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St. Peter’s Bariatric and Metabolic Care: An Integrated Weight Loss Team Working Together for Patient Success

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By: Elizabeth Landry

Obesity is a major chronic disease affecting many adults in the United States. At St. Peter’s Health Partners, the St. Peter’s Bariatric and Metabolic Care team treat obese and overweight patients in the greater Albany area, from Saratoga County, to Vermont, Western Massachusetts and even as far South as Poughkeepsie. Working out of both Samaritan Hospital and St. Peter’s Hospital, the multidisciplinary team includes providers specializing in bariatric surgery, internal and bariatric medicine, nutrition, and behavioral health to support a full range of individualized care for bariatric patients.

Samuel Hykin, MD, FACS, Director of Bariatric Surgery for St. Peter’s Health Partners, has been leading the team since 2021 and has spent over seven years performing bariatric surgery. Once patients have attended an informational seminar about bariatric medicinal options and chosen to pursue care with the team, the providers put together a weight loss plan that looks different depending on each patient’s needs and goals, as Dr. Hykin described.

“We really focus on individualizing strategies and procedures for patients, meeting them where they are in their journey. We look at the patient as a whole, determining what other medical comorbidities they have and what their goals are in terms of how much weight they want to lose. Whether patients decide bariatric surgery is right for them, or if they prefer to go the non-surgical route, our integrated team approach helps support them in reaching their goals,” said Dr. Hykin.

Minimally Invasive Bariatric Surgery Options

For many patients experiencing obesity, bariatric surgery is selected as the best strategy to help them reach their targeted weight loss. At St. Peter’s Bariatric and Metabolic Care, patients are required to receive several clearances to qualify for surgery, which helps to ensure patients are ready and can be as successful as possible. Prior to receiving a date for surgery, patients must achieve 5% weight loss, receive clearances from nutrition, behavioral health, and cardiology, have an endoscopy and possibly also a sleep study. To be considered for surgery, patients need to have a BMI (body mass index) of 35-40 or higher and may need to have at least one of the comorbidities associated with obesity, including diabetes, high blood pressure, sleep apnea and high cholesterol.

There are two main surgical options offered at St. Peter’s, a sleeve gastrectomy and gastric bypass, both minimizing parts of patients’ digestive systems, which can result in a loss of between 50-75% of excess body weight. Dr. Hykin explained how these surgeries have become significantly less invasive over the years, with most patients now able to go home the day after surgery.

“About ten years ago, medical society made a shift toward minimally invasive surgery and shorter hospital stays which have dramatically improved patient outcomes,” said Dr. Hykin. “Right now, I complete a gastric sleeve surgery in three to five small incisions, and a gastric bypass is done in four to five small incisions. Patients can be in and out relatively quickly and get back to their everyday lives without much interruption.”

Importantly, improved patient outcomes are tied to lower complication rates. Dr. Hykin has consistently achieved a 

complication rate at or below the national average while performing bariatric surgery at St. Peter’s, and the patient success rate at the bariatric care center has remained strong at about 85-90% even while seeing a high volume of patients.

In fact, the bariatric surgery center located at St. Peter’s Hospital has received the Bariatric Center of Excellence designation from the American Society for Metabolic and Bariatric Surgery (ASMBS), 

which requires a stringent certification process in addition to high patient success rates and low complication rates.

“The process is about patient safety, protocolizing your approach, low complication rates, quality follow-up care – all of that combined. If you meet the bar, you’re granted Center of Excellence status, and you must recertify every three years. During those next three years you need to continue to meet the standards you were originally qualified by, and the ASMBS reviews 

that time to ensure the standards were achieved. It’s a very rigorous process but it 

ensures excellence in bariatric care, which is what makes it so 

important,” stated Dr. Hykin.

Multidisciplinary Approach to Metabolic Medicine

Whether patients opt for bariatric surgery or if they choose to work toward weight loss using non-surgical strategies, the integrated, multidisciplinary team at St. 

Peter’s offers cohesive support to help patients overcome obesity. Leading the way in non-surgical bariatric medicine at St. Peter’s is Priyangika Pathirana, MD, board-certified bariatric medicine and internal medicine physician, who’s been with St. Peter’s Health Partners for about 17 years.

Dr. Pathirana’s approach to bariatric medicine involves four main strategies: changes in diet and nutrition, changes in exercise, behavioral modification, and medications, when appropriate. Her strategy for patients is highly customized based on each patient’s individual needs, and she explained how the process and the goals are about much more than reaching a target weight.

