Category: 2023

Clear Protocols as Important as Everamid Healthcare Staffing Shortage

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By Chris Zuccarini, Managing Director, National Healthcare Practice and Jennifer Negley VP National Healthcare Practice

Staffing shortages have hampered the United States economy since the onset of the COVID-19 pandemic. This shortage is particularly acute for the healthcare industry which faces a growing scarcity of trained professionals.

Healthcare employment has declined by 2.7% since the start of the pandemic. That exceeds the overall workforce decline of 2.3%. Low medical school admissions indicate that the situation won’t improve any time soon. The Association of American Medical Colleges predicts that by 2030, there will be a shortage of between 42,600 and 121,300 physicians in primary and specialty care. To make matters worse, nurses, home health aides, and medical assistant positions also have become difficult to fill. 

The staffing shortage has several causal factors. Baby boomer workers are retiring, with many choosing to retire early due to the pandemic. These exits combined with the shortage of trained professionals has led to numerous unfilled positions. This can lead to employee “burnout”— feeling exhausted and overworked— among those remaining employed. These employees are under greater stress as they have fewer peers to rely on for assistance.

Meanwhile, higher salaries are eating the payroll budget. The talent shortage has also given existing workers the power to demand higher salaries. For workers earning less than $60,000 per year, the reservation wage—the minimum acceptable wage for a job—increased by 26.4% from March 2020 to March 2021. Physician compensation has increased 29% since 2017, almost double the cumulative rate of inflation. Organizations must find creative ways to
enhance recruitment efforts when their payroll budget goes to fewer employees.

Measures to address staffing shortages

Many healthcare organizations enlist help from traveling professionals and clinicians to compensate for the scarce available talent. New employees may need to quickly learn an organization’s processes upon joining. However, rushing training can result in mistakes that could lead to costly outcomes.

All healthcare workers temporary and permanent—need to be thoroughly trained on an organization’s procedures so they adhere to precise protocols. Implementing an onboarding process that makes clear risk and responsibility is also beneficial

The risk of putting profits ahead of patient care

Another factor affecting the healthcare space is the rise in mergers and acquisitions. Some organizations engaging in M&A activity may take measures to cut costs to boost profitability. These measures may include laying off staff and eliminating positions. These organizations may pay the price, though. Scaling down a workforce can result in burnout for those who remain. 

Physician-related studies consistently show a strong association between medical staff burnout levels and errors that result in malpractice suits. Likewise, profit-driven decisions that harm patients can lead to costly lawsuits. Losses incurred in this manner are likely to be excluded from coverage under medical malpractice policies. 

Striking a balance with limited resources

Many healthcare organizations will have to implement creative recruiting techniques and benefits strategies as they struggle to fill open positions. Hiring candidates from outside the area can play a role in this. There is no evidence to suggest that someone from outside a region would be any less competent in their profession. Still, organizations should have firm onboarding protocols to assure that all employees are following standard procedures. Benefits are now an important part of job acceptance decisions. Benchmarking against the competition is a good way to see if some benefits enhancements could help with recruiting.

With creative recruiting and attractive benefits in play, organizations should then prioritize the mental and physical well-being of employees. Limiting hours and encouraging time off can keep employees from becoming overworked. Structuring departments to prevent any one individual from carrying too much stress or responsibility can also reduce burnout. Employees make fewer mistakes when they are rested and focused, decreasing the chances of legal action being taken against them. 

While the interplay between malpractice insurance cost and benefit offerings would not seem clearcut at first glance, we now know one can directly impact the other. Working with an experienced team dedicated to the healthcare space versed in both sectors can make all the difference. 

For more information on this topic and other insurance options, please contact Jenn Negley, Vice President, Risk Strategies Company, 267-251-2233 or JNegley@Risk Strategies.com.

What to do BEFORE considering a private equity transaction

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by Marc S. Beckman, J.D.

We have numerous clients who have completed private equity transactions and many more that are considering them. The allure of senior physicians monetizing a practice value together with the promise of fewer administrative headaches can be too great to ignore. Private equity transaction costs are particularly high and many physician practices are not prepared for some of the pitfalls and other surprises that await them. Some relatively simple advanced planning can save a practice a substantial amount in transactions costs, including attorney, accountant and other consultant fees. 

Private equity transactions for physician practices come in many forms. The most common structure involves the sale of the practice’s non-clinical assets to a buyer management services organization (MSO) and the sale of clinical assets to a new buyer professional entity (or the restructure of the existing professional entity) (collectively, the “Buyer”) in exchange for purchase price cash and rollover MSO equity. 

Compliance Audit

Far and away, the most important planning if a practice thinks it might consider such a transaction is to conduct a comprehensive compliance and billing audit. This should be done far in advance of any serious private equity transaction. Allow your counsel to manage this process in order to best preserve attorney-client privilege. The private equity backed Buyer is going to conduct extremely thorough due diligence. This process will involve much more than merely reviewing billing and coding history. This is especially true if the practice maintains ancillary revenue streams that might otherwise make it more attractive for private equity, such as imaging services such as ultrasound, MRI, PET, CT, clinical laboratory and/ or pathology services, radiation oncology, real estate, ASC and/or billing services. 

Among other issues, the due diligence process will undertake a critical review of the practice’s compliance with the highly technical and often misunderstood elements of the federal and state physician self-referral prohibitions (i.e. “Stark Law”). Accordingly, the practice’s historic manner and method of allocating revenue and expenses will be under the microscope (i.e. its compensation plan), including, for example, whether the practice is fully satisfying the myriad of elements involved in the Stark Law group practice and in-office ancillary services exception. Too many practices that do not undergo this self review presume they are in compliance but find that they are not when they are far into the expense of the transaction. Another common example is a heightened review of all real estate leases, particularly parttime and/or block leases with referral sources. Over time, some may have lapsed without executed renewals or the rents have fallen out of fair market value. Same issue applies for independent contractor relationships. 

