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Can Paid Medical Experts Guarantee Justice in Medical Malpractice Cases?

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Jennifer Negley

Expert witness testimony is essential to all medical malpractice legal proceedings. Usually, without a medical expert, plaintiffs cannot proceed to trial, and defendants are usually doomed to an adverse jury verdict. Medical experts are recruited in many ways, even from proprietary companies that offer a diverse variety of experts.

Finding these crucial experts varies from direct attorney contact to agencies offering a wide range of specialists. Though they’re key figures in court, their most important job is to be unbiased and help decide the case fairly. Professional organizations like the American Academy of Family Physicians have outlined stringent guidelines:

Unwavering Objectivity:
Physicians serving as expert witnesses must hold themselves to the highest ethical standards, ensuring complete and unbiased information is presented. They are not advocates, but impartial guides illuminating the medical realities of the case.

Adherence to Standards:
Their opinions should reflect the established benchmarks within their specialty, both at the time of the alleged incident and in the present. Thorough familiarization with the case and relevant medical standards is paramount.

Fair Compensation:
Recognizing the significant time and effort involved, reasonable and commensurate compensation for expert witnesses is essential.

In this time of shrinking fees and increased costs, physicians are debating if they should offer their services as a paid medical expert. Many questions arise when considering this path. One prominent national insurance carrier has challenged this matter with a few questions that can be beneficial when evaluating this option. Among them are:

Schedule Balancing:
Can you seamlessly integrate court appearances into your patient care schedule without compromising either?

Case Complexity:
Are you prepared for potentially vast medical records, repeated attorney meetings, lengthy depositions, and extended court battles?

Pressure and Performance:
How comfortable are you with verbal sparring and intense scrutiny in a courtroom setting?

Potential Repercussions:
Could your testimony be used against you in the future?

Maintaining Expertise:
Can you resist the pressure to stretch your opinions beyond your areas of expertise to better suit a particular
side?

Many physicians may not realize that their existing professional liability policies don’t automatically cover them for acting as a paid expert witness. This presents a significant financial risk you shouldn’t ignore. To make an informed decision, consulting your insurance advisor is vital. They can clarify your existing coverage and guide you toward securing any additional protection necessary to enter the world of expert witness testimony.

While the role of medical experts in malpractice cases remains crucial, both plaintiffs and defendants should carefully consider the implications before engaging a physician for compensated testimony. It’s a path demanding specialized skills, significant time commitment, and ethical considerations, necessitating a thorough self-evaluation and consultation with one’s insurance advisor. Ultimately, ensuring responsible and unbiased expertise in the courtroom necessitates understanding the complexities and obligations involved for all parties concerned.

For more information on your insurance options, please contact:

Jenn Negley,
Vice President, Risk Strategies Company
at 267-251-2233
or JNegley@Risk-Strategies.com.

Auburn Community Hospital Health System:A Destination For Quality Care

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By: Elizabeth Landry

Dr. James I. Syrett Chief Medical Officer, Dr. Daniel Alexander, Chief Administrative Officer & Chief of Orthopedics, Dr. Emily Brooks, Chief Nursing Officer Joshua Alexander, Chief Operating Officer, Stephen Graziano, MD, Division Chief of Upstate Cancer Center Adult Hematology/Oncology, Scott Berlucchi, President & CEO Christina Sherman, RN, Director of Cancer Services, Auburn Community Hospital, Erik Burch, Sr. VP Administration

It’s hard to imagine the growing Auburn Community Hospital (ACH) of today filed for bankruptcy just 16 years ago. Since 2007, bolstered by the belief brighter days were ahead and led by the expertise of CEO and President Scott Berlucchi, FACHE, LNHA, Auburn Community Hospital has experienced a financial and operational turnaround. Berlucchi is known for his specialty in managing and growing small rural hospitals and has a proven track record for turning around struggling healthcare systems, as evidenced most recently by his leadership of ACH.

Today, ACH is both a Safety Net and Sole Community Provider Hospital offering a myriad of medical services to its patients. The health care center also encompasses the top-rated Finger Lakes Center for Living skilled nursing facility, three urgent care centers in the surrounding communities, and Auburn Memorial Medical Services, a multi-specialty physician group. Exciting additional services that will soon be offered at ACH include the new Auburn Heart Institute, Comprehensive Cancer Care Center, and Auburn Concussion Clinic, as well as new initiatives focusing on orthopedic care and excellence in nursing.

Reflecting on this exciting phase of expansion, Berlucchi emphasized the hard work of the entire team at ACH.

“The Center will provide needed care for the local community that they would otherwise have to travel long distances for and will also increase employment”

“We are taking care of our business. We could not do this without strong support from our Board of Trustees, led by Anthony Franceschelli, and an exceptional management team that has worked hard to transform our healthcare system. Demand for ACH’s services, utilization and growth continues to increase as we bring acute, post-acute and preventive care to members of our community. What I am most proud of is according to a recent study by The University of Wisconsin Population Health Institute, Cayuga County has experienced remarkable year over year improvements in health outcomes vs. other NYS counties over the last 10 years despite numerous challenging health factors. That means as the only health system in the area we are making a difference in our community when it comes to health outcomes,” he said.

LIFE-SAVING CANCER CARE
A recent partnership with Upstate Medical Center has allowed ACH to bring highly advanced specialty outpatient treatments closer to home for its patients, with the new comprehensive Cancer Center planned to open in January of 2024. The addition of the Cancer Center to ACH is aimed at directly improving the health and well being of the hospital’s patient population, as data indicates that cancer is the leading cause of premature death in Cayuga County. Additionally, according to Truven Health Analytics, 80% of residents in the surrounding area must travel further than 25 miles to receive medical oncology services.

