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Culture in the Clinical Practice

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by Kathryn Ruscitto

I often wonder why the patient experience feels complete in one medical practice yet lacking in another. The answer usually lies in a collection of touchpoints: how the phones are answered, how staff greet patients, whether communication remains consistent between visits, and how issues are resolved when something goes wrong. These visible moments are only part of the story, but together they reveal the culture.

Exceptional patient care requires alignment across every department. Positive experiences reflect an organizational culture built on clear goals for every encounter, every person, and every time. Even when miscommunications arise, a strong culture ensures they are handled with courtesy, responsiveness, and accountability.

Leadership establishes this baseline and must hold itself to the same standards expected of everyone else. Hiring, training, and recognition programs should all reinforce the same core values. When expectations are transparent, team members flourish, morale improves, and retention is more likely to increase.  Mutual respect is also critical. A healthy culture must clearly articulate expectations for patient behavior, especially given the recent rise in workplace safety challenges. Patients deserve compassionate care, and staff deserve a safe, respectful environment in which to provide it.

The key elements of a strong culture include safety and trust, accountability and decision-making, feedback and innovation, and work-life balance and growth. These principles should be stated clearly and revisited as the organization changes. Culture is not a one-time announcement; it is something that must be reinforced every day through leadership actions, team behavior, and organizational systems.

As Michael Watkins noted in Harvard Business Review, “Culture is the organization’s immune system.” This idea captures the role culture plays in clinical practice: it helps teams respond to stress, navigate unexpected challenges, and access the right support when problems arise. It also shapes what the organization tolerates, what it rewards, and how it behaves under pressure.https://hbr.org/2013/05/what-is-organizational-culture

Looking back on a career in healthcare leadership, it is natural to think about how often l truly walked in the team’s shoes. While rounding can provide perspective, deeper listening often reveals whether an organization is living its values and whether the culture is supporting staff. Patient and client perspectives matter just as much. Surveys offer value, but in-person feedback creates a unique opportunity to ask follow-up questions, learn more deeply, and better understand what people are actually experiencing.

Finally, the empathy gap must be addressed. Many patients do not fully understand current workforce shortages or the administrative delays that affect care. It is helpful to provide that context and advocate for patience and kindness toward frontline staff. At the same time, the frustration patients feel when they cannot access care or communicate with providers is real. The challenge is to communicate these realities honestly while staying true to the organization’s values.

Resources for Building a Strong Culture in Clinical Practice

 

  • American Medical Association – Leading Change

https://edhub.ama-assn.org/steps-forward/pages/leading-change

 

  • National Center for Healthcare Leadership

https://www.nchl.org/

 

  • National Academy of Medicine – Culture of Health Program

https://nam.edu/our-work/programs/culture-of-health-program/–

 

please run with Kathy’s photo and normal contact info

Upstate University Hospital Serving Patients with a Laser-Focused Commitment to Quality

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By Elizabeth Landry

As the only academic medical center in Central New York, and the region’s largest employer, Upstate Medical University is a pillar of the area’s healthcare resources as well as a key component of the community at large. Intertwined with the organization’s continued growth is its focus on pursuing quality as the best measure of how it serves its patients.

“Something that’s been made clear to all by our hospital CEO, Dr. Robert Corona, is that quality is the priority at Upstate. He emphasizes that quality is our brand, that it’s what we want to be known for, and we are laser-focused on that,” said Amy Tucker, MD, MHCM, Upstate’s Chief Medical Officer. “Our leadership team is investing in the resources required to drive quality and patient safety.”

Dr. Tucker explained that as a complex academic medical center, quality is part of the education as well. With learners including medical students, residents, fellows, graduate students, nursing students and other health professional trainees, quality-related priorities are embedded at every step of their education.

“It is an expectation that students participate in quality from the very first stages of their education and it is a major part of their curriculum. It is part of what they see on wards and in clinics, so in the development of these future health professionals quality becomes a part of the culture,” she said.

Utilizing Quality Ratings and Metrics

Along with quality leaders at Upstate, including Matthew Glidden, MD, Upstate’s Chief Quality Officer, and Harvir Gambhir, MD, Upstate’s Associate Chief Quality Officer, Dr. Tucker and the Upstate leadership team look to several quality rating entities to understand how Upstate performs within the wider healthcare landscape.

Dr. Glidden shared that Upstate looks to scorecards from three benchmarking entities: CMS (Centers for Medicare and Medicaid Services), Vizient, and the Leapfrog Hospital Safety Grade. While these organizations rate hospital quality in different ways – some use older data while others use newer data, and some release the ratings publicly while others do not – each generally looks at data including patient readmission rates, patient experience, safety, mortality rates, and timely and effective care.

“Our overall goal is to provide the highest-quality, evidence-based care in a safe manner that reduces potential harm to patients and provides care they value, along with the best experience possible,” said Dr. Glidden. “Until you benchmark yourself to other hospitals, you don’t really know how you’re performing.”

Upstate’s quality score from Vizient, the largest leading healthcare improvement organization in the country, is particularly useful because the hospital is compared with other comprehensive academic medical centers, rather than smaller hospitals. The ratings also are often related; for example, the Leapfrog score, which primarily focuses on patient safety, uses a lot of metrics from the CMS scorecard, Dr. Glidden explained.

When looking at the overall metrics, there are many data points that show how Upstate’s focus on quality has paid off to benefit patients. In recent years, Upstate achieved a 20.7% relative reduction in overall risk-adjusted mortality, meaning that fewer patients died than would be expected based on their sickness and medical complexity.

“In terms of safety, we’ve been able to drive a significant improvement in our outcomes measure over the last four or five years. The data suggests that Upstate saves more lives when compared to expected among our academic peer group” said Dr. Tucker. “When we look at our mortality rate, it’s considerably below the national benchmark and has been sustained over a long period of time. That’s something we’re very proud of.”

Dr. Glidden shared that patient safety has improved significantly at Upstate during this period of intensified leadership commitment. Also, over the last two years there are additional specifics: accidental punctures and lacerations were reduced to zero. Patient falls resulting in serious injury were reduced by 87.4%, and there was a 54.5% reduction in serious pressure injuries, which are also known as bedsores.

