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Women In Healthcare- Setting No Limits: Recognize Your Dreams and Make Them Your Reality

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By Erin L.W. Zacholl

Swans move across water with such dignity and (what appears to be) effortless ability that it’s easy to admire what they achieve as they glide to their destination. Unless we really ponder what’s being done beneath the surface, we rarely see the hard work that’s propelling them. There are people among us with this same amazing trait. Dr. Tanya Paul is a shining example of someone with a calm and dignified quality that’s perfectly blended with a tenacious spirit that drives her to achieve her goals and then, set new ones.

Dr. Paul is a physician specializing in Obstetrics & Gynecology at Auburn Community Hospital. “Anything is possible if you want to work for it,” she says from a lifetime of experience. “Even as a young child, I have worked toward the direction of accomplishing my dreams.” Originally from Queens, New York, Dr. Paul graduated from the University of Virginia School of Medicine and completed her internship and residency at SUNY Upstate Medical University in Syracuse. “I knew from a very young age that medicine would be a large part of my future,” Dr. Paul reflects on the dreams of a school-aged child, “Although the type of medicine I’ve built my career on is different from my childhood goals, I knew I would become a doctor.”

“My medical ambitions began when I lost two grandparents in one year to cancer,” Dr. Paul remembers that this impacted her so profoundly, that she wanted to cure cancer. “I was so young, but this childhood tragedy opened my mind to practicing medicine. I was determined.” As a young girl, her medical direction would change, “When I was in 5th grade, a friend of mine endured a serious eye injury,” she details, “after seeing her appearance as she had been treated and was recovering, I wanted to be an eye doctor.” It was this dream that Dr. Paul clung close to through the rest of her adolescence and even through her medical school interview.

In medical school, Dr. Paul entertained her various rotations as a young student. “I kept an open mind to possibilities beyond my long-time dream, but was still focused on ophthalmology.” On her first night during her rotation in obstetrics, however, everything changed. “On that very first night, I was able to assist in the delivery of a baby,” she remembers with joy, “and that was it! Being a part of delivering that new life and interacting with the mother sparked a fire in me.” Dr. Paul recounts that everything about obstetrics and women’s medicine was interesting to her from that first night, “I followed through with my other rotations, including satisfying my life-dream of ophthalmology, but I knew being an OB/GYN was where my heart was leading me. Helping women through all the changes in their lives is where I belong.”

As a general obstetrician and gynecologist, Dr. Paul has more than 20 years of experience specializing in comprehensive health care in women of all ages. She is certified by the American Board of Obstetrics and Gynecology and prides her work on providing quality and compassionate care. “As important as my work is in serving medical care to my patients,” Dr. Paul says, “empowering women to take an active role in their healthcare is equally important. It’s so important for women to be healthy and to be heard. If I can help empower women to speak up for themselves, then I’ve been successful.” She says, “there is no distinct blueprint as an OB/GYN and every patient / woman deserves to be heard.”

Her confident and kind demeanor radiates in her voice. Dr. Paul’s ambitions have always been from a place of deep compassion. “I was the first person in my family to graduate college,” she says, “helping other women care for themselves is just part of my goal. Women, who come from a humble place, don’t always see their value and potential. If I can help boost them to realize not just their potential, but help them find the direction to their goals, then I’ve done my job.”

Identifying her own ambitions and reaching past them has always been the motor driving Dr. Paul. Throughout her entire career, she has taken on leadership roles including being the president of the medical staff at Auburn for two years. “I’ve been able to attain my goals and often strive beyond them, because of my support system,” Dr. Paul credits the strength of community. “It is important to have your community around you, to help you fill the gaps. Even if it’s a community of one, a strong support system is essential for all of us to boost ourselves toward our dreams.”

She also believes that what individuals need changes at different points in life and that it’s important to recognize change. “Throughout my career, when I take a job, I make sure that it fits into my life at that time,” Dr. Paul says, “Every person needs to figure out what works best for them where they are in their lives.”

As a physician, Dr. Paul loves the patient interactions the most. “When patients open up to me and I can humanize medicine to them, it’s very rewarding,” she says. “I try to give everyone a voice. Everyone wants to be, and should be, heard.” Dr. Paul believes that a person’s mental health is important in all aspects of medicine, “All doctors should encourage mental health as one of the standard check ups, like visiting the dentist or going for an annual physical.” She believes that all patients would be able to advocate best for themselves if mental health checkups were more universally practiced.

With so much already accomplished in her career, Dr. Paul continues to look forward, “There are always new goals in my scope,” she says, “I ask myself; how can I have the best impact on my community?” Right now, the answer to that self inquiry is her desire to help lower the Maternal Morbidity and Mortality Rate in our CNY Community. “This is such a large problem, and I want to be able to help our most vulnerable mothers.” Another career goal she has in her sight is truly assisting women transition through menopause and perimenopause with a healthy mindset and with accurate information. “This is an aspect of women’s medicine that is so unique to each patient that it’s difficult to generalize and yet, that’s what happens all too often.”

For Dr. Paul, the circumstances may change a bit, but she says, “What has allowed me to be who I am, at all stages of my life and career, is my strong faith and my amazing support system which includes my husband, three sons and extended family as well as the community that I live in. Raising my sons and seeing them grow into strong, compassionate young men is a tremendous inspiration. I feel blessed to have such a source of strength in my life. Everyone needs support to move ahead in life and I only hope that I can help those that need it the most, find it.”

Rome Health Here. Delivering the Best Care Out There.

