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Who Is the Futurist In Your Practice?

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by Jennifer Negley, Vice President, Risk Strategies

Friday, June 18, 2021

Definition: “A person who studies the future and makes predictions about it based on current trends.” —Oxford English Dictionary

We have been so occupied with managing how to get through the COVID-19 crisis, have we continued to spend time thinking about the future?

Healthcare providers demonstrated their agility during the past year in repositioning many services.

Practices rapidly incorporated telemedicine and the technology to support access during this time. Are you planning how to restructure access using this approach for chronic care, follow- up care and general questions? What is your strategy to incorporate new technology building on telemedicine?

We have been so occupied with managing how to get through the COVID-19 crisis, have we continued to spend time thinking about the future?

Healthcare providers demonstrated their agility during the past year in repositioning many services.

Practices rapidly incorporated telemedicine and the technology to support access during this time. Are you planning how to restructure access using this approach for chronic care, follow- up care and general questions? What is your strategy to incorporate new technology building on telemedicine?

Every practice needs a futurist — or everyone in the practice needs a futurist mindset. Your futurists should be reading cutting- edge newsletters, attending conferences, especially easy now when virtual, and looking for the best models and tools. Are you led by vendors, or are you driving your future?


Kathryn Ruscitto, Advisor

While no one can predict exactly when technology will take us to the next level, we can see what’s coming: artificial intelligence, virtual reality, companion robots, augmented reality, wearables, genome sequencing, nano technology, robotics and 3D printing. There is already a medical “Tricorder” in testing. A COVID-19 vaccine was developed in remarkable time. What are the implications for vaccines or other pharmacological treatment for viruses or disease from Lyme to asthma, and what impact will that have on your practice?

Marina Gorbis, in Five Principles for Thinking Like a Futurist, says,“Future thinking is not about predicting the future but rather it’s about engaging people in thinking deeply about complex issues, imagining new possibilities, connecting signals into larger patterns, connecting the past, present and future, and making better choices today.”

COVID-19 also brought more attention to home-based care. The use of technology and home care to deliver services may accelerate care models developed to deliver more care in the home setting. Home care growth has accelerated by 15% and this market is expanding rapidly. How are you considering collaborating with home delivered care?

Once you have identified the natural futurist in your practice, how do they stay current on topics ranging from discipline-related associations and conferences, to futurist resources, blogs and social media, to listening and watching your patients? A good example right now is wearables. Has your practice looked at how to use wearables with chronic care patients?

We have so many ways to treat injury and illness, yet most of the online websites for practices do not incorporate wellness and maintaining health information. How will we use technology to link the health experience across time, place and discipline, incorporating wellness and illness?

Many systems and large practices have added strategic positions focused on adapting new technology, quality and treatment algorithms and are well positioned for integrating new technology. Thinking through the options from innovations to new collaborations helps you be prepared whatever the future brings.

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

Work with a Broker: Your Career is Worth Protecting

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by Jennifer Negley, Vice President, Risk Strategies

Friday, June 18, 2021

For over a decade, physicians saw decreasing and flat rates due to a soft market. They may have come to expect similar pricing in the future. So why is the market changing now?

We recently experienced historically high malpractice verdicts. Some of the largest medical malpractice verdicts and payouts happened in 2019. For example, a Maryland jury awarded $229 million to a woman whose newborn suffered brain injury during childbirth, making it the largest medical malpractice verdict in U.S. history (the award was reduced to $209 million because of a state cap). Illinois and California saw verdicts in the hundreds and tens of millions of dollars in 2019 as well.

The inflated size of these verdicts comes with other effects, including rising costs of insurance claims, largely because of societal trends and views toward increased litigation, broader contract interpretations, plaintiff-friendly legal decisions, and larger jury awards. Prior to COVID-19, these adverse claims and astronomical verdicts to patients were the number one cause of rising premiums.

Economic downturn. Insurance carriers typically don’t make a profit on premiums alone, but rather by investing collected premiums into bonds. Malpractice insurers’ investment income has been decreasing over the last 20 years. Since bonds are not producing good returns due to interest rates being so low, insurance carriers are not as profitable, and need to increase rates.

COVID-19 Will Accelerate Rising Costs

It’s still too early to know how physicians will be directly affected by medical malpractice lawsuits and claims arising from the pandemic.

Jennifer Negley, Vice President, Risk Strategies

So far, we are seeing a rise in COVID-19-related claims. Carriers are expecting to see an increase in litigation as well, due to patients not having access to care when doctors’ offices were closed, especially in the early months of lockdowns. Some states have put forth protections for COVID-19-related claims, others have not.

Whether lawsuits will result in plaintiff-friendly verdicts is unknown. Courts that were shut down are also dealing with backlogs, and it will take a long time to see how things play out.

What Options Do Physicians Have?

During a hard market, policyholders might not only have to pay higher premiums, but could also be non-renewed by their insurers, as carriers will tighten up their underwriting. In difficult times, carriers will clean up their book of business, assess risk, and send non-renewals to those policy holders deemed too risky. In a hard market, physicians and physician groups still have some options:

  • If you’ve been with the same carrier for a while, work with a broker to decide if it’s feasible to shop across the market for better rates. Working with a good broker who has access to all markets and can approach top carriers for you is critical during hard markets.
  • Go with carriers highly rated by AM Best. Physicians need to make sure they are with financially secure carriers, as hard markets are times when many carriers fail, leaving their clients without coverage. When insurers know that AM Best would likely give them a poor rating, they often approach less reputable rating organizations, who do not have nearly the same guidelines as AM Best. Some carriers will choose to have no rating at all. Make sure that you choose an insurer that is highly rated by AM Best.
  • Pay extra attention to risk management to avoid claims and non-renewal. Good carriers will have risk management departments that can assist physicians with a number of ways to reduce their exposure to claims. Many carriers even offer discounts for physicians that take their risk management online courses.

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

The cost of medical malpractice insurance varies widely, depending on factors including specialty, location and coverage need. In a hardening market, in the midst a pandemic, physicians need to make sure that they are properly covered and have the correct broker, to keep the potential of loss as low as possible.

For more information on insurance options to protect your career please contact Jenn Negley at 267‑251‑2233 (cell) or by email at jnegley@risk-strategies.com.

The Influence of Clinicians

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By Kathryn Ruscitto

Wednesday, April 28, 2021

When clinicians exercise their leadership in the community, nothing is more powerful in commanding attention.

Vaccinations have some side effects and risks, no question. But the risk of not vaccinating is too high. At the start of the pandemic, I did not know anyone who had been diagnosed with COVID-19. Now, I know of two people who have lost the fight to the disease. Both too young, they did everything right to protect themselves, and still their grieving families were left behind.

A group I am familiar with came together in a community outside Central New York to help register patients for vaccines. Some of those patients shared the myths they heard and why they were not going to get vaccinated. As healthcare professionals, what you say to patients and demonstrate in some visible way matters. If you have colleagues discouraging their patients from the vaccine, are you openly discussing the damage this might do?

I asked Kris Paolino, MD, an infectious disease physician from SUNY Upstate who is treating COVID-19 patients, why people should be vaccinated against the disease.

“The more people vaccinated as soon as possible, the less time there is for variants to develop,” Dr. Paolino replied.

I have also heard of people being discouraged from receiving their second dose. According to the American Medical Association’s advisor Sandra Fryhofer, MD, “The most important thing, whichever vaccine you get for the first dose, is you have to get the second dose. You want to get the full dose. Also, there should be no mixing and matching of vaccines.”

Banner Health in Colorado has gone so far to quantify answers to some of those myths in their communications:

  • Especially important is encouraging young adults to get the vaccine, as recent outbreaks are impacting this younger group.
  • We are increasing the number of people vaccinated every day, but in many communities that average is still below 50%. We have a long way to go to end this outbreak. Leadership from clinicians will make all the difference!

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


Kathryn Ruscitto

Resources for educating patients

Expansion in Surgery at Upstate University Hospital Makes It a Healthcare Destination

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By Cari Wade Gervin

Thursday, April 22, 2021

Overarching expertise and training have made the hospital’s surgical offerings the most advanced in the region.

Lisa Lai, MD, is one of the Upstate University Hospital breast surgeons now using SCOUT, a wire-free radar localization system to treat breast cancer. The technology is more comfortable for the patient, increases the probability of complete cancer removal and reduces the likelihood of needing follow-up surgeries. Upstate is the only hospital in Central New York offering this treatment.
 