“Taken together, these results demonstrate meaningful progress in outcomes that matter most to patients,” said Dr. Glidden. These include surviving serious illness, avoiding preventable complications and infections, and recovering safely after surgery. “They reflect Upstate’s continued focus on improving care while serving patients who have significant illness and medical complexity.”

A Strategy for Success

The metric categories that rating organizations use to grade hospitals relate to the six pillars of healthcare quality Upstate embraces to aim for high scores: safety, timely, effective, efficient, equitable, and patient-centered care. A big part of how Upstate strives to achieve top-performing quality for patients is the concept of high reliability, which is underscored by Dr. Corona.

Originally used by the airline industry and the nuclear power industry — fields that are highly resilient to stresses on the organization and the imperative to continuously keep their customers satisfied — the five concepts of high reliability are: preoccupation with failure; commitment to resilience; sensitivity to operations; reluctance to simplify; and deference to expertise.

To put these concepts into action, Dr. Glidden uses the mnemonic of SOAP: Structure, Oversight, Accountability, and Processes. “When we have to clean something up, we look at questions like: How can we improve? What is the quality and operational structure? How do we maintain oversight of quality and operations? How do we hold people accountable, and what are our processes?” he said.

A strategic innovation that’s shown positive outcomes is the opening of the Care Connect Clinic across the street from University Hospital. The clinic allows patients to receive immediate walk-in care when they have an acute problem but don’t need to go to the emergency room.

“The clinic helps a timely flow of care and helps with access for patients, making it more convenient for them. It’s been a nice resource for the patients in our community and reduces the load on our ED,” said Dr. Tucker.

Another strategy Upstate has utilized to improve quality has been what Dr. Tucker termed the “clinical flash mob.” This strategy has increased immediate communication among care providers when there’s a difficult problem that requires input from experts across the organization.

“During a ‘clinical flash mob’ we get together over an emergency virtual meeting, discuss the problem together, and come up with an agreed-upon solution,” explained Dr. Tucker. “We’ve found this really helps with decision making and provides support for our clinicians.”

Staff on the Front Lines of Patient Care

When facing challenges and determining solutions, Dr. Glidden said leadership places great importance on listening to those who are caring for patients on hospital floors. Through a safety alert system, Upstate employees are empowered to report quality concerns and mistakes without a fear of retribution — an important part of the just culture and psychological safety found at Upstate, shared Dr. Glidden.

“It’s really the nurses, techs, managers—the ‘boots on the ground’ – who are telling us where we can improve. Upper-level departments process the information, but we always go back to the people on the front lines because they’re the ones that know how to solve the problem,” Dr. Glidden explained.

Beginning in November 2025, Upstate employees have come together to focus on quality through the Co-Elevate program. A series of monthly meetings that center on diverse topics, all related to quality, Co-Elevate brings senior leadership and frontline employees together to share their voices and help solve problems. The meetings include nurses, physicians, residents, fellows, pharmacists, environmental services workers, patient advocates and others.

“Co-Elevate is a link between the frontline workers who take care of patients and see quality concerns and the senior leadership,” said Dr. Gambhir. “We didn’t want another meeting to talk about quality metrics – we wanted a meeting to discuss the story behind what is happening and to work together to improve patient safety.”

Although the topics range widely, each one is always patient-centered, Dr. Gambhir said. All Upstate employees are invited to the meetings, which are held both in-person and virtually. Patient advocates and family advisors are also welcome as Co-Elevate panelists.

Despite being a relatively new program at Upstate, there are already tangible success outcomes. Dr. Gambhir highlighted new patient care huddles, an idea that came out of Co-Elevate meetings, in which all physicians and residents involved in a patient case will gather at the patient’s bedside together at the same time, helping to keep everyone on the same page. Another byproduct of the Co-Elevate program has been the implementation of Lean Six Sigma strategies in operating rooms for improved workflow efficiency. Overall, Dr. Gambhir said, Co-Elevate has helped create a more proactive culture at Upstate at all levels of the organization.

“We want to close the gap between how the work is imagined, and how the work is actually done,” stated Dr. Gambhir. “That’s where we’re heading. We want everyone to feel that we are all working together as a team.”

The Future of Quality at Upstate

Built upon guiding principles from leadership, it’s clear that Upstate’s focus on quality is steering the organization into the future. CEO Robert Corona, DO, MBA, continually presents quality as the “operating system” for the hospital, coordinating and connecting the functions of the entire enterprise. He also builds quality specifically into the strategic pillars he established when he first started as CEO: Quality, the Upstate Experience, Innovation and Sustainability and Growth.

“We can ask a quality question for each aspect of our strategy,” Dr. Corona added. “Are we delivering exceptional outcomes? Would we want this care for someone we love? Are we finding the best ways to operate? Are we building an organization that can fulfill its mission for generations? These are the questions that drive quality in every part of our system.”

Related to the strategic pillar of the Upstate Experience, the conversations are happening. “The goal is that we keep on speaking up, and we develop an interdisciplinary collaboration in a psychological safe space,” said Dr. Gambhir. “No matter if it’s a nurse or a resident who is on their first day at work, or a physician who’s been with us for ten years, we can talk freely in front of everyone. It is proactive culture, every day we try to improve, and things get better and better.”

Dr. Tucker also emphasized teamwork and open communication as some of Upstate’s priorities related to quality.

“We know when teams get together and focus on a common goal, and everyone’s helping one another, we see better outcomes,” said Dr. Tucker. “To increase the robustness of our communication pathways, we’ll be rolling out some new technology to make it even easier to connect with people in the moment.”

Looking toward the future, perhaps the most central goal for quality at Upstate is making sure patients are aware of the quality that’s available to them at the hospital.

“We really provide quality care here at Upstate. We want to provide the best care we can for the people here in Central New York, and it’s important to us that our public face reflects this, and people feel comfortable and secure when they come to us,” said Dr. Tucker. “We want that reassurance for patients. We want them to have the peace of mind that if they need care, Upstate is the place to come.”

