Category: 2025

Mental Health Access

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By: Kathryn Ruscitto, Advisor

Recent conversations with families seeking mental health resources have highlighted the severe challenges in accessing psychiatric care in our community. What began as routine inquiries have exposed a healthcare system stretched beyond capacity, with primary care physicians increasingly unable to connect patients with psychiatric specialists. The backlog, initially attributed to COVID-19 disruptions and workforce shortages, has reached critical levels that demand innovative solutions.

In consultation with Ann Rooney, Deputy County Executive for Human Services in Onondaga County, the scope of this challenge became clear. The County is actively responding through the Department of Children and Family Services, implementing triage systems designed to prioritize the most vulnerable patients and ensure they receive timely care. Ann also shared a tool the County recommends for physicians to consider called Clinicom (https://clinicom.com/). This algorithm helps providers assess mental health conditions in a timely manner to consider treatment options. Other counties in upstate New York, along with major health foundations from Buffalo to Albany, cite mental health and substance abuse among their top priorities for focus in the next year.

For families with private insurance and financial resources, online mental health platforms offer promising alternatives. Services like Talkiatry and BetterHelp provide access to licensed providers when traditional pathways fail, though they typically operate on a private pay basis. Online services must be licensed in your state to provide care. While often requiring private payment, they can help individuals navigate next steps and access immediate support. 

The mental health system is adapting through tiered care approaches. Psychiatrists focus on the most acute cases, while psychologists and therapists provide ongoing counseling and support for longer-term cases. This model maximizes specialist availability while ensuring comprehensive care. Primary care physicians have become frontline mental health providers by necessity. Many report managing mental health concerns, including substance abuse issues, while patients await specialist access. This reality requires staying current with available resources and access points. 

The range of inpatient beds in local health systems are critical parts of the mental health care system when individuals and families face crisis. These beds are also under severe stress from increasing demand. This adds to the crisis in access when immediate care is needed. Multiple barriers continue to impact access including rural geography limitations, insurance coverage gaps, and evolving telehealth regulations. Staying informed about available resources remains crucial for reducing patient frustration and improving care coordination. 

Thank you for all you do in supporting families facing mental health crisis.

From Patient to Partner: Judith’s Journey

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When you climb the porch stairs to the front door of Judith’s home, you’re greeted by a woman with a  radiant smile, and immediately sense a palpable warmth. She came to the inner city of Rochester to visit a cousin. While she never imagined she would stay, that’s exactly what she’s done. Her cousin eventually moved away, and Judith found herself alone—her daughter, her closest relative, lives more than five hours away.

Living on her own with no support system, Judith has faced numerous health challenges, including a bilateral knee replacement in 2023. It was during her recovery that she was first connected with a case manager. She didn’t expect her health plan to become a critical means of assistance, but that’s exactly what happened.

“As a former caregiver myself, I never thought I’d be the one needing support. But my care manager at Excellus is everything to me,” Judith says, her voice steady with emotion. “She’s more than just a voice on the phone—she is my lifeline. Whether it’s finding short-term rehab, helping me navigate the health care system, or simply reminding me I’m not alone, she’s there.”

And it’s that care manager who referred Judith to the Community Connections team who are now at her home helping to set up the Excellus BlueCross BlueShield (BCBS) app on her phone, which will allow her to access her identification card, find health care providers, check her medical coverage, track spending, and view claims. But what matters more to Judith is knowing that someone who cares is just a call or a visit away.

In the Field: Bridging the Gap to Better Health

Judith’s experience is just one of thousands. Across upstate New York, the case management and Community Connections teams are working quietly, relentlessly—to meet people where they are, in every sense of the phrase.

While SafetyNet CARE provides personalized phone-based support navigating local community and national resources like Meals on Wheels, Social Security benefits, and Veteran’s Assistance benefits, the Community Connections team takes it further. Established to locate and re-engage hard to-reach, medically fragile Medicaid members, the team is often knocking on doors, walking city blocks, and reaching out to those who’ve lost touch with the care they need and access they deserve. These are individuals who may be homeless, moving between homes, or simply unable to answer the phone.

While Excellus BCBS consists of more than 4,000 employees, the Community Connections team is small. Just seven people serve all 39 counties—yet their impact is immense. Last year alone, they received referrals to reconnect with nearly 6,800 members.

“We are here to serve our communities in any way that is needed to get and keep them healthy – that is the benefit of being a nonprofit, local health plan,” says Dr. Nicholas Massa, vice president medical affairs, commercial products and clinical integration at Excellus BCBS. “Through Community Connections, we may help a member with high blood pressure work with a nurse to keep the member’s health in check, provide special formula for a premature baby to a new mother who may be financially strapped, or acquire beds for family members who may be sleeping on the floor. The ways they are impacting lives are endless … and meaningful.”

Around the holidays, when the world can feel lonely for many, Community Connections shows up with food baskets and kindness. In 2024, they brought Thanksgiving meals to 375 families who might have otherwise gone without.

“Some of the reactions we see from our members when we deliver the baskets are gratitude, excitement, thankfulness, and tears of joy,” says Sylvia Lee, director of outreach and training programs at Excellus BCBS. “We are seeing a lot of food insecurities and a lot of need by individuals … it is such a rewarding feeling that you assisted someone in need.”

Community Connections Thanksgiving Baskets

“Any Day We Connect with a Member is a Good Day”

Dajia Richardson, Community Connections manager for the past six years, understands the significance of this work. She and her team are passionate about addressing health care disparities and improving overall health outcomes in their communities.

