What Do Medical Partnerships Mean For Healthcare?

Medical Center Partnerships or What’s Up Doc?

By Thomas M. Bincaniello, M.D.

Recently Stony Brook Medicine and the Mount Sinai Health System announced that they are entering into an affiliation agreement that includes collaboration in research, academic programs and clinical care.  Why one wonders would two academic medical centers that market themselves as “having it all” need to affiliate? 

They are, of course, not the first in the New York area.  NY Presbyterian and NY Hospital, each with an IVY league medical school, became one system NY Presbyterian some years back. On Long Island, North Shore University Hospital and Long Island Jewish Hospital, who were very competitive with each other, combined their hospitals into a system  North Shore-LIJ.  Recently the name was changed to Northwell.  Large systems often have smaller hospitals as part of their networks this helps to expand their base for referrals and the smaller hospitals benefit from the prestige and bargaining power of the larger system.

Affiliations or mergers advantage the systems at multiple levels – clinical, academic teaching and research. They don’t always achieve all that is desired, especially if there is a big cultural difference in the components that merge.  

Clinical advantages can include the combining of resources, elimination of duplicate competing services, larger patient bases, and more bargaining power with the payers.  Small hospitals often join these larger hospitals because alone they have little leverage with insurance companies.  On the other hand, it is difficult for an insurance company to not have a NY Presbyterian contract, which would make them less attractive to a large number of patient enrollees.  In addition, if not already part of a purchasing consortium they have a better bargaining position for prices on equipment and supplies needed for clinical care.

There is also an advantage to sharing the best clinical care processes to improve clinical outcomes.  Having a system with the resources to support standardization and quality care can make a big difference rather than trying to go it alone.

Teaching occurs at two levels in academic medical centers – students and post-graduate (residents and fellows).  At some institutions medical student teaching is governed by the medical schools.   So for example, Columbia Physicians and Surgeons and Cornell Medical College, Stony Brook and Mt. Sinai continue to have independent medical schools.  On the other hand, they may have residents in students rotate through their affiliates to take advantage of services that may be unique.

For the research mission, not only is there advantages in expanding the “brain power,” but the of sharing expensive research facilities and equipment.   Recruiting research scientists by having the combined resources and people to support the research makes such appointments more desirable for the candidates.  The prestige of the combined institutions makes them more attractive to graduate students, doctoral candidates and post-doctoral positions.    And when the research is translational (applying advances in basic research to clinical problems) have the larger patient referral base of the systems provides more potential patients for clinical trials.

As in any other business merger or affiliation, not all always goes smoothly.  The component members “cultures” may clash and old rivalries may not accept the new order.  So it may take years and a lot of effort to evolve into a smooth running system.

These partnerships can improve patient outcomes by focusing combined resources to improve care, bring new research advances to the bedside to advance care and teach medicine to future generations of providers fulfilling the Hippocratic oath to teach them this art.

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Thomas Biancaniello, MD is a Professor of Pediatrics (Cardiology) Columbia University Medical Center, Former Chief Medical Officer, Stony Brook University Hospital, Emeritus Professor of Pediatrics and Medicine, Stony Brook University

Shake Up In Trump's Campaign Has Roots In Smithtown

FYI -  THE Hill - Billionaire father and daughter linked to Trump shake-up By Jonathan Swan - 08/17/16 04:37 PM EDT

The Mercers, who previously put $13.5 million into a super-PAC supporting Ted Cruz’s bid against Trump, have recently converted the group into the Defeat Crooked Hillary PAC, targeting Democratic nominee Hillary Clinton.

Robert Mercer has reportedly made a “substantial” additional investment of at least $1 million in the new super-PAC, which has already spent $500,000 on digital ads attacking Clinton in eight battleground states. Additionally, he and particularly Rebekah have become influential figures in Trump World in the past few months. 

Rebekah Mercer “lives in a beautiful apartment in one of Trump’s buildings on the Upper West Side [of New York City] overlooking the Hudson River,” a source who knows her told The Hill. read more

Nine Eagle Scouts In Kings Park Class Of 2016

Kings Park Central School District Celebrates

Nine Eagle Scouts in the Class of 2016

Class of 2016 Eagle Scouts:  John Davignon, George Gonatas, Eric Homeyer, Thomas McGee, Matthew Meehan, Michael Messina, Mitchell Stern, Colin Tekverk, and Mark Turrisi (Dr. Eagen is also an Eagle Scout).

