Risk Assessment In Health Care

There are two skill sets under taught and undervalued among leadership teams: risk assessment and crisis management. A good risk assessment reduces the need for crisis management.

Often compartmentalized to an emergency manager, the fundamental responsibility for assessing and planning for risk rests with board members and leadership teams.

Assessing risks and hazards for health and patient safety, cyber security, facilities, programs, finances , reputation, compliance and integrity should be an annual agenda item for board members and other leadership. What are our priorities? Who could be harmed? Do we understand where our focus would improve the benefits and outcomes of this work? Everything has risk, but the opportunity in a risk assessment is to prioritize what can have meaningful risk reduction.

It’s a great area to use as a test case for a team. What keeps us up at night? How do we prioritize and prepare? In a crisis, do we have all the tools and plans to function? I have written a simulation for teams available on LinkedIn.com/kathrynruscitto. If you have engaged in this work, have your suppliers and subcontractors?

The coronavirus gave many teams the opportunity to experience in real time the lack of pandemic risk assessment and planning in our supply chain. This experience not only heightened our awareness about the vulnerabilities in our organizations but, more importantly, in our partners. We recognized how interdependent we are and the importance of asking those partners if they are also engaging in assessing risk.

Defense contractors and insurers maintain risk plans and have adopted good processes around input for these plans. In addition to the board or leader providing direction, they must engage input from all stakeholders in the organization. Those closest to the process best understand the vulnerabilities.

Kimberly Townsend, President and CEO of Loretto, states that her board created a risk management committee and has found the experience important.

“Our Board is using a board led committee to work with our leadership team to evaluate all aspects of our facilities and operations,” Townsend says.

Consider assessing your areas of risk and planning for the next crisis.


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

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Kidney Care at Nephrology Associates of Syracuse, PC Remains Focused on Patients

By Cari Wade Gervin

Tuesday, December 22, 2020

Despite a less than ideal 2020, Nephrology Associates of Syracuse, PC is looking ahead to the future.

The Team at Nephrology Associates of Syracuse, PC
 

As Nephrology Associates of Syracuse, PC began its 42nd year in business in January 2020, the future seemed as bright as it had ever been. A massive renovation was in the works. There were plans to add telemedicine to the practice to help improve ongoing outreach to rural patients.

And then came March — and the coronavirus pandemic.

“No one could have ever imagined what this pandemic would be like,” says Matthew Chaffin, MD, a nephrologist and the compliance officer for Nephrology Associates of Syracuse, PC. “It significantly altered how we took care of people.”

But after months of logistical challenges, Nephrology Associates of Syracuse has adjusted to the new normal. The team continues to provide management and treatment of advanced kidney disease, while leveraging telemedicine and remote mobile care teams to bridge the gap between cautious patients and in-office care.

“I think this was a good stress test,” says Adebowale Oguntola, MD, President of Nephrology Associates of Syracuse, PC and Medical Director of DaVita Kidney Care Central New York Dialysis Center. “The pandemic highlighted one of our key strengths — teamwork.”

“It’s satisfying to take care of complex problems and help patients feel better and to know we are making a difference in their life.”
— Matthew Chaffin, MD, nephrologist and compliance officer, Nephrology Associates of Syracuse, PC

Left to right: Jacquelyn Spencer, NP; Marcia Van Buren, NP; Tracy O’Neill, PA; Joanna Woodruff, NP; and Alyssa Miles, PA

Personalized Care for Kidney Disease

Despite the challenges presented by COVID-19, Nephrology Associates of Syracuse continues to be on the forefront of kidney disease management and treatment. The practice specializes in the treatment of chronic kidney disease, providing care for patients with diabetes-related kidney issues, high blood pressure and anemia, as well as those on dialysis and those who have had a kidney transplant.

“When you combine passion with training and excellence in what you do, it’s very powerful,” Dr. Oguntola says. “It’s contagious. People see that, and they feel that, and they have a sense of wanting to be part of something greater.”

At Nephrology Associates of Syracuse, PC, physicians personally see their patients on a regular basis. Nephrologists such as Dr. Chaffin may develop years-long relationships with patients.

“The reason why I became a nephrologist was because you could see one patient and follow them for years,” Dr. Chaffin says. “I know many of my patients so well that when I open the door and I walk in and I look at their face, I can tell if something’s going on,” Dr. Chaffin says. “I like that personal interaction with the patients. At the same time, it’s quite satisfying to treat complex problems and help patients feel better and to know that we are making a difference in their lives.”

