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Crouse Health: Leading the Way in Robotic Surgery — Past, Present and Future

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By Sherry Christiansen

Wednesday, February 26, 2020

As modern medical technology continues to see exponential growth, the Crouse Institute for Robotic Surgery remains a leader in the industry, largely due to its pioneering spirit and team-centered approach.

 
Since its inception in 2008, the Crouse Institute for Robotic Surgery has evolved to become the largest multispecialty robotic surgery program in Central New York. Crouse Health has a sizable team of highly skilled, experienced surgeons, each committed to the use of the newest, most advanced surgical technology available today. Surgeons at Crouse Health continually enhance their minimally invasive surgical skills in order to offer their patients the highest level of care possible.

Surgeons and administrators at Crouse, particularly those who were instrumental in laying the initial foundation for the program’s infrastructure, share their perspectives on how Crouse became the market leader in this highly competitive and continually evolving field of modern medical technology.

 

History of Robotic Surgery

Central New York was not the birthplace of robotic surgery, and the da Vinci Surgical System was certainly not the first robot designed to assist in performing surgical procedures. According to the American Journal of Robotic Surgery, a robot was used for the first time in a procedure over 30 years ago, when the PUMA 200 was utilized for needle placement during a CT-guided brain biopsy. There have been many advances in robotic technology since that first robotic-assisted procedure back in 1985. Each improvement led to the first da Vinci Surgical System, which was approved by the Food and Drug Administration in 2000. This early da Vinci model broke new ground as the first robotic surgery technology approved for general laparoscopic surgery

The Making of a Leader

Eventually, the Crouse Health team began to contemplate what it would take to establish a successful robotic surgery program of its own. When approached by its highly skilled staff of surgeons who had learned about the many benefits of robotic surgery, administrators at Crouse saw the promise of such a program and committed the resources to building it, in partnership with its surgeons.

Po Lam, MD, a board-certified urologist at Crouse Health, performs close to 200 robotic procedures each year. His fellowship training included endourology, laparoscopy and minimally invasive surgery at the University of Oklahoma Health Sciences Center. Dr. Lam was instrumental in getting Crouse Health’s robotic surgery program off the ground.

“In 2006, Crouse did not have a robotic surgery program. I met with Paul Kronenberg, MD, [CEO of Crouse Health at the time] to ask him if we could start a program,” Dr. Lam says. “Since then, the Crouse program has grown significantly.”

Dr. Lam, as well as GYN/oncology surgeons Mary Cunningham, MD, and Douglas Bunn, MD, conducted much of the initial research to learn about program start-up costs. They also estimated the number of cases it would take to make the investment in the technology, training and other expenses worth the initial expenditure.

“At that time, the technology cost between $1.2 million and $1.4 million,” Dr. Lam says. “This was a significant investment, but adding the technology made sense because of the tremendous service we would be able to offer to the community.”

After Dr. Lam and the other Crouse surgeons presented data on how and why the hospital should consider a new robotic surgery program, hospital administration gave the technology their stamp of approval, fully supporting the surgeons’ vision of bringing the leading-edge technology to Crouse.

The purchase of the hospital’s first da Vinci robot in 2008 was just the beginning.

“It’s vital to undergo the right preparation and training before using robotic surgical technology. Crouse Health provides great training for the surgeons, both the experienced surgeons and the new surgeons and residents, as well as the rest of the team.”
— Po Lam, MD, board-certified urologist at Crouse He

Meet the Team

Crouse Health features the largest multispecialty robotic surgery program in Central New York.

General Surgery

  • Akbar Ahmed, MD
  • Kenneth Cooper, DO
  • Jeffrey DeSimone, MD
  • Steven Gelb, MD
  • Taewan Kim, MD
  • Benjamin Sadowitz, MD
  • James Sartori, MD

Colorectal

  • David Nesbitt, MD
  • John Nicholson, MD

Gynecology Oncology

  • Rinki Agarwal, MD
  • Douglas Bunn, MD
  • Mary Cunningham, MD

Gynecology

  • Stephen Brown, MD
  • Nikole Bucsek, MD
  • Carla Liberatore, MD
  • Myron Luthringer, MD
  • Navpriya Oberoi, MD
  • Byuong Ryu, MD
  • Shane Sopp, MD

Urology

  • David Albala, MD
  • Po Lam, MD
  • Hadley Narins, MD
  • Nedim Ruhotina, MD
  • Harvey Sauer, MD
  • Jeffrey Sekula, MD
  • Daniel Welchons, MD

Bariatrics

  • Kenneth Cooper, DO
  • Jeffrey DeSimone, MD
  • Taewan Kim, MD

Teamwork

John Nicholson, MD, colon and rectal surgeon at Crouse Health, graduated with honors from SUNY Upstate Medical University in Syracuse in 1973. As a highly skilled surgeon, Dr. Nicholson was one of the first in the area to be trained on the da Vinci system.

“Crouse Health’s state-of-the-art technology wouldn’t be what it is today if it hadn’t been for the efforts of the staff and the support of the administration,” Dr. Nicholson says. “When the robotics program first launched, it was considered a badge of honor for nurses to be on the robotics team, so those who were selected worked very hard to ensure that the program was successful.”

While the robotic technology is the same at every hospital, the quality of the surgeons using the technology is what really matters.

“Crouse Health has the right staff and the right surgeons with the right training,” Dr. Lam says. “That is the recipe for success.”

The Crouse Institute for Robotic Surgery has continued to progress since its inception.

“Every few years a newer version of the technology is available,” Dr. Lam says. “Our administration helps us stay up to date on the newest technology, which allows us to offer the most advanced care possible to our patients.”

“Our robotic surgery program is physician driven, with an active steering committee and talented physicians, PAs, nurses and technicians, all trained to perform optimally as a team. The robot technology is just another tool for the staff. The physicians’ talent and engagement is what really drives the program, creating an environment where the staff providing patient care can really excel.”
— Seth Kronenberg, MD, Chief Medical Officer and Chief Operating Officer, Crouse Health

Expanding the Team

Benjamin Sadowitz, MD, FACS, a board-certified general surgeon, joined CNY Surgical Physicians (now known as Crouse Medical Practice – General Surgery) in 2015. He completed his fellowship in advanced gastrointestinal and hepatopancreaticobiliary surgery at Florida Hospital Tampa. Currently, Dr. Sadowitz largely specializes in robotic general surgery, which includes gallbladder, hernia, colon, appendix and anti-reflux procedures.