“I love that our team is driven by a natural curiosity and finds such satisfaction in making a difference, one member at a time. We don’t just check boxes—we listen, we care, and we persist,” she says. “If we can prevent just one crisis, if we can help someone feel seen, that’s a good day.”

The team has discovered that a personal visit may be more than an official letter or phone call to encourage Medicaid members like Judith. “The work goes far beyond traditional care,” Sylvia says. “It’s about building trust, encouraging prevention, and helping people believe in their own health journey.”

Dajia adds, “I’m proud of the work we do because it centers around increasing access to care, preventive care, and helps reduce long term costs. We make a difference when we catch things sooner rather than later— making certain that members don’t slip between the cracks and connect them to the resources they need.”

A Lifeline That Feels Like Local Family
Before Dajia leaves Judith’s home, Judith turns to her and, with quiet conviction says, “Thank you for giving me hope and being here today. I’ve never seen my care manager’s face, but I know her voice, and when I hear it—I know I’m going to be okay.”

That moment, quiet and deeply human, speaks volumes. “This isn’t about insurance – it’s about people, about showing up and standing beside someone when they need it most, reminding them they are not alone,” says Dr. Massa. “Judith’s care manager and Dajia … they are the faces and the voices of Excellus BCBS. We have a lot to be proud of, thanks to their work. And that’s the heart of our mission.” 

The Healthcare Engagement Team helps to ensure that individuals who are uninsured, underinsured, or have limited access to care due to financial or other barriers maintain access to essential health care services through Medicaid and the Essential Plan. The Case Management team at Excellus BlueCross BlueShield (BCBS) consists of nurses, social workers, mental health counselors and physical therapists that collaborate to provide telephonic comprehensive care to our members. They focus on physical, emotional, and social wellbeing to help members feel confident navigating their personal health journeys.

Community Connections is part of the Case Management team at Excellus BCBS in upstate New York. These employees find hard to- reach members to reconnect them with care management specialists. They travel to member’s homes to help them reconnect with the Health Plan and help offer in-person assistance when necessary. For more information about the Case Management or Community Connections programs, please call 1-877-222-1240.

Claims-made vs. Occurrence Insurance Policies:Understanding the Differences, Benefits, and Drawbacks

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By: Jenn Negley, Vice President, Risk Strategies Company

When it comes to liability insurance for professionals such as doctors, choosing the right type of policy is crucial. Two of the most common forms of coverage for professionals, such as doctors, lawyers, and business owners, are claims made and occurrence  policies. While they both offer liability protection, the way coverage is triggered and how long it lasts differs significantly. Understanding these differences is crucial for individuals and organizations to avoid costly coverage gaps and ensure they are adequately protected.

What is a Claims-Made Policy?
A claims-made policy provides coverage only if the claim is made during the policy period and the incident occurred on or after the policy’s retroactive date. The retroactive date is usually the date the insured first purchased a claims made policy and continuously maintained it. For example, suppose a doctor has a claims-made malpractice policy that starts on January 1, 2022, with a retroactive date of January 1, 2020. A patient filed a lawsuit on March 1, 2023, for something that happened in 2021. Because the policy is still active when the claim is made and the incident occurred after the retroactive date, the lawsuit is covered.

Benefits of Claims-Made Policies:

Lower initial premiums:
These policies are often cheaper in the early years because the insurer is only covering claims reported during the policy period, not the full history of a professional’s work.

Customizable tail coverage:
If you retire, take a break from your career, or switch insurers, tail coverage can extend your protection beyond the end of the policy. This helps cover claims that arise later from work you did while the policy was active.

Adaptability:
Claims-made policies are a good fit for professionals whose situations may change, such as a growing practice or changing insurers. However, continuity is key to avoiding coverage lapses.

Drawbacks of Claims-Made Policies:

Tail coverage can be expensive:
If the policyholder retires or switches carriers, they may need to buy tail coverage, which can cost up to 200% of the final year’s premium.

Coverage gaps: If there’s a lapse in policy renewal or the retroactive date changes, claims may be denied.

Complexity:
The nuances of retroactive dates and tail coverage can confuse policyholders unfamiliar with insurance jargon.

What is an Occurrence Policy?
An occurrence policy provides coverage for incidents that occur during the policy period, regardless of when the claim is filed. This means even if a claim is filed years after the policy expires, the insurer will still cover it if the incident occurred during the time the policy was active. For example, if a contractor has an occurrence policy from 2018 to 2020, and a claim is  filed in 2024 for a job completed in 2019, the claim will still be covered.

Benefits of Occurrence Policies:

Long-term peace of mind:
Once the policy is in place, the policyholder is protected for incidents that occurred during the coverage period, even if the claim arises years later.

No need for tail coverage:
This makes occurrence policies especially attractive for professionals who don’t want to worry about coverage after retiring or changing jobs.

Simplicity:
Easier to understand and manage over time, since there’s no concern over retroactive dates or claim reporting timelines.

Drawbacks of Occurrence Policies:

Higher premiums:
These policies usually cost more upfront than claims made policies, reflecting the broader protection they offer.

Limited availability:
Some insurers offer only claims-made policies for specific professions or high-risk fields.

Harder to budget long-term:
Because the insurer assumes longterm liability, the policy’s true cost can be challenging to estimate or predict.

How Do You Decide Which Policy Is Right for You?
Choosing between claims made and occurrence policies often depends on your financial situation, career stage, and risk preferences.

• Early career professionals may prefer claims-made policies for their lower initial cost.

• Established professionals or those nearing retirement might lean toward occurrence policies for their lasting protection.

