admin, Author at CNY MD News

New York State Proposed Executive Budget and the Section 18 Excess

Posted on October 12, 2022October 17, 2022 by admin

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 While originally enacted to help hospitalists avoid financial losses due to their “deep pocket” status, it has subsequently become a budget nightmare.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

Posted on October 12, 2022October 17, 2022 by admin

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:

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

Posted on October 12, 2022October 17, 2022 by admin

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

Posted on October 12, 2022October 17, 2022 by admin

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.”

The Role of Art and Cultural Institutions During Covid-19

Posted on October 12, 2022October 17, 2022 by admin

by Kathryn Ruscitto, Advisor

Wednesday, February 16, 2022

One of the opportunities in this phase of my life is devoting time to community organizations. I am currently Chair of the Board of View, an arts organization in Old Forge (viewarts.org).

As we headed into the Covid-19 pandemic, it seemed at first that our role would be limited. We soon learned differently. View pivoted to online offerings during the first year and slowly moved to in-person and online classes, exhibitions and performances.

Writing, yoga, drawing, music, pottery — all forms of art — drew people in. View realized quite quickly that we offered something that people needed during this time. Creativity was tied to mental health in a way we had not appreciated (or anticipated).

As clinicians increasingly discover and acknowledge the connection between mind and body, it makes sense to encourage patients to find creative outlets in their healing processes. Nationally, we see healthcare centers addressing these connections in the treatment of cancer, heart conditions, pain, and chronic illness.

Kathryn Ruscitto, Adviso

At the Benson-Henry Institute (BHI) at Massachusetts General Hospital, there is a deep history of examining the mind-body connection. They found that meditation has a positive impact on metabolism, breathing, heart rate and brain activity. Dr. Herbert Benson labeled these changes the “relaxation response.” The relaxation response is the foundation of Mind Body Medicine at BHI.

At Stony Brook, the Mind-Body Clinical Research Center actively addresses the connection between mental health, physical health and overall wellness. Their philosophy is that “Mind-body medicine is built on the foundation that thoughts, behaviors, emotions, biology and environmental influences can interact to positively or negatively affect one’s mental and physical health.”

At SUNY Upstate Medical University, integrative family physician Kaushal Nanavati, MD, leads the effort to incorporate meditation, yoga and relaxation into health care.

Spiritual care and prayer are also essential parts of the mind-body connection as reflected at St. Joseph’s Health, Crouse Health and Upstate Medical University.

Clinicians are no different than the patients they treat. There are many great examples of clinicians who engage in music, painting, jogging and cycling, making them perfect examples of the mind-body connection.

Covid-19 has challenged us in many ways, but it has also accelerated our learning about how closely connected our physical health and mental health are.

How does your practice integrate opportunities for employees and patients to make these mind-body connections?

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

Resources for Clinicians

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

Posted on October 12, 2022October 17, 2022 by admin

By Becca Taurisano

Tuesday, December 28, 2021

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

The Oneida Health Medical Oncology and Radiation Oncology team

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

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

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

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

Seamless Connection Between Campuses

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

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

William L. Griffin Medical Oncology Center

Access To Specialized Expertise

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

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

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

Focus On Quality

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

Sterile Compounding is completed by specialty-trained pharmacists and technicians on site at the

William L. Griffin Medical Oncology Center. Providing future opportunities for clinical trials to be delivered in Oneida.

Keeping Care Local

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

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

Investment In Technology

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

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

Oneida Health has designed a network of specialists, services, and technology,

including da Vinci Robotic Surgery (established in 2012), to support quality cancer care treatment in Oneida.

Personal Interaction With Staff

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

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

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

Oneida Health has become an imaging destination with new investments in state-of-the-art imaging technology

including a 3-Tesla MRI, Advanced PET/CT (pictured), and 3D Mammography.

Advancing The Approach

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

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

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

Medicare: Choice or Complexity

Posted on October 12, 2022October 17, 2022 by admin

By Kathryn Ruscitto, Advisor

Tuesday, December 28, 2021

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

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

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

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

Kathryn Ruscitto, Advisor

Peering Up Ahead

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

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

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

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

Resources for Consumers

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

Key Updates to the Medicare Physician Fee Schedule for 2022

Posted on October 12, 2022October 17, 2022 by admin

By Sarah Steinmann

Tuesday, December 28, 2021

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

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

Split Evaluation and Management Visits

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

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

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

Sarah Steinmann

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

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

Physician Assistant (PA) Billing

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

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

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

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

Dr. Wilson is Named CMO of Auburn Community Hospital

Posted on October 12, 2022October 17, 2022 by admin

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

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

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

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

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

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

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

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

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

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

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

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

A Second Dream Achieved

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

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

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

For more information, visit brightleafvinyard.com.

