Category: 2023

Upstate Cancer Center: Improving Cancer Outcomes for All

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BY BECCA TAURISANO

On our cover: The Upstate Cancer Center has been continuously accredited by the ACS Commission on Cancer since 2006 and is supported by services to meet its mission. Clockwise from top: the Clinical Pathology Lab on the fifth floor of the Cancer Center provides advanced testing and diagnostics. • Upstate’s mammovan covers 10 CNY counties. • TrueBeam technology provides precision radiotherapy at nearly any angle. • Interiors of the Cancer Center reflect the theme of healing supported by nature. • A dedicated nursing team at the Cancer Center location at Community Hospital. • The newest Cancer Center site in is opening in Verona, NY, this summer. • The infusion area at the Cancer Center at Community site on Onondaga Hill. • Surgeons provide leading-edge treatments and participate in the Cancer Center’s many tumor boards.

THE UPSTATE CANCER CENTER has a role that extends far beyond providing state-of-the-art care. Its mission to improve outcomes in the community is further supported by delivering preventative education and services, conducting biomedical research and clinical trials, and improving access for underserved populations. By expanding locations and support services, along with investing in cancer-fighting technology, the Upstate Cancer Center offers interdisciplinary treatments that are on par with national cancer centers and aligned with the Cancer Moonshot goal to cut the death rate from cancer by 50% over the next 25 years. 

Multidisciplinary Approach to Care

With a team of more than 90 board-certified physicians, the Upstate Cancer Center organizes cancer care into tumor-specific programs. While all types of cancer are treated, there are multidisciplinary programs for bladder; breast; gynecology oncology; head and neck; kidney; liver, gallbladder, and pancreas; melanoma; neuro oncology; prostate; thyroid and thoracic oncology. Tumor boards for the programs are comprised of surgeons, medical oncologists, radiation oncologists, radiologists, pathologists and other specialists, as well as a dedicated research associate to identify and recruit patients for clinical trials. “Patients who require decision-making that spans these disciplines are discussed at our tumor boards,” says Interim Director Thomas J. VanderMeer, MD, FACS. “The multidisciplinary team determines the best course of care involving multiple modalities.” The high degree of specialization and frequency of the tumor boards at Upstate Cancer Center is not found elsewhere in Central New York.

Clinical Innovation

The Upstate Cancer Center has numerous innovations in medical oncology, radiation oncology and surgery. Gennady Bratslavsky, MD, Deputy Director of the Upstate Cancer Center and chair of Urology, says the robotic surgery program has initiated novel surgeries not done elsewhere in the world, such as the first-ever robotic replacement of the vena cava and a level III inferior vena cava thrombectomy first performed here 10 years ago. Such technical advances on the surgical side allow patients to receive modern care as well as faster recovery and return to home.

“Our clinical pathways are very strong,” says Dr. Bratslavsky. “The expertise of our surgeons is unparalleled for the area.”

For radiation oncology, physicians offer numerous approaches in improved targeting, which minimizes potential damage to nearby healthy tissue and offers improved and shorter treatment regimens. “The radiation team offers treatment
with such precision the approach is on par with that of our surgical team,” says Dr. Bratslavsky. Radiation Oncology also works with several departments to provide opportunities for theranostics: a novel approach combining therapy with diagnostics. The radiation is delivered intravenously, only released at the molecular level where the tumor cells are located. “Theranostics is only just now becoming a concept in medical therapy, and yet at Upstate, our first patient was treated well over two years ago with this approach,” says Dr. Bratslavsky.

On the medical oncology side, the Upstate Cancer Center has committed to innovations in both preventative care and combination cancer therapy, currently serving as a site for cancer vaccine clinical trials. Oral chemotherapy is prevalent as well, allowing patients to take chemotherapy at home under the guidance of the Upstate Cancer Center. 

Expanded Locations and Telemedicine Options
In order to make cancer care more convenient for patients, the Upstate Cancer Center has expanded to several new locations and offers follow-up appointments by telemedicine. Upstate Cancer Center Associate Director, Richard J. Kilburg says “Our strategy was to establish satellite offices that could provide the same high-quality care, treatment and advanced research as our main cancer center location. That care is now closer to home for many patients.”

This summer, a new location in Verona will provide patients in Oneida and Rome nearby access to radiation oncology and medical oncology and, due to its proximity to the New York State Thruway, the location will be convenient to additional communities as well. A comprehensive Upstate Cancer Center offering radiation oncology and medical oncology is scheduled to open by January 2024 at Auburn Community Hospital, underscoring the importance of regional partnerships

Opening this summer, Verona is the newest Cancer Center location providing a convenient location for residents of Madison and Oneida counties. The 30,000-square-foot facility is located off NYS Thruway Exit 33 and will provide medical oncology, radiation therapy, radiology, laboratory, pharmacy and consultative services. The Verona site will provide multidisciplinary care with surgeons, medical oncologists, radiation oncologists and other specialists who consult together to manage each patient’s specific treatment and provide information back to referring physicians.

The Upstate Cancer Center Hematology/ Oncology location at Upstate Community Hospital has been open for just over a year and is already outpacing third-year projections. The location allows Upstate to provide life-saving cancer treatments for the southern

suburbs of Syracuse and as far away as Ithaca.  At the Madison-Irving Building in Syracuse, an Upstate Gynecology Oncology location has been open for nearly two years. This office specializes in gynecologic cancers and offers patients surgery and infusion therapy treatment options. “In all our satellite offices, we provide that convenience and state-of-the-art care available at our main campus,” says Kilburg.

During COVID, it became necessary to limit patients from coming into the
hospital if they were not receiving treatment. “It was evident that we needed
to treat more people from home,” says Kilburg. “We established the technology and moved many follow up visits to telemedicine.” While limitations have been lifted, telemedicine continues to be popular with patients who like the option for their follow-up appointments.

Improved Experience for Patients and Staff

Besides telemedicine and satellite offices, there are a wide array of support services to improve the patient experience. Services like integrative therapies, financial counseling, nutritional counseling, genetic counseling, palliative care, spiritual care, support groups, survivorship, tobacco cessation and free valet parking help patients and their families feel supported during treatment. The Upstate Cancer Center has expanded its look and feel to all its satellite offices, including integrating music and art in a healing way for patients. “Our patient satisfaction ranks us in the top 1 or 2% in organizations across the country,” says Dr. VanderMeer. “Cancer is a difficult disease to take care of, but our staff never let the challenges they face affect the patient experience. We want our employees to be able to provide excellent care to our patients.”

Dr. Vandermeer says a focus on clinical operations at the cancer center and regional sites is also key for the patient and staff experience. “We want to make this a people-first organization,” he says. “That goes for patients as well as healthcare providers.” A new Director of Clinical Operations at the Cancer Center, JJ Yakowec, DrPH, MPH, is helping improve workflows and making processes more efficient for the entire team. “Thanks to Dr. Yakowec’s efforts, we are already establishing improvements saving time and space to see patients in a more efficient manner,” says Kilburg. “That kind of operational efficiency is important to our patients and staff.”