To help alleviate these concerning circumstances, the Cancer Center allows patients to take advantage of “one-stop shopping” for their medical treatments, since the Cancer Center  is connected to the main hospital. Combined with the partnership of excellent SUNY Upstate cancer physicians, this increased convenience for patients will provide for more efficient, cost effective, and quality care right in their own community. Dr. Komal Akhtar, Medical Director for the new Cancer Center, has extensive training in Internal Medicine, Hematology and Medical Oncology, and is a member of the American Society of Clinical Oncology. She expressed her excitement about the impact the new Cancer Center will have on the area served by ACH.

“The Center will provide needed care for the local community that they would otherwise have to travel long distances for and will also increase employment,” she said. “The partnership with SUNY Upstate Cancer will provide world class care and lives will be saved because of the care given locally. This is the hospital’s highest priority and a critical part of our long-term sustainability as the largest employer in the area.”

INVESTMENTS IN CARDIAC CARE
Alongside the addition of the Cancer Center, ACH is enhancing the level of cardiovascular care for its patients with the new Auburn Heart Institute. Located in a newly renovated wing on the third floor of ACH, this multimillion-dollar investment in cardiac care will be led by Dr. Ronald Kirshner, who was recently appointed as its chair and medical director. Dr. Kirshner recently served as the Chief of Cardiac Services and Cardiothoracic Surgery at Rochester Regional Health Sands Constellation Heart Institute for over 30 years, and his clinical interests and expertise include creating systems to drive healthcare efficiency and quality.

After Berlucchi had asked Dr. Kirshner to come to ACH and recommend improvements to its cardiac care offerings, Dr. Kirshner found that for those in Auburn and Cayuga County, the risk of dying from heart disease is significantly higher than other parts of the state. He thus identified the need for a comprehensive cardiac care center at ACH, and the idea for the Auburn Heart Institute was born. The Heart Institute will offer many cardiac care services, from diagnostic testing to a cardiac catheterization laboratory, and the longterm vision is to perform procedures and surgeries at the facility.

Dr. Kirshner stated that he’s looking forward to continuing to build a strong team at the Heart Institute. “I’m excited about the opportunity to develop a world‐class heart institute in close collaboration with my colleagues and this community. We’re going to start out with the highest quality and that will be our North Star. Our goal is to make the Auburn Heart Institute a healthcare destination for cardiac care in Upstate New York. I’m committed to recruiting world-class cardiologists and other cardiac professionals to join our multidisciplinary team,” he said.

ENHANCEMENTS IN ORTHOPEDICS, NURSING AND MORE
Exciting new developments at ACH are certainly not limited to cancer and cardiac care. In the realm of orthopedic care, Dr. Daniel Alexander joined Auburn Orthopedic Specialists (AOS) in October of 2022, and he has over 20 years of experience performing more than 20,000 surgeries. He is laser focused on continuing to build a “patient first” orthopedic practice at ACH. “The team at AOS has built a first-class orthopedic practice, and I look forward to helping them grow this practice. All the surgeons in the AOS practice are doing remarkable work, and I’m impressed with the investments Auburn Community Hospital leadership has made in new technology to allow this practice to grow and serve this community. I’m excited, too, about working with our  local physicians and those healthcare professionals who are doing remarkable work in our operating rooms and in the various service areas offered throughout our healthcare system,” he stated.

Another important addition to the team at ACH is Dr. James Syrett, who joined the hospital in May of 2023 as the Chief Medical Officer. Board certified in both Emergency Medicine and EMS Medicine, Dr. Syrett has become only the third physician within a 100 mile radius of Auburn to be certified by ImPACT Applications Inc., a leading provider of concussion management tools, which helps ensure healthcare providers have the necessary skills and knowledge to use the tools effectively. Utilizing his extensive experience in EMS and Emergency Medicine, as well as an interest in the emergency management of concussions. Dr Syrett will serve as the Medical Director of the new Auburn Concussion Clinic, which opened in October and is seeing patients next day when referred from other physicians. This gives patients immediate access to concussion specialists, which is unusual in this region.

The groundbreaking growth of service offerings at ACH, from orthopedics to cancer care, cardiac care, and emergency concussion management, is also bringing about excitement and a new vision for the hospital’s nursing staff. Led by Dr. Emily Brooks, DNP, RN, who joined the leadership team at ACH as the new Chief Nursing Officer in June of 2023, the nursing staff’s goal is to serve the surrounding community with the utmost compassion and highest quality of  evidence-based care.

“We’re creating a culture of nursing excellence at Auburn Community Hospital,” Dr. Brooks explained. “We’re creating the best place for nurses to work in a healthy work environment. This will create a nursing workforce committed to delivering the very best evidence-based care. For every patient that comes into our hospital, the goal is to be able to care for them here, in their community. As such, we have developed the very first Auburn Community Hospital Nursing Strategic Plan. The focus is quality, patient experience, excellence, and nursing performance.”

BUILDING ON CURRENT GROWTH FOR FUTURE SUCCESS
Certainly, the focus on providing highquality health care for patients right in their own community that Dr. Brooks emphasized is already having an immensely positive impact.

Looking to the future, Berlucchi has a vision for ACH to build on this success in the surrounding community and partner with other area hospitals to better serve patients throughout the wider region, as well.

“We want to work with the other central New York hospitals to become more of a regional health care hub that partners to provide care for the growing population, in particular the increased healthcare needs of employees and family members of Micron when that ramps up. I’m also very concerned about the lack of sufficient mental health care in our area and plan on working with NYS, Cayuga County Health Department, and the other hospitals to develop a comprehensive plan to  serve the needs of those suffering from mental health challenges and addiction,” said Berlucchi.

However, for Berlucchi and the rest of the team at ACH, there is no limit
to how far ACH’s reach will extend and how many patients’ lives will be positively affected by the quality care being offered. “What’s happening right here in Auburn is that we are working together with our community, regional partners and our State and Local governments to build the model for rural community hospitals,'” Berlucchi said. “We’ll take care of Auburn. We’ll take care of Cayuga County. But mark my words, you’ll see a region that is growing and we are going to see the whole region coming to Auburn for the level of care that we’re providing.”

