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Syracuse Orthopedic Specialists Offers Full-Spectrum Spine Surgery

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By Thomas Crocker

Thursday, September 3, 2020

At Syracuse Orthopedic Specialists (SOS), a four-physician team of orthopedic surgeons specializing in spine surgery performs the gamut of procedures for neck and back pain, including a variety of outpatient operations at the practice’s ambulatory surgery center.

In most cases, nonoperative treatments provide sufficient relief from neck or back pain to allow patients to carry out daily functions and enjoy favorite activities. Options include nonsteroidal anti-inflammatory medications, chiropractic care, acupuncture, nerve-blocking cortisone injections and physical therapy (PT), which is available from the orthopedics and sports therapy team at SOS. Nonoperative care is also available from one of SOS’ partners in care, New York Spine & Wellness Center.

“PT is a mainstay of spine care and is quite effective at treating most back problems,” says Richard DiStefano, MD, orthopedic surgeon at SOS. “It’s an advantage to have PT in our practice because it’s easy for physicians and therapists to collaborate to tailor therapy for patients.”

Surgical Solutions

When conservative therapies prove ineffective, surgery may be appropriate. Large operations, such as cervical laminectomy, cervical fusion, cervical laminoplasty, and lumbar laminectomy and fusion, typically require hospitalizations of two or more days, and SOS spine surgeons perform these procedures at St. Joseph’s Health and Crouse Health.

Many spine surgeries do not require a hospital stay, and for these, SOS has a dedicated home: Specialists’ One-Day Surgery Center, located at 5801 East Taft Road in North Syracuse. There, surgeons perform anterior cervical discectomy and fusion, lumbar discectomy, and one-level laminectomy. Another outpatient procedure, sacroiliac joint fusion, may provide relief for individuals with sacroiliac joint dysfunction. Requiring just two small incisions in the buttocks, the procedure allows a spine surgeon to solidify the joint with a cage-like implant.

One of the most common procedures that Dr. DiStefano performs at the Specialists’ One-Day Surgery Center is spinal cord stimulator implantation. Spinal cord stimulation uses implanted electrodes and a small generator to deliver mild, pain-relieving electrical impulses to the cervical or lumbar spine.  Candidates include individuals for whom back surgery did not provide relief or who have chronic back or leg pain, degenerative spine changes, reflex dystrophy in the foot or knee, or painful neuropathies in the feet or hands, according to Dr. DiStefano.

Telemedicine Appointments Available

Video visits played a crucial role in allowing Syracuse Orthopedic Specialists to continue caring for patients during the COVID-19 pandemic. Telemedicine appointments through the SOS Virtual Visit App remains an option for initial and follow-up appointments, as appropriate, for patients who wish to see their orthopedic surgeon from the comfort of home.

“Patients undergo a one-week trial using electrodes placed percutaneously and an external battery pack,” Dr. DiStefano says. “If that’s successful, we permanently implant the electrodes in the spine through a small incision in the upper or lower back. The wires are connected to a generator in the buttocks. Patients can adjust the strength of the electrical signal with a remote.”

The variety of outpatient spine procedures available at the Specialists’ One-Day Surgery Center is indicative of the sweeping nature of spine care at SOS.

“Ours is a comprehensive spine program,” Dr. DiStefano says. “We perform procedures on all parts of the spine in inpatient and outpatient settings, and we also offer a wide range of nonsurgical treatments. Patients get all-encompassing care at SOS.”

For more information, visit sosbones.com or call 315-703-3442.

How the Coronavirus Will Impact Your Hiring Process

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By Kathryn Ruscitto

Thursday, September 3, 2020

As we return to work, we will see a dramatic impact in openings and hiring to fill those jobs.

In “How the Coronavirus Is Changing Hiring and Recruiting Going Forward,” Robin Ryan at Forbes states, “The fallout will fundamentally change recruiting and hiring practices long after the pandemic has passed.”

Locally we have seen the emergence of more remote work as teams are finding unique ways to use technology in healthcare delivery — from telemedicine to scheduling remotely, transportation, utilization of accessing records and messages through portals.

Susan Crossett, CEO at CPS Recruitment, notes many practices and healthcare organizations have reached out to utilize CPS’s remote expertise in leveraging technology to source quality candidates. The challenges she has observed in this environment include:

  • Long-term care facilities facing recruitment challenges as employees become increasingly concerned about safety and exposure to the coronavirus.
  • Hospital challenges with personal protective equipment are impacting their ability to recruit.
  • Nurses and clinicians are asking to see safety protocols in health environments before they will consider interviewing for a position.


Kathryn Ruscitto

The advantages Crossett sees developing are clear increases in productivity from remote work as employees see less challenges with transportation and child care. She also says employers will need to consider how to keep the team connected and support each other while working remotely from social opportunities to communications.

Employees are looking for work experiences that allow flexibility and safety and, in exchange, are providing unique approaches to filling back room needs.

Mike Humphrey, CEO at SOS , a multifaceted orthopedic practice with multiple locations, states, “We have now found that remote work offers new opportunities for efficiencies and for workforce satisfaction. At the same time it has required new workflows and processes.”

An Indeed survey reports the top five benefits of remote work for employees are related to personal satisfaction:

  1. Better work life balance
  2. Reduced stress
  3. Reduced absences
  4. Improved morale
  5. Fewer sick days

For further information, visit:

I chair the board of an arts organization that put more classes, exhibits, and performances online, which was done by employees working remotely. The result: an explosion of new visitors to the website and a realization that moving forward we need to offer both online and in-person opportunities. It has been a way to expand our market and, we hope, bring in new visitors as we reopen.

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

Crouse Health: Where Family is the Foundation

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By Cari Wade Gervin

Monday, June 29, 2020

The staff at Crouse Health’s Kienzle Family Maternity Center spend so much time helping new families come into existence, they’ve become their own workplace family, too.

 

“I feel like there’s a lot of camaraderie, which you need,” says Maria Ciciarelli, MD, FACOG, partner at CNY Women’s Healthcare. “If an urgent situation arises, nurses, other physicians and other attendings on the floor are the first to jump in. I think that’s one of the best things about working at Crouse.”

Suzanne Bartol, MD, FACOG, partner at Loftus, Ryu & Bartol agrees.

“We all work together and help each other out,” Dr. Bartol says. “But we are friends outside of being colleagues when we’re at work. That goes on at all levels, from residents to nurses to attendings.”

This tight-knit collegiality is why so many OB/GYNs have stayed at Crouse since they started medical school rotations or their residencies — in Dr. Bartol’s case, 19 years, and 16 years for Dr. Ciciarelli. It’s also why the standard of maternity care is so high at Crouse, says George Stanley, MD, FACOG, Assistant Professor of Obstetrics and Gynecology at Upstate Medical University and a Crouse-affiliated obstetrician.

“We have a highly experienced and trusted team of obstetricians who look out for each other and are able to assist colleagues while teaching residents and medical students,” Dr. Stanley says. “It’s a different experience when you are managing difficult cases, deliveries and surgeries with a person who is in training. It means you, as the trainer, have to really know what you’re doing to guide the trainee so they eventually will be as good as — or even surpass — your skill set.”