• Those who switch jobs or insurers frequently must carefully manage claims made coverage to avoid gaps.

Both policy types have their place, and the best choice depends on your specific situation. Consulting with an experienced insurance broker can help ensure your coverage aligns with your needs, career plans, and financial goals.

For more information, please contact Jenn Negley, Vice President, Risk Strategies, at 267-251-2233 or JNegley@RiskStrategies.com.

Upstate University Hospital: A Regional and National Leader in Healthcare Innovation

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By Elizabeth Landry

As Central New York’s only academic medical center, Upstate University Hospital is paving the way for much of the region’s healthcare needs. In fact, many of the hospital’s programs and facilities are blazing new trails of innovation, regionally and often nationally, as well.

“We think a lot like a private enterprise, even though we’re public, and that has helped us think innovatively and do well financially,” explained Robert J. Corona, DO, CPE, MBA, FCAP, FASCP who has served as CEO of Upstate University Hospital since 2018. Dr. Corona has been associated with Upstate in various capacities for over 30 years, completing his residency and fellowship at the hospital in the 1980s, serving as an educator periodically, becoming Chair of the Pathology Department in 2012, and serving as Chief Innovation Officer shortly after.

For Dr. Corona, continuing to lead the way in innovation is a core strength of Upstate, and his vision of innovation in health care encompasses new ways of incorporating machines, software, programs and buildings. “We need to be state of the art as a teaching hospital to be able to provide our trainees with the best technology and the latest innovations, so they can see how high-quality care is delivered,” he said.

Technological Innovations at the Forefront

Perhaps one of the most visible avenues in which Upstate utilizes cutting edge technology within its healthcare system is the use of drones and robots, which have combined to become the Autonomous Machines Department. Upstate began using drones around 2013, when Dr. Corona was the Chair of Pathology, but this technology has ramped up since he became CEO. The drones, which can fly over 40 trips per day, save the  organization time and costs by transporting medications and specimens for testing through the air rather than relying on couriers on the ground. Upstate is well on its way to reaching the goal of flying the drones between all its institutions. In addition to the time and cost savings, the innovative technology has also led to increased efficiency and satisfaction of patients.

“We use drones in our ‘Meds to Beds’ program, which means when you’re in the hospital and you get discharged, we provide you with your discharge medication so that you don’t have to go to the pharmacy. The order goes over to the retail pharmacy across from Community Hospital and then the drone flies the medication over to the hospital and we give it to patients when they’re discharged,” Dr. Corona said. Robots, the other piece that forms the Autonomous Machines Department, became part of the organization’s operations to help with staffing shortages, Dr. Corona explained.

“I worked with an engineer and found out that nurses spent 

about a third of their day chasing down supplies, moving food, picking up things in the cafeteria, bringing things to the lab, bringing sheets and any kind of supply, which is really not having nurses work to the top of their license. So, we ended up getting over a dozen robots that now deliver supplies and food.”

Dr. Corona added that such use of these machines has put Upstate at the forefront of healthcare technology not only regionally, but nationally. “I don’t know of any other institution that has a combined program of robotics and drones in an autonomous machines group,” he said. 

Another milestone of technological innovation at Upstate has been the recent opening of the Throughput Operations Center. A sort of central command center for the organization located in the former Telergy Building off Carrier Circle, the center features 22 live-feed monitors and 28 computer stations
that provide hospital officials with a real-time view of operations, including capacity demands, bed census, open beds, COVID information and patient transport status. The center is aimed at reducing bottlenecks, streamlining patient flow, and improving patient outcomes across the hospital network. Dr. Corona explained how the center is helping with capacity challenges and may even grow to include external healthcare organizations.

“We’ve had preliminary discussions with the Department of Health to see if we could coordinate with hospitals that have capacity and we would help them manage the patients if needed,” he said. “We’ve had interest in what I call a ‘virtual hospital system,’ where the Throughput Center would see all the participating facilities and help manage and balance the load.”

New Programs Directly Benefitting Providers

Upstate is one of only a handful of academic medical centers to offer a new Hospital Administration Leadership and Management Fellowship accredited by the Accreditation Council for Graduate Medical Education, or ACGME. This fellowship provides the opportunity for physicians to gain certification in this field.

“The physicians will spend time learning finance, operations, physician management and other skills leading to board certification in healthcare leadership,” explained Dr. Corona. Another significant, yet very different way Upstate is investing in innovations that directly benefit healthcare providers is through a recent safety initiative called “Respect and Heal,” a collaborative effort with other local healthcare entities. It was proposed by Dr. Corona after he and other regional CEOs wanted to address violence against healthcare workers.

“We are united in zero tolerance for abuse and are committed to sharing best practices to end harassment and assaults. We held a half day conference last year, which was standing room only, and we are moving to a full-day conference this year to share innovations and research,” said Dr. Corona. Upstate took on the role of coordinating and hosting the conference, which is offered to staff and leadership at the dozen hospitals that have committed to the principles of Respect and Heal.

Widespread Innovations in Healthcare Facilities

The team at Upstate has been on the forefront of innovative facilities and buildings for several years, with structures like the Upstate Nappi Wellness Institute, a building that’s been both LEED certified, signifying its sustainability, and Well certified, related to its eco friendly status. The building’s beautiful design is what Dr. Corona described as “friendly to the human experience.”

Another innovative space that has been approved is a new pathology building that will be built next to the Upstate Bone & Joint Center on Fly Road in East Syracuse. Dr. Corona elaborated on how pathology has become more innovative at Upstate over time, and why the new building is needed.

