Category: 2023

Clear Protocols as Important as Everamid Healthcare Staffing Shortage

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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 Strategies.com.

What to do BEFORE considering a private equity transaction

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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
or mbeckman@ccblaw.com.

ROME HEALTH:Enhancements and expansion for community-centered care

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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
future.

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.”

RomeHealth.org

 

It’s Tick Season: Be Tick Aware

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BY KATHRYN RUSCITTO, ADVISOR

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/
be-tick-aware/.

Locally, the CNY Lyme and Tick Borne Disease Alliance offers community education for groups, camps and clubs. For more information, contact Elizabeth Balfour at cnylymealliance.org/ 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. 

Resources
1. cdc.gov/ticks/longhorned-tick/index.html

2. cdc.gov/mmwr/volumes/7 /wr/mm7211a1.htm?s_cid=mm7211a1_w

3. Central NY Lyme and Tick Borne Disease Alliance cnylymealliance.org/

4. Dr. Brian Leydet, Jr., MPH leydetlabesf.weebly.com

5. Dr. Kris Paolino, Infectious Disease upstate.edu/id/healthcare/ida/physicians-
staff-profile.php?empID=paolinok

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

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

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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. 

AuburnHospital.org

SOS Hand & Wrist Center Expedites Patient Care

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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 sosbones.com. There you will find information on the center’s physician and therapy team, as well as conditions
treated. 

 

Left:  Devon J. Ryan, MD

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

Seven Steps To Medicaid Compliance Program Readiness

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By Maureen Dunn McGlynn

The mission of the New York Office of The Medical Inspector General (OMIG) includes enhancing the integrity of the Medicaid program by preventing and detecting fraudulent, abusive and wasteful practices within the Medicaid program. Pursuant to this mission, New York implemented compliance program requirements in 2009. Recently, amended regulations were adopted governing the implementation and operation of effective compliance programs for certain required Medicaid providers. These revised regulations include significant changes to the original regulations and will require affected Medicaid providers to review and revise their existing compliance programs. So, what steps should Medicaid providers take now to meet these new requirements?

1. Determine whether you are a required provider. As a condition of receiving payment under the Medicaid program, a “required provider” must adopt, implement and maintain an effective compliance program that satisfies the new regulations. “Required providers” include providers subject to Articles 28 or 36 of the Public Health Law, Articles 16 or 31 of the Mental Hygiene Law and managed care providers or managed long term care plans (MMCOs). Also included are providers who provide care services or supplies under the Medicaid program for which the Medicaid program is or should be reasonably expected by a provider to be a “substantial portion” of their business operations. A substantial portion of business operations means the provider claimed or received $1 million in any consecutive 12-month period, directly or indirectly from the Medicaid program.

2. Identify your risk areas. A required provider’s compliance program must apply to the provider’s risk areas. Risk areas are areas of the provider’s operations that are or should with due diligence be identified by the provider through its organizational experience. Areas of operations included in a compliance program must include billings, payments, medical necessity and quality of care, governance, mandatory reporting, credentialing, ordered services and contractor, subcontractor, agent or independent contractor oversight. An effective compliance program should be designed to be compatible with the provider’s characteristics (i.e. size, complexity, resources and culture) and be well-integrated into the provider’s operations.

3. Review and update your written policies and procedures and review them at least annually. Compliance programs must have written policies, procedures and standards of conduct accessible to everyone affected by the provider’s risk areas, including employees, chief executives and other senior administrators, managers, contractors, agents, subcontractors, independent contractors and governing body and corporate officers. The policies and procedures must describe compliance expectations, the provider’s fundamental principles, values and commitment to conduct its business in an ethical manner. In addition, the policies and procedures must include specific guidance on dealing with potential compliance issues, identify methods and procedures for communicating compliance issues to the appropriate compliance personnel and describe how potential compliance problems are investigated and resolved.

4. Appoint a compliance officer and plan compliance training. The compliance officer, who is not required to be an employee, reports directly to the chief executive or other senior administrator and periodically reports directly to the governing body. The compliance officer leads and coordinates the compliance committee, which is required to meet at least quarterly, have its own charter and consist of senior managers. Compliance training must be provided annually and must be part of orientation for new employees and occur promptly upon hiring.

5. Create and maintain effective lines of communication to ensure confidentiality. It is important that lines of communication directly to the compliance officer are publicized and available to all staff and Medicaid recipients of service by the provider, including a method for anonymous reporting of potential fraud, waste, abuse and compliance issues. With certain exceptions, the confidentiality of the reporter must be maintained.

6. Monitor and respond to compliance issues. A key component of an effective compliance program is a system for routine monitoring and identification of compliance risks. Monitoring activity results should be promptly shared with the compliance officer and appropriate compliance personnel. It is crucial that compliance issues are promptly investigated and corrected.

7. Take advantage of available resources. There are several resources available to assist in meeting compliance program obligations on the OMIG website (omig.ny.gov), including a compliance library, webinar, Compliance Program Review Module and OMIG’s Compliance Program Guidance. 


Maureen Dunn McGlynn is a member at
CCB Law, a boutique law firm focused
on providing counsel to physicians and
healthcare professionals. She can be reached
at 315.477.6276 or mmcglynn@ccblaw.com.

Upstate Cancer Center: Improving Cancer Outcomes for All

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BY BECCA TAURISANO

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

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

Multidisciplinary Approach to Care

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

Clinical Innovation

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

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

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

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

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

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

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

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

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

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

Improved Experience for Patients and Staff

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

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

Investment in Technology

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

Research Integration

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

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

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

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

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

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

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

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

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

Workforce Challenges

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BY KATHRYN RUSCITTO, ADVISOR

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

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

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

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

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

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

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

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

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

Mental Health in the Workplace

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By Elizabeth Landry

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

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

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

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

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

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

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

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

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