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Medicare: Choice or Complexity

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By Kathryn Ruscitto, Advisor

Tuesday, December 28, 2021

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

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

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

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

Kathryn Ruscitto, Advisor

Peering Up Ahead

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

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

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

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

Resources for Consumers

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

Key Updates to the Medicare Physician Fee Schedule for 2022

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By Sarah Steinmann

Tuesday, December 28, 2021

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

 

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

Split Evaluation and Management Visits

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

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

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


Sarah Steinmann

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

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

Physician Assistant (PA) Billing

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

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

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

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

Dr. Wilson is Named CMO of Auburn Community Hospital

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

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

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

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

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

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

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

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

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

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

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

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

A Second Dream Achieved

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

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

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

For more information, visit brightleafvinyard.com.

The Future is Now at Upstate University Hospital

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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.

Protect Your Practice With Five Critical Cyber Measures

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By Jennifer Negley, Vice President, Risk Strategies Company

Thursday, October 21, 2021

Safeguard your business from the cyber criminals aiming straight at health care

Health care has been a favorite target of hackers for years. In fact, from 2015 to 2019, ransomware attacks accounted for 28% of all known healthcare breaches. Any size practice is at risk. For years, many malpractice carriers have included some type of complementary cyber liability coverage. But with the rapid shift in the types of threats we’re encountering, you need to beware of what your policy does not cover. It is always advisable to seek a stand-alone product, which in almost every case, provides more comprehensive coverage.

Ransomware Trends

Since 2018, ransomware incidents increased 150% with 70% of involving a data exfiltration threat and an average 21 days of downtime. Due to these troubling trends, carriers are leaving the market, curtailing coverage or non-renewing insureds. To help control costs while maintaining comprehensive coverage, Risk Strategies National Cyber Risk practice recently identified five critical measures to consider when navigating a challenging market.


Jennifer Negley

  • Multi-factor Authentication: Historical data shows a direct correlation between cyber incidents and the lack of multi-factor authentication (MFA). All users in a company, regardless of their level of access, should have MFA, a sign-in method that requires users to confirm their identity through two or more separate mechanisms, such as facial recognition or verification code. This is especially important for remote and hybrid workforces. Without MFA, someone logging in with your credentials could gain access to email, company networks and key applications with sensitive data.
  • Endpoint Detection and Monitoring: Endpoint detection security systems monitor data in real time to determine if there are any ongoing active threats. Automatic monitoring and alert-generation is a crucial security measure, and it works best if there is a security operations center staffed in-house or via a managed service provider to monitor alerts 24/7.
  • Security Training: Making sure employees undergo security awareness training is essential. Having up-to-date enterprise technology is great, but your employees are your first line of defense. Specialty insurance brokers can be very helpful in finding vendors that provide security awareness and phishing testing, provide analysis on the results and implement a plan to improve when necessary.
  • Backups: Not backing up your data makes a ransomware attack exponentially more difficult to recover from — and much more expensive. All organizations should have a carefully considered process in place to restore their network with minimal disruption. Backup systems also need to be frequently tested to determine efficacy.
  • Regular System Patching: Software and hardware require regular patches to reinforce security vulnerabilities. Ransomware is always looking for the holes that patches are designed to fill. Make sure you’re staying current with your vendor’s latest updates and have a regular patching cadence with immediate action taken on high priority issues.

With the volatility of the current cyber market, having a specialty team available to walk you through products, services and best practices can make all the difference in securing the best policy terms.

For more information on insurance options, contact Jenn Negley at 267-251-2233 (cell) or jnegley@risk-strategies.com

When to Reach Out to Hospice

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By Kathryn Ruscitto, Advisor

Thursday, October 21, 2021

It May Be Earlier Than You Think.

Helping anyone on their end-of-life journey is hard, and having a good support system for families is crucial.

I once watched a family struggle in the ICU to help their family member on the journey. I wondered if their physician had suggested hospice. Did they know they could seek palliative care support from hospice even if their loved one didn’t qualify for full-time hospice care? Maybe the family refused to have the conversation or maybe they just weren’t ready. What else might we have done to help them through such a difficult time?

Recently, I had the opportunity to interview Dr. Zaki Badawy, the Medical Director of Hospice & Palliative Care of Chenango County.

I asked him when a clinician should reach out to hospice. This is what he said:

“When a person is in the final stage of an illness … and clearly is in the last six months of life and not seeking life-prolonging care, the patient needs additional support to remain at home or in their current setting. If a patient does not meet the criteria for admission to hospice, they may still qualify for palliative care support. Hospice provides a team to support the patient, with 24-hour access to a physician. Patients can be accepted with Medicare, Medicaid, private insurance and under the alternate plan of care in most long term care policies.”

Many times, patients and families don’t wish to face this difficult conversation. How do we as healthcare professionals find the best way to engage? By being prepared with resources, or helping them do their own research. The AARP website has a wealth of resources on the subject.