Dr. Sadowitz has firsthand experience of just how efficient the teamwork is at Crouse.

“About 18 months ago, we grew from two to four robotic systems at Crouse. Logistically, we needed to train a significant number of staff members to get all four systems up and running,” Dr. Sadowitz says. “We had a large group of OR staff — technicians, nurses and physician assistants — undergo training. Our robotics coordinator, Lisa Miller, our Director of Perioperative Services, Jill Hauswirth, and our head physician assistant, Cathy Burkett, were instrumental in identifying and eliminating training roadblocks.”

“The expansion was a huge initiative for Crouse,” says Dr. Sadowitz. “All four robotic systems were up and running by January 2019.”

“There used to be limitations when the robotic technology first came out. For example, patients with scar tissue from previous surgeries may have been disqualified. Now, there are fewer limitations because the technology is much better.”
— Po Lam, MD, board-certified urologist at Crouse Health

Crouse Institute for Robotic Surgery Today

Presently, Crouse Institute of Robotic Surgery providers perform over 1,750 robotic surgery procedures each year.

“Our four robots are not only in use full-time during the weekdays, but the robotic technology is also used after hours and on weekends,” Dr. Sadowitz says.

Seth Kronenberg, MD, Chief Medical Officer and Chief Operating Officer at Crouse Health, continues to support the legacy that his father, former CEO Paul Kronenberg, MD, started in 2008.

Dr. Seth Kronenberg has been a member of the senior administration at Crouse Health since 2014. He chose Crouse because of its culture of collaboration with the medical staff.

“Physicians here have a voice in the decision-making process, a focus which I believe differentiates Crouse Health from other hospitals and health systems in the region,” Dr. Seth Kronenberg says.

While Crouse Health may have been the last in Central New York to implement the infrastructure needed to perform robotic surgery, the hospital has surpassed all other programs when it comes to patient volume and availability of clinical applications. Today, in addition to having four state-of-the-art da Vinci Xi multispecialty robots, Crouse partners with Intuitive, the company that provides the robotic technology. Through the work of the surgeons, OR staff and the unique partnership with Intuitive, Crouse Health has become the regional leader.

“Crouse Health has the highest number of robotic surgeons in the area, including 25 multi-specialty surgeons, each providing the highest level of quality to our patients by using the robotics technology,” Dr. Lam says.

“When using the robot platform for cholecystectomy, a special imaging system [Firefly fluorescence imaging] helps to highlight the bile duct. Such illumination helps minimize the risk of injury to this fragile structure during dissection.”
— Benjamin Sadowitz, MD, FACS, board-certified general surgeon at Crouse Medical Practice – General Surgery.

The Future

Considering recent advances in robotic technology and the accomplishments of Crouse’s robotics team, it’s exciting to imagine what more the future might bring. Dr. Sadowitz believes Crouse may increase the number of robotic surgical systems it uses to five.

“Robotic surgery is fast becoming the standard of care for many surgical conditions,” Dr. Sadowitz says. “More than 40 companies are vying to get into the robotic surgery market, so it makes sense that there will be a role for robotics in every operating room in the country. There will be very few places or areas of surgery where robotics won’t be involved.”

Dr. Lam also sees an exciting future involving the next generation of robotic surgical systems.

“I think the new technology will be more intuitive, with many alert signals to notify surgeons when a situation during a procedure may require additional attentiveness, such as moving in the proximity of adjacent blood vessels. The launch of the newest technology may occur within the next 12 to 18 months,” Dr. Lam says. “At Crouse, we’re prepared to be one of the first to successfully adopt new generations of robotic surgical system technology.”

“We perform a procedure called a total proctocolectomy and ileal-anal pouch — sometimes referred to as j-pouch or an s-pouch. With robotic-assisted surgery, this procedure can be done sparing the anal sphincter, which means the patient will usually not need a permanent ostomy. With traditional surgery, these patients were hospitalized for one week to 10 days. After a robotic-assisted total colectomy, the patient can typically go home in three to five days.”
— John Nicholson, MD, colon and rectal surgeon at Crouse Health

Benefits of Robotic Surgery

Robotic surgery offers many benefits to patients compared to open surgery, including:

  • Shorter hospitalization
  • Reduced pain and discomfort
  • Faster recovery time and return to normal activities
  • Smaller incisions, resulting in reduced risk of infection and less scarring

For the surgeon, benefits of robotic surgery include:

  • An enhanced visual field: Surgeon has a superior view of the operating area. The high-definition camera provides a magnified, detailed view of the affected area
  • Superior dexterity
  • Access to hard-to-reach places

For more information about robotic-assisted surgery services offered at the Crouse Institute for Robotic Surgery, visit Crouse.org/robotics.

Upstate Urology Brings a Better Way to Detect Bladder Cancer to Central New York

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By Thomas Crocker

Wednesday, February 26, 2020

To enhance a burgeoning bladder cancer program, the Department of Urology at Upstate Medical University offers Blue Light Cystoscopy (BLC) with Cysview, a method that has been proven to increase detection rates of certain forms of bladder cancer.

Cysview is a photoactivating solution that causes bladder tumors to fluoresce when absorbed. Using it with BLC allows urologic oncologists to detect cancers that might have gone unnoticed under standard white light. Bringing BLC with Cysview to Upstate was a priority for Joseph Jacob, MD, MCR, Chief of the Bladder Cancer Program in the Department of Urology and Assistant Professor of Urology at Upstate Medical University. He joined Upstate Urology in 2017, intent on using his fellowship training to help meet the need for bladder cancer care in Central New York. Part of that meant acquiring advanced technology to improve quality.

“High-level evidence from recent randomized trials showed BLC with Cysview has been proven to benefit patients,” Dr. Jacob says. “This technology has been shown to increase the rate of detection of carcinoma in situ, which is typically flat, often difficult to see and identify, and can progress to more aggressive types of bladder cancer. That higher detection rate is a huge deal for patients.”

Studies have also demonstrated higher detection rates of nonmuscle invasive papillary bladder cancer using BLC with Cysview compared with white light cystoscopy.