Investment in Technology

Offering the latest technologies to treat patients ensures fewer side effects and better quality of life. “Our cancer treatment and quality of care is excellent as evidenced by our American College of Surgeons Commission on Cancer accreditations 18 consecutive years,” says Kilburg. Radiation oncologists are able to deliver radiation with extreme precision, even to difficult-to-reach areas in the body, using CT Simulators to plan and Varian TrueBeam linear accelerators to treat. “We are able to treat within millimeters of accuracy and spare vital surrounding tissue and organs.” The main campus of the Upstate Cancer Center houses three linear accelerators, and each satellite office will have a linear accelerator as well. Next year, they are planning to add a Magnetic Resonance Imaging Guided Linear Accelerator (MRI-LINAC) which has specific advantages in treating soft tissue tumors. The Cancer Center also offers the latest in cancer-fighting drug therapies that can be delivered orally or by infusion.

Research Integration

Upstate’s integration of research supports both discovery at the bench as well as treatments at the bedside, and every patient is evaluated for clinical trials. Upstate has streamlined its research focus to three areas: Cancer Cell Biology and Genetics, Cancer Therapeutics, and Cancer Prevention and Population Health. Leszek Kotula, MD, PhD, the Associate Director for Basic and Translational Research at Upstate Cancer Center says it is important to connect knowledge that is gathered in the laboratory to create potential treatments and diagnostic procedures at the bedside. “The number one requirement for novel medicine is help patients; not harm them. Clinical trials are so important because they allow us to understand side effects and provide improvement for treatment and prolong patients’ lives,” Dr. Kotula says. With over 72 open clinical trials at the Upstate Cancer Center, patients have the opportunity to participate in research to improve efficacy of treatment. Serving an area with two million people in population the Upstate Cancer Center is the only medical university in Central New York and has the highest participation and enrollment in clinical trials in the region. The integration of clinical innovation and research allows for the same therapies found at national cancer centers. One such innovative program utilizes immunotherapy to treat metastatic disease. “We can take cells from the patient, modify them in vitro, introduce genes or disrupt genes as needed, and then use them as a drug to treat the patient’s cancer,” says Dr. Kotula. “The big promise of immunotherapy is that we will be able to successfully treat metastatic cancer. Thanks to basic, clinical and translational research, we are able to use cutting-edge therapies at Upstate.”

In addition to the weekly tumor boards, a monthly molecular tumor board is run by Jeffery Ross, MD, world-renowned pathologist and co-founder of Foundation Medicine. Dr. Bratslavsky says the program is able to profile cancers in their advanced stage and identify specific genetic mutations that could be responsible for prognosis as well as response to therapies. “The molecular genetics language is agnostic to a specific tumor type, and we learn that many drugs can be effective in more than one cancer type when a specific gene mutation is present. Through this unique program we have been able to identify certain genetic mutations that allow us to alter the therapy and prolong patients’ lives,” says Dr. Bratslavsky.

One of the Upstate Cancer Center’s key new hires is Director of Clinical Operations JJ Yakowec, DrPH, MPH. As a key member of SUNY Upstate’s Cancer Center, she is leading the development, implementation and growth of its operational excellence program. This program supports continuous and sustainable operational improvements to benefit staff and patients. Dr. Yakowec has a background in data-driven strategic planning, process re-design, and was previously at Dana-Farber Cancer Institute in Boston, most recently as the senior manager for health systems improvement.

Reducing Disparities
Christopher Morley, PhD, Chair of the Department of Public Health and Preventative
Medicine and Telisa Stewart, DrPH, Associate Professor of Public Health and Preventative Medicine are working to reduce disparities among the rural, urban and refugee communities that Upstate serves. Each group has distinct challenges, ranging from financial factors, lower health literacy, historic mistrust of the healthcare industry, transportation issues or geographical distance from primary and specialty care. Studying and monitoring data at the population level helps to both identify social determinants of cancer rates in populations, as well as to design preventive interventions. “We can use large national data sets to examine the presence of different risk factors in different subsets of the population,” says Dr. Morley. “We can also use qualitative data by having conversations with people to explore what barriers people experience in their communities.” 

Data surveillance plays a part as well. If the data show an uptick in one kind of cancer, the researchers will determine where those instances of cancer are occurring and determine whether interventions could be put in place. Merging data analysis and community partnership is important for communities to adopt change and for there to be behavior modifications in health. “When you build community partnerships for cancer- based interventions, they are more successful,” says Dr. Stewart. “It has been proven you will have better adherence to certain behaviors, screening and treatment if you work with those communities to identify what works for them.” Upstate offers several programs in the community, including She Matters and We Matter for breast and colon cancer prevention and to reduce disparities, and
a mobile mammography van covers 10 counties for screenings.

By utilizing artificial intelligence and natural language processing, researchers can scour medical records and connect eligibility criteria to identify clinical trials and increase enrollment for patients in underserved populations. “We are making cancer prevention and control a priority for programmatic development to understand how to reach those populations more effectively,” says Dr. VanderMeer. “Part of providing cancer care is ensuring that you are meeting your constituents where they are.”

Meeting Cancer Moonshot Goals
In 2022, President Biden highlighted new national goals for the Cancer Moonshot program: to reduce the cancer death rate by half within 25 years and improve the lives of people with cancer and cancer survivors. As the academic medical center for the region with nationally and internationally renowned physicians and an emphasis on clinical trials, the Upstate Cancer Center is providing the groundbreaking cancer research the Cancer Moonshot is seeking. “At Upstate, we are addressing disparities in care and finding cures,” says Dr. VanderMeer. “We are recruiting basic and translational researchers so we can improve outcomes. All of the things we are doing to improve outcomes in our region, we are ensuring everyone experiences the gains.” 

For more information, please go to upstate.edu/cancer

The staff on Upstate’s Mobile Mammography van brings screenings to residents of 10 counties in CNY, many of whom would otherwise might not have access to care. The mammovan provides the same 3-D mammography available at all Upstate’s breast imaging locations and the images are read by board-certified radiologists. In addition, fecal immunochemical tests are provided in conjunction with We Matter, an outreach program to provide colon cancer screening.

Workforce Challenges

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BY KATHRYN RUSCITTO, ADVISOR

My mother has encountered the hospital, rehab and homecare-based workforces over the past several months; it has allowed me to see up close the challenges that have developed in the healthcare workforce. From food service to transportation to nursing, all areas have been impacted. This results in a number of bumps in care delivery for a 98-year-old patient: Lost dentures, lost hearing aids, lost glasses, missed meals, delayed appointment arrivals and delayed bathroom stops.

It has made our family more aware and ready to advocate when she need better support. I complained a lot, but this is really not the fault of the organizations and their current workforce; COVID broke our systems and put undue burden on the remaining healthcare workers. Employees are looking for us to do better in finding new approaches to recruitment and training to rebuild their teams.

These workforce issues are also coming at the very time we are seeing a dramatic increase in the age of our community residents. How do we solve these challenges?