The Kings Park Central School District was recently informed that they have nine (9) Eagle Scouts in the graduating Class of 2016.  While less than 4% of all scouts achieve the rank of Eagle Scout, the Kings Park High School Class of 2016 has far exceeded this mark.  The scouts’ service projects have definitely made a lasting impact in their community.  You can find their handy work at the San Remo Administrative Building, Kings Park High School, Caleb Smith State Park, Lucien Memorial Church, American Legion Post 944, Sweet Briar Farm, and St. Joseph’s Church.  These young men are leaders in their school and our community.  

Two words that Dr. Eagen typically uses to describe Kings Park’s “brand” are PRIDE and SERVICE.  According to Superintendent Eagen, “I have never lived or worked in a community that is as devoted to service as Kings Park.  Whether we are raising money for cancer or ALS research, participating in “Stuff a Bus,” or attending a luncheon for blind veterans, Kings Parkers value service like no other community.”  These nine Eagle Scouts serve as fine examples of the quality of young people that graduate from the Kings Park CSD.      

Dehydration In Children Can Lead To Dizziness And Fainting

BENIGN FAINTING IN ADOLESCENTS AND CHILDREN

By Thomas M. Biancaniello MD

Having a child faint can be a freightening experience for parents.  It is more common than most think, with 15% of kids fainting before reaching the age of 18, with most occurring after puberty begins.  Fortunately it is usually not related to heart disease.  It usually results from transient falls in blood pressure due to changes in body position (also called orthostatic hypotension – low blood pressure), standing (usually still) in hot environments, acutely painful episodes or periods of fear or anxiety (also called vasovagal).   With sudden decreased filling of the heart, there is initial compensation by increasing heart rate, but then a reflex response from the brain can result in slowing heart rate and falling blood pressure.  The medical term for this is neurocardiogenic syncope.  There may be complete unconsciousness, blacking out (awake but not able to see) or visual phenomenon such as “tunnel” vision, seeing spots, or dizziness. 

Whether there is complete loss of consciousness or just dizziness and uneasiness is somewhat dependent on the state of hydration.  All of us can experience a bit of dizziness when we get up from a nap or sitting, but usually the feeling is transient.  On the other hand, if you are dehydrated without enough fluids in your body, the bottom can drop out and you can faint.  This is actually a brain protective mechanism.  When not enough blood flow and oxygen are delivered to the brain, this reflex fall in heart rate and blood pressure causes the body to “go to ground” resulting in the head, the heart and the body all being at the same level making it easier from blood to return to the heart without fighting gravity and thus restoring blood flow to the brain.

It is important to recognize that this phenomenon cannot be overcome by “fighting it”.  The person should sit or lie down immediately when the feeling comes on and get up slowly only when they feel better.  Picking a child up after fainting can actually result in a 2^nd episode.  If possible someone should get them something to drink.  Hyperventilation, which can occur whenever we are in distress, can make this worse, so kids should slow their breathing down by counting to five (5) as they exhale.

It is important to keep well hydrated and avoid precipitating conditions (like hot showers in the morning which dilate vessels and reduce blood flow back to the heart).  We encourage kids to drink 8-12 ounces of fluid with breakfast (not just the milk left in the cereal bowl!) because most people are a bit dehydrated after a night’s sleep. We need to compensate for that early in the day.  We recommend another 80 ounces during the rest of the day.  The best way to judge whether you are drinking enough is the color of the urine – it should clear or light yellow, never dark after the early morning.  More fluids are required with heavy physical activity and during hot weather.  Kids involved in sports should be encouraged to drink more fluids if the urine remains dark despite following the recommended.

When should a parent worry that something more is going on?  If dizziness or fainting occurs during the period of exertion or very shortly thereafter, further evaluation is necessary because during exercise the heart rate and blood pressure should be maintained.  If there are associated complaints of palpitations or chest pain before an episode that should also trigger further evaluation. When there is any doubt, consult your physician.

