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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

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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.

The Pivot to Online

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By Kathryn Ruscitto

Friday, February 26, 2021

COVID-19 has taught us so many lessons, many of which we didn’t know we needed to learn. Some have been big surprises to organizations and others have helped to accelerate the work they do. In my world, board meetings, social events, fundraisers, conferences and educational forums have all worked in an online environment. We certainly lose some of the conversations and networking we experience in person but the expense, travel, time spent attending an event and the ability to interact from anywhere are big pluses.

I recently attended a Lyme disease research forum online that was hosted by State University of New York and organized by Saravanan Thangamani, MD. About 150 people attended, there were thirty presentations, materials were easily visible, and comments and questions were easily posted. It was an experience I am not sure would have happened at the same level in person.

“The online meeting allowed researchers like me to save time and resources on long-distance travel and reduce the carbon footprint,” Dr. Thangamani says. “Besides, increased participation and sharing information with a broader audience could not have happened if I had organized this meeting in a physical university building.”

On another day, I participated in a legislative breakfast via Zoom for a new organization. Ten elected officials attended without staff and then stayed to answer questions. It was efficient not having to travel to the event and the organization was able to share its message. The platform turned out to be a great way to educate.


Kathryn Ruscitto

I have also attended and helped plan five online fundraisers. I think it’s safe to say that while it’s helped during this time, it’s probably something we may discontinue when social events are able to return to normal. Organizations have tried hard to make the experience pleasant, but most people I have spoken with have had their fill of Zoom fundraising, although it may continue to work for organizations with a national reach.

So what are the implications for health care? Telemedicine has taken off, and software allows primary care physicians and specialists to more easily communicate and provide follow-up care and education for a wide range of health conditions.

Are all patients able to take advantage of this new world? Watching citizens attempt to register for COVID-19 vaccines has brought concern to this issue.

Sandra Sulik, MD, a family physician at St. Joseph’s Health with more than 27 years experience in the medical field, spoke about the importance of connecting with her elderly patients while keeping them safe at home.

“It not only allows us to continue the medical care for their chronic illnesses but also provides a touch-base point for many of the folks who live alone and are so isolated,” Dr. Sulik says. “Many of our visits are ideally suited to telemedicine, such as follow-up care for depression and anxiety and many other chronic illnesses that require mostly discussion.

“It does provide some challenges. Many situations require hands-on examination and of course that can’t be done via telemedicine. The technology, especially with the video visits, can be challenging for some clinicians and patients as well. Most of the time though, a really good visit can be accomplished.”

The reality is we are not going back to a pre-COVID-19 world, but we need to understand what has worked and what needs further analysis. How will we debrief these experiences and build toward a better future? This is an opportunity for our professional societies to explore.

Hopefully, we will see a return to a more normal environment later this year — let’s take the learning forward.

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

Kidney Care at Nephrology Associates of Syracuse, PC Remains Focused on Patients

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By Cari Wade Gervin

Tuesday, December 22, 2020

Despite a less than ideal 2020, Nephrology Associates of Syracuse, PC is looking ahead to the future.

The Team at Nephrology Associates of Syracuse, PC
 

As Nephrology Associates of Syracuse, PC began its 42nd year in business in January 2020, the future seemed as bright as it had ever been. A massive renovation was in the works. There were plans to add telemedicine to the practice to help improve ongoing outreach to rural patients.

And then came March — and the coronavirus pandemic.

“No one could have ever imagined what this pandemic would be like,” says Matthew Chaffin, MD, a nephrologist and the compliance officer for Nephrology Associates of Syracuse, PC. “It significantly altered how we took care of people.”

But after months of logistical challenges, Nephrology Associates of Syracuse has adjusted to the new normal. The team continues to provide management and treatment of advanced kidney disease, while leveraging telemedicine and remote mobile care teams to bridge the gap between cautious patients and in-office care.

“I think this was a good stress test,” says Adebowale Oguntola, MD, President of Nephrology Associates of Syracuse, PC and Medical Director of DaVita Kidney Care Central New York Dialysis Center. “The pandemic highlighted one of our key strengths — teamwork.”