Another common trap for the unwary involves excluded personnel. All medical practices participating with Medicare and Medicaid must ensure that no excluded persons are employed or contracted by their practice (whether as a billing provider or administrative staff person) and regular review of the excluded provider lists must be conducted to avoid utilizing such an individual, even if such person misrepresents themselves. While many practices have a vague familiarity with these issues, most do not engage in critical self-examination to ensure compliance. 

Why is this attorney guided advance review so important? Because the private equity Buyer will typically require the Seller practice to address these issues in the most conservative manner possible. That would include full self-disclosure and repayment of offers to pay penalties. In addition, it may also require significant escrows out of purchase price proceeds to secure future potential payments and indemnification obligations to the Buyer. Further, the advance review provides an opportunity for the practice to control the result based on its own risk tolerance and without being dictated by the Seller. We are aware of numerous instances when highly technical but financially insignificant compliance error resulted in literally millions of dollars of potential repayment and escrowed dollars significantly reducing the benefit of a private equity transaction.

Document/Contract Review
Regardless of whether a practice follows the above suggestion for an audit, a second significant cost-saving measure is for the practice to thoroughly prepare its paperwork in advance of the transaction. A substantial and often unnecessary cost of a private equity transaction is organizing and chasing down so much of the paperwork necessary for the Buyer and its counsel. Among the items most commonly requested is the evidence of admissions of all current practice owners and redemption of prior owners. Third-party payer agreements and vendor contracts are also notoriously hard to track down. Many will need to be terminated or assigned as part of the private equity transaction and therefore it is helpful to know the underlying terms of these documents. Longer term vendor or service contracts that may not be easy to terminate. Similarly, any liens or open lines of credit will need to be addressed. Even a zero balance line of credit needs to be closed so a lien termination can be filed, and this filing may take much longer than it should and hold up the transaction.

Employee census information should be maintained and kept up to date. The practice needs to ensure all contracts with employees and independent contractors are fully executed and maintained. Malpractice policies may need to be terminated, reporting endorsement (i.e. “tail”) may need to be priced and purchased including for the practice entity. If known in advance, some of these transaction costs can be more easily negotiated with the Buyer. There may also be planning opportunities for the practice as it will be terminating its defined benefit and defined contribution retirement plans. 

Another issue often overlooked until late into the process is patient and payer credit balances. This is money that the practice must account for to be refunded or turned over to the state register for unclaimed consumer credit balances. This can be an unpleasant surprise for practices that have allowed these balances to accumulate over a long period of time. A regular and routine process for reducing these balances can save a practice significant headaches and potential cash flow issues during the transaction process. 

Finally, before seriously entertaining a private equity transaction, physician practices are encouraged to have their corporate accountants collaborate in advance with their legal counsel. There are numerous potential tax implications to the transaction as well as the structure of the practice post-transaction that should be understood. Understandably, accountants are frequently concerned about the tax structure of the transactions promoted by the private equity backed Buyer, and will want the opportunity to weigh in before it’s too late.

Some advanced planning and consulting can go a long way toward saving a physician practice significant transaction expenses later. 

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

Speed Saves Lives

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Comprehensive Stroke Center at Crouse Health Outpaces Targets for Stroke Rescue Treatments and Improves Patient Outcomes

By Becca Taurisano

David Padalino, MD – Medical Director, CMP Neurosciences, Elena Gabriel, Radiologic Technologist Team Leader, Jorge Eller, MD, Bri Tonzi, Radiologic Technologist, Evan Belanger, DNP – Director of Neurosciences, Intensive Care, Kaitlyn LaChance MSN, RN, Jason Phelps BSN, RN, SCRN Clinical Supervisor, Alex Maksymiw, Radiologic Technologist, Patrick Ogar, Radiologic Technologist, Angela Horan, RN, Julia Galipeau, Radiologic Technologist

In the United States, someone has a stroke every 40 seconds. Stroke is a sudden interruption in blood flow to the brain caused either by a blocked blood vessel (ischemic stroke) or a burst blood vessel (hemorrhagic stroke). Even a decade ago, there was not much that could be done to help stroke patients, but now stroke is a potentially treatable condition, allowing stroke teams to reverse symptoms, preventing disability and death. By utilizing stroke rescue therapies like intravenous thrombolytics and mechanical thrombectomies, the stroke care team at Crouse Health’s Comprehensive Stroke Center is preserving brain function and saving lives with the fastest response times in the region. “Crouse continues to maintain the highest level of stroke program quality, for which it has achieved national recognition,” said Crouse President and CEO Seth Kronenberg, MD. “We consistently achieve extraordinary outcomes by actively seeking the engagement of our high-caliber medical team and staff, all of whom are dedicated to the Neurosciences service line and the overall patient experience.”

There is a saying in the field of Neurosciences: Time is Brain. “Stroke care is perhaps the most time-sensitive field of medicine there is,” said Jorge Eller, MD, Crouse Health Neurosurgery. “The quicker people are connected to a health system that is used to dealing with strokes, the quicker they can get proper medical attention and hopefully recover with very few deficits.” The advances that have occurred in the field of stroke care in recent years are impactful. “Due to improvements in technology, interventional techniques, and equipment as well as increased awareness, the morbidity of stroke has begun reducing,” said Raghu Ramaswamy, MBBS, Crouse Health Neurology. “I have seen many of my patients who were carried into Crouse after having a stroke, walk back into my clinic a few weeks or months later.”

Recognizing the symptoms of stroke can be challenging, but the most important cues to look for can be summed up with the acronym FAST: Face – facial drooping or asymmetry; Arm – arm weakness, especially on one side; Speech – difficulty speaking or understanding speech; and Time – note the onset of symptoms and seek emergency help immediately. If a patient experiences any of these symptoms, they should not wait to see if they feel better or sleep it off, but should immediately call 9-1-1. By keeping blood pressure under control, taking blood thinners for atrial fibrillation or hypercoagulative issues, not smoking, and maintaining a healthy lifestyle through diet and exercise, people can prevent strokes, but genetics can play a part as well.