 

Food is Medicine

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BY KATHRYN RUSCITTO, ADVISOR

The American Heart Association defines food is medicine as the provision of healthy food such as produce prescriptions, medically tailored groceries and medically tailored meals to treat, manage or prevent diet-related health conditions. We know that inner cities and rural communities often have poor access to stores or farmers markets, further complicating good food access when there is a health issue. In these circumstances we look to many community based organizations to fill those gaps.

Recently the increase in prices on all household goods has put a great deal of pressure on families and the elderly to adjust spending and for many that means cutting food expenses. USDA notes 14% of all households in the NYS as being food insecure. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/interactive-charts-and-highlights

Our local library in Old Forge in the Adirondacks has a wall of food shelves at the entrance. Always open, it’s used anonymously by residents in need. Food pantries in churches and food banks also report seeing steady increases in demand. My concern is those individuals who are isolated or not connected to resources.

In doing research I had the opportunity to talk with Rachel Sherrow, Chief Operating Officer of Citymeals on Wheels. Citymeals located in NYC, serves over 22,000 residents each month. My interest was to understand new ways for people to access help, especially with frail elders. In addition I wanted to understand how “Food as Medicine,” projects were connecting with clinicians. Rachael shared,

“Questions about food insecurity and access to fresh produce should be a standard part of a physician’s intake with patients. The HFIAS (Household Food Insecurity Access Scale) can open avenues for referrals and resources for those who need better nutrition or accessibility and can be part of the solution to better health outcomes for so many, especially our most vulnerable populations.”

https://citymeals.org

Citymeals has developed unique monthly boxes of supplies to allow additional meal access besides a home delivered traditional meal. They have found ways to close food gaps based on individual needs.

For office practices consider two simple food related questions on intake forms as a way to assess any food issues. Follow up linking a patient with 211NY.org or area churches, food banks and meal programs helps bridge an initial response to connecting a patient in need to resources.

Across Upstate NY there are resources unique to each community, but all share common missions to make food accessible to those in need. Consider how assessing this issue fits within your practice.

Navigating Physician Noncompete Clauses What’s Changing in New York by Brigid M. Maloney and Kennedy A. Farr

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If you’re a physician, your employment agreement likely contains a noncompete clause, and the rules governing that clause may be changing. States across the country are limiting or banning physician noncompetes, and New York could be next.

WHERE NEW YORK STANDS TODAY

As of today, New York has no statute specifically governing physician noncompetes. As a result, courts generally apply a common-law test when disputes arise. Under BDO Seidman v. Hirshberg, 93 N.Y.2d 382 (1999), a restraint is reasonable only if it (1) is no greater than required to protect the employer’s legitimate interest, (2) does not impose undue hardship on the employee, and (3) is not injurious to the public. Violation of any one of these prongs renders the covenant invalid. Separately, the Reed, Roberts standard quoted in BDO requires the restriction to be reasonable in time and geographic area. New York courts have historically given employers somewhat more latitude when restricting competition among learned professionals, including physicians, within a confined area, but they still scrutinize the particular facts and circumstances. For physicians, the public-interest prong is especially important because restricting a physician can limit patients’ access to care. An overbroad covenant is not automatically void. A court may partially enforce it by narrowing the restriction if the employer acted in good faith, without overreaching or coercively using its bargaining power. But a court may strike it entirely where the employer overreached, such as imposing the covenant as a condition of hiring.

In Long Island Minimally Invasive Surgery, P.C. v. St. John’s Episcopal Hospital, 164 A.D.3d 575 (2d Dep’t 2018), the covenant barred the surgeon from performing any type of surgery for two years within 10 miles of any of the practice’s seven offices and affiliated hospitals, including locations where he had never worked. The court held that the restriction was geographically unreasonable because it effectively barred him from practicing surgery in the New York metropolitan area, which far exceeded what was necessary to protect the practice’s interests. The court declined to partially enforce the covenant because it was clearly overbroad, the practice required it as a condition of hiring from a superior bargaining position, and it refused to negotiate the restriction.

WHAT’S PENDING IN ALBANY

New York Senate Bill S4641 passed the Senate in June 2025 and, as of this writing, remains in the Assembly Labor Committee. It would ban noncompetes for physicians regardless of income while preserving an exception for the sale of a practice. Separate physician-specific bills (S9228/A10981) would also address repayment of bonuses and training costs when a physician leaves a hospital employer.

THE NATIONAL PICTURE

i. Arkansas, Massachusetts, New Hampshire, and Wyoming: Prohibit physician noncompetes.

ii. Virginia: Bans noncompetes for most licensed health care professionals as of July 1, 2026.

iii. Maryland: Prohibits noncompetes for health care practitioners earning under $350,000.

iv. Oregon: Voids most physician noncompetes with hospitals and management services organizations.

v. Florida: Moves in the opposite direction by making certain “covered” noncompetes fully enforceable if notice requirements are met.

PRACTICAL TAKEAWAYS

i. Check the length and radius. Limit restricted areas to offices where you actually work, not every location the employer operates.

ii. Watch for clawbacks. Some agreements require repayment of bonuses, relocation expenses, or training costs when a physician leaves—terms that can function as disguised noncompetes.

iii. Plan your exit if you sell a practice. Sale-of-business noncompetes are treated differently and are generally enforced more readily.

iv. Confirm which state’s law applies. If you practice near a state line, review the choice-of-law clause because it can affect your legal rights.

v. Get it reviewed. Because the law is changing quickly, have your agreement reviewed by a legal professional before signing or giving notice.

Please note that this article is for general informational purposes only, is not legal advice, and does not create an attorney-client relationship. Because each situation is unique, the information is general in nature and should not be considered a substitute for legal counsel. Readers should not take, or refrain from taking, any action based on the information in this article without first seeking legal advice from competent counsel.

Marching Toward One Million:Why Pain-Management Education Should Begin Before Surgery

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Each year, millions of Americans undergo surgery, and more than half receive an opioid prescription. Yet one of the most important parts of the surgical journey is often overlooked: how pain will be managed afterward. For years, opioids have played a prominent role in postsurgical pain management. Today, advances in medicine offer more ways to manage pain effectively while reducing unnecessary opioid exposure when appropriate. As these options continue to evolve, patients deserve to understand the choices available to them.