Suzanne Bartol, MD and Maria Ciciarelli, MD, FACOG

When you ask physicians and staff what they love about working at Crouse Health’s Kienzle Family Maternity Center in Syracuse, you hear one word over and over: camaraderie.

 

“What differentiates Crouse maternity care is the fact that we have an entire hospital team available for both patients and physicians,” says Betty O’Connor, director of women’s and infants services. “There are five members of our nursing leadership team available to assist physicians and prospective patients through the process of selecting a physician and hospital to have their birth experience.”

Betty O’Connor, director of women’s and infants services confers with Brynne Stockton, RN, Nurse Manager (right)

 

A History of Woman-Centered Care

In 1887, no hospital in Syracuse offered maternity care or treated children. A group of 14 female community leaders, including Jessie Lansing Crouse (whose family would later fund the hospital enough to change its name), launched the Syracuse Women’s Hospital and Training School for Nurses. Crouse herself took the first five patients in her carriage to the home that housed the hospital.

Much has changed in medicine and maternity care over the past 133 years at Crouse, but the commitment to putting mothers first is still the number one priority.

The physicians, nurses and midwives at the Kienzle Family Maternity Center deliver close to 4,000 babies each year — more than any other hospital in upstate New York. Crouse also serves as the Regional Perinatal Center for the Central New York region.

Mothers come from diverse and varied backgrounds and hail from the Southern Tier all the way to the Canadian border.

Dr. Stanley says the nursing staff at Crouse has plenty of experience in treating different types of patient populations, which helps improve patient outcomes.

“We have nurses who have been with Crouse for 20 to 30 years and more,” Dr. Stanley says.

“These are our neighbors — our friends. These are the people we see in the grocery store. In a city the size of Syracuse, you run into your patients nonstop. And I think it’s a true team effort to provide the best care.”
— Stephen Brown, MD, FACOG, Director of Low-Risk Obstetrics at Crouse Health and President of CNY Obstetrics & Gynecology
Suzanne Bartol, MD

 

Low-Risk, High-Risk and Everything In-Between

The Kienzle Family Maternity Center is well known for its treatment of high-risk pregnancies, but most births each year are routine, low-risk births.

“If moms don’t want interventions, we don’t want to do any unless we need to,” Dr. Ciciarelli says.

The experience levels of the staff are important for all births, says Stephen Brown, MD, FACOG, director of Low-Risk Obstetrics at Crouse Health and president of CNY Obstetrics & Gynecology.

“I hear, ‘He’s the director of low-risk obstetrics, what’s his experience with high-risk obstetrics?’ Well, you never know when a pregnancy is going to go from low risk to high risk.” Dr. Brown says. “In the past week, I had a set of twins and another preterm baby who are both in the NICU right now.”

Given the maternal and infant mortality rates in the area, that level of care is crucial. In 2016, the state of New York was ranked 30th in the nation in maternal mortality. And Onondaga County has averaged 6.7 infant deaths per 1,000 live births in recent years, one of the highest rates in the state. It also has an 8.6% rate of preterm births, with 7.9% of babies born underweight.

“Crouse has 24-hour anesthesia care onsite,” Dr. Stanley notes. “When emergencies happen, we don’t have to call an anesthesiologist. If a patient has unplanned conditions that require intensive care, general surgery or neurosurgery, we have all those high-tech specialists right here at our fingertips.”

In addition to physicians and nurses, the maternity team includes lactation consultants, technicians and support staff.

“We are able to provide the one-on-one care our high-risk patients need,” Dr. Ciciarelli says.

And when neonatal intensive care is needed, the staff is ready.

“We have the highest level of NICU care available 24-7,” Dr. Brown says. “This gives patients confidence knowing they’re going to have anesthesia care and neonatal care available when they need it, if they need it. And it gives the physician — whether the pregnancy is low-risk or high-risk — the comfort level to say, ‘Listen, we can do what’s right. We can do it quickly. And we have backup in the NICU that’s available to us at all times.’”

“I really enjoy working at Crouse Health, even when it’s a stressful workday. It’s a work environment that’s conducive to taking care of patients and providing the best care possible.”
— Maria Ciciarelli, MD, FACOG, Partner at CNY Women’s Healthcare

Special Care for Tiny Babies

The Walter R.G. Baker Neonatal Intensive Care Unit at Crouse serves up to 1,000 preterm and medically challenged babies each year. It is the only NICU in Central New York designated by the New York State Department of Health as a Regional Perinatal Center.

“We take care of the sickest babies,” says Brynne Stockton, RN, MSN, nurse manager of perinatal services. “We have highly skilled nurses who are always staying up-to-date with the latest evidence-based practices and the highest standards.”

Some infants need longer-term care. The antepartum care team provides support for those mothers and families, often becoming close friends.

“I personally have had an experience with a family that was here with an antepartum patient,” Stockton says. “The mother delivered here, and the baby was in the NICU for many days. I still keep in touch with that family. We try to meet each other when they’re in the area. And that’s not just an experience I’ve had, it’s an experience that many Crouse OB nurses have.”

Stockton says nurses become friends with former patients, and that patients routinely send Christmas cards and updates about their now-grown babies.

Dr. Bartol and George Stanley, MD

On the Same Page

Even during low-risk births, it’s important to have staff in sync.

“When you have a patient who’s laboring, you could spend significant time up there with the same people, and you really get to know each other and you also get to know your patients very well,” Dr. Bartol says. “ I think that makes the unit work really well. It’s not just a place to clock in and clock out.”

During high-risk births, that cohesive unit is invaluable. Dr. Brown experienced one situation when a patient was transferred to Crouse from another hospital after the delivery took a serious turn.

“The anesthesia team, NICU staff, nurses and I all communicated before the patient’s arrival,” Dr. Brown says. “Then, as soon as the lab work and our initial evaluations were done, we were in the operating room ready to deliver the patient’s baby. The ICU was notified in case the mother needed intensive care afterward. To have everyone on the same page, before the patient even arrived at the hospital — I think that that type of communication and that type of skill level is evident only at an institution like Crouse that has all the resources available around the clock.”

Those resources led Dr. Stanley’s wife to have her three children at Crouse. Dr. Bartol also delivered her three children at the hospital.

“Clearly, I’m biased because I have chosen to work at Crouse, but I also chose to have my own children here,” Dr. Bartol says. “I feel we’re able to provide that higher level of care with excellence without patients feeling like we are trying to medicalize their care. We want our patients to follow their birth plans as safely as possible.”

That’s what the Crouse camaraderie is all about.

“We are very supportive of each other,” Dr. Brown says. “Everyone truly wants what’s best for patients because we take pride in following evidence-based medicine and providing compassionate care. I think patients truly do get a great experience when they deliver at Crouse.”

A Regional Focus

The Crouse Health’s Kienzle Family Maternity Center doesn’t just serve Syracuse — it’s also been the Regional Perinatal Center for Central New York since 1975, serving mothers and infants from a 14-county region. The program provides care and promotes healthy outcomes for mothers and babies during pregnancy, birth and after, with a focus on high-risk pregnancies and children with special needs.

Physicians across the region refer patients to Crouse, based on New York State’s system for perinatal care, which delineates four different levels. As the RPC, Crouse provides education, advice and support to affiliate hospitals throughout the region.