When an individual arrives at Crouse Health’s Emergency Department as a stroke patient, a stroke alert is activated and the entire stroke team is notified. Obtaining brain imaging is the first step. A CT Scan is completed to essentially rule out the possibility of a brain hemorrhage. Once that has been ruled out, CT angiogram and CT perfusion are the gold standard imaging modalities to determine what parts of the brain are potentially affected by an ischemic stroke and how much brain tissue is salvageable. When a stroke occurs, there is a part of the brain that is irreversibly damaged called the ischemic core. The area around the core where the blood supply is compromised but has not yet caused death of tissue is called the penumbra. The bigger the area of penumbra, the more successful a stroke rescue effort could potentially be.

“An ischemic stroke is essentially a permanent central nervous injury that results in a loss of some brain function,” said David Padalino, MD, Director of Neurosurgery Education for Crouse Neurosciences. The mission of the stroke care team is to limit the damage as much as possible. At Crouse Health, a neuroscience advanced practice provider is on site around the clock so that patients are seen within minutes of arrival. The provider can begin prepping the patient if it is determined that they are a candidate for one or both kinds of stroke rescue therapies offered at Crouse Health: intravenous thrombolytics or mechanical thrombectomy.

Intravenous Thrombolytics or “Clot-Busters”

According to Sami Abdul Malak, MD, Chief of Neurology at Crouse Health, the advent of intravenous (IV) thrombolytics or “clot-busting” medications (tPA or TNK) in the mid-1990s was revolutionary in the treatment of ischemic stroke in restoring blood flow to the penumbra. “The purpose of the thrombolytic is to try to dissolve the clot and open the vessel that has been occluded, which leads to the part of the brain that has been damaged,” said Dr. Malak.

Not everyone is a candidate for IV thrombolytics, however. If more than 4.5 hours have passed since they were last at their baseline function, a patient may not be a candidate for IV thrombolytic. Brain bleeding seen on the initial CT scan, a patient’s history of bleeding, being on blood thinners, or a large area of irreversible damage or core are all contraindications for administering thrombolytics.

Mechanical Thrombectomy

Mechanical thrombectomy is the other stroke rescue treatment available at Crouse Health. “2014 to 2015 was the beginning of a revolution in acute ischemic stroke care where these stent retrievers were absolute game changers and we started to see the benefit,” said Dr. Padalino. During a mechanical thrombectomy, the stent retriever is deployed using a microcatheter and the stent drags the clot out, or combined with aspiration, suctions the clot out, allowing blood to flow to the affected area.

It is not a procedure for everyone, but in patients who do qualify, they can see tremendous improvements in brain function. “As the technology gets better, we keep pushing the boundary for better and better results,” said Dr. Eller. “Patients who successfully undergo this procedure have a better outcome than they would have otherwise, and the faster we can do it, the more likely the patient will recover.”

One unique approach at Crouse is their use of conscious sedation to perform the procedure, which Dr. Padalino encountered while in medical school at the University of Buffalo. “The idea of doing a mechanical thrombectomy under conscious sedation is still a relatively rare thing,” Dr. Padalino said. “Other hospitals routinely do this under general anesthesia, which creates extra steps in the process, without significantly better results.”

Meeting and Exceeding Time Targets

Crouse Health has been a primary stroke center since 2007; in 2018, Crouse was designated a Comprehensive Stroke Center by internationally-recognized healthcare accrediting body DNV and in 2019, a Comprehensive New York State Stroke Center by New York State Department of Health, providing a full-range of rescue therapies to treat any kind of stroke. Oksana Kaskov, RN, BSN, Stroke Program Administrator, ensures that the program continues to meet targets set by the American Heart Association’s Get with the Guidelines, which recognizes hospitals that are achieving various performance metrics for stroke care.

Crouse Health’s Comprehensive Stroke Center has received the highest possible award for its speed in delivering stroke rescue therapies in both 2021 and 2022: Get With The Guidelines®-Stroke Gold Plus with Target: Stroke Honor Roll Elite Plus with Advanced Therapy with Target: Type 2 Diabetes Honor Roll. For IV thrombolytic, the guideline is 30 minutes for administering thrombolytic 50% of the time. According to 2022 data, Crouse Health is administering IV thrombolytic as fast as 18 minutes from patient’s arrival.

For mechanical thrombectomy, the guideline is for the stent retriever to touch the clot (called Door-to-First Pass) within 90 minutes of the patient’s arrival, 50% of the time. In 2022, Crouse Health overshot that goal and was able to perform the procedure within 90 minutes, 72.2% of the time. For the first quarter of 2023, they achieved this 94% of the time. The median time for mechanical thrombectomy at Crouse Health is currently 66 minutes.

“We looked at our entire process and determined what we needed so we could achieve these targets from Get with the Guidelines,” said Kaskov. “Right now the process is extremely efficient, but we are constantly looking for opportunities where we could shave time.”

Saving Time with Technology

The stroke care team utilizes the latest technology available to ensure they are delivering care quickly and efficiently. Using a communication system with ingrained artificial intelligence software, information is transmitted to the entire team in an expedient manner. “It is an amazingly good communication tool where we can talk to the entire team in one message,” said Dr. Padalino. “You can have coordinated discussions where everyone is looped in and it saves time.” Dr. Malak agrees. “By using this system, all attending physicians can get the imaging and decide on the management together. It is a collaborative, team effort,” he said.

Crouse Health’s two hybrid operating rooms (ORs) also help save time when it comes to stroke care, allowing for providers to perform an open surgery, if necessary. “When you access a blood vessel on an emergency basis, you can get persistent bleeding at the access site. If vascular surgery is required, you do not have to move the patient to another room, wasting time and risking infection,” said Dr. Padalino. “You can do an interventional case, an operating room case, and a hybrid of the two.” All of the necessary equipment is located in the hybrid ORs including surgical procedures, general anesthesia, and ultrasound. “It has everything we need,” said Dr. Eller. “We are providing comprehensive treatment in those rooms.”

