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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

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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

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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.

It’s Time To Listen to Our Primary Care Providers

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By Kathryn Ruscitto, Advisor

Monday, August 23, 2021

To every clinician engaged in primary care, how do we express how important you are to our health system?

Primary care providers are often the first people patients see with a concern, question or fear about what to do when they have a health issue. These essential healthcare professionals watch not only for medical issues, but the social and mental health pressures that often accompany physical conditions. They can see across the continuum, identify where the gaps are, and advocate for community health and other solutions.

However, I increasingly hear that we have lost the voice of the primary care clinician in public policy settings and planning as they face continuous overload, regulations and too many patients. Unfortunately, administrators sometimes forget to start with the boots on the ground before setting policy. Add in COVID-19, and we are overstressing one of the most important parts of our healthcare system.

In researching what is happening nationally, I came across a new and unique primary care paradigm that fully explores the opportunities and issues faced by primary care and calls for a shift in planning and financing. This new model was signed in 2020 by the following organizations:

Kathryn Ruscitto, Advisor

  • American Academy of Family Physicians
  • American Academy of Pediatrics
  • American Board of Family Medicine
  • American Board of Internal Medicine
  • American Board of Pediatrics
  • American College of Physicians
  • Society of General Internal Medicine

As patients, we need to understand that while the system is stressed from the COVID-19 pandemic and delayed demands, our primary care system is truly doing more than it can handle. We need to exercise some patience.

In a recent survey, I asked a group of community healthcare leaders to tell me about their good and bad experiences, and what they valued. Listening, engaging the community, being accessible, and connecting the pieces were some of the good aspects. Bad experiences were generally described as feeling disconnected or that the pieces provided did not work well together.

As administrators and policy convenors, we need to become more aware of the societies our clinicians relate to and enable those clinicians to have their voices heard. Are we building sabbaticals, learning opportunities and other supports to relieve some of the burden these clinicians face? I remember a healthcare program that granted leaders a one-month sabbatical every five years so they could completely disengage, think and learn.

We are in a very complicated time. So how do we repair the problems within our system, learn from the current crisis, and use technology and innovation to rebuild a stronger system?

To begin, we do it by listening and supporting the leaders on the front lines — those who know what works and what doesn’t.

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

Time for a Telehealth Check-Up? Start by Calling Your Broker

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By Jennifer Negley, Vice President, Risk Strategies Company

Monday, August 23, 2021

The COVID-19 pandemic proved telehealth is a viable healthcare delivery option for patients and practitioners. Understanding and preparing for its risks will ensure it remains a safe and steadfast solution.

In the quest to provide quality medical care during the COVID-19 pandemic, many medical practices quickly shifted to or increased their use of telehealth. While telehealth grew out of financial necessity for practices during the pandemic, it remains in favor due to its convenience, affordability and efficiency for patients.

According to Doximity’s “2020 State of Telemedicine Report,” in 2020, virtual care accounted for more than 20% of all medical visits in the U.S., and is projected to drive $29 billion in total healthcare services. The same study found that up to $106 billion of current healthcare spend could be virtualized by 2023.

Patients are largely on board, including both the younger generation, which appreciates the expanded office hours and flexibility telehealth provides, and seniors, who no longer receive Medicare or Medicaid reimbursement for medical visit transportation. Doximity states that prior to the pandemic, just 14% of Americans had tried telehealth at least once. Since the coronavirus, that number has increased by 57%, and for those with a chronic illness, the number has increased by 77%. With no signs of slowing down, the prognosis for telehealth has never been stronger.

For all its benefits, telehealth is not without risk. When patients canceled in-person visits, many states relaxed regulations to help medical practices keep up with demand. Now, these practices are finding it necessary to establish standard practices and protocols to safeguard operations and mitigate malpractice risks. From an insurance standpoint, there are emerging liability exposures that will undoubtedly arise from the COVID-19 pandemic and rapid adoption of telehealth. As states relaxed regulation, so have malpractice carriers regarding their coverage of telehealth. Most, if not all, have now reverted to their original determinants for covering telehealth. If your practice was not approved by your malpractice carrier prior to COVID-19, it’s important to ask your broker to confirm whether you are meeting the requirements currently in place to avoid any coverage gaps.

