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Doctors

Legislator William Spencer during the phone bank last weekend. Photo from Eve Meltzer Krief

Several Huntington doctors used an unusual tool this past weekend to abide by their sworn oath to do no harm — their phones — in an effort to deter passage of the Better Care Reconciliation Act, the U.S. Senate’s answer to the Affordable Care Act, known as Obamacare.

Physicians working throughout the town gathered to participate in a phone bank, calling residents in other states to try and encourage them to call their senators and protest the bill.

“The most important thing we can do right now is focus on a few key senators who will make or break this bill,” physician Eve Meltzer Krief said in a phone interview. “Senators want to hear from constituents so we’re talking to the constituents themselves. The people we spoke with this past weekend were overwhelmingly against the bill but weren’t calling their senators.”

The doctors called out of a pediatric office in Huntington and focused on West Virginia residents where U.S. Sen. Shelley Moore Capito (R) presides and had not yet declared if she would support the bill.

“When we call as physicians people listen,” Krief said. “We explain that we’re concerned, and we didn’t have one person hang up on us. Everyone listened to what we had to say. Doctors generally don’t get involved politically — I never have in my life — but this [bill] is definitely the wrong direction for American health care.”

For Suffolk County Legislator William “Doc” Spencer (D-Centerport), this event hit closer to home, as he was born and raised in West Virginia. His father was a schoolteacher in Welch, West Virginia.

Spencer said for West Virginia citizens, health care coverage is extremely vital, especially for residents who rely on Medicaid. So if the Senate’s bill is passed and Medicaid funding is cut, people there will suffer.

“The life expectancy here in Long Island is 82 years old and in West Virginia it’s 62 years old,” he said in a phone interview. “That’s the life span of a third-world country — for a place about 500 miles away from us.”

Spencer said most people he spoke to said they would call their senator after he spoke with them.

“This was very personal for me,” he said. “Most people there are going about their daily lives trying to make ends meet, and they aren’t thinking about what their officials are voting on.”

The legislator and Huntington-based doctor said he felt inspired after participating in the phone bank.

“I felt that I was making a difference not only for the people in West Virginia but also for my constituents in Suffolk County,” he said.

Although the Senate announced late Monday night they no longer had the votes to bring the health care bill to the floor, as two more Republican senators announced they would not support it, that does not mean the effort to change the current system was defeated.

“I was pleased and relieved to hear that two more senators pulled out of the bill and it was dead,” Dr. Kristin Bruning, a Huntington-based child psychiatrist who also participated in the phone bank said in a phone interview. “But when I woke up the next morning and heard about the repeal … I am very concerned.”

U.S. Sen. and Senate Majority Leader Mitch McConnell (R-Kentucky) said he now plans for the Senate to vote for a repeal alone and worry about a replacement later on.

“It feels like it’s just a desperate effort to do anything to annihilate the Affordable Care Act without careful planning,” Bruning said. “I worry that will throw the insurance industry into more disarray.”

By Victoria Espinoza

For Huntington residents, going to the emergency room just got a little less painful.

Huntington Hospital unveiled its new $53 million emergency department Dec. 13, which is capable of handling 64,000 patient visits per year. The department starts treating patients Jan. 3.

The new ED is more than double the size of the old. In total it’s 28,000 square feet, with 47 treatment spots and 12 private waiting stations where patients receive results. The facility was designed with a mission to significantly improve patient care.

“Efficiency is the idea behind this whole department,” Michael Recupero, director of patient care services in the ED said at the opening.

An entirely new system was put in place for dealing with patients from the moment they enter the building, to ensure their stay is as short and effective as possible.

Michael Recupero shows how the lighting system will works. Photo by Victoria Espinoza.
Michael Recupero shows how the lighting system will works. Photo by Victoria Espinoza.

Under the new method, patients are immediately seen by a nurse to determine if they need instant treatment in the main ED or treatment in one of the four intake rooms. The intake rooms are what Recupero calls “the game changers.”

“Traditionally you’d come in and be seen by a triage nurse, then you’d sit and wait in the waiting room for an undisclosed period of time, and then be brought to a room where you would wait some more,” he said. “Finally you’re seen by a doctor. But with this model, you’re seen by a nurse and then immediately placed in one of the intake rooms where a doctor will see you.”

The intake rooms feature a brand new lighting system that helps staff learn what step of care each patient in a room is at. The system, created by the University of Colorado, runs similar to a traffic light, but with four colors. If the light above an intake room is red, the patient is in the room and needs their vitals checked. If the red light is flashing that means vital check is complete. When the light is yellow, a provider is in the room and when flashing yellow, the provider completed their exam and the patient is ready to move. A green light indicates the room needs cleaning and flashing green means the room is clean and ready for the next patient. When flashing blue, the patient needs an EKG test done.

