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Working Together to Fight Seasonal Influenza

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As healthcare providers, we must champion effective strategies to fight influenza as it remains a public health concern. Together, we can help mitigate the impact of the flu, which includes prevention, early diagnosis, antiviral treatment, and patient education.

Prevention:
The First Line of Defense

Vaccination remains the most effective way to reduce the incidence of influenza. The Centers for Disease Control and Prevention emphasizes annual flu vaccinations for everyone six months and older, particularly high-risk groups such as the elderly, children, pregnant women, and those with chronic conditions like asthma, diabetes, and cardiovascular disease.

• Vaccination:
Encourage patients to get vaccinated early in the flu season, ideally before the end of October. Even if the vaccine doesn’t completely prevent infection, it can significantly reduce the severity of illness and risk of complications.

• Hygiene Practices:
Advise patients to practice good hygiene—handwashing with soap and water, using hand sanitizers, covering coughs and sneezes with a tissue, and avoiding close contact with sick individuals.

• Masks and Social Distancing:
Recommend mask-wearing and maintaining social distance in crowded areas. Early Diagnosis and Symptom Management Early recognition of symptoms can mitigate the severity of the illness and limit spread to others. Influenza often presents fever, chills, cough, sore throat, muscle aches, fatigue, and headaches. Because other viral infections, like COVID-19 and RSV, may share similar symptoms, rapid diagnostic tests (e.g., molecular assays or antigen tests) can help distinguish influenza from other respiratory illnesses and guide treatment decisions.

• Differential Diagnosis:
Not all respiratory infections are influenza, and testing can help differentiate between viral causes. PCRbased tests and rapid antigen tests remain essential in confirming the diagnosis.

•Symptom Management:
Recommend hydration, rest, and over-the-counter medications (e.g., acetaminophen or ibuprofen) to manage fever and aches. Remind patients not to give aspirin to children due to the risk of Reye’s syndrome.

• Antiviral Treatment:
Antiviral drugs, when started  early (within 48 hours of symptom onset), can reduce severity and duration of flu symptoms. Oseltamivir (Tamiflu®), zanamivir (Relenza®), and baloxavir marboxil (Xofluza®) are FDA approved antivirals that can be used to treat uncomplicated flu, especially in patients at high risk of complications.

• Indications for Antivirals:
Consider antiviral treatment for patients with severe symptoms, underlying health conditions, or those who are immunocompromised. It is especially important in preventing complications such as pneumonia, hospitalization, and death.

• Early Intervention:
The key to effective antiviral use is early intervention. Educate patients that starting antivirals within 48 hours of symptom onset provides the best outcomes. Delayed treatment may offer limited benefit.

Patient Education:
Empowering Communities Educating patients about flu prevention, recognition, and treatment is crucial. Ensure patients are aware of the importance of vaccination, early treatment, and seeking care if they experience complications such as difficulty breathing, chest pain, or worsening symptoms.

• Community Outreach:
Consider hosting flu vaccine clinics, providing informational materials, and using social media platforms to encourage vaccination and proper hygiene practices.

• Addressing Vaccine Hesitancy:
Engage in open discussions with patients about their concerns regarding the flu vaccine. Provide evidence based information on vaccine safety and efficacy to dispel myths and misinformation. Monitoring and Surveillance Stay informed on flu activity in your region through resources like the Centers for Disease Control and Prevention and World Health Organization. Monitoring trends can help you anticipate outbreaks, implement preventive measures in your practice, and allocate resources appropriately. By staying proactive in our approach to flu prevention, diagnosis, and treatment, we can reduce the burden on our patients and healthcare systems.

Fighting For Physicians: Members of County and State Medical Societies Benefit From A Collective Voice in Albany

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By: Molly English-Bowers

A practicing plastic surgeon for 36 years, Malcolm Roth, MD, has spent the last 25 years volunteering in the name of patient care, equitable treatment for physicians, and ways for those physicians to thrive. His commitment to advocacy for physicians in the Capital District led Roth to leadership roles in a number of physician groups, including the American Society of Plastic Surgeons, the New York Society of Plastic Surgeons, the New York Society for Surgery of the Hand, and the New York County Medical Society. He currently is in the last year of a two-year term as president of the Medical Society of Albany County.

“I got involved because we all need to be able to continue to practice, to do what we feel our mission is, which is to take care of people,” Roth said. “And if we can’t afford to keep the doors open, we can’t afford to do that. One way to take care of people is to speak to legislators and try to advocate for a climate that allows us to take care of our  patients.”

The Albany County Medical Society is one of 54 such groups in New York State; county-level members automatically are enrolled in the Medical Society of the State of New York as well as the American Medical Association. These collectives represent all physicians—whether in a solo practice, part of a small group, working in a “super group,” employed by a hospital or those in academia.

“I think it’s really important for our patients that physicians are advocates to make certain that our legislators not pass legislation that would hinder access to quality care and also to maintain legislation that protects patients and physicians,” Roth said.

As Roth tells it, when he was in his third year of medical school in 1980, he grew tired of hearing practicing physicians complaining about issues that negatively affected their ability to do their jobs.

At that time, the malpractice crisis was in full swing, and that carried with it the very real possibility that physicians couldn’t afford to work in New York.

“It was the Sword of Damocles hanging over the head of every physician in New York State,” Roth said. 

“I spoke up to them and said they need to go to Albany and complain to the Legislature if they wanted to get something done.

Unfortunately, the answer I got then and I still get now is, ‘I’m too busy.’

“And so, the reality is there are not enough physicians who are willing to take time off whether it’s once a year to go to Albany or to Washington, or once a week. It could be after work to speak to a local politician to tell them how they’re having a hard time because of legislation that’s weighing down on them, that’s making it difficult for all of us. It comes down to the bottom line.”

Practicing physicians are business people and if the cost of staying in business becomes burdensome, the business could shutter. “It’s very unusual that somebody says to themselves, ‘I want to make a lot of money so I’m going to be a physician.’ What they say is that they want to take care of people. And one way to take care of people is to speak to legislators and try to advocate for a climate that allows us to take care of our patients and not worry about a lawyer coming to sue us,” Roth said.