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By Tami S. Scott

Rome Health is making positive and significant changes to local, community based healthcare. By investing in new technology and a comprehensive master facility plan, the hospital is prepared to deliver the best care “here” — in Rome, N.Y. – so local patients can stay local.

Now in the final phases of a years-long master facility plan, administrators will soon see the fruits of their labor come to life with the construction of a 30,000 square-foot, three-floor modernized addition that will replace the hospital’s current operating rooms and intensive care unit.

Its advancements in new technology, including the Da Vinci Xi surgical system, the 7D Image-guided surgical system for spine care, and EUS and ERCP equipment for GI purposes, benefit both surgeons and patients, particularly those with complex cases. And with its recent expansion of gastroenterology services, patient needs will be fully met without the hassle of long distance travel or months-long waiting periods.

“Our goal was to match the skill set of our physicians with the desire of our community to receive local healthcare here, and match that with the technology we have available to them to provide those services,” said Chief Medical Officer Cristian Andrade, MD.

A new surgical center and intensive care unit
The new Kaplan Center for Surgical Services (named in honor of philanthropists Charles and Florence Kaplan) will be transformed from its existing design to a contemporary, stateof- the-art surgical center with four new operating rooms, two new procedure rooms, and a pre- and post-op area that will be located directly next to the ORs — important for not only flow of care but also patient satisfaction, said 

Chief Operating Officer Ryan Thompson, MBA, FACHE. The front entrance, lobby and waiting room are also being
remade.

Construction will be completed in three phases. The addition for the ORs and ICU is under construction and will be open in mid-2025. In the second phase, the old ORs will be repurposed for pre-op and post-op space. The third phase creates staff support space and will be complete by mid-2026.

“When we make facility changes in our design, we really focus on making sure that we’re finding the balance first and foremost of how it’s going to impact the patient,” Thompson said. “Second, how it’s going to work for the teams that are providing care, including the physicians and advanced practice clinicians and nurses, and even the workflow of our environmental services staff. And then third, to make sure that staff has a space they can go to provide respite during the day, as they’re very busy providing care.”

The new nine-bed ICU considers all aspects of patient and care team needs. Among the highlights are larger individual rooms to accommodate not only the critical care team and necessary equipment but also family members so they too can participate in their loved one’s healing journey.

“We all know that family participation and loved ones’ care lends itself to better patient outcomes,” said Acute Care Director Kelly West, R.N., B.S.N. “And that’s very important to us.”

The rooms also boast specialty beds to reduce the risk of pressure wounds, specialty rooms for behavioral health population, private restrooms with accessibility features, an advanced ventilation system for infection control, more natural daylight to aid in healing, and charting located at pods adjacent to the bedside to allow for closer connection with the patient.

King + King Architects and Haynor Hoyt Corporation built a mockup of the ICU and the OR in the hospital garage so staff could experience what the rooms would look like and how large they would be. “We put the outlets on the walls where we wanted them, we put monitors on the walls where we would want them,” said Vicki Weiss, R.N., OR nurse manager. “Some of the small things that you wouldn’t think were important are so important to the staff.”

The $45.7 million capital project is being funded through a partnership of more than $29 million in public funding and private philanthropy, including a $26 million New York State Transformation Grant and $3 million in ARPA funds from the City of Rome. The Rome Health Foundation kicked off the public phase of the capital campaign in January with $14.2 million already raised. The goal is to raise $16.5 million.

“We’re about a million and a half dollars away from hitting that overall goal,” Thompson said. “It’s just tremendous support from the community to be able to hit that.”

Advanced technology, gastroenterology services

“The DaVinci Xi Surgical System was among the first new pieces of equipment that Rome Health acquired and was very well received by our medical staff colleagues,” said Chief Medical Officer Cristian Andrade, MD. The goal was to get staff trained and able to utilize the robot well before the new surgical center is open, and the plan “went seamlessly,” he said. “We had our first non-proctored surgery with robotic assistance performed on June 12 by our general surgeon, Dr. [Keneth] Hall,” — also a bariatric surgeon.

Since then, Rome Health has equipped other general surgeons and gynecologists to perform robotic assisted surgery. “We will likely be doing some urologic procedures in the near future as well,” Dr. Andrade added.

Dr. Hall explained the benefits of robotic-assisted surgeries as enhancing surgical precision, control, and efficiency. “This advanced system enables smaller incisions, leading to reduced pain, scarring, and faster recovery times. It also decreases the risk of complications and improves surgical outcomes,” he said. “The robot’s capabilities streamline surgeries, allowing for more efficient use of operating room time and potentially increasing patient throughput.”

General surgeon Dr. Samuel Molica, DO is hopeful that the advanced technology will prevent the more difficult minimally invasive procedures from being converted to open.

The same benefits and even more apply to the 7D Image-guided surgical system for spinal surgeries.

“The advantages we have received from using the 7D technology is that infection rates are minimal to non existent and patients who may have been at high risk now have the opportunity to receive the needed surgery due to the smaller incisions and how minimally invasive the procedure can be,” said Dr. Nicholas Qandah (aka Dr. Q), a leading back and spine surgeon in the CNY region.

Rome Health administrators also found a way to combat the regional shortage of gastroenterologists by establishing a GI practice this past spring at the Medical Center on the main campus of the hospital.

“When we got together as an administrative team to develop a physician development plan, it became very clear from a community needs assessment that there was a significant need for gastroenterology services to be provided here locally,” Dr. Andrade said. “If you look at that specific specialty, lots of times, patients here would have to be transferred sometimes two or three hours away to be able to get the level of care we’re going to be able to provide right here at home.”