“My goal for each patient is to help them become a healthier person, medically and psychologically. It’s not just about appearance – it’s about much more than the weight. Patient goals are very individualized, and so we receive a full patient history and create an individualized plan for how to change their eating and exercise habits. For example, some people cannot do regular exercises so we may teach them how to do chair exercises. It’s certainly not a ‘cookie-cutter’ type of approach,” said Dr. Pathirana.

Working with Dr. Pathirana to provide customized plans for weight loss through diet and exercise is a team of three registered dieticians including Lauren Zielinski, RD. Seeing non-surgical metabolic patients as well as surgical patients both pre- and post-operatively, Zielinski and the team help guide patients in balancing out their meals, focusing on a low-carbohydrate and higher-protein diet to achieve weight loss goals.

Zielinski aims to provide realistic strategies for patients that help them be more likely to achieve success. “I like to meet patients wherever they’re ready to make changes. I’m all about sustainability and being realistic with where the patient currently is and what changes they want to make,” she said.

Rounding out the integrated medical weight loss team is Alyssa Kontoh, licensed mental health counselor and board-certified bariatric counselor. She completes psychological assessments for patients pursuing surgery and offers support for any patient needing mental health guidance, including non-surgical patients seeing Dr. Pathirana, as well. Many patients have been struggling with obesity and weight issues since childhood, and Kontoh works with patients regarding their family history of eating habits, including food rules or messaging they may have carried over into adulthood.

Kontoh emphasized how the integrated team approach at St. Peter’s, as well as the support groups she offers, set the team apart from other bariatric medicine centers.

“Our office is truly based in a multidisciplinary approach,” Kontoh said. “We’re a very close office and we have very good communication with each other. We make sure we’re letting each of the other providers know if a patient may have a higher need for enhanced support as they work toward their goals. I also think the support groups we offer are a major highlight of our office – we cover topics ranging from binge eating to navigating change to the stress of the holiday season. The number of resources we offer is often surprising to patients.”

Helping Patients Attain Long-Term Success

With all the medical weight loss providers working together, the team at St. Peter’s helps set bariatric patients up for success on the rest of their journey. Once weight loss goals are reached, patients can choose to remain engaged with the office as often as they like, and surgical patients are seen regularly post-operatively at one week, one month, three months, six months, one year and yearly thereafter.

Although each provider or team of specialists at St. Peter’s approaches bariatric medicine through a different lens, a common thread that connects them all is how rewarding they each find it when they can celebrate their patients’ successes alongside them. For each, overcoming obesity is less about the number on the scale and more about the unique and often seemingly simple achievements that affect each patient’s life in different ways.

“My goal for patients is to give them their lives back,” said Dr. Hykin. “My favorite story is about a gentleman who came to me for bariatric surgery, and I asked him the true reason for why he came to our office. He told me he had been at the Great Escape over the summer and couldn’t fit into the rollercoaster with his son. He remembered riding the rollercoasters with his father when he was young and it being the best time they had together. When he couldn’t create that memory with his own son, he said that was the moment he knew he needed help. He was very motivated, completed the program, and when he came back for his six-month follow-up, he said, ‘Doc, you’re going to like this. We went back to the Great Escape, and I was able to ride that rollercoaster with my son. It was a blast.’ You can’t put a price tag on that. It was one of those moments that just sticks with you.”

Certainly, as the practice expands and grows to help support more patients in reaching their weight loss goals, the motivation for each provider at St. Peter’s will remain focused on finding strategies that work for each individual patient, as Dr. Pathirana emphasized.

“It’s the patient’s weight loss journey and I’m here to help them and offer support as needed for each individual,” she said. “It’s the simple things that really do matter, which show how their progress really affects their life. It’s a very rewarding job. This is my happy job. I so enjoy working with my patients.”

Who’s Taking Care Of The Physicians?

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By: Bari Faye Dean

MSSNY’s Peer Coaching Program Combats Stigma, Offers ‘Safe Space’ for Docs Battling Demons

It’s no secret that physicians live in a pressure cooker of stressors. They want to provide the highest quality care to patients, give the most of themselves to their families and personal life and, all the while, find themselves buried in paperwork and the inexplicable frustrations brought on by the technology required to balance healthcare regulations and insurance red tape.

“Doctors aren’t weak. We are strong and resourceful,” said Frank Dowling, MD, a psychiatrist in private practice on Long Island. “But even steel has a breaking point.”

Without intervention, stress and burnout can lead to severe health issues, including depression, PTSD, substance abuse and even suicide. No question about it: something has to give – before a practitioner gives in to stress, burnout or a personal challenge that has been threatening to sideline them. The bottom line, wonders Bonnie Litvack, MD, a Mount Kisco, NY-based radiologist who specializes in breast imaging, is this: “Who’s taking care of the physicians while physicians take care of everyone around them?”