“Upstate Medical University invested in Blue Light Cystoscopy with Cysview based solely on a desire to improve quality for patients in Central New York. That makes me proud to be part of Upstate.”
— Joseph Jacob, MD, MCR, Chief of the Bladder Cancer Program in the Department of Urology and Assistant Professor of Urology at Upstate Medical University

 

 

Detection and Removal

Most patients with bladder cancer are candidates for BLC with Cysview due to the typically noninvasive nature of the disease, according to Dr. Jacob. Available at Upstate Cancer Center at Upstate University Hospital since March 2019, BLC with Cysview begins with the introduction of Cysview into the bladder via catheter. The medicine is left to coat the bladder for one hour.

“Cysview is full of molecules that can be absorbed by cells, and the cells can be activated with a certain wavelength of light,” Dr. Jacob says. “In the procedure room, I use a standard white-light camera that allows me to switch to blue light. Under that wavelength, cancers pop out in bright pink that’s quite obvious compared with normal bladder tissue.”

Treatment often takes place concurrent with BLC with Cysview, which can supplement transurethral resection of a bladder tumor, a common procedure for staging and removing bladder cancer. Removing the tumor may set the stage for intravesical therapy, such as immunotherapy or chemotherapy.

“The bladder is an imperfect sphere with areas that require careful scrutiny,” Dr. Jacob says. “Using only white light, we might miss some subtle, small or flat lesions, but BLC with Cysview helps prevent that. If we were to overlook a flat carcinoma in situ, for example, then we would miss the opportunity to provide immunotherapy, which is the treatment of choice for this type of cancer.”

For information about the Department of Urology at Upstate Medical University, visit upstate.edu/urology.

Public Health: Surveillance, Research and Prevention

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By Kathryn Ruscitto; Wednesday, February 26, 2020

The current crisis with the emerging Coronavirus, combined with a challenging flu year, reminds us all of the important role of our Public Health officials.

Public health takes the entire health system — including patients, community providers and environmental factors — into account. The CDC and local health departments provide early warning systems. Public health has played a key role in every community across this country, from managing communicable diseases such as HIV to the outbreak of the coronavirus. Laboratories and clinicians report results to local health departments, who then coordinate aggressive tracking and communications across their communities and with the New York state health department.

“The foundation of our work is based on our mission to protect [the] health of our community residents with [a] vision of community partnership. We follow [the] principle of health equity and advocate for [the] CDC’s Health in All Policies (HiAP) [approach] because these impact social determinants of health,” says Indu Gupta, MD, Onondaga County Health Commissioner. “Both as a practicing physician and now as a leader of a mid-size public health department, I always followed these two principles in order to improve health outcomes, and continue to do so now.

“It is important to understand and acknowledge that health care and public health are interdependent, [such that] one’s focus to improve and protect [the] health of one person at a time can result in improving [the] health of the entire community by collaborative partnership with all the members of a public health system. Public health departments play a central role in this. While health systems work at the micro level, public health provides [a] bridge to the community to provide a macro-level perspective and leadership to engage all those [who] impact [the] health of a community!”

Helpful Resources

A report exploring the social determinants that factor into health status can be found at the Onondaga County Health Department website and is an excellent summary of data and actions that have been coordinated across local health systems and providers. While these are identified actionable goals, public health must deal equally with emerging, unpredictable health challenges.

Clinicians across Central New York are part of the public health system and may be the first to experience an outbreak or indication of a systemic gap in care.

Dr. Gupta began her career as a primary care internal medicine physician and appreciates the role clinicians play in the health system. She cares deeply for her patients and understands the importance of assessing the whole person and their environment to understand the best approach to treatment. Onondaga County is in a unique position to have a leader who experienced the provision of clinical care before leading an experienced team of public health professionals.

The coming year will challenge all health providers to think about how they prepare for emerging trends in health. Environmental factors are influencing the increase in asthma, diarrhea and food-borne illness, tick-borne disease, and heat-related conditions.

Key Priorities for Onondaga County

Indu Gupta, MD, Onondaga County Health Commissioner, notes that key priorities of the Onondaga County Community Health Assessment and Improvement Plan for 2019–2021 include:

  • Preventing chronic diseases
  • Promoting well-being and preventing mental and substance-use disorders
  • Promoting a healthy and safe environment
  • Promoting healthy women, infants and children
  • Preventing communicable diseases

You can reach out to Kathryn Ruscitto on LinkedIn or via email at krusct@gmail.com.

 

The Labor and Employment Law Landscape

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By Anastasia Semel

Anastasia Semel

Several significant changes to state and federal labor and employment laws are taking effect this year. Employers need to be aware of these laws in order to adjust employment policies and procedures accordingly. Understanding and complying with these laws is essential. Below is a nonexhaustive list of laws enacted to date:

1. Increases In Minimum Wage and Salary Thresholds

Effective Dec. 31, 2019, the minimum wage is $11.80 for employees in areas of New York state, other than New York City, Nassau, Suffolk or Westchester counties. Additionally, New York state’s Minimum Wage Act and applicable regulations raised the minimum salary threshold to $46,020.00 annually ($885.00 weekly) for exempt executive and administrative employees in areas other than New York City, Nassau, Suffolk or Westchester counties. 

New York state does not have its own minimum salary threshold for exempting professional employees; however, the federal Fair Labor Standards Act and applicable regulations increased its threshold amount to $35,568.00 annually ($684.00 weekly). Employers should confirm that their wage rates and exemption classifications are in compliance with federal and state laws.

2. Salary History Ban

Effective Jan. 6, 2020, New York Labor Law Section 194-a bans employers from inquiring about or relying on salary history, including compensation and benefits, when making employment decisions. More specifically, the law bans employers from asking job applicants and current employees about their salary history and relying on salary history as a factor in deciding whether to hire or how much to pay an applicant or employee. Employers cannot (1) require applicants or employees to reveal salary history as a condition of consideration for a position; (2) request salary history information from an applicant’s or employee’s former employer; or (3) refuse to interview, hire, promote, or otherwise employ or retaliate in any other way against an applicant or employee who exercises the right not to reveal salary history.

If an applicant or employee voluntarily discloses his or her salary history, the employer may take it into consideration. Additionally, if the applicant or employee volunteers his or her salary history information in order to negotiate higher pay when an offer of compensation is made, the employer may take steps to confirm the accuracy of that information.

Employers should train human resources personnel, and anyone involved in the hiring process, on permissible and prohibited questions and actions under the new law.