Dr. Badawy says Medical Orders for Life-Sustaining Treatment (MOLST) from the New York State Department of Health is also part of the conversation. The initiative states:


Kathryn Ruscitto, Advisor


Zaki Badawy, MD

“The (MOLST) program is designed to improve the quality of care seriously ill people receive at the end of life. MOLST is based on the patient’s current health status, prognosis and goals for care. The discussion emphasizes shared medical decision-making that helps the patient understand what can and cannot be accomplished. The result is a set of medical orders that must be honored by all healthcare professionals in all settings.”

At the time a MOLST form is completed, maybe then patients and families will be encouraged to consider hospice in their planning.

Thank you to all the clinicians who choose this highly valued and honorable work. Dr. Badawy remarked that end-of-life care support is an underutilized service in our health system — and hospice teams have much to offer.

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

References for end-of-life conversations

  1. AARP: aarp.org-caregiving/basics/info-2020/end-of-life-talk-care-talk.html
  2. Chenango County: hospicechenango.org
  3. CNY and the Finger lakes: hospicecny.org
  4. Oswego County: health.oswegocounty.com/programs/1_hospice/index.php
  5. Cortland County: hospicare.org
  6. Oneida County: hospicecareinc.org
  7. National Hospice and Palliative Care Organization: nhpco.org
  8. molst.org

Comprehensive, Leading-Edge MRI Services at Magnetic Diagnostic Resources of Central New York

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By Thomas Crocker

Thursday, October 21, 2021

Celebrating 35 years as Central New York’s premier provider of MRI services, Magnetic Diagnostic Resources of Central New York (MDR of CNY) draws on the expertise of dozens of fellowship-trained radiologists and a relentless commitment to quality to provide an exceptional experience for patients and referring clinicians.

The prostate MRI patient experience begins with compassion and care and ends with image quality excellence.
Pictured: MRI technologist Paul Mingle
 

Established in 1985, MDR of CNY’s mission is to provide superior, specialized MRI services in a welcoming, warm and patient-focused environment, transforming what often is an apprehensive experience into a notably calm one.

“A variety of factors distinguish our services from others in the region,” says Jacqueline Floyd, ARRT(R)(MR), MBA, CEO of MDR of CNY. “We have nine convenient locations throughout Central New York, and we invested in the latest specialized software to offer organ-specific specialty scans, some of which are not available at other organizations in our region. We think it’s important to offer a host of MRI services to Syracuse and surrounding communities.”

The new wide bore 1.5T GE 450W high-field scanner will enhance breast MRI comfort with a unique range of exclusive, patient-friendly features so you can relax in comfort during the scan. Pictured: MRI technologist Paula Mulholland
 

A Variety of Specialty Scans

MDR of CNY has long been known for providing breast MRI. In certain cases, this modality can complement mammographic findings during diagnostic evaluation, help measure the extent of known breast cancer, assist in assessing eligibility for or response to hormone therapy or chemotherapy, provide additional information about suspicious findings, and screen patients at high risk due to genetic mutations or history of radiation therapy to the chest, according to The American Society of Breast Surgeons Consensus Guideline on Diagnostic and Screening Magnetic Resonance Imaging of the Breast. MDR of CNY was an early adopter of dedicated breast coils — components that play a key role in creating images of the breasts by transmitting and receiving radio waves during a breast MRI — and CADstream, a software program that helps radiologists visualize abnormalities and plan interventions in a timely manner. MDR of CNY was also one of the first MRI providers to offer MRI-guided breast biopsy. The American College of Radiology (ACR) has accredited MDR of CNY for nine MRI accreditations and four breast MRI accreditations. The organization maintains its status by seeking reaccreditation every three years.

“MDR of CNY has always focused on ACR accreditation for MRI in general and for subspecialty MRI,” says Scott Buckingham, MD, partner radiologist at MDR of CNY. “ACR accreditation is a hallmark of quality and the most widely recognized guarantee for patients that an outside entity has reviewed the capabilities, experience and training of the professionals who conduct MRI studies.”

In addition to breast MRI, MDR of CNY is a high-volume provider of prostate MRI — which can help determine whether a biopsy is warranted and provide guidance during that procedure, as well as aid prostate cancer staging and radiation therapy planning — and many other specialty MRI services, including:

  • Cardiac MRI
  • Conditional pacemaker MRI
  • Enterography
  • Elastography
  • Fetal MRI
  • Inhance, non-contrast MRA
  • MR arthrography
  • MR urography
  • Spectroscopy
  • Stroke and advanced neurofunctional imaging

Patients who have a specialty scan at MDR of CNY can be confident they will receive an accurate reading of their images, as one of the organization’s key differentiators is its team of 47 board-certified, fellowship-trained partner radiologists from two of Central New York’s largest radiology groups, CRA Medical Imaging and St. Joseph’s Imaging Associates. These radiologists possess subspecialty training in a variety of fields, including breast imaging, neuroradiology, musculoskeletal imaging and body imaging.