“It’s really amazing,” Recupero said. “With visual queues, we don’t even have to have a conversation. [A doctor] can see what’s happening in each room without anybody telling [him or her].”

On the wall of every intake room is a whip-off board with a checklist of certain tests a doctor may order.

Within the first five minutes you’re getting orders done,” Recupero said.

One of the private waiting results stations. Photo by Victoria Espinoza.
One of the private waiting results stations. Photo by Victoria Espinoza.

He explained the ED is spilt into half of an emergency department and half of an urgent care center. Patients with less serious illnesses are taken to “super track” spaces where they quickly get antibiotics, or an X-ray, and are then sent to one of the 12 results waiting areas, which are private cubicles with lounging chairs and floor to ceiling windows.

The main part of the department will be divided into an east wing and a west wing, with a nurse’s assistant, doctor and three nurses on each side. Another doctor is designated to the trauma area, which deals exclusively with patients in extreme conditions.

Recupero said other standout features in the new ED are a pediatric wing that can treat up to nine children at once, a radiology section exclusively for the ED — meaning no other departments are allowed to take time away from ED patients to use the machine — a dedicated Ob/Gyn area and a behavioral health area.

Michael J. Dowling, the CEO of NorthWell Health, of which the hospital is a member, said the hospital plans to apply for level three trauma designation in 2017.

“It’s a new beginning here,” he said at the opening. “This is just a wonderful example of what you can do when a lot of people put their efforts together and have the communities and patients interests forefront.”

Leonardo Huertas, chairman of emergency services for the hospital, said the new treatment style at Huntington Hospital will be a win for patients.

“The emergency department leadership has envisioned a way to best care and manage our patients,” Huertas said. “The new ED was designed with an eye for innovation. We wanted to change the traditional sequential process which is riddled with bottlenecks and delays.”

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Convenient, cost-efficient medical care offers today’s patients flexibility

It’s midnight and you wake up with a stabbing earache. Or you’re suffering an indescribable stomach pain. It’s not so bad that you need to see a doctor now, but you’re still worried about it.

Twenty years ago, the next logical step would have been to trek out to the local emergency room —a feat both time-consuming and costly. Today’s patient, though, is likely turn to an urgent care center for medical attention.

A convenient middle ground between the ER and scheduling a visit with your primary doctor — where wait times for an appointment only seem to grow — more and more people are frequenting urgent care centers, where patients can be treated for anything ranging from sore throats to minor lacerations requiring stitches. And on Long Island, business is booming.

“There has definitely been an increase in the number of urgent care centers that have been opening up around the area,” said Dr. Gerard Brogan, executive director of Huntington Hospital.

North Shore-LIJ Health System, of which Huntington Hospital is a member, has jumped into the business of urgent care centers themselves. The system announced last November that it was opening 50 GoHealth Urgent Care centers in the New York-metropolitan area over the next three years.

The centers, which are open on nights and weekends, serve as a “portal of entry” into the health system’s 18 hospitals and more than 400 outpatient physician practices throughout New York City, Long Island and Westchester County, according to a news release announcing the initiative last year.

“People are busy. They really don’t want to wait a long time to be seen and cared for. As long as the care is of high quality — whether it’s in urgent care centers or the ER fast track — it really doesn’t matter, as long as they’re getting the right care at the right time and it’s part of a coordinated comprehensive primary care program.” — Dr. Gerard Brogan, executive director of Huntington Hospital

Brogan said the rise of urgent care is a “recent phenomena” on Long Island, as much of the country has already seen this boom. At Huntington Hospital, the facility’s “fast track” area in the ER serves as an urgent care center, offering the same convenient hours centers do, but with the backup of an entire hospital. The hospital added this service to its medical repertoire about seven years ago, he said.

“The patients want that,” Brogan said. “People are busy. They really don’t want to wait a long time to be seen and cared for. As long as the care is of high quality — whether it’s in urgent care centers or the ER fast track — it really doesn’t matter, as long as they’re getting the right care at the right time and it’s part of a coordinated comprehensive primary care program.”

Convenience and an increased need in the marketplace is why urgent care centers have grown nationally, according to Dr. William Gluckman, of FastER Urgent Care in Morris Plains, New Jersey. Urgent care isn’t a new thing, though — the concept has been around for 20 years, and many of these facilities are mom-and-pop operated. “I would say we’ve certainly seen a large boom in growth nationally and locally in the northeast over the last five years,” he said.