Rome Health recruited two board certified gastroenterologists, Dr. Aamer Mirza, MD, who has been practicing for more than 24 years, and most recently Dr. W. Asher Wolf, MD. “They’ve been very well-received by the community. We’ve already seen the demand for their services skyrocket,” Dr. Andrade said. Dr. Wolf ’s advanced background includes providing patients with endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) services. Consequently, Rome Health invested in the equipment to perform these procedures.

“There’s only a handful of other gastroenterologists in the Central New York region that provide these procedures,” Dr. Andrade said. Additionally, with Dr. Wolf on board, Rome Health is now offering weekend appointments for colonoscopies, providing greater accessibility and convenience for patients.

Keeping it local

Rome Health decided long ago to set its sights on the needs and wants of its community — to have access to the best physicians with advanced technology — locally.

“When we decided to acquire these different technologies, first of all, the patient was at the center of it, really keeping in mind what the desire for the community has been, and [it] really has been to receive quality care right here at home,” Dr. Andrade said. Dr. Qandah drove it home: “Our top priority is to bring ideal health care to our region. That way we can deliver the care locally and patients can get better quicker in their own home, in their own
community.” 

Nursing Work Force Shortages

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By: Kathryn Ruscitto,
Advisor

I was recently asked to moderate a panel in NYC sponsored by the Mother Cabrini Health Foundation , on the shortage in the nursing workforce.

Leaders from a variety of settings discussed the challenges facing nursing and the opportunities to improve recruitment and retention.

The Center for Workforce Studies specifically detailed options to address recruitment ranging from scholarships, and tuition assistance to nursing residencies, and mentors. Among retentions strategies were nursing councils within programs like Magnet and Pathways to Excellence. Clearly the demand for nurses is increasing and the challenges facing nurses are also increasing.

The issue that struck me the most listening to this panel was the dramatic increase in workplace violence. Many public facing employees in our society have seen an increase in violence, health professionals are seeing that same increase. There are no easy answers, but there are many research projects that have looked at the issues and have detailed violence prevention programs and interventions. Public Health Services have identified the same process model to be used across all violence prevention in areas from domestic violence to health care.

Fig. 1: 10 Essential Public Health Services
Currently the focus in most health settings is on training for assessing and managing risks, leading to reporting and assigning resources for the most at risk patients. One of the clearest messages from the panel was on leaders placing a priority on training, and reporting.

It is also not just nurses facing these challenges, but all those who are part of the health care team. Violence prevention training must be part of all onboarding and communications across the team must be ongoing.

Resolving conflict avoids violence and is a skill to learn for all aspects of life. Take any training offered and look for resources on conflict resolution, violence prevention, and policies. Syracuse University offers unique training through PARCC, the Program for the Advancement of Colloboration and Conflict Resolution.   https://www.maxwell.syr. edu/research/program-for-the-advancement- research-on-conflict-collaboration

Health professionals need our advocacy and support in bringing attention to these challenges. While we all must focus on first preventing violence, when it occurs action needs to be taken to protect health professionals in all settings.

Resources:
Center for Workforce Studies
https://www.chwsny.org/

NIH
https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC9536186/

Journal of Emergency Nursing
https://www.jenonline.org/article/S0099-
1767(23)00059-4/fulltext

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

5 Points Your Physician Employment Agreement Should Address Regarding Med Mal Coverage

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By: Jenn Negley

Physician employment agreement clauses regarding your medical malpractice coverage are complex issues that are often muddled at best, and some even create more questions than they would if they just didn’t deal with the important malpractice insurance issues. Confusion and ambiguous wording in contracts create lawsuits so fully understanding these five points will help immensely:

1. Who will be purchasing what coverage?

Most Physician employment agreements at least state if the employer or employed physician will be purchasing coverage. The issues go well beyond that, but most agreements only hit the broad-brush basics.

2. Retro coverage or not when joining a new practice?

Will retroactive coverage be purchased for the employed doctor’s possible previous exposure? If not, who will pay for the expensive “tail” coverage? If retroactive coverage is being brought into the new practice who will be paying the difference between the “mature” policy cost and a first-year claims-made policy cost? Tail coverage allows a physician to extend coverage after the cancellation of a claims made policy. With tail coverage, if a claim is filed that reflects the period of the expired policy, coverage is provided even though the policy is no longer in effect. An important portion of the employment agreement should address any professional liability insurance coverage that will be required, as well as which party will be responsible for acquiring and paying for the coverage. If the professional liability insurance is a “claims made” policy, then tail coverage needs to be addressed in the agreement as well in case of departure or termination.

3. What limits will be required to be purchased?

There are differing opinions on purchasing low or high liability limits so the physician employment agreement needs to address the limits issues, as well as situations in which the employed doctor might want higher limits than most in the group, which brings up if this will be allowed and, if so, who will pay for the increased costs of a higher limits policy.

4. Quality of insurance company:

To say the least, not all insurers are created equal and there are vastly different thoughts on the risks versus costs of purchasing coverage from a financially unstable insurer versus an A.M. Best toprated insurer.

5. Departing physician’s tail issues:

Will a tail purchase be required, or will it be acceptable to purchase continuing coverage, keeping the in-force retroactive coverage date for at least five years after leaving a group? Will the choice between those two depend upon termination with cause or not, and/or termination by which party? Since there is now a stand alone tail market, what quality of tail insurer is acceptable, and how long of a tail must be purchased, since even one year tails can be bought but do not begin to offer relief for the much longer liability risk window?