“When I returned to Upstate as the pathology chair after 16 years in the industry, I had experience in digital imaging and developing medical products,” he said. “The new facility
is going to leverage recent research in digital pathology, molecular diagnostics, applications of AI relevant to diagnostics, and quantum computing.”

Another recent facilities development at Upstate is a plan to build an annex which will include a new Emergency Department and a new Burn Unit. The team at Upstate is also exploring the development of a cellular therapy center reflecting recent innovations in

 stem cell technology.

The Upstate Cancer Center at Verona is unique due to the organization’s collaboration with the Oneida Nation, a relationship that Dr. Corona explained is one of the first of its kind.

“To the best of our knowledge, this is the first collaboration where a public New York state hospital has worked with a native nation to build a health facility. It’s been a wonderful relationship – they’ve been amazing to work with.”

Providing Cutting-Edge, High-Quality Care
The Verona Cancer Center is one of Upstate’s several cancer centers, with other locations in Syracuse, Oswego, Auburn and at Community Hospital. These widespread resources reflect Dr. Corona’s focus on providing healthcare where people in the community need it most.

“I see us as having a responsibility to grow and provide state-of-the-art care locally for our community, so people don’t have to leave the area for exceptional cancer care, cardiac care or stroke care. We have an obligation to really drive outstanding quality, and to incorporate the most relevant tools and approaches to do so.”

For Dr. Corona and the team at Upstate, that’s what innovation is all about. 

The new Upstate Throughput Center features 22 live-feed monitors and 28 computer stations that provide hospital officials with a real-time view of operations, including capacity demands, bed census, open beds, and patient transport status to streamline care.

Research and Teaching: What Sets Upstate Apart

The two pillars of Upstate University Hospital that perhaps most distinguish the organization from other hospitals in the region are research and teaching. These components stem from the hospital’s role in the overarching Upstate Medical University. Academic medical universities like Upstate include a medical school and a research enterprise as part of their core mission, along with patient care.

Every research project at Upstate is focused on finding cures and improving human health. Current research initiatives and projects include tumor cell invasion and immunotherapy for treating cancer, exploring the genetic bases of neurological and psychiatric disorders, and utilizing AI and machine learning for advancements in pathology diagnoses. Patients benefit from access to clinical trials, and every patient at the Upstate Cancer Center is assessed for their potential to participate in a clinical trial.

Focusing on education, Upstate’s role as a teaching hospital ranges from faculty educating third- and fourth year students on their clerkship rotations, to medical residents and fellows arriving for their training, to offering continuing medical education and grand rounds that are open to area physicians.

Agility In Recruitment In Health Settings

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BY KATHRYN RUSCITTO, ADVISOR

During Covid I watched a hospital in Florida implement a variety of new positions based on specific tasks. From the basic welcome to a room with detailed instructions done by a patient tech to a full assessment being done remotely by a nurse.. The goal being to reduce clinical time at the bedside from tasks that paraprofessionals and professionals could accomplish rather than the bedside nurse. It worked well.

More recently some hospitals are using remote Nurses to support community based nurses. Access to experts in Diabetes, Wound Care and cardiac care are active across the country. When done with care and training, it gives nurses specialized back up they might not have immediate access to on a local level. 

Agility during times of workforce stress is working for many organizations. Placing an emphasis on innovation is key for health leaders. The strategic issues confronting healthcare feed into the workforce shortages.

Rising costs, lower reimbursements, financial
implications from value based care, cybersecurity, and introduction of new technologies like AI are all contributing to high turnover rates.

Many health care employers are opening new points of access for existing employees to increase education and training . In addition they are working with community colleges and job transition programs as people see layoffs in other areas to transition to health training programs. From military transitions, to immigrants these recruitment paths are helping.

Recently I met an Administrator, Rosemarie Tamunday- Casanova, from Right Accord, who has recruited nurses from the Philippines. We discussed that foreign born recruitment has and is being done primarily in acute settings. We pondered whether surgery centers and private offices might also be an option for these nurses.

Finally, the use of AI and digital strategies to reach broader audiences and make your organization known is essential in recruitment. There is no question that agility in essential in and professionals recruitment. There are successes and best practices evolving if we are open to their adoption.

Background:
https://www.hhs.gov/health are/workforce/recruit- train retain/index.html#get-grant

https://www.aha.org/aha center-health-innovation- market-scan/2022-12-06 how-build-yourfuture-workforce-pipeline

https://magazine.hcahealthc re.com/people/career- and development/creating workforce-solutions- and-advancing-healthcare professionals/

https://www.nga.org/public tions/preparing- the-next generation-of-the-healthcare workforce-state-strategies-for-recruitment-and-retention/

https://www.kornferry.com/ bout-us/events-webinars/talent-acquisition-trends-2025

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

Help Me… HELP YOU.

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by Jenn Negley, Vice President, Risk Strategies Company

Throughout my career, I have often had those thoughts in my head while trying to assist medical groups or individual physicians resistant to working with an agent or broker. While some skepticism is warranted, and we acknowledge that any industry has both positive and negative aspects, there are specific factors to consider in medical malpractice insurance that can increase the likelihood of achieving positive results. How can you determine the professionalism of an agent you are working with, such as myself, and help us assist you effectively?

Several factors should be considered, starting with an individual’s approach and the carrier and policy solutions they recommend. In most instances, these factors have significant consequences and can help you determine if this is an individual you should work with.