There are seven clinical departments that offer surgery at Upstate University Hospital. Collectively, the hospital offers more surgeons, robotic instrumentation and specialty procedures than any other facility in Central New York, with the Department of Surgery providing the largest component.

“We’ve grown in almost every area,” says Robert Cooney, MD, a bariatric and trauma surgical specialist and Professor and Chair of Surgery at SUNY Upstate Medical University for 12 years. “When I started here, the department had a strong foundation, but needed to develop surgical expertise in several areas. Now we are committed as an institution to providing the most advanced care in the region.”

“Every one of our surgeons is fellowship-trained,” Dr. Cooney says of his department, which has 12 surgical divisions with many surgeons also cross-trained in more than one specialty. “This allows us to bring the most leading-edge care to all our patients.”

Chairman Gennady Bratslavsky, MD, and Vice Chair Oleg Shapiro, MD, head up the team of 23 urologic surgeons at Upstate Urology.
 

A Breadth of Surgical Specialties for Adults and Children

Of the departments offering surgery, ENT, Neurosurgery, Ophthalmology, Orthopedics, Urology, along with Surgery itself, also offer procedures for children.

“When I started, we had one pediatric surgeon in the department who was close to retirement,” Dr. Cooney says. “This year we just hired our fifth pediatric surgeon, and now we provide 24/7 pediatric surgical care for the entire region. We have built out the program in Golisano Children’s Hospital and developed an entire infrastructure for pediatric surgery.

“Our goal continues to be to meet the needs of the people in Central New York, so they don’t have to travel to Boston or New York City or somewhere else for care,” Dr. Cooney says.

Upstate Community Hospital orthopedics was awarded a DNV Center of Excellence designation for hip and knee replacement.
The surgical skills of Timothy Damron, MD; Robert Sherman, MD; and Emil Azer, MD, contributed to this honor.
 

Expanding Cancer Care

The past decade has seen the expansion of cancer surgical specialties at Upstate.

The surgeons who treat cancer see patients through the Upstate Cancer Center, a newer facility which provides disease-specific, multidisciplinary care to patients with different types of cancer.

Thomas VanderMeer, MD, FACS, Professor of Surgery at Upstate Medical University and Division Chief of Surgical Oncology, Hepatobiliary and Pancreatic Surgery, says he joined the Upstate University Hospital team two years ago so he could practice in its state-of-the-art Cancer Center.

“The surgeons work with radiation oncologists, medical oncologists and a wonderful group of allied health professionals,” Dr. VanderMeer says. “Surgeons and physicians tend to lead these teams, but the contributions of our diverse team of nursing and specialists in integrative medicine, psychology, palliative care, nutrition, cancer genetics and social work are important to providing the comprehensive care that cancer patients need. This integration of resources and people dedicated to caring for patients with cancer is really unrivaled in the region.”

The Cancer Center’s multidisciplinary approach is key to ensuring patients receive the best care, with dedicated teams addressing specific cancer types and reviewing cases together.

“In terms of treatment, most people are going to need some combination of surgery, chemotherapy and radiation,” Dr. VanderMeer says. “Figuring out how to incorporate the best available treatments into our pathways of care, especially as a patient’s status changes, is something that requires constant attention from our team.”

Based on emergency surgery outcomes, Upstate is a top trauma hospital nationally. It was recognized for
“meritorious outcomes” by the American College of Surgeons National Surgical Quality Improvement Program.
 

Improved Outcomes for Organ Transplants

Kidney transplantation also has been an area of growth. In the past five years, the transplant program has increased positive outcomes for patients, with the 1,000th deceased donor transplant performed in late 2020 and more than 400 living donor kidney transplants to date.

The average time it takes to receive a kidney transplant in New York State is five years, but Upstate University Hospital has cut that time in half. The team has also launched a pancreas transplant program, and the hospital has the only approved pediatric kidney transplant program in Central New York.

Transplant Division Chief Reza Saidi, MD, FACS, FICS, says the program has developed a reputation for getting people timely transplants.

Preethi Ganapathy, MD, PhD, is a surgeon and a scientist specializing in glaucoma. She, along with Robert Fechtner, MD,
are the only two surgeons in the region to perform surgery on patients with pediatric glaucoma at Upstate’s Center for Vision Care.
 

Peak Surgical Quality

In December 2020, Upstate announced that the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) named Upstate Community Hospital as one of just 89 facilities nationwide for meritorious outcomes for surgical care. Among its many awards, Upstate also has earned DNV accreditation as a Center of Excellence for Hip and Knee and as Blue Distinction Center, which also was achieved by its spine program. The pancreatic surgery program is recognized by the National Pancreas Foundation as a National Center of Excellence, and the breast cancer program is accredited nationally. In 2018, NSQIP recognized Upstate University Hospital as a high performer regarding care of high-risk surgical patients.

“The Surgical Quality Program focuses on monitoring and improving the quality of surgical care,” Dr. VanderMeer says. “We believe that by measuring what we do and being intentional about the way we provide care, we can make sure that our patients’ outcomes are always improving.”

Upstate defines outcomes not just on typical things, like complications or timings.

“We also prioritize patient satisfaction and quality of life so that our clinical care addresses all the needs of our patients and their families,” Dr. VanderMeer adds.

Division Chief G. Randall Green, MD, and Stephen Waterford, MD, are the cardiac surgeons at the multidisciplinary Upstate Heart Institute.
 

Coordinated Care for Comorbidities

The size of the Upstate University Hospital system makes it easy to coordinate comprehensive care for patients, no matter what health struggles they may be facing.

It is not uncommon for more than one surgical team to be treating a patient and the communication infrastructure streamlines bringing in any necessary experts. The surgeons also take care to communicate with primary care providers, as the hospital may be treating a patient for one condition or several.

Upstate Introduces TT Maze Procedure: An example of new offerings

There’s good news for patients with atrial fibrillation (AFib). The Upstate Heart Institute is now offering advanced minimally invasive surgery to eliminate chronic atrial fibrillation.

The total thoracoscopic maze (TT Maze) procedure can be used for many patients in place of the traditional open chest maze procedure to correct severe abnormal heart rhythms.

“TT Maze is a great treatment option because it provides a very high success rate without large incisions on the chest,” says Stephen Waterford, MD, Assistant Professor of Surgery. “Another benefit is that a heart-lung machine is not used, so the heart is left beating on its own during the entire procedure.”

Awareness of AFib has been growing alongside the increasing numbers of fitness devices and apps that monitor heart rhythms. But many of the six million Americans who suffer from AFib don’t know they have it.

“Many patients who didn’t know they have AFib will come in for the very first time with a stroke, which is devastating,” Dr. Waterford says. “If a physician has a patient with atrial fibrillation, they may want to contact us.

“We operate a hotline Monday through Friday for physicians and patients,” he adds. “It’s already made a difference. We have had a lot of people who call the hotline who otherwise would never have been treated.”

Formerly at Mount Sinai Hospital in New York City, Dr. Waterford also specializes in mitral valve repair and surgical treatment of chronic thromboembolic pulmonary hypertension. He joins cardiac surgeon G. Randall Green, MD, the Medical Director of the Upstate Heart Institute, in expanding the range of procedures offered.

For more information about AFib, TT Maze surgery, or other treatments, call the Upstate AFib information line, 315‑500‑AFIB (2342).

A Commitment to Education Makes a Difference

As a medical university, most of the surgeons providing services at Upstate University Hospital also are faculty at Upstate’s College of Medicine, demonstrating an ongoing commitment to education and training.

“One of my proudest accomplishments is that the surgical clerkship is now rated one of the top educational experiences by the medical students,” Dr. Cooney notes.

In addition to educating medical students, Upstate is growing its surgical fellowship programs. Last year, Upstate Medical University created its first ever vascular surgery fellowship and this year will offer its first fellowship in reconstructive urology.

The academic mission is an essential part of the hospital. Surgeons participate in ongoing clinical trials and research to develop the state-of-the-art knowledge and techniques to solve medical unknowns and improve outcomes.

Surgeons collaborate with Upstate science colleagues on a range of projects. One study is focused on lung injuries in patients with COVID-19 and how to help them heal and recover. Others studies involve collecting samples of breast and brain tissue for cancer research. Several departments — Surgery, Ophthalmology, Urology, Orthopedics and Neurosurgery, in particular — have considerable faculty and external funding dedicated to their research mission.

