Rome Health Here. Delivering the Best Care Out There.

By Tami S. Scott

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Advanced technology, gastroenterology services

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

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

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

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

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

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

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

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

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

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

Keeping it local

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

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

Nursing Work Force Shortages

By: Kathryn Ruscitto,
Advisor

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

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

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

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

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

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

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

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

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

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

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

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

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

By: Jenn Negley

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

1. Who will be purchasing what coverage?

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

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

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

3. What limits will be required to be purchased?

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

4. Quality of insurance company:

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

5. Departing physician’s tail issues:

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

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

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

By Erin L.W. Zacholl

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

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

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

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

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

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

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

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

Is Your Restrictive Covenant Still Enforceable?

By: Sarah E. Steinmann

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

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

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

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

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

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

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

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

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

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

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

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

Next Steps for Employers 

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

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

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

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

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

By: Robert C. Cupelo, MD Principal Investigator

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

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

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

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

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

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

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