As an orthopedic surgeon, I’ve seen pain management practices evolve throughout my career. Early in my training, postsurgical recovery followed a largely uniform pattern: a patient had surgery, and an opioid prescription followed almost automatically. It was rarely presented as a choice; it was simply standard practice. Over time, that approach has become more nuanced, with greater emphasis on tailoring pain management plans to each patient’s needs. While every recovery is unique, the goal remains the same: helping patients recover comfortably, safely, and confidently. That’s why these conversations should begin long before surgery. When patients understand the full range of available options, including non-opioid therapies, they are better equipped to make informed decisions with their healthcare team.

Pain management remains one of the most overlooked parts of the surgical journey. Patients may spend weeks preparing for the procedure itself by researching providers, learning about the operation, arranging time away from work and figuring out support at home. Yet, the discussion of how their pain will be managed afterward is often condensed into a brief exchange shortly before discharge. This is not a failing of any individual provider; it reflects the time constraints clinicians face when communicating complex information. As a result, some patients may leave the hospital without fully understanding the options available to them.

A Mission Beyond the Operating Room

My passion for improving patient education around surgical recovery inspired me to launch March2AMillion, a nationwide initiative with a bold goal: helping one million patients recover from knee or hip replacement surgery with little to no opioids. Through work with hospitals, healthcare organizations, community events and patient advocacy groups across the country, the initiative raises awareness of today’s pain management options and encourages patients and providers to begin these conversations before surgery, not after.

The initiative grew out of a recurring pattern I saw in clinical practice. Patients would return for follow-up visits asking questions that should have been addressed before they entered the operating room. Could opioids have been avoided? Why were other pain-management options not discussed? By the time these questions arise, the opportunity to make a different choice has often already passed. March2AMillion is designed to shift that timeline so that these conversations happen during preoperative visits rather than after surgery.

One of the most common things I hear from patients is that they didn’t realize they had a choice. Many assume opioids are an expected part of recovery, often based on what they have heard from friends and family or experienced during a previous surgery. While opioids continue to play an important role in postsurgical care, today’s pain management landscape also includes non-opioid therapies that may be incorporated into individualized treatment plans when appropriate.

These options may include long-acting local anesthetics, regional nerve blocks, other non-opioid analgesics and multimodal approaches that address pain in different ways. When patients understand what is available, they can ask better questions, have more productive conversations with their providers and better understand what their recovery may look like.

Awareness Drives Better Decisions

Innovation alone isn’t enough if patients do not know their options. Education remains one of the most powerful tools we have. By encouraging patients to ask what pain management options are available, whether non-opioid therapies may be appropriate and what to expect during recovery, we can support a more informed and collaborative approach to care.

Even modest shifts in when these conversations happen can make a meaningful difference. When a patient enters a preoperative appointment having already considered a few key questions, the discussion with their surgical team becomes more substantive. It moves beyond a one-way delivery of instructions and becomes a genuine dialogue. In turn, the patient’s preferences, medical history, and any concerns about opioid use – whether rooted in past experiences, family history, or a desire to minimize exposure – are factored directly into the treatment plan. This kind of shared decision-making can help patients feel more informed and prepared as they head into surgery.

Through March2AMillion, I’ve had the privilege of meeting healthcare professionals and patients across the country who share the same goal: improving recovery through education, innovation, and personalized care. Whether I am speaking with providers about introducing non-opioid options earlier or with patients navigating their recovery, these conversations reinforce my belief that meaningful change begins with awareness. They also show that progress depends not only on new drugs, devices or protocols, but on earlier, and more open communication between patients and providers.

Thoughtful conversations about postsurgical pain management can also help patients understand the risks and potential side effects associated with opioids, including misuse, nausea and constipation. When patients and providers discuss the full range of available strategies, they can develop a plan that balances effective pain management with each patient’s needs and preferences. As non-opioid pain management continues to advance, we have an opportunity to redefine what patients expect from recovery. My hope is that every patient feels empowered to discuss their options before surgery and work with their healthcare provider on a pain management plan tailored to their individual needs. This is not about replacing one default with another; it is about replacing the notion of a default altogether with individualized plans built on open communication.

By continuing to educate, advocate, and encourage open dialogue, we can support efforts to reduce unnecessary opioid exposure while helping patients make informed decisions with their healthcare providers. One million conversations might seem ambitious, but each one begins the same way: with a patient asking what their options are and a provider taking the time to explore that with them. Learn more about my mission at March2Amillion.com.

This article is sponsored by Pacira BioSciences Inc. Dr. Andrew Wickline is a partner of Pacira BioSciences.

2026 Pacira Pharmaceuticals, Inc., a wholly owned subsidiary of Pacira BioSciences, Inc.

PP-NP-US-2010 08/26

Dr. Jonathan Huang: Filling the Gap in Gastroenterology and Hepatology Care at ACH

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By Elizabeth Landry

When Jonathan Huang, DO, AGAF, FAASLD joined Auburn Community Hospital (ACH) in January of this year, his arrival helped meet a significant need in specialized patient care. A board-certified hepatologist and gastroenterologist who serves as Chief of Auburn Gastroenterology at ACH, Dr. Huang helps alleviate the significant shortage of hepatologists across Upstate New York, including the Central and Southern Tier regions outside the city of Rochester.

“I wanted to help address that need by partnering with local community providers and bringing specialized hepatology care directly to patients,” Dr. Huang said of his decision to practice medicine at ACH.

A Rochester native with more than 20 years of medical experience including highly specialized expertise in liver disease, Dr. Huang also practiced at the University of Rochester Medical Center for 15 years as a Transplant and General Hepatologist, where he was an Associate Professor of Medicine and Director of the Digestive and Liver Disease Center for Research. He felt drawn to ACH, which he describes as an “ideal fit”, because of a desire to have a meaningful impact on the surrounding area.

He and the hospital’s administration “shared a strong vision for growth and saw an opportunity to expand specialty services,” said Dr. Huang. “It was an environment where I felt I could both provide high-quality subspecialty care and help build something meaningful for the community.”