Surgeons also partner with external institutions, such as nearby Syracuse and Cornell Universities for tissue engineering and brain tumor research.

Upstate Departments Offer Wide Range of Surgery Expertise

Surgery

With more than 40 fellowship-trained surgeons, Upstate’s Department of Surgery is the region’s largest surgical practice. It is available 24/7 as a resource for patients with complex surgical problems in the Central New York region and serves Upstate’s Level 1 trauma center. Its divisions of surgery include: Acute Care; Bariatrics; Cardiac; Dentistry; General (Thyroid, Gallbladder, Hernia); Minimally Invasive and Robotic; Pediatric; Surgical Oncology (Breast; Colorectal; Endocrine; Hepatobiliary); Plastics; Thoracic; Trauma and Acute Care; Transplant Surgery; and Vascular and Endovascular. The department supports many multidisciplinary services.

Neurosurgery

The Upstate Brain & Spine Center has 11 faculty from the Department of Neurosurgery. The practice offers comprehensive neurosurgical services for a wide range of conditions related to the brain and spine, including brain tumors, pituitary tumors, degenerative spinal diseases, AVMs, epilepsy, Parkinson’s disease, stroke, and neck and back pain. Advanced technology includes the Gamma Knife, Gamma Tile, endoscopy, the ROSA robot, laser ablation and an intraoperative MRI surgical suite. The department, together with the Department of Neurology, has formed the new Upstate Neurological Institute to be the starting point for care.

Obstetrics and Gynecology

The department furnishes medical advice, education, and treatment in the entire range of reproductive health. This includes services for adolescents, women in the childbearing age and the peri- and post-menopausal years. Recent surgical expansion includes the Gynecologic Oncology program at the Upstate Cancer Center, with four surgeons from the department offering a full range of diagnostic, surgical and therapeutic options for malignancies at two locations.

Ophthalmology

The Center for Vision Care is a full-service ophthalmology center and the home of Upstate’s Department of Ophthalmology. The Center for Vision Care provides a wide variety of eye-care services, from comprehensive eye exams, to treatment of eye disease, to complex ophthalmic microsurgery. It is the only area center to perform glaucoma surgery on children. The Department also has a robust research arm with the Upstate Vision Research Center which seeks the fundamental understanding of vision, from molecules to cells and tissues to visual perception, and to apply this knowledge to finding cures for blindness.

Orthopedics

Upstate Orthopedics has 21 fellowship-trained surgeons specializing in all areas of orthopedics. In addition to its Fly Road site, this practice anchors Upstate Community Hospital Orthopedics, and its surgeons utilize the area’s only MAKOplasty, an advanced robotic arm technology that allows for more accurate hip and knee replacement. Surgeons perform a variety of procedures at this location — including inpatient and outpatient hip and knee replacement — and the surgical skills of three Upstate Orthopedic surgeons contributed to the facility earning distinction as a DNV Center of Excellence.

Otolaryngology

The Otolaryngology-Head and Neck Surgery department, also known as Upstate ENT, has dedicated specialists in each area of otolaryngology who provide expert care for patients. Comprehensive ENT services are available to adults and children and specialties include allergy; pediatric; craniofacial-cleft; hearing/otology/neurotology; head and neck, including cancer; facial plastics/reconstructive; voice/swallow; and rhinology-sinus/skull base. The department is committed to education and research as well as patient care, and performs life changing humanitarian work, including surgery for facial deformities and the aftermath of abuse, locally and abroad.

Urology

Upstate Urology is a team of 23 surgeons who provide comprehensive care for men, women and children. With fellowship-trained specialists in nearly every urological discipline, they treat a wide range of diseases and conditions including incontinence, infertility, kidney stones, bladder, kidney and prostate cancer, enlarged prostate, undescended testicles and ureteral strictures. They offer the latest treatments and technology — such as Blue Light Cystoscopy and UroNav — and specialize in reconstructive, robotic and laparoscopic surgery. Research includes clinical trials and NIH-funded studies.

Upstate Cancer Center

The Upstate Cancer Center offers surgery from many departments in its multidisciplinary approach, which includes radiation oncology and medical oncology to create teams dedicated to the patient’s type of cancer.

Discover more about Upstate University Hospital’s many surgical options at upstate.edu/media/surgery.

Auburn Orthopedic Specialists Offers Leading-Edge Care Close to Home

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By Hillary Eames

Thursday, April 22, 2021

A combination of skilled physicians and advanced technologies help provide quality orthopedic care to the community.

Brian Tallerico, DO, using the Mako robotic arm to perform knee replacement surgery at Auburn Community Hospital.
 

Together, the four physicians and three physician assistants at Auburn Orthopedic Specialists can boast approximately 90 years of orthopedic experience. With expertise in a variety of fields ranging from hand and wrist surgery to sports medicine to joint replacement, these providers can meet the majority of patients’ orthopedic needs at Auburn Community Hospital.

“We aim to provide a high quality of care for patients close to their homes,” says Michael Wilson, MD, MBA, orthopedic surgeon at Auburn Orthopedic Specialists and Deputy Chief Medical Officer at Auburn Community Hospital. “When patients and primary care physicians can have the majority of orthopedic issues treated at a community hospital, that’s a great convenience to them both.”

“We have a comprehensive team of specialists who provide exemplary orthopedic care in joint replacement, sports medicine, and upper and lower extremity surgery,” says Brian D. Tallerico, DO, Chief of Orthopedic Surgery at Auburn Orthopedic Specialists. “We have four fellowship-trained orthopedic surgeons, including Dr. Wilson and myself.”

Dr. Wilson brings several years of experience as a foot and ankle orthopedic surgeon to Auburn Orthopedic Specialists, including serving as Chief of Foot and Ankle Surgery at Harvard and founder of the Harvard Fellowship of Foot and Ankle Surgery in 1995. Dr. Tallerico has nearly two decades of experience, including serving as a surgeon in the United States Navy.

“We’re still making additions to our group,” Dr. Wilson says. “We hope to include a fellowship-trained sports medicine specialist who can provide sports medicine for adults, as well as high school- and college-age patients, which will be a huge benefit to the community. We’re also hoping to expand our capabilities in hand surgery. Roughly 25% of emergency department visits are related to hand and wrist trauma. It would be greatly beneficial if patients could receive treatment here for the majority of their hand problems.”

Comprehensive Patient Care for Joint Replacement

One of the services offered at Auburn Orthopedic Specialists is the total joint replacement program, in which physicians at Auburn Orthopedic Specialists work with referring primary care providers and patients to ensure excellence in care from diagnosis to rehabilitation.

“When a patient is referred to us for joint replacement, they may come to us with X-rays from a primary care provider, or we can do them on-site,” says Steven Kieb, DMSc, PA-C, physician assistant at Auburn Orthopedic Specialists. “We’re able to schedule most patients for joint replacement surgery within one month.”

“Preparation for joint replacement includes a comprehensive workup and optimization of each individual patient for their upcoming joint replacement, which includes not just the referring provider but other consultants as well,” Dr. Tallerico says. “We include cardiologists, rheumatologists, pulmonologists, physical therapists and nutritionists. It’s a multidisciplinary approach.”

State-of-the-Art Technology

The expertise of providers at Auburn Orthopedic Specialists is matched by the leading-edge technologies available for orthopedic care, ranging from advanced MRI to minimally invasive surgery. The facility offers hip and knee replacements using the Mako robotic-assisted system, with Dr. Tallerico spearheading the efforts to procure the technology.

“The technology follows the capabilities of each surgeon,” Dr. Wilson says. “With Dr. Tallerico, a highly qualified joint surgeon on board, we were inspired to purchase the system to meet his needs.”

The Mako system is a robotic surgical system that offers high-precision, minimally invasive joint replacement surgery. Before each procedure, the orthopedic surgeon takes a CT scan of the patient’s hip or knee joint. Using those images, the Mako system helps develop a personalized surgical plan unique to the patient’s anatomy. AccuStop technology guides the surgeon according to the plan during the procedure, helping the surgeon avoid healthy tissue and allowing for smaller incisions.

“We do a lot of in-office education for patients about what to expect before, during and after joint replacement surgery, so I will often explain how the Mako improves outcomes,” Kieb says. “After surgery, the majority of patients stay one or two nights in the hospital, and most are up and walking the evening of their surgery.”