Confidential Assistance from Trained Peer Coaches
The Medical Society of the State of New York’s (MSSNY) Physician Wellness and Resilience Committee launched a Peer 2 Peer (P2P) program. This program offers a vital lifeline to physicians, residents and medical students who are having emotional difficulties but have decided not to seek help because they are afraid of the stigma attached to mental healthcare – especially for physicians who are “supposed to be able to handle everything,” Dr. Litvak said.

When a participant reaches out for help, they are connected with a P2P Program peer supporter, a fellow medical professional, who has been trained to actively listen and offer feedback during one or two phone calls or video chats.

“We are providing psychological first aid,” said Dr. Dowling, who has been a peer supporter since the inception of the MSSNY program. “It’s therapeutic because it provides support and empathy, but it’s not treatment. If the participant needs a clinical referral and agrees to take one, they will be connected with the help they need.”

To date, almost 100 physicians have been successfully trained in crisis management by MSSNY’s P2P Program. During three-hours of training, peer supporters are trained to know what resources are available and how to guide a physician to get the help they need moving forward. If you would like to learn more about becoming a peer supporter, contact Emily Rento, Program Coordinator, at erento@mssny.org.

“Too many doctors are suffering in silence because they fear that if people knew what was going on in their heads, others would look at them differently,” Dr. Dowling said. “The P2P Program allows doctors to help our peers manage their battles confidentially.”

Indeed, the entire program is 100 percent confidential. There is no paper trail. There is no reason to fear retribution at work. If you need help, reach out now. You can get connected with a peer supporter by emailing P2P@mssny.org or by calling 844-P2P-PEER (844-727-7337).

P2P Provides a Safe, Judgment-Free Space
“There is a real need for this program. Many other fields have these types Physicians are human beings and they need a safe space, where they can be validated and talk about their feelings without judgment,” explained P2P Program peer supporter Dr. Litvack.

Dr. Litvack was president of MSSNY in 2020 2021 during the height of the COVID-19 pandemic, when the P2P Program was launched. “COVID exacerbated everything physicians are dealing with at work and in their personal lives. I am proud we were able to start the P2P Program then, Dr. Litvack said. “But it’s a few years later and we see those life stressors haven’t gone away. Physicians faced them long before COVID and we will be facing them long after.”

Take It From Someone Who’s Been There
Janine L. Fogarty, MD, a diagnostic radiologist in Rochester, NY, is not only a trained peer supporter, but she knows first-hand how a career in medicine can cause a level of stress that can engulf a physician. She has been there and retired from that.

“I retired from a long medical career in 2022 because I was burned out beyond repair,” Dr. Fogarty said. “At work, I had all the responsibility and no control. I couldn’t affect change for my patients. I couldn’t do it anymore. I was so emotionally isolated. No one around me knew I was struggling. My work environment wasn’t healthy for me so I couldn’t reach out there. I could talk with friends but they didn’t really understand because they are not physicians.”

Dr. Fogarty remembers the days of the physicians’ lounge, when a step away, a cup of coffee and a quick chat with a colleague could do wonders to calm a stressed doctor down. Those days are long gone, she said. “You put your head down and move forward. You don’t want to disappoint patients or coworkers.”

This combination, she said, is a recipe for disaster in a physician community where shortages are rising at record rates. Bringing back a sense of comradery could be a real solution for physicians who are struggling and need connection, she said.


At the same time, physicians don’t reach out for help because of the stigma they believe is alive and well throughout the medical community.

“Every day, doctors choose to suck it up and don’t get the help they need,” Dr. Dowling said. “If doctors can get help earlier, without anyone knowing, it can make all the difference. The P2P Program has done this for many physicians all around New York.”

If you need someone to talk with or a physician you know is struggling, MSSNY’s P2P Program is here to help. For more information, email P2P@mssny.org or call 844-P2P-PEER (844-727-7337).

Changing Weather Patterns and the Potential Impaction Environments and People

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By Kathryn Ruscitto, Advisor

This week I had the opportunity to talk to two science experts who I have asked to be part of a panel on restoration of parks and landscapes after two recent hurricanes. The Garden Club I belong to in Florida works to raise money to restore pollinator gardens and native plantings, and we will be sponsoring a panel to help people plan for the future.

The scientists listened and observed and said, be sad for what is lost but move on. Our weather patterns are changing, and what worked in the past needs rethinking. What survived, and what didn’t, and how do you use resources and time to plan for the future.

Sobering but great advice.

