise. This practice is built with the patient in mind.”

“At Auburn Community Hospital, our vision is simple: to provide the best outcome for every patient, every time.”
— Scott Berlucchi, President and CEO, Auburn Community Hospital
(L to R) Scott Berlucchi, President & CEO, Tammy Sunderlin, Chief Nursing Officer, Dr. Tanya Paul, Stephen Graziano, Chief of Upstate Cancer Center
 

Raising the Bar in Orthopedic Care

A combination of skilled physicians and advanced technologies allows ACH to provide top-quality orthopedic care for patients close to home. With expertise in a variety of fields ranging from hand and wrist surgery to sports medicine to joint replacement, ACH providers can meet the majority of patients’ orthopedic needs.

“When patients and primary care physicians can have the majority of orthopedic issues treated at a community hospital, that’s a great convenience to them both,” says Michael Wilson, MD, MBA, orthopedic surgeon at Auburn Orthopedic Specialists and Chief Medical Officer at ACH.

ACH plans to make more additions to the orthopedic group, including a fellowship-trained sports medicine specialist for patients of all ages and expanded capabilities in hand surgery.

“Roughly 25% of emergency department visits are related to hand and wrist trauma,” Dr. Wilson says. “It would be greatly beneficial if patients could receive treatment here for the majority of their hand problems.”

For patients needing joint replacement surgery, Auburn Orthopedic Specialists use advanced MRI technology and minimally invasive surgical tools, such as the Mako system. Auburn Orthopedic Specialists uses the most up-to-date version of the Mako system, making it the most advanced joint replacement surgical system in the area.

“Patients who undergo surgery with the Mako system can expect shorter hospital stays and less pain following surgery,” says Brian D. Tallerico, DO, Chief of Orthopedic Surgery at Auburn Orthopedic Specialists. “Referring providers should also know that the Mako system offers increased accuracy with bone cuts and resections, as well as improved accuracy with joint implant positions, ultimately leading to better patient function.”

Quality Control — The Joint Commission Gold Seal of Approval Accreditation

Even during the midst of the pandemic, ACH didn’t waiver on their commitment to quality services and patient safety for all. The facility has received the Gold Seal of Approval from The Joint Commission for the past 11 years on several quality measures including effective communication, health care associated infections, medication safety, patient identification verification and universal protocols.


(L to R) Dr. Tanya Paul, Dr. Loren VanRiper, Dr. Amy McDonald, Dr. Donald Calzolaio
 

Finger Lakes Center for Living

At ACH’s Finger Lakes Center for Living rehabilitation and residential facility — which received a 5-star rating from the Centers for Medicare & Medicaid Services for the third year in a row — residents enjoy safe, quality health care for both short-term rehabilitation and long-term residential care. To receive a 5-star rating, Finger Lakes Center for Living achieved above-average quality scores for health inspections, staffing and quality measures. In addition, the Finger Lakes Center for Living was recently named one of the Best Nursing Homes in 2021 by US News and World Report.

The Team at Finger Lakes Center for Living Nursing Home

“We are very proud of our nursing home for once again receiving this prestigious award,” Berlucchi says. “This recognition is meaningful because it signifies that we are providing an exceptional patient experience and continue to see great results year after year. This is a credit to our employees and the volunteers who play such a critical role in offering the highest quality of care, especially during this very difficult time.”

Furthermore, Finger Lakes Center for Living has had no COVID-19 related deaths, and ACH’s vaccination clinic for Finger Lakes Center for Living staff, residents and family also contributed to its 95.9% vaccination rate.

Retaining and Growing Talent

At Auburn Community Hospital (ACH), culture and teamwork are priorities. Recently Auburn Community Hospital celebrated Employee Recognition Day. One hundred and twenty employees were recognized with service to ACH from five years to 45 years. This says a lot about the employees and their commitment to the healthcare system and to their community.

It also is interesting to note ACH has a very low turnover rate compared to other hospitals. This event is a reminder of how important it is for everyone to support the current workforce and continue to strengthen and grow the team.

The pandemic has tested ACH, just like most hospitals. The headlines regularly herald hospitals are in crisis. Working in health care is a different kind of occupation. It is a vocation for many. There are challenging days but there is a strong commitment among the employees. Small rural community hospitals like ACH are the cornerstones of communities because they take care of family, friends and neighbors who live in the community.

Similar to the larger hospitals in the region, Auburn is challenged by workforce issues, especially during a pandemic. Recruiting employees, especially nurses, medical technicians, lab technicians, radiology technicians, and many others come from a limited pool. It can be difficult to compete with the size and scale that larger hospitals offer. However, ACH has a lot to offer including steady and stable employment, a welcoming culture and a safe working environment.

Auburn encourages employees and others to help recruit from personal and professional community contacts. The hospital is appealing for its pride and love of the community. This is more about their mission than economics. ACH is committed to strengthening their workforce and to meet whatever challenges come their way.

A New Contract

To further attract and retain talented employees, the board members of ACH recently signed a new union contract to increase nurse wages and benefits. The new union contract also benefits employees of Finger Lakes Center for Living.

“ACH prides itself on its history of union collaboration,” says Scott Berlucchi, President and CEO of Auburn Community Hospital. “We also recognize that the process of reaching an agreement during a contract negotiation is not always an easy one. We have enormous respect for our nurses because of their unwavering dedication and commitment to our patients and our community.”

“Not only do we take care of you and your family when you have health issues, but we are also the largest employer in the area and with that comes a significant responsibility,” Berlucchi continues. “ACH generates more than 1,200 jobs in this community and helps maintain and improve our quality of life in this beautiful region of New York State.”