“What’s happening right here in Auburn is that we are working together with our community, regional partners and our State and Local governments to build the model for rural community hospitals,’” Berlucchi said. “We’ll take care of Auburn. We’ll take care of Cayuga County. But mark my words, you’ll see a region that is growing and we are going to see the whole region coming to Auburn for the level of care that we’re providing.”

 

Artificial Intellegence

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BY KATHRYN RUSCITTO, ADVISOR

We are planning a Heritage trip and have spent hours doing research. My daughter pulled up Chat GPT, gave it a few directions and in 30 seconds it listed an itinerary, things to visit, and lots of other info for consideration.

In a moment it became clear to me how Artificial Intelligence can augment my work. I still had to decide who, what, where, and when, but AI took the data that exists, boiled it down and gave me options to start with. It saved time, and while not perfect, gave me info I had not looked at prior.

Can AI do the same thing in health care? From chronic illness , to assisting in the development of new devices and drugs, can AI supplement clinicians work flow? Can it review charts and data, predict at risk patients, and match patients to treatments?

The current use of AI in some phone processes, has proven to be a barrier when a question did not fit the algorithms. In time, those early designs will be improved. For AI to work in health care, it needs to be integrated into clinician workflows, not added as yet another step. The debate about AI replacing human decisions is concerning and deserves consideration. But more likely it will free the workforce from analytical tasks and move to higher level thinking. In addition, other concerns relate to the bias of the data. But the advancement of AI will likely be similar to the integration of computers, smart phones and laptops into our daily lives. They didn’t replace humans, but a human without a smart phone or laptop does not have the advantages in easily accessing info and education. If AI can improve care for patients, by adding to the analytical knowledge of clinicians in an era of accelerated information and inventions, it will advance care.

I looked for some examples where AI is integrated in health care and found specialists are using AI in nephrology and cancer treatments. “Penny” at UPenn is helping clinicians with complex patients between visits, “The technology has the potential to improve patient health by guiding them through complex medication schedules, keeping clinicians routinely updated about a patient’s condition, and enabling clinicians to step in at early signs of trouble.” h t t p s : / / w w w. a a m c . o r g / n e w s / how-ai-helping-doctors communicate- patients.

Additionally there are many applications already in use for detecting disease through programs that analyze bacteria, and other disease criteria to lead to diagnosis and treatment in radiology, pathology and cancer treatments.

For clinicians to be comfortable with machine learning, or language learning that reads patient records and integrates info to recommend treatment, they will want a clear understanding of the quality of the ap’s learning. Also, it’s track record in making accurate diagnosis, and their ability to integrate their own clinical history and knowledge. The AMA cautions clinicians about bias and inaccuracy in todays AI algorithms, but notes it will continue to improve and tomorrows physicians will see a reduction in paperwork burden and back room operations from chart reviews to billing. https://www.ama assn.org/practice management/ digital/why generative-ai-chatgpt cannot- replace-physicians

In the past 100 years we have moved from an agrarian society, to an industrial society, to an age of information. We have now entered what is being called the age of knowledge, or the creative age. Understanding AI’s potential is our best advantage to adapting it in applications for health care.

Resources: https://www.jnj.com/inno ation/artificial-intelligence- in-healthcare &utm_source=goog

AI Won’t Replace Humans https://hbr.org/2023/08/a -wont-replace-humans- but-humans-with-ai-will replace-humans- without-ai

The Current State of AI in Healthcare: https://healthtechmagazin .net/article/2022/12/ ai-healthcare-2023-ml-nlp more-perfco

Kathryn Ruscitto, Advisor, can be reached at linkedin.com/in/kathrynru citto or at krusct@gmail.com

 

Corporate Transparency Act

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On January 1, 2024, a new federal law, the Corporate Transparency Act (“CTA”), will go into effect. The main purpose of the CTA is to crack down on the proliferation of shell companies used as shields in money laundering, tax avoidance, and similar activities. However, the new reporting requirements will also compel most businesses created by filing documents with the Secretary of State to provide the information outlined in the CTA. Any business entity that must report to FinCEN is called a “reporting company” in the language of the CTA. The information will have to be reported to the Financial Crime Enforcement Network (“FinCEN”), which is part of the Department of Treasury.

There are three main parts to the new reporting requirements: beneficial ownership information (“BOI”), company applicants, and information about the reporting company itself. Reporting companies must submit the information of everyone possessing beneficial ownership. A beneficial owner is defined in the CTA as an “individual who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, exercises substantial control over the entity, or owns or controls 25 percent or more of the ownership interests of the entity or receives substantial economic benefits from the assets of the entity.1” While owning or controlling over 25 percent of the business entity is fairly straightforward, the definition of “substantial control” is less obvious. Within the CTA, the definition of substantial control is expansive. It includes, but is not limited to, any senior officers of the company, persons having authority over the appointment or removal of any senior officer or a majority of board members, persons who direct or have substantial influence over important decisions made by the entity or have control over an intermediary entity that exercises substantial control over a reporting company. Since the definition of a beneficial owner is expansive, careful consideration will have to be given to make sure everyone who meets the definition of a beneficial owner has their BOI entered into the FinCEN site.

A “company applicant” is the individual who files the application with the Secretary of State and, in addition, the person who directs or controls the filing if more than one individual is involved. However, at least at this point in time, there can only be two company applicants. The company applicants might not be anyone who works  for or controls the reporting company in question. The company applicant could, for instance, be the lawyer and paralegal hired to help bring the entity into existence. The company applicant information will only have to be submitted once.

The reporting company will need to disclose its 1) legal name, 2) DBA names, 3) business address, 4) state of formation, and 5) Taxpayer Identification Number. The beneficial owners of the reporting company will have to disclose their 1) legal name, 2) date of birth, 3) residential address, 4) unique number from an acceptable document such as a U.S. passport, state ID, or driver’s license, and 5) an image of that document.