Auburn Orthopedic Specialists uses the most up-to-date version of the Mako system, making it the most advanced joint replacement surgical system within the community.

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

Specialized Care in the Finger Lakes

Auburn Community Hospital offers a wealth of specialized services to the Finger Lakes region. When patients in Cayuga County and surrounding areas need high-quality, patient-centered health care, they do not have to travel far. Auburn Community Hospital (ACH), a not for-profit facility, provides both acute and general hospital services to the population of 80,000. Roughly 95% of ACH physicians are board-certified in one or more specialties, ensuring that the majority of patients can access the care they need close to home.

“At Auburn Community Hospital, our vision is simple. We will provide the best outcome for every patient, every time,” says Scott Berlucchi, President & CEO, Auburn Community Hospital. “We want you to know that we are always challenging ourselves to make the healthcare experience better for our patients, physicians and staff, and ultimately our community.”

“We’ve upgraded to arthroscopic ankle surgery, as well,” Dr. Wilson says. “We’ll be offering ankle replacements in the future as we gain the ability to do cartilage repair and bone deficits in the foot and ankle. We’ll also expand our capabilities with shoulder replacements as we continue to move forward.”

The Future of Local Orthopedic Care

Providers hope to expand the facility’s orthopedic capabilities to ensure the majority of the community’s needs can be met in one convenient location. From investing in innovative technologies to selecting skilled and experienced physicians and staff, Auburn Orthopedic Specialists will work with local primary care providers to deliver high-quality orthopedic care.

“I think Auburn Orthopedic Specialists is going to be a very exciting service to the community within the next generation,” Dr. Wilson says. “We’re aggressively building the breadth of and quality of our orthopedic services to ensure patients’ problems can be addressed near their homes.”

Excellence in Orthopedic Hand Care

Kathi Teixeria, MD, board-certified orthopedic specialist at Auburn Orthopedic Specialists, boasts several years of experience in orthopedic hand surgery, an especially beneficial practice to the many laborers and factory workers of the community. With ultrasound-guided Sonex Health MicroKnife hand surgery, Dr. Teixeria is able to treat patients with hand issues so they can return back to work with limited down time.

“This procedure is done under local anesthesia,” Dr. Teixeria says. “Patients walk in dressed in their street clothes. They sit in a procedure room on a reclining-type chair, put their operative arm out on a table, and about 15–20 minutes later, their surgery is done. They get up, walk out and drive home themselves.”

The Sonex Health MicroKnife’s incision is three to four millimeters in length with no stitches required. Most patients can return to their normal activities three to five days after their surgery.

“A lot of people are hesitant to have carpal tunnel surgery because they don’t want to be out of work for three to four to six weeks, but it may not be necessary if they qualify for the Sonex Health MicroKnife surgery,” Dr. Teixeria says. “If a physician has patients who may qualify, I encourage them to send their patients to us so they can learn more about the Sonex Health MicroKnife technique. Patients may be pleasantly surprised that they don’t have to limit their activities for that long after carpal tunnel release surgery.”

Healthcare construction with surgical precision

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By Martha E. Conway

Thursday, April 22, 2021

G.M. Crisalli and Associates Inc. started with two people working out of a two-bedroom apartment 32 years ago. Now the company has 44 employees who work out of their main offices located on Hiawatha Boulevard in Syracuse. The firm generally serves clients from Wisconsin to Maine to Maryland, and all states in between.

Carthage Area Hospital
 

“We build almost everything except roads and bridges and infrastructure,” says owner and President Gary Crisalli, who’s been in the construction business for 45 years. “There’s no type of building construction work that we do not perform.”

From first job to first in the field

Crisalli says he was interested in medical construction early in his career and was encouraged by a previous business partner in the mid-1980s to bid on a remodel project at SUNY Upstate Medical University Hospital. G.M. Crisalli & Associates Inc. got the contract in 1990 and the project was completed in 1991. Crisalli successfully bid other projects at Upstate University Hospital and has done an increasing number of medical facility projects for all major hospitals and many private medical facilities throughout the company’s history.

New builds and renovations have unique considerations, from making sure existing services remain available to local, state and federal restrictions for various types of construction. Essential to successful healthcare-related projects is considering the special working conditions demanded of each worksite, such as the type, age and condition of the existing structure and current municipal services, knowing if the area will be kept operational by the medical group, and the availability and access during working hours. Are there quiet times and peak times during patient services for work crews to consider? Are all team players who will be affected by construction kept in communications to understand the impact on their ongoing operations?

“Less-experienced contractors may not know how to create and work within the restrictions of a protected environment, the impact of air filtration and quality air monitoring, and how to successfully manage those things for staff and patient safety and comfort,” Crisalli says. “Everything has to be kept very clean and dust-free, and you have to monitor airflow and air quality. You must be aware of all considerations involved in working in sterile environments. You must have good communication and control of the activities on the jobsite at all times, knowing who is there and what tools and materials are being delivered, installed and used throughout the construction of the project.”

Crisalli says when performing medical work of any kind, the scheduling process must be at the last third of the preconstruction process and extremely thorough — a must due to the long lead times on specialty materials and equipment needed for projects. Worked into that scheduling are staff and facility requirements during construction and all safety and code issues to be considered before, during and after construction completion.

“We like to have all stakeholders buy into the project schedule prior to project commencement to alleviate delays in the construction process,” Crisalli says.

Island Health Center in Ithaca, New York
 

Reputation for quality and integrity

“For the benefit of our clients, we try to bring our vast construction experience and knowledge to the project in order to be the best-trusted partner, liaison and friend before, during and after the project is finished,” Crisalli says. “Our reputation is based on our integrity, in the trust given to us by our many clients and in the accuracy in estimates, schedules, work quality and high level of professionalism. We take our responsibility as construction professionals very seriously. We believe our clients should rely on the professionals building the project and should not have to worry about the construction of a facility that they have hired our company to build for them.”

Crisalli says he employs 18 experienced project superintendents. He stated that one half of the company employees have been with G.M. Crisalli and Associates Inc. for up to 30 years. Crisalli feels very fortunate to have worked with Vice President Rocco “Rocky” Paone during that same time.

“Experienced and dedicated personnel, construction administration, construction procedures, practices and performance, at every milestone along the way, result in the highest-possible quality project,” Crisalli says. “At the end of the process, we want to see our clients satisfied and happy with every aspect of their new facility.”

Crisalli says the firm is always looking to integrate new systems to anticipate clients’ needs and ensure projects are turnkey operations at completion.

“Most of my people have been with us for quite a few years,” Crisalli says, “but we have a few new people, too, helping us do whatever we can to make us a better company. We have our own group of sub-contractors, offer competitive rates and have the capability to adapt and grow — like what was demanded of us working in a pandemic.”

One of those adaptations was the implementation of DocuSign to tame the contracting paper lion.

Work in progress at American Renal Associates Dialysis Center in Rome, New York
 

Client care is Job No. 1

Rocky handles the marketing and sales and performs the front-end of projects (the pre-construction functions formerly done under the umbrella of estimating).

“I also cold-call potential clients and follow up with clients whose projects are complete, as well as work to maintain relationships with a variety of professionals across a diverse field of disciplines,” Paone says.

Medical construction requires a level of cleanliness more than most construction projects, Paone says, explaining that G.M. Crisalli and Associates Inc. understands the demands of working in something tantamount to a clean room environment.

“It’s not for everyone,” Paone says. “You can’t just take someone out of residential construction and tell them to go drywall an operating room. There are a specific list of additional dos and don’ts in the medical environment, and sometimes they impact patients’ lives and safety. We have to maintain stringent levels of quality control for these projects.”

In addition, the firm pays particular attention to the health of its own employees, making sure they are current with tuberculosis testing and additional health considerations, especially in the era of COVID-19.

“There are a lot of additional boxes we have to check to work in a medical setting of any kind,” Paone says.

And that medical savvy transfers to other projects requiring those heightened precautions, such as cleanliness and quality concerns.

“But we can build good, old-fashioned buildings, too,” Paone says.

University Hospital in Syracuse, New York
 

Project in progress

G.M. Crisalli is working on a tenant improvement fit-out for American Renal Associates Dialysis Center in Rome.