“It’s satisfying to take care of complex problems and help patients feel better and to know we are making a difference in their life.”
— Matthew Chaffin, MD, nephrologist and compliance officer, Nephrology Associates of Syracuse, PC

Left to right: Jacquelyn Spencer, NP; Marcia Van Buren, NP; Tracy O’Neill, PA; Joanna Woodruff, NP; and Alyssa Miles, PA

Personalized Care for Kidney Disease

Despite the challenges presented by COVID-19, Nephrology Associates of Syracuse continues to be on the forefront of kidney disease management and treatment. The practice specializes in the treatment of chronic kidney disease, providing care for patients with diabetes-related kidney issues, high blood pressure and anemia, as well as those on dialysis and those who have had a kidney transplant.

“When you combine passion with training and excellence in what you do, it’s very powerful,” Dr. Oguntola says. “It’s contagious. People see that, and they feel that, and they have a sense of wanting to be part of something greater.”

At Nephrology Associates of Syracuse, PC, physicians personally see their patients on a regular basis. Nephrologists such as Dr. Chaffin may develop years-long relationships with patients.

“The reason why I became a nephrologist was because you could see one patient and follow them for years,” Dr. Chaffin says. “I know many of my patients so well that when I open the door and I walk in and I look at their face, I can tell if something’s going on,” Dr. Chaffin says. “I like that personal interaction with the patients. At the same time, it’s quite satisfying to treat complex problems and help patients feel better and to know that we are making a difference in their lives.”

Collaborative Approaches to Complexity

At Nephrology Associates of Syracuse, PC, most patients have multiple comorbidities, which can make care complicated at times. The nephrologists must stay aware of each patient’s status and treatment plan in terms of heart function, blood sugar and many other medical indicators.

“We remain in contact with multiple care providers about each patient,” Dr. Chaffin says. “And some cases are complicated enough that we see a patient frequently — sometimes once a month.”

This collaborative and personalized approach to care is what makes Nephrology Associates of Syracuse, PC different, as providers constantly work closely with both patients and other healthcare organizations to create integrated care for each patient. The six board-certified physicians on staff share similar philosophies and often consult with one another, too.

Ties Forged by Compassion

Many patients spend years at Nephrology Associates of Syracuse, PC, including at the end of their lives. Not all patients, however, have chronic conditions. Sometimes, nephrologists can provide treatment that resolves a medical episode entirely.

“At the beginning of my practice, I saw one patient — a young lady with high blood pressure,” says Adebowale Oguntola, MD, President of Nephrology Associates of Syracuse, PC and medical director of DaVita Kidney Care Central New York Dialysis Center. “She didn’t want to see me initially because she thought I was a young doctor. She expected to see a gray-haired doctor.”

After several months of treatment, Dr. Oguntola cured the underlying problem that caused the woman’s high blood pressure.

“I informed her that her blood pressure was good and she did not need to see a nephrologist anymore,” Dr. Oguntola says. “She seemed kind of disappointed.”

That patient is not the only one who has been sad when their care at Nephrology Associates of Syracuse, PC has ended, even though the cause is a happy one.

“I think examples like that are a testament to the kind of services we provide,” Dr. Oguntola says. “That is why we are the practice of choice for our patients.”

“We care deeply about our patients,” Dr. Oguntola says. “We enjoy collaboratively working together to provide excellent care. And when we collaborate with other specialties, people respect us because of the excellence we strive for.”

“Nephrologists are very independent-minded people,” Dr. Chaffin adds. “To have a large group of nephrologists who all can work together and believe the same philosophy is unusual. It’s one of the reasons I came to Syracuse.”

“When you combine passion with training and excellence in what you do, it’s very powerful. It’s contagious. People see that, and they feel that.”
— Adebowale Oguntola, MD, President of Nephrology Associates of Syracuse, PC and medical director of DaVita Kidney Care Central New York Dialysis Center

Continuing Care During COVID-19

After the onset of the pandemic, the practice modified workflows and adopted protocols to ensure safety and health precautions for both patients and staff.

“Every member of the group rolled up their sleeves,” Dr. Oguntola says. “We were able to restructure the workflow with the appropriate screenings and CDC guidance. The staff were unbelievably amazing and continued to work under hard conditions with a good attitude.”

Despite the safety protocols, many patients stayed away.

“Very few people were willing to come to the office for about two months, appropriately afraid of catching COVID-19,” Dr. Chaffin says. “That set the practice back. When patients started to return, however, we were overwhelmed trying to catch up on two months’ worth of patients who hadn’t been seen.”

Toward the end of 2020, the team continues to see patients who have delayed care since March, sometimes to deleterious effects.