The physician employment  agreement should outline all these terms on whether the group or the individual physician is obligated to pay for and purchase these coverages. By clearly stating the expectations and requirements in the employment agreement there should be no question about what is expected surrounding the beginning, duration, and termination of the employment relationship. All parties in an employment agreement need to fully  educate themselves with a knowledgeable and experienced malpractice insurance expert to prevent any unrealized expectations or miscommunications about the key issues, and a misstep in this area can lead to coverage gaps or coverage issues which can lead to very costly legal actions.

Women In Healthcare Look For The Beacons: Building Hope Through Behavioral Health

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By Erin L.W. Zacholl

There is a special glimmer when you realize that you are in the presence of someone who didn’t necessarily find the right course in life but were simply placed on it. Perhaps by serendipity or fate, Stephanie Montgomery was led to a small path at an early age. She recognized its direction, worked hard, persevered over tough times and forged a mighty highway out of its humble start.

Stephanie is the Administrative Director of Behavioral Health at Syracuse Community Health. Her SCH career began almost 30 years ago when she served as the receptionist for the Counseling Addiction and Psychological Services (or CAPS) department of SCH. Every promotion she has earned since serving as receptionist was created for her. She has truly pioneered her own career while making opportunities for others to follow. “I firmly believe that all of us must stay focused and use what we have in front of us as an advantage, nota hurdle,” Stephanie speaks these words with a laser focus.

At an early age, she found herself the victim of domestic violence and used this experience as a building block, not a crushing boulder. “Syracuse Community Health was my safe place,” Stephanie recalls with accomplishment. “I used this period of my life to propel myself. I kept pulling myself up and that experience helps me with much of what we do in Behavioral Health.” Stephanie continued, “It’s not always easy, but we all must recognize our own strengths and stay committed. Keeping my word is so important; to the people I serve and to myself.”

Stephanie feels that is both her responsibility and honor to especially reach areas of our general population that are often misheard and misunderstood. “As a biracial woman, I understand what it’s like to feel connected to more than one place, but not necessarily feel grounded in either,” she speaks from the heart, “I am proud to help other biracial women, as well as others in our community who are most vulnerable. We all need to recognize our value and belonging, and SCH is such a wonderful platform for this purpose,” her words are spoken with a smile. “There is so much here to offer our community.”

Through her own journey at SCH, Stephanie attests that her years at SCH have seen, much change, yet much has also stayed the same. “While the stigma of mental health has alleviated over time, I would love to see it gone,” Stephanie reflects, “it’s still a roadblock.” When Stephanie speaks, her words are annunciated from such a place of solid experience, ,“When someone is diagnosed with cancer, there is no judgment when the patient needs help and treatment. Society needs to treat people facing addiction and mental illness the same as they would treat someone with a terminal disease.” She believes that the department title Behavioral Health helps integrate all the services the SCH offers while hopefully helping to eliminate the stigma associated with the “addiction” portion of CAPS. “The majority of addiction patients are navigating a deeper illness,” Stephanie says, “often, overdosing is a result of self-medicating for an underlying condition.” Through her decades at SCH, Stephanie has seen the, addiction crisis evolve from crack cocaine toward opioids. “It’s eye-opening when you look around,” she says, “mental health and the opioid addiction have exploded; waiting lists are long, but hope exists.”

Stephanie’s department at SCH offers a personalized approach to care and treatment. Their individualized method of care is respectful, educational and focuses on a person-centered journey. “We treat the whole person,” Stephanie explains the approach to SCH’s services. “It’s important to respect each person’s perspective by listening to them and by supporting  improvements in their mind, body and spiritual well-being.” She also stresses the importance of seeing someone in person. “Since COVID, there is such a shortage of mental health providers, social workers, marriage-family and crisis therapists.” Additionally, the pandemic found many providers with their own issues and unable to provide services to others. Since COVID, New York State has also started telehealth, services, to include mental health. While this helps broaden the possibilities for more people to seek help, Stephanie cautions that “many professionals went into private practice with the convenience of telehealth, even though providers really do need to see people in person (at least sometimes).”

The Behavioral Health Department at SCH is small and intimate, but large in the services offered and the accreditations of their team. “It’s important that our community understands all that is offered here,” Stephanie proudly states. “W are a unique behavioral health department with a team that specializes in Medication Assistance Treatment Services, Out-patient Addiction Services (inclusive of impaired driver assessments) as well as Individual and Family Therapy.” Stephanie says that she loves watching the transformation in people that are seeking help and pursuing help, “I was brought up here and to be able to work in such a place that is so patient focused and understanding about the populations we serve is a tremendous feeling.”

At SCH, Stephanie Montgomery makes every day intentional. “Did I do my best today?” she asks herself nightly. “I have gone through seasons of my careers at SCH and each one found me right where I needed to be,” reflecting on her years. “I feel so blessed to be part of this humbly wonderful team.” Stephanie is often asked how she balances her work and professional lives. In addition to her gratitude for the environment at SCH, she always replies, “My simple answer is Faith, Family and a good support system; no matter how large or small that system may be.”

Is Your Restrictive Covenant Still Enforceable?

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By: Sarah E. Steinmann

The Federal Trade Commission (“FTC”) made a big splash this spring when it published its Final Non-Compete Clause Rule (“Rule”), which bans most post-employment non-compete agreements between employers and workers.

The FTC issued the Rule under its authority to regulate “unfair restraints on trade and business” and intends for the Rule to open the door for new businesses, innovation, and increased wages for workers.

Until now, non-compete covenants have been governed by state law, with the scope and enforceability of such arrangements varying widely. The Rule—set to go into effect on September 4—will affect businesses nationwide and across industries, including those operating in the healthcare space.