3. Employee Rights Regarding Reproductive Health Decisions

Effective Nov. 8, 2019, New York Labor Law Section 203-e prohibits employers from (1) accessing an employee’s personal information regarding the employee’s (or dependent’s) reproductive health decisions without prior informed, affirmative written consent; (2) discriminating or taking any retaliatory personnel action against an employee with regard to compensation or the terms, conditions or privileges of employment because of or based on the employee’s (or dependent’s) reproductive health decisions; and (3) requiring an employee to sign a waiver or other document that purports to deny the employee the right to make their own reproductive healthcare decisions.

The law permits employees to bring a civil action in any court of competent jurisdiction and seek various legal and equitable remedies, and it also provides for an additional award of civil penalties against any employer who retaliates against an employee for bringing a complaint.

4. Expanded Worker Protection Under the New York State Human Rights Law

Several changes to the New York State Human Rights Law (NYSHRL) take effect in 2020.

Nondisclosure agreements (NDA) as part of employment contracts entered on or after Jan. 1, 2020 must include an explicit policy that allows the employee or potential employee to speak with “Law enforcement, the Equal Employment Opportunity Commission, the state Division of Human Rights, a local commission on human rights or an attorney retained by the employee or potential employee.” Without this language, NDAs are void and unenforceable to the extent that they prohibit disclosing factual information regarding any future claims of discrimination.

Effective Feb. 8, 2020, employers of any size, including those with just one employee, are subject to the NYSHRL.

Finally, effective Aug. 12, 2020, the statute of limitations for reporting claims of sexual harassment to the state Division of Human Rights will be extended to three years.

Employers should ensure they are in compliance with these laws and consult legal counsel if they have specific labor and employment law questions or concerns.

Anastasia Semel is an associate at CCB Law, a boutique law firm focused on providing counsel to physicians and healthcare professionals. She can be reached at 315-477-6232 or asemel@ccblaw.com.

Oneida Health and Roswell Park Comprehensive Cancer Center: Unparalleled Radiation Oncology in CNY

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By Jenna Haines

As a member of the Roswell Park Care Network, the Dorothy G. Griffin Radiation Oncology Center at Oneida Health replicates the clinical care and quality assurance approaches employed at Roswell Park Comprehensive Cancer Center, the only National Cancer Institute (NCI)-designated center in Upstate New York.

Oneida Health and Roswell Park continue to expand cancer care in Central New York.

Oneida Health Cancer Care, a member of the Roswell Park Care Network — the most expansive community cancer, supportive and specialized care affiliation spanning New York State, led by Roswell Park — brings high-quality services to patients with cancer in Central New York. The most recent — and one of the most exciting — developments is the opening of the Dorothy G. Griffin Radiation Oncology Center in Oneida, which opened to the public in July 2019.

The Dorothy G. Griffin Radiation Oncology Center includes an on-site CT simulator, which aids in image guidance to deliver increasing doses of radiation to the tumor with maximum normal-tissue sparing.
 

“For patients with cancer, this strong partnership between Oneida Health and Roswell Park Comprehensive Cancer Center means they no longer need to leave Oneida for their radiation or medical oncology services. They no longer need to sacrifice and supplant their personal lives in order to benefit from NCI-level cancer care.”
— Shilpa Vyas, MD, Medical Director of the Dorothy G. Griffin Radiation Oncology Center

 

Oneida Health

Founded in 1899, Oneida Health offers a variety of primary care and specialty services, as well as access to a 101-bed hospital and 160-bed extended care facility. Most recently, the organization was awarded both the 2019 “Outstanding Patient Experience” award and the 2019 “Patient Safety Excellence” award by Healthgrades. They are among the top 2% of hospitals in the nation to receive both awards, and the only hospital in New York State to have both distinctions in 2019.

Advanced Services, Technology and Expertise

The Dorothy G. Griffin Radiation Oncology Center is a 6,000-square-foot facility overseen by the center’s full-time Medical Director, Shilpa Vyas, MD, a fellowship-trained, board-certified Roswell Park radiation oncologist.

“Oneida Health Cancer Care is essentially a clinical extension of Roswell Park,” Dr. Vyas says. “I am available at the Dorothy G. Griffin Radiation Oncology Center five days a week, and it is my responsibility to ensure we are providing each and every patient with the same, high-quality radiation oncology services they would receive if they travelled to our main campus in Buffalo.”

According to Dr. Vyas, these radiation oncology services include CT simulation for radiation treatment planning scans and multiple kinds of external beam radiation therapy (EBRT) — a technique that uses a TrueBeam linear accelerator to generate and deliver precise photon beams into tumors inside the body.

“We offer all the cutting-edge EBRT treatment techniques here in Oneida, including intensity-modulated radiation therapy and volumetric-modulated arc therapy, which we use in conjunction with image guidance in order to deliver increasing doses of radiation to the tumor with maximum normal-tissue sparing,” Dr. Vyas says. “We also offer stereotactic ablative body radiation therapy, which has emerged as a very effective and safe treatment modality for early-stage lung cancers and patients with oligometastatic disease in the brain, spine, liver, lung and other disease sites. With our respiratory motion management equipment, we are able to accurately target tumors that are prone to move as patients breathe. Motion-tracking strategies, such as gating or deep-inspiration breath hold, ensure that radiation is delivered accurately.”

The Dorothy G. Griffin Radiation Oncology Center, which opened in July of 2019, is located at 601 Seneca Street in Oneida.
 

The Roswell Park Advantage

In addition to receiving expert-level care from the program’s on-site Roswell Park radiation oncologist, medical dosimetrists and medical physicists, patients at the Dorothy G. Griffin Radiation Oncology Center benefit from Roswell Park Comprehensive Cancer Center’s world-renowned resources and protocols, including:

  • Guideline-driven care: Dr. Vyas and her team follow the same quality standards of Roswell Park in Buffalo, NY, including evidence-based radiation treatment guidelines and adherence to treatment planning protocols that carefully control radiation doses to improve patient outcomes and quality of life.
  • Peer-reviewed treatment plans: Every patient’s radiation treatment plan is reviewed by a team of radiation oncologists at Roswell Park. In addition, all radiation oncology staff based in Oneida are trained on Roswell Park standards. This translates to exceptional National Cancer Institute-level radiation oncology care for residents of Central New York.
  • Clinical trials: Oneida Health Cancer Care patients have access to clinical trials at Roswell Park, which offers one of the most robust early phase clinical trials programs in New York. These trials are explicitly centered around the development of new cancer treatments and provide opportunities for patients in every phase of the disease process to access, and potentially benefit from, new treatment modalities before they are available on the market.
  • Tumor board: Providers at Oneida Health Cancer Care have access to Roswell Park’s Tumor Board — a multidisciplinary team of physicians that meets weekly in Buffalo to review cases that are either unique or challenging and to collectively recommend a course of action.
External Beam Radiation Therapy is a technique that uses a TrueBeam linear accelerator to generate and deliver precise photon beams into tumors inside the body.