Misdiagnosis: In telehealth, misdiagnosis is the biggest malpractice risk. Virtual consultations and examinations present challenges in patient communication, reviewing diagnostics and loss of contextual clues that may lead to misdiagnosis. According to CRICO, two-thirds of telemedicine-related claims received between 2014-2018 were related to misdiagnosis. With a lack of in-person visits, most carriers are bracing for a significant increase in claims of this type, adding to the worrisome uptick in frequency and severity across all filed claim categories.

Data Security Risk: Telehealth data security has never been more vulnerable and the means of attacks are rapidly changing. While most malpractice policies provide cyber insurance, coverage is often limited. Securing a separate, stand-alone cyber policy is critical in providing your practice the latest comprehensive coverage. Due to the evolving nature of cyber liability, having a brokerage team that specializes in this coverage could protect your practice from significant financial loss should it become a target.

State Jurisdiction: During the COVID-19 telehealth surge, geography blurred with healthcare professionals offering services across state lines. Physicians need to check with their medical malpractice carriers to determine proper insurance coverage since many have tight geographical limitations.

One thing is certain. Telehealth is here to stay and getting stronger. Make sure your program is in top-notch shape, so patients receive the right care, at the right place and time.

For more information on insurance options, contact Jenn Negley at 267-251-2233 (cell) 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

Oneida Health Hospital Earns Highest Quality Rating From CMS

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Monday, August 23, 2021

Only 455 of the more than 3,300 hospitals in the nation received a five-star rating.

Oneida Health Hospital has received a five-star rating for overall quality of care from the Centers for Medicare & Medicaid Services (CMS) in its recently released 2021 hospital rankings annual report. Oneida Health Hospital is one of only seven hospitals in the entire state to receive CMS’ coveted five-star rating.

CMS’ hospital star rankings, which are posted on the government’s “Hospital Compare” website, is a consumer’s guide to hospital quality and considered among the top hospital report cards available. The five-star scale helps patients compare and identify top-performing hospitals for their care. The recent release ranks Oneida Health Hospital among the top 14% of all eligible hospitals in the U.S. with respect to overall patient safety and patient experience.

“The CMS five-star rating is a testament to the quality of care our patients receive at the hospital, every day,” says Gene Morreale, President and CEO at Oneida Health. “Our team of medical providers and organizational staff are providing some of the highest quality of care in the region. We couldn’t be prouder of their dedication to patient-centered care and teamwork.”

The CMS star rating is comprised of more than 50 individual measures addressing health outcomes from five areas of health care including mortality, safety of care, readmission, patient experience, and timely and effective care. Of 4,586 hospitals nationally:

  • 455 hospitals (13.5%) received five stars
  • 988 hospitals received four stars
  • 1,018 hospitals received three stars
  • 690 hospitals received two stars
  • 204 hospitals received one star

For more than a quarter of hospitals nationally (1,181) no information was available. To learn more about the CMS Star Ratings Program or to compare hospitals in the region, visit Medicare.gov/care-compare.

Oneida Health serves an area comprised of approximately 29 communities in Madison and western Oneida counties with a population of approximately 100,000.

Operated by Oneida Health Systems, Inc, a New York State not-for-profit corporation, the organization includes a 101-bed acute care hospital, emergency department, state of the art surgery center, 160-bed extended-care and short term rehab facility, primary care offices, internal medicine, comprehensive lab services, home medical equipment, comprehensive imaging services, outpatient therapy, and care specialties in: oncology, cardiology, neurology, podiatry, vascular, sleep, OB/GYN, orthopedics, wound care, GI, pulmonary, and ENT.

“It is the ongoing commitment of our providers and staff that makes our hospital’s five-star rating possible,” Morreale says.

For more information on Oneida Health Hospital, visit oneidahealth.org.

Leading-Edge Joint Replacement Care at Syracuse Orthopedic Specialists

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By Hillary Eames

Tuesday, June 22, 2021

Syracuse Orthopedic Specialists’ One-Day Surgery Center offers patients the comfort and convenience of an outpatient facility combined with the expertise of fellowship-trained surgeons and nationally recognized success rates.