A downside Brogan said he could see with the proliferation of urgent care centers is when patients use them in lieu of primary care, missing out on important health screenings, for example, “that would be very important to maintaining high quality, cost effective care,” Brogan said.

At GoHealth, patients of the North Shore-LIJ Health System stay within their network, meaning the various hospitals and doctors all communicate with one another, no matter where the patient goes for service, Brogan said.

Urgent care centers aren’t looking to be the next primary doctor, though. Calvin Hwang, of CityMD, which operates 16 urgent care centers on Long Island, said the company would be at 54 locations by this year, which include the five boroughs and New Jersey. Hwang, who is the first non-physician executive of CityMD, said the urgent care company urges patients to find a “medical home” in a primary care physician.

“We’re not trying to take over primary care groups,” he said. “They do feel that we’re taking their patients away and they’re threatened by us. We’re actually trying to make them more efficient. And the same thing with ERs. We’re trying to make them more efficient. We believe that urgent care has a role in the overall medical care system.”

Urgent care isn’t going away anytime soon — the market is growing, especially on Long Island, he said. CityMD will see more than one million patients this year, he said.

Asked how he sees urgent care transforming in the future, Hwang said he felt even the word “urgent” would get redefined, conforming to the needs of the customer. It could mean video chatting via cell phone with a doctor to see if something’s okay.

“The way the millenials [are] consuming health care is completely changing,” he said. “It’s going to evolve.”

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By Melissa Arnold

Imagine this: You’re out with friends at a barbecue and wake up the next day with an unusual rash. On top of that, you’re just not feeling well.

Most people would head to a nearby urgent care center, emergency department or doctor’s office to get checked out. In all of these situations, though, you’re probably in for a wait of several hours. And in the case of a doctor’s office, you might have to wait a few days or even longer to be seen.

But what if you could take a picture of that rash with your cellphone and text it to a doctor, who responds right away with advice before calling in a prescription? Even better, what if you could do that at any time, seven days a week?

Such direct access to a doctor isn’t just a fantasy anymore. It’s a type of care called concierge medicine, and it’s spreading rapidly across the country.

Concierge practices come in several different forms, but in all cases, patients pay an annual or semi-annual fee to their physician, even if they don’t visit the office. In exchange, patients are guaranteed shorter wait times, longer, unrushed appointments and 24/7 access if a problem arises.

The fee varies widely depending on the location of the practice and the services they offer. Some physicians will also charge based on a patient’s age or medical status.

Dr. Bruce Feldman works independently, traveling throughout Long Island and occasionally elsewhere to meet his patients at their workplace, home or another location.

“My preferred population is an executive or professional who is too busy to go to the doctor. I go directly to them,” said Feldman, who also has offices in Melville and Port Washington. “If a guy is making a fair living, the idea of driving to the doctor and having to spend time waiting usually doesn’t sit well. And yet they want to be successful at their jobs and function at an optimal level.”

Feldman does have patients come in for an initial physical, but as he gets to know them, care becomes less about face-to-face contact and more about communicating by phone or email as needed.

The biggest difference between concierge and traditional medical care, Feldman said, is the focus on preventing future health issues instead of attempting to resolve existing problems.

Both Feldman and Dr. Vasilios Kalonaros of Northport agreed that preventative care is lacking in traditional medicine, and patients are suffering for it.

“When you’re only given 15 minutes with a patient, it’s like putting your finger in a dam — you can’t always take the time to treat every issue,” Kalonaros says.

Small practices are a hallmark in concierge medicine. Most doctors limit themselves to a few hundred patients, allowing for longer visits.

Before Kalonaros made the switch to concierge medicine eight years ago, he was seeing up to 40 patients a day. Now, it varies between eight and 12. Feldman sees about four patients each day, with only 60 patients total.

And statistics show that a doctor with time to spare makes a difference for patients. According to MDVIP, a private network of physicians that includes Kalonaros, concierge patients are hospitalized 72 percent less than those seeing a traditional doctor. In addition, the American Journal of Managed Care reports that concierge medicine ultimately saves the health care system more than $300 million in Medicare expenses.

Its popularity appears to be growing, too. There are now hundreds of concierge doctors throughout the country, and more than 20 on Long Island alone.

Before choosing a concierge doctor, it’s best to determine exactly what you want. Are you looking for a doctor who takes your insurance, does house calls or has inexpensive fees? Answering these questions will help narrow the field.

Then, ask for a consultation. Use that time to get to know them, learn about their services and determine if he or she is a good fit for your needs.

Fees vary widely in the concierge world, from under $2,000 annually to more than $20,000.