Collaborative Approaches to Complexity

At Nephrology Associates of Syracuse, PC, most patients have multiple comorbidities, which can make care complicated at times. The nephrologists must stay aware of each patient’s status and treatment plan in terms of heart function, blood sugar and many other medical indicators.

“We remain in contact with multiple care providers about each patient,” Dr. Chaffin says. “And some cases are complicated enough that we see a patient frequently — sometimes once a month.”

This collaborative and personalized approach to care is what makes Nephrology Associates of Syracuse, PC different, as providers constantly work closely with both patients and other healthcare organizations to create integrated care for each patient. The six board-certified physicians on staff share similar philosophies and often consult with one another, too.

Ties Forged by Compassion

Many patients spend years at Nephrology Associates of Syracuse, PC, including at the end of their lives. Not all patients, however, have chronic conditions. Sometimes, nephrologists can provide treatment that resolves a medical episode entirely.

“At the beginning of my practice, I saw one patient — a young lady with high blood pressure,” says Adebowale Oguntola, MD, President of Nephrology Associates of Syracuse, PC and medical director of DaVita Kidney Care Central New York Dialysis Center. “She didn’t want to see me initially because she thought I was a young doctor. She expected to see a gray-haired doctor.”

After several months of treatment, Dr. Oguntola cured the underlying problem that caused the woman’s high blood pressure.

“I informed her that her blood pressure was good and she did not need to see a nephrologist anymore,” Dr. Oguntola says. “She seemed kind of disappointed.”

That patient is not the only one who has been sad when their care at Nephrology Associates of Syracuse, PC has ended, even though the cause is a happy one.

“I think examples like that are a testament to the kind of services we provide,” Dr. Oguntola says. “That is why we are the practice of choice for our patients.”

“We care deeply about our patients,” Dr. Oguntola says. “We enjoy collaboratively working together to provide excellent care. And when we collaborate with other specialties, people respect us because of the excellence we strive for.”

“Nephrologists are very independent-minded people,” Dr. Chaffin adds. “To have a large group of nephrologists who all can work together and believe the same philosophy is unusual. It’s one of the reasons I came to Syracuse.”

“When you combine passion with training and excellence in what you do, it’s very powerful. It’s contagious. People see that, and they feel that.”
— Adebowale Oguntola, MD, President of Nephrology Associates of Syracuse, PC and medical director of DaVita Kidney Care Central New York Dialysis Center

Continuing Care During COVID-19

After the onset of the pandemic, the practice modified workflows and adopted protocols to ensure safety and health precautions for both patients and staff.

“Every member of the group rolled up their sleeves,” Dr. Oguntola says. “We were able to restructure the workflow with the appropriate screenings and CDC guidance. The staff were unbelievably amazing and continued to work under hard conditions with a good attitude.”

Despite the safety protocols, many patients stayed away.

“Very few people were willing to come to the office for about two months, appropriately afraid of catching COVID-19,” Dr. Chaffin says. “That set the practice back. When patients started to return, however, we were overwhelmed trying to catch up on two months’ worth of patients who hadn’t been seen.”

Toward the end of 2020, the team continues to see patients who have delayed care since March, sometimes to deleterious effects.

Implementing telemedicine started as a challenge due to the nature of nephrology care. The technology allowed for safe, remote visits but could not meet nephrology patients’ need for detailed physical exams and lab work. Additionally, some patients had difficulty adapting to the medium.

“Many of our patients are over age 65, so the practice helped patients acclimate to the technology in order to complete telemedicine appointments,” says Anne Zaccheo, MBA, FACMPE, Practice Director of Nephrology Associates of Syracuse, PC. “Through creative thinking and patience, the practice identified appointment alternatives and offered multiple telemedicine options to allow for audio and visual communication in an attempt to meet each patient’s care needs.”

Zaccheo is also the President of the New York Medical Group Management Association (NY MGMA), “an active association of professional medical group practice leaders from all across New York […] whose members are dedicated to the advancement of group practice management through educational programs and the exchange of information and knowledge among and between colleagues.” Zaccheo shares that the practice benefitted from the sharing of local best practices and collaborative problem solving related to COVID-19 and other practice challenges among other healthcare practice leaders in NYMGMA.