Implementing telemedicine started as a challenge due to the nature of nephrology care. The technology allowed for safe, remote visits but could not meet nephrology patients’ need for detailed physical exams and lab work. Additionally, some patients had difficulty adapting to the medium.

“Many of our patients are over age 65, so the practice helped patients acclimate to the technology in order to complete telemedicine appointments,” says Anne Zaccheo, MBA, FACMPE, Practice Director of Nephrology Associates of Syracuse, PC. “Through creative thinking and patience, the practice identified appointment alternatives and offered multiple telemedicine options to allow for audio and visual communication in an attempt to meet each patient’s care needs.”

Zaccheo is also the President of the New York Medical Group Management Association (NY MGMA), “an active association of professional medical group practice leaders from all across New York […] whose members are dedicated to the advancement of group practice management through educational programs and the exchange of information and knowledge among and between colleagues.” Zaccheo shares that the practice benefitted from the sharing of local best practices and collaborative problem solving related to COVID-19 and other practice challenges among other healthcare practice leaders in NYMGMA.

As the pandemic spread, the practice began offering private blood draws for transplant patients who were nervous to go to the office, a practice that they still continue. Nephrology Associates of Syracuse also continues to operate satellite locations in Camillus, Fayetteville, Fulton and Vernon to provide access to nephrological care for patients without a mode of transportation. A mobile team consisting of a physician, advanced practice provider, medical assistant and phlebotomist travels together to ensure ongoing care is available to patients.

“Providing access to rural areas and to patients who are unable to travel to the main office is an important value and priority for the practice,” Zaccheo says.

Renovations — and Innovations — Continue

The renovations at Nephrology Associates of Syracuse will better support the new workflows and provide an enhanced patient experience. There will be a new clinical laboratory, a new blood draw room, two new patient bathrooms, a renovated waiting room, a new reception area, two new bariatric exam rooms, a new medical assistant area and a new break room for employees.

Matthew Chaffin, MD, Compliance Officer


Adebowale Oguntola, MD, President


Phillip Ondocin, MD


Anne Zaccheo, MBA, FACMPE, Practice Director at Nephrology Associates of Syracuse, PC and President at New York Medical Group Management Association


At the time of publishing, the COVID-19 pandemic has entered a second wave, and there is hope with a vaccine to be available in the U.S. shortly.

“Our goal is to enhance the patient experience and improve collaboration among team members,” Zaccheo says. “The changes will enable our team to further optimize clinical workflows and enhance communication, as well as upgrade the office and work environment for patients, staff and providers.”

Learn more about Nephrology Associates of Syracuse, PC at nephrologysyracuse.com.

St. Joseph’s Health Extends Access to Heart Care

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Tuesday, December 22, 2020

Heart failure affects more than 6 million people in the United States and is escalating rapidly, with an estimated 960,000 newly diagnosed cases annually. In many cases, patients who visit the emergency room (ER) for heart issues do not attend the recommended follow-up visit with a cardiologist. This leads to continued cardiac issues down the road.

Russell Silverman, MD, FACC, Medical Director of the St. Joseph’s Health Heart Failure Clinic and Chief Medical Officer at Rome Memorial Hospital, (pictured on screen) using the Bluetooth technology on a patient.

With that in mind, the St. Joseph’s Health Cardiovascular Institute has opened a Heart Failure Clinic at its Brittonfield Cardiology office. The Heart Failure Clinic will provide early follow-up (within one week) to patients without an established physician/cardiologist, provide care to the uninsured and serve as a bridge for patients who aren’t able to make a follow-up appointment within one week.

“We see it time and again. People end up in the ER with heart conditions, and when they are released, they don’t see a cardiologist fast enough, or they don’t start their medications right away,” says Russell Silverman, MD, FACC, Medical Director of the St. Joseph’s Health Heart Failure Clinic and Chief Medical Officer at Rome Memorial Hospital (RMH). “This can cause continuing heart issues. The incorporation of the Heart Failure Clinic at St. Joseph’s Health will further improve access to timely, quality care and improve outcomes for our heart failure patients.”

The Heart Failure Clinic is a partnership with University of Rochester Medical Center. URMC cardiologists Leway Chen, MD, and Mark Tallman, MD, will each see patients at the Brittonfield location, reducing the need for patients to travel to Rochester for routine care. Developing an advanced heart failure treatment clinic also allows St. Joseph’s Health to provide care to its left ventricular assist device (LVAD) patient community — care that is not currently available.