A Well-Orchestrated Team

Caring for stroke patients takes a village. The team is made up of several departments including: Emergency Medical Technicians who are the first-responders on the scene of a stroke, Emergency Department providers quickly assessing and imaging patients in a chaotic setting, Neurology providers making the decision to give IV thrombolytics and/or to pursue advanced imaging, Neurosurgery providers determining if a patient is a candidate for mechanical thrombectomy, Registered Nurses and Surgical Technicians who prepare for and assist with procedures, and post-operative care like Rehabilitation, Physical Therapy, Occupational Therapy, and Speech Therapy. “All of these fields have to work together like instruments in an orchestra,” said Dr. Eller. “It is a very concerted effort that has to happen continuously, and we have to continue to perform at that pace time and time again.”

Educating the Entire Organization

Most stroke patients come through the Emergency Department, but some are already admitted to the hospital and later develop stroke symptoms. “We have to be prepared to respond to each one of these cases to provide the fastest and most effective care,” said Dr. Padalino. Crouse Health focuses on stroke education to ensure staff are able to recognize neurological issues and activate a Code B (for brain) which alerts the stroke care team. “We did a lot of stroke education throughout the organization, including the Emergency Department and beyond,” said Kaskov. Monthly stroke team meetings are held to discuss continuing to meet time targets and coordinate interactions with other departments to ensure everyone is on the same page.

Providing the Best Care for the Community

Stroke is one of the leading causes of disability and death worldwide. Having access to a Comprehensive Stroke Center is a tremendous benefit for Central New Yorkers. “We have a significant opportunity to impact a large population with this effort,” said Dr. Padalino. “The senior leadership at Crouse has done everything possible to keep this program going so we can continue to provide the best care for the community.” Providing comprehensive stroke care takes a significant investment in people, equipment, and resources and Crouse Health’s commitment to this program has not waivered even in the face of the global demands facing the healthcare industry. “The Comprehensive Stroke Center designation is evidence of Crouse Health’s commitment to serve the community,” said Dr. Eller. “Central New Yorkers can be very proud to have this program here.”

CALLOUT:

“All of these fields have to work together like instruments in an orchestra,” said Dr. Eller. “It is a very concerted effort that has to happen continuously and we have to continue to perform at that pace time and time again.”

The Crouse Health Comprehensive Stroke Center Core Stroke Team

Stroke Medical Director and Chief of Neurology – Sami Abdul-Malak, MD

Stroke Program Administrator – Oksana Kaskov BSN, RN

Director of Neurosciences, Intensive Care – Evan H. Belanger, DNP

Clinical Director, CMP Neurosciences – Jameson Crumb, PA

Medical Director, CMP Neurosciences – David Padalino, MD

Chief Medical Officer and Medical Director, ICU – David Landsberg, MD

Medical Director, Hospitalist – James Leyhane, MD

Medical Director, ED – David Mason, MD

ED Physician and EMS Representative – Michael Jorolemon, MD

Jorge Eller, MD

Raghu Ramaswamy, MBBS

Hassan Elnour, MD – Medical Director of Neurophysiology and Epilepsy

Dr. Ronald L. Kirshner Appointed Chair & Medical Director Of The Auburn Heart Institute (AHI)

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Auburn N.Y. – May 1, 2023, Auburn Community Hospital (ACH) announced today that Dr.
Ronald L. Kirshner has been appointed Chair and Medical Director of the new Auburn Heart
Institute (AHI). Dr. Kirshner’s appointment coincides with a multi‐million investment the
hospital is making to expand its cardiovascular services to meet the needs of patients in the region.

Dr. Kirshner is a renowned cardiothoracic surgeon who comes to the Auburn Heart Institute from Rochester Regional Health Sands‐Constellation Heart Institute where he served as the Chief of Cardiac Services and Cardiothoracic (heart) Surgery for over 30 years. Dr. Kirshner is a graduate of Temple University Medical School and completed his internship and residency at the University of Rochester Medical Center. He has also completed fellowships in Vascular Surgery and Cardiothoracic Surgery at the University of Rochester Medical Center. He has been practicing as a cardiothoracic surgeon at Rochester General Hospital since 1985. He is board certified in Cardiac and Thoracic surgery. Dr. Kirshner’s clinical interests and expertise include Cardiac and Thoracic Surgery and creating systems to drive healthcare efficiency and quality.

“I speak on behalf of Auburn Community Board of Trustees in warmly welcoming Dr. Kirshner
to our health care system,” stated Anthony Franceschelli, Chairman of the ACH Board of
Trustees. “Dr. Kirshner is known far and wide as a leader in the specialty of Cardiac Services
and brings with him a wealth of expertise that will be invaluable to, not only to our hospital,
but to our patients and community as well.”

“We look forward to Dr. Kirshner advancing our cardiac services for our community. With the
help of New York State and Senators Schumer and Gillibrand Auburn Community Hospital is
experiencing a significant transformation of healthcare in our community that includes our
new $15 million comprehensive cancer center, a multi‐million‐dollar heart institute and a
robust orthopedic practice, combined with a five‐star nursing home, 3 Urgent Care Centers,
along with primary care and specialty care services,” stated Scott Berlucchi, President, and
CEO.

Patients Traveling to Central New York

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By: Kathryn Ruscitto, Advisor

Recently a tragedy in another community brought patients and family members to Syracuse. A question was asked, where should they stay? This reminded me of several unique options that help families coming to CNY for health care and in need of housing. Not every community has these resources, and they are valuable parts of our health systems. How do we as health leaders support these organizations and find ways to assist their volunteers.