As the pandemic spread, the practice began offering private blood draws for transplant patients who were nervous to go to the office, a practice that they still continue. Nephrology Associates of Syracuse also continues to operate satellite locations in Camillus, Fayetteville, Fulton and Vernon to provide access to nephrological care for patients without a mode of transportation. A mobile team consisting of a physician, advanced practice provider, medical assistant and phlebotomist travels together to ensure ongoing care is available to patients.

“Providing access to rural areas and to patients who are unable to travel to the main office is an important value and priority for the practice,” Zaccheo says.

Renovations — and Innovations — Continue

The renovations at Nephrology Associates of Syracuse will better support the new workflows and provide an enhanced patient experience. There will be a new clinical laboratory, a new blood draw room, two new patient bathrooms, a renovated waiting room, a new reception area, two new bariatric exam rooms, a new medical assistant area and a new break room for employees.

Matthew Chaffin, MD, Compliance Officer


Adebowale Oguntola, MD, President


Phillip Ondocin, MD


Anne Zaccheo, MBA, FACMPE, Practice Director at Nephrology Associates of Syracuse, PC and President at New York Medical Group Management Association


At the time of publishing, the COVID-19 pandemic has entered a second wave, and there is hope with a vaccine to be available in the U.S. shortly.

“Our goal is to enhance the patient experience and improve collaboration among team members,” Zaccheo says. “The changes will enable our team to further optimize clinical workflows and enhance communication, as well as upgrade the office and work environment for patients, staff and providers.”

Learn more about Nephrology Associates of Syracuse, PC at nephrologysyracuse.com.

St. Joseph’s Health Extends Access to Heart Care

Tuesday, December 22, 2020

Heart failure affects more than 6 million people in the United States and is escalating rapidly, with an estimated 960,000 newly diagnosed cases annually. In many cases, patients who visit the emergency room (ER) for heart issues do not attend the recommended follow-up visit with a cardiologist. This leads to continued cardiac issues down the road.

Russell Silverman, MD, FACC, Medical Director of the St. Joseph’s Health Heart Failure Clinic and Chief Medical Officer at Rome Memorial Hospital, (pictured on screen) using the Bluetooth technology on a patient.

With that in mind, the St. Joseph’s Health Cardiovascular Institute has opened a Heart Failure Clinic at its Brittonfield Cardiology office. The Heart Failure Clinic will provide early follow-up (within one week) to patients without an established physician/cardiologist, provide care to the uninsured and serve as a bridge for patients who aren’t able to make a follow-up appointment within one week.

“We see it time and again. People end up in the ER with heart conditions, and when they are released, they don’t see a cardiologist fast enough, or they don’t start their medications right away,” says Russell Silverman, MD, FACC, Medical Director of the St. Joseph’s Health Heart Failure Clinic and Chief Medical Officer at Rome Memorial Hospital (RMH). “This can cause continuing heart issues. The incorporation of the Heart Failure Clinic at St. Joseph’s Health will further improve access to timely, quality care and improve outcomes for our heart failure patients.”

The Heart Failure Clinic is a partnership with University of Rochester Medical Center. URMC cardiologists Leway Chen, MD, and Mark Tallman, MD, will each see patients at the Brittonfield location, reducing the need for patients to travel to Rochester for routine care. Developing an advanced heart failure treatment clinic also allows St. Joseph’s Health to provide care to its left ventricular assist device (LVAD) patient community — care that is not currently available.

Bluetooth stethoscope

“The Heart Failure Clinic improves access to timely, quality care and improve outcomes for our failure patients,” Dr. Silverman says. “There’s been a need for a clinic like this for many years. St. Joseph’s Health saw that need and stepped up to offer this important resource for the community.”

Strategic placement of the heart failure clinic within the Brittonfield practice offers availability to stress, echo and EKG services, as well as access to on-site cardiologists. It also supports the goal of reducing preventable readmissions in heart failure patients.

Dr. Silverman performs a stress test on a patient.

 

Improving Access in the Mohawk Valley

St. Joseph’s Health is also teaming up with RMH to offer patients in rural areas access to highly advanced cardiac care. “Bluetooth stethoscope” technology is now being used at the Cardiovascular Institute at RMH to connect cardiologists to patients without physically being together.