Medical Society of the State of New York

When a physician joins their county medical society, they automatically become a member of the Medical Society of the State of New York (MSSNY). With main offices in Albany, MSSNY has ready access to state government, including the Legislature and governor. Jerome Cohen, MD, is the president of the society.

“MSSNY provides a collective voice for physicians,” Cohen said. “We have a common legislative agenda and advocacy on issues that are important to our members. The Medical Society is a large group, numbering 16,500 physicians, and as such we are more effective than what an individual can do on their own.”

In addition to being the political agent for New York’s physicians, MSSNY also provides the advantage of anonymity for physicians to present problems without fearing retribution from insurance companies or employers, as well as leadership development, member benefits, physician wellness, payer relations, and education.

“MSSNY has been around since 1807,” said Cohen. “Obviously, things have changed over the past several centuries and the Medical Society has changed with that. When the society was first formed it was exclusively a men’s club, women were not in medical practice. With women in medical practice, priorities change and MSSNY has welcomed women into the leadership fold.”

Advocacy
Meeting several times a year, MSSNY’s Legislative and Physician Advocacy Committee determines legislative priorities from policies adopted at the House of Delegates, which convenes every April; officer elections occur at the same time. “The Legislative Committee determines our priorities, the issues we should be focusing on,” said Morris M. Auster, Esq., senior vice president and chief legislative counsel for MSSNY.

“Historically, they have been about advancing the ability of patients to receive needed care in a timely manner, and that takes a number of different forms,” he added. “It can be the timing of payments by insurance companies, reducing or eliminating health insurer hassles such as pre-authorizations, having to respond to a million different records requests, public health concerns such as immunizations. We also have been working to try to get liability insurance costs reduced because in New York we have some of the highest insurance costs in the country.”

Part of the job of Thomas Lee, MD, MBA, executive vice president of MSSNY, is to explore and improve member benefits. “One of the greatest benefits to members, and by extension non-members, is we help pass laws and improve regulations that benefit all physicians and patients,” he said.

“For example, the society has opposed excess liabilities expansion because liability is a cost, it’s an insurance premium physicians pay into. When there’s increasing liability that will cost physicians and their employers more money and that takes money out of the healthcare system for patient care. As a result, we save a physician $25,000- $30,000, on average, a year in premium costs alone.” That savings more than pays for the annual MSSNY membership fee of $460.

In addition, MSSNY facilitates a number of committees and subcommittees devoted to specific issues physicians may face. Counted among those are: Employed Physicians, Physician Wellness and Resilience, Scope of Practice, Legislation and Physician Advocacy, and Public Health.

MSSNY has developed the Grassroot Action Center for physicians to send letters to their legislators. “We give them a starting point and they can then customize it,” said Auster. “We also have templates for op-eds or letters to the editor. We try to give physicians tools to help them write and get pieces in the local media to educate the public about a particular piece of legislation that might be helpful to patient care or call attention to one that might be harmful to patient care.”

Leadership Development
Members,
new and existing, are urged to volunteer for committees and attend advocacy activities, and to write letters and make calls to their legislators. “As people volunteer, we see who is stepping up and we encourage that,” said Cohen. “Once we identify those who are volunteering and stepping up, we encourage them to become leaders at the state level.” But members aren’t joining MSSNY in a vacuum; mentors stand at the ready should they need assistance.

“We assign mentors to those who are new to leadership, and there is a parallel system at the county level.” That mentoring occurs in the Office of the President as well. “We have three people in that office,” Cohen said, “the past president, the current president, and the future president. The past president is mentoring the current president who then mentors the future president so there is continuity at that level.” Presidential terms last one year, and with three physicians in the Office of the President, it’s a three year commitment.

To help meet the needs of women, this past year, MSSNY established a Women’s Leadership Academy, designed to foster female leadership within the organization. MSSNY now spends time on issues of work/life balance and practicing medicine while also raising a family.

Physician Wellness
Working as a doctor brings with it enormous stresses, with burnout sometimes being the ultimate result. MSSNY designed a Peer-to Peer program to ease some of the anxiety. Callers into the program–medical students, residents, and fellows, as well as attending physicians in 17 specialtie are paired with peers of similar circumstance to work through issues.

“It is not a formal counseling program,” noted Lee, “but is really to share experiences and get some personal guidance to the caller. The problems identified could be personal, economic, practice or  administrative. This is a confidential program, and we destroy the files after the encounter is closed.”

Should the caller need more intensive help, MSSNY runs a Physician Health Program that deals with substance use disorders and significant psychiatric disorders. “A referral can be made confidentially and if the caller opts to participate that’s also confidential,” Lee said.

“I can’t think of a single reason why a physician should not enroll in a collective that is advocating for him or her,” said Lee. “We’re there to advocate for physicians and patients, and it is also our job to provide an environment which welcomes more physicians who want to practice in New York. Our friends in the government and regulatory world and insurance industry need to recognize that: By improving the work environment for physicians, you’re going to have a robust workforce to take care of patients.”

Education
Physicians always need to meet required educational hours and MSSNY can help. It offers free access 24/7 to online continuing medical education courses. Other opportunities for learning include mandatory courses on controlled substance prescribing and infection control. MSSNY also credentials and co-sponsors CME programs for healthcare institutions and county medical societies.

Member Benefits
Daily and weekly newsletters keep physicians up to date on healthcare issues of the day. Through its business partners, MSSNY offers discounted products on life and disability insurance and an exclusive 10 percent discount on medical liability insurance premiums. Other unique member benefits include investment products such as an exclusive Physicians Life Income Plan, which provides tax advantaged current income and asset protection. An attractive higher education loan program for physicians and their families is available for initial borrowing and refinancing. Additionally, individual and group health insurance options are available for practicing physicians, their families, and employees. “We continue to interview business partners regularly to assess and expand our benefits program,” said Lee.