“We were competitively bidding the project and added G.M. Crisalli to the bid list based on the strength of their health portfolio and depth of knowledge exhibited by Rocco Paone,” says Marc Eagles of American Renal Management LLC, Project Management. “Construction projects are always challenging. This project was no different. G.M. Crisalli’s knowledge of the market, construction processes and subcontractor strength helped to make this a successful project.”

Money is a big motivator for clients, and medical clients are particularly cost-conscious and want to spend their money wisely.

“We work with clients to help them analyze budgets and look at what is really needed versus areas where savings can be safely realized,” Paone says. “If anti-static or anti-microbial flooring is called for, you really can’t compromise a lot there. We try to make clients aware of the trade-offs in these kinds of decisions. We’ve learned how to adapt to these details better than your average contractor and offer customers the pros and cons of every potential alternative and decision as they set up their budgets.

“We care about clients, we care what clients think about us, we care enough to tell the truth, even when the truth hurts,” Paone continues. “We’re all looking forward to a very rigorous 2021 season as COVID-19 waves its ugly head goodbye and we tackle the projects that were sidelined and those sprouting up as a result.”

“The medical field will grow because of the increasing aging population and new and improving technology,” Crisalli adds. “We plan to be at the forefront of that.”

“Without exception, every G.M. Crisalli employee involved with the project was professional, knowledgeable and easy to work with,” Eagles says. “I would recommend them on their construction acumen, professionalism and competitive pricing.”

Medical project résumé

G.M. Crisalli’s project list includes extensive renovations, constructions and additions at SUNY Upstate Medical University, St. Joseph’s Hospital Health Center, Van Duyn Center for Rehabilitation & Nursing, Carthage Area Hospital, Nunn’s Home Medical Equipment, Crouse Hospital, Cayuga Medical Rehabilitation Center, Mohawk Glen and Health & Dental Services Center, among others.

Crisalli and Paone both say the Cayuga Medical Rehabilitation Center and Island Health & Fitness Center in Ithaca was one of their favorite projects. It included a two-and-a-half-year-long project consisting of design/project buildout of new tenant space and construction management services for a five-story health and fitness center with attached medical facility.

For more information, call 315-454-0000 or visit gmca.com.

Oneida Health and Roswell Park: An Unmatched Approach to Quality

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By Becca Taurisano

Thursday, April 22, 2021

When the Dorothy G. Griffin Radiation Oncology Center opened in Oneida in July 2019, it eliminated the need for Central New Yorkers to leave the region for high-quality radiation treatment. As a member of the Roswell Park Care Network, the new center provides Roswell Park Comprehensive Cancer Center’s stringent approach to quality.

Left to right: Shaun Maroney, RT(T) MHA; Kare Nicholas, RN, BSN; Vanessa Rundle, MS, CMD, RT(R)(T); Meghann Wright RT(T); Brianna Rossi RT(T); Maya Mathew, MD; and Rebecca Butka
 

In 2016, Oneida Health set out to build a first-class oncology program. From the beginning, they knew one factor mattered more than any other: delivering an unmatched approach to quality. To achieve this, Oneida Health partnered with Roswell Park Comprehensive Cancer Center.

Roswell Park Comprehensive Cancer Center, based in Buffalo, is ranked No. 14 nationally in cancer care by the 2020–2021 US News & World Report, putting them among the top 1.5% in the nation for comprehensive cancer centers. Roswell Park is the only hospital system in Upstate New York to be recognized in 2020–2021. They are also the only National Cancer Institute (NCI) Designated Comprehensive Cancer Center in Upstate New York. NCI is the highest federal rating a cancer center can achieve in recognition of their innovative research and leading-edge treatments.

As a member of the Roswell Park Care Network, Oneida Health brings the services of Roswell Park to Central New York.

“Everyone deserves convenient access to the best care possible,” says Gene Morreale, President and CEO at Oneida Health. “Our affiliation provides the impact of Roswell Park’s comprehensive cancer services through pathway care plans developed with the expertise of their world-renowned physicians. Together with our onsite full-time Roswell Park Physicians and highly trained staff, we are able to provide patients with access to some of the latest treatment options from a nationally ranked cancer center.”

The most recent addition to Oneida Health’s Cancer Care program is the newly constructed 6,000 sq. ft. Dorothy G. Griffin Radiation Oncology Center. Maya Mathew, MD, a Roswell Park radiation oncologist, is the full-time Medical Director of the center. As a child growing up in Kerala, India, Dr. Mathew knew she wanted to pursue a career in oncology when her aunt was diagnosed with cancer. After coming to the United States, Dr. Mathew completed a surgical internship at Penn State and residency at Loyola University Medical Center in Chicago. Later on, while practicing radiation oncology for nearly three years at Memorial Hospital in Gulfport, she was struck by the number of advanced cancer patients she was seeing, particularly young patients. Mathew knew she wanted to be affiliated with a NCI-designated cancer center so she could actively focus on promoting awareness of cancer prevention, early detection and treatment in the community, which is what drew her to Roswell Park.

“I was frustrated seeing advanced cases in a semi-rural area when I practiced. Now, I am able to bring Roswell-quality comprehensive cancer care, No. 14 in the nation, and No. 2 in New York State, to the people of Central New York,” Dr. Mathew says. “When you are fighting the side effects of cancer treatment, it is helpful for the patient to receive treatment locally. Patients receive the same quality of care here close to home as they would at the main center in Buffalo. That is the uniqueness of our program. We provide the full Roswell experience.”

From treatment planning, to peer review, quality assurance and treatment delivery, the center’s approach is designed to deliver the same quality of care that is provided in Buffalo. Throughout the process, Dr. Mathew and her team rely on the research backing and clinical expertise of Roswell Park in Buffalo.

“All protocols, whether medical oncology or radiation oncology in Oneida, are common across Roswell Park physicians,” Dr. Mathew says.


Maya Mathew, MD, Medical Director of Radiation Oncology

Planning Tailor-Made Treatment

In treatment planning, the goal is to always preserve as much healthy tissue as possible using the ALARA (as low as reasonably achievable) approach to radiation dosages, while still effectively treating the cancer site and achieving the best patient outcome. During the treatment planning phase, Dr. Mathew conducts anatomical contouring using CT images, which is both an art and a science to treatment planning.

“We determine what to treat and what to spare,” Mathew says. “Radiation therapy is not a recipe that can be followed for everyone. We are providing personalized treatment plans. It is more of a tailored approach.”

Using an onsite CT simulator, Dr. Mathew and her team use advanced imaging techniques and software to deliver precise dosages while taking every measure to minimize the exposure to healthy tissue. In some cases, Dr. Mathew can also take advantage of other imaging modalities including a new PET/CT and 3 Tesla MRI available at Oneida Health to fuse images for more invasive tumors.

When more complex cases are presented at the center, Dr. Mathew has the advantage of Roswell Park’s tumor board. The tumor board is a multidisciplinary team of Roswell Park medical and radiation oncologists, radiologists, pathologists and surgical oncologists who are among the best in the nation. This team ensures that the treatment plan is the right one.

“Roswell is a comprehensive cancer center, so we can lean on our team to come up with the most appropriate plan,” Dr. Mathew says. “This is particularly beneficial to the patients as they benefit from their specialized expertise. That is the beauty of collaborating with a comprehensive cancer center.”


Patients benefit from on-site simulation CT and advanced imaging located conveniently on campus. Rossi is pictured.

Peer-Review by Disease-Site Specialists

Once a treatment plan has been designed by Dr. Mathew, it is presented at a peer-review conference where all the Roswell park radiation oncologists examine the treatment plan. This process is adhered to for every patient. The peer-review board has disease-site specialists who perform a rigorous review of every proposed treatment plan across Roswell Park’s outpatient network. The board dissects the plans, ensures that all dose limits are met, field arrangements are optimal, comorbidities are properly considered and makes any suggestions for improvement.

“The board is made up of different radiation oncologists who treat specific disease sites, so I’m getting the expertise from specialized physicians who are reviewing my treatment plans,” Dr. Mathew says. “That is an assurance for the patient and the referring providers that they are getting the best possible care.”


During the treatment planning phase, Dr. Mathew and Roswell Park Dosimetrist, Vanessa Rundle, MS, CMD, RT(R)(T), conduct anatomical contouring using CT images, which is both an art and a science to advanced treatment planning.