Applicability
Most healthcare entities will be subject to the Rule, which applies to “all persons and private for profit business entities,” regardless of business structure. While non-profits are generally not subject to the Rule, the FTC will scrutinize non-profit corporations to determine “whether either the corporation or its members derive a profit.” If they do, the Rule will apply.

On the other hand, anyone who produces work for a business, including employees, independent contractors, interns, and even unpaid volunteers, is considered a “worker” protected under the Rule.

FTC Defines Non-Compete Clause
A non-compete agreement is a restrictive covenant that prevents a worker from working for or operating a business that is competitive with the employer after the worker ceases to work for the employer.

The Rule implements a broad definition of “non-compete clause” to include restrictions in employment agreements, workplace policies and even oral agreements between parties. Any term or condition of employment that “prohibits a worker from, penalizes a worker for, or functions to prevent a worker from” working for or operating a business after their employment with the employer ends is prohibited under the Rule.

The Rule also extends to other types of restrictive covenants such as non-disclosure and non solicitation agreements—if they have the same effect as a standard non-compete (i.e. if they prevent a worker from, or penalize a worker for, seeking or accepting work after their employment ends). Businesses that offer on-the-job training should be aware that training repayment agreements might be challenged under the Rule.

Exceptions
The Rule does not prohibit restrictions on workers during their employment, so a business can prevent workers from simultaneously working for their competitors. The Rule also allows noncompete restrictions between buyers and sellers of a business in connection with the sale of a business or an individual’s ownership interest.

Existing Covenants
The Rule is retroactive, so non  compete agreements made before September 4 between businesses and their workers will become unenforceable. 

One notable exception will allow businesses to enforce existing noncompetes against their senior executives. A “senior executive” is an employee who earns more than $151,164 per year, who is in a “policy-making position,” and who has “final authority” over decisions controlling a significant aspect of the business. For most physicians, the question of whether they are in a “policy making position” will be the most controversial in determining the enforceability of a restrictive covenant.

State Laws
Physicians and healthcare businesses may be familiar with existing state laws and regulations and shouldn’t assume they no longer apply. While the Rule supersedes existing state laws and regulations that conflict with it, states are free to regulate non, compete covenants outside the Rule’s scope.

Next Steps for Employers 

Employers will need to notify every worker subject to a non compete that it is no longer enforceable, so businesses should start identifying workers affected by the Rule. They should also start preparing the notices, which must be “on paper” and delivered personally or by mail, e mail, or text message. Businesses might also consider why they used noncompetes and how they might achieve their business aims within the bounds of the Rule.

Legal Challenges
Employers rushed to challenge the Rule in court, seeking injunctions to prevent it from going into effect. A federal judge in Texas issued a preliminary injunction temporarily halting implementation of the Rule and is expected to issue a final decision by August 30. In a separate case in Pennsylvania, the court rejected the employer’s request for an injunction. Businesses should keep an eye out for developments as the September 4 effective date approaches. Because of the pending litigation and the plethora of cases we expect to be filed in the coming months, ultimately, this is an issue that will probably reach the Supreme Court for a final determination. 

If you have questions about the enforceability of your restrictive covenants, it is crucial to act now to ensure your agreements are in full compliance with the FTC’s new Rule before the September 4 deadline. For questions, contact Lippes Mathias attorney Sarah E. Steinmann by phone at 315-477- 6232 or by email at ssteinmann@lippes.com.

Significant research for this piece was performed by Jennifer E. Forward, summer associate, Albany Law School (anticipated Class of 2025).

Cardiovascular Disease Research:One Phase Ahead of Alzheimer’s Studies?

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By: Robert C. Cupelo, MD Principal Investigator

For everyone involved in neurological disease research, the last two years have brought about major advances in our understanding of Alzheimer’s disease and related neurodegenerative disorders. Along with the discovery of new avenues for effective therapies, we now have, for the first time, proven disease modifying treatments. And as we acquire more options shown to be effective, we look forward to applying these tools and developing regimens not only to treat this disease, but also to prevent the very onset of its clinical manifestations.

But when it comes to the area of metabolic disorders and their role in causing cardiovascular disease, science is in an historical phase ahead. As someone who started his medical training in the late 1970s, I can attest to the lack of effective, convenient, and tolerable treatments for conditions like diabetes and hyperlipidemia at that time,relegating many patients to a life with relentless symptom progression, cardiac events and frequent essentially palliative surgical procedures. I can even remember a very respected and prominent cardiovascular surgeon who could predict with uncanny but somewhat sad accuracy when his successful bypass patients would be back in the OR requiring another procedure. With limited therapeutic options available, patients often endured a poor quality of life, many experiencing a feeling of helplessness, despite valiant efforts at lifestyle modification.

The release of lovastatin (Mevacor) in 1987 changed all that. The first statin to gain FDA approval, it was the first truly effective treatment for hypercholesterolemia. Actual statistical proof that it reduced cardiovascular events and surgeries would come a little later (it’s now required for approval of these medications), but we all knew from the start that this was a game changer. It could be said that it was, in effect, the first viable disease modifying medication for coronary artery disease. And in the years since, countless pharmaceutical advances have followed, treating not just elevated LDL cholesterol, but numerous other metabolic conditions which increased risk for cardiovascular disease, such as other dyslipidemia, type II diabetes, chronic renal disease, coagulation abnormalities, obesity, and acquired diseases of myocardial function.