Improved Access to Care

A big reason Dr. Huang desired to practice medicine at ACH is the hospital’s central location, which makes it accessible to patients throughout the region. Since he joined the team, a top focus has been making the patient experience as streamlined and accessible as possible, from the initial referral through diagnostic testing and endoscopic procedures, as well as increasing access to gastroenterology and hepatology clinics. Direct-access colonoscopy is one example of how this growth in services has directly impacted patients at ACH.

“For appropriately selected, low-risk anesthesia patients, we can schedule the procedure directly without requiring an unnecessary pre- or post-procedure clinic visit,” Dr. Huang explained. “This can significantly reduce barriers to care and improve access to colonoscopy, while also allowing our clinic appointments to be available for patients who truly need a gastroenterology or hepatology consultation.”

The Auburn Gastroenterology & Hepatology practice at ACH is also offering exciting new technologies that represent an important expansion of the diagnostic capabilities available to patients in the surrounding community, Dr. Huang said. QuinTron Breath Testing and Mindray VCTE technologies are now available at ACH, designating the hospital as a destination for specialized diagnostic services. ACH is also the first location in New York State outside of New York City to offer Mindray VCTE.

“[These technologies] are at the forefront of their respective fields and provide valuable tools for the diagnosis and risk stratification of certain disease processes that previously required patients to travel outside the region,” stated Dr. Huang.

Building Trust and Relationships

Collaborating and building relationships with other local healthcare providers is a central priority for Dr. Huang alongside expanding direct access to patient care. Recognizing the complex nature of the healthcare system, Dr. Huang believes the best care is provided when physicians and healthcare providers work together to deliver comprehensive, coordinated care.

“We often talk about the importance of building trust in the doctor-patient relationship, but I believe it is equally important to build trust among local healthcare providers,” he said. “I’m committed to developing those relationships so that we can communicate effectively, streamline care, and give both patients and referring providers confidence that they are receiving the best possible care.”

Ultimately, Dr. Huang said, his goal is to make the healthcare system feel more connected and seamless for both patients and the providers caring for them. An important part of this collaborative approach is also developing and maintaining close working relationships with larger institutions, such as the University of Rochester Medical Center.

“By serving as a local access point and maintaining strong connections with these centers, we can help patients navigate more complex care when needed, including facilitating access to specialized services such as liver transplantation,” he explained.

Advancing into the Future

Surveying exciting developments on the horizon within both gastroenterology and hepatology, Dr. Huang said he envisions each field becoming increasingly personalized, preventative, and technology driven. Within hepatology, advancements are leading to earlier identification and treatment of chronic liver disease, primarily regarding metabolic dysfunction-associated steatotic liver disease (MASLD), before patients develop advanced fibrosis or cirrhosis. Additionally, Dr. Huang anticipates advancements in noninvasive biomarkers and imaging technologies will aid in identifying risk and guiding treatment while decreasing reliance on invasive testing.

In the field of gastroenterology, areas such as polyp detection, pathology interpretation, and clinical decision support are being bolstered by the development of artificial intelligence as an adjunct to clinical care. Dr. Huang emphasized the importance of remaining thoughtful about how providers utilize such technologies and preserving both clinical judgment and the physician-patient relationship.

“We’re seeing major advances in areas such as endoscopy, noninvasive assessment of liver disease, biologic therapies, and targeted treatments, and I expect those trends to continue,” Dr. Huang said. “Ultimately, I think the future of GI and hepatology will be about combining these advances with personalized, patient-centered care. Innovation in our field can translate directly into earlier diagnosis, better treatment, and ultimately better outcomes for patients.”

No matter which direction the fields of gastroenterology and hepatology progress into, however, Dr. Huang remain excited about the future of his practice at ACH. Most exciting to him, he said, is being part of a tight-knit community that grows together while delivering specialized care at the forefront of medicine.

“There is a real opportunity to expand access to advanced gastroenterology and hepatology services while maintaining the personable, community-focused culture that makes ACH special,” said Dr. Huang. “Being able to contribute to that growth while building lasting relationships with patients and local providers is what I find most rewarding.”

UHS Focused Ultrasound Program Expands Treatment Options for Patients with Essential Tremor and Parkinson’s Disease

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INCISIONLESS OUTPATIENT PROCEDURE DELIVERS SUSTAINED TREMOR IMPROVEMENT AND FUNCTIONAL GAINS

   For patients across Upstate New York, living with Essential Tremor and Parkinson’s Disease, a treatment once confined to a handful of academic centers in large urban areas is within reach at United Health Services (UHS) in Binghamton, NY: magnetic resonance–guided focused ultrasound (MRgFUS). This technology delivers hundreds of ultrasound beams through the skull, guided by MRI, to a millimeter-scale target deep in the brain, generating enough heat to create a precise therapeutic lesion—without an incision, a burr hole, anesthesia, or ionizing radiation. UHS was the first healthcare system in Upstate New York to offer MRgFUS. Since launching the program in December 2024, UHS has treated more than 180 patients. More than 30,000 MRgFUS procedures have been performed worldwide.

MRgFUS, commonly referred to as Focused Ultrasound, is FDA-approved for the treatment of Essential Tremor and Tremor-Dominant Parkinson’s Disease. The initial FDA approval in 2016 covered unilateral thalamotomy of the ventral intermediate nucleus for the dominant hand. Because most patients with Essential Tremor have bilateral symptoms, a multicenter trial of staged bilateral thalamotomy was subsequently completed, and its results supported FDA approval of staged bilateral ablation for Essential Tremor in 2022 (Kaplitt et al., JAMA Neurology, 2024). FDA approvals for Tremor-Dominant Parkinson’s Disease subsequently occurred in 2018 (unilateral tremor), 2021 (unilateral motor complications), and 2025 (staged bilateral motor complications).