Concierge medicine is familiar to some, thanks to the USA Network’s medical drama series “Royal Pains.” The show follows a cardiac surgeon who becomes a private physician for the wealthiest residents of the Hamptons.

While some of the show’s themes are accurate, its sole focus on upper-class patients is just a stereotype.

“Most of my patients are not wealthy — they are middle and lower-middle class,” Kalonaros said. He added that a concierge doctor can be a great option for those with minimal or no insurance, because his $1,650 fee guarantees access to him at any time.

And Feldman argues that when you don’t get sick in the first place, this model will save you money that would be otherwise spent on medication or more extensive treatment.

But both doctors are quick to admit it’s not the best option for everyone.

“If you have a good relationship with your existing doctor, you don’t need a concierge doctor. But if you’re frustrated or not getting the care you need and are willing to pay more, a concierge doctor might be for you,” Feldman says. “It’s about having a partner in your wellness.”

For those interested, contact Dr. Bruce Feldman at (646) 801-7541, www.mypersonaldocny.com, and contact Dr. Vasilios Kalonaros at (631) 239-1677. Or visit www.mdvip.com to learn more about concierge medicine on Long Island.

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A view of a healing garden at Mather Hospital’s new pavilion. Photo from the hospital

New facilities at John T. Mather Memorial Hospital aim to reduce infection rates and bring more doctors to the area.

The Port Jefferson hospital recently dedicated its new Arthur & Linda Calace Foundation Pavilion, adding more than 28,400 square feet of space to the north side of the hospital that is being used to house patient rooms as well as medical offices and conference rooms.

According to Mather spokesman Stuart Vincent, there are 35 one-bed rooms in the new pavilion. Rather than using the space to add to the hospital’s 248 beds, beds were moved from existing double rooms into the new pavilion, creating 70 new single-bed patient rooms throughout the hospital.

A view of a patient bedroom at Mather Hospital. Photo from the hospital
A view of a patient bedroom at Mather Hospital. Photo from the hospital

Taking away those 35 double rooms and adding the 70 single rooms means “for the first time, the majority of rooms at Mather are now single-bedded, which aids in both patient healing and in reducing the risk of infection spreading among patients,” Vincent said in an email.

The patient rooms in the new pavilion will be used for intermediate care and will each have their own medication cabinet and a computer for managing patient information, according to Vincent. The unit also keeps nurses close to patients, with nursing stations throughout the floor.

Joseph Wisnoski, CFO at Mather, said in a previous statement, “A single-bed patient room is no longer a luxury, but the standard for hospitals across the nation.”

That patient unit is located above two floors of new offices and conference rooms and a 180-seat conference center. When the hospital broke ground on the expansion project two years ago, officials said the office space would be used to combat a shortage of primary care physicians by training more of those professionals — who would then hopefully stay in the area — in a graduate education program that includes seminars and symposia.

The pavilion is Mather’s first expansion in more than a decade, and Vincent said it is the sixth expansion since the hospital opened in 1929. It was named for Arthur and Linda Calace, the primary donors on the project, who raised their family nearby and wanted to give back to the community. The Calaces and other donors combined to cover $5 million of the total construction cost.

Dr. Frederick Schiavone with emergency medicine residents in the Clinical Simulation Center. Photo from Melissa Weir

Stony Brook is sending some fresh faces to one of its neighboring hospitals.

Earlier this month, Stony Brook University Hospital heralded in a new partnership with John T. Mather Hospital that will transition the Port Jefferson facility from a community hospital into an academic teaching hub. But that doesn’t mean Mather will be losing its community-centric feel, hospital officials said.

The partnership began in 2012 when Mather officials started seeking advice from Stony Brook Medicine on how to establish a new graduate medical education program, and quickly evolved into Stony Brook Medicine’s sponsorship of the program. Mather welcomed its first class of 19 residents studying internal medicine in July 2014 and it has been all-systems-go ever since. And if all goes well, Mather said it aspired to reach 100 residents at the end of five years.

“It’s an investment in the future,” said Dr. Joan Faro, chief medical officer at Mather, who works as the site’s designated institutional officer for the graduate medical education team and initially reached out to Stony Brook Medicine to explore the partnership. “Our standards will be as high, or even higher, as they have been as they are passed down, and we are so fortunate to take advantage of [Stony Brook Medicine’s] expertise and guidance.”

Under the new system, Stony Brook’s graduate medical education program reviews Mather’s selections for residency program directors and then Faro sends recommended candidates back to Stony Brook. The candidates are then interviewed and authorized for appointments. When Mather residents graduate, they will receive a Stony Brook University Hospital crest alongside the Mather crest on their graduation certificates.