“Our team has many years of experience performing subspecialty reads,” Dr. Buckingham says. “That’s important because patients whose images are read by a radiologist with specific training in an MRI subspecialty and high-volume experience tend to enjoy more accurate results.”

The patient experience and excellence in quality starts with an experienced and professional leadership team.

 

Prioritizing Safety

Patient safety is paramount for MDR of CNY, which is why its technologists and other members of the team take all necessary steps to safeguard patients before conducting scans. Those steps include verifying that patients’ medical implants are MRI compatible, analyzing records of patients’ previous studies and evaluating kidney function, as the use of a gadolinium-based contrast agent during an MRI can cause problems for certain patients, such as those with diabetes or chronic kidney disease. When appropriate, the MDR of CNY team uses a handheld device called i-STAT to conduct a point-of-care blood analysis that can reveal kidney function.

“Patients can undergo testing with i-STAT in the office at the time of the scan rather than having lab work at a different facility,” Dr. Buckingham says. “That’s a much more convenient way of determining whether a patient is suitable to receive a contrast agent because it doesn’t require separate office visits and eliminates unnecessary cancellation of studies.”

If a patient needs an MR angiogram but has suboptimal kidney function, the MDR of CNY team can perform his or her study using Inhance, a technique that allows technologists to capture images of the renal arteries without using a contrast agent.

Highly trained radiologists at MDR of CNY are board certified with the American Board of Radiology and considered
experts in their field. Pictured: MRI technologist Stephanie Labulis and radiologist David Wang, MD

Convenient and Compassionate

Providing a seamless, one-phone-call scheduling experience for referring providers is a point of pride for MDR of CNY, as is the organization’s ability to accommodate urgent imaging requests and its commitment to scheduling appointments within a two-week timeframe. When needed, MDR of CNY can accommodate STAT requests.

When patients arrive at one of MDR of CNY’s nine locations, they encounter an atmosphere designed to allay any anxiety they may feel about undergoing an MRI. The staff sets the tone.

“Patients have never met a kinder or more compassionate staff,” Floyd says. “Our technologists truly understand how to calm and reassure patients. If a patient is feeling exceptionally anxious, we may give him or her the option to visit the office a day or two before the appointment to talk with our staff about the scan and observe the machine. Our experienced technologists ensure that the patient feels safe and comfortable and stay in voice contact throughout each exam.”

For patients with claustrophobia, a wide-bore MRI scanner and an open unit are available at neighboring locations on Brittonfield Parkway in East Syracuse.

“We do what is best for our patients,” Floyd says. “Our technologists treat every patient with compassion and professionalism, which is why we routinely receive comments in our patient satisfaction surveys singing their praises.”

For more information, visit mdrcny.com. Click on “Referring Physicians” to request an appointment for a patient or call 315-454-4810, press 1.

Timely Communication

Swift communication with referring providers and seamless transmission of scan results is a priority for Magnetic Diagnostic Resources of Central New York. That is why the organization, its partner radiology groups CRA Medical Imaging and St. Joseph’s Imaging Associates, and their associated health systems use a shared picture archiving and communication system. Referring providers receive nonurgent image reports within 24 hours. Providers receive urgent results as soon as a radiologist finishes reading the images.

Crouse Medical Practice Is a Leader in Providing Patient-Centered Care in Central New York

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Crouse Medical Practice surrounds each patient with team-based primary care services tailored to meet every individual’s unique needs.

When it comes to medical care, paying attention and responding promptly to clues that may hint of a potentially dangerous health condition is critical to achieving optimal patient outcomes. Primary care providers specialize in this type of powerful prevention, and thanks to Crouse Medical Practice, established in 2010 by Crouse Hospital, the Central New York community can count on a strong network of more than 220 providers to deliver attentive, high-quality primary care services.

“Primary care is the center of care for the patient, and there is a real need for this in our community,” says Seth Kronenberg, MD, Chief Medical Officer and Chief Operating Officer of Crouse Health and President and Medical Director of Crouse Medical Practice. “We strive to surround the patient and each primary care physician with a team-based approach to care management — when patients are in the hospital and as they transition back to their lives after discharge. Being able to provide that care in a high-quality manner is critically important for both the health of our patients and for the community.”

Crouse Medical Practice — Monazza Ahmed, MD, Todd Lentz, MD, (seated), Seth Kronenberg, MD, Rachna Zirath, MD

Monazza Ahmed, MD confers with Rachna Zirath, MD

“I want to involve my patients in their care so they can take ownership of their personal health. We work together as a team.”
— Rachna Zirath, MD, internist and integrative and holistic medicine practitioner at Crouse Medical Practice

Expanding Access to Care

With the addition of new providers in various specialties and subspecialties, Crouse Medical Practice has widened the breadth and depth of care it provides. Today, Crouse’s primary care network is one of the largest in the region. In fact, during 2020, more than 126,000 office visits took place at its various locations, even in the midst of the coronavirus pandemic.