I am spending some of my time talking to my foundation and donor contacts and demonstrating that workforce development funding is essential right now. Programs that fund scholarships, training, support entry into the health field by offering day care support to employees while in school and other incentives are desperately needed.

Ultimately, recruiting outside traditional employee segments and reaching out to other countries may be in our future. Syracuse University is working to connect veterans with opportunities, and LeMoyne College is focused on growing nurses, clinical affiliates and the physical therapy workforce. LeMoyne also is retraining foreign-trained health employees through HARC (www.lemoyne.edu/Values/In-the Community/Healthcare-Advancement-Resource-Center).

SUNY Upstate, St. Joseph’s Health and Crouse Health continue growing nursing and medical staffs. In one organization, they have found a shift to part-time positions drew in employees who would not consider full-time work. Remote work for others has helped with backroom operations. Technology is allowing for expertise of one nurse or physician to be spread across many states.

Particularly successful are several demonstrations around the state drawing foreign-born health workers into retraining; others are reaching out to high schools to create work-study slots while still in school with a seamless progression to a job. In talking to Gwen Crosett, founder of Constant Care247 – a provider of home-based care, she said many caregivers never finish nursing school because they are too busy working to keep a roof over their families’ heads.

“Recently, I sponsored a graduate from nursing school who was having a difficult time passing her boards,” Crosett said. “She did not have the money and resources to hire a tutor. ConstantCare247 invested in a tutor, bought her the books and, hopefully, mid-year she will be able to call herself an RN.  I feel, as an employer, investing in her success will help all of us in the long run.”

This environment requires unique approaches and creativity to draw new candidates into the health-care workforce. Reaching out to schools, welcoming refugees to our community and drawing retirees back to unique models is in all our futures.

Mental Health in the Workplace

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By Elizabeth Landry

Over the past several years, many in the U.S. have suffered poor mental health and suicide rates have remained steady. Working people tend to be affected by these issues at a high rate. A rise in remote employment leading to feelings of isolation as well as high-stress, fast-paced work environments are contributing factors to these patterns.

According to Dr. Omar Colon, Medical Director of Behavioral Services at Oswego Health, there are several warning signs employers can monitor for to help recognize workers who may be suffering and at risk for suicide. Arriving late to work, working excessive hours, increased stress at work or at home, mentioning access to weapons and generally any behavior out of the norm for a specific person are all red flags indicating an employee may be suffering poor mental health.

Addressing these issues in the workplace can seem daunting due to the unfortunate stigma that often surrounds mental health and suicide. However, Dr. Colon emphasized it’s important for gatekeepers in the workplace, such as managers and HR personnel, to help break down this stigma by simply asking their employees how they’re feeling and offering a welcoming environment where workers can feel comfortable having discussions about what’s happening in their lives.

“When we see these red flags in our work, we have to pay attention as gatekeepers and be ready to receive these messages. We need to be thinking, ‘Wait a minute – does this person need some help? Are we making it easy for this person to access the help they need?’” explained Dr. Colon.

In addition to identifying when employees may be at risk for poor mental health or even suicide, employers can strive to boost mental well being in the workplace by encouraging employees to practice good mental health habits when they encounter stressful situations.

“We’ve been focused on creating a culture where it’s OK to take a break from stress at work and come back refreshed, even if that means just a five-minute walk,” said Alissa Viscome, Employee Engagement Manager at Oswego Health.

The COVID pandemic has also created additional mental health-related difficulties in the workplace. An increase in remote employment, virtual meetings, masks and physical occupancy limitations have all made it more difficult for employees to create important bonds with one another.

The staff at Oswego Health has been working to create more opportunities for employees to connect with one another, even if those connections must be virtual. Employees at Oswego Health have participated in activities like sharing photos of pets with one another on National Pet Day and collectively taking part in self-care opportunities during the different themed months of the “Action for Happiness” calendar. Although these initiatives may seem simple, they can make a big impact that encourages interpersonal connections and helps boost mental wellness among teams in the workplace.

Residents of Oswego County and beyond can find treatment resources at one of several inpatient and outpatient facilities, including the brand-new Lakeview Center for Mental Health and Wellness. Additionally, the Oswego Health website offers a Wellness Library where employers can find educational awareness articles about mental health and suicide as well as practical tips to help support general mental well being both in the workplace and at home.

Nephrology Associates of Syracuse, P.C. Give Patients a Comprehensive, United Approach to Kidney Care

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By Daniel K. Brantley

[Deck] Over the past 44 years, Nephrology Associates of Syracuse, P.C. has continued to grow and enhance the kidney care they provide, making them a top choice for advanced, compassionate care.

Founded in 1978, Nephrology Associates of Syracuse, P.C. began with a small team that held an important but simple goal: “To provide high-quality nephrological care for our patients.” However, achieving that goal requires nephrologists and other specialists to work closely together. When they do, remarkable things can happen.

“If you get 10 nephrologists in a room, you’re going to have 10 different opinions,” says Matthew Chaffin, MD, a nephrologist with Nephrology Associates of Syracuse and Medical Director of the DaVita Central New York Dialysis Clinic. “Our unified way of practicing and approaching patients is unique for nephrologists, and it is ultimately better for the patient.”

Integral to their practice is taking a comprehensive, holistic approach to kidney care by looking at each of their patient’s medical conditions to determine if and how they might be affecting the kidneys. Dr. Chaffin says they view nephrology “not solely as the practice of caring for kidneys, but for the overall person.”

Over the years, Nephrology Associates of Syracuse, P.C. have increased their locations and grown their service area. They’ve also established an in-house laboratory to provide rapid blood-test results that clinicians can discuss with their patients the same day. The main office, numerous satellite locations and six dialysis units are located in and around Syracuse, accessible to patients from Canada, Pennsylvania and everywhere in between.

Pandemic-Proven Care

As it was for all healthcare facilities, the COVID-19 pandemic was challenging for Nephrology Associates of Syracuse, P.C. But in time, the stresses of the pandemic also offered growth opportunities that ultimately improved how they provided nephrology care.

“The pandemic changed a lot of what we do — especially during the early stages when everything shut down,” says Antoine Azar, MD, nephrologist and internal medicine physician with Nephrology Associates of Syracuse, P.C. and Medical Director of the DaVita Dialysis Clinics in Syracuse and Ithaca. “We had to improvise, to find ways to see kidney patients and ensure they remained stable during unstable times.”

While much of the world shut down, that wasn’t an option for the practice. When serving patients with chronic kidney failure (CKD), closing the doors — even temporarily — could be disastrous. However, some patients started to miss necessary appointments because they were afraid of contracting the virus. That’s when the organization implemented some creative solutions. In addition to setting up virtual visits, the group established alternate, standalone blood test locations that allowed patients to receive necessary tests near their homes, with minimal interaction with others. All visitors and staff must wear masks and be screened upon arrival. The results were forwarded to Nephrology Associates of Syracuse, P.C., for review, and a nephrologist discussed the results with patients in the office or via video conference.