Bluetooth stethoscope

“The Heart Failure Clinic improves access to timely, quality care and improve outcomes for our failure patients,” Dr. Silverman says. “There’s been a need for a clinic like this for many years. St. Joseph’s Health saw that need and stepped up to offer this important resource for the community.”

Strategic placement of the heart failure clinic within the Brittonfield practice offers availability to stress, echo and EKG services, as well as access to on-site cardiologists. It also supports the goal of reducing preventable readmissions in heart failure patients.

Dr. Silverman performs a stress test on a patient.

 

Improving Access in the Mohawk Valley

St. Joseph’s Health is also teaming up with RMH to offer patients in rural areas access to highly advanced cardiac care. “Bluetooth stethoscope” technology is now being used at the Cardiovascular Institute at RMH to connect cardiologists to patients without physically being together.

“This is truly remarkable technology. It’s the first of its kind in the region,” Dr. Silverman says. “It enables us to bring high quality heart care to areas that might otherwise not be served by these types of subspecialties.”

During a consultation, the patient at RMH is accompanied by a nurse or respiratory therapist (RT). They connect via computer to the cardiologist in Syracuse. The cardiologist speaks with the patient to assess how he/she is feeling. Then, the nurse or RT moves the Bluetooth stethoscope to different parts of the patient’s chest and neck so the physician can hear and see the patient’s heart activity.

“Our goal is to use this remarkable technology to keep patients close to home,” Dr. Silverman says. “By treating their heart issues using the Bluetooth stethoscope, we hope to limit the number of patients who need to be transferred out of town to St. Joseph’s Health if they don’t need tertiary care. They can stay close to their loved ones, which is what we strive for.”

St. Joseph’s Health and RMH are the only hospitals in the region using this technology. It is currently being utilized for inpatient and ER consultations.

To refer patients to the St. Joseph’s Health Cardiovascular Institute in the Dorothy G. Griffin Cardiovascular Center at RMH, call 315-338-7220.

To refer patients who need advanced heart failure management to the Heart Failure Clinic at St. Joseph’s Health, call (315) 703-5090. In addition, any patient being released from hospitalization at St. Joseph’s Health Hospital and other Central New York hospitals, as well as those being discharged from rehabilitation centers, can be referred to the Heart Failure Clinic.

St. Joseph’s Health is one of only eight hospitals in the nation to be named an American Heart Association Center of Excellence. It was also listed as one of America’s 50 Best Hospitals for Cardiac Surgery in a national study by Healthgrades, and it received the highest performance rating for Heart Bypass Surgery by U.S. News & World Report. For more information, visit everybeatmatterssjh.org.

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

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By Thomas Crocker

Tuesday, December 22, 2020

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

The prostate MRI patient experience begins with compassion and care and ends with image quality excellence. Pictured: MRI technologist Paul Mingle 
 
Established in 1985, MDR of CNY’s mission is to provide superior, specialized MRI services in a welcoming, warm and patient-focused environment, transforming what often is an apprehensive experience into a notably calm one.
 

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

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

A Variety of Specialty Scans

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

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

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

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

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

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

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

 

Prioritizing Safety

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

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

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

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

Convenient and Compassionate

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

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

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

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

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

Timely Communication

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

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

A Healing State of Mind: SUNY Upstate Medical University Is Advancing the Landscape of Neurology and Neurosurgery

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By Katy Mena-Berkley

Monday, November 2, 2020

At the State University of New York Upstate Medical University, neurologists, neurosurgeons and neuroscience researchers work together to offer a robust spectrum of neurological solutions to the Central New York community.

Ruham Nasany, MD, is leading a multi-disciplinary team for the new Neuro-Oncology program.
 

Located in Syracuse, Upstate is the region’s main referral center for specialized medical care and the only one to have a comprehensive neurological disorders program.

“Central New York is a large territory that covers one-third of the state and is home to one-tenth of New York’s population,” says Luis Mejico, MD, Professor and Chair of the Department of Neurology at SUNY Upstate Medical University. “In order to satisfy and meet the needs of our community, we have expanded our established programs to form the Upstate Neurological Institute. This is critically important at a time when neurology and neuroscience is the most sought-after specialty in the country.”

In the past 15 years, SUNY Upstate Medical University’s neuroscience offerings have expanded tremendously. Together, the departments of Neurology and Neurosurgery have doubled its number of faculty, recruiting the best and brightest clinical minds from all corners of the United States, and have also retained a significant portion of SUNY Upstate Medical University trainees and residents.