With Stony Brook Medicine’s help, Mather has instituted its own de facto recruiting system for promising prospects in the medical arena. By inviting residents into Mather, the hospital is not only ingraining its culture into the learners at an early stage, but it is also setting them on a path that could potentially lead to long stays working there, Faro said. And with the recent opening of a new 35-bed facility on the Mather campus, the time could not be better for residents to be learning on-site.

Dr. Frederick Schiavone, vice dean of the graduate medical education program at Stony Brook Medicine, teamed up with Carrie Eckart, executive director of the same program, to help transition Mather into an academic teaching hospital over the past year and said it could not be going more smoothly, as Mather’s staff steps up to new teaching roles.

“It’s a passion,” Schiavone said. “People like to teach, love to teach. It’s built into what being a doctor means. When residents thank us for helping teach them, you couldn’t ask for a better reward.”

One of the benefits of becoming a teaching hospital for Mather, Faro said, is that the staff are required to stay on top of the latest developments in medical education and training, which means that Mather’s patients receive advanced methods of health care delivery. Schiavone said the affiliation was ideal for Stony Brook Medicine as it allows staffers to train residents from the beginning as they are brought up throughout the system.

“We need to reach out to our community,” Schiavone said. “The focus is always to deliver the best health care in Suffolk County. Mather’s success is our success.”

And by putting collaborative patient care at the center of the model of delivering health care, Schiavone said Stony Brook Medicine was benefitting from having more residency spots to dole out.

Having residents under the same roof as Mather’s experienced medical professionals would only raise the level of care the community hospital provides by reinforcing the facility’s standards, Faro said.

Editor’s note: This version of the story was updated to correctly reflect the number of residents Mather has taken in as its inaugural class.

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A group of new Stony Brook medical students display their first stethoscopes, donated by the school’s alumni association. Photo from Stony Brook University School of Medicine

The 132 first-year students of the Stony Brook University School of Medicine Class of 2019 — the largest ever in the school’s history — officially began their training with the school’s annual White Coat Ceremony.

At the Aug. 23 event, the incoming medical students received their first physician-in-training white coats and took the Hippocratic oath for the first time. The Class of 2019 is a talented and diverse group coming from New York State, eight other states, and around the world.

Only 7.4 percent of the total 5,255 applicants were accepted. A larger portion of students in this class, compared to previous incoming classes, already have advanced degrees. A total of 23 hold advanced degrees, including one Ph.D., one Doctor of Pharmacy, 18 masters’ and three Masters in Public Health.

“Today is a celebratory and symbolic day for all of you. As you receive your first white coats, enjoy the honor and responsibility that comes with wearing the white coat,” said Kenneth Kaushansky, senior vice president of Health Sciences and dean of the School of Medicine. “Medicine is a field unmatched in the range of emotions you will experience. You will be struck by many firsts — your first newborn delivery, your first sharing of a diagnosis of cancer, the first patient you will see cured, and your first patient death. And never forget that your journey will require lifelong learning, as you take part in many advances in the art and the science of medicine in the years to come.”

Among the many accomplished members of the Class of 2019 include Tony Wan, the son of Chinese immigrants, who enlisted in the U.S. Marine Corps right after high school. He served two tours in Iraq — where his duties included providing first aid to fellow soldiers.

He then left the military and pursued college at CUNY-York College, where he graduated as class valedictorian in 2012. After seeing too many of his fellow Marines with life-changing injuries, he’s motivated toward becoming a neurologist specializing in traumatic brain injuries. Wan said he particularly wants to work to improve the care of veterans.

Persis Puello, a mother of two and the oldest incoming student, at 34 years of age, is also part of the 2019 class. She earned advanced degrees from Columbia University, a Master of Science in Applied Physiology and Nutrition; and from Stony Brook, a Master of Science in Physiology and Biophysics. Her career as an athletic trainer and nutritionist inspired her to work toward becoming an orthopedic surgeon and, eventually, a team doctor.

She credited support from her husband and her sister for enabling her to raise her two young children, ages 3 and 8, while pursing the challenge of a career in medicine.

Nicholas Tsouris, who grew up in Stony Brook and is a former professional lacrosse player, was part of a team of fellow students hailed by Popular Mechanics magazine as “Backyard Geniuses” for their invention of a spoke-less bicycle. After graduating from Yale, he worked on Wall Street while playing major league lacrosse, later deciding to pursue medicine.

The school has steadily increased its incoming class size over the past several years in order to address the significant shortage of physicians nationally, as cited by the Association of American Medical Colleges.

New to the ceremony this year was the presentation of a stethoscope to each student to accompany with their white coats. The school’s alumni association donated the 132 stethoscopes for the event.

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