Payer Relations

MSSNY’s expertise helps physicians optimize revenue through resolution of claims, takebacks, and billing issues, and assists members in navigating healthcare regulations. A frequent cause of physicianstress and burnout are administrative burdens imposed by federal and state governments,” Lee said.

If a physician is employed by a healthcare institution, he or she must comply with additional administrative and documentation requirements. “Many physicians have to document after their regular work hours by accessing the system remotely,” Lee said. “Further administrative burdens include prior authorization requirements and responding to document requests. These all significantly compound a physician’s workload. Even with clerical help, at the end of the day it falls on the physicians.”

Medical Society of Albany County
Even though MSSNY serves as the conduit between county societies and state government, the Albany County group can at any time call an executive committee to discuss and decide upon an issue.

“That has always been the focus on the county,” said Jonathan Dougherty, executive vice president of the Medical Society of Albany County. “If there’s an issue that comes up, we form a subcommittee for the life of the issue.” The group, which numbers 400 members, also holds legislative retreats twice a year, one in the Catskills and the other in the Adirondack village of Lake Placid.

Furthermore, if there is an issue that needs state or even federal legislative attention, those can start with the county as well. “Individual physicians or counties can prepare resolutions that are introduced to the House of Delegates,” Dougherty said.

“If those resolutions pass the House of Delegates, lobbyists place them into legislative recommendations or oppositions. Then MSSNY gets legislative sponsors one in the state Assembly and one in the Senate. Or the resolution gets referred to the AMA so it can get introduced into Congress.”

While doctors can choose to join their county society, Dougherty encourages membership for many reasons, chief among them the advocacy that takes place at the Capitol. There is strength in numbers–more membership dues means more lobbyists employed to further physicians’ issues in the state Legislature.

“It’s important to note that what happens on the state level affects us at the county, and vice-versa,” said Dougherty. “Just because doctors may not want to participate is not going to stop the trial lawyers, it’s not going to stop the community action groups or the allied health professionals. They’re going to sink every proposed legislation they can.

“Doctors are individualists and a lot of them don’t understand how important advocacy is. We’ve got to have resources to be able to protect them. Doctors need advocacy. They need support.” 

For more information on the Medical Society of the State of New York, visit mssny.org or call (518) 465 8085. You can reach the Medical Society of Albany and Ulster County at albmed.org or by calling (518) 439-0626.

Serving on a Board

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By Kathryn Ruscitto, Advisor

Throughout my career I have served on a variety of Not for Profit Boards. It’s a way to serve the community, open doors, connect people and causes, and to learn Boards can help you to build new skills, connect with new parts of the community, begin to plan for things you want to do in your free time or in retirement. Good Board members want to learn and aren’t afraid to ask questions. Recently I was at the View Arts Center in Old Forge and met a new surgeon who had moved to Syracuse. She had taken the time to explore not for profit arts organizations in the region and was visiting them to get to know the region.

Boards function differently, and expectations of Board members can vary. It really is important to think through why you are joining a Board and what your expectations are for that service.

Some simple guidelines should always be part of a Board members thinking: What is expected of me: time, donations, terms of service.

What do I expect from the organization: following state and federal guidelines, communications on meetings and important issues.

How do you go about deciding on a Board or getting to know what organizations might be a good fit? Talk to colleagues, look at their current Board list, call and talk to the Executive Director. Many of you attend community fundraisers, also a good place to ask about Board service.

The Boards I have enjoyed the most, pushed what I knew, and connected me to best practice ideas. The Boards I found frustrating provided information but didn’t use my skills or ask for help. 

Not for profits are local, regional and national. Some belong to larger associations or organizations that have Boards at multiple levels. Board service in a not for profit is as a volunteer and is uncompensated. Organizations carry Board and officer insurance coverage to protect Board members.

There are also For Profit Boards of start ups and businesses that seek certain disciplines for their Boards and do provide compensation and other benefits. These Boards choose members primarily through other Board members. The services that promise to get you a Board seat in exchange for a fee are unproven.

Some mix of Board service across for profits and not for profits during a career is desirable.

Resources:
www.councilofnonprofits.o g/running-nonprofit/ governance leadership/board-roles and-responsibilities

www.boardeffect.com/blog pros-cons-nonprofit-board-membership/

www.boardsource.org/fundamental-topics-of-nonprofit-boardservice/roles-responsibilities/

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

Grieving Families Act 3.0: What’s Changed?

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By Jenn Negley, Vice President, Risk Strategies Company

Most in healthcare and medical malpractice have been keeping an eye on the GFA legislation for several years now knowing the negative effect it would have on an already stressed sector. While all involved are assumed to have good intentions, it appears they have a blind spot when it comes to the GFA’s impact on the State’s medical malpractice insurance market and in turn healthcare. This failure to address the concerns continues with GFA 3.0 despite being clearly indicated in past vetoes.

While GFA 3.0 did eliminate “disorders” as a category of damages it maintained “grief or anguish.” The GFA 3.0 also still looks to broaden the current statute of limitations from two years to three years. GFA 3.0 originally scaled back the “eligible” family members that could recover damages to the current law’s definition only to propose assembly bill AB 9232B/S8485B that would result in the expansion of eligible family members once again. What is most troubling to industry experts is the current GFA calls for an immediate implementation effective for all wrongful death that occurs on or after January 1, 2021.

As I mentioned last year when discussing the GFA 2.0, malpractice carriers are already struggling with upticks in claim frequency and a dramatic rise in payout amounts. A recent study released in April 2024 by the New York Civil Justice Institute titled Consumers in Crisis How New York’s Hostile Liability Environment Inflates Insurance Cost and Fleeces Empire State Families (www.nycji.org/research) details the issues already contributing to a difficult insurance market. If signed as is, it will add to the pressures already in play. With no caps in place, more time to file, and the broadening of who can file the deck will be stacked against malpractice carriers. In addition, adding the change retroactively eliminates a carrier’s ability to make the necessary financial adjustments potentially forcing some out of the market. To maintain solvency, carriers as well as the insurance department will keep a close eye on these trends which might indicate the need for increased rates. Milliman, an independent actuary determined with the new inclusion of grief and aguish only, rates would need to be increased by 40%. As this has dragged out for several years, I have had the opportunity to speak to many of New York’s carriers’ upper management and everyone agrees such an increase would be a disaster for New York’s healthcare market, but all also note their fear that the New York State Department of Financial Services will see it as a necessity for admitted carriers to remains solvent.