The company applicants will need to disclose the same information as the beneficial owners with one potential difference: if the company applicant is registering the company in the course of the applicant’s business, such as lawyers, paralegals, or others, then the business address of the law firm will be substituted for the residential address. Also, the company applicant information will be required only for business entities that are formed on or after Jan. 1, 2024. The BOI will be required of all entities that are reporting companies regardless of their date of formation.

Businesses already in existence on Jan. 1, 2024, will have one year to file an initial report. For Businesses formed on or after Jan. 1, 2024, and before Jan. 1, 2025, an initial report must be provided to FinCEN within ninety days of formation. On and after Jan. 1, 2025, businesses will have to submit the required information within thirty days of formation. Another thing to note is that changes in beneficial ownership will need to be filed. Any changes in ownership or changes in organizational structure will require subsequent filings to keep the BOI up-to-date. Certain businesses are exempt from the reporting requirement, but most of these businesses are those in heavily regulated areas of finance. Otherwise, the important exemption to note is the “large operating company.” To qualify as such, a company needs 1) more than 20 full-time employees, 2) more than 5 million dollars in gross receipts/sales in the US, and 3) a commercial, physical street address in the US. All three of these elements must be met. For example, a business that]  operates online with no commercial, physical street address will not qualify for the exemption even if it has more than 20 employees and over 5 million dollars in gross receipts or sales. The other exemptions will be listed at the end of this post. While this legislation has mostly flown under the radar and might come as a surprise to many business owners, there is still time to prepare the necessary information. CCBLaw is here to help answer any questions and assist your business to ensure compliance with the CTA. In the meantime, to avoid potential civil and criminal penalties, entities that will qualify as reporting companies should make determinations as to who will be considered a beneficial owner under the CTA and gather the necessary information to submit to the FinCEN portal once it is active. Importantly, reporting companies will also want to consider who will have the responsibility of updating any changes in BOI to FinCEN because, as addressed above, as beneficial ownership changes, BOI is required to be updated within 30 days of any such change.

More links:
FinCEN website Small Entity Compliance Guide FinCEN contact page

Benjamin Goldberg is an associate at CCB Law, a boutique law firm focused on providing counsel to physicians and healthcare professionals. He can be reached at 315-477-6214 or bgoldberg@ccblaw.com.

 

Physician Burnout A Healthcare Crisis Impacting Quality Of Care And Driving Medical Errors

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Although physician burnout is not a new phenomenon, it has been put in the spotlight recently due to its rise in frequency. A 2021 survey by the Mayo Clinic and Stanford Medicine noted that 62.8% of physicians experienced symptoms of burnout, up from 38% in the previous year.

While the crisis of COVID has dissipated and was a leading stressor, one could argue the effects are still lingering. For one, the continued questioning of science and proliferation of misinformation around medicine in general has created a rift in the physician-patient relationship. Additionally, physicians often point to the administrative obstacles brought on by changing governmental requirements as a key component to their increase in job dissatisfaction. The AMA
recently spoke out on the topic of prior authorization, noting it as an antiquated system that must be reformed and a key point of frustration for doctors.

Burnout can occur in any workplace, but for physicians and health networks, its impact on patient safety sparks a need for additional concern. For some time, the focus on patient safety has been placed on a system approach, but this ignores a key component. While putting these systems in place has clearly shown to be beneficial, one could argue these benefits are derailed by overwhelmed providers suffering the fatigue of burnout.

Dr. Daniel Tawfik, a lead author of a study published in the Mayo Clinic Proceedings, looked at systems versus physician burnout in contributing to errors. What he found was “…rates of medical errors tripled in medical work units, even those ranked as extremely safe if physicians working on that unit had high levels of burnout. “The correlation between physician burnout and potential errors is not surprising, and with the significant increase in physicians reporting struggles as noted above, we must support physicians in the functions of their daily practice to make an impact on decreasing medical errors. We all have a personal stake in setting up the structures to support our physicians, as the impact goes beyond staffing or financial concern, and to the heart of the quality of care goal that every provider and health system strives for daily. It is incumbent on administrators to encourage an open dialogue on mental health that supports colleagues checking in with each other. These efforts must go beyond a pat on the back, to a review of the systems in place cultivating the accelerated rates of burnout.

Multiple pain points contributed to the issue at hand that must be addressed. Solving this requires actions from the government, insurance carriers, the tech sector, and health systems to change workflow responsibilities, increase reimbursement, and eliminate redundant administrative tasks, allowing physicians to do what they are trained to do. The first thing we must do is listen to what our providers are telling us they need. I believe Jack Resineck, Jr., MD, former President of the AMA, said it best in speaking out for his fellow colleagues: “Physicians haven’t lost the will to do our jobs – we are just frustrated that our health care system is putting too many obstacles in the way.” This is a fixable problem that cannot be ignored.

Connect with Jenn Negley, Vice President, National Healthcare Practice at Risk Strategies at 267-251-2233 or jnegley@ risk-strategies.com

Growing in Strength: Expanding Upstate’s Heart Care Program

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By: Becca Taurisano

With an influx of new talent, Upstate University Hospital’s heart care program is growing stronger than ever. Bringing experience from some of the nation’s top medical facilities with formal training in specialties like structural interventional cardiology, the program is leveraging the knowledge and talents of the well established heart care team at the region’s only medical university. Upstate has assembled a dynamic group of providers that is expanding the program and offering comprehensive heart health care to Central New York.

Full Range of Services
The heart care program at Upstate University Hospital provides a full range of services—preventative, interventional, surgical, and post-operative. With six cardiology practices in the greater Syracuse area, the heart care team has increased accessibility to care and bolstered their footprint in the community. In addition to Upstate’s downtown Syracuse location, which includes the dedicated Heart and Vascular Center, cardiology consult services are available at Upstate Community Hospital as well.

The heart care team treats all health issues related to the heart including coronary artery disease, valvular heart disease, congestive heart failure, arrhythmias including atrial fibrillation, complex aortic disease including aneurysms, cardiac tumors, and the full spectrum of structural heart disease including closure of small holes in the heart. All the major cardiac surgical services are available, from open surgery to less invasive transcatheter procedures.