“Modern oncology care is an intricate, orchestrated symphony of different oncology specialties. However, we really go to great lengths to ensure that Oneida Health Cancer Care patients have access to highly specialized programs and to coordinate it so that as many of these subspecialties as possible are available within a single setting.”
— Thomas Schwaab, MD, PhD, Chief of Strategy, Business Development and Outreach at Roswell Park Comprehensive Cancer Center

Roswell Park Comprehensive Cancer Center

Founded in 1898, Roswell Park Comprehensive Cancer Center was one of the nation’s first three NCI-designated cancer centers and is currently the only NCI-designated cancer center located in Upstate New York. Additionally, this Buffalo-based organization was recently ranked No. 14 by the U.S. News & World Report’s 2019-20 “Best Hospitals for Cancer” list — placing it among the top 1.5% of nearly 900 centers nationwide.

Collaboration Across Locations

According to Gene Morreale, President and CEO at Oneida Health, the availability of these services and the seamless discourse between physicians in Buffalo and Oneida are the result of the system’s advanced telemedicine capabilities.

“Through the use of telemedicine, our team can communicate directly with Roswell Park specialists in Buffalo, including their tumor board,” Morreale says. “Roswell Park physicians are able to instantly see any relevant patient results and discuss personalized patient treatment plans based on their areas of expertise with our physicians here in Oneida. Access to an expanded network of knowledge helps ensure that we are accurately diagnosing patients and prescribing the most appropriate care based on National Comprehensive Cancer Network (NCCN) cancer care guidelines.”

Thomas Schwaab, MD, PhD, Chief of Strategy, Business Development and Outreach at Roswell Park Comprehensive Cancer Center, agrees.

“Oneida Health Cancer Care patients have immediate access to the highest level of oncology care close to home,” Dr. Schwaab says. “We are happy we can offer patients state-of-the-art equipment and clinical and technical expertise that only an NCI-designated cancer center can provide. Our shared vision is making a big difference.”

Total Cancer Care in Oneida

Prior to the opening of the Dorothy G. Griffin Radiation Oncology Center, Oneida Health launched the Oneida Health Cancer Care Medical Oncology Center in 2018 in affiliation with Roswell Park. The center, which houses 12 infusion suites, a hematology/oncology office and a telemedicine room, is directed by a Roswell Park-affiliated physician and offers evaluations, chemotherapy infusions, palliative medicine, specialized physical therapy, nutrition services and several cancer screening services. Oneida Health Cancer Care and Roswell Park opened the Dorothy G. Griffin Radiation Oncology Center one year later. “From the start, Oneida Health and Roswell Park’s leadership had a singular vision in providing a cohesive, high quality cancer care program which would deliver the presence of an NCI-designated cancer center in Oneida,” says Morreale. “The addition of radiation oncology to our already successful medical oncology program extends the treatment options we can provide for a more comprehensive approach to cancer care locally.”

Oneida Health is currently in the process of completing the third phase of their collaborative vision for cancer care in Central New York, expanding its outpatient imaging, the Alice M. Gorman Imaging Center. Upgrades, for instance, include the addition of a 3 Tesla MRI, a new PET CT machine, a nuclear medicine camera and a second 3D mammography machine. Additionally, Morreale notes, he wants to start focusing on initiatives around cancer prevention and early detection — initiatives that will allow cancer to be identified at its earliest stage and provide patients with the best possible outcomes.

Patients at the Dorothy G. Griffin Radiation Oncology Center benefit from receiving expert-level care from the program’s on-site Roswell Park radiation oncologist, medical dosimetrists and medical physicists. (Pictured: Medical Dosimetrist Vanessa Rundle, MS, CMD, RT(R)(T) and Shipla Vyas, MD, Medical Director of the Dorothy G. Griffin Radiation Oncology Center)

“Our technology is the most current technology on the market. However, I think the biggest benefit to our patients is the expertise of the Roswell Park physicians who have been tasked with developing these treatment plans and administering the various treatments we offer. It is because of them that our patients are able to receive world-class cancer care directed by an NCI-designated cancer center right in Oneida.”
— Gene Morreale, President and CEO at Oneida Health

In addition to the newly opened Radiation Oncology Center, Oneida Health and Roswell Park previously opened a Medical Oncology Center in 2018. The center offers 12 infusion suites and a hematology/oncology office, as well as a telemedicine room. The center is directed by a Roswell Park-affiliated physician who provides evaluations, chemotherapy infusions, palliative medicine, specialized physical therapy, nutrition services and several cancer screening services.

Recently, Oneida Health and the YMCA have teamed up to begin the process of developing survivorship services.

“It is important for us, as a health system, to support patients by providing them with access to holistic services, including exercise, spiritual care, yoga and a variety of other support services aimed at benefitting patients as they fight with what can be a very difficult situation,” Morreale says. “Research shows if you promote wellness and activity during and following a patient’s cancer treatment, they do better.”

Future plans call for further expansion of the survivorship program. Oneida Health plans to offer survivorship services on the first floor of a building across the street from the medical oncology center. While those renovations are underway, services will temporarily be offered out of a YMCA facility conveniently located on the Oneida Health campus.

Morreale highlights these offerings for cancer survivors as just one more example of the level of care and the breadth of services that Oneida Health Cancer Care and Roswell Park Comprehensive Cancer Center aim to offer patients in Central New York.

“We are dedicated and focused on providing the highest quality care and the best patient and family experience in the region,” Morreale says. “With Roswell Park Comprehensive Cancer Center as our partner and the high-caliber staff that we have working with us, I believe we are providing a very special service here in Oneida — a service that is only continuing to grow to meet the needs of our patients.”