To be clear, none of the admitted carriers are looking to take these steps but cannot ignore the independent statistical analysis of the GFA’s impact on their ability to defend New York’s healthcare providers and facilities. With little change, the “New” GFA the Governor’s veto message from last year still rings true. “Legitimate concerns have been raised that the bill would likely lead to increased insurance premiums for the vast majority of consumers, as well as risk the financial well-being of our healthcare facilities – most notably, for public hospitals that serve disadvantaged communities.” For the health safety of all New Yorkers GFA 3.0 in its current form needs to be vetoed once again.

Reach out to Governor Hochul now.
Facebook: @Governor Kathy Hochul

Twitter: @govkathyhochul

Instagram: @govkathyhochul

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

The views expressed in this article on pending legislation are solely those of the author and do not necessarily reflect the official stance, policies, or opinions of Risk Strategies. This article is intended for informational purposes only and should not be construed as professional advice.

Medtronic Expands Aible Spine Surgery Ecosystem with New Technologies and Siemens Healthineers Partnership

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Medtronic plc, a global leader in healthcare technology, announced at the North American Spine Society (NASS) 39th Annual Meeting in Chicago the commercial launch of several software, hardware, and imaging innovations. These enhancements are designed to advance AiBLE™, the Medtronic smart ecosystem of innovative navigation, robotics, data and AI, imaging, software and implants that enable more predictable outcomes in spine and cranial procedures. In line with its commitment to increasing the quality of care for patients with spinal conditions, Medtronic also announced a partnership with Siemens Healthineers to explore opportunities to further expand access to advanced pre- and post operative imaging technologies for spine care. New advancements in the AiBLE™ ecosystem build upon the company’s commitment to procedural innovation and execution, and include the following: 

O-arm™ 4.3 software, which introduces advanced navigation volumes, dose reduction, and enhanced image confirmation. With this release, Medtronic now offers the industry’s longest 3D scan length for cone beam CT images, which allows surgeons to capture additional spine levels in one scan and streamline their workflow. O-arm™ is the first and only intraoperative imager that uses AI, with 70% less radiation dose compared to the standard protocol, while maintaining image quality1. Medtronic Implant Resolution (MIR) further enhances decision-making by reducing metal artifacts around select screws, enabling confident final screw placement.

UNiD™ Adaptive Spine Intelligence (ASI), a Medtronic integrated service and software platform that leverages AI and predictive models to help surgeons deliver patient-specific surgical plans and implants, now includes MRI Vision, which integrates with CoLumbo from Smart Soft Healthcare into the UNiD™ workflow. This new tool employs computer vision technology to automatically analyze lumbar MRIs to segment, label, and measure key aspects related to common pathologies. MRI Vision will allow spine surgeons using UNiD™ ASI to access automated PDF reports and annotated DICOMs (Digital Imaging and Communications in Medicine) in the UNiD™ Hub to identify and quantitatively measure areas of interest such as muscle area with fat infiltration, key spinal alignment angles, key characteristic related to stenosis, and more. UNiD™ is powered by more than 28,000 patient procedures and continues to grow in adoption worldwide.

Mazor™ robotic guidance
system with 5.1 software is the first and only spinal robotic system that integrates AI, bone cutting, and graft delivery. Mazor enables comprehensive preoperative and intraoperative planning that goes beyond screw placement to include complete construct design with screws, rods, interbodies, and bone removal. The newest version of 5.1 software introduces Maximum Intensity Projection (MIP), which supports improved image quality. 

New implant innovation with ModuLeX™ Spinal System, which offers increased visualization of the surgical area while allowing the operative flexibility to create an optimized construct for the patient. ModuLeX™ is the next generation of the Medtronic CD Horizon™ product family, a 40-year leader in spinal fixation. Global corporate partnership to complement Medtronic imaging offerings Medtronic also unveiled a global partnership with Siemens Healthineers during the meeting. The two companies anticipate comarketing the Siemens Healthineers Multitom Rax™ imaging system and integrating the platform into the Medtronic AiBLE™ ecosystem for spine surgery. The companies also anticipate collaborating across technology development, marketing, and commercial activities to advance clinical outcomes.

The Multitom Rax™ offers a unique combination of imaging technologies that can be used across musculoskeletal conditions, including spinal patients. With standing, weight bearing imaging, cone-beam CT, and supine X-ray capabilities, the Multitom Rax™ supports the commitment Medtronic has to advancing the standard of care across the care continuum.

“Partnering with Siemens Healthineers advances our commitment to reduce variability and improve outcomes for spinal patients,” said Skip Kiil, president of Medtronic Cranial & Spinal Technologies, which is part of the Medtronic Neuroscience Portfolio. “We are thrilled with the prospect of working with the industry leader in imaging and to leverage the depth of imaging experience and expertise, commercial footprint, and shared commitment to data science to advance our AiBLE strategy and shared pursuit of better patient outcomes.” The envisioned partnership will be an evolution of the AiBLE™ ecosystem which integrates connected care and predictive technology to advance surgery.

“We are excited about the prospect of partnering with Medtronic to bring our solution to spine centers and empower spine surgeons and neurosurgeons to be more precise in the operating room,” said Verena Schoen, Executive Vice President X ray Products at Siemens Healthineers. “Multitom Rax™ delivers geometrically accurate images which allows precise measurements of the patient’s vertebrae. 

diagnosis and treatment planning, but also to surgical execution
and post-surgical control.”