“We were founded on primary care and continue to grow those services in our offices across the area,” Dr. Kronenberg says. “We have also expanded into other specialties where we have identified a need in the community, including cardiology, neurosciences, general surgery and bariatrics.”

To achieve such a high level of growth, Crouse Medical Practice collaborates closely with the medical directors working within the different specialties, making a point to prioritize physician engagement at each location.

“We run Crouse Medical Practice according to a private-practice, physician-led model,” Dr. Kronenberg says. “That concept has been attractive to physicians, especially those with a private practice background.”


Seth Kronenberg, MD, Chief Medical Officer and Chief Operating Officer at Crouse Health and President and Medical Director of Crouse Medical Practice.

“I send all of my family members who need care to Crouse Medical Practice. I have trained with several of the other physicians and am confident in the collective commitment to provide efficient, patient-centered care every step of the way.”

— Todd Lentz, MD, primary care practitioner, board-certified in internal medicine

A Network of Support

Primary care providers under the Crouse Medical Practice umbrella have the benefit of working autonomously while still receiving support from Crouse Medical Practice’s quality experts and nurse navigators. Each Crouse Medical Practice site is certified as a Patient-Centered Medical Home (PCMH) by the National Committee for Quality Assurance (NCQA). This model of care focuses on ensuring that the patient is the focus of care and, according to the NCQA, has been shown to enhance quality, patient experience and staff satisfaction while also minimizing healthcare costs.

“Because we are a multispecialty medical practice adhering to the PCMH concept, we are able to better coordinate patient care among those specialties and the nurse navigators who work through those specialties,” says Rachna Zirath, MD, primary care internist, integrative and holistic practitioner at Crouse Medical Practice. “We are also all on the same electronic health record, which makes it seamless to provide and coordinate services. That collaboration truly puts Crouse Medical Practice on the forefront of team-based primary care.”

As that team-based care continues to evolve, Crouse Medical Practice is well positioned to provide more advanced care to the community in a way that is compassionate, effective and efficient.

“Crouse Medical Practice works continuously with our physicians on improving quality and shifting the focus from the old fee-for-service model to the new model of quality programs and population health,” Dr. Kronenberg says. Crouse Medical Practice actively participates in all value-based payment programs, with the goal of improving quality, lowering cost and enhancing the patient experience. Crouse Medical Practice has excelled in accountable care organizations with both commercial and governmental payers and continues to achieve excellent quality scores.

“We are seeing more and more physicians look for employment through hospital systems, and I think that our team-based approach to care will continue to be attractive to physicians in the area,” Dr. Kronenberg adds.

Board-certified internal medicine physician Todd Lentz, MD, is one of those physicians. After working as a hospitalist for 10 years, Dr. Lentz was seeking a transition to primary care. A native of the area, he was excited to practice in a familiar community and was drawn to Crouse Medical Practice because of its reputation for excellence and collaboration.

“Crouse has always been renowned, so joining the Crouse Medical Practice team was an easy choice,” Dr. Lentz says. “I got my start in the Syracuse/Downtown location and was excited when the opportunity presented itself to help develop primary care at our Camillus location.”

A Community of Care

Primary care providers with Crouse Medical Practice focus on preventing manageable conditions through early intervention. By equipping patients with knowledge about their personal health and the tools they need to maintain or improve it, their physicians can promote health for entire families.

“Primary care is the backbone of medicine that provides a strong baseline and foundation of health care to our patients,” says Dr. Zirath, MD, “We establish a rapport with our patients that can extend to other family members. It becomes one helping the other as a team to make the community very strong.”

Specialized Services, Conveniently Located

As Crouse Medical Practice has expanded, so has the scope of specialized services offered at its various primary care locations.

In response to community needs, cardiology is one area that continues to grow significantly. Crouse Medical Practice Cardiology provides everything from diagnostic and interventional cardiac services to electrophysiology, all to optimize the heart health of each individual patient.

Crouse Medical Practice has also become a strong support network for stroke care provided at Crouse Hospital, the first in the region to earn Comprehensive Stroke Center dual certification from DNV-GL Healthcare and New York State Department of Health.

“Comprehensive Stroke Center designation is a prestigious honor for Crouse Hospital and one that is difficult to achieve,” Dr. Kronenberg says. “Because we strive to maintain the Comprehensive Stroke Center program, we need physicians in neurosurgery, neurology and neuroendovascular care, and we have expanded into that area at Crouse Medical Practice.”

Providers at Crouse Medical Practice locations offer other types of specialized care, including endocrinology, pulmonology and surgery, making it easy for patients to access the care they need quickly and easily.

“A lot of older female patients want the convenience of seeing one doctor,” says Monazza Ahmed, MD, women’s health and primary care provider at Crouse Medical Practice’s Syracuse/Downtown location. “We can provide the complete spectrum of care for these patients. We do everything from bone density screenings to pelvic and breast exams. We offer same-day mammograms and send biopsies to our surgical group. Primary care is the captain of the ship.”