Sarah’s s Guest House on Roberts Ave. provides lodging, transportation, meals, and a
comforting atmosphere to patients and or family members above the age of 18. Completely
operated through donations, no stay requires a payment, although donations can be made if a
family can manage. All a patient or family member needs to do is contact Sarah House at
315-475-1747 to make a reservation, and ask they have a medical referral from a social worker or hospital staff.

Over 1000 people stay at Sarah’s House each year, which has led to an expansion effort to move from 11 to 22 rooms that will provide more accessibility including an elevator. 

David Haas , the Executive Director , projects the caring and concern this organization has for those facing a crisis for themselves or a family member. He noted that stays range from several days to months depending upon each persons needs. What a gift for a patient to know they and their family will not face major housing expenses in the midst of a health crisis.

The Sarah’s House website includes ways in which individuals or organizations can help them through gifts or donations on their wish list. https://sarahsguesthouse.org/

David also noted that for patients and families in CNY who need to travel elsewhere there is an online network. Heathcare Hospitality, includes many other homes across the country that provide similar care. https://www.hhnetwork.org/

In addition the Ronald McDonald House provides housing for families coming to Syracuse with seriously ill children. https://rmhcny.org/what-we-do/stay-with-us/

A referral is needed and reservations are coordinated through their intake process.The Cancer Society has several efforts to help locate housing through their Hope Lodge program with houses in Rochester and Buffalo. They also maintain discounted medical lodging rates with many major chains.

In summary do your offices have this information on your websites and available to patients?

How might you support this work in your giving plans?

As regional access continues to be challenged more out of town patients may be presenting to your practices.

Housing resources for CNY:

Sarah’s Guest House: https://sarahsguesthouse.org/

Ronald McDonald House: https://rmhcny.org/

Hope Lodge: https://www.cancer.org/support-programs-and-services/patient-lodging/hope-lodge.html

Transportation resources: https://www.mercymedical.org/ 

 

ROME HEALTH:Enhancements and expansion for community-centered care

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by Elizabeth Landry

Aerial view of Rome Medical Center, opened November 2022

Rome Health has always strived to provide excellent health care for those in the local community. As the tagline says, Rome Health aims to deliver “The best care out there. Here.” 

Over the past few years, the organization has taken its approach to health care to a whole new level by redefining what it means to offer community-based health care that provides accessible and efficient care to all patients in the local community. The brand new, state-of the- art Rome Health Medical Center opened to patients in November 2022, and Rome  Health has launched several other team-based initiatives that all contribute to enhancing the overall experience for everyone involved in the health care system.

When the team at Rome Health set out to begin enhancing the way health  care is provided to the local area, everything centered on what would ultimately be most beneficial to those in the community.

“As we engage the local community here, it was clear very early on that what the community desired was to receive high-quality, cost effective care here locally without having to travel to other regions of the state or elsewhere,” said Cristian Andrade, M.D., and Chief Medical Officer at Rome Health. 

“When we designed the medical center and the other projects we’re working on currently, really the central focus was the patient and local community needs.”

The new Medical Center delivers convenient care for patients by serving as a centralized entry point to all services, including primary care, pediatrics, specialty care, imaging needs and lab work. Many members of the team at Rome Health have seen first-hand how this accessible, efficient approach to health care has been a boon for patients in the community.

“I think just having new construction at Rome Health is very invigorating for the community,” said Ankur Desai, M.D., Chairman of the OB/GYN department. “It fortifies the fact that we have a very strong hospital system under our leadership. That’s very important for a hospital serving a local community. And the area we serve is rather large – it’s not just Rome. Having that new, modern construction is very important.

“Consolidating the services also enhances quality of service in terms of giving the patients flexibility and making it easy for them to get to where they need to go, not only for seeing their providers, but also with the ancillary services such as radiology, lab work and so on.”

This new space at the heart of Rome Health and the further innovations being planned also bring together providers from across the health care spectrum, allowing them to work together more cohesively in a truly team-based environment. The benefit of this setup is not only for the patients but also for the staff and the providers, themselves.

“We’re aiming to provide not only a better patient experience but also a better overall experience,” Ryan Thompson, Chief Operating Officer at Rome Health said. “It’s a better experience for the patients, the providers and the staff, which really makes it perfect for a thriving community. When you think about it, we’re not just approaching it from the perspective of one point of view, but rather it’s a holistic perspective for enhancing the entire care environment.”

Multidisciplinary Health Care Enhancements
Since Rome Health offers a robust care network including primary care, surgery and various specialties including, but not limited to, bariatrics, maternity, neurology, orthopedics, pulmonology and urology, it’s no surprise the variety of planned enhancement projects are multidisciplinary in nature and by design.

 

One of the planned enhancements at Rome Health is a new c-section suite that’s set to open at the end of spring or in early summer. Currently, patients who need a c-section have to go down four floors in order to reach the existing c-section suite. The new suite will be located adjacent to the maternal child services department on the fourth floor, providing a much more convenient and accessible experience for both patients and staff.

Thompson explained how Rome Health’s multidisciplinary approach was instrumental in getting the plans correct from the beginning of the process. “When we started the c section suite, we brought together teams from maternity, the OR, our central sterile department, building services, environmental services and many others,” he said. “In doing so, we were able to come up with a design that is thoughtful based on multistakeholder input.”

Another significant infrastructure improvement being planned at Rome Health also relates to surgery. About eight months ago, the team began putting designs together for a brand new operating room facility. In February 2023, Rome Health received a $26-million award from the New York State Department of Health, which will allow the current 1950s-era operating rooms to be replaced by a state-ofthe- art suite that will better match the high quality of surgical services Rome Health has offered to patients for many years. The new suite will include four operating rooms and will accommodate continuous advancements in surgical technology, including robotics and other complex surgical procedures.

“The benefit to the hospital and to the community of being able to modernize the infrastructure of our operating rooms is going to be tremendous,” said Dr. Desai. “We are doing the most modern surgery with the team of doctors and surgeons we have at present, and now that’s going to be reflected in the location in which we do our surgery. That’s a great injection of positivity for our community and for the hospital.”