We at Velocity Clinical Research Syracuse embrace the study of the prevention and treatment of metabolic and cardiovascular diseases with today’s therapeutic tools and ask, “How do we best help the further development of our current available medications, and how do we promote their best use both in primary (warding off the first event) and secondary (warding off subsequent events) prevention?” The dedicated and competent staff at our research site on Brittonfield Parkway have run and are actively running several studies in multiple, areas of metabolic disorders including two studies for hypertriglyceridemia, an oral PCSK9 inhibitor for patients with hypercholesterolemia at increased cardiovascular risk (currently in maintenance phase), a long-acting basal insulin dosed weekly, an oral GLP- 1 that is more effective and tolerable than currently available options, and several classes of injectable weight loss medications, assessing not only their efficacy with weight loss but also the metabolic consequences of the therapy.

As always, clinical research studies are fluid in nature, often starting and ending enrollment somewhat suddenly and unpredictably. So, if you have any interest in participating in this research, or would just like to know more about it, we encourage you to call us to learn of our latest developments. We can also keep you up to date on our ongoing efforts to study Alzheimer’s disease, another core focus at our site. Indeed, we look to a vision of the future when, just as we now have with metabolic disorders, we will have numerous and varied options available to people at risk of dementia and other neurodegenerative diseases.

At Velocity Syracuse, we encourage our Central New York medical community colleagues to keep us in mind as a dynamic and viable partner in your efforts to provide preventative care and treatment to your patients, including ones at elevated cardiovascular risk. And as always, we especially seek people from diverse backgrounds and those who are traditionally underserved, as they can potentially benefit in many ways from participation in clinical research. A culture of inclusion is especially vital to the accuracy and validity of our results.

Heart disease is still the number one cause of death for Americans, but our health care system has been making progress on this for quite a few years now. Let us at Velocity Clinical Research Syracuse help you and your patients keep that ball rolling.

Comprehensive Care Alliance: Enhancing Back Pain Management through a Full Spectrum Partnership

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Primary care physicians are familiar with diagnosing back pain. But when it comes to discerning the source of the pain and how to treat it, a referral to the physicians at Syracuse Orthopedic Specialists (SOS) and New York Spine & Wellness Center (NYS&WC) is often the next step. The medical groups are in partnership to provide a continuum of care, creating the most complete musculoskeletal group in Central New York and helping patients navigate through their back pain.

Chronic back pain, defined as lasting at least three months, accounts for the most common pain complaint among American adults, according to a 2019 study by the Centers for Disease Control and Prevention, afflicting 39 percent of patients. In 2023, the World Health Organization outlined these key points about low back pain:

  • It is the single leading cause of disability worldwide and the condition for which the greatest number of people may benefit from rehabilitation.
  • It can be experienced at any age, and most people experience it at least once in their life.
  • Prevalence increases with age up to 80 years, while the highest number of low back pain cases occurs at ages 50 to 55, and more prevalently with women.
  • Non-specific low back pain is its most common presentation (about 90 percent of cases).

Providers at both SOS and NYS&WC offer initial consultations to patients experiencing back pain. “It’s really important having a trusted partner because there are many sides to pain management,” said Jessica Albanese, MD, a spine surgeon with the SOS Neck and Back Team. “Between our two practices, we offer the full spectrum of interventions. Patients can begin care at either practice and providers will diagnose and navigate patients to the most appropriate specialist to support their treatment and recovery.”

“The best first step for a patient with back pain is to seek treatment and guidance from their primary care provider” shared Dr. Brendan McGinn a specialist in Anesthesiology and Interventional Pain Management at NYS&WC. “By having an initial consultation with their PCP, patients can most effectively take first steps to help manage their pain by trialing a nonsteroidal anti-inflammatory drug (NSAID) or an oral steroid, physical

 therapy, and then if it’s indicated, a referral to SOS or NYS&WC”.

Patients are also welcome to contact SOS and NYS&WC directly to request appointments. Both practices accept nearly all insurance types and do not require referrals unless the patient’s insurance company requires it.

Dr. Ryan McConn a specialist in Anesthesiology and Interventional Pain Management at NYS&WC shares, “The benefit of the close partnership between our two organizations is that patients have seamless access to both groups and the services they provide once within our doors. Each practice will consult patients and ensure care is given by the most appropriate provider.”

Upon initial consultation at either organization, patients may meet with a physician assistant, nurse practitioner, or physician. Each clinical team is highly trained, working in tandem to deliver specialized medical care to every patient.

Together, from initial consultation through treatment, clinicians focus on patient education. “A lot of time is spent with our patients, in both practices, educating them and having a discussion about what is going on, the options they have, and the risks and benefits of each option,” Dr. McConn continued. “I refer to it as ‘getting organized’ because when they first come in, they’re in distress, they don’t know exactly why and they’re not sure how this ends for them and they’re nervous.”

After an initial consultation, conservative treatment options are discussed at both practices. Because of the partnership and symbiosis of SOS and NYS&WC, providers can discuss all options from the musculoskeletal perspective to make people feel better. Between the two practices, services include: physical therapy, behavioral therapy, diagnostic and prescriptive services, electrodiagnostic lab, X-ray and MRI Imaging, and ultimately surgery if all conservative measures fail.

Conservative Approach to Spine Care

When pain is reported, figuring out where it hurts is the first step. “We are able to identify the source of the pain using technologies such as X-rays, MRIs and electrodiagnostics to narrow down the diagnosis,” said Dr. Albanese. New York Spine and Wellness Center has the only accredited electrodiagnostic lab in Central New York.