Health experts are beginning to look at the issue of changing weather patterns and its impact on health as well. Research suggests more respiratory and cardiac- related chronic conditions, spread of parasites and pathogens, as suggested by increases in tick-borne diseases, West Nile and Dengue, and more foodborne illness, as suggested by the recalls we are experiencing due to outbreaks from food across the country.

For those patients who work outside, the exposure is leading to more risks related to heat and cold. Many clinicians were trained in a period where climate impact on patients was not part of anyone’s curriculum. That has changed.

The American Medical Association in November issued stronger statements on this topic:

“Climate change has adversely affected people’s physical and mental health. Climate- related risks are not distributed equally. The AMA recognizes that minoritized and marginalized populations, children, pregnant people, the elderly, rural communities, and those who are economically disadvantaged will suffer disproportionate harm from climate change.”

The American Hospital Association has developed tools for organizations to look at their behaviors and policies to promote sustainable practices and reduce environmental impacts.

It’s a broad topic that leads us to consider both personal and professional implications. How do I adjust my behaviors and even my investments of time and resources in renewable technology and research.

Sobering issues, but we should focus on what we can do individually to improve our education and actions.

Resources:
Climate Doctors: https://www.youtube.com/ watch?v=bgvMYCMy57w

•AHA Survey on Climate Change: https://
www.aha.org/news/headline/2024-01-24 survey- most-clinicians-support-hospital efforts-address- climate-change

AMA Advocacy on Climate Effects: https:// www.ama-assn.org/delivering-care/ public-health/advocacy-action-combatting- health-effects-climate-change

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

Physician Burnout: Seeing Improvement but Still a FixableCause for Medical Errors

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By: Jenn Negley, Vice President, Risk Strategies Company

Physician burnout is not a new phenomenon, but its prevalence has recently reached alarming levels. According to a 2021 survey by Mayo Clinic and Stanford Medicine, 62.8% of physicians reported experiencing burnout. While the numbers have improved, with a more recent AMA study showing that 50% of physicians are now struggling with burnout, the issue remains far from solved. The lingering effects of the COVID-19 pandemic, growing mistrust in medical science, and misinformation continue to place added stress on healthcare providers, making burnout a critical issue that affects both physicians and patients.

The Lasting Impact of Administrative Challenges

A key factor fueling burnout in physicians is the increasing administrative burden they face. Constantly changing regulations, including the often-onerous prior authorization (PA) processes, have been cited by physicians as major contributors to job dissatisfaction. The American Medical Association (AMA) has voiced concerns about PAs, describing them as a “barrier between patients and necessary care under the guise of controlling costs.” According to the AMA’s latest survey, 95% of physicians reported that the PA process either somewhat or significantly increased their burnout.

While administrative tasks are a challenge in many professions, in healthcare, the stakes are much higher. When physicians are overwhelmed by paperwork, their ability to provide optimal patient care is compromised, which directly impacts patient safety. Medical errors, which are already a significant concern, are further exacerbated by burnout.

Physician Burnout and Its Link to Medical Errors

The relationship between physician burnout and medical errors is well documented. In a study led by Daniel Tawfik and published in Mayo Clinic Proceedings, it was revealed that rates of medical errors tripled in work units where physicians reported high levels of burnout—even in units with top safety ratings. This data makes it clear: burnout doesn’t just affect physician well-being—it directly impacts the quality of care they provide.

Though healthcare systems have made progress in improving patient safety through system-level interventions, we cannot overlook the role of the physician’s mental health. If physicians are experiencing burnout, even the most well-designed systems will fail to prevent medical errors. In fact, burnout could undo many of the safety gains achieved through system-level changes. To reduce errors and improve care, we must address the root cause of burnout.

Addressing the Root Causes of Burnout

There are clear steps that can be taken to reduce burnout and improve both physician well-being and patient care. First and foremost, healthcare organizations must create a culture where mental health is prioritized. This begins by fostering an open dialogue about burnout, encouraging physicians to seek help when needed, and ensuring they have access to mental health resources.

While individual support is crucial, systemic changes are just as important. The administrative burden physicians face must be reduced by streamlining processes such as prior authorizations and cutting down on redundant tasks. Physicians should be allowed to focus on patient care, rather than spending countless hours on paperwork. Furthermore, healthcare leaders must listen to the needs and concerns of their staff, ensuring that burnout is addressed not just as a personal issue but as an organizational one.

• To make a lasting impact, addressing burnout requires collaboration among all stakeholders, including healthcare systems, insurance companies, the government, and technology providers. Solutions should include adjusting workflows, improving reimbursement rates, and eliminating unnecessary administrative barriers. If we tackle these issues, we can create an environment that supports physicians and, in turn, improves the quality-of-care patients receive.