The Future is Now at Upstate University Hospital

Posted on October 12, 2022October 26, 2022 by admin

By Robin Overbay, MMS, PA-C

Thursday, October 21, 2021

Academic medical centers are paving the way to a new tomorrow by changing how health care is delivered. Among its innovations, Upstate University Hospital is using advanced technologies such as AI, robotics and drones to serve as workforce multipliers, and expanded telehealth platforms to improve access to patient care.

Construction on the building across from University Hospital, the Nappi Wellness Institute, is expected to be completed in spring 2023.

Adapting to the pandemic resulted in the acceleration of new ideas and technologies, some of which were already underway at Upstate and were brought into newly relevant focus when COVID hit. Leaders specifically sought innovations that addressed the needs of the workforce — both to retain staff and reduce the risk of burnout — as well as to support optimal patient care. The C-Suite empowered staff to collaborate on projects across the entire Upstate system, headed toward the vision for the hospital set by the hospital CEO: To evolve to care that is first predictive and preventative, then personalized and participatory for every patient.

“Centralized systems don’t work well in a pandemic because large numbers of sick patients overwhelm the hospitals,” says Robert Corona, DO, MBA, CEO of Upstate University Hospital and a professor at SUNY Upstate Medical University. “To remove those pressure points of entry, we need to look at ways to decentralize. When you’re not solely defined by the bricks and mortar of the hospital, you can distribute medical resources in a way that allows for such options as point-of-care testing, home testing, home monitoring, and telehealth — all of which balance who needs to come to the hospital itself.”

For example, Upstate partnered with Microsoft to create a series of chatbots for virtual assessment which could be done at home. The first chatbot determined the need for COVID-19 testing for any member of the community. This was followed by a daily self-screening tool for employees to use prior to entry of an Upstate building. Both projects reduced the demand on telephone operators and screeners.

The hospital also created an influenza-like-illness (ILI) clinic equipped with necessary resources to test and treat patients with upper respiratory or flu-like symptoms and isolate those who may be positive for COVID-19 from other potentially vulnerable patients. The ILI was an effective and efficient alternative to the busy emergency room.

Upstate was an active participant in clinical trials to test the safety and effectiveness of COVID-19 vaccines for adults and children.

The saliva-based COVID-19 PCR test developed at Upstate received FDA approval and is capable of processing 15,000 tests per day. Upstate also was involved in the development of a saliva-based COVID-19 antibody test to identify IgA, IgM and IgG antibodies. That test is under review by the New York State Department of Health.

Hospital without Walls: The Telehealth Boom

In many instances, the pandemic shifted the delivery of ambulatory care to a telemedicine platform. Upstate recognizes the value in making telehealth a permanent way to deliver health care when it makes sense to do so for the patient.

Through telehealth, Upstate is aiming to provide the same kind of care patients would receive in person using advanced computing and communications— a goal made more attainable following a recent $2 million grant from the Federal Communications Commission for telemedicine upgrades.

“We were thrilled to receive a grant of that magnitude and opportunity, and it’s going to go to very good use,” says Nancy Daoust, EdD, LNHA, FACHE, Chief Ambulatory Officer at Upstate University Hospital. She says the grant will facilitate a system-wide integration of its telemedicine infrastructure within the existing electronic medical record system, making appointments easier for patients and providers.

The grant also will be used for hardware for video consultations and remote wearable monitoring systems to measure patients’ vital signs and to collect other clinical data. The integrated telemedicine platform also will enhance the ability for Upstate physicians to treat critical patients through remote connections to other hospitals, such as what is already being done with its telestroke program.

With remote visits on the rise, Daoust also hopes to see legislative support to ensure all people — rural and urban populations — have unfettered internet access to take advantage of the benefits of telehealth care.

Use of telemedicine has surged at the hospital and a new $2 million FCC grant will support additional infrastructure in the EMR system.

The “Meds to Beds” program allows Upstate patients to get their prescriptions filled at Upstate’s outpatient retail pharmacies, making it easier for hospitalized patients to get their prescriptions promptly upon discharge and more likely to take needed medications once they are home.

Ensuring Continuum of Care

While telemedicine was not used by many departments pre-pandemic, Upstate rapidly deployed telemedicine in many ambulatory settings, improving access to care when many patients were afraid or unable to leave their homes. Mark Zeman, Chief Information Officer at Upstate, says that very soon after launching the COVID-era telemedicine program, the hospital was caring for thousands of patients via the technology. Within two weeks, the number of telemedicine visits grew from 10 to over 6,000 visits — a phenomenal increase of 59,900%. Additionally, without transportation issues or other barriers, such as the need to take significant time off from work, more patients were able to keep their appointments.