Most patients have returned to in-person visits, where extra precautionary steps continue in place, as kidneys can suffer substantial damage from COVID-19, particularly among ICU patients placed on ventilators. Patients remain isolated from others throughout their visit, reducing their infection risk. Telemedicine is available for patients who cannot make in-person appointments.

Prioritizing Value-Based Care

Today, nearly $114 billion (20%) of Medicare spending goes toward kidney disease care, according to CMS. Value-based programs were designed to reduce the cost of care to patients with CKD and improve the quality of care they receive, ultimately reducing hospitalizations and readmissions.

Nephrology Associates of Syracuse, P.C. makes sure every laboratory test ordered is necessary and that patients receive the appropriate when and where they needed it. An essential element of delivering value-based care is coordination.

“In general, Syracuse-based providers do a good job of coordinating care amongst hospitals and physicians from the moment of discharge until the patient returns to the clinician’s office,” Dr. Chaffin says. “But every step along the way could use improvement.”

One of those improvements is rooted in better communication, particularly with the release of ICD-10, the medical coding system that makes condition recordkeeping more specific. CKD coding is more fragmented, and diagnostic details require even more specificity. While certainly helpful for improving patient outcomes, inputting so much more data is time-consuming. To improve the speed and specificity of data entry, Nephrology Associates of Syracuse, P.C. modified its software. The IT improvement can now more accurately describe a patient’s condition, enhance the patient transition from hospital to office setting and improve the ability to predict potential expense and real-world risk of future events.

Identifying Risk of Rapid Decline

Until recently, clinicians who attempted to predict kidney function decline couldn’t be 100% certain. Nephrology Associates of Syracuse, P.C. now uses KidneyIntelX™, which provides sophisticated and precise data to help forecast rapid decline among their CKD patients. Primarily limited for use on patients with diabetes and those who are nephrotic, KidneyIntelX scores patients based on their risk of experiencing rapid kidney failure progression.

“Although we can use charts and graphs to look at the rate at which a patient’s creatinine is rising, you’re only estimating what [that future level] is going to be,” Dr. Chaffin says. “KidneyIntelX uses a set of newer, novel blood and urine tests to give better predictive values of whether someone is at high risk for kidney failure progression that will ultimately lead to a need for dialysis.”

To complement these new advancements, Chaffin says they are considering the value of offering genetic testing. For example, certain genes, such as apolipoprotein(a) in Black patients, are more common among those at highest risk for progressive CKD and they will eventually require dialysis. Even among patients experiencing mild kidney failure, the presence of certain genes increases the potential risk for future dialysis. Genetic testing can empower providers to further educate their patients to take control of their health in ways that may postpone the need for dialysis.

Smarter Patients Are Healthier Patients

The goal of kidney care is the same for both patients and clinicians: to find ways to maintain optimal kidney health throughout life. Reaching this goal requires medical expertise and patient participation.

“Patients are a key part of their own care team, and to play their role well requires appropriate and frequent education,” Dr. Azar says. “When patients know what’s going on and understand their disease, they tend to be more compliant and follow up.”

In the U.S., 9 of 10 people with kidney disease are unaware they have the condition. These same statistics are mirrored in Syracuse. When referred patients come in for their initial appointment at Nephrology Associates of Syracuse, 90% don’t know why they were referred by their primary provider. Dr. Azar says even among patients who have advanced kidney disease, an estimated 50% to 65% are unaware of their condition.

“This lack of education is striking,” he says. “So we try to shed some light on things.”

In many cases, diagnosis is the first bit of light shedding to take place. Since so many patients are generally unaware of their health problem, and are unfamiliar with kidney disease in general, education is the critical next step. Patients immediately receive education from their care team during each visit and are offered additional educational opportunities.

During CKD education classes, patients learn the specifics of their disease, what may happen to their kidneys in the coming years, available treatment options that are most likely to succeed, diet and lifestyle modifications and more. These one-on-one classes give patients the opportunity to learn at their own pace and engage with an advanced practice provider in person or online about their disease.

Patients who want to learn more can sign up for advanced education classes which go into greater depth on a variety of topics. Classes are also tailored to meet patient needs. They may learn the difference between hemodialysis and peritoneal dialysis, survival rates for their condition and other information that helps them get a firmer grasp on their health. Each educational session concludes with an opportunity for patients to ask clarifying questions that help ensure they’re understanding what they’ve learned and can put it into action.

“No matter what disease a patient comes to us with, we strive to make their lives better every day,” Dr. Chaffin says. “It’s why we’re here, and that united philosophy we follow drives everything we do.”

Nephrology Associates of Syracuse, P.C. diagnose and treat the following conditions:

  • Acute kidney conditions
  • Anemia management
  • Autoimmune disease of kidneys
  • Blood pressure management
  • Chronic kidney disease (all stages)
  • Diabetic nephropathy
  • Electrolyte abnormalities
  • Glomerulonephritis
  • Metabolic bone disease management
  • Polycystic kidney disease
  • Renal-related diabetes management
  • Renal transplant care, pre- and post-transplant

Nephrology Care Begins With Primary Care

With so many patients unaware of their kidney disease, many present to Nephrology Associates of Syracuse, P.C. with late-stage disease. As a result, nephrologists often have limited treatment options when a patient arrives for evaluation and therapy. An earlier diagnosis goes a long way toward changing that circumstance.

To increase the number of people diagnosed in the early stages of kidney disease, primary care providers should screen patients regularly. Annual blood and urine tests, especially for those with high blood pressure or diabetes, can detect kidney disease before it progresses.

However, early detection is not always sufficient, as patients may not understand, listen to or act on their provider’s advice. That’s why PCPs should do what nephrologists do: educate their patients until the education has an effect.

“When someone hears they have kidney disease, they may not pay attention or they may be in denial, because it’s a silent disease in the early stages,” says Antoine Azar, MD, nephrologist and internal medicine physician with Nephrology Associates of Syracuse, P.C. and Medical Director of the DaVita Dialysis Clinics in Syracuse and Ithaca. Because it doesn’t cause symptoms early on, Dr. Azar estimates more than 50% of PCP-referred patients neglect their initial nephrology appointment.

“Unfortunately, the majority come back in a year or two with worse kidneys and symptoms,” he says. “By that time, it may be too late to intervene.”

To combat this tendency to ignore kidney disease, patients must understand the severity of their problems and take appropriate action. For this to occur, clinicians should educate patients at each visit, underscoring the fact that they themselves are their best advocate for improved health.

Early Referral Improves Results

Declining kidney function commonly leads to dialysis, whether hemodialysis or peritoneal, in-home or at a dialysis center. When dialysis is insufficient or inappropriate, transplant becomes an option. In these cases, Nephrology Associates, P.C. providers refer patients to the nearest transplant center. They also prepare patients for their transplant and resume care when patients get discharged post-transplant.

But with an early referral, patients may eliminate the need for transplant. Studies have found patients who are referred to a kidney specialist prior to needing dialysis have reduced mortality. Providers are urged to continue referring patients when urine or blood tests indicate kidney disease.