A conservative approach works best, especially with any spinal issue. “We always maximize non-surgical care first,” Dr. Warren Wulff, a spine surgeon with the SOS Neck and Back Team, said. “Only the smallest percentage of patients where that doesn’t work do we consider for surgery. In our toolbox of surgical procedures, we always select the least invasive way that works. We match the procedure to the problem, giving the best chance for a good outcome.”

Still, the first order of business is reducing the pain, and there’s the expertise of Dr. McConn and Dr. McGinn. “Surgery is never the first line treatment for pain unless the patient has neurological deficits.” Dr. McGinn said. “When pain is the issue, there are many interventions along the continuum of care before reaching the surgery option.” 

Some patients ask for a cortisone shot, thinking that will solve the problem. “But that injection is intended to be more of a bridge toward a faster recovery as the body heals and gets stronger with exercise,” Dr. McGinn added. “It’s supposed to allow for improved functionality and to get patients moving again above all. An injection is part of a multi-modal approach to recovery that can also include chiropractic care, acupuncture, physical therapy, and surgical intervention.”

Importance and Impact of Physical Therapy

Physical therapy is one of the most common treatment choices. “Motion is what makes people feel better, and we typically start treatment with PT,” Dr. Albanese said, “and having patients relearn how to move. They may have some mechanical dysfunction, so they work with the therapy team on strength and mobility.”

Physical therapy includes therapist-guided strengthening, stabilization, and stretching, re-training functional movements, hands-on joint and tissue mobilization, and patient education. At SOS, the therapists pride themselves on individualized, personalized care. SOS offers Orthopedic & Sports Therapy at 5 locations surrounding Central New York, as well as offering remote physical therapy (RTM). RTM is offered to patients living outside the area, to those with limited access to transportation, as well as to patients who prefer online care.

One of the greatest benefits of the Orthopedic & Sports Therapy department within SOS is the close relationship built with the physicians. This direct connection enhances communication amongst the entire care team to expedite patient recovery.

On average, SOS patients achieve superior outcomes with fewer visits and shorter treatment durations compared to national averages. This is consistently shown through the outcomes and patient satisfaction data measured by FOTO Inc. (Focus on Therapeutic Outcomes, Inc.). FOTO has 26 million patients, which is the largest database of outpatient orthopedic therapy patients to compare and the greatest participation by therapy providers.

Non-Operative Interventions 

If pain persists, other interventions remain, which is a huge benefit to starting with conservative treatments. “That’s where New York Spine & Wellness Comes in. They can prescribe medications that may be appropriate and perform minimally invasive procedures – options that are still non-surgical,” Dr. Albanese said.

“While we specialize in spine pain and back disorders, we treat all types of acute and chronic pain” said Dr. McGinn. “Some of our interventions can help patients avoid surgery by working through injuries and healing while others can be used as maintenance therapy for chronic arthritic or disc-based pain in the spine for which there is no real surgical option. Other procedures can involve temporary or permanent implants that can treat debilitating nerve pain that may be severely affecting quality of life. We also perform minimally invasive surgeries in patients with spinal stenosis who may be poor candidates for more invasive surgery due to their age or medical comorbidities.”

Surgical Innovation

“Given enough time and attention, many painful spinal conditions will resolve with non-surgical measures only.” shared Dr. Warren Wulff. In instances when surgical intervention is recommended, we use the latest technology and newest techniques such as neuromodulation and minimally invasive surgery at our orthopedic focused surgery center”.

Neuromodulation, through the use of a spinal cord stimulator, is a recent trend in pain management, and Wulff is expert in the procedure. The International Neuromodulation Society defines it as “the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body.” The goal is to re-establish normal function of the nervous system.

Neuromodulation itself is nothing new. Cardiologists have been using the technology for more than 90 years. “People whose hearts don’t beat regularly, most often get a pacemaker, which is a neuromodulator,” said Wulff. “Similar systems are being investigated to treat tremors, epilepsy, limb ischemia, obesity and eating disorders, and even depression—stimulating the brain with painless magnetic pulses.”

Again, that approach begins conservatively. “We can attach an external version of the neurostimulator for a week,” Wulff said. “If the patient has a good reaction, a permanent device is implanted. This is a 1-2 hour procedure that requires an overnight stay. The benefits can be lifelong.”

“These patients may have been highly medicated for years, taking higher doses of opioids with all the negative consequences,” Wulff continued. “Once you get patients off opioids, they feel better and think clearer. It also leads to reduced need for spinal procedures, and medications, which results in long term savings to the healthcare system.”

Reducing a patient’s pain is the ultimate goal, and both practices advocate for attempting the least invasive, most conservative treatments first. “With everybody being unique,” said Dr. McConn, “there is no one modality that is going to relieve symptoms long-term. It’s actually a combination of all these modalities. I tell patients I don’t know what’s going to work for you but we have the access to all options and we’re going to find a combination that’s going to make the pain more manageable and enhance your quality of life.”



The Importance of Culture in Health Care

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By: Kathy Ruscitto

A few months ago I had the opportunity to hear two physicians talk about their careers as they received recognition. Dr. Kara Kort, a surgeon, and Dr. James Tucker, a family physician.

Both are esteemed by their patients and colleagues. They are passionate about the profession they chose and the work they do as physicians and leaders in their disciplines.

As they spoke, the words, tone, and tears they shared all spoke to service to others. They chose medicine to help people.

In his remarks Dr. Tucker thanked to his patients for letting him be part of their villages, lives and families.

Dr. Kort talked about how being vulnerable in her own life experiences , enabled her to help patients at critical points in their lives.