Primary Care in the Midst of a Pandemic

When COVID-19 struck the region, the team at Crouse Medical Practice had the technological infrastructure in place to manage patients’ health while adhering to social distancing guidelines.

“During the early stages of the pandemic, we saw significant utilization of telemedicine,” Dr. Lentz says. “Our EHR provided a strong foundation for the robust telemedicine operations we needed to conduct exams virtually. Moving forward, telemedicine will continue to be prevalent at levels that are much higher than they were prior to COVID-19.”

However, Crouse Medical Practice also kept offices open, and providers were available to see patients who needed in-person consultations. In addition, COVID-19 units were set up to care for patients who had the coronavirus.

Throughout the COVID-19 pandemic, nurse navigators provided invaluable support to patients and clinicians. Their guidance will continue to be of critical importance as Crouse Medical Practice continues to help patients make choices to improve their overall health.

“COVID-19 taught everyone how important it is for patients to focus on living healthier lives,” Dr. Ahmed says. “The healthier a patient is, the higher the chances to beat infection. We were focusing on this message prior to the pandemic by highlighting the value of managing weight and blood pressure and staying up to date with vaccines. COVID-19 has made this correlation even more obvious.”

Locations

Primary Care at Brittonfield
5000 Brittonfield Parkway, Ste. A100, East Syracuse, NY 13057
315-449-3800
Specialties: Primary Care, Cardiology, Neurosurgery, Endocrinology

Primary Care at Camillus
5417 West Genesee St., Ste. 3, Camillus, NY 13031
315-476-2323
Specialties: Primary Care, Endocrinology, Cardiology

Primary Care at Manlius
4500 Pewter Lane, Bldg. 1, Manlius, NY 13104
315-682-6600
Specialties: Primary Care

Primary Care at Syracuse/Downtown
739 Irving Ave., Ste. 200 and 300, Syracuse, NY 13210
315-479-5070
Specialties: Pulmonology, Primary Care, Endocrinology, Bariatrics, Neurosurgery, Neurology

Cardiology at Clay/Liverpool
8324 Oswego Road, Suite C, Liverpool, NY 13090
315-470-7409

Primary Care at Camillus
5417 West Genesee St., Camillus, NY 13031
315-766-116
Specialties: Primary Care


Elizabeth Riccardi, MD


Stephanie St. Denis, RN and Barabara Clayton, MD

A Family Focus

Women who want to practice medicine while also raising their families can have it all at Crouse Medical Practice, where work-life balance is a key element of the practice’s culture.

“Women physicians in 2021 should not have to choose between career and family,” says Monazza Ahmed, MD, women’s health and primary care provider at Crouse Medical Practice’s Syracuse/Downtown location “I am able to work part-time and have the freedom I need to focus on raising my children. Finding an organization like Crouse Medical Practice that supports that work model is huge. They are very respectful and accommodating.”

A Holistic Approach to Patient Care

As an internist and integrative and holistic medicine practitioner at Crouse Medical Practice, Rachna Zirath, MD, provides guidance to patients that is focused on more than physical health.

“I look at a patient’s physical ailment, but I also try to assist them with their mental, emotional, spiritual, and social health,” Dr. Zirath says. “Taking this holistic approach brings out the best in the patient.”

Dr. Zirath’s approach to health blends effortlessly into the Crouse Medical Practice primary care space.

“As a multispecialty practice, Crouse Medical Practice is dedicated to providing the best supportive care for each patient, whatever that may look like,” Dr. Zirath says. “It is a very integrated approach for the patient. They are not being seen for just one problem.”

Patients managing various health challenges that affect overall wellness and quality of life can find the support they need from Dr. Zirath.

“I take the time to listen to my patients’ concerns and provide a comprehensive plan,” Dr. Zirath says. “I offer simple ways to deal with the problem, which may be physical, mental, spiritual or social, so patients can change their attitudes and look at things in a different way.

During COVID-19, Dr. Zirath found the focus on positivity to be especially important for patients facing pandemic-related stress. She encouraged her patients to engage in exercise routines that they enjoy, eat nutrient-rich foods in appropriate portions, and stay connected with themselves, their families and their community.

“Focusing on personal responsibility is a much better approach to improving a patient’s health outcomes,” Dr. Zirath says.