Whether transplant or dialysis is necessary or appropriate, Nephrology Associates of Syracuse, P.C. has the expertise and experience to diagnose and treat all forms of kidney disease.

Satellite Services

When the COVID-19 pandemic exacerbated the need for convenient care, Nephrology Associates of Syracuse, P.C. adopted telemedicine technology, which they continue using to this day. Virtual medicine is not, however, the only convenience-enhancing approach they use.

Satellite locations throughout the area make it easier for those with kidney disease to receive the care they need, close to home. Nephrology Associates of Syracuse, P.C. satellite offices can be found in the following locations:

  • Camillus
  • Fayetteville
  • Fulton
  • Vernon

Additionally, nephrologists visit patients weekly at Crouse Hospital and St. Joseph’s Hospital and rotate through Central New York dialysis centers.

To refer patients to Nephrology Associates of Syracuse, P.C. in Syracuse or a satellite location, visit nephrologysyracuse.com/contact or call 315-478-3311

Excellus BlueCross BlueShield Advances Maternal Health Equity

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By: Becca Taurisano

Childbirth is inherently risky, but for minority women, it can be life-threatening. Consider the birth experience of global tennis star Serena Williams. Williams had a history of pulmonary embolism and, while recovering in the hospital after giving birth via c-section, she had difficulty getting her providers to acknowledge her symptoms. After repeatedly advocating for herself, doctors eventually found several small blood clots in her lungs and administered life-saving treatment. Sadly, hundreds of women each year are not as fortunate.

To advance health equity for all and address implicit bias and structural racism in health care, Excellus BlueCross BlueShield appointed Gina Cuyler, MD, as vice president of health equity and community investments in November 2021. A graduate of the University of Rochester School of Medicine and Dentistry, Dr. Cuyler is a board-certified internal medicine physician who is passionate about improving health outcomes for everyone. Using a cross-functional, data-driven approach, Dr. Cuyler is working to embed health equity across every aspect of Excellus BlueCross BlueShield’s organization and addressing maternal health disparities is one of her top priorities.

Maternal health is the continuum of care that includes the time before pregnancy, pregnancy itself, and one year postpartum. The health conditions of mothers before pregnancy impacts maternal and child health outcomes and, under Dr. Cuyler’s leadership, Excellus BCBS is working to address negative outcomes such as severe maternal morbidity (SMM). The U.S. Centers for Disease Control and Prevention defines SMM as “unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health.” The many drivers of maternal health include socioeconomic status, access to maternal health providers, geographic location, structural racism and implicit provider bias.

“Women of color are particularly at risk for negative maternal health outcomes independent of socioeconomic status, education or other factors. A Black mother with a college education is likely to have worse maternal health outcomes than a White mother without a college education,” notes Dr. Cuyler. A Blue Cross Blue Shield Association study on racial and ethnic disparities in maternal health revealed that preexisting health conditions, such as hypertension, diabetes and asthma, strongly correlate with higher SMM. The study found that Black women ages 35-44 have a 66% higher rate of SMM and are more likely to suffer pregnancy-related complications than white women in the same age range. The U.S. maternal mortality rate is the highest among similarly developed countries, with 17.4 deaths per 100,000 live births. “With all of the wealth, resources and knowledge in our country, we must do better,” says Dr. Cuyler.

Maternal health affects more than just mothers and their babies, but the community as a whole. When pregnancy complications arise, premature birth, low birth weight and prolonged stays in neonatal intensive care units increase as well. There is a societal cost when maternal health is not a top priority, says Dr. Cuyler. From the family members who suffer the loss of their loved one, to employers and co-workers bearing the burden when a parent has to take time off to care for their child, or worse, when an employee dies from pregnancy complications, maternal health affects families, businesses and communities. “It has a comprehensive impact on everyone,” Dr. Cuyler says, “we all bear the cost.”

Dr. Cuyler is addressing the drivers of higher SMM in a data-driven way. “Health equity work requires metrics,” Dr. Cuyler says, “you can’t manage what you can’t measure and you can’t measure what you can’t define.” After creating a health equity strategy for Excellus BCBS, Dr. Cuyler brought on health equity data analysts to help her capture and analyze the metrics required to determine actionable solutions. Collecting robust data is also dependent on identifying the attributes of the people in underserved communities, and that requires patients to submit complete attribute information so they can be identified appropriately in the data.

The COVID-19 pandemic highlighted health disparities in our nation, especially for people of color and, Dr. Cuyler says, the narrative surrounding health equity is expanding. Aligning with the health equity frameworks of New York state, the National Committee for Quality Assurance and the Centers for Medicare and Medicaid Services, Excellus BCBS is advancing equity along with quality in the healthcare arena. Dr. Cuyler’s goal is to embed health equity in every part of the organization. “Health equity is an enterprise initiative and we work in a cross-functional manner. I have deputized an army of ambassadors in our organization to understand how their work contributes to being able to provide meaningful health outcomes and improve health equity for all.”

In October 2022, Excellus BCBS announced the first round of recipients of Member and Community Health Improvement (MACHI) grants to address SMM and related health equity issues in upstate New York. Eight non-profit organizations were selected within the Health Plan’s 39-county service area to share $1 million in grant funding over the next three years. “We assembled a cross-functional, interdisciplinary team to determine these grant recipients to address depression, education, safety, lactation and homelessness,” says Dr. Cuyler, “we are very excited about the opportunity to impact at multiple points of the maternal health care continuum.” Additionally, Excellus BCBS provides bias in maternal health training to health providers in the region through a partnership with the March of Dimes.

Health equity is personal for Dr. Cuyler. Born in Panama, she immigrated to the United States with her mother when she was a young girl (her father died when she was two years old). Dr. Cuyler recounts an experience at a public hospital in New York City after her mother burned herself cooking. For over 16 hours, they sat in “a room full of black and brown people in agony. I realized that for some people, the health care system isn’t always equitable or kind,” Dr. Cuyler recalls.

Dr. Cuyler states that many patients have better health outcomes when a provider shares the same attributes of a patient population (race, gender, language, cultural background), and thus, she co-founded the Black Physicians Network of Greater Rochester, an organization whose mission is to reduce health disparities and improve the health of the community by increasing the number of black physicians. “I do believe it helps for you to see a physician that came from the same circumstances,” says Dr. Cuyler, “I am passionate about mentoring because I didn’t have a mentor. I had to figure everything out the hard way.” 

Dr. Cuyler wants every single person in the United States to have access to equitable healthcare and, to achieve that, she wants every person to ask themselves what they are doing to advance health equity in their sphere of influence. For those in the health care community, it is important to build trust. “Today we are committed to doing better not just for some but for everyone. We want to help patients feel engaged, educated and empowered, and for health care providers to understand how important they are in advancing health equity,” says Dr. Cuyler, “everyone has a role to play.”