“Our clinical neuroscience program is the most advanced in the region, touching on the three pillars of neurological clinical care, education and research,” Dr. Mejico says. “We have invested a lot of effort into generating programs that provide the best care for our community, and we continue to expand and improve high quality care here in Central New York.”


Luis Mejico, MD, is the Chair of Neurology and is part of the multidisciplinary Neuro-Ophthalmology clinic, one of the dozen specialty clinics in the department.

Satish Krishnamurthy, MD, leads the Neurosurgery department and is a funded researcher. In Fall 2020 he received a $324,000 DOD grant to find a pharmacological solution for hydrocephalus instead of repeated shunt surgery.

Leading-Edge Solutions Close to Home

While people may need to travel for specialized operations such as neurosurgery, Upstate provides a more convenient option for patients and families in Central New York, as well as northern and western Pennsylvania.

“We cover the length and breadth of neurosurgery, offering the treatment options that our community needs,” says Satish Krishnamurthy, MD, MCh, FAANS, Professor and Interim Chair of the Department of Neurosurgery at SUNY Upstate Medical University. “The idea is to have the country’s best care right here in our patients’ backyard.”

Established in 1966, the Department of Neurosurgery has a long-standing history of training neurosurgeons to manage a wide variety of disorders found in the brain and spinal cord.

“Neurosurgery at Upstate has always catered to the sickest of the patients, while also contributing to education and making sure neurosurgeons not only do a good job, but provide the community with the best care possible,” Dr. Krishnamurthy says. “We have a specially trained team and high-end technology right here.”

Stroke Care and Telemedicine

Patients in rural communities who experience stroke can trust the board-certified stroke physicians at Upstate University Hospital to provide expert care via telemedicine. Using and interactive video conferencing, Upstate’s team can connect with emergency departments at partnering regional hospitals in real time. Each patient may see a consulting neurologist and Upstate’s stroke specialists. Together, this team provides timely medical evaluation and administration of tPA treatment to improve outcomes and minimize risk of long-term complications.

Upstate Brain & Spine Center is staffed by the largest team of neurosurgical specialists in Central New York, providing a spectrum of services to patients at Upstate University Hospital. The team also provides support to patients at multiple Upstate facilities, including its Level I trauma center — the only one in the region — Upstate Cancer Center, Upstate Golisano Children’s Hospital, neonatal care units and Upstate Comprehensive Stroke Center.

Intensive Care for Neurological Conditions

Upstate University Hospital is home to the only structured neurocritical care service in Central New York. The dedicated unit is designed to treat, manage and evaluate patients with the most severe and complex conditions affecting the brain and spine. During the past decade, Upstate’s Neuro ICU has nearly more than tripled in size, expanding from an eight-bed unit to a 27-bed unit.

“The expansion meets the growing needs of the region,” says Julius Gene Latorre, MD, MPH, Medical Director of the Upstate Comprehensive Stroke Center. “This was in part fueled by the advancement in acute stroke care and in medical advances in the management of neurosurgical conditions and traumatic brain injuries.”

The neurology specialists in the Neuro ICU typically treat patients with intercranial hemorrhage that may be related to a spontaneous hemorrhage of the brain or traumatic hemorrhage of the brain. They are also practiced in managing the care of patients experiencing brain injury related to loss of oxygen from cardiac arrest. Other conditions these specialists may see include uncontrollable seizures and complex neuromuscular conditions, such as Lou Gehrig’s disease.

In addition to technology and equipment commonly found in ICUs, the Neuro ICU at Upstate University Hospital also has monitoring equipment specially designed to monitor brain function, such as continuous electroencephalogram (CEEG) monitoring critical in the detection of non-convulsive seizures.