The Healthcare Team at Crouse Medical Practice

Primary Care

Monazza Ahmed, MD
Paraskos Araouzos, MD
Soubhi Azar, MD
James Blanchfield, MD
Debra Buchan, MD
Barbara Clayton, MD
Victor Croglio, MD
Erik Daly, MD
Mark Erlebacher, MD
Andrew Hathaway, MD
Caroline Keib Cramer, MD
Todd Lentz, MD
Martin Noonan, MD
Elizabeth Riccardi, MD
Eileen Stone, MD
Hnin Thandar, MD
Albert Tripodi, MD
Christina Walton, DO
Rachna Zirath, MD
Douglas Zmolek, MD
Dawn Cassell, DC, FNP-C
Amira Goldberg, MSN, NP
Jeffrey Lape, PA-C
Jamie Mangovski, PA
Ashley Maxam, MS, PA-C
Beverly Mosher, RN MSN FNP
Dylan Rodner, RPA-C
MacKenzie Renee Rotella, MSN, APRN, FNP-C
Danielle Ryan, FNP, MSN
Stephen Senenko, PA-C, RD, CDN
Andrew Snider, PA
Teri Strine, RN MSN FNP-C
Corissa Tefft, PA-C
Kelly Woods, MS, RN, FNP-C

Bariatric Surgery

Jeffrey Desimone, MD, Medical Director
Kenneth Cooper, DO
Taewan Kim, MD
Catherine Huss-Johnson, PA
Michael Merola, NP
Melinda Shaw, PA
Kathleen Tindall, NP
Tracy Walker, NP

Cardiology

Nishith Amin, MD
Jeffrey Ascenzo, MD
Joseph Battaglia, MD, Medical Director
William Berkery, MD
Anil George, MD
Matthew Gorman, MD
Joshua Harrison, MD
Nikhil Joshi, MD
James Longo, MD
Charles Miller, MD
Tristan Petrie, MD
John Ulahannan, MD
Erin Bahamonde, NP
Anna Buckman, NP
Meghan Maynard, PA
Lindsey Oltz, PA
Jeanne Pietrzak, NP
Chistopher Souza, NP

Endocrinology

David Di Cesar, MD
Steven Zygmont, MD
Nola Gardner, FNP-BC
Kristy Ventura, FNP-C

General Surgery

Akbar Ahmed, MD
Tammy Congelli, MD
Steven Gelb, MD
Thomas Hartzheim, MD
Herbert Mendel, MD
Benjamin Sadowitz, MD
William Schu, MD
James Sartori, MD, Medical Director
Tanveer, Zamani, MD
Heidi Huddleston-Cross, PA

Interventional Spine & Pain Management

David Moorthi, MD

Neurology

Sami Abdul-Malak, MD
John Cullen, MD
Vikas Gupta, MD
Richard Jackson, MD
Natan Khishchenko, MD
Konstantin Timofeev, MD
Michael Vertino, MD
Meredith Chesare, PA
Tabatha Jorgenson, PA
Colin Maloney, PA
Alyssa Seldes, PA

Neurosurgery

Gregory Canute, MD
Ross Moquin, MD
David Padalino, MD, Medical Director
Raghu Ramaswamy, MD
Clifford Soults, MD
Evan Belanger, NP
Corrie Burgess, NP
Linda Casey, NP
Reggie Cayetano, PA
Jameson Crumb, PA
Sara Finney, PA
Joshua Hennessy, PA
Timothy Ko, PA
Nura Jaber, PA
Gregory Pier, PA
Dipendra Sah, PA
Robert Sawyer, PA
James Shuler, PA
John Stulb, PA
Gregory Verway, PA
Laura Vogt, PA

Psychiatry

Kevin Johnson, MD
Mallory Connor, NP

Pulmonology

Stephan Alkins, MD, Medical Director
Viren Kaul, MD
Emily Weston, FNP-C

Making Excellence Accessible at Auburn Community Hospital

Posted on by admin

By Katy Mena-Berkley

Monday, August 23, 2021

By investing in sophisticated technologies and talented clinicians, Auburn Community Hospital has created an advanced and compassionate healthcare center for people living in the Finger Lakes region.

Entrance to OB/GYN Offices and Women’s Health Center
 

A treasure is nestled in the heart of Auburn — an acute care facility where medical professionals serve roughly 80,000 friends and neighbors throughout the Finger Lakes region. Over the past several years, Auburn Community Hospital has built a comprehensive suite of services that provides a dependable and robust spectrum of care for numerous conditions.

“Auburn is a very close-knit community, and the patients here — even though they are part of a rural area — expect and deserve high-quality care,” says Paul Fu, MD, MBA, Chief Medical Officer, Auburn Community Hospital and Auburn Memorial Medical Services, PC. “The community has options and can drive to Syracuse or Rochester, but they would like to stay in this area if they can.”

To meet this need, Auburn Community Hospital has worked to build on existing resources while keeping the future in mind. By closely examining service lines, responding to physician needs and recruiting exemplary support staff, Auburn Community Hospital is delivering value-based healthcare solutions with maximized efficiency and high standards of quality.

“We measure and track the care we provide and constantly compare ourselves to national benchmarks,” Dr. Fu says. “That is the kind of excellence our patients deserve.”

