St. Joseph’s Health:Trailblazers in Robotic Surgery

By Martha Conway

St. Joseph’s Health has always been an early adopter of technology, so it is no surprise they became the first facility in Central New York to acquire da Vinci robotic surgery technology and start a comprehensive program for patient care – not long after the FDA approved da Vinci for general surgery, such as cholecystectomy and Nissen fundoplication to treat foregut problems. Surgeons performed 43 robotic surgeries the first (partial) year, nearly quadrupling that number the following year. St. Joseph’s Health has performed 13,284 robotic surgeries to date. As a result, they have attracted the surgical expertise of a range of specialists who use the technology to improve the health of patients, and their robotic surgery program is second to none in the U.S. In addition to the above, St. Joseph’s surgeons are using da Vinci for revascularization (coronary artery bypass), heart valve repair, hiatal hernia repair and other gastric reflux procedures, as well as groin or belly hernias, gynecological procedures, urology (including prostate) procedures and colon procedures. They are the leaders in robotic general surgery cases in Central New York. 

The breadth and depth of surgeon expertise mean patients experience less scarring, shorter hospital stays, faster recoveries, less pain and few infections with da Vinci.

“To continue recruiting high quality surgeons – including our newest surgeon coming in September, we need to have robotic access availability,” said Chief Medical Officer Dr. Philip Falcone.

“Virtually everyone in a surgical residency and fellowship training receives robotic instruction and expects this to be available in the hospitals where they work. Robotics are now the norm, and access to this technology is an expectation for most surgeons.” 

The Heart of the Robotic Surgery Program at St. Joseph’s Health 

“St. Joseph’s started investing in robotic surgical technology at least 15 years ago,” said Dr. Zhandong Zhou, a cardiac surgeon who performs bypass and valve procedures using da Vinci. “Surgeons can do single bypass surgery, but not many people need single vessel revascularization, so we started doing robotic bypass to the left anterior descending artery, then PCI [percutaneous coronary intervention] to non-LAD territories, which we called ‘hybrid’ revascularization.”

“St. Joseph’s is dedicated to robotic surgery.” “We put resources into it, employ excellent robotic surgeons and lead the market in terms of technology… ”
Dr. Belfield

Defects in the LAD cause widow-maker (often fatal) heart attacks; PCI opens narrowed or blocked sections of the artery, restoring blood flow to the heart.

“One of the major benefits is that patients recover very well, and – after a couple of weeks – they can do pretty much everything,” he said. “The results from this procedure have been wellreceived, but most people need multivessel bypass. Not everybody can have hybrid revascularization bypasses, so we started the multi vessel bypass. Initially, it was stressful, difficult and took a long time. We recently revised the technique to get them done more quickly and achieve identical results to standard surgery. We just presented our results at the STS Coronary Conference and got very positive feedback.”

“There are only a handful of people doing this in the country, and that makes us stand out,” Dr. Zhou said. “We are showing the world we are one of the few hospitals with the technology and expertise to perform robotic revascularization as good as standard surgery and with quicker recovery. Now patients come in and ask for robotic bypass, but the robots are in high demand because there are a lot of specialties using them, so we just don’t have enough spots.”

Dr. Zhou focuses on coronary bypass surgery because so many patients need it. “About half of open heart surgery patients need coronary bypass, and about half need valve surgery,” he said. “Mitral valve repair can be done robotically, but with limited scheduling slots and minimally invasive surgery being very successful – also done through a very small incision – we can do those either robotically or standard using special instruments, and we can do as good a job as with the robot. For the coronary bypass surgery part, we can do more along the lines of bypass, if we have the [scheduling] spots. Down the road, one of the areas to explore is total robotics – make the incision even smaller.”

Dr. Zhou said while the priority right now is catching up on patients needing bypass, there are other things they can do. “If we can get bypass surgery caught up and I find more time, I can do more,” he said. “We do about 1,000 surgeries a year; 400 to 500 of them are coronary bypass surgeries. We have about 100 mitral valve surgeries, some of which can be done robotically, but I can use special instruments and do as good a job. We do about 400 to 500 coronary bypass surgeries; last year, we did about 20 to 30 percent of them robotically. ”

By avoiding sternotomy and using a rib spreader to access the heart, there is less trauma to the body, minimal scarring, very low infection rates, shorter hospital stays and quicker recovery times. Patients should still expect some discomfort for a few days because of the need for a chest tube.

