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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.

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

Posted on by admin

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.