Stephen Brown, MD, FACOG, with baby
 

For more information on maternity services at Crouse, visit crouse.org/services/maternity.

Auburn Community Hospital’s New Home for Women’s Health

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By Thomas Crocker

Monday, June 29, 2020

Anchored by OB/GYN services with a reputation for excellence, the Women’s Health Center at Auburn Community Hospital is fast becoming a comprehensive destination for women’s health that encompasses more than maternity services and gynecologic surgery.

Established earlier this year, the Women’s Health Center reflects a fundamental fact of women’s lives: their health and wellness needs change dramatically throughout life, from family planning and prenatal care to menopause and beyond. Caring for women across their lifespan requires diverse services, and that is what the Women’s Health Center offers.

“The Women’s Health Center reflects the evolution of Auburn Community Hospital’s commitment to women’s health,” says Loren Van Riper, MD, FACOG, Chief of OB/GYN Services at Auburn Community Hospital. “Initially, that revolved around obstetrics and gynecologic surgery, but we’ve pushed forward to include breast care and other services as part of the Women’s Health Center. This center was a long-term goal for the hospital because there was a need for it in our community. Women shouldn’t have to drive 45 minutes to Syracuse for the everyday health services they need.”

True to its roots, the Women’s Health Center offers full-spectrum maternity services, including prenatal care, labor and delivery, and postpartum care. In addition to providing obstetric care, Dr. Van Riper and his colleagues also perform the gamut of gynecologic surgery, including minimally invasive and vaginal procedures.

“We treat patients for endometriosis, pelvic pain, stress urinary incontinence, abnormal uterine bleeding and pelvic relaxation, among other problems,” Dr. Van Riper says. “I specialize in vaginal surgery. On the minimally invasive side, we frequently perform laparoscopic pelvic surgery, including hysterectomy, oophorectomy and tubal ligation.”

“I’m excited to work in the community where I grew up and at the hospital where I was born.”
— Amy Hoeft MacDonald, MD, OB/GYN, who joined Auburn Community Hospital and its Women’s Health Center in July

The Women’s Health Center also offers services that make it a destination for all women, not just new or expectant mothers. These services include breast care and imaging, with more planned for the future.

“Women tend to put others first — resulting in their own self-care being secondary,” says Tanya Paul, MD, FACOG, OB/GYN at Auburn Community Hospital. “It’s gratifying to be part of a center where women can receive all the care they need, including ultrasounds, screening mammograms, bone density screenings, referrals for colonoscopies and other preventive health services, and breast care from a SUNY Upstate Medical University specialist, in addition to OB/GYN services.”

An OB/GYN Team With Deep Community Ties

Auburn Community Hospital’s four board-certified OB/GYNs and three midwives recently moved their office to the hospital, where an attached, one-level building serves as the home of the Women’s Health Center. Over time, the hospital plans to migrate all women’s health providers and services to this building to bring everything under one roof.

The OB/GYN team features clinicians with decades of experience who share a passion for caring for women of all ages and improving women’s health in Central New York, where their roots run deep. Dr. Van Riper has lived in the Auburn area for years and practiced at Auburn Community Hospital for more than a decade, most of that time while serving as Chief of OB/GYN Services. A graduate of the University of Virginia School of Medicine, Dr. Paul performed her internship and residency at SUNY Upstate Medical University in Syracuse and practiced OB/GYN in Central New York for 13 years before joining Auburn Community Hospital in 2013.

OB/GYN Donald Calzolaio, MD, FACOG, graduated from SUNY Upstate Medical University and performed his residency at Upstate University and Crouse hospitals. He has cared for women in Central New York and Connecticut for 25 years, the past 10 at Auburn Community Hospital, where he enjoys the atmosphere of a small, community-based facility.

The newest member of the team, OB/GYN Amy Hoeft MacDonald, MD, joined Auburn Community Hospital in July after spending six years in private practice in Rochester. She graduated from SUNY Upstate Medical University and performed her residency at University of Rochester Medical Center.

“Auburn Community Hospital was an attractive destination for me because of the OB/GYN group’s reputation for delivering excellent care,” Dr. MacDonald says. “The hospital is focused on meeting the unique needs of the community, and the recent integration of breast care into the Women’s Health Center is a great example of that. I am excited to be part of a group that is constantly looking to grow and change to deliver better care to patients.”

Comprehensive Maternity Services

A variety of factors make Auburn Community Hospital an outstanding place to have a baby. Welcoming and homey, the Stardust Community Birthing Center In Memory of John and Irene Bisgrove features:

  • A certified lactation consultant on staff
  • A dedicated OB/GYN for performing Caesarean sections
  • All-private labor and delivery and postpartum rooms, with the former featuring whirlpool tubs for use during labor
  • Around-the-clock availability of epidural anesthesia services
  • Experienced, compassionate nurses, many of whom are certified in Advanced Cardiac Life Support, Neonatal Resuscitation, Inpatient Obstetric Nursing or Electronic Fetal Monitoring (EFM)
  • Outpatient breastfeeding support
  • Staff-led childbirth education classes and birthing center tours

The birthing center is pleased to offer EFM, which records fetal heartbeat and uterine contractions throughout labor without a provider having to be present.

“EFM is a newer innovation, and the advantage of it is that OB/GYNs, midwives or nurses can review the monitor data strips remotely and improve communication between patients, nurses and providers. It also provides educational opportunities for all staff,” Dr. Calzolaio says. “If there’s any concern, I can review the information on my phone or the computer in my office and, if necessary, attend to the patient before the nurse notifies me of a problem.”

An all-female midwifery program gives expectant mothers the option of seeing a midwife for certain aspects of prenatal care and receive one-on-one support during labor and delivery.

“Our OB/GYNs and midwives practice as part of one group, and we coordinate closely with them throughout each patient’s pregnancy,” Dr. Calzolaio says. “Patients see both OB/GYNs and midwives throughout pregnancy, and there’s a midwife on call with an OB/GYN every night. Patients’ perceptions of their delivery experience are extremely positive when they receive care from a midwife.”

Care doesn’t end with patients’ discharge.

“We place follow-up phone calls after moms and babies go home to ensure they’re doing well and point them to community resources if they need anything,” says Susan Bobb, RN, Director of Women’s Services at Auburn Community Hospital. “Women love the individual attention they get here that isn’t always possible at bigger facilities.”

Academic-Level Breast Care In a Community Setting

Last summer, Auburn Community Hospital took the first step toward establishing a comprehensive breast program when Ranjna Sharma, MD, FACS, Chief of the Section of Breast Surgery, Medical Director of the Breast Cancer Program and Associate Professor of Surgery in the Department of Surgery at SUNY Upstate Medical University, began holding a clinic and performing procedures at the hospital. Dr. Sharma joined SUNY Upstate Medical University in March 2019 after nearly a decade at Beth Israel Deaconess Medical Center in Boston. She visits Auburn Community Hospital every Monday and alternates between seeing patients in clinic and performing surgeries.

“SUNY Upstate Medical Center and Auburn Community Hospital thought it was important to make comprehensive breast services available to more people in the greater Central New York community,” she says. “We started with surgical services in 2019, and we began bringing medical oncology services to Auburn Community Hospital earlier this year. Hopefully, we’ll be able to add radiation oncology in the next two to three years to complete the program.”