“Comparing May 2019, when almost all visits were completed in the clinic, to May 2020, when most visits were conducted via telemedicine, the no-show rate decreased by 59%,” Zeman notes.

He added that the hospital also bolstered its cybersecurity to protect it from ransomware threats and phishing attacks. “Recognizing the need to be even more diligent in securing our network, we accelerated multi-factor authentication, worked extensively with an expert cybersecurity consulting group to test our defenses and focused on enhancing our endpoint protection.”

At a time when PPE and other supplies were scarce nationwide, Upstate implemented a plan for supply chain integrity to ensure their hospital was prepared, which continues today. Stephanie Shattuck, Associate Administrator for Support Services at Upstate University Hospital, says her team identified key products critical to the pandemic, including PPE, ventilators and other respiratory care supplies, and came up with a plan to maintain a 180-day supply. They built a safety stock to respond to volatility in the supply chain and used data visualization tools and dashboards that give real-time information on stock levels and immediate alerts when stock is low. They also acquired extra warehouse space to store additional inventory.

Nursing Advances New Technology

Despite unprecedented pandemic-related challenges, Upstate achieved Magnet designation this year. “Achieving and maintaining Magnet designations requires us to innovate and push boundaries,” says Scott Jessie, MSN, RN, NEA-BC, Chief Nursing Officer at Upstate University Hospital. “Regardless of current challenges, we will meet patients’ needs and continue to provide comfort and support,” Jessie says. “It’s our mission, and it’s why we chose this field.”

Using a collaborative approach, the nursing staff implemented technologies and practices, such as TeleTracking, which manages bed capacity and tracks patient progression through discharge and into post-acute care. Additional daily patient care technologies include Vocera for communication, vital signs alarms, and remote video monitoring for patient safety.

Nursing also is playing a key role in developing a new Throughput Operations Center to manage all patient movement into and out of the Upstate system, and a “Hospital at Home” model for acute care patients to be treated using telemedicine, the EMR, and workflow intelligence developed by Upstate’s IMT team.

“For the past three years, in part out of necessity, Upstate has become a hotbed for innovation and creative thinking. Our work on data visualization and solutions, drones, chatbots, and even governance and portfolio management is driven by the creative minds at Upstate — and enabled by leadership that is unwilling to accept the status quo and strives to be a technology leader in academic medical centers.”
— Steve Roberts, Director of IMT Advanced Technologies at Upstate University Hospital

Drones As Workforce Extenders

In 2020, Upstate launched the Air Upstate Consortium to test, develop and incorporate drone technology into health care, first delivering COVID-19 testing kits between hospitals. This program received the first waiver ever given by the Federal Aviation Administration to fly over populated areas and deliver medical supplies.

“These flights demonstrated that drone deliveries can be scalable and economically viable, which positions Upstate and the central New York region to be nationally recognized leaders in the application of drone technology in health care,” says Steve Roberts, Director of IMT Advanced Technologies at Upstate University Hospital.

In addition to the drones performing deliveries, Roberts says the hospital is looking at small robots which could be used to deliver food, medications and other materials within the hospital. The efficiencies from robot technology would free up healthcare professionals who typically perform these duties to better utilize their skills toward other aspects of patient care.

Wellness and Prevention

As Ben Franklin once said, “An ounce of prevention is worth a pound of cure,” and the same parallel can be drawn in medicine. Upstate currently has about a 60% inpatient to 40% ambulatory care portfolio ratio, and their goal is to flip those ratios, with wellness and prevention as the basis.

“We know that to do this well and efficiently, we will rely on technology and innovations,” Daoust says. “What’s most critical is that we also keep the patient’s experience at the forefront. While it’s great to have the bells and whistles that technology provides, it’s most important that we’re laser focused on patient care and that our patients feel special.”

The Nappi Wellness Institute, generously funded by the Nappi family, will eventually be the home of several existing ambulatory clinics that focus on prevention, general medicine and wellness, with a special focus on Alzheimer’s disease. Currently under construction and slated to be completed in the Spring of 2023, the Nappi Wellness Institute will be equipped with technologies for appointment reminders and real-time location services to help guide patients to the correct floor once they are in the building.

Drones In Flight.

CEO Dr. Bob Corona and CIO Mark Zeman prepare for a drone test flight.

Focus Groups For the Future

Upstate’s internal focus groups are also a critical part of the decision-making process. A mixture of clinical, administrative, financial, IMT and other staff provide a collaborative approach to solving problems and getting feedback on new processes and technologies. Focus groups allow for a diverse and inclusive perspective.

Moving forward, Upstate acknowledges the tremendous challenges facing the healthcare industry, but the hospital staff are also confident in their ability to find solutions to keep their patients well cared for and satisfied.