“After that comes out, things are dramatically better,” he said, adding that cryotherapy is available. “I don’t think patients know the range of options available at St. Joseph’s Health. I’m operating all the time, so I don’t have time to spread the message, but anyone who needs these procedures can call my office. I am happy to talk to them.”

Not everyone is a candidate.

“Some patients are too obese, and that makes it hard,” he said, “and some patients have very small arteries.”

Dr. Balasubramaniam Siva Kumar, a general surgeon who has performed well more than 2,000 robotic surgeries to date, agreed.

“It’s a definite advantage in many surgeries, but it’s not the answer for all surgeries,” Dr. Kumar said. “It’s still not ideal for very large growths and tumors, because it’s riskier to maneuver around larger structures. The size of the patient is a consideration, too. It’s difficult to use robotic surgery in pediatrics because of the positioning required for smaller patients. There is a need to miniaturize the equipment to use robotic surgery in smaller people and on larger masses and growths, as well as extensive cancers.”

Over the years, we’ve been able to maintain the highest standards through a committee approach to program oversight. The range of services is wide and very high-quality.”
Dr. Kumar

Infection rates are almost non-existent because they don’t do sternotomies, Zhou said.

“Chest wall incisions rarely become infected,” he said. 

“Occasionally, a large breasted woman gets an infection because the incision typically is under the breast, and moisture can collect there; but cosmetically for women, it’s very good. With large breasted women, we can make the incision above the breast to avoid chances of infection.”

Exemplifying the Range of Possibilities

Dr. Kumar started performing robotic surgery about 17 years ago when Chief of Urology, Dr. William Roberts, asked him to collaborate with the urology team to do laparoscopic urologic procedures.

“He asked me to lead an expansion into general surgery,” Dr. Kumar said. “I learned everything I could, and we were among the very first to adopt robotics for general surgery.”

Foregut and hiatal hernia surgeries top the list of robotic procedures Dr. Kumar performs today. He’s also done colon surgery, hernia repair and pancreatic surgeries.

“Robotic technology adds dimension to surgery,” he said. “We can gain a much wider range of access to more radius and with more precision, expanding the ability to do more precise surgeries.”

Dr. Kumar said there also are hybrid procedures that allow access to areas of the body that are difficult to reach and previously required large openings to access. “You can use  robotics to reach the areas, then do hands-on surgical procedures via very small openings,” he said. “I do quite a range of robotic surgeries and don’t plan to add any new ones; however, the technology continues to evolve, and St. Joseph’s Health is working on developing further services in this field.”

Like Dr. Zhou, Dr. Kumar said robotic surgery minimizes trauma to tissue. He said surgeons used to do exploratory surgery with a wide-open field to see inside the body. Now the same results are achieved without that trauma. He said there are benefits to surgeons, also.

“Surgeons can work in a comfortable, seated position and achieve better reach with robotic instruments,” Dr. Kumar said. “They can perform much more intricate procedures for much longer periods of time, and they experience much less fatigue doing laparoscopic surgeries than they did during traditional procedures that required great manipulation.”

St. Joseph’s Health Tailors Care to Each Patient

Dr. Beata Belfield is a minimally invasivetrained general surgeon whose fellowship was in robotic surgery; she was recruited by St. Joseph’s Health for precisely that reason.

“Robotic surgery was an absolute prerequisite for any hospital in which I chose to work,” she said, adding that the program is cutting-edge, and the staff are very happy to help create a great patient experience. “I specialize in gallbladder removal, hernia repair and anti-reflux procedures; I’m very happy with my niche, but I would like to do more acute surgeries – procedures we would otherwise do through a big open incision – emergency procedures I’d prefer to do robotically, if possible.”

Dr. Melinda Stevens, a general surgeon, said she’s been doing robotic surgery since about 2015, starting out with small hernias under the mentorship of Dr. Kumar.