Health equity is when each person has a chance to have optimal health. – Gina Cuyler, MD

At the end of the day, we have to make sure we are making progress in maternal health equity because the stakes are so high. – Gina Cuyler, MD

Drakos Clinical Laboratories: Providing Healthcare Without Walls in Central New York

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COVID-19 has radically disrupted the U.S. healthcare industry, which in turn has disrupted other business industries and entire communities. Healthcare workers are experiencing burnout at alarming rates. In a 2020 EClinicalMedicine survey, almost 50 percent of healthcare workers reported they were burned out from the COVID-19 pandemic. A 2021 special report from Morning Consult found that, since February 2020, 18 percent of healthcare workers have left their roles, 12 percent were laid off, and 31 percent have contemplated leaving their jobs.

Burnout and turnover issues are worsening U.S. healthcare provider shortages and hospital occupancy issues that existed even before the pandemic. Patients often wait long hours in the emergency room before seeing a physician, and many leave before they’re seen at all. If you’re in the healthcare industry, these could be your patients. If you’re in any other industry, these could be your employees. Either way, this issue affects us all.

The healthcare industry needs new, flexible solutions to ensure everyone has the access to care they need. In Central New York, Drakos Clinical Laboratories strives to serve patients wherever they are. Drakos provides mobile, at-work and at-home medical testing, concierge medical services, and medical testing logistics for large-scale events and productions. The company is now pursuing new partnership opportunities to help better reach patients.

“At Drakos, we believe in healthcare without walls,” says Drakos Founder and CEO Heather Drake Bianchi. “If we can go into a patient’s home, workplace, or another safe location to check their vitals and do their laboratory work, it lessens the pressure on hospitals, urgent cares, and physicians. It can also be safer for many patients, especially people who are immunocompromised or have young children or older adults at home.”

Drakos’s story begins in 2020 when its CineMedics division was founded. CineMedics was created to address the unprecedented medical testing needs on film sets during pandemic.

“When the pandemic began, there was a significant need to keep entertainment productions running safely. People’s livelihoods depended on it,” says Drake Bianchi. “This was particularly important being from Central New York where we have a relatively new, but rapidly growing film industry. We knew that our skills as first responders were a natural fit for protecting people in this moment and ensuring they could do their jobs without worrying about COVID.”

The company’s roots are in community paramedicine. Many of the staff members, including Drake Bianchi, are first responders who are experts at providing critical medical services in any environment. A scientist as well as entrepreneur, Drake Bianchi earned her Master of Science in human anatomy and physiology from Northeast College of Health Sciences and her bachelor’s in biomedical sciences from RIT. Before founding CineMedics and Drakos, she spent 16 years working in critical care medicine, both in the U.S. and internationally. She has served as a paramedic for National Geographic, Remote Medical International, and the Ocean Classroom Foundation.

In the pivotal first months of the pandemic, the Drakos/CineMedics team helped developed new protocols that became the standard throughout the film industry. They provided medical services to major productions, including the cast and crew of the Oscar-nominated “Don’t Look Up.” They were also hand-picked by the CNN conference “LIFE ITSELF” to conduct large-scale event testing for a VIP crowd. At “LIFE ITSELF,” they provided the COVID-19 testing for attendees such as Dr. Anthony Fauci, several past U.S. Presidents, astronaut Mark Kelly, actress Goldie Hawn, and more.

Over the past two years, Drakos/CineMedics has grown from seven people to a team of 50, with locations throughout the U.S. and in the UK. They continue to be sought out by major production companies as the #1 preferred company for these services.

Most recently, CineMedics provided care for the cast and crew of the new Netflix film “The Union.” Described as a “blue-collar James Bond,” the action thriller stars Mark Wahlberg, Halle Berry, and J.K. Simmons.

As a result of CineMedics’ work on the film, Wahlberg asked Drakos/CineMedics to provide concierge medical care for him and his friends and family on his current project, an Apple Original film titled “The Family Plan.”

There’s still more Drake Bianchi and the Drakos team want to do. Drake Bianchi previously assisted in search and rescue efforts for Hurricanes Katrina, Irene, and Sandy. Having seen firsthand the barriers that underserved populations face when trying to access healthcare, she has also committed the next phase of her business to using her mobile technology to bridge that gap for veterans, rural populations, low-income individuals, the sex worker industry, and the LGBTQ+ community right here in Central New York.

“Sometimes I can’t believe this is my life. It’s an incredible honor to be able to deliver quality care to so many people,” says Drake Bianchi. “I love being able to meet people where they are and ensuring they have what they need to be healthy.”

Increasing access to healthcare services became even more important to Drakos when a close colleague was diagnosed with cancer during a recent production. Seeing their friend fight cancer accelerated the Drakos/CineMedics team’s desire to serve more people.

“To survive cancer, you have to survive chemo, which means staying out of the hospital and staying hydrated,” says Drake Bianchi. “We want to reduce their exposure in the hospitals. Our friend and colleague getting their cancer diagnosis jumpstarted our work to provide these services and do them well.”

Drakos believes that this kind of care is the wave of the future, with both immediate and long-term implications. While the immediate need for everyone in our community is apparent, by 2040, more than 20 percent of the U.S. population will be 65 years or older—a demographic change for which the U.S. healthcare and caregiving systems are currently unprepared, especially in light of the damage caused by the pandemic. Additionally, many older people want to age in place, creating a need for services to come to them.

Drakos aims to ensure everyone has the care they need, where they want it, now and in the future.

Looking ahead, Drake Bianchi sees boundless ways to innovate Drakos and how healthcare is provided—which could have significant positive impacts on other entities within the healthcare industry, as well as the health and productivity of our community overall.

“We have the tools to make healthcare more accessible, more inclusive, and more tailored to patients’ individual needs,” says Drake Bianchi. “We’re ready to connect with new partners who are also excited to help shape the future of healthcare.”

For more information please see: https://cinemedics.us/

https://drakos-clinical-laboratories-cny.square.site/

St. Joseph’s Health Cardiovascular Institute dream team grows

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By: Martha Conway

In late November, the St. Joseph’s Health Cardiovascular Institute in Syracuse expanded its award-winning cardiac surgery team by welcoming the return of Dr. G. Randall Green. Green left St. Joseph’s Health five years ago with hopes of building a cardiac surgery and surgery training program at SUNY Upstate Medical University, but resources came up short.

He returned to a team and a place he loves.

“St. Joe’s had a great program in the past and it has remained a great program in the five years I wasn’t there,” Green said. “I think the people who put the program together and ran it for 10 years being back together is a great story of Central New York having a resource that it deserves.”

Green said it took a long time and many people to get St. Joseph’s Health’s program to where it is now, and it’s done nothing but maintain its excellence during his five-year absence.

“To succeed at providing quality cardiac surgery services, one must have skilled partners like our surgeons Doctors [Charles] Lutz, [Zhandong] Zhou, [Ahmad] Nazem and [Anton] Cherney and our talented group of cardiologists,” said Chief Medical Officer Dr. Philip A. Falcone. “They are great clinicians, have worked with Dr. Green in the past and are here to collaborate with him to provide excellent cardiac care.”