 

Quality Assurance for Every Patient

Once the peer-review board has ensured a plan meets Roswell Park safety protocols and provides the best approach to treatment, an onsite Roswell physicist performs end-to-end quality assurance tests. The quality assurance conducted by the physicist validates the treatment plan will be delivered as prescribed. If any part of the plan does not meet Roswell standards, treatment will not be administered and the plan will be reevaluated. This process is performed for every patient receiving care at the center.

“The quality assurance piece with the help of our physics team is essential. They have their protocols to follow and if the plan does not adhere to Roswell standards, the plan will not be approved to roll out,” Dr. Mathew says. “It is a long process but in the end the patient can be assured that they receive the best care.”

In addition to internal quality assurance, the center also participates in third party review to further validate the quality of treatment plans being delivered. The review is completed by the MD Anderson Imaging and Radiation Oncology Core (IROC) Quality Assurance Center in Houston, Texas.


The center is equipped with TrueBeam radiotherapy, the most advanced linear accelerator and radiosurgery treatment system available. Pictured from left to right: Meghann Wright, RT(T), and Rossi

 

Excellence in Treatment Delivery

At Oneida Health, the quality of cancer treatment delivery is a combination of state-of-the-art technology and staff expertise. Radiation therapists use a TrueBeam linear accelerator to generate and deliver precise photon beams to tumors in the body, as well as Stereotactic Beam Radiation Therapy (SBRT) to deliver a course of therapy in a condensed timeframe. Radiation therapists also employ motion management (RGSC- Respiratory Gating for Scanners), DIBH (Deep inspiration breath hold), and prone breast radiation therapy techniques to reduce unnecessary radiation doses to healthy organs.

“We have cutting edge treatment systems here in the building so the patient does not have to go anywhere else. But the expertise of the staff, in the field of cancer care, is the difference,” Dr. Mathew says.

Oneida Health staff are also trained to educate the patient about what treatment they are getting and why, making the patient a partner in the treatment they receive and providing them with comfort along the way.

“Each cancer patient is close to my heart,” Dr. Mathew says. “Walking them through their treatments to completion, and achieving the best patient outcome; that is most rewarding for me. The patient experience is an essential ingredient to the delivery of a quality treatment plan.”


Collaboration of a highly skilled team of employees is the difference in providing and meeting stringent quality treatment measures at the center. Pictured left to right: Kare Nicholas, RN, BSN, and Chief Radiation Therapist/Radiation Oncology Center Manager Shaun Maroney, RT(T), MHA

 

Cohesive Patient Care

Patients and providers who choose Oneida Health will also benefit from the collaboration and continuum of care between medical oncology, radiation oncology and the imaging centers on campus. The William L. Griffin Medical Oncology Center, which opened in 2017, offers 12 infusion suites, a hematology/oncology outpatient office and is directed by a Roswell Park-affiliated physician who provides evaluations, chemotherapy infusions, palliative medicine, hematology, nutrition services, and several cancer screening services. As part of a three phase plan to oncology, Oneida Health has also invested in the expansion of their imaging, which now includes a 3 Tesla MRI, CT Simulation, PET/CT, nuclear medicine camera and a second 3D mammography machine.

“This cohesive, high-quality cancer care program was the singular vision of the Roswell Park and Oneida Health partnership from the start,” Morreale says. “Because of valued relationships with the Griffins and Gormans, as well as Roswell Park, we can now provide the very best cancer care to Central New Yorkers right in Oneida.”

For more information about Radiation Oncology at Oneida Health, visit oneidacancer.org.

 

Pomeroy Emergency Services at Crouse Health Teams Up for Fast Stroke and Cardiac Response

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By Sandee Curry

Friday, February 26, 2021

The Pomeroy Emergency Services Department at Crouse Health is bringing a higher level of emergency care to patients in Central New York. The facility—completely redesigned and expanded in 2017—features an innovative layout designed to treat patients faster and more safely, especially for stroke, when time is brain, and for cardiac events, when every second counts.

 

As a dually accredited Comprehensive Stroke Center, Crouse Health provides patients access to the latest technological advances for stroke and interventional neurosurgery along with highly skilled and compassionate providers and an integral partnership with community Emergency Medicine Services (EMS) providers. Each member of this collaborative effort plays a unique and crucial role in the care of patients needing urgent intervention. Additionally, Crouse Health is one of only five hospitals in New York state to use a recently developed artificial intelligence software that can assist in diagnosing stroke, which saves precious minutes for patients.

With stroke being the fifth leading cause of death and a major cause of disability in the United States, the key to better outcomes is reducing the length of time between the onset of symptoms and accurate diagnosis and treatment.

“Our communication with local and regional EMS providers, primary care physicians and specialists is what separates Crouse from other institutions,” says Seth Kronenberg, MD, Chief Operating Officer and Chief Medical Officer at Crouse Health. “We have incredibly talented physicians and advanced practice providers in the emergency department [ED] and in interventional cardiology and neurology. The ability of the specialists and emergency services team to deliver fast treatment times, improved communications and excellent patient care, while having access to the latest technology, results in optimal patient outcomes.”

This collaboration is built on mutual respect and quick action between the ED and EMS partners. Emergency Services receives advance notification from EMS and can then engage the interventional stroke or cardiac teams — even before the patient arrives at Crouse.

David Mason, MD, FACEP, Medical Director and Chief of Emergency Services for Pomeroy Emergency Services, oversees all of Emergency Services’ clinical operations. A strong advocate for Crouse’s partnership with EMS, Dr. Mason and his colleagues constantly re-evaluate their system and processes to improve patient care and make it easy for EMS providers to bring their patients to Crouse.

“We bring our separate areas of expertise to help care for patients,” Dr. Mason says. “The ED is a team, but the bigger team for a stroke or a cardiac patient is the neuroscience team, the cardiac team, the EMS team who brought them in, and the post-acute care team, all working together to provide the most advanced, multidisciplinary care possible.”


“Dr. Mason talks to me as if I were his medical student. He genuinely wants everyone to have the same learning opportunities and for everyone to have the knowledge they need to handle their part of the process, and ultimately that is the best thing for patient outcomes.”
— Sarah Jerjen, paramedic with Fayetteville Fire & EMS, Greater Baldwinsville Ambulance Corps and American Medical Response

Sharing Knowledge Saves Lives

The Crouse team relies on a coordinated effort between emergency, neurology, neurosurgery, interventional radiology services, CT imaging and the nursing staff, to identify stroke patients.

David Padalino, MD, FAANS, Medical Director for Crouse Medical Practice – Neurosurgery, a board-certified neurointerventionalist, has led Crouse in attaining its comprehensive stroke certification , which was granted in 2018 and reflects the highest level of regional experience for the treatment of serious stroke events.

Within seconds to minutes, Dr. Padalino and his team are notified of a potential stroke patient. Information from EMS and the ED is shared with his team, and if the determination is made that neurosurgery is needed, they receive a call. When EMS arrives, they are met at the door and the patient is immediately brought in for a CT scan.

“We pride ourselves on approaching every individual case as if it’s the first one of its kind with the enthusiasm of making sure everything that needs to be done gets done,” Dr. Padalino says. “If there’s potential for a delay, we try to find ways to avoid that delay in the future, anything from information processing to human factors and system issues.”

Joseph Battaglia, MD, FACC, is a cardiologist who leads Crouse’s cardiology team to achieve fastest door-to-intervention times and best patient outcomes.

“The national standard for door-to-cardiac intervention is 90 minutes,” Dr. Battaglia says. “Our goal and our standard is consistently under 60 minutes.”

In 2018, Crouse Health earned the American Heart Association (AHA) Mission: Lifeline Gold Receiving Quality Achievement Award for STEMI (heart attack), the first hospital in the region to receive this designation. Crouse’s cardiology group, Crouse Medical Practice — Cardiology, has almost doubled in size in the past few years, adding several physicians and bringing the number of providers to 13.

Dr. Battaglia and his team have always worked closely with Emergency Services. Crouse’s Miron Cardiac Care Center has active adult and pediatric cardiac catheterization labs, and Emergency Services and the cardiology team hold monthly joint meetings to review patient cases.

From the time the ambulance gets to a patient, EMS can transmit an EKG to the ED. The ED and a cardiologist review the status of the patient prior to arrival. “Coordination of care happens well before the patient even arrives in the ED, which can save precious minutes — and save lives,” Dr. Battaglia adds.

ED physicians can call the cardiologists’ cellphones when they have questions, and the cardiologists come to the ED frequently throughout the day to review cases with the teams. There is also a monthly quality control meeting focusing on the hospital’s STEMI patients.