Similar to the planning process for the new c section suite, the new operating room design plans have been multidisciplinary, with input from many different teams at Rome Health. “We had discussions with anesthesia providers, surgeons and many others right from the start,” said Ashley Edwards, MSN, RN, CCRN-K, NE-BC, Chief Nursing Officer at Rome Health. “We did some mock-ups and then revised them based on all the stakeholders’ feedback. Everyone has had input as to what is going to work best from the time patients are coming in the door all the way to the time they are either discharged or admitted upstairs.

It’s definitely been a multidisciplinary process, and we’re really excited for the final result.”

Also on the list of enhancements to surgery related spaces at Rome Health is the recent renovation of an entire section of patient care rooms in the Surgical Acute Care Unit on the second floor. The setup of the rooms wasn’t ideal for bariatric surgery patients specifically, so the team at Rome Health renovated the rooms from top to bottom, ensuring they would meet the needs of those patients
during their entire stay.

Additionally, new vital sign machines will be installed in patient rooms throughout Rome Health that will download directly into the electronic health record. These new machines will replace the current machines that have to be rolled from room to room, greatly improving efficiency and saving valuable time for the whole team.

However, perhaps the most significant investment at Rome Health has been focused on the actual team carrying out so many services for patients, as pointed out by Dr. Andrade. “One of the things we’ve invested in is our people,” he said. “We’ve put a lot of investment into provider recruitment, particularly in surgical sub-specialties that weren’t present locally here in Rome. We’ve also increased our access to primary care by recruiting primary care providers, both nurse practitioners and physicians, and we’ve also made sure we positioned ourselves to be able to recruit the highest talent and the most qualified folks to this community.”

National Recognitions for Quality Patient Care

In order to find evidence that Rome Health’s continued investments into its high-quality health care have been successful, you don’t have to look very far. The diverse team’s effort to implement processes that support consistent delivery of evidence-based care has been recognized by major organizations for several years. 

U.S. News & World Report has named Rome Health as a High Performing hospital for Maternity Care (Uncomplicated Pregnancy), which is the highest award a hospital can earn from U.S. News & World Report for maternity care. The same organization also recognized Rome Health as a Best Nursing Home for the fourth year in a row.

Excellus Blue Cross Blue Shield has selected the hospital as a Blue Distinction Center for several specialties, including spine surgery, bariatric surgery and maternity care. The Blue Distinction Center label signifies a commitment to delivering high-quality patient safety and better health outcomes, based on objective measures determined by input from leading accreditation and quality organizations, as well as the medical community.

Speaking specifically about the maternity care awards, Dr. Desai highlighted how the team-based approach is at the heart of the great health care Rome Health provides. “These awards really tell you through and through about our team approach,” he said. “High performance has to do with patient care, with our delivery success, with breastfeeding and newborn care. So it incorporates not just what the providers do during deliveries, but the team approach with the nursing staff, as well. I don’t think one facet can work well without the other, and that is what gives us the good fortune of receiving such awards.”

Continuous Improvements Still to Come

Certainly, with many awards and accreditations under its belt, several enhancements already completed and even more planned for the future, Rome Health is delivering on its promise to provide excellent health care that meets the specific needs of patients in the local community. The multidisciplinary and team based approach for achieving accessibility and efficiency for patients in the community has laid the foundation for continuous improvements into the
future.

For Thompson, summing up Rome Health’s plans going forward is really quite simple. “We’re going to continue to redefine what community-based health care means,” he said. “For us, our plan is to continue to engage in the community and find out where the needs are, and then align what we can do to help meet those needs,” he said. “I think it’s important to always go back to the context of our mission. Our mission is to provide quality health care with compassion. As a system, we want to ensure the best care out there is here, meeting the needs of the people in our community.”

RomeHealth.org

 

It’s Tick Season: Be Tick Aware

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BY KATHRYN RUSCITTO, ADVISOR

Ticks can carry a variety of illnesses. The past few years, we are seeing new varieties of ticks with higher infection rates. The diseases they carry are often missed or mistaken for other illness and can quickly turn dangerous.

According to Dr. Kristopher Paolino, MD, assistant professor of medicine and assistant professor of microbiology and immunology at SUNY Upstate Medical University – our local clinical expert in Tick Borne diseases – anaplasmosis is spreading in the deer tick population in our area.

“We’ve seen several dozen in the Syracuse region over the past two years,” Paolino said. “Patients generally present within a week of a tick bite, with high fevers, headaches and flulike illness. Labs show low platelets and WBC. Liver enzymes (AST and ALT) are moderately elevated. Many will have some vague GI upset. They can go downhill quickly if doxycycline isn’t started, and it can be lethal.

“Luckily, doxycycline usually results in improvement within one to two days after starting it. It’s the closest thing to a magic trick I can do. I think the big thing is to be aware of anaplasma and babesia in our area due to tick borne diseases.”

During 2011 through 2019, a total of 16,456 cases of babesiosis were reported to the Centers for Disease Control by 37 states; New York reported the largest number of cases – 4,738 total, an average of 526.4 per year.

Why is this increase happening? According to ESF Assistant Professor of Epidemiology & Disease Ecology Dr. Brian Leydet, MPH, our regional research expert on ticks, global climate change and other factors are making new habitats suitable for the blacklegged ticks survival resulting in increases in reported cases of human Lyme disease in areas we didn’t see much disease 15 20 years ago.

So what can we do about this increased risk? We recommend prevention education with patients and community groups.
• Be tick aware
• Avoid areas where ticks hide (wood piles, high grasses, leaves)
• Wear light-colored clothing when hiking
• Apply approved repellants
• Remove any ticks you find embedded and send for testing
• Examine yourself and other members of your household – and don’t forget the pets
• When returning from a hike, put clothing in the dryer for 15 minutes on high.