St. Joseph’s Health Cardiovascular Institute encompasses cardiology, cardiac surgery and vascular services. Robotic-assisted surgery leads to shorter recovery, less scarring and better overall health, and surgeons have expertise in all areas of heart surgery. The full range of services include:

  • Aortic valve surgery
  • Arrhythmia correction surgery
  • Coronary revascularization program (CABG)
  • Heart failure surgery
  • Mitral and tricuspid valves
  • Pulmonic valve surgery
  • Robotic valve program
  • Structural heart disease
  • Thoracic aortic disease
  • Transcatheter aortic valve replacement (TAVR)
  • Valve repair

St. Joseph’s Health instituted the first Structural Heart Program in Central New York, resulting in better patient outcomes, lower costs and fewer readmissions.

Green said the experience of the team, historical record of excellence from its members and 100-percent focus on patients turn out consistently superior results.

“This means adherence to policies and procedures that have been developed over time and 100-percent commitment to what I will generically refer to as ‘customer service’ or being the kind of providers you would want for your husband or wife,” he said. “It’s communicating that way, empathizing that way and going the extra mile for each patient- the way you would want it done for your loved one.

“If that’s what we model every single day, nobody can beat us. That attitude – that commitment to quality and outcomes – is what defines cardiac surgery at St. Joe’s.”

Part of the total care experience requires dedicated primary care physicians and cardiologists, as well as proper discharge planning.

“Maximum medical management – that’s what makes a world-class program,” Green said. “If we didn’t have the greatest cardiologists and best primary care physicians aligned with St. Joe’s, we wouldn’t be world-class.”

St. Joseph’s Health quality outcomes for cardiology and cardiac surgery are well-documented. Earning three out of three stars in the most competitive database in the country, St. Joseph’s Health lands in the top 10 percent year after year.

“Anybody can put up good outcomes in one year – statistics often work that way,” Green said. “When you reach it in multiple categories over many years, something is being done right here.”

St. Joseph’s Health Cardiac Institute, established in 1976, continues to be one of the best programs in the nation, as evidenced by the many accolades and awards for quality and patient outcomes its program received over the past 46 years. Some of the hospital’s many recognitions include:

  • Healthgrades’ America’s 100 Best Coronary Intervention Award – 2022
  • Healthgrades’ America’s 50 Best Hospitals for Cardiac Surgery – 2021 through 2023
  • Society of Thoracic Surgeons’ Top 6 Hospitals in the Nation for Cardiac Surgery, having the top distinction in five out of five cardiac surgical categories
  • American Heart Association/Mitral Foundation Reference Center Award for Mitral Valve Repair for demonstrated superior clinical outcomes in degenerative mitral valve repair
  • Healthgrades’ Valve Surgery Five-Star Recipient 10 years in a row – 2012 through 2021

“This year, St. Joseph’s Health received the highest rating possible from STS, a national cardiac surgical quality group, which confirms our excellent outcomes and dedication to high-level cardiac care,” Falcone said. “These outcomes are the result of a very motivated and talented team of nurses, technicians and physicians, all focused on providing the best patient care.”

Falcone said St. Joseph’s Health cardiac care program continues to look to the future by developing advanced technologies including minimally invasive valve replacement, robotic cardiac surgery, new electrophysiology techniques and researching new cardiac vessel perfusion and stenting opportunities.

“We continue to expand our coverage and availability for patients from other hospitals in Central New York and beyond through our Care Flight helicopter and transfer programs,” Falcone said. “Our goal is to be the absolute best cardiac care center, period.”

Green said emerging technologies and potential treatments are growing more rapidly every year and that, while you want to be an early adopter, you want to adopt technology that’s been proven effective.

“There are so many competing technologies right now, it’s hard to know which one is most efficacious, easiest for the patient, etc.,” Green said. “Having several surgeons in one place with the breadth of clinical coverage and depth of experience to sit down and decide which ones to explore is an opportunity none of us has ever had before.”

“In our community, you don’t need to go to Cleveland Clinic or Columbia or Stanford,” Green said. “You can get really great cardiac surgical care right here in Syracuse at St. Joe’s.”

“Whether it’s an evaluation for heart disease, the need for urgent treatment of occluded coronary vessels or treatment for an abnormal cardiac rhythm, our cardiologists are prepared to render whatever services patients require,” Falcone said.

“I’m rejoining the best surgeons in New York and probably beyond,” Green said. “They’re really outstanding surgeons, but they’re also really outstanding people. When it comes to heart surgery, it’s a team sport, and this is a dream team.”

Private Equity Expanding Pursuits in Health Care Investment

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Chris Zuccarini, Managing Director, National Health Care Practice, Risk Strategies Company

The trend of private equity (PE) firms seeking high returns in health care has been in full bloom for more than a decade. But whereas previously PE was focused on a top-down approach of buying hospitals and health systems, that focus has begun to shift toward less-costly, smaller specialty groups and physician practices.

Bain & Company’s 2021 Global Healthcare Private Equity and M&A Report found that investors are pursuing new “buy-and-build” strategies in less-penetrated segments of the provider sector. The report notes that there is increased focus among PE firms on areas that are promoting the shift toward home-based and outpatient care, along with “risk-bearing targets” like Medicare Advantage providers operating under capitation models and behavioral health providers.

Mission Alignment is Essential

For health care entities considering an investment from a private equity firm, the risk/reward calculus is complicated by recent downturns in patient volume and revenues due to COVID-19. The pandemic exposed the weaknesses that small providers face in a fee-for-service (FFS) environment and amplified the need for health care companies to maintain sufficient capital resources on hand to remain competitive and viable

The short-term financial windfall that may come from an acquisition must be weighed against the long-term implications, especially for physician practices who need to consider whether they are going to be part of an eventual sale. PE firms have a term of exit, typically within five to seven years, to meet shareholder obligations, so it is fair to raise a concern about what happens when that time is up.

Perhaps most importantly, compatibility relies on cultural alignment between PE firms and health care organizations. The economic model must support the care mission. Ensuring that the missions of the acquiring and acquired organizations are transparent and well aligned is critical for successful outcomes.

Improvements in Efficiency and Accountability

Partnerships between PE firms and medical groups have proven especially advantageous for easing the administrative burden for smaller providers. PE provides practices with a backstop to improve cash cycles and back-office processes, such as management reporting and compliance work.

PE investment has also allowed post-acute companies to grow and test new business models, delivering greater access to in-home care and telehealth. Technology is breaking down the traditional brick–and- mortar localized care delivery system, expanding access and lowering costs. PE brings the capital, and the know-how, to build these assets at scale.

In addition, the involvement of a PE firm creates visibility into the performance of a health care business, holding internal teams accountable for efficiencies to satisfy shareholders while delivering exemplary patient care. In August 2020, a JAMA study found hospitals acquired by PE firms experienced increases in net income as well as improvement in quality metrics.