Especially optimized for spine imaging, it not only contributes to faster 

About the Cranial & Spinal Technologies Business at Medtronic

As the market leader, Medtronic is transforming the standard of care in spine and cranial surgery worldwide by putting patients first and solving complex conditions for spine and neurosurgeons. With 150 products covering more than 20 pathologies, we serve over 4 million patients annually. Continuing our legacy of innovation, the AiBLE™ ecosystem is the culmination of everything Medtronic has built in Cranial & Spinal Technologies over the past two decades.

By integrating advanced technologies and a patient centric approach, we provide a customizable health solution for the primary challenges in cranial and spine surgery: the need for increased predictability and precision, more efficient workflows, and better surgical outcomes. For more information, visit www.Medtronic.com/AiBLE and follow CST on LinkedIn.

About Medtronic

Bold thinking. Bolder actions. We are Medtronic. Medtronic plc, headquartered in Galway, Ireland, is the leading global healthcare technology company that boldly attacks the most challenging health problems facing humanity by searching out and finding solutions. Our Mission — to alleviate pain, restore health, and extend life — unites a global team of 95,000+ passionate people across more than 150 countries. Our technologies and therapies treat 70 health conditions and include cardiac devices, surgical robotics, insulin pumps, surgical tools, patient monitoring systems, and more. Powered by our diverse knowledge, insatiable curiosity, and desire to help all those who need it, we deliver innovative technologies that transform the lives of two people every second, every hour, every day. Expect more from us as we empower insight-driven care, experiences that put people first, and better outcomes for our world. In everything we do, we are engineering the extraordinary. For more information on Medtronic, visit www.Medtronic.com.

World Health News In Brief

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By: William Ecenbarger

-The British Journal Lancet reports that individuals vaccinated against Ebola who still developed the disease were much less likely to die than the unvaccinated–even if they were infected before they got the shots. The case fatality among those vaccinated with Merck’s Ervebo was 27 percent as opposed to 56 percent among those who did not receive the shot.

– Lancet also said worldwide obesity rates among children and adolescents quadrupled between 1990 and 2002, while the adult rate doubled. “As those rates climb, the burden of obesity is evolving,” the journal said. “Obesity and chronic diseases such as diabetes were once the province of wealthy countries, but now the conditions are also seen in low- and middle-income countries, in step with the rapid adoption of industrialized lifestyles featuring more processed foods and less physical activity.”

-Why do South Asians have a higher risk of heart disease than individuals of European descent? A study by the Journal of the American College of Cardiology suggests that the disparity might be the result of differences in how blood vessels damaged by cardiovascular problems are repaired.

-A JAMA Pediatrics study in Australia found that extreme heat was linked to a greater risk of preterm births in the third trimester of pregnancy. Preterm births with high heat exposure were 7.5 percent compared to 4.9 percent with normal temperature exposure. The authors said the findings had “clear implications for our warming world.”

-The World Health Organization reports that nearly every nation has dirty air, and the major culprit is fossil fuels. The most polluted air was found in Bangladesh, Pakistan, India and Tajikistan. The cleanest air was in Australia, Finland, Estonia and several small island nations.

-Apotek Hjärtat, which has about 390 pharmacies in Sweden, says it will no longer sell anti-aging skin care products to persons under 15. The chain said it would restrict products containing the ingredients AHA acid, BHA acid, vitamin A, vitamin C and enzyme peeling unless the teenagers had parental consent. There is widespread concern in Europe that these products could be harmful to young skin. There are also concerns “about the psychological impact of children obsessing over ageing.”

-Fabrice André, president elect of the European Society of Medical Oncology, says a new cancer-naming system that emphasizes molecular characteristics rather than the organs where the cancer originates would be a step forward. “We’re not saying it was a mistake to classify cancers based on anatomy or that people should have done things differently in the past. But look, the framework is no longer adapted to the types of treatments that are available,” Andre said.

-A study in China found that tai chi offered more benefits in lowering blood pressure than moderate aerobic activity. The results of the clinical trial, which tracked 342 individuals with hypertension, were published in the journal JAMA Network Open.

St. Peter’s Health Partners: A Pioneer in Robotic Surgery; Exceeds 22,000 Robotic Procedures

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By Tami S. Scott

For Dr. Lin Wang, who practices general, laparoscopic, and robotic surgery, having a da Vinci® computer-enhanced surgical system at her disposal was critical in her decision-making to join the team at St. Peters Health Partners in Albany.

“If I could, I would spend most of my time in the operating room on the da Vinci,” said Wang, who is with St. Peter’s Hepatobiliary, Pancreatic, and General Surgery, a practice of St. Peter’s Health Partners Medical Associates. “I would not work at a place that did not have a robot.”

Those sentiments reflect the position of many surgeons who are now completing their residency programs fully trained in performing minimally invasive surgeries, including robotic procedures.

The benefits are vast for both doctors and patients – less complications, less scarring, and quicker recoveries.

The Capital Region is fortunate to be the home of two hospitals within St. Peter’s Health Partners to have secured five da Vinci surgical systems: four located at St. Peter’s Hospital in Albany and one at Samaritan Hospital in Troy.

St. Peter’s Hospital has been in the forefront of robotic surgery, being the first hospital in the Capital Region to acquire the technology in 2004.

Since then, St. Peter’s and Samaritan hospitals combined have performed the greatest number of robotic procedures in the Capital Region with more than 22,000 to date. Pioneers in this latest and most advanced type of minimally invasive surgery, they are also national leaders: St. Peter’s Hospital ranks in the top 1% of total robotic surgery volume across more than 2,400 hospitals in the United States.

So, what exactly is robotic surgery and how does it relate and differ from other minimally invasive surgeries such as laparoscopy and advanced endoscopy? First, minimally invasive surgeries are performed by making small incisions and with surgeons using a camera with console and long instruments to do the actual surgery. They have become more and more routine over the last 20 years.

“Probably the first progression from open surgery to minimally invasive surgery would have been laparoscopy,” said Dr. Nicholas Montalto, chief medical officer for acute care, St. Peter’s Health Partners. “The da Vinci robot, the computer-assisted surgery, is a progression from laparoscopy.”