Dr. Sharma sees patients with and performs surgeries to remove benign and malignant breast masses. She holds clinic at the Surgical Specialties Clinic located at 77 Nelson St. in Auburn.

“It’s exciting to bring our expertise and multidisciplinary care model to Auburn,” Dr. Sharma says. “Local breast care was something that the medical community and area residents wanted and needed. It’s important for women to have access to high-quality breast services. We’re happy to bring them to this community and look forward to expanding the program in the years to come.”

For more information, call 315-255-7011 or visit auburnhospital.org.

Community Collaboration

In partnership with the Cayuga County Health Department, Auburn Community Hospital recently established the Healthy Moms, Healthy Babies Program, which educates mothers about and helps them access a wide range of community-based services that can benefit them and their babies.

“Through the Healthy Moms, Healthy Babies Program, moms can access doula services, assistance with transportation, breastfeeding support from certified lactation counselors and the Special Supplemental Nutrition Program for Women, Infants, and Children,” says Susan Bobb, RN, Director of Women’s Services at Auburn Community Hospital. “First-time moms can sign up to receive an in-home visit from a nurse, and if children have special healthcare needs, the Healthy Moms, Healthy Babies Program can help them enroll them in early intervention programs.”

A Vision for the Future

The OB/GYNs at Auburn Community Hospital hope to make the newly established Women’s Health Center a destination that women can turn to for wellness education.

“Eventually we would like for the center to offer other services as well,” says Tanya Paul, MD, FACOG, OB/GYN at Auburn Community Hospital. “It would be wonderful for women to visit the center for meditation and yoga, nutrition services and other tools to make better lifestyle choices.”


Loren VanRiper, MD, FACOG, Chief of OB/GYN Services


Ranjna Sharma, MD


Amy MacDonald, MD


Donald Calzolaio, MD, FACOG


Tanya Paul, MD, FACOG


Susan Bobb, RN, Director of Womens Services

Use the “Pause” and Review Your Practice Agreements

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By Marc Beckman, JD

Monday, June 29, 2020

On March 22, Governor Cuomo put New York State on “Pause,” closing all non-essential businesses statewide. As of this writing, upstate New York has just begun its multi-phase reopening.

Physicians have been hit particularly hard by the COVID-19 pandemic. While some serve bravely on the front lines while battling a new and unknown virus without adequate supplies of personal protective equipment, others were suddenly left with empty schedules as patients were unable or unwilling to be seen in the office. Revenue disappeared almost overnight, and overhead and staffing personnel had to be drastically reduced wherever possible.

During this time, physicians saw some of the best qualities of their partners. Many such partners readily acquiesced to numerous and unexpected necessary changes, whether it be adjusting their work schedules to implement telemedicine, or drastically adjusting practice routines and physical office layouts to ensure patients and staff felt as comfortable as possible.


Marc Beckman, JD

Ultimately, many voluntarily took significant pay cuts. However, some partners did not.

As attorneys to physicians, we know that legal agreements are often meant to be signed, put in the file and often never looked at again. When the parties to such agreements all mutually agree to modify their relationship, then the changes sometimes needed for a practice or an individual are easily made. However, when a party does NOT agree to a change, whether it be a clarification to avoid misunderstandings or a substantive change needed because of the pandemic, those agreements may need to be dusted off to determine the relative rights and obligations of the parties.

That is, when the written words really matter, what do they say? It is at that time when practices often regret not having regularly reviewed their legal agreements to ensure they are updated as the practice has changed over time. Here are a few examples.

Shareholders Agreements and Bylaws – This Agreement is between the practice and ALL of its shareholders. For a partnership or a professional limited liability company, shareholder agreements and bylaws are typically bound up into a partnership or operating agreement. Critically, these documents typically define the events, the occurrence of which obligates an individual physician owner to sell their equity and for the practice to be obligated to buy it. Typical events include death, permanent disability and termination of employment. However, other events to address include partial disability, opportunities/obligations to become part-time (including call and coverage obligations), and closure/modification of practice locations. In addition to the obligation to buy/sell, the purchase price must be addressed, whether it be absolute or formulaic.

Here may be the first place to begin your review. The value of an equity interest in a medical practice is likely very different now than it was even just one year ago. Does your document account for this? Also, the tax implications of how the purchase/sale is accomplished must be discussed so all parties understand the intent and ramifications. For this reason, it is not uncommon to create a separate deferred compensation arrangement that is taxed as ordinary income to the departing physician and fully deductible to the practice. Does your agreement keep the departing physician responsible for his/her billing in case of audit or investigation?

Employment Agreements / Member Services Agreements – This is the Agreement between the individual physician and the practice. Typically, this can only be amended with the agreement of both the individual physician and the practice. From the practice perspective, this document should be as flexible as possible. From the individual perspective, this document provides individual protective “rights”, including the conditions of termination and on what notice. Instead of having a compensation formula within the employment agreement, better to make reference to a separate document more readily amended — or even better — a “plan” that can be modified as determined by the managing Board or delegated to an even smaller set of leaders such as a compensation committee.

Finally, commonly overlooked is a discussion about the requisite votes to modify these agreements. Collectively, we are referring to the “rule books” for how decisions are made amongst partners and between the partnership and the individual. Too often, practices discover after the fact that this is more difficult than presumed because of one or two recalcitrant holdouts.

Like we are doing with the coronavirus, take a small pause now and avoid a bigger problem later.

Marc Beckman is a founding member of CCB Law, a boutique law firm focused on providing counsel to physicians and healthcare professionals. He can be reached at 315-477-6244 or mbeckman@ccblaw.com.

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

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By Thomas Crocker

Monday, June 29, 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.”

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

Timely Communication

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

Historic Heart Care at St. Joseph’s Health Cardiovascular Institute

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By Allison Gorman

Monday, April 27, 2020

With a growing team of specialists, the most advanced treatments and state-of-the-art facilities, St. Joseph’s Health Cardiovascular Institute continues to make history as a top regional and national cardiac program.

From performing the first successful open-heart surgery in Syracuse to helping pioneer new protocols for transcatheter aortic valve replacement (TAVR), St. Joseph’s Health has been at the forefront of cardiac care, both regionally and nationally, for decades. In the past 10 years, St. Joseph’s has reinforced that position, expanding its team of highly trained cardiac specialists and adding to its menu of advanced interventional procedures, minimally invasive surgeries and mechanical supports to treat even the most complex cases.

The heart of St. Joseph’s cardiac program is its flagship hospital in Syracuse, which capped off $400 million in renovations with the addition of a state-of-the-art surgical tower in 2014 and a 45,000-square-foot Cardiovascular Institute in 2018. The program serves a 15-county area that extends from Canada to Pennsylvania and the Finger Lakes to Utica.

St. Joseph’s has also invested in meeting people where they live to fight heart disease — the leading cause of death in New York and the United States. With the addition of CareFlight, a medical helipad on its Syracuse campus, and more satellite locations opening throughout Central New York, St. Joseph’s ensures that distance is no obstacle for treatment at one of the nation’s top cardiac programs.