The physician team is composed up of cardiologists, cardiac surgeons, interventional cardiologists, a structural interventional cardiologist, electrophysiologists, and a cardiac critical care anesthesiologist who is the newest member of the team. They are supported by advanced practice providers (APPs), nurses, operating room staff, perfusionists, cardiac catheterization laboratory staff, anesthesiology staff, imaging staff, and Intensive Care Unit (ICU) staff.

Preventative education and postoperative treatment are both key components to the heart care program. For congestive heart failure patients, there is an educational support team located in Upstate’s downtown Syracuse location to help patients with lifestyle, dietary information, and support to keep them out of the hospital. This complements  the cardiac rehabilitation program at the Upstate Health Care Center in Syracuse.

Introducing Dr. Marek Polomsky, Cardiac Surgery

Cardiac surgeon Marek Polomsky, MD joined Upstate University Hospital this July as an Assistant Professor of Surgery and the Medical Director for Cardiac Critical Care. He is board-certified by the American Board of Surgery and the American Board of Thoracic Surgery and most recently was the Surgical Director of the Mechanical Circulatory Support Program and the Quality Chair for Cardiothoracic Surgery at the University of Vermont Medical Center. He was attracted to Upstate University Hospital’s status as a teaching hospital, with a long tradition of educating successful medical students and surgical residents and providing top cardiac surgical care, which supports his interest in teaching  and optimizing surgical performance and outcomes.

Cardiac surgeons at Upstate University Hospital benefit from a vast array of institutional resources. This can be found in the operating rooms which are equipped with the latest technology and supported by cardiac anesthesiologists proficient in the specific needs of heart patients such as utilization of transesophageal echocardiograms. “Whatever I need to do procedures, we have it here at Upstate,” said Dr. Polomsky. “The most important resource is our staff. The support from nurses, nurse practitioners, physician assistants, perfusionists, and laboratory technicians, makes this possible. The level of talent here is remarkable.”

Quality is a primary focus for Dr. Polomsky, both intraoperatively and postoperatively. He follows and has implemented protocols for Enhanced Recovery After Surgery (ERAS), through which Upstate optimizes postoperative care, such as weaning patients off ventilators and early extubation, minimizing blood transfusions, early mobilization, and focusing on nutrition. For Dr. Polomsky, compassion for his patients is paramount. “I treat each patient as if they were a member of my own family. I make sure they have the appropriate surgery that is based on medical evidence. That is what I am most proud of,” he said. “It is vital for our community to have a strong cardiac care program here, and there is a common goal among all of us for the program to grow.”

Introducing Dr. Michael Fischi, Interventional Cardiology

Michael Fischi, MD, FACC, FSCAI joined Upstate University Hospital in September 2022 as an interventional cardiologist. Using catheters to diagnose and treat heart and vascular conditions, allows patients to avoid open-heart surgery while providing life-saving results. Dr. Fischi has a background in electrical engineering and gravitates toward the tools and technologies utilized in transcatheter procedures. During his cardiology fellowship at Duke, he focused his research on cardiac assist devices, coronary interventional technology, drug-eluting stents and polymer delivery platforms. Dr. Fischi holds U.S. patents for a multi chamber sequentially inflating cardiac assist device, muscle function augmentation, and a novel percutaneous Left Ventricular Assist Device (LVAD). He also did a fellowship in coronary and peripheral vascular intervention at the University of Rochester, is a fellow of the American College of Cardiology, and is a fellow of the Society for Cardiovascular Angiography and Interventions.

The environment at Upstate University Hospital was a major draw for Dr. Fischi, with its focus on a heart care team that works well together and encourages learning to support patient care. “We have a nurturing environment here. People are encouraged to develop new skills and are not afraid to ask questions. Our staff is well-trained and equipped to handle emergent situations,” he said.

One of his focuses is on developing relationships with other area hospitals, primary care physicians, and external cardiology practices. “Referring physicians are looking to work with people who will provide their patients with quality care, inform them of the results of the procedure, and take care of their patients in a timely manner, without having to jump through a lot of hoops,” he said. “We are in the position to offer that to them here at Upstate.”

Team Approach to Patient Care

The cardiologists and cardiac surgeons at Upstate use a team approach, using direct communication and constant collaboration to ensure patients receive the best possible care. Larry Charlamb, MD, Interim Chief of Cardiology said, “The cardiac surgeons are our closest allies in treating patients. It is a natural allegiance for all of us to work together to provide care.” The cardiology and cardiac surgery teams confer regularly to discuss patient cases and develop the best treatment plan moving forward.

Cardiac surgeon Marek Polomsky, MD, said, “Every patient is discussed in a team setting and is cared for in a collaborative manner.” In addition, a joint cardiology, cardiac surgery, and vascular surgery conference meets once a month, where the heart care team shares perspectives on the diagnostic evaluation process, treatment, and outcomes of complex cardiovascular and aortic cases. There are echocardiogram, electrocardiogram (EKG/ECG), and cardiac catheter laboratory conferences conducted regularly as well.

Introducing Dr. Srikanth Yandrapalli, Structural Interventional Cardiology

Srikanth Yandrapalli, MD, FACC joined Upstate University Hospital this July as a Structural Interventional Cardiologist. Following his role as Chief Resident of Internal Medicine at New York Medical College at Westchester Medical Center, Dr. Yandrapalli completed three fellowships in cardiovascular diseases: interventional and structural cardiology at New York Medical College; Massachusetts General Hospital/Harvard Medical School; and Brown University Hospitals. He also worked as an interventional cardiologist at Brown University hospitals. He is board certified by the American Board of Internal Medicine in Internal Medicine, Cardiovascular diseases, and Interventional Cardiology.

Dr. Yandrapalli is one of the few formally trained structural interventional cardiologists in Central New York. Structural interventional cardiology is a specialized field that manages structural abnormalities or defects within the heart including the valves, the muscle, and the septum or chambers. It bridges the gap between surgery and medicine, allowing patients to receive treatment in a less invasive way.