The surgical system integrates robotics and extremely sophisticated computer technology with the skills of the surgeon. It allows the surgeon to perform delicate operations with great precision and maneuverability but requiring only tiny surgical openings.

“Because the robot allows us better dexterity, the camera can potentially allow us better visualization compared to minimally invasive,” Dr. Wang said. “Instead of seeing in two-dimensional image [like with laparoscopy, for instance], we have binocular vision when we work through the robot.”

Also, straight instruments with basic capabilities are replaced with the robot’s “extra wrist” that can “turn in a way that we wouldn’t normally be able to do with laparoscopic instruments,” she added. “I think for a lot of surgeons, it helps us to do certain dissections in a much more ergonomic way.”

Worthy to note is that the term “robotic” often misleads people to believe that the robot is performing the surgery.

“The machine doesn’t do anything that the surgeon isn’t doing,” Dr. Montalto said. “It’s computer-assisted surgery. The visualization is superior, and the movement of the instruments is superior.”

Robotic procedures encompass several different surgical specialty areas, such as general surgery, colorectal, gynecological oncology, gynecology, hepatobiliary and pancreatic, urology, and thoracic.

“It’s a wonderful tool that has improved laparoscopy tenfold with wristed instruments, with visualization, with postoperative recovery – I think it’s a wonderful tool for all of our patients,” said Dr. Barbara Brazis, chief of robotic surgery at St. Peter’s Health Partners.

She hopes administration throughout the country will make it a priority to find ways to make these surgeries accessible to all.

“The length of [hospital] stay is far decreased after robotic than open surgery and sometimes even laparoscopic. There are some specialties where you can take the length of stay from 10 days down to two days – that’s a huge savings for the hospital. Right there the robot would pay for itself,” Dr. Brazis said.

When asked if insurance companies can be a barrier for robotic procedures, Dr. Montalto said not anymore.

“About 10 years ago, especially in the gynecology field, there were a couple of insurance companies that would not pay for the surgery to be done robotically versus laparoscopically or open, because the literature didn’t show a definite advantage in terms of mortality or serious complications by using the robot,” Montalto said. “They didn’t consider that there was any advantage – that’s not the case anymore. I haven’t encountered that in years as robotics has become so popular … There’s a tremendous number of advantages from robotics that I think the insurance companies weren’t necessarily appreciating.”

In the field of gynecological oncology, robotic surgery has had a wide impact.

“Robotic surgery has dramatically improved gynecologic oncology care,” said Dr. Joyce Barlin, a surgeon with Women’s Cancer Care Associates in Albany. “Robotic surgery offers superior visualization along with articulation of instruments to assist in the challenging dissection often required for oncologic surgery.”

In fact, more patients are becoming knowledgeable about robotic procedures and how it can help them in the recovery process.

“Patients are often aware of robotic surgery prior to their initial consultation and are grateful that robotic surgery is available through our Women’s Cancer Care Associates practice at St. Peter’s Hospital,” Barlin said. “Most of our patients undergoing major surgery using the robotic platform are able to safely go home on the same day of surgery.”

Is robotic surgery the future for all surgeries?

Dr. Rebecca Keim, a general surgeon with St. Peter’s Hepatobiliary, Pancreatic, and General Surgery, specializes in hepatobiliary and pancreatic cases. She was already in practice when she chose to train in robotic surgery and now performs about 100 surgeries per year with the da Vinci. This estimate is in addition to about 150 laparoscopic cases she performs per year.

“As we have more time for robotics, people are switching more and more from laparoscopic to robotic if there’s availability to do so,” she said.

However, Dr. Keim still performs traditional open techniques, which tend to be “large cancer cases that aren’t amenable to robotics or are just too complex.” She explained the dual efforts of docking and undocking the robot when necessity calls. For example, if Dr. Keim is working with the da Vinci on a cancer case for hours due to a tumor factor and the surgical team is not progressing, they can simply undock the robot, she scrubs in, and they do the case bedside.

“There’s times, too, when you go back and forth,” Keim added. “There’s times when we come bedside, we take out a specimen like a tumor, and then we redock the robot again and finish the operation.”

“I don’t think that minimally invasive or robotic surgery could ever replace everything that we do open,” Dr. Wang said. “There’s always a role for open surgery. Again, depending on the situation, it tends to be for more emergent type situations, where there’s not time to dock a robot or get those instruments in. Open surgery will always be there as an option.”

Dr. Brazis also agreed that open surgery will always have a place in the operating room.

“First of all, there are some people who aren’t trained in robotics and some surgeries are deemed to require open surgery in some specialties … so open surgeries are still done very often,” she said.

Again, St. Peter’s and Samaritan hospitals have five da Vinci surgical robotic systems to date. Donors have helped play a crucial role in the program by providing philanthropic support for the purchase and use of the surgical systems at St. Peter’s Health Partners.

“More and more surgeons coming out of residency programs and fellowship programs are trained on the da Vinci robot versus 10 years ago when they weren’t,” Montalto said.

And if they’re not skilled in it but would like to be, there is a comprehensive training pathway that includes several components, including system orientation with Intuitive, the company that makes the da Vinci robot, as well as hands-on training, and a proctoring program.

Dr. Keim said she believes the future of surgery will involve training people who can perform open, laparoscopic, and robotic surgery, which will in turn extend the training periods.

“It’s a big paradigm shift and you really have to be facile at all techniques when taking care of patients,” Keim said.

She said she thinks hospital leaders understand the need to support surgeons who want to use robotics. Though there’s a significant expense, they will find a way financially that makes sense.

“I think in 10 years, the costs are going to drop because [robotics] is going to become so common. I think other companies are going to get in the mix and allow it to become more affordable, she said.

A drop in cost aligns more with Dr. Montalto’s way of thinking, which is that robotics is the future of all surgery.