Joseph Battaglia, MD, FACC, a world-class cardiologist who leads Crouse Health’s cardiology team

“There has always been support 100% of the time for every emergency case, and it’s a huge responsibility for us to be able to provide the kind of care we provide to the community. It is a privileged role we have, and I feel fortunate that we are fully supported to take care of our patients and make sure they get the best treatment possible.”
— David Padalino, MD, FAANS, Medical Director for Crouse Medical Practice – Neurosurgery

Partners in Care: A Crucial Role Recognized

Sarah Jerjen, a paramedic with Fayetteville Fire & EMS, Greater Baldwinsville Ambulance Corps and American Medical Response, appreciates how the providers at Crouse recognize the importance of EMS, especially in critical calls for stroke and cardiac issues.

“Every hospital gets a pre-arrival notification, but at Crouse, I feel confident calling ahead, not only for neurology and catheterization lab calls, but just to get the opinion of a doctor,” Jerjen says. “I know that the next time I go there, I can find that same doctor or physician assistant, talk to him or her about it, and they’ll remember what I said and take time to explain the case to me. Crouse sees us as critical partners in the care of our patients. That level of attention and interest does not happen in every ED.”

Crouse also offers classes that are not only open to physicians, PAs and nurses, but EMS providers as well, providing opportunities for EMS to enhance skills and knowledge.

EMS and Emergency Services are fully integrated with the neurosciences team for stroke care.

“Not every person who comes in exhibiting stroke symptoms is having a stroke,” Dr. Padalino says. “The ideal situation is to work together to find the best way to identify the patients who are having true strokes as fast as possible so the most appropriate treatment can be administered.”

 

“Healthcare workers all share a mission, and that is to do the best we can for patients and to help alleviate suffering. Whether it’s this pandemic or the opioid crisis, whatever it is, we’ll always be here to support each other and our community.”
— David Mason, MD, FACEP, Medical Director and Chief of Emergency Services for Pomeroy Emergency Services

A Feedback Loop

Jerjen is thankful that everyone at Crouse recognizes EMS providers and appreciates and respects their role.

“That does not go unnoticed,” Jerjen says.

Another way providers who work with Crouse constantly learn and improve is through feedback about stroke patient outcomes. Oksana Kaskov, Crouse Neuroscience Institute Stroke Coordinator, makes posters highlighting their success stories to all EMS providers who come into the ED, as well as physicians and nurses, emphasizing the critical role EMS plays in the delivery of life-saving care. The posters include photos of the patient’s imaging, showing pre- and post-intervention for a clot and showing post-reperfusion imaging.

“It creates a good rapport between EMS and the physicians, which ultimately benefits the patients at Crouse,” Jerjen says.

Patients who came to the hospital in an ambulance with severe, potentially life-altering deficits, and who are able to walk out of the hospital after treatment,are certainly rewarding cases of which the entire collaborative team can be proud.

Registered nurses Chris Addario (left) and Patty Moses have 65 years of emergency services experience between them and two more reasons why people say “Take me to Crouse.”
 

Enhanced Communication through Artificial Intelligence

Crouse is one of only five in the state with access to the cloud-based Viz.ai software. This app can be used on a smartphone and provides communication that allows for sharing of CT images with the neuroscience and stroke team. Within moments of a patient receiving a CT scan, the crystal-clear image is available and the team can message each other about the patient’s care through HIPAA-compliant software. Image sharing previously took much longer because it required access to a computer.

“It’s not just the PA and the surgeon communicating,” Dr. Padalino says. “It’s the PA, the neurosurgeon, the neurologist, the neuro interventional team and the emergency services team. We are all on the same page regarding the patient’s plan of treatment.”

With stroke care, imaging is a significant part of finding and removing the clot, so having advanced imaging, perfusion studies and angiograms available for the neurosurgeon at a moment’s notice is invaluable. Algorithms within the software’s programming read the images and flag the team if the patient is someone who would benefit from endovascular therapy and stroke rescue.

“We still have to train, so we don’t rely solely on the AI software,” Dr. Padalino says. “Programmers are using a national database of images from those who use this software to train the computer to recognize when it sees a problem that needs immediate intervention.”

Secure communication has long been problematic among providers. The benefit of having a HIPAA-compliant system in which patient names, ages and medical record numbers can be disclosed, is that everyone involved in the communication can be sure they are referring to the same patient, leaving less room for error. Before, providers had to make phone calls or encrypt their conversations. This platform has provided the ability to communicate securely with the team, allowing everyone to be on the same page while saving valuable time.

A Reflection on 2020

During the COVID-19 pandemic, healthcare workers around the globe were suddenly faced with an unprecedented challenge.

For David Mason, MD, FACEP, Medical Director and Chief of Emergency Services at Crouse Health, 2020 was a challenging year. Reflecting on the past 12 months, he is grateful for how the healthcare providers came together to support each other in caring for the community.

The staff at Crouse implemented safety protocols long before they were mandated, and there was a significant effort to minimize exposure to other patients, staff and EMS personnel who needed to be in contact with those patients.

“We are proud of our relationship with EMS,” says Seth Kronenberg, MD, Chief Operating Officer and Chief Medical Officer at Crouse Health. 


Seth Kronenberg, MD, Chief Operating Officer and Chief Medical Officer at Crouse Health

 “Ever since March, they have been on the frontlines — out in the field with no negative pressure rooms. The work they have done for our community is incredible, and we couldn’t be more thankful for the service they provide.”

The American College of Emergency Physicians was sending dozens of emails each day from physicians across the United States sharing their experiences. Dr. Mason and Crouse leadership assimilated lessons people were sharing from other parts of the country that had already been hit with the pandemic and tried to prepare as best as they could.

Telemedicine became invaluable for both providers and patients during 2020. Access to telemedicine exponentially increased in a short time, which helped keep people safe. In coming years, it could mean a long-term decrease in unplanned Emergency Department (ED) and urgent care visits, which could shift the landscape of urgent and emergent care.

“Crouse has done a phenomenal job managing the COVID crisis,” says Sarah Jerjen, paramedic with Fayetteville Fire & EMS, Greater Baldwinsville Ambulance Corps and American Medical Response. “They were one of the first hospitals that asked for a pre-arrival notification for anyone exhibiting COVID-19 symptoms, and they opened their doors to COVID patients from other city hospitals.”

The ED is one of the safest places to be during the pandemic, according to Dr. Mason. With stringent infection control practices and visitation policies in place, nothing is more important at Crouse than the safety of patients and staff. Heart attacks and strokes are time sensitive, so it is critically important for patients to not miss windows for lifesaving care.

“Healthcare workers all share a mission, and that is to do the best we can for patients and to help alleviate suffering,” Dr. Mason says. “Whether it’s this pandemic or the opioid crisis, wherever it is, we’ll always be here to support each other and our community.”

To learn more, visit crouse.org.

Oneida Health: A Comprehensive Approach to Gastroenterology

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Friday, February 26, 2021

Since 2019, Oneida Health has quickly developed a first-class Gastroenterology program led by fellowship-trained physicians and an experienced advanced medical provider. As a local hospital-based outpatient office, they provide a patient-centered approach focused on safety for all types of gastroenterology conditions with specialized advanced therapeutic treatments.

Oneida Health has invested over $1.5M in 2019 in new technology and the expansion of its Endoscopy Center.
 

Oneida Health has been providing endoscopic procedures to patients in Central New York for almost 30 years. In 2019, Oneida Health was faced with the anticipated closure of a privately-owned outpatient GI practice that provided patient procedures in the hospital for more than 20 years. With a desire to keep care local, Oneida Health began the process of recruiting and building its own GI outpatient network.

What began as a few exam rooms in the hospital in the mid-90s has now evolved to a modern endoscopy center with the latest advanced technology and an outpatient office lead by fellowship-trained and board-certified physicians who provide a comprehensive approach for all types of gastroenterology procedures, testing and treatment.

“Providing exceptional care close to home is at the core of everything we do,” says Gene Morreale, President and CEO at Oneida Health. “With the inevitable departure of the only outpatient GI office located in Oneida, our leadership team was determined to create continued access to digestive disease services for the patients we serve. This opportunity provided us with the ability to develop a newly designed program focused on the highest level of safety and patient experience, second to none.”