“The smaller the incision, the less risk of infection,” Dr. Stevens said. “As for intra-abdominal complications, they are slightly less with the robot because of the 3D visualization and the ability to handle the tissue with instruments that move exactly like our hands. It’s so much better than standard laparoscopic cameras, which are very good, but it’s better with 3D visualization.”

Dr. Belfield said robotic surgery is a good option for appropriate patients. “Certain procedures are not conducive to being done minimally invasive, so robotic surgery is another tool in our tool kit,” she said. “There are certain hernia procedures I do mostly robotically, then at the very end do something open, such as scar revision or removal of excess skin. But most surgeries are either open or robotic.”

“I’ve since developed further skills with larger, more complicated hernias, colon surgery, emergency surgeries – including appendix – and also use the robot more now for doing gallbladders because of the superior visualization and tissue handling,” Dr. Stevens said. “Every year, I’m growing the list of things I do with robotics vs. what I used to do just laparoscopically.”

Dr. Stevens said she wants to add large, complicated hernias that normally are done with a component separation in open fashion.

“I’d like to do it robotically, which is a longer procedure, but in the end, it’s less post op pain for patients, so it’s worthwhile doing it that way,” she said, adding that certain surgeries are not ideal to be performed robotically.

“Patients who’ve had numerous surgeries and who have a lot of scar tissue may not do well with robotic surgery,” she said. “It is best to talk to your surgeon about whether you’re an ideal candidate, because it’s hard to know what your surgeon will think, even if you’ve had surgery before. Meeting with the surgeon helps patients understand their disease process and whether it is a good option for robotic surgery. We tailor our approach to individual patients.”

Dr. Stevens agreed. “It’s difficult to gain access to the abdomen,” she said. “You really need to be able to fully see everything in order to get in safely to avoid injury to the bowel, in particular. Sometimes we have to convert to open in those patients. Some patients are extremely petite – very thin. For a tiny umbilical or groin hernia, the openfashion incisions for those wouldn’t be much bigger than with the robot, so sometimes it doesn’t make sense to use the robot for those. It’s really patientby- patient. I sit down with my patients and  explain the ins and outs of standard laparoscopic vs. open vs. robotic, and we decide together.”

Drs. Kumar and Belfield emphasized that the robot is one of the tools the surgeon uses – it does not move independently of the surgeon.

Dr. Belfield said she believes robotic instrumentation will get smaller and less expensive as other companies enter the field, driving competitors to make more efficient, smaller, and less expensive technology.

“Years ago, robotic technology was focused on cardiac surgery, but so many specialties use it, there isn’t focus on particular specialties,” Dr. Zhou said. “In a few years when the patent expires, a lot of companies will likely try to come up with new and better technologies.” Dr. Stevens believes some of the instrumentation will result in smaller incisions; she also thinks the number of procedures surgeons are able to do with the robot will continue to increase as more physicians become proficient with the technology, which will allow them to increase the versatility of its use with time and experience.

Dr. Kumar added he thinks technological developments are going to focus on miniaturization for pediatric patients and imaging improvements that will allow 3D images to be overlaid on the patient’s anatomy to better target more precisely something like a tumor.

“Applications will widen,” he said. “Resulting enhancements could mean da Vinci isn’t just a surgical tool anymore, but possibly a treatment delivery method for something like precision radiation completed with surgery. The next 20 years we will see things very different from what we are seeing today.”

Why St. Joseph’s Health?

“St. Joseph’s is dedicated to robotic surgery,” Dr. Belfield said. “We put resources into it, employ excellent robotic surgeons and lead the market in terms of technology. We were the first to have a robot in an outpatient surgical center and the first to have the newer generation of Xi surgical robot in the main hospital. St. Joseph’s is cutting-edge on surgical robotic technology and a high volume center that leads to shorter hospital stays and fewer complications for patients.”

“St. Joseph’s has the longest and broadest range of experience with robotics in Upstate New York,” Dr. Kumar said. “Over the years, we’ve been able to maintain the highest standards through a committee approach to program oversight. The range of services is wide and very high-quality.”

“Our longevity in the field and ability to attract the most talented surgeons are the reasons we get superior results,” Dr. Zhou said.