(L-R) Stephen Bogosian, MD, Anthony Orio, MD, Seth Greenky, MD, Michael Clarke, MD, Timothy Izant, MD, Brett Greenky, MD, Kevin Kopko, MD
 

Since opening its doors in 1999, Syracuse Orthopedic Specialists (SOS) has been a leading name in providing comprehensive orthopedic care. With specialties including sports medicine, foot and ankle, hand and wrist, spine, and joint care, patients have always trusted SOS to offer high-quality care.

Providing Joint Replacement Patients a Choice in Upstate New York and Beyond

For patients in New York and throughout the country, total joint replacement is on the rise, specifically for hip and knee joints. As the demand for leading-edge orthopedic care increases, SOS physicians and staff — one of the largest specialty-trained joint replacement teams in the country — are able to accommodate the growing need for joint replacement while meeting patients’ expectations for excellence.

Each of the eight joint replacement surgeons on staff at SOS is fellowship-trained in joint replacement surgery, and many have made extensive contributions to orthopedic research. This evidence-based and comprehensive approach to care gives them a reputation that extends well beyond Central New York, with patients travelling from the Mohawk Valley, North Country and Southern Tier regions to seek care at SOS.

“Our additional training has allowed us to build a large program for joint replacement patients over the last 25 years,” says joint replacement surgeon Brett Greenky, MD, President of SOS. “We perform more than 3,000 joint replacements per year.”

Nurse Navigators Sarah Brandt, RN, and Tammi Walker, RN

Building a Joint Replacement Legacy at SOS

Dr. Greenky works alongside his brother Seth Greenky, MD, orthopedic surgeon at SOS, and will soon welcome his nephew, Max Greenky, MD, to the team in August to join his father and uncle as a fellowship-trained joint replacement specialist. (See “Introducing Dr. Max Greenky to Syracuse Orthopedic Specialists.”)

“Our three younger physicians are Dr. Max Greenky, Dr. Kevin Kopko, and Dr. Anthony Orio, and all three are amazingly talented,” Dr. Brett Greenky says. “They’re well-educated and highly skilled physicians establishing their joint replacement practices, and they are in the top of their class.”

Dr. Brett Greenky uses sports to illustrate why the combination of experienced physicians, such as himself, and specialty-trained younger physicians, such as his nephew, heightens their level of orthopedic care.

“It’s like managing a baseball team,” he says. “If your shortstop or hitter are getting older, you’ve got to make sure you’re bringing on newer players. The more established physicians like me are in our last decade of practice. We’re making sure we have excellent talent on board, especially because the need for joint replacement is only increasing.”

Revolutionizing Joint Replacement at Specialists’ One-Day Surgery Center

As the push for patients to receive total joint replacements at outpatient facilities receives wider acceptance, SOS is prepared.

“There’s a trend where 50% of patients, maybe even 60%, may not go to a hospital for joint replacement care,” says Kevin Kopko, MD, joint replacement surgeon at SOS. “This could happen within the next four or five years.”

Already ahead of the curve, the Specialists’ One-Day Surgery Center offers total hip and knee replacements to qualifying patients on an outpatient basis. To date, success rates at the facility are equal to or better than national averages. The SOS research department reports that, of their outpatient surgery recipients, nine out of 10 patients who receive total hip or knee replacements report less pain and improved quality of life in as little as six weeks following their procedures.

“We select patients who are low-risk for anesthesia complications, have fewer comorbidities, and are planning a discharge to their home after joint replacement,” Dr. Kopko says. “We take our healthiest patients — roughly 20% to 25% of surgery recipients — to the surgery center and provide the same level of care they would receive at the hospital, in an environment designed specifically for orthopedic care.”

“Some patients have no other health concerns besides their hip or knee arthritis,” says Anthony Orio, MD, adult reconstruction surgeon at SOS. “For those patients, or patients with well-controlled comorbidities who are otherwise healthy, getting surgery at the center gives them the safest, most efficient way to receive a joint replacement, and it gets them back to where we believe is the most effective place for patients to recover — their own homes.”