For structural cardiology procedures, planning is essential and the first step is imaging. Utilizing CT Scan imaging and advanced perioperative transesophageal echocardiography with 3D technologies, the staff can create 3D models of the patient’s anatomy in order to determine the feasibility and approach to managing a structural heart condition. “This ensures a really good roadmap. I have to know what to expect so that we can provide safe and effective treatment to our patients,” Dr. Yandrapalli said.

Through his training, Dr. Yandrapalli has cultivated knowledge of the latest tools and technology. “I have learned not just how to do these procedures, but also how to navigate complications and risks that may arise, so we can more safely treat patients,” he said. Upstate University Hospital leadership is committed to providing advanced services and is focused on improving the access to the minimally invasive procedures Dr. Yandrapalli performs, including providing the latest technology available. “Technology plays a really important role in what I do. We want to offer the least invasive treatment available to our patients and we are committed to doing that at Upstate,” he said.

“The cardiac surgeons are our closest allies in treating patients. It is a natural allegiance for all of us to work together to provide care.”

Looking Ahead to the Future With a strong  foundation and the support of senior leadership, the heart program can continue to add new offerings to its service line. Upstate Medical University Department of Medicine Chair, Cynthia Taub, MD and Upstate University Hospital Chief Medical Officer, Amy Tucker, MD are both cardiologists with extensive background in clinical practice and program development. With leadership laser-focused on the prioritization of heart care, Upstate is positioned to see tremendous growth in the coming years by serving the needs of the community. “We are building on the strengths of the academic medical setting where we can offer an even greater range of cardiac services, such as the expertise needed for patients in our Cancer  Center whose treatment may affect the heart, or patients in our obstetrics/maternal fetal medicine program who have cardiac conditions during pregnancy. There is room to develop more preventative care and address care disparities. We have the system and expertise to offer that,” said Dr. Taub.

By developing relationships with regional hospitals, primary care physicians, and cardiology groups, Upstate looks to further expand its access. In the last year, catheter laboratory volume has increased by 50% and referrals have risen as well. Two of the cardiac catheter laboratories are being updated, featuring the most up-to-date technology available for the interventional cardiologists to perform transcatheter procedures. The heart care program also plans to recruit additional staff in several areas including electrophysiology, advanced cardiac imaging, advanced heart failure cardiology to expand access to services.

Private Equity in Health Care and the Impact on Non Profit Care

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BY KATHRYN RUSCITTO, ADVISOR

I have worked my entire career in government or nonprofits. It has led me to see the value of models that protect access to care for those who are underserved. The non profit model uses profits to re-invest in the provision of care in the community. Income is derived from profitable areas of care . Where the cost of care is not covered by insurance or there is no insurance, donors, grants and government subsidies often fill the gap.

For many years in New York State, regulations prevented private equity firms and for profit models to provide health care in some areas.

That’s changing.

Private equity seeks to make a profit. When a private equity firm buys a non profit provider or starts a new health care business, it’s expected to produce income for investors. It’s a common business model in this country.

At the same time we need to provide care to our communities that may not be profitable.

In Plunder, by Brendan Ballou, he provides a good analysis of the growing concerns about the impact of private equity in our society. The book looks at examples of private equity acquisitions in long-term care that drain income to other related corporations, leaving the non profit organization without resources to provide adequate care.

Another important study from the Columbia School of Public Health published this past July, was the first thorough review of global private equity ownership in medical settings. It stated, “Private equity investment was most closely associated with increases in costs for payers and patients in some cases as high as 32%. Private equity ownership was also associated with mixed to harmful effects on healthcare quality, while the impact on health outcomes and operations was inconclusive.”

So is one model preferable over the other, can they co exist or collaborate? Can the efficiencies from a private equity operation help not for profits find ways to reduce overhead for sustainability? Venture Philanthropy seeks to apply the principles of venture capital to achieve charitable objectives. There are several experiments going on where private capital invests in philanthropic goals such as Bain Capital’s , New Profit. Jeffrey Walker in the Stanford Innovation Review, March 2019 says private equity is showing that in order for nonprofits to succeed in this new financial environment they need to demonstrate better measurement of results, and management expertise. Investors are hands on advisors to a business and he suggests that donor expertise is often prevented from transferring their knowledge to the non profit setting.

This is a complicated arena , and one that could change the face of years of community care. Covid has placed great financial pressure on many large providers, and private equity acquisitions are adding to that financial pressure.

We need to continue to watch the impact in our communities of mergers, acquisitions and closures in health care and advocate on behalf of access and delivery of care.

Resources:

Plunder, Brendan Ballou, 2023, Public Affairs

Columbia School of Public Health Publichealth.columbia.edu

The Emerging Capital Markets for Non Profits, Kaplan and Grossmn, hbr.org

Stanford Social Innovation Review, ssir.org

Kathryn Ruscitto, Advisor, can be reached at linkedin.com/in/kathrynruscitto or at krusct@gmail.com

The Newest Member of the Syracuse Orthopedic Specialists Neck & Back TeamL Jessica Albanese, MD

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As the newest member of the Syracuse Orthopedic Specialists Neck & Back Team, Jessica Albanese MD brings nearly seven years of experience to the care of spinal conditions and injuries. Dr. Albanese received her bachelor’s degree from Arizona State University and earned her medical degree from the University of Nevada, Reno School of Medicine. She completed her residency at the Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas. Prior to joining SOS in August, Dr. Albanese completed a fellowship in adult spine surgery at the Duke University School of Medicine.

Q What orthopedic specialty do you practice?
Dr. Albanese: I diagnose and care for spinal conditions and injuries from age 12 and up. I treat a variety of spine disorders: degenerative conditions, such as scoliosis, stenosis, degenerative disk disease, deformity. Spinal infection and spinal tumors. Traumatic injuries— fractures and dislocations.