To learn more about Oneida Health Cancer Care, visit oneidacancer.org.

New York State Budget Updates: Health Care Impacts

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By Kathryn Ruscitto

This column has always been a great place for legislative updates, and Jerry Hoffman would want me to spend some time on our current legislative environment.

I reached out to several healthcare leaders and asked what’s keeping them up at night for the next budget year. My sense is their annual list of concerns is lengthened due to the large gap created in the budget between state and federal funding for Medicaid care in New York state.

Clinicians often engage with the state budget due to malpractice and insurance reforms. While important, issues that impact the environments in which their patients receive care and in which they practice are equally important.

Kathryn Ruscitto

The American Medical Association, which primarily advocates for clinicians, notes its key areas of advocacy as public health, access to care, patent reform, reduction in administrative burdens and judicial advocacy for physicians and patients. They recommend clinicians use their voices as leaders in their communities. Patients denied access to care, particularly underserved communities in poverty, see higher rates of chronic illness and lower life expectancies.

This coming year changes to reimbursement and funding to Medicaid programs may threaten critical community-based services and bills to mandate staffing levels threaten many healthcare providers.

The national debate swirls around the future structure of access and coverage.

In the meantime, providers must help patients every day. Those patients are often struggling with insurance costs, medication costs and access to specialty care.

We all see the impact of drug abuse and addiction among young people and we need to advocate for increased funding for access to treatment and community care.

Pay attention during the next few months and use your voice and your professional associations to raise concerns about these reductions and changes to funding for critical services. Talk to legislators, email their offices and let your voice be heard.

You can reach out to Kathryn Ruscitto on LinkedIn or via email at krusct@gmail.com.

Informational Resources

A Renewed Culture of Collaboration and Innovation Takes Root at Upstate University Hospital

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By Thomas Crocker

Inspired by the vision and leadership of a CEO who is one of their own, physicians at Upstate University Hospital thrive in a culture in which partnership and engagement are paramount — and they are free to grow and innovate in the service of providing world-class patient care.

Upstate University Hospital CEO Robert Corona, DO, MBA, is not a proponent of leading from behind a desk.

“I try to stay out of the office as much as possible,” he says. “I’d rather go on rounds with physicians and nurses or visit the physical plant to ask what’s important to those who work there, and then provide the tools they need to succeed. Regardless of their role in the organization, people want to know their work makes a difference and that they’re trusted and appreciated.”

Appointed in January 2019, Dr. Corona’s path to the hospital’s CEO position included two decades in clinical and academic realms at Upstate Medical University to a leadership role at the medical diagnostic device manufacturer Welch Allyn. His journey instilled a belief in him that an organization is only as strong as the talented people who power it. Most recently, Dr. Corona was the John B. Henry Professor and Chair of the Department of Pathology and Laboratory Medicine, Medical Director of Neuropathology, Chief Innovation Officer, and Vice President of Business Development at Upstate Medical University prior to his appointment as CEO at its hospital.

“People are our strength,” Dr. Corona says. “They work at Upstate because they want to belong to something bigger than themselves. We’re situated in a large region and serve many different populations across a wide swath of the state. Everyone at the hospital feels a sense of appreciation and value for the contributions they make to the institution because the communities we serve rely on us for so many services that only Upstate provides.”

In less than a year, Dr. Corona has united the Upstate community around a vision of transforming the hospital into an innovative teaching institution. That vision rests on four pillars: relentless pursuit of high-quality care, leveraging innovative technologies to make the hospital smarter, commitment to environmentally sustainable practices and sourcing, and promotion of what Dr. Corona calls “the Upstate experience.”

“The Upstate experience is exceptional for patients and families but also our employees,” he says. “Focusing on all three groups creates a positive interchange. Happy employees result in happy patients and families. Happy patients and families help create a more pleasant work environment for providers and nonproviders alike.”

The Upstate experience empowers physicians to do their best work at the bedside, in the laboratory and in the classroom — in short, it is an atmosphere in which physicians can pursue their passion. Here is a look at how several Upstate physicians are doing just that.

“I’m passionate about integrating advanced technologies into our work at Upstate University Hospital, including computing, communications, robotics and artificial intelligence. Human capital is crucial to this effort. When so many people are using their senses to care for others, they improve the intelligence of the hospital.”
— Robert Corona, DO, MBA, CEO of Upstate University Hospital

Upstate University Hospital CEO Robert Corona, DO, MBA, set fresh priorities for the clinical system when he was appointed as CEO in January 2019. The pillars shown in the graphic below are presented as a reminder at each month’s Management Forum and other meetings. With two hospitals, the Golisano Children’s Hospital, and nearly 70 specialty clinics, quality care, patient experience, innovation and sustainability are priorities.

Amy Tucker, MD, MHCM

Before she joined Upstate University Hospital in 2017 as Medical Director of Ambulatory Services, Dr. Tucker practiced cardiology at the University of Virginia for 25 years, serving as the Director for Ambulatory, Consultative and Rehabilitation services in the Cardiovascular Division. As much as she enjoyed clinical care, Dr. Tucker wanted to spend the next phase of her career improving the healthcare system for clinicians and patients. The opportunity to do that attracted her to Upstate University Hospital, where she became Chief Medical Officer early this year.

“I’m excited about pursuing strategic growth, expanding clinical services for patients, and improving the quality and safety of care,” Dr. Tucker says. “I want to help remodel our healthcare system at Upstate to provide better access and clinical services to the patients in Central New York.”

A fundamental component of Dr. Tucker’s strategy to enhance patient care is to improve the well-being of the hospital’s medical staff. With support from Dr. Corona and other hospital leaders, Dr. Tucker works in collaboration with a well-being task force to combat physician burnout. She also works with an EHR usability group in partnership with the IT department. To improve access to care, Dr. Tucker notes that Upstate is expanding specialty services to key areas and, in July, welcomed its first class of family medicine residents. Upstate will connect these trainees with local physician practices in the hope that many will stay to establish their careers in Central New York, thereby helping alleviate a shortage of primary care physicians in the region.

“Our new leadership team is committed to serving the people of Central New York,” Dr. Tucker says. “We are working to create a healing environment, educate the next generation of healers, and pioneer new diagnostics and therapeutics to provide cutting-edge care.”