A Standardized Pathway to Stellar Results

The Specialists’ One-Day Surgery Center outpatient joint replacement program focuses on key elements such as a standardized clinical pathway. This includes essential components such as proper patient selection, preoperative patient and family coach education, perioperative multidisciplinary coordination, multi-modal pain management, and early and effective post discharge planning for the return to home. High-risk patients receive the same quality care within the hospital, but for many patients, the convenience and comfort of the Specialists’ One-Day Surgery Center is an attractive option.

“A majority of hip and knee replacement patients go home the same day as their surgery,” Dr. Kopko says. “That’s because we’ve designed a facility and team centered around giving our patients comprehensive orthopedic care. This includes a hands-on systematic approach to each patient’s surgical process and recovery.”

While the typical patient goes home the day of their surgery, for those traveling more than two hours, or needing further recovery time, the Specialists’ One-Day Surgery Center also includes eight rooms for overnight stays. These hotel-like rooms allow patients and their loved ones to receive post-operation care while still maintaining outpatient status.

“At our surgery center we have a highly skilled, multidisciplinary team caring for patients from arrival until departure,” Dr. Kopko says. “The team has a direct communication pathway to the surgeon and has ready access to him whenever needed.”

“Our outpatient program has an emphasis on quality and safety outcomes,” Dr. Kopko explains. “The team focuses on evidence-based protocols and pathways, including critically important early postoperative mobilization, pain management, blood conservation, state-of-the-art wound management and VTE prophylaxis.”

Nurse Navigation Improves the Patient Journey

Nurse navigators Sarah Brandt, RN, and Tammi Walker, RN, at Syracuse Orthopedic Specialists (SOS) begin their work as soon as a patient elects to have a procedure by collaborating with the patient and his or her providers to ensure high-quality, personalized and comprehensive care is delivered from start to finish and beyond.

“The nurse navigators perform comprehensive assessments with each patient,” Brandt says. “We make individualized care plans for them based on their goals after surgery and current health status, and we share those with the team at the outpatient surgery center.”

Before patients undergo surgery, one of the requirements is to participate in an education session. This session covers what to expect before and after surgery, including their stay at the surgery center. In addition to the educational video, the nurse navigators also educate patients on what medical equipment will need to be obtained and when to schedule physical therapy. If needed, nurse navigators also assist patients with coordinating after-discharge care needs. The nurse navigators maintain communication with the surgery center to keep staff and providers abreast of patient needs and conditions.

“We check office and triage notes, and if there are any red flags, we call patients to follow up with them to make sure nothing is missed,” Walker says. “Then, we’ll check physical therapy notes to make sure they’re progressing.”

The goal is to make sure every patient they see is fully supported and cared for every step of the way.

“After surgery, we’re ensuring patients stick to the plan we collaboratively created,” Brandt says. “We educate patients on pain management and encourage them to reach out if they have any concerns. We stay in contact throughout their road to recovery.”

Dr. Clarke speaks with Dr. Izant
 
Dr. Seth Greenky and Dr. Brett Greenky with Dr. Bogosian
 
Dr. Orio confers with Dr. Kopko

Low Infection Rates

By limiting the amount of time spent in the facility, patients limit their exposure to potential causes of infection.

“Infection is probably the single thing that can cause joint replacement patients to have problems,” Dr. Kopko says. “Generally, the risk of infection is between 2% to 3% around the country. At our facility it’s less than 0.03%.

“If there’s one thing we’ve learned from COVID-19, it’s that social distancing works,” he adds. “The fewer interactions patients have after surgery, the lower their risk of infection.”

Advancing Care With Advanced Technology

The Specialists’ One-Day Surgery Center is one of the largest ambulatory surgery centers in the Northeast and currently one of the only outpatient facilities in the region to offer robotic surgery. Leading-edge robotic technology allows for patients with certain anatomical nuances who still meet outpatient qualifications to receive the benefits of robotic surgery as well as outpatient surgery. For some patients, robotic surgery for total or partial knee replacement is available with use of the robotic surgical system at the surgery center. The handheld operating technology assists the surgeon in achieving extremely precise implant placement and alignment.

“I tell patients that all eight of us can hit the bull’s-eye for hip and knee replacement, but the robot allows us to hit dead center,” Dr. Orio says. “It’s not something necessary for every case, but it provides extra information that lets us perform surgeries with even greater precision for certain indications.”