A Comprehensive Approach

Oneida Health’s new outpatient office, Oneida Health GI Specialists, opened in August 2019 with the recruitment of Uzma Abbasi, MD, Nurse Practitioner Deborah Clarey, and a well-experienced care team with decades of gastroenterology experience. In 2020, Oneida Health also welcomed Rashaan Friend, DO, MBS.

Together, they provide a one-stop shop for patients with a focus on patient safety and care.

“Myself, Dr. Abbasi, and Deborah offer in-office visits for all types of gastroenterology conditions in a convenient and comfortable outpatient setting,” Dr. Friend says. “We also provide advanced diagnosis in a hospital nationally recognized for patient safety and experience.”

“Our goal is to be a comprehensive digestive disease center that can provide for the needs of every patient right here in Oneida,” Dr. Abbasi says. “Beyond colonoscopies and gastroscopies, we provide numerous specialties including endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). We are always seeking to provide patients with the latest in advanced diagnosis for increased disease prevention — it’s the baseline of our approach to care.”

In 2019, Oneida Health also invested over $1.53 million into its endoscopy center located on the third floor of the hospital. Renovations included new, state-of-the-art scopes and HD-video processors that lend to more enhanced imaging, as well as an expansion of its admitting, recovery, and waiting rooms, and a reimagined patient flow.

Increased Access to Advanced Diagnostics: EUS and ERCP

Patients often sacrifice treatment modalities when accessing care in a rural setting. Oneida Health prevents that by providing a number of support services and specialties which are not commonly found in a rural community.

“EUS is one of the best technologies to detect anomalies of the digestive tract and nearby structures and organs,” Dr. Abbasi says. “We can visualize pathology in the pancreas, biliary tree and lymph nodes in the abdomen and mediastinum.”

ERCP is often a service that needs to be referred out in GI offices. With the arrival of Dr. Friend in 2020, Oneida Health now specializes in it.

“ERCP is a nonsurgical outpatient exam that only requires sedation,” Dr. Friend says. “It can be used to provide therapeutic treatment of diseases of the liver, pancreas, cholangiocarcinoma, and extract stones from the bile duct along with radio-frequency ablation. Most importantly, ERCP can reduce the risk of other more serious complications down the line while aiding in early detection.”

Both EUS and ERCP allow for the diagnosis and treatment of a wide variety of illnesses and anomalies, particularly in the diagnosis and treatment of early-stage cancers that are undetectable with other diagnostic tools.

Patients who need additional testing and treatment, including surgery, also benefit from Oneida Health’s network, such as its affiliated medical and radiation oncology program with Roswell Park Comprehensive Cancer Center.

In addition to these services, Drs. Abbasi and Friend continue to envision more advanced treatment options at Oneida Health.

“With these advanced endoscopic modalities, we can provide precise staging of early digestive cancers. We can safely biopsy abdominal and mediastinal lymph nodes, and pancreatic mass, and can endoscopically remove large colon polyps with minimal risks,” Dr. Abbasi says. “We also recently started providing video capsule endoscopy and will soon be providing ablation treatment of Barrett’s esophagus to prevent esophageal cancer. Our vision for a comprehensive digestive disease center in Oneida is quickly becoming a reality.”

“I have been providing outpatient care in GI for over 20 years in Oneida,” says Deborah Clarey, NP, at Oneida Health. “The transition to Oneida Health and additions of Drs. Abbasi and Friend, has evolved our approach to patient care. I couldn’t be more excited for the patients and families we serve.”

For more information, call 315-361-2385 or visit oneidahealth.org.

Office Info

Oneida Health GI Specialists
301 Genesee Street
Oneida, NY 13421

315-361-2385

Meet the Providers


Uzma Abbasi, MD attended Allama Iqbal Medical College and then obtained her medical degree and doctorate in Internal Medicine at Columbia University College of Physicians and Surgeons in New York City, where she completed her residency as well as her fellowship in gastroenterology. She is board-certified by the American College of Gastroenterology and the American Board of Internal Medicine. She chose Oneida Health, seeking to practice in a close-knit, rural community.


Rahsaan Friend, DO, MBS, earned his doctoral degree from the Philadelphia College of Osteopathic Medicine in Pennsylvania. He completed his residency in internal medicine at Albert Einstein Medical Center in Philadelphia and earned a fellowship in gastroenterology at St. John’s Medical Center in Michigan. He is board-certified by the American College of Gastroenterology and the American Board of Internal Medicine. Friend was won over by Oneida’s rural nature, a place where he and his wife wanted to raise their children.


Deborah Clarey, NP, a native of Oneida, received her bachelors of nursing from SUNY Institute of Technology before receiving her nurse practitioner’s degree from Community General Hospital in Syracuse. Deb has been working in gastroenterology at Oneida for over 20 years. Previously she worked in various capacities in private practice and the hospital setting, including pediatrics and more than 10 years in the operating room.

Recent State And Federal Actions Signal That Telehealth Is Here To Stay

Posted on by admin

By Maureen Dunn McGlynn

Friday, February 26, 2021

Telehealth is defined as the use of electronic information and communication technologies to deliver health care to patients at a distance. Prior to the COVID-19 public health emergency (PHE), telehealth played only a small role in patient care. However, during the PHE, telehealth became especially important as a replacement for in-person visits with a healthcare provider. In the past year, there have been a number of temporary waivers and relaxations of statutory and regulatory requirements to expand the use of telehealth. The recent issuance of the 2021 Physician Fee Schedule (PFS) and Governor Cuomo’s plan to expand telehealth in New York are sure signs that the telehealth momentum is continuing and many of the temporary flexibilities will become permanent.

2021 Physician Fee Schedule Final Rule

The PFS final rule released by the Center for Medicare and Medicaid Services (CMS) included the addition of 60 new telehealth services that will be covered and reimbursed by Medicare. These services will remain on the Medicare telehealth services list through the end of the calendar year in which the PHE ends. Many are likely to become permanent.

In the PFS, CMS revised the definition of direct supervision to permit virtual presence of the supervising physician using real-time interactive audio and video technology. The current definition of direct supervision requires the physician to be physically present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. Under the new definition by the CMS, direct supervision can be met if the supervising physician is immediately available to engage via interactive audio and video. This change to the direct supervision definition means telehealth services may be furnished and billed when provided incident to a distant site physician’s service under the direct supervision of the billing professional provided through virtual presence.


Maureen Dunn McGlynn

The frequency limit for subsequent nursing facility visits was increased to permit one Medicare telehealth visit every 14 days. Medicare previously covered only one telehealth visit per month. In addition, the list of practitioners able to be reimbursed for using telehealth was expanded to include clinical social workers, clinical psychologists, physical and occupational therapists and speech language pathologists.

CMS clarified that if the provider and patient are in the same location and the provider uses telecommunications equipment to furnish the service to, for example, avoid the risk of COVID-19 exposure, the telehealth rules don’t apply. In those situations, the practitioner should bill for the service furnished as if it was furnished in person, and the service would not be subject to any of the telehealth requirements.

Proposal to Expand Access to Telehealth in 2021

On January 10, Governor Cuomo announced proposed regulatory and statutory changes to expand and improve access to telehealth. The Governor’s proposal would permanently adopt many of the temporary telehealth flexibilities that were available during the PHE.

Under the proposal, location requirements for Medicaid would be eliminated. Provider flexibilities, including interstate licensing reciprocity with states in the Northeast for specialties with historic access shortages, and use of certain unlicensed staff to deliver substance use disorder and mental health services would be permanently adopted.

Coverage for telehealth by commercial plans, as well as Medicaid, would be required at rates that incentivize rates. Insurers would also be required to offer their members an e-triage or virtual emergency department platform which would enable individuals to receive a symptoms assessment and a referral to a network of providers or a nearby emergency department when warranted.

The proposal contains changes to increase operability and access to electronic records among healthcare providers. For example, telehealth platforms would be required to participate in the Statewide Health Information Network for New York (SHIN-NY) or otherwise demonstrate interoperability with other providers in the insurer’s provider network and the SHINY-NY patient consent process would be streamlined.

In light of these growing opportunities to facilitate their patients’ access to care and generate revenue, it makes sense for healthcare providers to embrace telehealth now.

Maureen Dunn McGlynn is a partner at CCB Law, a boutique law firm focusing on providing counsel to physicians and healthcare professionals. She can be reached at 315-477-6276 or mmcglynn@ccblaw.com.