“St. Joseph’s has been at the forefront of robotic surgery and particularly in the field of general surgery, which really got started doing upper abdominal surgeries, like hiatal hernias,” Dr. Stevens said. “St. Joseph’s has been doing this longer and in significantly higher numbers than any other hospital in the area, and we have continued to increase its use across the breadth of general surgery. We have numerous surgeons with various levels of robotic surgical expertise and experience.

In general surgery, we work as a team, and there’s always someone there to take care of any problem.”

St. Joseph’s:
• leads robotic general surgery cases in Central New York (9,300-plus cases vs. the closest competitor with 7,000);
• has the busiest cardiac robotic program in CNY;
• was the first in CNY to have a da Vinci system at an outpatient facility and the first to have an Xi at a surgery center;
• has performed more than 1,700 robotic cases in 2022 and more than 1,100 so far in 2023;
• have five surgeons who have passed 1,000 robotic cases each; and
• they are the leaders in da Vinci foregut procedures in Central New York, performing 153 cases in 2022 and 102 so far in 2023.

“I think it’s important for people to understand this technology will be the standard of care in many facets of surgery, and it isn’t offered everywhere,” Dr. Stevens said. “Having a hospital filled with surgeons very experienced with the robot is an important option people should know about.” 

Workforce Challenges, Part Two

BY Kathryn Ruscitto, Advisor

Earlier this year, I wrote about nursing workforce challenges. As the year has progressed, I find myself bumping into deeper workforce challenges in rural communities; leading the list is housing. I don’t believe this is just a rural issue; I think it extends to urban areas, as well. A few times in my career, I was involved with large organizations that took on housing challenges from building senior and building workforce housing to improving a neighborhood. Some projects required direct involvement as a sponsor; other times, it was acting as a catalyst by attracting a partner. 

So whose responsibility is it to ensure a community has all levels of housing? As short term rentals have gained popularity, much of the low rent stock has been eaten up by more profitable ventures. Teachers, service workers, young families find themselves fighting for access to affordable rentals and first time homes. 

They often have to handle further distances from work, move in with their families or co share a more expensive rental.

Generally, not-for-profits have taken the lead in Central New York, such as Home HeadQuarters, Housing Visions and Christopher Community. Some for-profit builders have also taken on tax credit projects. Tiny Homes for Good addresses the needs of the homeless; others facilitate apartment rentals for special needs populations.

Home HeadQuarters CEO Kerry Quaglia is focused on the rehabilitation of older homes in Syracuse and new construction. Quaglia says new construction often offers a better option to reduce costs to a first-time homebuyer.

“Housing continues to be a major priority for our communities, especially helping low-income and first-time homebuyers access the housing market safely and affordably,” Quaglia said, adding that part of what is slowing his work at adding affordable housing units is finding contractors, who are facing workforce shortages.

Occasionally, I post blog thoughts on LinkedIn and recently issued a challenge to anchor institutions such as colleges and health systems to look at workforce housing as a challenge and strategic requirement. I took notice of the many comments and cheers from colleagues across the country. I hope it stimulated some thinking about next steps. 

While housing projects may not fit the priorities of a small practice, talking to elected officials and developers about locations and needs might. Use your voice to share what you are hearing from your employees and communities. If you sit on anchor institution boards, ask about their plans or conversations on this topic.
Communities that look at this issue and offer tax incentives or deed restrictions, or land banks dedicated to workforce development, will begin to solve workforce challenges at all levels.

Further resources on this topic:
“Adirondack Housing at a Threshhold”: https:// www.adirondackexplorer.o g/stories/adirondack- housing-at-a-crossroads

“In Vail, housing shortage threatens America’s ski wonderland”: https:// sports-colorado- sheep-vail-7a622d88e2678b32ce-

Local resources:
Christopher Community
Home HeadQuarters
Housing Visions
Two Plus Four Construction

Kathryn Ruscitto, Advisor, can be reached at or at


Dr. Praveena Paruchuri, MD Joins Auburn Heart Institute

Praveena Paruchuri, MD, is a cardiology specialist with 17 years of experience. She comes to Auburn Cardiology from St. Francis Hospital in Roslyn, New York. Dr. Paruchuri has also practiced in a number of the largest cardiology departments in New York City hospitals including NYU Long Island Hospital, as the Director of Adult Congenital Heart Disease.