A team, including vascular surgeon Syed Zaman, MD, performs surgery in one of St. Joseph’s state-of-the-art surgical suites. The St. Joseph vascular team has more experience performing a full range of services than any other hospital in the region. The hospital’s exceptional outcomes earned them a High Performing rating in abdominal aortic aneurysm repair by U.S. News and World Report.
 

Cycle of Success

The axiom “success breeds success” is especially true when failure can have fatal consequences. In other words, it’s no coincidence that St. Joseph’s performs about 1,000 cardiac surgeries a year (including the most open-heart procedures in the region, with the lowest risk-adjusted mortality rates) — and that it was named one of the top six hospitals in the nation for heart surgery by The Society of Thoracic Surgeons.

“There are many heart surgery programs in Central New York, but there’s only one that does more than a thousand cases a year,” says Joseph Spinale, DO, MBA, Chief Medical Officer (CMO) for St. Joseph’s Health. “That’s how we get the outcomes we do.”

It’s a self-perpetuating cycle: More heart valve surgeries than any other provider in the region and more coronary artery bypass grafting (CABG) procedures means more patients referred to St. Joseph’s or sent there from places like Watertown, Ogdensburg and Binghamton.

Expert providers are key players at St. Joseph’s, too, according Ahmad Nazem, MD, FACS, Chief of Cardiac Surgery at St. Joseph’s.

“The only way you have more cases is to obtain good outcomes — those go hand in hand,” Dr. Nazem says. “With that kind of volume, you end up attracting better talent at all levels.”

Dr. Russell Silverman, MD, FACC, Director of Medical Cardiology for St. Joseph’s, sees the same dynamic at work on the interventional side. St. Joseph’s is one of the top five producers in the state, with four times more volume than any other hospital is Syracuse.

“Our cath lab is available 24/7 for patients with acute problems that we can address,” Dr. Silverman says. “It’s even available for elective procedures seven days a week, which means we perform inpatient elective procedures on the weekends.”

The medical helicopter also keeps the cath lab busy.

“We transport critically ill patients and perform necessary procedures,” Dr. Silverman says. “We have some of the best interventional physicians in the state.”

James Connelly, MD
“It’s a given: When you do more cases, you end up with more experience, and more experience translates into better outcomes.”
— Ahmad Nazem, MD, FACS, Chief of Cardiac Surgery at St. Joseph’s Health
 

Becoming an Institute
Dr. Spinale, an invasive cardiologist, suspects his medical specialty is part of what led St. Joseph’s to offer him the newly created position of CMO in 2017. He admits that St. Joseph’s renowned cardiovascular program, including its impressive new surgical tower, was part of what inspired him to accept the offer.

His first goal as CMO was to unite the competing cardiovascular groups upon which the program was built, to create a single enterprise: the Cardiovascular Institute.

“One of the biggest sources of waste in health care is clinical variation,” Dr. Spinale says. “By pulling everyone together and having one way of managing treatments that are based on best practices and clinical research, we can eliminate that waste and provide quality care with better outcomes at a lower cost.”

Since then, the Institute has steadily grown. Its team of specialists now includes five cardiac surgeons, 11 cardiac anesthesiologists, five vascular surgeons, six interventional cardiologists, two cardiac electrophysiologists, 16 medical cardiologists, and 22 physician assistants and nurse practitioners.

5 Reasons to Trust St. Joseph’s Health for Cardiac Care

  1. Excellus BlueCross BlueShield Blue Distinction Center+ for cardiac care
  2. Consumer Reports top 15 heart surgery centers in the U.S.
  3. Society of Cardiovascular Patient Care accreditation for chest pain with percutaneous coronary intervention and resuscitation
  4. Accreditation for Cardiovascular Excellence for cardiac catheterization
  5. American Association of Critical-Care Nurses “Silver level” Beacon Award for cardiovascular-surgical ICU

The ultramodern cardiac facilities at St. Joseph’s Health in Syracuse were built to accommodate a burgeoning caseload. The $63 million Christina M. Nappi Surgical Tower includes an expansive waiting area and 110 spacious, private rooms that are primarily used by cardiac inpatients.

“When the patient feels better in a space, that affects their improvement, and the family feels more at ease with the patient staying there,” Dr. Spinale says.

The tower’s design also enhances the progress of patient care. When communication is easier and transfer times are shorter, outcomes improve.

Similarly, the $32 million Merola Center for Cardiac Care, which houses catheterization, electrophysiology, interventional radiology facilities, 40 patient bays and a hybrid OR, was designed both for patient comfort and for the delivery of safer, more coordinated care.

Care Flight Helicopter

“Our goal is to do what’s right for the patient. Not necessarily what any one individual wants to do, but what the group thinks is best, based upon best practices and guidelines in the cardiology and cardiovascular surgery literature.”
— Russell Silverman, MD, FACC, Director of Medical Cardiology at St. Joseph’s Health
 

Advanced Surgical Treatments

St. Joseph’s cardiac surgical program provides a full menu of advanced treatments, including robotic and minimally invasive procedures, for valvular disease, stenosis and insufficiency, as well as aortic pathologies.

“A large part of our procedures is minimally invasive,” Dr. Nazem says. “For example, we go through the right side of the chest with a small incision and do mitral valve surgery, aortic valve surgery and tricuspid valve surgery. Almost all the incisions are, at most, 7 to 8 centimeters in length.”

Some of the surgical techniques offered at St. Joseph’s, like the valve-saving “David Procedure,” aren’t available elsewhere in Central New York. Other surgical options offered there are less about a specific technique than the surgeons’ comfort and experience treating complex cases in a minimally invasive way.

“We do triple valve replacements through a right-side, thoracotomy, minimally invasive incision,” Dr. Nazem says. “That wouldn’t happen many other places.”

For CABG, St. Joseph’s surgeons offer both robotic surgery and open bypass, including an off-pump procedure for patients at high risk for embolization or stroke.

St. Joseph’s Health: Heart History in the Making

  • The first successful open heart surgery in Syracuse was performed at St. Joseph’s Hospital in 1958, and St. Joseph’s was the third hospital in the U.S. to perform angioplasty.
  • Famous physicians who have worked or studied at St. Joseph’s include Charles Dotter, MD, a pioneering interventional radiologist who invented angioplasty; Andreas Gruentzig, MD, who expanded Dr. Dotter’s angioplasty; Goffredo Gensini, MD, who first identified coronary vasospasms (and established St. Joseph’s cath lab); and Antonio Colombo, MD, who pioneered the concept of adequate stent deployment and the use of intravascular ultrasound for coronary stenting.

“Because St. Joseph’s has the largest cardiac and critical care anesthesiology team in Central New York, it can safely offer procedures for patients who wouldn’t otherwise be cleared for them,” says Courtney Maxey-Jones, MD, a cardiac anesthesiologist and intensivist at St. Joseph’s and its Medical Director for extracorporeal membrane oxygenation (ECMO) and mechanical support.

The Institute added ECMO in 2018, to better support “the sickest of the sick,” according to Dr. Maxey-Jones. She’s part of a smaller team of critical care cardiac anesthesiologists that provides 24/7 evaluation of eligibility for ECMO for cardiac or respiratory etiology. The team also works closely with the cardiologists and cardiac surgeons to manage day-to-day operation and then removal of mechanical support devices.