“This is truly remarkable technology. It’s the first of its kind in the region,” Dr. Silverman says. “It enables us to bring high quality heart care to areas that might otherwise not be served by these types of subspecialties.”

During a consultation, the patient at RMH is accompanied by a nurse or respiratory therapist (RT). They connect via computer to the cardiologist in Syracuse. The cardiologist speaks with the patient to assess how he/she is feeling. Then, the nurse or RT moves the Bluetooth stethoscope to different parts of the patient’s chest and neck so the physician can hear and see the patient’s heart activity.

“Our goal is to use this remarkable technology to keep patients close to home,” Dr. Silverman says. “By treating their heart issues using the Bluetooth stethoscope, we hope to limit the number of patients who need to be transferred out of town to St. Joseph’s Health if they don’t need tertiary care. They can stay close to their loved ones, which is what we strive for.”

St. Joseph’s Health and RMH are the only hospitals in the region using this technology. It is currently being utilized for inpatient and ER consultations.

To refer patients to the St. Joseph’s Health Cardiovascular Institute in the Dorothy G. Griffin Cardiovascular Center at RMH, call 315-338-7220.

To refer patients who need advanced heart failure management to the Heart Failure Clinic at St. Joseph’s Health, call (315) 703-5090. In addition, any patient being released from hospitalization at St. Joseph’s Health Hospital and other Central New York hospitals, as well as those being discharged from rehabilitation centers, can be referred to the Heart Failure Clinic.

St. Joseph’s Health is one of only eight hospitals in the nation to be named an American Heart Association Center of Excellence. It was also listed as one of America’s 50 Best Hospitals for Cardiac Surgery in a national study by Healthgrades, and it received the highest performance rating for Heart Bypass Surgery by U.S. News & World Report. For more information, visit everybeatmatterssjh.org.

Comprehensive, Leading-Edge MRI Services at Magnetic Diagnostic Resources of Central New York

By Thomas Crocker

Tuesday, December 22, 2020

Celebrating 35 years as Central New York’s premier provider of MRI services, Magnetic Diagnostic Resources of Central New York (MDR of CNY) draws on the expertise of dozens of fellowship-trained radiologists and a relentless commitment to quality to provide an exceptional experience for patients and referring clinicians.

The prostate MRI patient experience begins with compassion and care and ends with image quality excellence. Pictured: MRI technologist Paul Mingle 
 
Established in 1985, MDR of CNY’s mission is to provide superior, specialized MRI services in a welcoming, warm and patient-focused environment, transforming what often is an apprehensive experience into a notably calm one.
 

“A variety of factors distinguish our services from others in the region,” says Jacqueline Floyd, ARRT(R)(MR), MBA, CEO of MDR of CNY. “We have nine convenient locations throughout Central New York, and we invested in the latest specialized software to offer organ-specific specialty scans, some of which are not available at other organizations in our region. We think it’s important to offer a host of MRI services to Syracuse and surrounding communities.”

The new wide bore 1.5T GE 450W high-field scanner will enhance breast MRI comfort with a unique range of exclusive, patient-friendly features so you can relax in comfort during the scan. Pictured: MRI technologist Paula Mulholland
 

A Variety of Specialty Scans

MDR of CNY has long been known for providing breast MRI. In certain cases, this modality can complement mammographic findings during diagnostic evaluation, help measure the extent of known breast cancer, assist in assessing eligibility for or response to hormone therapy or chemotherapy, provide additional information about suspicious findings, and screen patients at high risk due to genetic mutations or history of radiation therapy to the chest, according to The American Society of Breast Surgeons Consensus Guideline on Diagnostic and Screening Magnetic Resonance Imaging of the Breast. MDR of CNY was an early adopter of dedicated breast coils — components that play a key role in creating images of the breasts by transmitting and receiving radio waves during a breast MRI — and CADstream, a software program that helps radiologists visualize abnormalities and plan interventions in a timely manner. MDR of CNY was also one of the first MRI providers to offer MRI-guided breast biopsy. The American College of Radiology (ACR) has accredited MDR of CNY for nine MRI accreditations and four breast MRI accreditations. The organization maintains its status by seeking reaccreditation every three years.

“MDR of CNY has always focused on ACR accreditation for MRI in general and for subspecialty MRI,” says Scott Buckingham, MD, partner radiologist at MDR of CNY. “ACR accreditation is a hallmark of quality and the most widely recognized guarantee for patients that an outside entity has reviewed the capabilities, experience and training of the professionals who conduct MRI studies.”