Malpractice insurance is a highly specialized market with significant financial implications. If you have an agent pitching you other coverages and adding malpractice insurance at the last minute, I would be wary. Sticking with someone who focuses on medical malpractice insurance is always best; not only will you benefit from their knowledge, but it often impacts the carriers they have access to, which leads us to the second item to keep an eye out for. If an agent is pushing one carrier, this is always a red flag. The most qualified agent should be able to provide you with multiple alternatives, giving you a nonbiased view of what is available. Another consideration is whether the carrier has an A rating from A.M. Best. In the insurance world, it is advisable to avoid lesser-rated companies, and I would not rely on ratings from any rating agency other than A.M. Best, which is the gold standard.

The type of policy an agent pushes might also be a cause for concern. If an agent is asking you to change your coverage type from occurrence to claims made to save money, they are doing you a disservice. While this will generate savings in the first 2 to 3 years, the scheduled premium increases will bring you back to your original cost and possibly more. In group settings, you will often have to amend employment contracts to address who is responsible for tail costs when a provider leaves your group. If your practice ever sells, most buyers will likely require you to purchase a tail for the entire group, and the cost can range from 100% to 200% of your current premium.

When working with a specialty broker, you also gain the advantage of a service team that knows how to navigate the processes for each carrier because of the volume of business they place. With that volume, you typically have a dedicated underwriting team that builds strong relationships, allowing for more collaborative efforts to provide solutions that would not usually be available. In competitive markets, this could result in increased savings, and in a challenging market, it could limit rate increases. Don’t be fooled into assuming that large-name brokerages are the best solutions. Typically, it comes down to the volume that a particular office does, not what the brokerage does as a whole, and again circles back to the question of whether they specialize in this coverage. 

We are all too aware of the financial stress healthcare is under. Still, there are professionals readily available to serve as an honest partner in alleviating those pressures in a way that protects your longterm security and meets your needs. I hope these market insights, in a small way, help you in your future endeavors. r practice, and your patients, depend on it. 

For more information, please contact Jenn Negley, Vice President, Risk Strategies Company at 267-251-2233 or JNegley@ Risk Strategies.com.

Dr. Hadley Narins Fills a Gap in Patient Care with a Focus on Quality of Life

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By Bari Faye Dean

Hadley Narins, M.D., never set out to become a specialist in  female urology, but as she progressed through her medical training, she saw a significant gap in care. “Nearly 50 percent of the patients coming in were women, yet so few urologists were specializing in female pelvic health,” the board-certified, fellowship trained urologist said. When she was a medical student, she didn’t see any women residents in urology, making the field feel male-dominated. But instead of being deterred, she found an opportunity to make a difference.

Although she initially considered a focus on general urology and cancer, her experiences in training opened her eyes to the pressing need for female pelvic health specialists. “Few men want to focus on female urology,” she explains. “Most gravitate toward prostate and kidney cancer.”

Dr. Narins earned her medical degree from Thomas Jefferson Medical College in Philadelphia, then completed a General Surgery internship and Urology Residency at SUNY Buffalo, finishing in 2017.

Practicing since 2018 at Associated Medical Professionals of New York, Dr. Narins specializes in treating women suffering from voiding dysfunction and pelvic organ prolapse and reconstructive surgery with minimally invasive techniques, including robotic sacrocolpopexy.

Transforming Lives, One Surgery at a Time
Urologic surgeries for women might not be lifesaving—but they are life-changing. “The most rewarding part of my job is meeting with a patient post operatively and seeing how happy they are,” Dr. Narins said. “Many experience almost immediate relief.”

Her practice serves a vast region, extending from the Canadian border to the rural areas of Central New York. “There is a huge need for specialists like me in Syracuse,” she said. “We all need to clone ourselves two or three times to meet the demand, especially as the Baby Boomer generation ages.”

While many of her patients are women who have had children, some experience significant pelvic floor disorders despite never giving birth. In addition to primary surgeries, she performs revision surgeries for patients who have experienced recurrence or complications following prior treatments. She conducts robotic surgeries at Crouse Hospital, where she played a key role in developing the Female Urology and Pelvic Reconstruction program. Routinely, she performs many procedures at Intrepid Lane Ambulatory Surgery Center, the facility owned by her practice.

A Patient-Centered Approach
Dr. Narins prioritizes building relationships with her patients. “I want to take care of them clinically, but I also want to know who they are as people,” she said. “What’s important to them? What is their family life like? I genuinely care about my patients and want them to feel heard and valued.”

Her team includes a physician assistant, nurse practitioner and dedicated nurse, ensuring patients receive comprehensive, evidencebased care. “We stay up to date with the latest literature and make sure our patients not only get the best clinical outcome but also feel supported throughout their journey.”

Life Beyond the Operating Room
Outside of work, Dr. Narins leads a full life with her husband and three children, ages 8, 5 and 2. Married in 2016, she credits her husband —a stay-at-home dad—with keeping their household running smoothly. “He does all the cooking,” she said, laughing.

Gardening is her sanctuary. “Work is work. I get a lot of gratification from it, but it’s stressful. When I’m in my garden, I’m physically working hard, but my mind is in a calm, contemplative state,” she said, noting she even starts her  mornings in the garden before heading to surgery.

Her family grows tomatoes, cucumbers, green beans, eggplant, okra, Swiss chard, and squash, with the children eagerly picking their favorites to eat raw. “They can identify so many different flowers,” Dr. Narins said. “When the weather is nice, I come home from work, change out of my scrubs, and we stay outside until the mosquitoes come out.”

Many of her patients are gardeners, too, allowing her to foster an unexpected but meaningful connection. “It’s a common passion. When I talk to my patients, I see them as people, not just cases. And I think that makes a difference.”