“The program has really taken off,” Dr. Maxey-Jones says. “It has allowed us to have some patients who either come in having an acute MI or otherwise would die of cardiogenic shock and to recover some of them and return them to independent daily living.”

Dr. Nazem says St. Joseph’s cardiac surgeons often use Impella heart pumps independently or in combination with ECMO to support patients in heart failure.

Nelly Kazzaz, MD
“Once you get out of New York City, St. Joseph’s is the premier cardiac program in the state.”
— Joseph Spinale, DO, MBA, Chief Medical Officer at St. Joseph’s Health

Advanced Structural Techniques

As the relatively young subspecialty of structural cardiology continues to evolve, St. Joseph’s has stayed ahead of the field by sending its providers to receive training from high-volume providers of advanced procedures, such as TAVR and MitraClip, and by hiring new physicians from strong interventional and structural heart programs.

St. Joseph’s is known for helping advance the use of TAVR, a minimally invasive procedure for severe aortic stenosis. The American Heart Association compares the down time and recovery of a TAVR procedure to that of a balloon treatment or angiogram.

St. Joseph’s participated in clinical trials for the use of TAVR in low-risk patients, and it’s still the major provider of TAVR in Central New York.

“We do a lot of minimally invasive surgeries that other hospitals in the area wouldn’t be able to do,” Dr. Nazem says. “We are ahead with TAVR in this area, and we’re definitely the only robotic center that has done it for years and has great experience with it. The fact that the Merola Center for Cardiac Care has a hybrid OR for TAVR procedures helps us enormously.”

A situation like TAVR failing is extremely fatal. The shorter time between patients getting CPR and getting their chest opened, the better the outcomes and the more lives get saved.

In addition to structural procedures, St. Joseph’s interventionalists offer the WATCHMAN procedure for atrial fibrillation; emergency interventions, such as EkoSonic Endovascular System (EKOS) for acute pulmonary embolism; cryoablations and radio frequency ablations; and implantation of pacemakers and defibrillators.

St. Joseph’s Health anesthesiologists work in the Electrophysiology Lab, studying the electrical activity of a patient’s heart to find where an arrhythmia is coming from. St. Joseph’s performs more than 1,700 electrophysiology procedures, 250 radio frequency ablations and 350 implantable cardioverter defibrillators annually.
“The most critically ill patients are those undergoing cardiac surgery, so having additional training in either critical care or cardiac anesthesia is very important to safety as well as having good outcomes in the cardiac surgery world.”
— Courtney Maxey-Jones, MD, Cardiac Anesthesiologist and Intensivist, Medical Director for extracorporeal membrane oxygenation and Mechanical Support at St. Joseph’s Health

Clinical Care

Structural and surgical cardiology might make headlines, but therapeutic management of heart disease is critical to a robust cardiology program. St. Joseph’s cardiologists have long been known for their clinical excellence, which they extend to patients across Central New York through the hospital’s many satellite locations.

In April, St. Joseph’s opened its 11th location: a heart failure clinic operated in conjunction with Strong Memorial Hospital in Rochester. Both hospitals work together to provide remote monitoring of patients with implanted devices.

A 12th location, which will be the Cardiovascular Institute, is set to open in Fayetteville in June.

The Institute is built on a service line model that begins with the medical cardiologist. If more specialized treatment is required, the best approach is determined by a full team of cardiac physicians, in consultation with the patient and often the primary care physician.

“It takes a committee, not a doctor, to make these decisions,” Dr. Silverman says.

He cites the recent example of a 78-year-old patient who came to him with shortness of breath. The patient, a smoker, had significant pulmonary and coronary disease. He’d had a heart attack and a number of coronary interventions, including bypass, and Dr. Silverman had followed the patient’s aortal stenosis for years. The question was whether this new symptom was related to a diseased valve or diseased lungs.

After a battery of tests and evaluations by pulmonary, surgical and interventional specialists, the team determined that TAVR was the correct approach. Two weeks after the valve replacement, Dr. Silverman watched his longtime patient walk up and down the hall, breathing easier.

“We made the best decision in that case,” Dr. Silverman says. “The patient’s longevity is more than a year, despite his lungs, and the life that he will have now will be better than the life he had prior to the intervention.”

With all the awards St. Joseph’s cardiac program has earned, its physicians ultimately measure success by moments like this.

“I’ve seen patients in dire situations: If they move, they can have a heart attack, fibrillate and die,” Dr. Nazem says. “But I take them to the OR and complete the necessary procedure, and the next day they’re sitting up in bed, and the next day they’re walking. There’s nothing more rewarding than those results for my patients.”

To learn more about St. Joseph’s Health heart care, visit everybeatmatterssjh.org.

Targeting Tick-Borne Disease in Central New York

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By Katy Mena-Berkley

Monday, April 27, 2020

The Central New York Lyme and Tick-Borne Disease Alliance is on a mission to eradicate increasingly prevalent tick-borne illnesses that have historically gone undetected in Central New York.

CNY Lyme Alliance members tour Thangamani Tick Lab at SUNY Upstate

 

A year and a half ago, career strategist and coach Anne Messenger was experiencing unusual fatigue, a symptom her provider attributed to sleep apnea when she went in for a routine annual physical.

“I yawned all the way through that appointment,” Messenger says. “But I also had other symptoms that were affecting my quality of life.”

In addition to the debilitating exhaustion, Messenger had heart palpitations, pain in her left foot, a strange tickling sensation in the back of her neck and brain fog that interfered with her ability to remember something as simple as the current score during a game of tennis.

It would take the counsel of another medical professional whose children were devastatingly impacted by Lyme disease to finally offer a possible explanation — Messenger may have Lyme disease herself.

To get to a definitive diagnosis, Messenger consulted Kristopher Paolino, MD, Assistant Professor in the Department of Medicine at State University of New York Upstate Medical University.

“Dr. Paolino is Upstate’s Lyme person,” Messenger says. “He figured out my diagnosis and invited me to a research conference at Cornell University.”

At that conference, the Central New York Lyme and Tick-Borne Disease Alliance began to take shape in the minds of people who could make a difference. Clinicians, researchers, scientists and higher education executives from Cornell University, Binghamton University, SUNY College of Environmental Science and Forestry and Upstate Medical University were gathered together, investigating opportunities for translational research and collaboration.

“Multiple times in multiple ways, I heard scientists in the back of the room say they needed patients to observe,” Messenger says. “That happened again and again.”

Syracuse resident Royale Scuderi came to Messenger’s mind as she brainstormed about an organization that could effectively address the challenges of tick-borne disease.

Group presentation in Old Forge, New York (Left to Right): Kathy Ruscitto, Vice Chair; Kristopher Paolino, MD, MTM&H, FACP;
Anne Messenger, Alliance Board Chair; Brian Leydet, PhD, SUNY ESF; Scott Santarella, CEO, Global Lyme Alliance

“It is clear that delay in diagnosis and initiation of treatment of Lyme disease can result in increased morbidity with increased risk for chronic symptoms. Missing a case of anaplasmosis can have dire consequences.”
— Kristopher Paolino, MD, Assistant Professor in the Department of Medicine at State University of New York Upstate Medical University

Life with Lyme Disease

Diagnosed with late stage Lyme disease in March 2011 and with another tick-borne disease known as Babesia just four months later, Scuderi knew first-hand about the life-changing consequences of not having the right information at a critical time.