Innovation and Leadership for Access

Chief Medical Officer Amy Tucker, MD, is working with Chief Ambulatory Officer Nancy Daoust on data pulled from EHRs to evaluate room utilization for access and throughput in the outpatient clinics. “We are looking at ways we can see more patients and use our clinic space more efficiently,” Dr. Tucker says.

Jeremy Joslin, MD, MBA, Associate Chief Medical Officer for Capacity and Clinical Operations, is focused on maximizing capacity — such as the recent project to improve patient logistics by streamlining cross-campus transportation. His work supports the goal to provide the most immediate access to care at one of the busiest transfer centers in the state.

Matthew Glidden, MD, (left) Associate Chief Medical Officer, works to expand care at Upstate’s community campus. The Upstate Birth Center completed a $9.2 expansion and renovation; upcoming projects upcoming include dialysis and an expansion of the ICU at the Broad Road location.

Greg Conners, MD, MPH, MBA, Chair of Pediatrics and Executive Director of the Upstate Golisano Children’s Hospital, notes that the recent 10th year celebration was crowned with a special announcement. A new $3 million gift from benefactor Thomas B. Golisano will establish the Golisano Center for Special Needs. The center will allow Upstate to serve 7,600 children per year, a 167% increase compared to 2018. Conners also states that improving access to mental health care for teens is a pressing concern for the region, and one that will be helped by new adolescent psychiatric beds coming online. The inpatient unit will directly connect with outpatient services. Upstate departments are working with Hutchings and the Office of Mental Health to provide a continuum of care for these patients ages 12–17.

Lawrence Chin, MD, FAANS, FACS

Dr. Chin is the Interim Dean of the College of Medicine and Robert B. and Molly G. King Professor of Neurosurgery at Upstate Medical University. In the eight years since he arrived as Chair of Neurosurgery at Upstate University Hospital, Dr. Chin has been an integral part of a surge of growth and innovation that established the Upstate Brain and Spine Center and has produced a variety of programs and services found nowhere else in Central New York. These include a pediatric neurosurgery program, epilepsy surgery program, the Gamma Knife center, an intraoperative MRI suite for brain surgery, among others. The department’s surgeons also support the Upstate Comprehensive Stroke Center and its Level I trauma center.

In October, Dr. Chin witnessed the opening of a facility that is especially significant to him: Upstate’s new multispecialty outpatient building at the Township 5 mixed-use development in Camillus. A collaboration between the hospital and Upstate University Medical Associates at Syracuse (UUMAS) — Upstate’s faculty practice plan — the Township 5 building includes family medicine, cardiology,orthopedic surgery, pulmonology, rheumatology,neurosurgery, neurology, pain medicine, physical medicine and rehabilitation, urology, otolaryngology, vascular surgery, and psychiatry and behavioral health clinics, as well as a laboratory, radiology services and a physical therapy suite.

Dr. Chin credits Dr. Corona for spearheading the Township 5 project during his time as head of UUMAS, a role that rotates among department chairs. Dr. Chin continued the effort when he assumed leadership of the faculty practice plan.

“We’ve never had a collaboration on this scale between the physician practices and the hospital, but it was easy because everyone bought in to the importance of this project,” Dr. Chin says. “Working together to accomplish this goal in less than two years — from planning to opening — shows a great degree of integration between the physicians and hospital leadership.”

The support of leadership played an integral role in the establishment of a new neurosurgery outpatient clinic at Upstate Community Hospital (recently known as the Community Campus.) The clinic is scheduled to open January 2020.

“Upstate is about people,” Dr. Chin says. “It’s about treating our patients and staff with respect, and using the best technology available to deliver treatment.”

Innovation and Leadership for Education

Neurosurgeon Lawrence Chin, MD, recently transitioned from two roles — Department Chair and Head of the Medical Faculty Practice — to take on the Interim Dean role for Upstate’s College of Medicine. As a dean engaging in clinical practice, early exposure to patient interactions, increasing diversity and career mentoring are among his aims for students.

Danielle Katz, MD, is the Associate Dean of Graduate Medical Education. Each year, her office oversees more than 600 medical residents and fellows in 49 accredited GME programs. The newest residency program in Family Medicine, a collaboration with the Syracuse VA Medical Center, drew more than 400 applicants for six spots.

Geriatrics Chair Sharon Brangman, MD, launched the ACE (Acute Care of the Elderly) team approach for older adults in the hospital, where she also conducts ACE rounds and related education. She leads the state-designated Center of Excellence for Alzheimer’s Disease (CEAD) that provides comprehensive services for the diagnosis and management of Alzheimer’s disease and other dementias.

G. Randall Green, MD, JD, MBA

The Director of the Upstate Heart Institute, Dr. Green joined Upstate University Hospital in 2017 and was determined to do nothing less than change how patients receive heart care in Central New York.

“I’m excited about the opportunity to create a regional academic center of excellence in heart care,” Dr. Green says. “Upstate has the resources, and now, under the direction of Upstate Medical University Interim President Mantosh Dewan, MD, and Drs. Corona and Chin, we have the highest level of leadership aligned to create what I came here to achieve, which is to transform Upstate into an academic heart care program that has the highest quality and most patient-focused care in the area.”

Dr. Green and his colleagues are well on their way to realizing his vision. Previously, Upstate performed approximately 50 cardiac surgeries per year, and it is now on track to perform 400 annually — a 700% increase. The Division of Cardiology has doubled in size, thanks to an influx of new providers, and is looking to add new techniques and treatments for heart failure and structural heart disease. In the research realm, Upstate is studying a prosthetic bypass conduit as part of a $3 million grant with Cornell University, and leaders are investigating the possibility of creating a clinical database for aortic disease.

“It is time for Upstate to achieve something big in heart care, which is a high strategic priority,” Dr. Green says. “All credit for the growth we’re experiencing goes to the management team we have in place now. Our leaders are aligned in how they think about heart care, and we have the right personalities on the team to build an academic center of excellence in heart care.”

Innovation and Leadership for Care

Upstate Heart Institute Director G. Randall Green, MD, MBA, JD, continues his work as a leading cardiac surgeon while building on existing strengths toward the vision of an institute that reflects the full scope of the interrelated mission — patient care, medical education, research and community service.