Dr. Paruchuri attended Saint George’s University School of Medicine in Grenada, West Indies, and completed her residency program at Winthrop University Hospital in Mineola, NY. Additionally, she completed her General Cardiology Fellowship at Winthrop University. She is board certified in cardiovascular disease, Cardiovascular Computed Tomography, Nuclear Cardiology, and Internal Medicine.

Dr. Paruchuri is skilled in assessing conditions ranging from routine to complex adult congenital heart disease and devising treatments in line with the latest research and treatment protocols. She also is proficient in multi modality cardiac imaging including structural TEE, cardiac CTs, echocardiograms, and nuclear stress testing. Dr. Paruchuri is known for building excellent rapport with patients and colleagues to facilitate effective clinical care and has a passion for caring for women’s cardiology issues. “I am excited to join a growing cardiology practice at Auburn Community Hospital and to be able to practice in the Auburn community and be a part of building the Auburn Heart Institute,” she said.

“We are thrilled to have Dr. Paruchuri join the Auburn Heart Institute. She has an exceptional background and considerable experience in caring for patients in some of the most prestigious New York City cardiology institutions. By securing Dr. Paruchuri’s services, we are well on our way to achieving our goal of developing a world-class heart institute in Auburn. N.Y.,” said Ronald Kirshner MD, Chair and Medical Director of the Auburn Heart Institute (AHI). Dr. Paruchuri is accepting new patients now. 

Please call Auburn Cardiology
17 Lansing Street, Auburn NY

Crouse’s Pomeroy College of Nursing Settles into New Location

By Molly English-Bowers

After more than 100 years on University Hill, Pomeroy College of Nursing at Crouse Hospital has moved to the Crouse Medical Center at 5000 Brittonfield Pkwy., East Syracuse. In late 2021, Syracuse University purchased the Marley Education Center at 765 Irving Ave., which the college had occupied since 1991. The relocation, just nine miles from Crouse Hospital, benefits students and college staff with minimal adjustment. “It’s a win-win for our students,” said Patty Morgan, MS, RN, Dean of the College, adding that students attend Pomeroy to become registered nurses. “This is a new facility accessible to our students just off I-481, near the state Thruway and our general education partner, Le Moyne College.” The facility was intentionally designed to meet the needs of all students, creating an excellent student experience within a dynamic learning environment. Available to students enrolled at Pomeroy are:
• three classrooms of increasing size, equipped with smartboards, video/ audio recording capabilities and comfortable seating;
• a library with thousands of books, journals and videos related to nursing and medicine, including access to online databases and texts;
• a nursing skills lab with seven patient treatment bays and mannequins that parallel a hospital acute-care setting;
• a simulation center with two fully functioning patient rooms and three high-fidelity mannequins – adult, birthing mother and baby;
• a biology lab used for teaching microbiology and anatomy and physiology;
• several areas for quiet study, group study and a student lounge for relaxation and student interaction;
• a computer lab;
• a highly regarded nursing faculty, many of whom are graduates of the college; and
• ample free parking. 

The nursing skills and simulation center areas allow students the opportunity to work with faculty and one another to grow and develop. “These areas augment students’ education,” Morgan said. “We are not using these areas to replace the clinical experience gained only in a hospital setting, rather providing students with a safe space to develop and practice their skills.” 

The modern simulation center features various high-fidelity mannequins that can be programmed with more than 200 scenarios intended to represent real patient experiences often encountered in hospitals. Scenarios involving the birthing mother and baby allow students to learn about the management of two patients at once, accessing newborn health and the immediate needs of a postpartum mother simultaneously.

Faculty members and simulation staff control the scenarios via computer terminals located in a control room centered between patient rooms. Faculty are able to watch students complete simulation experiences via one-way glass, providing immediate feedback, if necessary. A debrief room completes the space, where students and faculty are able to view a video/audio recording of their simulation experience and discuss what went well and what requires further development – providing an excellent learning opportunity for students. 

“Simulation experiences are not graded,” said Amy Graham, Assistant Dean for Enrollment. “They are intended to help students gain knowledge and experience, as well as to learn to think critically and develop teamwork.” 