“There are programs that have only robotic surgery – every single case is done robotically, and they run the robot 24 hours a day, seven days a week, 365 days a year,” he said. “A goal for our program will be to do that also because one of the limitations of robotics is only being able to do it during business hours.” Staff on evenings and weekends may not be as proficient with robotics, so training all staff is vital for treating patients with the same opportunities for care.

“I think it doesn’t give the patient the optimal care if you can’t offer robotic surgery around the clock,” Dr. Montalto said. “The time of day shouldn’t matter.”

Paramedicine: Creating a first line of access and follow-up in our communities

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By: Kathryn Ruscitto, Advisor

Definition: “Community paramedicine is a relatively new and evolving healthcare model. It allows paramedics and emergency medical technicians (EMTs) to operate in expanded roles by assisting with public health and primary healthcare and preventive services to underserved populations in the community.” Rural Health Information Hub

Recently I wrote about new models developing in primary care. From telemedicine to urgent care, access for certain conditions can be met as an adjunct to the traditional primary care physician .

Paramedicine has been developing in many states since 2009. Every community has different needs, and Paramedicine programs look different from community to community.

What these programs have in common is identifying what will help the existing health care system in that area by addressing unmet needs.

A scan of existing programs suggests common focus areas include:

  1. 911 triage to prevent dispatching an ambulance crew.
  2. Chronic Care management in the home, in collaboration with home care, hospice, health departments or primary care practices.
  3. Preventing readmissions or ER visits by offering some chronic care education services in the home and facilitating communications with providers.
  4. Helping patients get to the right setting and identifying resources to support them.
  5.  Immunizations
  6. Supporting the frail elderly in remaining at home with extra support.

In NYS there are pilots underway to look at Paramedicine as part of the health landscape. In others states these programs have long been a successful part of health care. Florida in particular has a compete manual for ambulances to approach certification and to train ALS paramedics.

The current demonstrations in NYS were funded by the Mother Cabrini Health Foundation, awarding grants to the Iroquois Association and the NYS Home Care Association. These pilots are about to expand from three to six. They have worked best in areas where a champion within the department takes lead in the community collaboration. Gary Fitzgerald the CEO of Iroquois notes, “EMS providers can be used more effectively in our communities.”

I spoke with the pilot in Jefferson County that is working in collaboration with their Health Department and home care agency. Paul Barter, the Jefferson County EMS Director was enthusiastic about the impact of their pilot program in Jefferson County. He stressed how excited his providers are in helping patients better understand their disease, medications, and have a better quality of life. A review of their data tells them they are reducing calls to 911 and transports to emergency rooms.

These pilots are particularly important in areas where primary care has contracted, or the local ER has closed. Workforce shortages have also hit Ambulance Corps and foundations and the Health Department should look at investments and incentives to help EMS providers expand through Incentives, including scholarships and tax credits.

There are so many positives to community based care in improving health outcomes. Paramedicine is one part of a growing system of options for communities to consider. The NYS Health Deportment should make these programs a permanent option in the NYS Healthcare landscape.

References:

https://www.ruralhealthinfo.org/topics/community-paramedicine

https://www.flexmonitoring.org/sites/flexmonitoring.umn.edu/files/media/bp34.pdf

https://paramedicnetwork.org/mce/

https://emsa.ca.gov/community_paramedicine/

https://www.iroquois.org/

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

Healthcare Organizations Very Vulnerable to Cyberattacks

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By: William Ecenbarger

Like most other organizations, healthcare facilities have moved toward total digitization. The major benefit of this change is that it has provided an efficient way of sharing patient records among healthcare professionals. Compared to paper-based records, electronic health records require less workforce, time, and physical storage.

However, this shift has created a new and growing risk: cyber-attacks that are compromising patient information, delaying patient procedures and tests, and rerouting ambulances to alternative emergency rooms.

“The health care sector is experiencing a significant rise in cyberattacks, putting patient safety at risk,” warns Andrea Palm, deputy secretary of the U.S. Departent of Health and Human Services. “These attacks expose vulnerabilities in our health care system, degrade patient trust, and ultimately endanger patient safety.”

The HHS Office for Civil Rights said the medical information of some 88 million Americans was exposed in the first 10 months of 2023. HHS also reported a 93 percent increase in large, healthcare-related cyber breaches between 2018 and 2022.

Much of the official concern is focused on breaches of patient privacy.

Healthcare institutions are a gold mine for cyber attackers. They hold huge amounts of information on patients–not just medical records, but also financial information, Social Security numbers, names and addresses. Moreover, unlike most businesses, they are open all the time–meaning, as the Seattle Times pointed out in a recent article, “they might be more likely to prioritize avoiding disruptions and, therefore, more likely to pay a hacker’s ransom.”

Geetha Thamilarasu, an associate professor of computing and software systems at the University of Washington and a specialist in health care security, said patients’ health information is valuable to cyber-attackers, who can use stolen medical records to buy bogus prescriptions, sell identity information online and file fraudulent insurance claims.

“There is a huge underground market on the dark web,” Thamilarasu told the Seattle Times. “Research shows that if a compromised credit card sells for about $1 to $5 each, a compromised medical record can sell anywhere from $400 to $500 — sometimes even $1,000.”

Moreover, anyone concerned about stolen Social Security numbers can enroll in a credit-monitoring agency, but patients have little recourse if their personal health information is stolen.

There are often hundreds of Internet-connected devices in a hospital, each of which may require a different type of security. “While an X-ray machine itself might not carry any patient data, it can act as an entry point for attackers trying to break into an organization’s broader network,” Thamilarasu said.

The American Hospital Association recently warned: “Health care organizations are particularly vulnerable and targeted by cyberattacks because they possess so much information of high monetary and intelligence value to cyber thieves. The targeted data includes patients’ protected health information (PHI), financial information like credit card and bank account numbers, personally identifying information (PII) such as Social Security numbers, and intellectual property related to medical research and innovation.”

John Riggi, the AHA’s Senior Advisor for Cybersecurity and Risk, said hospitals and other healthcare organizations constantly face attacks that can put patient safety at risk. “That’s why I advise hospital senior leaders not to view cybersecurity as a purely technical issue falling solely under the domain of their IT departments. Rather, it’s critical to view cybersecurity as a patient safety, enterprise risk and strategic priority and instill it into the hospital’s existing enterprise, risk-management, governance and business-continuity framework.”