An incisionless alternative to open surgery, Focused Ultrasound is performed inside an MRI scanner, which provides real-time target definition, treatment planning, and closed-loop thermometry so the Neurosurgeon can monitor tissue temperature and lesion location as energy is delivered in an awake patient. That “triple feedback” of immediate clinical response, live thermography, and anatomical imaging allows low-temperature test sonications to confirm clinical benefit and identify potential adverse effects before creating a permanent lesion, offering an advantage over the delayed and less predictable effects of radiosurgery (Krishna et al., JAMA Neurology, 2018). Unlike deep brain stimulation, Focused Ultrasound does not require cranial surgery, implanted hardware or ongoing device management. The procedure is performed on an outpatient basis and patients typically experience improvement immediately following treatment.

Focused Ultrasound is generally well tolerated by patients. The most common early adverse effects are gait disturbance and paresthesias, which tend to subside over time; other reported effects include dysarthria, ataxia, taste disturbance, and speech difficulty (Hamani et al., Journal of Neurosurgery, 2026). In the real-world staged bilateral cohort, approximately 45% of patients reported at least one adverse event within six months—most commonly sensory disturbance (27%), instability (12%), and dysarthria (12%)—with nearly all events characterized as mild (Vilas et al., Movement Disorders, 2026). Clinicians should counsel patients that bilateral treatment carries a somewhat higher adverse-event rate than unilateral ablation, historically driven by speech and balance effects, which is why bilateral procedures are staged (Kaplitt et al., JAMA Neurology, 2024). 

Clinical studies continue to demonstrate durable outcomes. Five-year follow-up data following first side treatment showed a 73.1% improvement in tremor severity, a 44.5% improvement in functional disability and quality-of-life measures and no serious or delayed adverse events. 

FDA clinical trial data for second-side treatment demonstrated an 80.2% improvement in tremor severity at six months, as well as improvements of 64.3% in tremor and motor function and 74.3% in functional disability, reflecting meaningful gains in patients’ ability to perform daily activities independently.

“Because we were the first program in Upstate New York to offer this technology, we have developed significant experience in treating patients with Focused Ultrasound,” said Simone Betchen, MD, MBA, Chief of Neurosciences/Attending Neurosurgeon. “That experience allows us to refine patient selection, enhance outcomes and deliver an exceptional patient experience with care close to home.”

During evaluation, patients undergo imaging studies, including an MRI and CT scan, to assess skull characteristics necessary for treatment. Certain implanted devices and medical conditions may affect eligibility, although ferromagnetic implants, including some pacemakers, do not automatically exclude patients from consideration. With no upper age limit for treatment, Focused Ultrasound expands treatment access for patients who may not be candidates for more invasive procedures. The treatment is covered by Medicare, Medicaid and most commercial health insurance plans.

Essential Tremor affects approximately 2% of the population and is nearly 10 times more prevalent than Parkinson’s Disease. The condition can significantly impact an individual’s quality of life, interfering with activities of daily living, employment, communication and hobbies. Although medications can be effective initially, many patients experience diminishing benefit over time or develop intolerable side effects. Similar challenges occur in patients with Tremor-Dominant Parkinson’s disease, creating a need for alternative therapies.

Potential candidates generally should:

  • Be at least 22 years old for treatment of Essential Tremor or at least 30 years old for treatment of Tremor-Dominant Parkinson’s Disease

  • Have disabling tremor or tremor impacting activities of daily living, despite medical management

  • Be able to tolerate MRI imaging without significant claustrophobia

  • Be able to remain still for approximately one to two hours

  • Be able to communicate throughout the procedure

  • Meet MRI safety requirements

“The Focused Ultrasound procedure is performed at the UHS Salanger Outpatient Center located in Vestal, while initial evaluations and follow-up visits may occur in-person at UHS Neurosurgery in Johnson City or via telehealth,” said Betchen.” “Patients may be referred by a neurologist or primary care physician, or they may self-refer through our website.

“As Focused Ultrasound technology becomes more widely available across Upstate New York, primary care physicians, neurologists, and movementdisorder specialists have an evidencedbased, safe and incisionless treatment option for patients whose symptoms remain inadequately controlled with medication and who may not be candidates for invasive surgery,” said Kate Foxx, MD, Attending Neurosurgeon.

UHS is the Southern Tier’slargest and most comprehensive healthcare system. UHS Neurosurgery offers the region’s most comprehensive brain and spine care program, built on more than 40 years of leadership in the field and offers comprehensive adult neurosurgical care, including cranial and spine surgery for cerebrovascular disease including open vascular and endovascular treatment of aneurysms, brain and spine tumors, degenerative spine disease, spine deformities, and neuromodulation. UHS is also Joint Commission certified as a Comprehensive Stroke Center and Core Spine Surgery program. 

For more information, call 607.763.5404 or visit nyuhs.org/focused-ultrasound. Referrals may be faxed to 607.203.4245.

Q&A with Dr. Nicholas Massa Vice President, Chief Medical Officer, Excellus Bluecross Blueshield Why Deeper Provider Partnerships Matter

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Strong partnerships between local health plans and community providers are essential to building a more connected health care system. When providers, hospitals, and health plans work together, they can improve care coordination, reduce fragmentation, and create a better experience for patients and clinicians alike.

At a time when health care costs continue to rise, collaboration also presents an opportunity to simplify care delivery and address local health care challenges in meaningful ways.

Few people understand the importance of provider collaboration better than Dr. Nicholas Massa, vice president and chief medical officer for Excellus BCBS. As a local physician and health care leader in Central New York, Dr. Massa has seen firsthand how stronger alignment between providers and health plans can support better patient outcomes and reduce barriers to care. Below, he shares his perspective on the value of deeper partnerships.

What benefits can result from increased collaboration between health plans and providers?

Dr. Nicholas Massa: Patients have long told me that navigating the health care system can feel fragmented and disconnected. Stronger collaboration creates better alignment between physicians, hospitals, care teams, and health plans around a shared goal: delivering the best possible, high-quality care for our patients.

When organizations work together more effectively, providers and health plans gain greater access to tools and resources that support patient care, including enhanced care management, more actionable data, and better visibility into services patients receive across care settings. Ultimately, that means less time spent navigating the system and more time focused on patients.

What impact can these partnerships have on administrative burden?

Dr. Nicholas Massa: I often hear from providers that administrative complexity remains one of the biggest challenges they face today. Through stronger relationships and better information sharing, we have opportunities to streamline processes and reduce unnecessary administrative work.