Certificate Of Need Coming For Private Equity?

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By: Marc Beckman and Ben Goldberg

New York State is poised for a significant shift in healthcare oversight with the amendments to the state’s Disclosure of Material Transactions law proposed in Governor Kathy Hochul’s FY 2026 Executive Budget. Previously, with the introduction of PHL Article 45- A, which took effect on August 1, 2023, the New York State Department of Health (“DOH”) was authorized to scrutinize healthcare transactions taking place in New York State. These legislative changes are designed to further regulatory scrutiny over healthcare transactions, aiming to curb rising costs and ensure market stability.

Governor Hochul’s proposed legislation introduces the Cost Market Impact Review (“CMIR”), a framework modeled after similar regulatory mechanisms in states like Massachusetts. The CMIR would empower state regulators to assess healthcare transactions, particularly those involving consolidations, mergers, and acquisitions, to evaluate their potential impact on cost, access, and competition. One change that should be immediately noted is the extension of the required notice of a “material transaction” provided to DOH, which was 30 days under the PHL Article 45- A, and would be increased to 60 days.

Among the components of the CMIR are pre-transaction review, assessment of market impacts, and enforcement measures. During the pre transaction review, healthcare entities engaging in significant transactions will be required to submit documentation for state review. If the “material transaction” will increase a healthcare entity’s gross in state revenue by $25 million or more, notice will have to be provided to the New York State Department of Health (“DOH”) and documentation submitted to the DOH for review. Material transactions include but are not limited to mergers, acquisitions, assignments, sales, other conveyances of assets, voting securities, and membership or partnership interests. It is also important to note that material transactions include contracts, if they increase the revenue by $25 million or more, and entities like managed services organizations that provide administrative services to healthcare entities, even if they don’t provide healthcare services themselves. The $25 million will be based on a 12 month lookback period. This is somewhat straightforward if the transaction is a single transaction. However, should there be a series of related transactions, the revenues associated with each of the transactions will be added together to determine the total impact on New York’s healthcare markets.

Since the intent of the review is to analyze whether a proposed transaction could lead to increased prices, reduced competition, or diminished healthcare access, the notice given to New York’s DOH will include, among other things:

• the names of the parties conducting the transaction and their current addresses,

• copies of any definitive agreements governing the terms of the material transaction, including pre- and post-closing conditions, in-state revenue from practice or operating locations in New York,

• plans to reduce or eliminate services and/or participation in specific plan networks,

• a brief description of the nature and purpose of the proposed transaction

• the anticipated impact of the material transaction on cost quality, access, health equity, and competition in the market locations where the transaction is taking place.

When a transaction is found to have negative cost or market implications, regulators may impose conditions or even prevent the transaction from proceeding.

Key Proposed Amendments Include:

Lowered Reporting Thresholds:
More transactions subject to mandatory disclosure, ensuring greater regulatory oversight.

Expanded Scope: Nonprofit and for-profit healthcare entities, including physician groups and private equity backed organizations, will face increased scrutiny.

Stronger Enforcement Mechanisms:
The state may impose penalties for non-compliance and require additional corrective actions from healthcare organizations.

Potential Impact on Healthcare Providers and Patients
The implementation of PHL Article 45-A and the proposed amendments to the Disclosure  of Material Transactions law could significantly reshape the healthcare landscape in New York State. Providers facing increased regulatory oversight may slow down consolidation efforts, leading to more rigorous due diligence before executing transactions. While enhanced scrutiny could help prevent monopolistic practices and cost increases, among the concerns for patients is that providers may delay or abandon transactions that could improve healthcare access and efficiency.

With heightened scrutiny regarding these transactions, private equity firms and large health systems may face more barriers to market entry and expansion, altering investment strategies in the state’s healthcare sector. Reading the changes to the Disclosure of Material Transactions law generously, it appears the intent behind Hochul’s proposed regulatory reforms is to ensure healthcare transactions do not compromise affordability, access, or market competitiveness. While these measures align with broader national efforts to curb healthcare costs, their implementation will require careful balancing to prevent unintended consequences.

Stakeholders in the healthcare industry should prepare for increased regulatory compliance obligations. As with similar frameworks used to analyze business transactions—such as antitrust statutes and certificate-of-need applications—it is uncertain how forcefully New York will enforce these new CMIR assessments if they are passed by the legislature. Furthermore, it remains unclear what appetite the DOH will have for prohibiting or limiting such transactions.

However, whether or not the DOH takes an aggressive stance if Governor Hochul’s proposals become law, healthcare entities will still need to comply with the submission of notice and the concomitant documents to DOH and should prepare accordingly.

If you have questions pertaining to the proposed legislation and how it may impact you, please reach out to Marc S. Beckman (mbeckman@lippes.com), Benjamin W. Goldberg (bgoldberg@ lippes.com) or a member of the Lippes Mathias Health Care Practice Team.

Nephrology Associates Of Syracuse, PC:Remaining Dedicated to Superior Kidney Carein a Dynamic Medical Landscape

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By: Elizabeth Landry

In the post-Covid-19 pandemic world, healthcare continues to evolve with new challenges and innovations alike. Nephrology Associates of Syracuse, PC (NAS) has been on the forefront of the treatment and management of kidney disease in Central New York for more than 45 years and remains dedicated to addressing challenges in healthcare head on while also utilizing the latest in medical technology.