“I did not see a tick, nor did I have the bull’s eye rash,” Scuderi says. “Consequently, there is no way to discern how long I was infected with those diseases prior to my diagnosis. I do not remember when the symptoms started, but if I had the typical flu-like symptoms, we dismissed them as just that, flu or a virus. Lyme was not something that I or my doctors even considered.”

For months before her diagnosis, Scuderi experienced a widening range of debilitating symptoms, among them recurring headaches, nausea, joint pain, severe fatigue, and neck and back pain. She also began to develop fever, chills, shortness of breath, heart palpitations, stiff neck, insomnia, mental fogginess, difficulty concentrating and problems recalling words.

“As my health declined, I visited doctor after doctor,” she recalls. “I was tested for autoimmune diseases, cardiac conditions, pulmonary complications and allergies, along with an MRI to look for multiple sclerosis or neurological causes. I was misdiagnosed with arthritis and fibromyalgia. I was told repeatedly that the test results all looked normal and they could find nothing wrong with me.”

A local clinician finally tested Scuderi for Lyme and treated her with doxycycline. But relief of her symptoms was brief, as the Babesia co-infection further compromised Scuderi’s health.

After consultations with a specialist in Long Island, and another year of treatments, Scuderi finally began to find some relief, but only after the tick-borne diseases cost her significant time, money and wellness. It was three years before Scuderi could return to her normal daily activities.

“The toll of this long journey caused enormous hardship and suffering for myself and my family, along with years of lost wages and the end of a career as a freelance writer, as I could no longer form coherent thoughts,” Scuderi says. “It took several more years to eliminate the substantial debt incurred as a result of lost wages, treatments not covered by insurance and extensive travel.”

Scuderi says that when Messenger approached her during summer 2019 with the concept of an organization that would bring together clinicians, patients, researchers and advocates in an effort to solve the mysteries of tick-borne disease, she was eager to get involved. Today, Scuderi has turned her experience into action and serves as Executive Director for the Central New York Lyme and Tick-Borne Disease Alliance.

“The hope is that we can help attack the Lyme and tick-borne illnesses in our region through education and outreach to medical providers and to the community at large,” says Dr. Paolino, who is one of the founding members of the Central New York Lyme and Tick-Borne Disease Alliance. “We will also approach the problem via research initiatives that target environmental factors to help with prevention, as well as laboratory and clinical studies.”

Addressing a Growing Concern

Investigating the rapid rise of tick-borne disease is one of the chief objectives of researchers like Brian F. Leydet Jr., MPH, PhD, Assistant Professor of Epidemiology & Disease Ecology in the Department of Environmental and Forest Biology at SUNY College of Environmental Science and Forestry. In his research, Dr. Leydet, who is also on the board of the Central New York Lyme and Tick-Borne Disease Alliance, saw a spike in tick-borne disease in the region in 2008, an uptick that has not slowed.

“If we don’t think about stopping the spread of ticks in this area, then eventually, they are going to be everywhere,” Dr. Leydet says “We will also see increases in cases of tick-borne diseases, like Lyme disease, Babesia and anaplasmosis, unless we can figure out vaccines or some miracle method to wipe out the entire tick population. Once ticks are established, they are very hard to get rid of. We need to stop these ticks from spreading, because that is what is bringing disease into new areas.”

In partnership with area infectious-disease clinicians and scientists also involved with the Alliance, Dr. Leydet is working to advance diagnostics and vaccines for tick-borne diseases.

“I cannot think of a place where this would work better than in Syracuse,” Dr. Leydet says. “All I do is study tick-borne disease. The infectious disease clinicians are doing so many different things with patients and the local university experts have important insight into what is going on in the community. The Alliance will be a source of very unique information for patients and clinicians alike.”

A Resource for the Underserved

Due to lack of access to financial and medical resources, tick-borne disease has historically gone undetected and untreated in underserved communities such as the inner city, another challenge that the Alliance is seeking to address.

“So many families do not have access to the care they need, and when they are finally diagnosed, they are not covered by insurance,” says Kathy Ruscitto, Vice Chair of the Central New York Lyme and Tick-Borne Disease Alliance. “Early treatment is essential.”

Investigating the Offender

Saravanan Thangamani, PhD, Professor of Microbiology and Immunology at State University of New York Upstate Medical University and Director of the SUNY Center for Environmental Health and Medicine, leads a tick-submission program for patients who find a tick on their bodies. Through the Citizen Science Tick Testing Program, those patients may send the tick in so that Dr. Thangamani and his team can assess the tick for pathogens and gather data to better understand the threat presented by these arachnids.

This robust gathering of information has already helped identify where ticks are most prevalent and offers patients vital information about whether they have contracted infections, including Lyme disease, Babesia and Ehrlichia.

To learn more about Lyme education for healthcare professionals, visit globallymealliance.org/education-awareness/physicians-training-program.

To track the emergence of ticks and tick-borne diseases in New York, visit www.thangamani-lab.com.

Brandiss Pearson, RN, Director of Community Engagement at Saint Joseph’s Health Hospital, was recruited to join the Alliance as a board member and to closely connect with inner-city communities.

“Underserved individuals are often not able to get the support they need,” Pearson says. “My role gives me the opportunity to speak about Lyme in a way that I would not have been able to before.”

One of the earliest initiatives of the Alliance is a grant for outreach to those in the region’s underserved neighborhoods.

“It is perplexing to me that we fight mosquitos, treat EEE, yet we have no strategy for tick control, eradication or treatment,” Ruscitto says. “Our goal in the Alliance is to help connect research, education, and treatment to help the residents of New York.”

To learn more, visit cnylymealliance.org.

World Class Care in Central New York at Auburn Community Hospital

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By Katy Mena-Berkley

Monday, April 27, 2020

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.

ACH’s comprehensive scope of services includes cardiology, neurology, radiology, bariatrics, and obstetrics, as well as lifestyle-focused programs in areas such as nutritional counseling and pastoral care.

“At Auburn Community Hospital, our vision is simple. We will provide the best outcome for every patient, every time. 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. ACH health system invests in our community to make it better and trusts that our community will make the health system better in turn. We are neighbors and we need to take care of each other,” stated Scott Berlucchi, President & CEO, Auburn Community Hospital.

Collaborating for Cancer Care

Enhancing the expertise of the oncology specialists at ACH is a partnership with Syracuse-based Upstate Cancer Center, the only academic medical center in the region. Upstate’s program is ranked in the top 20% in the United States by the American College of Surgeons Commission on Cancer and is the only facility in Central New York accredited by the organization.

Located on the hospital’s first floor, Upstate Cancer Center at Auburn Community Hospital offers a spectrum of advanced diagnostic and treatment resources delivered by board-certified physicians and nurses with extensive experience in hematology and oncology.

“We’re very excited about bringing all of the resources of Upstate and an academic medical center to Auburn,” says David B. Duggan, MD, Professor of Medicine at Upstate Cancer Center and Medical Director of Upstate Cancer Center at Auburn Community Hospital. “The physicians we work with are highly trained and have many years of specialized training.”