Julius Gene Latorre, MD, MPH, Medical Director of Upstate Comprehensive Stroke Center, the first in the region

Harish Babu, MD, Assistant Professor of Neurosurgery at Upstate, is one of the clinicians providing care to patients with surgical disorders of the brain and spine. Together with his colleagues, Dr. Babu provides intensive neurosurgery embracing sophisticated technologies. The neurosurgeons and neurosurgical researchers specialize in brain bleeds, brain tumors, hemorrhages, pediatric care, nerve and spine problems, and strokes. Upstate’s neurosurgical technologies include:

  • Minimally invasive robotic surgery — Operating through small incisions, can avoid some complications associated with surgery that requires a larger opening. Using stereotactic laser ablation, the neurosurgery team can address multiple neurological conditions, including epileptic foci and tumors.
  • Endoscope — “Using an endoscope, we are able to investigate the nooks and crannies of the brain in a manner that does not disturb surrounding tissue,” Dr. Babu says. “We can use endoscopes through the nose to reach the brain for surgeries. Then we can use pointed lasers to burn tumors. We also have computerized microscopic navigation techniques, which are like a GPS for the brain that allows you to target a specific pinpointed area.”
  • Fluorescein-guided neurosurgery — Using a green-water soluble dye known as sodium fluorescein, neurosurgeons can more accurately investigate a tumor site. The dye accumulates on areas of the brain where the blood-brain barrier has been damaged, highlighting the tumor tissue more clearly.
    “In some patients, we do not think that we can see every single cell with our eyes or an MRI machine,” Dr. Babu says. “When we inject the dye as part of surgery, the tumor cells will light up differently compared to the normal brain. That helps us remove those tumors and keep the normal parts of the brain in intact.”
  • Focused radiation Gamma Knife — This computerized treatment planning software helps neurosurgeons precisely locate targets in the brain and deliver concentrated doses of radiation to the affected area. As a result, surrounding tissue is spared. Gamma Knife radiation may be used to treat a variety of neurologic conditions, including benign brain tumors, such as meningiomas and pituitary adenomas, malignant brain tumors, such as primary brain tumors and metastatic tumors, blood vessel defects, such as arteriovenous malformations, and functional complications like trigeminal neuralgia. The region’s only Gamma Knife is considered to be patient friendly as it is a one-time outpatient procedure.
  • Awake craniotomy — Using specialized anesthesiology techniques, neurosurgeons are able to operate while a patient is still awake. Neurosurgeons may ask a patient who is undergoing an awake craniotomy to perform an action, such as playing the violin or singing, during the surgery.
    “We do this to make sure that the function of the brain is preserved, and we are not cutting into important brain tissue,” Dr. Krishnamurthy says.

Expert Epilepsy Care

A Level 4 comprehensive epilepsy center, Upstate University Hospital is equipped with the technology and expertise to deliver effective epilepsy care. The epilepsy program has expanded during recent years, increasing the monitoring unit in the hospital. If surgery is needed, fellowship-trained neurosurgeons can perform a range of procedures, including Robotic Stereotactic Assistance (ROSA) for localization and treatment of the epileptic foci using minimally invasive surgical methods.

Robert Beach, MD, monitoring patient Amyee Rodriguez of Gouverneur, New York

An Exploration of Possibility

The Brain Tumor Research Laboratory at SUNY Upstate Medical University is a unique resource that works hand in hand with the Department of Neurosurgery to enhance patient care and outcomes.

“The laboratory is a research unit, a self-contained research facility that is completely integrated with the clinical mission of the Department of Neurosurgery,” says Mariano Viapiano, PhD, Associate Professor of Neurosurgery and Neuroscience and Director of the Brain Tumor Research laboratory. “We support the work of the clinicians by allowing them to perform research activities with clinical specimens. That research allows them to receive better details about the clinical case of the patients and more information about the tumors, enabling a better diagnosis and prognosis.”

Frozen samples of brain cancer tumors can be carefully thawed, put in a nourishing medium and placed in a body-temperature incubator to bring them back to life at Upstate’s Brain Tumor Research Laboratory.

Dr. Viapiano works with a multidisciplinary team of experts in the laboratory, including two senior scientists who are biochemists, two research fellows, one junior trainee and a laboratory manager, Sharon Longo.

“Sharon has been lab manager for 24 years,” Dr. Viapiano says. “I am fortunate to have her here. She runs day-to-day operations, and we have an outstanding relationship.”

Together, the specialists in the Brain Tumor Research laboratory facilitate a bench to bedside pipeline to support clinical experts treating tumors associated with primary brain cancer, including glioma, neuroblastoma, rare tumors, skull-based tumors and brain metastases.

For this pipeline, a clinician may collect a tumor specimen, with patient consent, during surgery to send to the lab. Dr. Viapiano’s team performs genetic and molecular analysis on the specimen and can even reproduce the tumor. The research team can further investigate by administering experimental therapies.