At the practice’s main office located on Buckley Road in Syracuse and at several satellite offices located in nearby communities, NAS offers access to high-quality, specialized kidney care when 

patients are referred by their primary care provider. The office’s five dedicated physician owners and seven advanced practitioners are all experts in the field of kidney care, working with patients one-on-one to deliver 

personalized care for each individual. The team also provides hospital care at Crouse Hospital and St. Joseph’s Hospital Health Center in Syracuse, offers hemodialysis care at six locations in Onondaga County, and facilitates home hemodialysis and peritoneal dialysis at the DaVita and Fresenius Dialysis home/PD centers.

The team at NAS works collaboratively to ensure patients receive superior nephrology care, while actively participating in programs and medical enhancements that make managing kidney disease more efficient for patients, help lower overall costs, and that are aimed at decreasing hospitalizations. Although keeping all factors in balance can be a challenge, the NAS team is confidently rising to the occasion and continues to demonstrate a strong commitment to excellence in the field of kidney care.

CATCHING KIDNEY DISEASE – Early is Critical

For many years, NAS has worked to educate patients about kidney disease – in fact, the practice’s vision statement specifically includes “efforts to increase awareness and early detection.” Kidney disease is often described as a “silent killer” and many of the physical symptoms of the disease aren’t recognized by the general population until the disease has severely progressed, unfortunately, as nephrologist Philip Ondocin, MD, who joined the practice in 2002, explained.

“Patients won’t know they have kidney disease unless their blood or urine is checked,” Dr. Ondocin said. “Oftentimes, people just equate kidney function with urine output. Patients will tell us they’re making a lot of urine, but even still they may not be clearing toxins. So, it’s only through a physician or provider visit with blood work and urine tests that we can identify how well the kidneys are functioning. Kidney disease is largely asymptomatic until it’s very late, so people need to be screened.”

Along with screening for kidney function, primary care referrals to NAS are also imperative in catching kidney disease before it progresses. The NAS providers have strong relationships with local referring physicians and providers, and they encourage all patients who have learned of a potential risk for kidney disease to heed new-patient referrals and not delay meeting with a nephrologist to determine an individualized kidney care plan.

To make the referral process more efficient and help ensure new patients can be seen as soon as possible, NAS has partnered with Phreesia, a vendor partner, which provides an online dedicated new patient referral toll-free fax line and online new referral submission form. NAS nephrologist Antoine Azar, MD, who’s been with the practice since 2016, described how these tools that help streamline new referrals are complemented by the strong communication between office staff and providers to help ensure patients are seen in a timely manner and with urgency that matches the severity of their kidney health concerns.

“Phreesia is a tool that helps with rapid review of new referrals, but our front office staff is also educated about knowing when to check with providers if they notice something is off with the referral,” explained Dr. Azar. “They know that if they see a referral with higher creatinine, which means worse kidney function, they need to check with a physician. Every day in the office there’s a physician available they can confer with. We always try to risk stratify the referrals, so for more stable patients we can usually see them within a few weeks, but for more urgent referrals we can usually see patients within a week.”

Dr. Azar added that the practice is also careful not to accept referrals for patients who don’t currently need to be seen by a nephrologist. “Sometimes we’ll find that a patient may need to be seen by a urologist or a vascular surgeon instead, so in those cases we’re honest with the patient that they were referred to us by mistake. We try to avoid unnecessary referrals in order to save patients time and money, and we make sure to communicate back to their primary care office, so they understand, too,” he said.

VALUE-BASED CARE FOR INCREASED QUALITY AND COST-SAVINGS

One of the biggest challenges facing all physicians who provide care to Medicare and Medicare Advantage patients, in both primary care and specialty care, is the continued decline of the Medicare Physician Fee Schedule.

In looking at data from 2013 – 2023, the Consumer Price Index increased by 29.3% from 2013 to 2023. Inflation adjusted, per-visit Medicare Physician Fee Schedule payments decreased by 12.2% for outpatient office visits and 19.1% for inpatient visits from 2013 to 2023. Adjusted for inflation, national health expenditures increased by 33.9% for physician services from 2013 to 2021. In comparison, Medicare Physician Fee Schedule payments over the same time period, 2013 to 2021, increased by 1.3% for outpatient office visits but decreased by 10.6% for inpatient visits.1 Dr. Ondocin highlighted how the practice works together to face this challenge, which often leads to rising expenses for operations, clinical supplies and more.

“The Medicare fee schedule changes every year and there’s not much we can do about that. Some physician groups like the American Medical Association lobby for adjustments, but it’s really out of our control. Anne Zaccheo, our practice director, is very good at making sure our office runs as lean as possible, which helps sustain our practice considering these challenges. We’re also fortunate to stay in private practice because we’re autonomous and we can care for patients the way we prefer. We still do 20-minute follow up visits and onehour consultations. So, we feel we can maintain the quality of our practice even with the challenges,” stated Dr. Ondocin.

Another way the practice aims to save on costs while still providing high-quality health care to patients is by engaging in several value-based care (VBC) initiatives. NAS has contracted with both KidneyLink and Excellus BlueCross BlueShield REACH Kidney Care, two VBC offerings which seek to prevent unplanned trips to emergency departments and hospitals. While KidneyLink is for patients with traditional Medicare Part B who have stage 4 or 5 chronic kidney disease and those on dialysis, REACH is for Excellus members in Medicare, Medicaid, commercial and those self-insured employers who opt to include the program in their annual benefit offerings.

“These programs focus on patients with advanced kidney disease,”
said Dr. Azar. “So, mainly patients with less than 30% kidney function. We focus on trying to delay progression, delay starting dialysis and delay hospitalizations, which are ways to help save on costs down the road while also ensuring we maintain great care for our patients.”