Extensive clinical experience is one of the strengths of the Pomeroy curriculum, said Morgan. Students begin clinical rotations early in their first semester/ term of study. Student-to-faculty ratios during rotations are typically nineto-one, with rotations taking place at Crouse Hospital, Upstate Golisano Children’s Hospital and Hutchings Psychiatric Center.

“The fact that the college is affiliated with Crouse Hospital means that our clinical education component is very strong,” said Graham. “Students develop professional relationships, often leading to employment opportunities.”

Another strength that Morgan touted is the nursing faculty. “They are knowledgeable, supportive and skilled in the classroom and clinical environment,” she said. In fact, many members of the faculty are Crouse graduates.

The college’s career placement rate, which measures the percentage of graduates who obtained a position as a registered nurse within 12 months of graduation, is consistently in the high 90s, noted Morgan. Many  graduates choose to begin their professional nursing careers at Crouse Hospital, while others choose to practice elsewhere, depending upon their desired specialty or geographic location post-graduation. The latest figures published on the college’s website show placement rates of 98 percent in 2019, 97 percent in 2020 and 95 percent in 2021. 

An important indicator of any associate degree nursing education program is the National Council Licensure Examination (NCLEX)-RN exam first-time pass rate. Pomeroy’s pass rate is consistently higher than state and federal rates, most currently at 92 percent, said Graham. Students prepare for the licensing exam in various ways throughout their matriculation at the college, including testing. Additionally, Morgan said, students complete a fourday NCLEX RN preparation and review course prior to graduation. 

Pomeroy College of Nursing at Crouse Hospital offers three options for students to earn their degree. The traditional day option gives students the opportunity to earn an associate degree in applied science with a major in nursing in four semesters. The evening/weekend option allows students to earn their degree in just 16 months and is ideal for those with daytime commitments. The Degree-in- Three option with Le Moyne College allows students to earn both their associate degree and bachelor of science degree in nursing in three years while studying simultaneously at Pomeroy and Le Moyne.

Beginning in 2017, New York state began requiring registered nurses interested in practicing in the state to earn their B.S. in nursing within 10 years of being licensed. The initial associate degree qualifies a graduate to work as a graduate nurse, sit for the licensing exam and then work as a registered nurse. The Degree-in-Three option provides a continuous pathway to the bachelor in nursing degree without the worry of the looming 10-year requirement. 

Students who choose to do so may complete their general education course requirements elsewhere and, if successful, transfer those credits into Pomeroy. Included are science courses – anatomy and physiology, microbiology and nutrition – and English and psychology courses. Completing general education courses prior to matriculation at the college is especially helpful to students enrolled in the evening/weekend option, though all students may begin their nursing education at Pomeroy with all or some of those courses completed elsewhere. 

Pomeroy College of Nursing at Crouse Hospital admission applications are reviewed on a rolling basis with target dates of April 1 for fall admission and Sept. 1 for spring admission. Applications and additional information can be found online at The college may be reached via phone at (315) 470-7481 or via email at

Clear Protocols as Important as Everamid Healthcare Staffing Shortage

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

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

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

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

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

Measures to address staffing shortages

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

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

The risk of putting profits ahead of patient care

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

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

Striking a balance with limited resources

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

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

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

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

What to do BEFORE considering a private equity transaction

by Marc S. Beckman, J.D.

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

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

Compliance Audit

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

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

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

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

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

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

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

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

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

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

ROME HEALTH:Enhancements and expansion for community-centered care

by Elizabeth Landry

Aerial view of Rome Medical Center, opened November 2022

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

National Recognitions for Quality Patient Care

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

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

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

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

Continuous Improvements Still to Come

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

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


It’s Tick Season: Be Tick Aware


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

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

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

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

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

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

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

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

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


2. /wr/mm7211a1.htm?s_cid=mm7211a1_w

3. Central NY Lyme and Tick Borne Disease Alliance

4. Dr. Brian Leydet, Jr., MPH

5. Dr. Kris Paolino, Infectious Disease

Kathryn Ruscitto, Advisor, can be reached
at or

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

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

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

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

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

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

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

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

SOS Hand & Wrist Center Expedites Patient Care

By Molly English-Bowers

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

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

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

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

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

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

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

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

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

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

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

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


Left:  Devon J. Ryan, MD

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