“It is so important to us as a hospital and outpatient center to look for providers who are the best of the best.”
— Paul Fu, MD, MBA, Chief Medical Officer, Auburn Community Hospital and Auburn Memorial Medical Services, PC

Specialized OB/GYN Services

In an ongoing effort to offer a full range of advanced services to patients, Auburn Community Hospital is paying particular attention to growing a handful of key specialties that are in high demand, including OB/GYN and orthopedics.

“Preventive health care is a critical part of well-rounded care in the community,” says Amy MacDonald, MD, OB/GYN, Auburn Medical Center. “The whole purpose is to identify concerns and address them before they have a chance to become problematic.”

A team of four physicians and three midwives at the Women’s Health Center at Auburn Community Hospital provides a multitude of services including breast care, family planning, prenatal care, labor and delivery, and assistance with managing menopause. Clinicians are also trained to perform minimally invasive and vaginal gynecologic surgical procedures to manage conditions such as abnormal uterine bleeding, endometriosis, pelvic pain and stress urinary incontinence.

Patients who visit the Women’s Health Center receive their care in newly updated examination rooms from clinicians who use the latest technological equipment, including in-office ultrasound and the MyoSure Tissue Removal System, a minimally invasive hysteroscopic tool that allows physicians to resect abnormal tissue, fibroids and polyps.

“With MyoSure, you can examine the uterus and abnormal tissue without incision because everything is done vaginally,” Dr. MacDonald says. “Using this tool, we can get a really targeted biopsy, which is especially helpful if we are concerned about uterine cancer or addressing polyps. In the past, the only other option in these situations would have been to make an abdominal incision similar to a cesarean section. This saves a lot of recovery time for many women.”


Amy MacDonald, MD, is Board Certified in Obstetrics and Gynecology and a Fellow of the American College of Obstetricians and Gynecologists. Dr. MacDonald joined Auburn Obstetrics & Gynecology in May of 2020 after practicing in Rochester, N.Y. at ParkWest Women’s Health, a practice affiliated with Strong Memorial Hospital. Dr. MacDonald is also a Clinical Assistant Professor of Obstetrics and Gynecology at the University of Rochester Medical School.

(L/R) Scott Berlucchi, President & CEO, Tammy Sunderlin, Chief Nursing Officer, Tanya Paul, MD, OB/GYN, Past President Medical Executive Committee, Stephen Graziano, MD, Division Chief of Upstate Cancer Center, Adult Hematology/Oncology, John Riccio, MD, Chief Medical Officer, David Duggan MD, Upstate Cancer Center, Adult Hematology/Oncology

 

Investing in Orthopedics

The orthopedics program at Auburn Community Hospital has experienced a similar renaissance. Under the leadership of Brian D. Tallerico, DO, Chief of Orthopedic Surgery at Auburn Community Hospital and Auburn Orthopaedic Specialists, the team has placed a keen focus on quality and accessibility to care.

“I was living and practicing in Wyoming when the opportunity to practice in Auburn and be closer to family presented itself,” Dr. Tallerico says. “Auburn Community Hospital President and Chief Executive Officer Scott A. Berlucchi, FACHE, NHA gave me what I needed to successfully lead this program and the rest is history. We hit the ground running and have not let our foot off the gas since then.”

To improve the patient experience and attract skilled and talented physicians to the orthopedic team, Auburn Community Hospital invested in the Mako robotic technology from Stryker to perform robot-assisted hip and knee replacement.

“With Mako, our surgeons still perform the surgery, but by getting CT scans of each patient’s anatomy, we can perfect the implant position and increase our accuracy with our bony resections, so our implants go in with more accuracy,” Dr. Tallerico says. “This leads to better joint longevity, better function, less pain, more rapid recovery and better outcomes. After offering this state-of-the-art technology for six months, our results have noticeably improved.”

The orthopedics team is also using the SX-One MicroKnife to streamline surgical performance and enhance patient outcomes. Hand surgeon Cathy Teixeria, MD, uses the minimally invasive technology with ultrasound guidance for precision carpal tunnel release. Recovery is rapid, and most patients are able to resume use of their hand and wrist within a few days with less pain and fewer or no postoperative therapy sessions.

Collaborating to Enhance Outcomes

Auburn Orthopaedic Specialists’ fellowship-trained physicians have an average of 25 years of professional experience. Their expertise is complemented by an equally seasoned orthopedic physician assistant, Steve Kieb, PA.

“We recruited Steve about a year and a half ago when we started getting really busy,” Dr. Tallerico says. “He has 24 years of orthopedic experience and has been very involved in building an orthopedic center of excellence. That partnership mindset, in combination with our supportive administrative team, cutting-edge technology and fellowship-trained clinicians and surgeons, make the highest quality of care available right here in Auburn and the Finger Lakes region. We’re a quality organization from top to bottom.”