CONTINUING PROVEN CARE STRATEGIES

Although the practice strives to help patients avoid acute kidney concerns, hospitalizations due to kidney injury and disease do occur. NAS is continuing to prioritize timely, thorough care after a hospitalization, which, as Dr. Azar explained, can help prevent rehospitalizations. 

“Care after a hospitalization is very, very important,” he said. “A lot of patients get discharged with medication changes and instruction changes, but they’re so sick at the time and overwhelmed, they don’t follow through. We try to get every one of our patients who end up in the hospital to come and see us within a week, or a maximum of two weeks, after discharge so we can take their blood pressure, see how they’re doing, check their medications, make sure their labs are steady and make sure their kidneys are tolerating any new medications. There are a lot of cases where we catch something a little earlier and have prevented re hospitalization.” 

Another program NAS is  continuing to offer is Chronic Care Management, also known as Connected Care. Designed to support patients with two or more chronic, life-threatening diseases, this program involves monthly care support through a personalized care manager who reviews medications with patients, makes sure they’re getting their medications refilled, talks to them about weight gain, and much more. Dr. Ondocin shared that the program “is great – it’s kind of like an extension of our practice. All the gathered information is incorporated directly into our electronic health record.”

NEW ADVANCEMENTS TO SUPPORT KIDNEY HEALTH

In addition to continuing these proven programs, the team at NAS is always staying informed on the latest research and innovations in the field of nephrology, such as increased access to home dialysis for patients with acute kidney injury, kidney regeneration technology and policy changes aimed at expanding living donor support for kidney transplants. The practice plans to roll out a new initiative this year called remote patient monitoring (RPM), which provides physicians with real- time, in-home blood pressure and weight status, saving valuable time for patients and physicians alike and helping to prevent emergencies and hospitalizations.

“In nephrology, we manage a lot of hypertension. RPM is the gold standard for managing hypertension in patients,” said Dr. Ondocin. “The blood pressures and weights will be stored with AccuHealth, a new vendor partner, and then shared with us in our electronic health record. So, we’ll actually have real-time home monitoring data for these patients, and we’ll have access to more data points so we can better manage our patients with hypertension.”

While these new ways of managing risk factors and  supporting kidney health are exciting, the team at NAS continues to emphasize screening for kidney health concerns and caring for overall health as the primary ways to 

prevent or slow down the progression of kidney disease. The National Kidney Foundation recommends regular screenings, following a healthy diet, focusing on hydration, taking medications  as directed, managing stress, and exercising as ways that individuals can support their kidney health.

Similarly, for the NAS team, supporting kidney health all comes back to awareness, education, and proactive care.

“We try to educate folks about early detection and prevention of kidney disease, including our referring physicians,” said Dr. Ondocin. “We really try to educate people as much as possible about what their level of kidney dysfunction is, what to look out for, what labs to follow – how to most help themselves. That’s our thing, we just try to keep our patients healthy.” 

1https://pubmed.ncbi.nlm.nih. gov/38262816/

To refer patients to Nephrology Associates of Syracuse, P.C. in Syracuse or a satellite location, visit nephrologysyracuse.com/ contact or call 315-478-3311.

Reset With Nature

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BY KATHRYN RUSCITTO, ADVISOR

It is easy to get stressed from a variety of things.

Sometimes all it takes to reset is by engaging the outdoors. In, “The Fundamentals of Environmental Neurosciences,” is a summary of current research that looks at the relationship between people and their environments. The premise is that urban design must take into account the importance of green space and its impact on the mind and body.

It doesn’t matter where I am when I share that I live part of the time in the Adirondacks, immediately people smile and often share a story of the Adirondacks from their childhood. Recently a customer service agent in another state started singing the jingle from the waterpark in Old Forge over the phone!

A drive to the Adirondacks can reduce anxiety, improve health, mental health, creativity and inspire new ideas.

I am hoping to plant some seeds for a day or an overnight in nature for you and your family.

Wherever you are in eastern or western, New York State, you are close to the most amazing natural resource, the Adirondack Park.

The drive to the Park pulls in views that are soothing and beautiful. A winter visit with a warm fireplace and a great dinner improves sleep and the ability to manage stress. A summer visit and kayak or swim in the many beautiful lakes and rivers, adds to reducing stress during busy office practice months. It might not be possible to take a long vacation, but planning some reset breaks adds to your health.

It requires focus on creating the time on your calendar and some research to decide where. When our daughter was young we called these exploration days, no work, just family time to do something new. Often we chose Adirondack locations such as Moss Lake, Cascade Mountain, Saranac Lake or our favorite, Hemlock Hall. No tv, electronics or cell service. Just peace and quiet.

It’s not just about hiking, although there are some of the best trails anyplace in the US. From Old Forge to Inlet to Long Lake to Saranac, Elizabethtown and Lake George. Unique villages, great small libraries and excellent restaurants. Fishing, biking,camping, or just communing with nature can lead to a healthier sense of well-being.

Here are resources to help your planning!

Resources:
The Adirondacks Drives: https://visitadirondacks.com what-todo/ scenic-drives-byways

Views: https://visitadirondacks.com/

Events:
Saranac Lake WInter Carnival
Old Forge Winter Carnival
Raquette Lake Winter CarnivalFrozen Fire
and Lights, Inlet
Wild Lights at the Wild Center

More at https://www.iloveny.com/search/?q=Adirondacks

Restaurants by region
https://www.adirondack.net/ estaurants/all/

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