“We generate a wealth of information that we can provide back to the clinicians to improve the patient’s diagnosis and prognosis,” Dr. Viapiano says. “We can provide that information to pathologists, and they can initiate therapeutic strategies based on that data.”

The Brain Tumor Research Laboratory also has an established protocol for tissue collection, allowing the team to collect specimens from every patient who consents to provide tumor tissue for research.

Expert Neuro- Oncologic Care

Upstate University Hospital is pleased to welcome Ruham Alshiekh Nasany, MD. A graduate of Upstate’s residency program, Dr. Nasany serves as Assistant Professor of Neurology, Director of the Brain Tumor and Neuro-Oncology program at the Upstate Cancer Center.

“Dr. Nasany completed her neuro-oncology fellowship at Memorial Sloan Kettering Cancer Center in New York City, which is a major cancer institute in the world,” says Luis Mejico, MD, Professor and Chair of the Department of Neurology at SUNY Upstate Medical University. “She has special training in neuro-oncology, which allows us to develop a program that will inspire new protocols.”

“Collecting those specimens has helped us to create a large repository or tumor bank that we can use for research purposes.”

Additionally, if a physician thinks that a unique tumor case would be of particular importance, the lab may set up a protocol to reproduce the tumor in animal models or in vitro.

“We are proud to have the best technology at the national level to provide care and the expertise we provide adds a whole component that allows us to evolve brain cancer care,” Dr. Viapiano says. “If you refer your patients to Upstate, you can count on not only the highest standard of care but also the best standard of analytical services in diagnostic prognosis and research.”

Upstate Neurological Institute

SUNY Upstate Medical University Interim President Mantosh Dewan, MD, has announced the formation of the Upstate Neurological Institute.

The new Institute unites two prominent departments — Neurology and Neurosurgery — to create the largest team dedicated to neurological disorders in Central New York.

In addition to patient care within these core departments, the Neurological Institute membership will expand to include collaboration with the 14 other clinical and basic science departments at Upstate Medical University, which have services or research to improve the health of persons with neurological disorders.

The setting supports the endeavor with many services that are one of a kind in the region. Upstate University Hospital has an entire hospital floor dedicated to patients with brain injuries. It was the region’s first comprehensive stroke center and has a level-4 level epilepsy center. Advanced neurosurgical technologies include intra-operative MRI, minimally invasive robotic and laser surgery tools, and the region’s only Gamma Knife. The Institute also is part of a medical university that offers robust neuroscience research aimed at treatments and cures.


SUNY Upstate Medical University Interim President Mantosh Dewan, MD

For more information, visit upstate.edu/neuro.

Minimal Medication, Maximum Care at Genesee Orthopedics & Plastic Surgery Associates

Posted on by admin

By Cari Wade Gervin

Monday, November 2, 2020

Andrew Wickline, MD, FAOSS, FAAHKS, uses a joint replacement program that minimizes opioid use to promote holistic healing and better outcomes.


Andrew Wickline, MD, with a robotic surgical system. He is now also using a different type of technique called kinematics alignment for personalized fit. The negative to the robot is that it shoe horns people into the same size fit no matter what their pre-existing pre-arthritic alignment was. Kinematic alignment allows for that. Genessee Orthopedics will be performing a trial of an augmented reality system in the near future.

 

Total knee replacement is one of the more painful surgeries.

“My patients used to say, ‘I’d rather have another child than do this again,’” says Andrew Wickline, MD, FAOSS, FAAHKS, an orthopedic joint reconstruction specialist at Genesee Orthopedics & Plastic Surgery Associates.

The level of pain associated with a total knee replacement typically results in a large prescription for narcotic pain medication post-surgery. With opioid use and addiction up across the state, however, Dr. Wickline created a different approach for his patients. He now uses multiple non-opioid choices and a game-changing home therapy plan he created.

“There’s somewhere between an 8% to 14% risk of permanent opioid addiction after a total knee replacement for a patient who didn’t use opioids before,” Dr. Wickline says. “That’s at least eight out of 100 people or at least 50,000 people a year nationally. That’s a frightening number.”


Dr. Wickline

“There’s somewhere between an 8% to 14% risk of permanent opioid addiction after a total knee replacement for a patient who didn’t use opioids before.”
— Andrew Wickline, MD, FAOSS, FAAHKS, orthopedic joint reconstruction specialist at Genesee Orthopedics & Plastic Surgery Associates

The Problem With Opioids

In 2018, opioids were involved in almost 47,000 overdose deaths — 69.5% of all drug overdose deaths. Although New York has not been hit as hard as some other states, the problem continues to grow.