Health professionals often choose their career to contribute to improving  the  health of others. Clinicians  value their  professional expertise, training, the ability to give their patients high quality care , and collegiality across a health care system.

The reality is they are facing complex systems that require automation, long hours to balance their complex demands, and frustrated patients with payer barriers. We knew we were going to face a large segment of retirements across physicians and nurses, COVID accelerated those trends. The current system feels broken to many clinicians and patients.

In an article in Medscape, Drs. Toprol, Verghese and Pearl discuss Physicians’ roles in accelerating  system changes to improve patient care. They all suggest some of the challenge is clinician resistance to letting go of old culture, and adopting new more efficient options like telemedicine. Changes that allow patient access and follow up during workforce shortages is better than delayed, or no care at all.

Other experts feel the most important investment we can  make is a shift away from fee for service care to value based care, aligning incentives around patient outcomes. 

While these examples may be part of structural system redesign, shared culture is equally important.

Medicine is a team sport. It requires collaboration across a spectrum of disciplines, workforces, and payers. We must listen and value the input of the health professionals if we are to rebuild our health systems culture and workforce to continue to provide high quality patient centered care. System redesign alone, in the absence of shared culture will not resolve our issues.

Right care, right time, right place, right cost is often included in marketing and headlines these days. The underlying assumption being we have a shared culture of achieving this care. 

As you plan retreats , strategy and future goal sessions, spend time discussing culture and clinician input into our future in health care. It is the most important thing we need to do to meet our challenges.

Resources:

Healing the Professional Culture of Medicine – Mayo Clinic Proceedings

To End Burnout, Doctors Must Change the Culture of Medicine

https://hbr.org/2022/09/5-steps-to-restore-trust-in-u-s-health-care

Change Healthcare Cyber Attack: Cybersecurity Lessons Learned

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With consequences and impact of Change Healthcare actively being determined, I wanted to share some insights below from our Cyber Team Leader Allen Blount

Change Healthcare’s recent cyber-attack sparked a crucial discussion on cybersecurity, business continuity, and contingent liability insurance within the healthcare sector. Cyber-attacks in healthcare have been increasing in severity, with far-reaching consequences for businesses, physicians, and insurers alike. Here are key observations and tips for protecting your organization.

Analyze the broad impacts of the Change Healthcare cyber attack

The Change Healthcare attack did more than compromise patient data. This breach halted operations and affected multiple sectors. It disrupted billing for physicians and pharmacies, threatening their financial stability. Three takeaways:

  1. The event highlighted the interconnected nature of our digital world, showing how finance, technology, and retail sectors are vulnerable, too. All organizations can gain insights from studying this cyber-attack.
  2. The situation demonstrated how third-party vendors can pose unintentional cyber risks. It’s worth taking a second look at your vendor cybersecurity. Could you benefit from additional technical and contractual safeguards?
  3. The Change Healthcare situation underscores the importance of strong business continuity planning (BCP). A swift, decisive response to a cyber-attack helps protect sensitive information, preserve customer trust, and maintain organizational resilience against catastrophic outcomes.

Assess vendor management and oversight

Effective vendor management involves assessing and mitigating risks throughout the vendor lifecycle, from selection and onboarding to continuous monitoring and management. Businesses need to:

  • Conduct thorough due diligence and risk assessments before engaging with any vendor to understand their cybersecurity posture and risk exposure.
  • Include specific cybersecurity requirements and obligations in vendor contracts. Ensure clear definitions of roles and responsibilities in the event of a data breach or cyber incident.
  • Implement continuous monitoring of vendor security practices. Evaluate compliance with contractual obligations to identify and address vulnerabilities promptly.
  • Ensure vendors have robust incident response plans that align with your organization’s response strategies. How will you coordinate efforts in the event of a cyber-attack?
  • Establish a comprehensive vendor risk management program that incorporates regular reviews, audits, and updates to security requirements based on evolving threats.

Revisit cyber liability insurance and business interruption coverage

The Change Healthcare cyber-attack illustrates the complexities of contingent business interruption claims, a major financial strain for affected parties. Cyber liability insurance policies differentiate between direct losses from cyber incidents and contingent business interruptions. This creates a maze of requirements for proving a claim.

The role of companies like Change Healthcare is under debate. Are they IT or data management suppliers within UnitedHealth Group? This distinction affects contingent business interruption claims directly. As a result, healthcare providers and other stakeholders face difficulties in securing timely reimbursements, complicating the recovery process.

Here are three tactical best practices to consider when navigating cyber liability insurance claims after a breach:

  • Keep detailed records of all disruptions and expenses incurred due to the cyber incident. Documentation is key in substantiating claims for lost income versus lost revenue and deciphering between direct and contingent business interruptions.
  • Review your cyber liability insurance policy thoroughly to understand the coverage scope, including breach response and contingent business interruption coverage. This understanding is key for identifying potential gaps and ensuring that claims fall within the policy’s parameters.
  • Engage with your insurance carrier early and maintain open lines of communication throughout the claims process. Providing updates and being responsive to inquiries can facilitate a smoother claims process and help in advocating for your coverage rights.

While there are nuances to each carrier’s standalone cyber coverage it is typically more robust than any throw in coverage you might have with your malpractice policy, so we do encourage you to review how you are covered.  

The contents of this article are for general informational purposes only and Risk Strategies Company makes no representation or warranty of any kind, express or implied, regarding the accuracy or completeness of any information contained herein. Any recommendations contained herein are intended to provide insight based on currently available information for consideration and should be vetted against applicable legal and business needs before application to a specific client.