Q Why did you choose the spine?
Dr. Albanese: I actually started orthopedics wanting to treat trauma-fixing broken bones, fractures, acute injuries. But once I learned more about the orthopedic specialties, I discovered I like the spine. I thought the pathology of spinal injuries and conditions was really interesting. There are a lot of complex issues with the spine and a lot of ways to solve a problem. Then there is the surgery itself—I enjoy operating around the spinal cord and the nerves. There is a lot of innovation going on right now, so there are a lot of solutions we can offer patients.

Q Orthopedics in general is a very male-dominated field. In 2022, Medscape’s Physician Compensation Report found that the number of female orthopedic surgeons was at 9 percent. How do you feel about that?
Dr. Albanese: That’s actually starting to change. It’s important for patients to see more diversity, to have more options when seeking care. It’s exciting to be part of that change, growing the number of women in the field.

I’d like to help introduce The Perry Initiative (perryinitiative.org) locally. They offer a Medical Student Outreach Program that provides a hands-on introduction to orthopedic surgery for women in medical school. Participants are connected with local mentors and peers while completing two surgical simulations and participating in discussions. I hope to be a role model and show girls and young women that orthopedics is a viable option for them. Exposure is the largest limiting factor: If you don’t know the opportunity is there, you don’t know to pursue it.

Dr. Albanese is accepting new patients. Appointments can be made by calling 315 251-3232 or visiting sosbones.com to request an appointment.

Returning to CNY: As the Newest Surgeon on the Joint Replacement Team at SOS: David A. Quinzi, MD

David A. Quinzi, MD is returning toCentral New York as the newest surgeon on the Joint Replacement Team at Syracuse Orthopedic Specialists. Dr. Quinzi received his bachelor’s degree from Cornell University and earned his medical degree at Upstate Medical University in Syracuse. He completed his residency at the University of Rochester Medical Center and in July completed a one-year fellowship in adult reconstruction surgery at the Rothman Institute in New Jersey.

Q What type of orthopedic specialty do you practice?
Dr. Quinzi: I am a joint replacement surgeon for the hip and knee, performing joint replacement for hip and knee arthritis whether for general wear and tear or other reasons such as post traumatic arthritis. I also perform revision hip and knee arthroplasty for dysfunction or wear of previously replaced joints. I think that joint replacement as a sub-specialty has an innate ability to get people active again and doing what they like to do. Arthritis is a big quality of life killer, and giving people new joints is a great way to get people active and back to enjoying life and the things they like to do.

Overall, knee arthritis is more common than arthritis in the hip, although both are prevalent. The bulk of joint replacement surgeries are performed for arthritis whether it’s standard wear and tear (think tires wearing out), or arthritis related to previous trauma. Avascular necrosis can cause joint collapse and pain as well.

Q How has robotic technology changed the way you perform surgeries?
Dr. Quinzi: Robotics is the more modern way to perform knee replacements. It was available toward the mid-portion of my residency, and in fellowship it was a large portion of my training. Fifty percent of the knee replacements I performed used robotic technology. I think it adds benefit in patients that have arthritis with significant deformities. It further helps with planning how a surgeon will perform the surgery and allows you to more accurately rotate the components for a more “patient” specific technique.

Q Are there other ways joint replacement surgery has changed?
Dr. Quinzi: There are multiple approaches to hip replacement— posterior, anterior and lateral—and there has been a shift towards the anterior approach overall which is the approach I utilize. With the direct anterior approach you use a pathway between muscle planes so you don’t cut muscles which I think helps with early recovery. It’s also easy to obtain x rays intraoperatively, which helps with positioning and sizing the components as well as leg length restoration.

Q Do you have a philosophy about patient care you’d like to share?
Dr. Quinzi: Medicine today can be very mechanical and robotic. I try to keep it
very conversational with my patients. I like to talk about their day-to-day activities and find commonalities with them. I treat their conditions with those activities in mind. I try to stay away from typing notes while I’m with the patient and make it more informal.

Q You are from Upstate New York. Where did you grow up and why did you decide to return?

Dr. Quinzi: I from Rochester and my wife is from Fayetteville. We attended medical school for four years here at Upstate Medical University. She’s an anesthesiologist and we were lucky enough to couples-match together at the University of Rochester Medical Center. We love it here, so we decided to come back, settle down and raise our family. We just had a baby in August and we have another daughter who is 2 1/2. My wife is taking a little time off and will start back to work in November as an anesthesiologist in town.

Dr. Quinzi is accepting new patients. Appointments can be scheduled by calling 315 251-3100, extension 9814 or by visiting sosbones.com to request an appointment.

Grieving Families Act: Necessary Adjustment to an Antiquated Statute or Disastrous for New York Health Care?

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Round two of the Grieving Families Act has slight changes but is substantially the same one vetoed by Gov. Kathy Hochul earlier this year, citing the need to evaluate the “impact of these massive changes to the economy, small businesses, individuals, the state’s complex healthcare system.”

The sponsors wrote in their justification on NYSenate.gov, “New York’s wrongful death statute is over 175 years old, and it is unfortunately out of step with nearly every other state because New York’s laws prohibit grief-stricken families from recovering damages for their emotional suffering from the death of their loved one.”

The current law, which awards compensation for pecuniary loss only, impacts most harshly on children, seniors, women and people of color – people who often have no income, significantly less income or who have been traditionally undervalued in our society.

How does the act change the current wrongful death statute? The act changes who can file suit from relatives in line for direct inheritance to include those with a close relationship to the decedent. Clearly, it greatly expands those given the right to sue with little clarification on the definition of “close relationship.” Also, lawsuits previously included a single request for compensation tied to economic damages; now grief, loss of consortium and sympathy may be included.

While proponents note that the emotional component is part of most other states’ wrongful death statutes, it neglects the fact that, unlike the Grieving Families Act, most states have a cap on this type of compensation. With no cap, quantifying grief will lead to astronomical payouts. Adding to the speed at which these payouts will come to fruition, the changes will be applied to any cause of action that accrues after July 1, 2018.