A Collaborative Care Team

To ensure patients are an excellent fit for outpatient joint replacement surgery, a high-quality, continuum-of-care team at SOS enables providers to consistently communicate with each other throughout the patient journey.

As soon as a patient elects to undergo joint replacement, the nurse navigators at SOS are there to ensure patients and physicians are provided with the most accurate and up-to-date information. (See “Nurse Navigation Improves the Patient Journey.”)

“We want to make sure patients have everything in order for a successful recovery,” Dr. Orio says.

Prior to surgery, patients also meet with the physical therapy team to create their rehabilitation plan and schedule their first post-operative appointment. Physical therapists stay in constant communication with surgeons during patient recovery, ensuring patients are reaching the goals established prior to their surgery. In many cases, physical therapy and physician offices are within the same building, and therapists can provide updates to physicians with a quick walk down the hall.

“Surgeons provide patients with a joint replacement, but we’re only a part of their full recovery,” Dr. Orio says. “We need the well-established practice of other providers and services at SOS for a successful patient outcome.”

Once a month, physicians also collaborate with each other through joint replacement council meetings. These monthly meetings serve as a place to update best practices, review current research and literature, and discuss difficult cases with SOS colleagues.

“We have eight fellowship-trained doctors experienced in joint replacement surgery with significant experience, and each of us think differently in regard to how cases should be handled,” Dr. Orio says. “It’s a good sounding board for us to bounce ideas off of one another.”

“Communication is the reason our success rates are so high,” Dr. Kopko adds. “Our joint council has run for the last decade, and it’s where we learn about what’s going on nationally and within the community.”

SOS also runs a joint replacement registry, a robust database to collect information about joint surgeries, types of prosthetics, and patient outcomes, and has contributed 10 years of joint replacement data to the national databank. Not only does the data allow physicians to track success rates of surgery and prosthetic types, but it offers real-data comparisons to illustrate the SOS team’s remarkable numbers.

“The success of our program is documented by our numbers compared to national data,” Dr. Brett Greenky says. “When compared, our data points are equal to or greater than national averages, which offers evidence of the quality of care patients receive here.”

SOS Fellowship-Trained Joint Replacement Surgeons

Stephen Bogosian, MD

Michael Clarke, MD

Brett Greenky, MD

Max Greenky, MD — Joining August 2021

Seth Greenky, MD

Timothy Izant, MD

Kevin Kopko, MD

Anthony Orio, MD

The SOS Joint Registry and Research Stats on Outpatient Joint Surgery

9 out of 10
Nine out of 10 hip replacement patients report less pain by six weeks after surgery.

99%
Ninety-nine percent of hip replacement patients report less pain by six months after surgery.

95%
Ninety-five percent of hip replacement patients report that surgery met or exceeded their expectations with regards to motion and strength one year after surgery.

9 out of 10
Nine out of 10 knee replacement patients report less pain by six weeks after surgery.

> 96%
More than 96% of knee replacement patients report less pain by three months after surgery.

Introducing Dr. Max Greenky to Syracuse Orthopedic Specialists

Max Greenky, MD, joint replacement surgeon at Syracuse Orthopedic Specialists (SOS), will officially join the team in August 2021. He will work alongside Seth Greenky, MD, joint replacement surgeon at SOS, and Brett Greenky, MD, joint replacement surgeon and President of SOS — his father and uncle, respectively.

“I saw how much my dad and uncle loved going to work every day,” Dr. Max Greenky says. “It’s hard for that not to influence you when you’re growing up.”

Even still, Dr. Max Greenky planned to explore other specialties in medical school, as he attended Thomas Jefferson University Medical College with an open mind.

“There was nothing I loved more than orthopedics,” he says. “These are operations that help people and help them quickly. For the right patient, it’s a successful way to help them regain their quality of life.”

A Syracuse native, Dr. Max Greenky is currently completing his fellowship at Duke University. He will return to the area with his wife and children to join the family business.

“I loved growing up in Upstate New York, and a lot of my friends and family are still in the area,” he says. “I’m excited to return.