For more information, visit globallymealliance. org/about-lyme/prevention/
be-tick-aware/.

Locally, the CNY Lyme and Tick Borne Disease Alliance offers community education for groups, camps and clubs. For more information, contact Elizabeth Balfour at cnylymealliance.org/ or 315.551.2551. Ticks are here, and we need to protect ourselves and our families through prevention and quick action when a tick bite occurs. Be tick aware, and help educate your patients and teams. 

Resources
1. cdc.gov/ticks/longhorned-tick/index.html

2. cdc.gov/mmwr/volumes/7 /wr/mm7211a1.htm?s_cid=mm7211a1_w

3. Central NY Lyme and Tick Borne Disease Alliance cnylymealliance.org/

4. Dr. Brian Leydet, Jr., MPH leydetlabesf.weebly.com

5. Dr. Kris Paolino, Infectious Disease upstate.edu/id/healthcare/ida/physicians-
staff-profile.php?empID=paolinok

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

Auburn Community Hospital Awarded $21M Grant By New York State

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Statewide Health Care Facility Transformation III Program Supports Essential Health Care Services.

Auburn Community Hospital (ACH) has been awarded a $21 million Statewide Health Care Facility Transformation Grant. ACH applied for $21 million dollars to fund two major projects that address significant community health care needs. Auburn will use the funding to develop an outpatient Cardiac Care Institute on its campus and to expand and modernize its operating rooms and surgical services.

The ACH Cardiology Institute will include a hospital-wide multidisciplinary team of health professionals linking Admissions, the Emergency Department, the Cardiac Catheterization Team, Intensive Cardiac Care Unit, Inpatient Telemetry, Outpatient Testing, the Laboratory, Imaging Services and Cardiovascular Rehabilitation. This will allow ACH to provide outpatient cardiac services which is a significant need in Cayuga County. Cayuga County has an increasingly elderly population with the inherent cardiac issues that accompany aging, as well as its emergent and longterm cardiac repercussions for patients who suffered from COVID-19.

In addition, this funding will allow ACH to modernize the OR rooms and expand its surgical services. ACH will expand the size and capacity of its operating area, including three new state-of-the-art operating rooms and one new procedure room. These ORs and procedure room will allow ACH to increase the number of surgeries and interventional radiology procedures. The volume increase encompasses hip and knee surgery, orthopedic sports surgeries, ENT and bariatric surgeries, and is directly related to new surgeons and specialists ACH has hired. This also complements ACH’s collaboration with the SUNY Upstate faculty practice to permit their surgeons to schedule additional surgeries at ACH. The additional OR capacity will also allow ACH to dedicate certain rooms for ambulatory surgery versus inpatient or emergency surgeries and allows for interventional radiology procedures in partnership with the University of Rochester Medical Center. 

“We are delighted to receive this news from the State of New York. A great deal of support has been provided by Governor Hochul and the NYS Health Department for ACH and its transformation. We are also thankful to our NYS legislators and community leaders for their support of our hospital. The creation of our Cardiac Institute, combined with the new cancer center, and the OR expansion will provide the essential care that our community needs and that today they may have to travel long distances to receive these services. These services will now be accessible in our own backyard by our worldclass doctors, nurses, and health care professionals.” explained Scott Berlucchi, CEO. 

The NYS funding is solely dedicated to capital projects and cannot be used for operations. 

Auburn Community Hospital Auburn Community Hospital (ACH) is a notfor- profit, 99-bed acute care facility with a mission to provide compassionate quality care to our community. ACH is the sole provider of acute and general hospital services in Cayuga County and the surrounding areas located in the Finger Lakes region of Central New York including the only 5-Star Long Term Care and Rehabilitation Center in the state. 

AuburnHospital.org

SOS Hand & Wrist Center Expedites Patient Care

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By Molly English-Bowers

It’s been a busy few months at Syracuse Orthopedic Specialists’ Hand & Wrist Center. Last fall, physicians moved into new space on the second floor at 5719 Widewaters Parkway, DeWitt. And just over a month ago in March 2023, physical and occupational therapists moved into the same location. 

“Bringing everyone who treats hand, wrist and elbow injuries under one roof means better collaboration between therapists and doctors,” said director of hand therapy at SOS Benjamin Brightman, MS OT/L, CHT, of the move from 5823 Widewaters Parkway, East Syracuse. “It also allows patients to have easier, same day services. If a patient is being fitted for a custom splint and needs therapy the same day, we’re able to accommodate them more easily. It was more complicated for patients to leave one office and go to another. Our new location gives us and them immediate access, which is better for the patient. We’re better able to streamline our processes and have better protocols, so everyone on the team knows what is expected and what the outcome should be.” 

Now, when a patient sees a physician for a post-operative appointment, that patient can  cross the hall to visit PT or OT during the same appointment, if need be. Likewise, if a therapist needs a doctor’s expertise, a patient can walk across the hall. It’s comprehensive treatment in one location. Both departments share a waiting room, with doctor offices on one side and therapy offices on the other. 

The new hand center has two dedicated X-ray machines and state-ofthe- art equipment, allowing for a more efficient continuum of care and even better patient outcomes. 

The Hand & Wrist Center’s treatment team includes six fellowship-trained orthopedic hand and wrist surgeons and five certified hand therapists and assistants. One of those physicians, Devon Ryan, MD, joined SOS in August 2022 as the newest member of the medical team. He’s been very pleased with his transition to the practice. “Everyone working at the Hand Center, from the front desk to the other hand surgeons, has been incredibly accommodating and helpful, so getting my practice up and running has been as streamlined as possible.” 

“I think part of our expansion is population-driven within the broader Syracuse area, and with Amazon expanding and Micron on the way, our population will only get larger as more people move here for jobs ” said Ryan. 

Brightman has worked at the Hand and Wrist Center for almost six years. He supervises two occupational therapists and two occupational therapy assistants who treat more patients year over year. “There’s more awareness within the general population, so they seek care more,” he said. “We’ve grown every year that I’ve been here. Before we moved in, it was more complicated for patients to leave one office and drive to another. Our new facility gives them and us immediate access.”