Although one can see the merits of the justification noted above, it ignores the realities of its impact on the state. The state leading in claims and payout amounts will be a windfall for plaintiffs’ attorneys. Malpractice carriers are already struggling with upticks in claim frequency and the dramatic rise in award amounts. The act will add to the pressures already in play. To maintain solvency, carriers and the Insurance Department will keep a close eye on
these trends, which might indicate the
need for increased rates.

As we all know, the healthcare sector in some ways is still recovering economically. The margins that most hospitals and small practices operate under are often slim. Any increase will have a significant impact on the ability of dedicated healthcare workers to provide quality care. The sad truth is that underserved or undervalued individuals – the ones the act intends to help – will be the ones to suffer disproportionately from the misguided attempts to correct the current statute.

Most involved feel the act will be approved by Gov. Hochul in some form; it is such a high-profile legislation that garners a great deal of sympathy, and it is incumbent upon everyone to reach out to ensure any change is done in a manner that will not harm those it is meant to help. I leave you with this final thought from New York State Medical Society President Paul A. Pipia, M.D.

“We urge Gov. Hochul to veto this legislation again and call for the creation of a workgroup that can develop balanced legislation that will expand the rights of grieving families without devastating our healthcare system in the process.”

I encourage you to reach out to Gov. Hochul (@govkathyhochul) on Facebook, Twitter and Instagram.

For more information, please contact Jenn Negley, Vice President, Risk Strategies Company at 267 251-2233 or JNegley@ Risk-Strategies.com.

Syracuse Community Health: Continued Expansion Under New Leadership

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Over the past five-and-a-half years, Syracuse Community Health has undergone significant change and laid the groundwork for exciting transformations still to come. Led by Mark Hall, who joined Syracuse Community Health as interim President and CEO in 2018 and came on full-time in 2019, the health care organization has been serving the Syracuse community since the 1960s. With Hall at the helm over the past several years, Syracuse Community Health has begun efforts to expand care into surrounding areas in Onondaga County, is nearing the completion of a brand-new, state-of-the-art building and is planning a family medicine residency program, all while maintaining the central mission of serving patients and those who have difficulty accessing quality health care.

This year will mark the beginning of another new chapter for Syracuse Community Health when Keith Cuttler takes over as President and CEO on November 1. Cuttler joined Syracuse Community Health in 2021 as Chief Operating Officer and also took over the role of Chief Business Development Officer in 2022. His over twenty years of experience working in health care has included leadership roles at several local hospitals, including serving as the President and CEO of East Hill Medical Center in Auburn, NY.

As Hall prepares to hand over the baton to Cuttler, he outlined the achievements from his tenure at Syracuse Community Health (SCH) that have laid the groundwork for continued growth and success for the organization under Cuttler’s leadership, to expand its footprint throughout Onondaga County.

“One success we’ve experienced over the past several years has been the financial turnaround. A little over five years ago, we were in a dire financial position, but now we’re very much on solid footing. Secondly, we’re excited to see the fruition of our plans to construct a new building at 930 South Salina Street, which will be opening to the public over the next month. Thirdly, we have pulled together a strong management and senior executive team, which includes Keith, who we were blessed to have join us almost two years ago. SCH now has a great foundation on which to grow under Keith’s leadership,” said Hall.

Evolving Care Through New Construction and a Residency Program

As a Federally Qualified Health Center (FQHC), Syracuse Community Health centers around a mission to provide individuals with access to quality health care services. While never losing sight of this foundational purpose, Cuttler is looking forward to continuing the growth of the organization that was initially spearheaded by Hall. “I’m excited to continue efforts toward providing access to quality care to a much larger population than has traditionally been the case. There’s strong recognition that there are folks all over Onondaga County and in Central New York that are suffering from poverty. We don’t just have poverty located within three small zip codes and everyone outside those zip codes is in the middle or upper class. We have poverty everywhere and people who need access to health care everywhere,” Cuttler explained. 

The brand-new, state-of-the-art medical facility opening soon at 930 South Salina Street is the first major component of Syracuse Community Health’s expansion into offering care to a wider population in need of health services. Looking further down the road, the planned Family Medicine Residency Program that will begin in 2024 will transform Syracuse Community Health into a teaching health center where primary care physicians will receive specialized experience from learning at a Federally Qualified Health Center. For Cuttler, these developments at Syracuse Community Health will launch the health center into a new stage in its evolution.

“The opening of the new building at 930 South Salina Street is effectively turning a page and starting a new chapter for Syracuse Community Health,” Cuttler said. “It is there that we show the greater community that Syracuse Community Health is an ambulatory care provider that’s multi-disciplinary and provides extraordinary health care in an exceptional environment with stateof- the art equipment. Beyond that, we’re very excited about the new residency program and about the transformation of the organization into a teaching health center. I believe we’ll be only the third teaching FQHC in the State, and we’ll be the primary trainers of family medicine physicians going forward. Both the new building and the upcoming residency program give us that leg up and that opportunity to really open up our services to a much broader audience.” 

A Continuum of Success into the Future 

Cuttler emphasized that although these changes are publicly taking place alongside a shift in leadership at Syracuse Community Health, the outcomes are by no means resulting from the transition of Hall to himself as President and CEO. 

“It’s sort of like growing a plant: you plant a seed and the roots grow first, but it’s only later that you see the flower come up. What the public will begin to see as we transition leadership has actually been growing and taking place over the last five plus years, and particularly with the new building. Those plans languished on a shelf for years and years and Mark was the one that gave that project life. We wouldn’t be opening a new building next month if he hadn’t made executing on those plans a priority,” Cuttler stated. 

As for Hall, he isn’t retiring, but rather shifting his focus back to the business he created 18 years ago, M.S. Hall + Associates. Even though he’s resigning from his official role at SCH, his connection with Syracuse Community Health is one that won’t be completely ending anytime soon. 

“My connection to the health center will always be strong, being that this is where I received care when I was a child when my parents would bring me here,” said Hall. “I’ll always be connected, whether directly or indirectly, formally or informally as we move into the future.”