Thinking Long Term

The health care industry is in a mature stage of PE involvement in core hospital service. With increased segmentation across the industry, the trend is growing and shifting. A JAMA study released in February 2020 found that more than 350 physician practices were acquired by PE firms between 2013 and 2016. The study concludes that PE firms see ample business opportunities in the physician practice space, expecting annual returns greater than 20%, though there remain “unknown implications for care delivery and patient outcomes” in the future.

Provider leaders should consider what they need long-term out of a PE transaction, secure commitments to quality and ensure that the new management will continue to invest as the industry moves away from FFS and expands into new business models.

Practices also need to consider the legal and compliance complexities that can arise out of the new administrative structures resulting from a PE investment. Risk Strategies Health Care Practice experts have extensive experience evaluating and advising on these partnerships and stand ready to help you achieve the best possible outcomes.

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

Beware the Overtime Trap

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By Bruce Wood, Esq.

It’s no secret that there is a nationwide shortage of skilled medical professionals, particularly nurses and physician assistants, which has resulted in longer work weeks for many employees. Those staffing shortages will not be resolved soon and healthcare employers need to be careful to avoid running afoul of federal and state wage and hours laws governing the payment of overtime compensation.

There is a common misconception that all medical professionals are exempt from overtime compensation. The Fair Labor Standards Act (FLSA) provides an exemption from the Act’s minimum wage and overtime requirements for any employee employed in a “bona fide professional capacity”. To meet that test the employee’s primary duty must be the performance of work requiring knowledge of an advanced type in a field of science or learning customarily acquired by a prolonged course of specialized intellectual instruction.

Clearly, licensed physicians are considered professional employees. And so are registered nurses, nurse practitioners, physician assistants, and certain certified medical technologists. Licensed practical nurses and other similar health care employees, however, generally do not qualify as exempt professional employees because possession of a specialized advanced academic degree is not a standard prerequisite for entry into those occupations.

In addition to meeting the test of a bona fide medical professional, the exempt employee must also be paid on a salary basis; however, the salary requirement does not apply to those who practice medicine (e.g., physicians) and while it may be argued that NPs and PAs practice medicine (since they can diagnose and treat), the courts interpreting the FLSA have generally held that they do not.

Thus, if the NP or PA is compensated on an hourly basis, the FLSA requires the payment of overtime compensation for work in excess of 40 hours per week. In the absence of unusual facts and circumstances, the employment of an NP or PA on a fixed salary should be exempt from the FLSA overtime requirements.

Some healthcare employers may be tempted to try to avoid the statutory overtime requirements by structuring the hourly compensation arrangement as an independent contractor relationship rather than an employment relationship. Independent contractors are not protected by the FLSA. But the government is wise to attempts to skirt the wage and hour laws merely by calling a worker an independent contractor. The IRS, and more recently the Workers’ Compensation Board, have been aggressive in recharacterizing independent contractors as employees, with the imposition of fines, penalties and interest against the offending employer.

That is not say that there cannot be legitimate independent contractor arrangements. But the employer would wishes to use independent contractors should make sure that those contractors meet certain requirements: they should be truly independent with the right to control the means of their work; maintain their own insurance; have their own business cards and business identity; and preferably perform services for more than one medical practice.

What if the healthcare employer enters into an independent contractor agreement with the professional’s limited liability company (LLC) or corporation? Will that pass muster and thus exempt the hourly compensation from the overtime requirements?  The answer is a clear “maybe”. The courts will look to the economic reality of the arrangement and the designation of the contract between the parties will not be determinative. The fact that compensation payments are made to an entity rather than a real person, and issued a 1099 instead of a W-2, does not insulate the arrangement from potential recharacterization.

A medical practice that has hourly compensation arrangements with healthcare professionals without paying overtime compensation when earned creates not only an ongoing legal and financial risk but one that could derail the sale of the practice in the future. Hospitals, private equity venturers and other buyers conduct very thorough due diligence when undertaking acquisitions. Part of the due diligence will be an audit of employment practices to ensure that federal and state wage and hour laws have been complied with. If the potential acquirer believes that the medical practice has significant legal exposure from noncompliance, it may have leverage to extract large financial concessions, or in the worst case to walk away from the deal.

Bruce Wood is a member at CCB Law, a boutique law firm focused on providing counsel to physicians and healthcare professionals. He can be reached at 315-477-6292 or bwood@ccblaw.com.

Regional Reach

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Kathy Ruscitto

FIRST, I WANTED to share how much I enjoy feedback on these editorials. When people take time to agree or disagree, it improves both of our thinking. My perspective comes from my
experience. Thank you for sharing your experiences!

This column is on regional reach.

Living in the Adirondacks, I often receive phone calls from families in crisis — generally at night or on weekends. Care is limited to primary care in many rural areas, with no urgent care and little access to specialty care. “Where should I go?” is the most common question I hear.

Resident population has grown in the Adirondacks and many rural communities post COVID, and summer and seasonal tourism has also swelled throughout the region. The same thing
has happened in every tourist community around us.

When I get calls about where to go for care, I encourage them to call their primary care physician wherever they are and request a telemedicine consult. However, people often go to the local ambulance center, and the staff there may not be available if they are responding to a call. I have developed a shared list of urgent care centers in the region from Utica to Rome to Syracuse, and I also refer people to LivingADK (livingadk.org), an organization that
advocates for the region and maintains a list of regional resources.

Families travel routinely from throughout the ADK Park to Utica, Rome and Syracuse for orthopedic care, mental health care, cardiac care, emergency care and testing. They share with me the gaps they find and the difficulty they have in figuring out where to go. Sometimes they just pack up in the summer and return to their home communities hours away when they can’t figure out where and how to access care.

So my questions to your practice are these: Are you a local or regional resource? Do you offer screening clinics in rural communities? How do patients in rural communities, particularly
in the summer, know you are there? Does your marketing reflect your regional presence?

Conversely, I ask community leaders about how rural communities educate their residents and plan information around access to care for summer residents and tourists. Old Forge estimates it can go from 2,000 to 20,000 summer residents and tourists on a busy weekend. When there is an injury, the closest care is one to two hours away by car. 

The landscape in health care is changing, and patients are traveling further to access specialty care. Many large centers from the Mayo Clinic to Cleveland Clinic are offering telemedicine and access in ways that minimize travel.

What are the opportunities available through technology to expand your regional reach? How do regional screening clinics open up access for patients? Finally, are there innovative solutions for accessing care in tourist communities where an urgent care center could only be successful in peak season?

Think about reaching out to the regional organizations who provide info to summer visitors and new residents. I know LivingADK would love to hear from others not included in their database.

Thanks for all you do in serving these communities. 

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

Further Reading
1. Emerging Stronger From the Crisis: What’s Next
for Regional Providers? (mckinsey.com/industries/
healthcare-systems-and-services/our-insights/emerging-strongerfrom-
the-crisis-whats-next-for-regional-providers)
2. How Standing Up Regional Markets Is Improving Access to Health
Care (health.mil/News/Articles/2022/01/11/How-Standing-Up-
Regional-Markets-is-Improving-Access-to-Health-Care)
3. Healthcare Access in Rural Communities (ruralhealthinfo.org/
topics/healthcare-access