“Once you become an opioid user, you end up costing the medical system double the average amount of cost for a year,” Dr. Wickline says. “For commercial payers, for example, the average cost is around $11,000. But if you’re an opioid user, it goes up to almost $20,000.”

Even just a 24-hour prescription of narcotics has a 6% risk of chronic opioid addiction. So, after studying the issue and working with patients, Dr. Wickline published a study — 23-hour TKA in 10 Opioid Pills or Less Through 90 Days: A Non-Selected Prospective Consecutive One Year Cohort — earlier this year outlining his approach.

Dr. Wickline (center) with Uday Myneni, MS, MBBS, MCH, and his resident team at the first annual arthroplasty conference in Hyderabad, India. Dr. Wickline performed the first anterior hip replacement with the HANA table, televised live to over 400 surgeons.

 

Dr. Wickline’s Study

Published in the Journal of Orthopaedic Experience & Innovation in July and co-authored with Maryann Stevenson, RPh, the study focused on 386 patients who underwent a total knee arthroplasty (TKA).

During a four-month period, the patients received education, home-based physical therapy and a continuous adductor canal block with ropivacaine during surgery. Pain levels were recorded pre-surgery and through the first three postoperative days, then again at three weeks, six weeks and 12 weeks post-surgery.

The study found that 86% of patients were able to get through the 90-day period with 10 opioid pills or less. This is the lowest published opioid use in the nation, five times lower than the next best paper, which found people used 50 pills post-surgery on average. In addition, 85% did not need formal physical therapy, saving them around $720 and reducing their exposure to COVID-19.

“I have a lot of patients who live up in the Adirondacks, and they have no access to therapy,” Dr. Wickline says. “Patients who went to rehabilitation and had two hours of therapy every day had more pain and took more narcotics. My patients who live up north and had no access to therapy followed my simple exercises and experienced less pain.”

The formal study confirmed Dr. Wickline’s anecdotal experience, he says. His patients also experienced a 1.2% readmission rate through 90 days, one of the lowest in the nation based on CMS data. In addition, 64% of TKA patients were able to go home the same day as surgery, and 91% of patients left the hospital within 23 hours.

“By getting patients out of the hospital sooner, we prevent complications, lower the risk of MRSA and COVID 19, and lower the risk of C. diff-caused colitis,” Dr. Wickline says.

“What I saw with patients who went to rehab and had two hours of therapy every day, they had more pain and took more narcotics … than the patients who lived up north and had no access to therapy and just followed my simple exercises.”
— Dr. Wickline

Improved Outcomes, Faster

According to the study, Dr. Wickline’s patients reached 110 degrees of flexion on average within three weeks. That’s seven weeks earlier than the 2018 American Academy of Orthopaedic Surgeons textbook on rehabilitation states is normal.

Dr. Wickline stresses that his patients haven’t been cherry-picked to improve outcomes, either, which is documented in the study.

“The protocol fits everyone,” Dr. Wickline says. “If you have medical comorbidities, I might have to keep you overnight but the study shows that most patients can go home the same day. You can decrease your complications by following this protocol, and you don’t have to be a 57-year-old marathon runner with a bad knee and no medical history to qualify for this.”

Dr. Wickline’s protocol includes a daily progress plan he says is simple for patients to follow.

“Patients do a little bit of exercise each hour and then immediately sit down, elevate and ice to control the swelling,” Dr. Wickline says. “They get the range of motion, but they create the least amount of swelling, so the pain goes away quicker.”

Dr. Wickline says the exercises take five to eight minutes each hour. Combined with ice, elevation and NSAIDs, most patients’ pain is manageable, he says. And the protocol is also a great option for people who have struggled with addiction, whether with opioids or other substances.

“We had around 30% of patients who did not take any opioid medication after discharge,” Dr. Wickline says. He also offers cryoablation that can freeze the nerves around the knee for up to three months for patients who want zero opioids in or out of the hospital.

“Anxiety is a prime culprit in reaching for a pain pill,” Dr. Wickline says. “I have a very detailed education book on what to expect, so my patients know exactly what is normal during their joint replacement recovery.”

Visit andrewwicklinemd.com or call 315-735-4496 to learn more about outpatient joint replacement with the least opioid use in the nation.