The goal is simple: make it easier for providers to deliver high-quality care and easier for patients to access the services they need.

What does success look like?

Dr. Nicholas Massa: Success means healthier patients, fewer preventable complications and hospitalizations, and a health care system that better supports coordinated, high-quality care. It means providers and health plans working together to address the needs of the communities they serve.

Most importantly, success is measured by the experience of our patients. When care is easier to navigate, more integrated, and focused on the whole person, we create better outcomes and a stronger health care system for everyone.

No single organization can solve today’s health care challenges alone. By strengthening partnerships across our provider community, we can create a more seamless, patient-centered health care experience and build a healthier future for the people we serve.

Scott A. Berlucchi, FACHE, NHA: A Passionate, Purpose-Driven Leader Building Strong Healthcare Systems

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Almost 20 years ago, in 2007, Scott Berlucchi, FACHE, NHA signed a two-year contract to be the President and CEO of Auburn Community Hospital (ACH). He didn’t intend to stay in Auburn for very long, and certainly didn’t think he would relocate his family from Pennsylvania to Central New York – however, almost two decades and a successful career later, that’s exactly what happened. Today, Berlucchi leads the same hospital in the same capacity, although much has changed over those twenty years: he helped lead a financial and operational turnaround that brought ACH out of bankruptcy and has grown it into a bustling, multi-specialty healthcare hub.

Originally from Pennsylvania, Berlucchi developed the passion and skills for leading small, rural hospitals before he arrived at ACH. Serving as the President and CEO of a few different healthcare systems in Pennsylvania between 1995 and 2007, such as Elk Regional Health System and Lancaster General Susquehanna Division, Berlucchi developed a keen understanding of the importance of local access to quality, specialized care in a small hospital setting. One of the first projects he undertook at ACH was rebuilding and enhancing OBGYN and Women’s Health, which was on the verge of being eliminated.

“In Lancaster, I learned at the feet of some brilliant people who built one of the only women and baby hospitals in Pennsylvania. They were so ahead of the curve with their comprehensive dedication to women and maternal health,” Berlucchi said. In just one example of many, he developed and executed a plan that brought OBGYN and Women’s Health at ACH from the verge of nonexistence into a thriving and growing specialty within the hospital system.

In 2010, the Becker Report named ACH a top ten hospital turnaround, and in 2019 Berlucchi was featured on a list of the top 60 rural CEOs by the same publication. Helping to reinvigorate struggling hospitals is a passion and a skillset Berlucchi has embraced over the decades, he said.

“I’m not a doctor, but I can help heal broken hospitals and health systems. I’m able to take particularly small, rural hospitals that are struggling in any way, shape, or form, and strategically transform them into healthcare systems that meet the needs of the communities they serve,” Berlucchi explained.

Building Blocks of Success

Looking back over the transformation of ACH since he took the helm, Berlucchi highlighted several accomplishments that were achieved along the way. The recent opening of the hospital’s Cancer Center, the Auburn Cardiovascular Institute and the Women’s Imaging facility are all exciting specialty additions to ACH that were made possible by several years of hard work and strategy. ACH’s Leapfrog score, a safety grade given to hospitals across the nation, has improved from a D to a B, almost attaining an A rating, which reflects strong enhancements made over time. In addition, ACH’s nursing home, Finger Lakes Center for Living, recently received a five-star rating from Care Compare.

“These are just ratings,” Berlucchi said, “but the work that goes into them is all about patient safety and quality of care.”

The work to achieve these milestones is structured in a strategic way, Berlucchi explained. He and his team always have a three-year plan that guides their operations, which is updated each year. The one-year operating plans are then broken down into 90-day increments, in which accomplishments and successes are reported and analyzed. Berlucchi emphasized the role his team plays in making sure the work gets completed with quality and efficiency.

“I’m very, very proud of my management team, the board, the medical staff, and the workforce. In all of those regards we have very dedicated professionals, physicians, allied health, maintenance workers, and office staff. Our community of workers are extremely dedicated to ACH and to the Auburn community. I’ve learned you can build buildings, recruit doctors, and start programs, but it won’t work unless you have a dedicated workforce to make it all happen,” Berlucchi explained.

During COVID and in the years since the pandemic, he said, there have been many challenges facing the healthcare sector that ACH has had to navigate alongside other hospitals and health care facilities. Rising demands for medical care mean that many hospitals have been operating at or over capacity, leading to strain and stress on existing systems and infrastructure.

“In my 40-year career, the post-COVID years have been some of the most challenging,” Berlucchi said. “It just changed the landscape of traditional healthcare. We’re being asked to see about 30% more patients with the existing infrastructure, and therein lies the need for creativity and innovation because we don’t necessarily have more dollars to make things happen. The Cancer Center we recently opened is already at capacity. We’re only five months into our Cath Lab being opened and it’s tripled and quadrupled our volume estimates. Thankfully, we have a great group of doctors, nurses and personnel that rise to the occasion and meet the needs of the community.”

Growing and Innovating into the Future

In addition to meeting the needs of the wider community in Auburn, the needs of the 65-plus population are quickly increasing. Many of the added services and facilities ACH now offers have an eye toward the present and future needs of this specific, growing population.

“I see a tremendous growth opportunity in meeting the needs of the aging population, particularly around chronic illness and disease. We’re a full-service hospital, but our older community members are accessing cardiology-related services in particular,” said Berlucchi, highlighting a growing need for cancer services, orthopedics, neurology, and services related to movement disorders within this population, as well.

Alongside other small, rural hospitals, ACH is also innovating and growing to meet increasing patient needs by partnering with larger, academic medical centers. Berlucchi shared that ACH partners with several nearby health centers to enhance its service offerings. ACH partners with SUNY Upstate for several service lines including cancer care, intensive care, and critical care; with the University of Rochester for neurology and cardiology; and with Rochester Regional Health for anesthesia.

“No man is an island, and no small hospital is an island. It’s good to build those clinical affiliations, and sometimes those affiliations can mature into joint ventures along service lines,” Berlucchi said.

Finally, recruiting top talent for ACH is a major priority for Berlucchi as he and the team continue to strive to meet the community’s needs.