Riggi, a former FBI cybersecurity specialist, urges hospitals to adopt “a culture of cybersecurity” that would result in staff members seeing themselves as “proactive defenders of patients and their data.”

“The cyber bad guys spend every waking moment thinking about how to compromise your cybersecurity procedures and controls. The best defense begins with elevating the issue of cyber risk as an enterprise and strategic risk-management issue. If possible, you should also dedicate at least one person full time to lead the information security program, and prioritize that role so that he or she has sufficient authority, status and independence to be effective. Furthermore, you and your team should receive regular updates on your organization’s strategic cyber risk profile and whether adequate measures are dynamically being taken to mitigate the constantly evolving cyber risk.”  

According to the healthcare news publication HealthcareDive, cyber-attacks exposed 385 million patient records from 2010 to 2022. though individual patient records could be counted multiple times. The HIPAA Journal says the number of healthcare data breaches has been increasing over the past 14 years. In 2023, 5,887 data breaches of 500 or more records were reported to the federal officials. In 2023, more than 540 organizations reported healthcare data breaches to HHS, affecting more than 112 million people.

Riggi said hospitals have been working to put in place better safeguards and more backup systems to prevent such attacks and respond to them when they occur. But he said it is almost impossible to make them completely safe, especially because the systems need to rely on Internet and network-connected technologies to share patient information among clinicians involved in a patient’s care. “Overall, that’s a good thing,” he said. “But it also expands our digital attack surface.”

The HHS recently released a cybersecurity strategy for the healthcare sector that includes these actions:

 –Publish voluntary healthcare sector cybersecurity performance goals to “help healthcare institutions plan and prioritize implementation of high-impact cybersecurity practices.”

 –Provide resources to “incentivize and implement cybersecurity practices.” HHS said it would work with Congress to obtain new authority and funding to administer financial support and incentives for domestic hospitals to implement high-impact cybersecurity practices.

–Implement an HHS-wide strategy to support greater enforcement and accountability. HHS will propose new enforceable cybersecurity standards.

–Expand and mature the one-stop shop within HHS for healthcare sector cybersecurity. This will “deepen HHS and the Federal government’s partnership with industry, improve access and uptake of government support and services, and increase HHS’s incident response capabilities.”

The AHA’s Riggi offered his expertise. “I am available to assist your organization in uncovering strategic cyber risk and vulnerabilities by conducting an in-depth cyber-risk profile, and by providing other cybersecurity advisory services such as risk mitigation strategies; incident response planning; vendor risk management review; and customized education, training and cyber incident exercises for executives and boards. Please contact me for more information at 202-626-2272 or jriggi@aha.org.

When to Report a Potential Medical Malpractice Claim: Protecting Yourself and Your Practice

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by Jenn Negley

Peace of mind is paramount for healthcare providers. However, some physicians hesitate to report potential medical malpractice claims to their insurance carriers for fear of jeopardizing their coverage. This article aims to clarify the importance of timely reporting and dispel common misconceptions.

Understanding “Claims-Made” and “Occurrence” Policies and Incident Triggers

With a claim-made policy the carrier defends incidents reported during the policy period, even if the incident itself occurred earlier (within the retroactive date). Crucially, both the incident report and the claim itself must happen while the policy is active.

An Occurrence policy protects you from any incident that “occurs” during the policy period, regardless of when a claim is filed. Meaning, the carrier you are insured with when the incident occurred covers you for the claim and is who you need to report to.

Why Early Reporting Matters

Delaying an incident report can have serious consequences. If a potential claim later materializes, the insurer may deny coverage due to non-disclosure. Even when switching insurers, a past unreported incident could negatively impact future coverage options.

What is an Incident? What is a Claim?

An incident is any event that could potentially lead to a future claim. This includes situations causing injury, potential injury, or even dissatisfaction with a service. Claims come in two forms: formal and informal.

  • Formal claims: Receiving a legal document, a demand letter from an attorney, or even a seemingly innocuous request for medical records by a patient’s lawyer (unless unrelated to your care).
  • Informal claims: Verbal threats of litigation, requests to waive fees, or patient harassment.

Examples of Incidents to Report:

  • Patient deaths
  • Birth injuries
  • Serious injuries
  • Disfigurement
  • Loss of limbs
  • Sensory impairment
  • Verbal threats
  • Patient family harassment

Additional Reporting Recommendations

Report any instance involving:

  • Demands for money
  • Legal threats
  • Lawsuits naming you
  • Notices of intent to sue
  • Requests for arbitration or depositions

Protecting Yourself After Reporting

Once you report an incident, communication is key:

  • Only discuss the case with your claims manager, a lawyer representing you, protected peer-review attendees, or your spouse.
  • Never alter medical records, even for seemingly minor corrections.
  • Do not include claim correspondence in patient records.
  • Maintain copies of all claim-related documents in a secure location.

A Word on “Background” Interviews

Be wary of requests from plaintiff attorneys to discuss a case you’re not directly involved in. These seemingly casual interviews can be traps leading to future lawsuits against you. Always contact your insurer and request legal representation for such inquiries.

By understanding reporting requirements and taking proactive steps, healthcare providers can protect themselves and ensure their medical malpractice insurance provides the valuable protection they deserve.

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

Sidebar:

Risk Strategies, National Health Care malpractice team by the numbers:

  • Supports over 6,000 clients representing over $200,000,000 in physician premiums.
  • Representing every major medical malpractice insurance carrier in the market. In New York, we represent MLMIC, EmPro(PRI), The Doctors Company (TDC), HIC, MedPro RRG, Coverys RRG, ProAssurance RRG, TDC RRG, AMS RRG.
  • Specialists with over 25 years’ experience in medical malpractice insurance
  • Programs designed for independent physicians and self-insured programs as well as large practices and hospitals.