In addition to breast MRI, MDR of CNY is a high-volume provider of prostate MRI — which can help determine whether a biopsy is warranted and provide guidance during that procedure, as well as aid prostate cancer staging and radiation therapy planning — and many other specialty MRI services, including:

  • Cardiac MRI
  • Conditional pacemaker MRI
  • Enterography
  • Elastography
  • Fetal MRI
  • Inhance, non-contrast MRA
  • MR arthrography
  • MR urography
  • Spectroscopy
  • Stroke and advanced neurofunctional imaging

Patients who have a specialty scan at MDR of CNY can be confident they will receive an accurate reading of their images, as one of the organization’s key differentiators is its team of 47 board-certified, fellowship-trained partner radiologists from two of Central New York’s largest radiology groups, CRA Medical Imaging and St. Joseph’s Imaging Associates. These radiologists possess subspecialty training in a variety of fields, including breast imaging, neuroradiology, musculoskeletal imaging and body imaging.

“Our team has many years of experience performing subspecialty reads,” Dr. Buckingham says. “That’s important because patients whose images are read by a radiologist with specific training in an MRI subspecialty and high-volume experience tend to enjoy more accurate results.”

The patient experience and excellence in quality starts with an experienced and professional leadership team.

 

Prioritizing Safety

Patient safety is paramount for MDR of CNY, which is why its technologists and other members of the team take all necessary steps to safeguard patients before conducting scans. Those steps include verifying that patients’ medical implants are MRI compatible, analyzing records of patients’ previous studies and evaluating kidney function, as the use of a gadolinium-based contrast agent during an MRI can cause problems for certain patients, such as those with diabetes or chronic kidney disease. When appropriate, the MDR of CNY team uses a handheld device called i-STAT to conduct a point-of-care blood analysis that can reveal kidney function.

“Patients can undergo testing with i-STAT in the office at the time of the scan rather than having lab work at a different facility,” Dr. Buckingham says. “That’s a much more convenient way of determining whether a patient is suitable to receive a contrast agent because it doesn’t require separate office visits and eliminates unnecessary cancellation of studies.”

If a patient needs an MR angiogram but has suboptimal kidney function, the MDR of CNY team can perform his or her study using Inhance, a technique that allows technologists to capture images of the renal arteries without using a contrast agent.

Highly trained radiologists at MDR of CNY are board certified with the American Board of Radiology and considered experts in their field. Pictured: MRI technologist Stephanie Labulis and radiologist David Wang, MD

Convenient and Compassionate

Providing a seamless, one-phone-call scheduling experience for referring providers is a point of pride for MDR of CNY, as is the organization’s ability to accommodate urgent imaging requests and its commitment to scheduling appointments within a two-week timeframe. When needed, MDR of CNY can accommodate STAT requests.

When patients arrive at one of MDR of CNY’s nine locations, they encounter an atmosphere designed to allay any anxiety they may feel about undergoing an MRI. The staff sets the tone.

“Patients have never met a kinder or more compassionate staff,” Floyd says. “Our technologists truly understand how to calm and reassure patients. If a patient is feeling exceptionally anxious, we may give him or her the option to visit the office a day or two before the appointment to talk with our staff about the scan and observe the machine. Our experienced technologists ensure that the patient feels safe and comfortable and stay in voice contact throughout each exam.”

For patients with claustrophobia, a wide-bore MRI scanner and an open unit are available at neighboring locations on Brittonfield Parkway in East Syracuse.

“We do what is best for our patients,” Floyd says. “Our technologists treat every patient with compassion and professionalism, which is why we routinely receive comments in our patient satisfaction surveys singing their praises.”

Timely Communication

Swift communication with referring providers and seamless transmission of scan results is a priority for Magnetic Diagnostic Resources of Central New York. That is why the organization, its partner radiology groups CRA Medical Imaging and St. Joseph’s Imaging Associates, and their associated health systems use a shared picture archiving and communication system. Referring providers receive nonurgent image reports within 24 hours. Providers receive urgent results as soon as a radiologist finishes reading the images.

For more information, visit mdrcny.com. Click on “Referring Physicians” to request an appointment for a patient or call 315-454-4810, press 1.