“You always have to be trying to recruit the best and the brightest to your community,” he stated. “At the end of the day, medical professionals rely on one another. It’s always a multidisciplinary approach. It’s very important for physicians that your colleagues are as strong as you are for the best patient care. Recruitment and retention of a quality workforce is critical to our core mission.”

Purpose-Led Community Leadership

Reflecting on almost four decades of leadership at small, rural hospitals and health centers, Berlucchi highlighted the men and women who shared their own experience and made it possible for him to bring success to hospitals in Pennsylvania and now ACH.

“I’m very proud of the role of mentoring in my career, particularly the men and women who mentored me and have made me the person that I am. My family, of course, and my faith, first and foremost, but there are a lot of men and women and professionals who have helped shape me along the way,” said Berlucchi.

Now, as he continues through a phase of his career where he has decades of experience under his own belt, Berlucchi enjoys passing on the knowledge he’s gained with young professionals who will take over the reins in years to come.

“I’m trying to pave the road forward now, where I get young professionals or middle-aged professionals who are new at ACH or in a new role, and I try very hard to mentor the next generation. My thought process is that once upon a time, somebody was kind enough to show me the ropes, and in turn I became a better professional to serve the community. At this stage of the game, I feel a duty and a responsibility to coach, train, and mentor the next generation of healthcare leaders. All the trials and tribulations and the experiences I’ve had cannot be learned in a book. I think all professionals owe that to their profession, to not hold onto knowledge, but to release it for others to pick up,” he said.

However, Berlucchi is not yet ready to leave his work behind and for a very simple reason: he loves it too much. Roughly quoting a phrase from the Pennsylvania Dutch, he said, “If you’re fortunate enough in life to wake up one day and know what your purpose and your passion are, and if you’re lucky enough to find work that is synonymous with your purpose and your passion, then you’ll never work another day in your life.

“I’m just very blessed to understand what my passion is and what my purpose is, and very lucky to be afforded an opportunity to have a leadership role in a healthcare organization,” Berlucchi continued. “I’ll be providing healthcare leadership in some way, shape or form for a very long time because I love what I do, and it doesn’t feel like work.”

And although he never intended to stay in Auburn for longer than two years, let alone two decades, his love for the community and for ACH also keeps him going.

“I guess I’m right for Auburn and Auburn’s right for me,” he said. “Look at all the wonderful things we’re doing together. ACH has been here for 150 years, and I’m sure it’ll be here another 150 years because we’ve built a strong program and a strong legacy, and we’re doing very good work for the community.”

2026 Mid-Year Report to the Upstate New York Construction Industry

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Earl R. Hall, Executive Director, Syracuse Builders Exchange

Reflecting on mid-year data, including membership utilization, I am pleased to report that the Syracuse Builders Exchange continues to demonstrate exceptional strength, stability, and growth. The Association remains well-positioned to serve the regional construction industry today while preparing for future opportunities.

The Syracuse Builders Exchange is proud to be the largest construction industry association in New York State with approximately 1,100 member firms. For more than 150 years, our mission has remained unchanged—to provide the resources, services, advocacy, and professional relationships that help our members succeed in an increasingly competitive marketplace.

Membership continues to grow as more construction firms recognize the value of belonging to an organization that delivers measurable benefits. New members are joining because they see an association that provides a wide variety of services, is financially sound, professionally managed, and committed to helping their businesses succeed. Our continued membership growth reflects the confidence the construction industry has placed in the Syracuse Builders Exchange and the value our programs provide every day.

The Builders Exchange is financially sound, generating strong operating revenues, maintaining adequate financial reserves, and operating with no debt – all while maintaining the fiscal goals and objectives of a 501c6 not-for-profit trade Association. This conservative financial stewardship ensures that the Syracuse Builders Exchange remains independent, sustainable, and capable of investing in new programs and member services without compromising our financial security.

The Syracuse Builders Exchange Electronic Plan Room is one of the Association’s most valuable member resources, providing contractors, subcontractors, suppliers, and construction professionals with immediate access to current bidding opportunities throughout the region. Members can easily view project plans, specifications, addenda, and other bidding documents from any location, allowing them to identify and pursue new business opportunities efficiently.

In addition to convenient access to bid information, the Electronic Plan Room offers powerful estimating and digital takeoff tools that help members improve the accuracy and speed of project estimates. These features enable users to measure quantities directly from electronic drawings, streamline estimating workflows, reduce costs, and enhance competitiveness. By combining comprehensive project information with advanced digital tools, the Electronic Plan Room helps members save time, increase productivity, and position their businesses for continued success in today’s competitive construction marketplace.

One of the Builders Exchange’s highest priorities continues to focus on education and safety training. Over the past year, we have expanded our schedule of education, professional development, and safety training classes, providing members with practical knowledge that enhances productivity, strengthens knowledge of regulatory compliance, and improves workplace safety. These programs have become one of the defining benefits of membership and reflect our commitment to helping member firms remain competitive and safe.

Equally important are the opportunities the Builders Exchange provides for members to build lasting and meaningful professional relationships. Throughout the year, the Association has hosted a wide variety of social gatherings, networking events, awards programs, and industry meetings that strengthen connections among contractors, subcontractors, suppliers, design professionals, and project owners. These events foster collaboration, encourage new business opportunities, and reinforce the sense of community that has always distinguished the Syracuse Builders Exchange.

Looking ahead, the Builders Exchange remains focused on innovation and continuous improvement. We will continue investing in education, safety training, technology, networking opportunities, and member services while maintaining the financial discipline that has made the Association one of the strongest and most respected trade organizations in the State.

None of these accomplishments would be possible without the support and engagement of our members, volunteer leadership from the Board of Directors, committee members, and dedicated staff. The Builders Exchange’s membership participation, ideas, and commitment have helped build an organization that serves as the voice of the construction industry throughout Upstate New York.

The future of the Syracuse Builders Exchange is bright. With consistent revenues, no debt, growing membership, expanding educational and safety programs, vibrant networking opportunities, and adequate financial reserves, our association is well prepared to meet the challenges and opportunities long into the future.