Wrists and hands present a variety of conditions, both chronic, like Carpal Tunnel Syndrome and trigger finger, and acute, such as sprains and fractures. It’s that variety that appeals to Ryan. “I really like the complexity; there’s quite a bit of intricate anatomy involving the hand and wrist,” he said. “You work with all different tissue types—more than skin and bones.”

Among the conditions treated by physicians at SOS are ganglion cysts, finger dislocation, trigger finger and tendon injuries. Carpal Tunnel Release is the most common operation performed at SOS. In 2022, over 1,600 carpal tunnel surgeries were performed at The Specialists’ One-Day Surgery Center. The cause of Carpal Tunnel Syndrome, however, isn’t always as simple as occupational or repetitive motions such as typing at a computer keyboard.

“It’s hard to know for sure if those are the causes,” said Ryan. “What’s more clear is that those types of activities worsen the symptoms. I suspect that mild Carpal Tunnel Syndrome is more symptomatic than it was 10 or 20 years ago given the increasing usage of computers and smartphones. In addition, 30 to 40 years ago, the surgery for Carpal Tunnel Syndrome was a bigger deal; there was a larger incision and longer recovery.” 

Now most of these surgeries are endoscopic, with a single 1/2-inch incision in the wrist. “Recovery is often as short as a 2-3 days, which allows for a quicker return to work,” Ryan said. “Sometimes the full recovery can take a few months, but the typical patient sees almost immediate relief. A lot of patients, when they finally pull the trigger on Carpal Tunnel surgery, say they wish they had taken the leap sooner.”

Indeed, according to clevelandclinic. org, the success rate for carpal tunnel surgery is 95 percent. If you need treatment for hand and wrist ailments, contact the SOS Hand & Wrist Center at 315-251-3162 or visit sosbones.com. There you will find information on the center’s physician and therapy team, as well as conditions
treated. 

 

Left:  Devon J. Ryan, MD

Right: Benjamin Brightman, MS, OT/L, CHT

Seven Steps To Medicaid Compliance Program Readiness

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By Maureen Dunn McGlynn

The mission of the New York Office of The Medical Inspector General (OMIG) includes enhancing the integrity of the Medicaid program by preventing and detecting fraudulent, abusive and wasteful practices within the Medicaid program. Pursuant to this mission, New York implemented compliance program requirements in 2009. Recently, amended regulations were adopted governing the implementation and operation of effective compliance programs for certain required Medicaid providers. These revised regulations include significant changes to the original regulations and will require affected Medicaid providers to review and revise their existing compliance programs. So, what steps should Medicaid providers take now to meet these new requirements?

1. Determine whether you are a required provider. As a condition of receiving payment under the Medicaid program, a “required provider” must adopt, implement and maintain an effective compliance program that satisfies the new regulations. “Required providers” include providers subject to Articles 28 or 36 of the Public Health Law, Articles 16 or 31 of the Mental Hygiene Law and managed care providers or managed long term care plans (MMCOs). Also included are providers who provide care services or supplies under the Medicaid program for which the Medicaid program is or should be reasonably expected by a provider to be a “substantial portion” of their business operations. A substantial portion of business operations means the provider claimed or received $1 million in any consecutive 12-month period, directly or indirectly from the Medicaid program.

2. Identify your risk areas. A required provider’s compliance program must apply to the provider’s risk areas. Risk areas are areas of the provider’s operations that are or should with due diligence be identified by the provider through its organizational experience. Areas of operations included in a compliance program must include billings, payments, medical necessity and quality of care, governance, mandatory reporting, credentialing, ordered services and contractor, subcontractor, agent or independent contractor oversight. An effective compliance program should be designed to be compatible with the provider’s characteristics (i.e. size, complexity, resources and culture) and be well-integrated into the provider’s operations.

3. Review and update your written policies and procedures and review them at least annually. Compliance programs must have written policies, procedures and standards of conduct accessible to everyone affected by the provider’s risk areas, including employees, chief executives and other senior administrators, managers, contractors, agents, subcontractors, independent contractors and governing body and corporate officers. The policies and procedures must describe compliance expectations, the provider’s fundamental principles, values and commitment to conduct its business in an ethical manner. In addition, the policies and procedures must include specific guidance on dealing with potential compliance issues, identify methods and procedures for communicating compliance issues to the appropriate compliance personnel and describe how potential compliance problems are investigated and resolved.

4. Appoint a compliance officer and plan compliance training. The compliance officer, who is not required to be an employee, reports directly to the chief executive or other senior administrator and periodically reports directly to the governing body. The compliance officer leads and coordinates the compliance committee, which is required to meet at least quarterly, have its own charter and consist of senior managers. Compliance training must be provided annually and must be part of orientation for new employees and occur promptly upon hiring.

5. Create and maintain effective lines of communication to ensure confidentiality. It is important that lines of communication directly to the compliance officer are publicized and available to all staff and Medicaid recipients of service by the provider, including a method for anonymous reporting of potential fraud, waste, abuse and compliance issues. With certain exceptions, the confidentiality of the reporter must be maintained.

6. Monitor and respond to compliance issues. A key component of an effective compliance program is a system for routine monitoring and identification of compliance risks. Monitoring activity results should be promptly shared with the compliance officer and appropriate compliance personnel. It is crucial that compliance issues are promptly investigated and corrected.

7. Take advantage of available resources. There are several resources available to assist in meeting compliance program obligations on the OMIG website (omig.ny.gov), including a compliance library, webinar, Compliance Program Review Module and OMIG’s Compliance Program Guidance. 


Maureen Dunn McGlynn is a member at
CCB Law, a boutique law firm focused
on providing counsel to physicians and
healthcare professionals. She can be reached
at 315.477.6276 or mmcglynn@ccblaw.com.