Conclusion: Physician Burnout Is a Fixable Problem

While physician burnout rates have improved, they remain alarmingly high and continue to contribute to medical errors. This is a crisis that cannot be ignored. The good news is that burnout is a fixable problem—one that requires the collective effort of healthcare leaders, administrators, policymakers, and the broader healthcare system. By addressing the root causes of burnout, such as administrative burdens, and fostering a culture of mental health support, we can reduce medical errors and ensure that physicians are able to provide the best possible care to their patients.

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

Tackling Drug Costs In New York State

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New York Governor Kathy Hochul signed legislation amending subdivision five of Section 280-a of the New York Public Health Law (“PHL”) and announced new regulations that aim to protect New Yorkers from the rising cost of prescription medications. Both target the operations of Pharmacy Benefit Managers (“PBMs”) by prohibiting business practices that raise the cost of prescription drugs and by increasing opportunities for independent pharmacies to compete with large, PBM-affiliated pharmacies. 

What are Pharmacy Benefit Managers?

PBMs are third-party ‘‘intermediaries’ that help negotiate costs and payment of prescription drugs between the major players in the prescription drug supply chain: health insurance providers, drug manufacturers, wholesalers, and pharmacies. PBMs determine which drugs are accessible to consumers, at what cost, and often by what pharmacies. 

PBMs contract with health insurance providers to manage prescription drug benefits for insured beneficiaries. PBMs do this by creating and maintaining formularies, which are lists of prescription drugs covered by health insurance plans. Each insurance plan has a unique formulary. When creating a formulary, PBMs negotiate discounts and rebates with drug manufacturers. That determines the prices insurance plans pay for prescription drugs and payments pharmacies receive for distributing drugs to consumers insured by the plan. 

When PBMs negotiate rebates with drug manufacturers, they typically retain a percentage of the rebate as profit, rather than passing the full amount to consumers. Because prescription drugs with higher prices often have higher rebates, PBMs are incentivized to include higher priced drugs on their formularies.

PBMs also play an administrative role for insurance providers by directly reimbursing pharmacies for dispensing drugs. PBMs receive administrative fees for these services from insurance providers and profit from ‘spread pricing.’ When a PBM receives a higher payment from an insurance provider than the amount the PBM pays to pharmacies, the PBM retains the difference. Legislators have identified spread pricing as a factor in increasing costs of prescription drugs for consumers.

The Federal Trade Commission reports that only three PBMs manage approximately 80% of all prescriptions filled in the U.S and that pharmacies affiliated with those PBMs account for nearly 70% of all specialty drug revenue. Critics argue that the tightly controlled marketplace has led to increased costs to patients and the closure or sale of independent pharmacies. 

PBM Regulation in New York 

In January 2022, Governor Hochul signed a first-of-its kind law in New York, providing for licensure and registration of PBMs. The law also set new standards that PBMs are required to comply with when operating in the State. In addition to reducing costs for consumers, Governor Hochul cited increased transparency regarding PBMs’ operations as a chief goal of the law.

The State Department of Financial Services is empowered to enforce the law and can receive complaints of violations of the law by PMBs from New Yorkers, pharmacies, and health care providers.

Impact of Amended PHL and New Regulations 

On September 27, 2024, the Governor signed legislation that eliminated the ‘gag clause’ that had prohibited pharmacists from telling consumers about negative reimbursements charged to pharmacies for prescription drugs. Negative reimbursements cause pharmacies not to stock certain drugs, limiting access to essential prescription drugs for consumers. By lifting the gag clause, pharmacists can explain why they cannot stock certain drugs, and consumers can use that information to petition their health insurance provider to increase access. 

The Governor recently announced new regulations governing market conduct for PBMs that:

• allow home delivery of prescription drugs by in network pharmacies;

• mandate PBMs to publish formularies and pharmacy directories;

• require PBMs to establish customer service lines;

• prohibit PBMs from steering patients to affiliated pharmacies;

• prevent PBMs from passing losses onto pharmacies when the PBM mistakenly approves a dispensed drug;

• permit small pharmacies to submit and receive electronic communications from PBMs; and

• require PBMs to apply the same audit standards to all in network pharmacies, helping small pharmacies compete with PBM affiliate pharmacies.

The regulations, supported by the Pharmacist Society of the State of New York, are anticipated to empower consumers, increase access to prescription drugs, level the playing field for small pharmacies and lower costs of prescription drugs across the State. 

For questions, contact Lippes Mathias attorney Sarah E. Steinmann by phone at 315-477-6232 or by email at ssteinmann@lippes.com.

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.