The skilled nursing staff at Upstate Cancer Center at Auburn is trained to administer a variety of treatments, including chemotherapy and infusion regimens, implementing plans designed by specialists and tailored to each individual patient. In the event that consultations or procedures are not available at the Auburn location, patients will have priority access to the facility in Syracuse. In either location, patients can expect a multidisciplinary case review by a team of experts. 

“Bringing the Upstate team to Auburn provides that team approach to cancer care that all patients want,” says Christina Sherman, RN, Director of Auburn Community Hospital Cancer Services, Upstate Cancer Center at Auburn Community Hospital.

An Engine for Economic Health

In addition to enhancing the physical wellness of the community, Auburn Community Hospital (ACH) is doing its part to improve economic fitness. Specifically, the Healthcare Association of New York State reported the following statistics associated with ACH:

People in Numbers

  • 400 babies delivered
  • 5,300 individuals admitted to hospitals
  • 25,000 individuals treated in the emergency room
  • 140,000 outpatients received care

Dollars and Cents

  • $175,000,000 in economic activity
  • $60,000,000 in payroll expenditures
  • $21,000,000 of generated tax dollars
  • $11,000,000 in community benefits and investments

“We want second opinions. We want to know what other doctors think. These are doctors who are world-class in their fields of expertise. This practice is built with the patient in mind.”

As a resident of Auburn and a longtime member of the Upstate Cancer Center team in Syracuse, Sherman was a strong proponent of the collaboration with ACH.

“Auburn was an underserved area in terms of cancer services, and I was seeing patients from my community drive to Syracuse for the expertise that they needed,” Sherman says. “The Upstate Cancer Center at Auburn offers local options from a multidisciplinary team in a familiar and intimate setting. Dr. Duggan grew up in Auburn, and his expertise in the field is unmatched.”

In addition to cancer treatments, Upstate Cancer Center at Auburn provides on-site pharmacy and phlebotomy services to streamline the delivery of medications and lab results.

Upstate Cancer Center at Auburn Community Hospital
 
Examination Room
 
Infusion Room
 

Dedicated to Core Values

In every area of expertise, clinicians, nurses and administrators at Auburn Community Hospital deliver service in accordance with four key principles. Clinicians who refer patients to ACH can count on:

  • Collaboration. Each individual on the ACH team works together with patients, external partners and one another to enhance health and well-being throughout the community.
  • Accountability. The ACH staff takes personal responsibility for individual and team performance.
  • Respect. Treating patients, families, co-workers and other members of the community with consideration, dignity and sensitivity is a priority for ACH.
  • Excellence. Adhering to the highest standards when delivering clinical care and overall service as well as continuously enhancing knowledge and skills is of paramount importance to the ACH team.

“Not only do we take care of you and your family when you have health issues, but we are also the largest employer in the area and with that comes a significant responsibility. Auburn Community Hospital generates more than 1,200 jobs in this community and helps maintain and improve our quality of life in this beautiful region of New York State,” Scott Berlucchi stated.

Answering the Virtual Call During the COVID-19 Pandemic

One of the most critical ways Auburn Community Hospital has been a leader in meeting the needs of the community during recent months is by rapidly enhancing telehealth capabilities for 90% of affiliated healthcare providers. The adoption of telehealth at ACH has been led by Paul Fu, MD, neurologist and Deputy Chief Medical Officer. Initially intended to offer choices for rural patients in need of routine appointments, the telehealth options were made available to any patients who would prefer to have consultations at home during the pandemic.

Auburn-based software development and services company Medent provides the telehealth options to ACH, and the process is seamless for clinicians and patients alike. Once a patient schedules his appointment, he receives a link through either an email or text message. When the appointment time arrives, the patient may open the link on a computer, smartphone or tablet and virtually connect with the provider.

Celebrating Advancements in Orthopedics: Syracuse Orthopedic Specialists’ One-Day Surgery Center

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By Hillary Eames

Monday, April 27, 2020

The Syracuse Orthopedic Specialists’ One-Day Surgery Center celebrates one year of merging convenience with high-quality care in their new location.

April marks the one-year anniversary of the new, expanded location of the Syracuse Orthopedic Specialists’ One-Day Surgery Center.

 


J. Alan Lemley, MD


Brett Greenky, MD

“We opened our same-day surgery center in April 2019,” says James Alan Lemley, MD, President of the Surgery Center and Orthopedic Surgeon with Syracuse Orthopedic Specialists. “It’s given us the capability to do things that were previously only available to patients in hospital settings.”

Syracuse Orthopedic Specialists has offered outpatient surgery services for two decades, but as trends in orthopedics suggest outpatient procedures will become the standard of care, expanding to the new, state-of-the-art center was necessary to continue providing excellent care.

“There is a movement in orthopedics to make procedures traditionally inpatient-only, such as spinal surgeries or total joint replacements, into outpatient procedures,” says Brett Greenky, MD, President of Syracuse Orthopedic Specialists. “The advantages of same-day surgery for orthopedic procedures are significant.”

Benefits of Same-Day Total Joint Replacement

Total joint replacements, in particular, have shifted toward outpatient versus in-hospital procedures in recent years, and surgeons at Syracuse Orthopedic Specialists were the first to embrace the trend. Physicians use equipment and technology in outpatient settings that were previously considered only fit for hospital settings, allowing patients to receive hospital-quality care without spending several days in the facility. The practice of outpatient procedures lowers medical costs for patients and insurance companies, discounting the prices at an average of roughly 40%.

“Studies also show that the risk of infection goes down with the amount of time spent in the operating room,” Dr. Lemley says. “We’ve created a team of physicians, anesthesiologists, nurses and scrub technicians who know how to perform surgeries as efficiently and optimally as possible to minimize patient risk and complication.”

Patient Selection Designed to Increase Success

To ensure the success rate of outpatient orthopedic surgery is kept at optimal levels, physicians and staff at the center also implement a conservative patient selection process. If a patient has an A1c of 8.0 or higher, a BMI above 40 or other comorbidities that Syracuse Orthopedic Specialists’ physicians refer to as “hard stops,” the patient is discouraged from receiving orthopedic surgery on an outpatient level. Physicians, however, do not allow this to prevent patients from receiving excellent orthopedic care.

“We have a total joint replacement council that meets monthly to discuss such cases,” Dr. Greenky says. “If we think a patient needs an operation but has one or more of those hard stops, the panel reviews the case before anyone makes a decision and puts it to a vote. We will also continue to adjust our guidelines as new information becomes available.”

For patients for whom outpatient surgery is not an option, the locally owned One-Day Surgery Center also maintains a close relationship with nearby referring hospitals to ensure patients receive safe, effective and excellent orthopedic care.

To learn more about Syracuse Orthopedic Specialists, visit sosbones.com.

Virtual Visits

Syracuse Orthopedic Specialists is now offering Virtual Visits, to ensure timely and safe care for their patients. Also known as telemedicine, Virtual Visits allow patients to schedule a video visit with their doctor. Patients can stay home and continue their care without interruption.

Visit sosbones.com or call 315-251-3100 to learn more.