Cardiologist Mark Charlamb, MD, recently brought an eight-physcian practice to Upstate, essentially doubling the number of cardiology faculty and increasing the number of outpatient sites to six. Patients will have streamlined care with greater access to other experts and treatments, as needed. The expansion also secures the safety net services for vulnerable patients.

Surgeon Ranjna Sharma, MD, Medical Director of the Breast Cancer Program, was recruited from Beth Israel Deaconess and Harvard to grow and develop an academic breast cancer program. Her arrival expanded the team to four dedicated breast surgeons, with reach to underserved areas. Her aims include to increase investigator-initiated research and promote community outreach.

Mark Charlamb, MD, FACC

A cardiologist and alumnus of and former chief resident at Upstate, Dr. Charlamb joined the university’s faculty on Sept. 1 with his colleagues — seven physicians and five nurse practitioners — from the Cardiovascular Group of Syracuse. That move doubled the number of cardiologists at the Upstate Heart Institute and increased the number of Upstate’s outpatient cardiology clinics to six. For Dr. Charlamb, joining the faculty was a homecoming after 21 years in practice.

“My colleagues and I are now part of Syracuse’s only academic medical center, which allows us to work with residents and fellows in a teaching program,” Dr. Charlamb says. “We’re excited to grow our practice by working in an academic setting and collaborating with a variety of specialists across the institution.”

Dr. Charlamb points to the leadership renewal that has taken place at Upstate as playing an instrumental role in his group’s decision to join the university faculty.

“Dr. Corona is a people person. He is easy to work with and brings a physician’s perspective to the CEO role,” Dr. Charlamb says. “He made our transition seamless and welcomed us with open arms. The technology at Upstate is of the highest caliber. The connectivity is great — EHRs are available across all campuses and practices, so we can read and review patients’ studies from anywhere. Technology is constantly growing and changing, and it’s important to keep up with it to stay efficient and produce the best outcomes for patients.”

Innovation and Leadership for Future

Urology Chair Gennady Bratslavsky, MD, (center) leads a large robotic surgery team for prostate, kidney and bladder cancers, as well as other complex urological surgeries. In addition, he has overseen many clinical trials to evaluate new therapies for urologic cancers and introduced novel technologies such as Uronav fusion platform for prostate cancer and blue light cystoscopy for bladder cancer.

Michel Nasr, MD, Interim Chair of Pathology and Laboratory Medicine oversees the region’s most specialized pathology department with 36 faculty members. The department aims to provide world-class services to patients and clinicians using cutting- edge technologies. Up next: The department is looking to further develop both digital pathology services and next generation sequencing technology to offer the most advanced laboratory diagnostics throughout Central and Northern New York.

Sri Narsipur, MD, Interim Chair of Medicine, guides the largest clinical, research, and education department at Upstate. The 11 divisions that comprise medicine have made advances that help with both common and rare conditions, as well as reach underserved communities across 17 counties in Central New York. New services in development include a center for lupus research and tele-consulting for regional physicians and providers.

To learn more, visit upstate.edu/hospital.

Your Culture of Leadership

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By: Jeff Rogers

Leading an organization of any size can be a difficult endeavor. By nature, leadership is subject to interpretation and variation, but only if we allow it. I have written a lot on leadership styles and bedrock principles. I have learned along the way and often speak to the idea that business systems do the heavy lifting and leaders lead people. I believe that to be true. I am also big on systems and accountability. Below is my idea of what can happen when you lead with systems. It’s funny how people behave when they can understand and get behind your vision. Help them connect the dots. Here is my idea on how to accomplish that sometimes-complicated effort.

Vision, Mission, Values

  • Who you are and where you are going
  • How you are going to get there
  • Our rules
  • Used as a tool (so much of it becomes embedded in the company DNA)

Five-Year Goal

  • Think big
  • Specific picture
  • Belief

Jeff Rogers

Three-Year Goal

  • Aligned with five-year goal and guidepost
  • Specific
  • Belief

Annual Solid Intention (One-Year Goal)

  • Valuable, attainable, measurable, committed to memory, burning desire
  • Guidepost goals
  • The game and goal (keep score, post the score, share the win)
  • Teach the team how to win
  • Used to prioritize issues list

90-Day Rocks

  • Path toward solid intention
  • Priorities listing
  • Reviewed and modified at executive team meetings

Weekly Action Plans

  • From the executive team meeting notes
  • Results are a must and exceptions require early notice and reasons
  • Communicated to team via executive team member representative

Accountability Chart for Sales, Operations, Administration, Integrator, Visionary

  • Includes specific areas of responsibility
  • Used for accountability and action steps assignment
  • Flat as practical
  • Used for communication (between executives and the team)
  • Appeals to integrator (who uses discretion)

Executive Team and Executive Team Meetings

  • Department “Leaders” (own the process and results)
  • Weekly meetings, monthly meetings, quarterly 90-day plan reviews
  • Prioritize issues list
  • Action steps assigned to individuals and they are accountable for completion
  • Written notes and executive team binders
  • Leadership training

CEO Briefings: Monthly Letter to the Team and Stakeholders

  • Report on executive team initiatives
  • Introduce new team members
  • Reinforce the vision, mission, values and highlight specific achievements
  • Updates on the game and goal
  • SOP training

Issues List

  • Comprehensive listing of every issue standing between where you are and where you want to be
  • Prioritized
  • Reviewed and strategized at monthly executive team meetings

Right People in Right Positions

  • Must be aligned with vision, mission, values
  • They have to “Get it”
  • They have to “Want it”
  • They have to have the capacity
  • No square pegs in round holes

The Great Bullpen: Monthly Team Meeting

  • After hours with food provided
  • Compare behavior to vision, mission and values; when not congruent, agree to change the statements or the behavior
  • Current condition
  • Leadership briefing
  • Leadership training, SOP training and team-building exercise
  • Game and goal update
  • Awards

Systems

  • Documented
  • Trained
  • Accountable
  • SOP development

Marketing and Sales

  • Define your target market
  • Competitive differentiators
  • Patient process and patient acquisition

Sharing Success

Share in team success stories and thank-you statements among team members

This is a very comprehensive outline you can use for success in your practice.

For more information on guidance and assistance implementing a more robust culture of leadership experience in your practice, you may contact Jeff Rogers at 315-430-0657, email JeffRogersCoach@gmail.com or visit JeffRogersCoach.com.

MD News July-August 2020

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MD News May-June 2020

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