Brian D. Tallerico, MD, DO, Chief of Orthopaedic Services


(L/R) Nursing Student, Tanya Paul, MD, Amy MacDonald, MD, Loren Van Riper, MD, Emily Pilato (MyoSure Rep)

Crystal Spurgeon, RN (Background), Denise Lawton, RN (Foreground) – Upstate Cancer Center at Auburn Community Hospital

Contemporary Cancer Care Close to Home

The partnership between Auburn Community Hospital and Upstate Cancer Center has been in the making for decades. Today, the relationship has come to fruition with the state-of-the-art Cancer Center at Auburn Community Hospital.

“The initiative began 30 years ago with our nephrologists at Upstate offering patient care at Auburn,” says David Duggan, MD, MACP, Professor of Medicine at Upstate Medical University. “Now there are several groups of physicians from Upstate that come to Auburn to provide support for a wide spectrum of cancers, intensive care, critical care and infectious disease consultation. We try to do as much as we can here in Auburn. It has been a real partnership that has helped a lot of patients get good care closer to home.”

The Comfort of Convenience

Today, patients facing cancer can count on receiving comprehensive care from highly trained clinicians with expertise in cancer care. Plus, patients do not have to travel into the city far for treatment infusions, follow-up appointments and consultations with cancer specialists who are actively involved in the latest clinical research. Should additional resources be necessary, Upstate is a phone call away.

“We are able to provide very contemporary care here at Auburn Community Hospital,” Dr. Duggan, a hematologist oncologist, says. “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.”

Imminent Group Practice Profit Allocation Changes

Posted on by admin

Be sure to prepare for what’s in store for physician practices

We are quickly approaching the January 1, 2022 effective date for the group practice “overall profits” definition revisions from the Centers for Medicare & Medicaid Services (CMS) final rule. Since physician practices need to qualify as a group practice in order to rely on the In-Office Ancillary Services exception (IOASE) set forth in the Physician-Self Referral Law (Stark Law), prudent groups are advised to review their current compensation models and ensure they are in compliance with the updated regulation.

In summary, unless a specific exception applies, the Stark Law prohibits physicians from referring designated health services (DHS) payable by Medicare to entities with which the physician has a financial relationship. These “financial relationships” generally include employers, affiliated hospitals or a practice in which such physician is an owner. The IOASE provides an authorized exception for internal referrals within the physician’s “group practice” for services performed or supervised by another physician of such group practice, in the same building, and billed by the group practice. A group practice exists when it:


Kyle Sutliff

  • Consists of a single legal entity and unified business having centralized decision-making, control over the group’s assets and liabilities, consolidated accounting and financial reporting, and operating primarily for the purpose of being a physician group practice
  • Consists of at least two physicians who substantially provide the full range of their patient care services through the joint use of shared office space, facilities, equipment and personnel
  • Substantially Bills all (at least 75%) patient care services furnished through the group
  • Conforms to specific compensation distribution limitations discussed in more detail below

Physicians in a group practice may be paid “a share of overall profits of the group” provided the share is not determined in any manner that is directly related to the volume or value of referrals of DHS by the physician. Prior to the clarifications set forth in the final rule, “overall profits” was defined to mean either all DHS revenue of the group or, “the profits derived from DHS payable by Medicare or Medicaid of any component of the group practice that consists of at least five physicians.” This language created some ambiguity and confusion in smaller groups or those that provided multiple forms of DHS and gave rise to the question of whether DHS could be allocated on a service-by-service basis.

To address those issues, the new provisions on “overall profits” require all DHS, whether allocated to the group as a whole or a pod of five or more physicians, to be aggregated before distribution. This clarified that service-by-service distribution is prohibited and that group practices of less than five physicians cannot separately allocate DHS revenue to different subgroups within the practice.

Fortunately, the final rule also clarifies that some of the previously existing examples of permissible DHS distributions for a group practice (five-physician pod) continues to be deemed not directly related to the volume or value of referrals if:

  • They are divided per capita
  • They are distributed based on the group’s revenues from services that are not DHS

OR:

  • If DHS constitutes less than 5% of the group’s total revenue AND the portion of DHS distributed to any given physician constitutes less than 5% of such physician’s total compensation.

However, these advised allocations do not preclude the provision of a productivity component if it is based on services personally performed by the physician or “incident to” such personally performed services, and calculated in a reasonable and verifiable manner.

The final rule provides additional guidance regarding these productivity-based distributions by stating that in addition to the profit distribution methods mentioned above, a productivity bonus is not related to the volume or value of referrals when based on total patient encounters or relative value units (RVUs), provided each are personally performed by the physician.

Group practices should take this opportunity to review their DHS allocation formulae to ensure continued compliance with the new clarifications and also take full advantage of more customizable productivity options.

Kyle Sutliff is an associate at CCBLaw, a boutique law firm focused on providing counsel to physicians and other healthcare professionals. He can be reached at 315-477-6261 or ksutliff@ccblaw.com.

Resources

Federal Register,www.federalregister.gov/documents/2020/12/02/2020-26140/medicare-program-modernizing-and-clarifying-the-physician-self-referral-regulations.