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Thomas Biancaniello, MD is a Professor of Pediatrics (Cardiology) Columbia University Medical Center, Former Chief Medical Officer, Stony Brook University Hospital, Emeritus Professor of Pediatrics and Medicine, Stony Brook University

SUFFOLK CLOSEUP - Open Your Wallet For A 12 Year Surcharge On Electric Bill

SUFFOLK CLOSEUP

By Karl Grossman

Smithtown residents, indeed people throughout Suffolk County and New York State, will be getting higher utility bills because of the State Public Service Commission this month approving—despite strong opposition—a $7.6 billion bail-out of aging nuclear power plants in upstate New York. Their owners have said are uneconomic to run without government support. 

As a result, there will be a surcharge for 12 years on electric bills paid by residential and industrial customers through the state.

Governor Andrew Cuomo—who appoints the members of the PSC—has called for the continued operation of the nuclear plants in order to, he says, save jobs at them. 

The bail-out would be part of a “Clean Energy Standard” advanced by Mr. Cuomo. Under it, 50 percent of electricity used in New York by 2030 would come from “clean and renewable energy sources”—with nuclear power considered clean and renewable. 

A Suffolk County resident, PSC member Patricia Acampora of Mattituck, joined the other three members of the commission in voting August 1 for the bail-out and “Clean Energy Standard.” She is a former state assemblywoman from Suffolk County and also ex-chairwoman of the Suffolk County Republican Party. Mr. Cuomo is a Democrat.

“Nuclear energy is neither clean nor renewable,” testified Pauline Salotti, vice chair of the Green Party of Suffolk County, at recent hearing in Riverhead on the plan. 

“Without these subsidies, nuclear plants cannot compete with renewable energy and will close. But under the guise of ‘clean energy,’ the nuclear industry is about to get its hands on our money in order to save its own profits, at the expense of public health and safety,” declared a statement by Jessica Azulay, program director of Alliance for a Green Economy, based in Syracuse with a chapter in New York City. Moreover, she emphasized, “Every dollar spent on nuclear subsidies is a dollar out of the pocket of New York’s electricity consumers—residents, businesses and municipalities” that should “instead” go towards backing “energy efficiency, renewable energy and a transition to a clean energy economy.”

The “Clean Energy Standard” earmarks twice as much money for the nuclear power subsidy than it does for renewable energy sources such as solar and wind.

Its claim is that nuclear power is comparable because nuclear plants don’t emit carbon or greenhouse gasses—the key nuclear industry argument for nuclear plants nationally and worldwide these days because of climate change. What the industry does not mention, however, is that the “nuclear cycle” or “nuclear chain”—the full nuclear system—is a major contributor to carbon emissions. Numerous statements sent to the New York PSC on the plan pointed to this.

“Nuclear is NOT emission-free!” Manna Jo Greene, environmental director of the Hudson River Sloop Clearwater, wrote the PSC. The claim of nuclear power having ‘zero-emission attributes’ ignores emissions generated in mining, milling, enriching, transporting and storing nuclear fuel.”  Further, “New York no longer needs nuclear power in its energy portfolio, now or in the future. Ten years ago the transition to a renewable energy economy was still a future possibility. Today it is well underway.”

“Nuclear power is not carbon-free,” wrote Michel Lee, head of the Council on Intelligent Energy & Conservation Policy. “If one stage,” reactor operation itself, “produces minimal carbon…every other stage produces prodigious amounts.” Thus the nuclear “industry is a big climate change polluter…Nuclear power is actually a chain of highly energy-intensive industrial processes which—combined—consume large amounts of fossil fuels and generate potent warming gasses. These include: uranium mining, milling enrichment, fuel fabrication, transport” and her list went on. Further, “New York no longer needs nuclear power in its energy portfolio, now or in the future. Ten years ago the transition to a renewable energy economy was still a future possibility. Today it is well underway.”

In opposing the New York nuclear subsidy, Dr. Mark Z. Jacobson, professor of civil and environmental engineering and director of the Atmosphere/Energy Program at Stanford University, wrote in an op-ed in Albany Times Union, the newspaper in the state’s capitol, that he was “shocked” by the PSC’s “proposal that the lion’s share of the Clean Energy Standard funding would be a nuclear bail-out.” He said “allowing the upstate nuclear plants to close now and replace them with equal energy output” from offshore wind and solar power “would be cheaper and would create more jobs.” The closure of the upstate plants “would jeopardize fewer than 2,000 jobs” while a “peer-reviewed study” he has done “about converting New York State to 100 percent clean, renewable energy –which is entirely possible now—would create a net of approximately 82,000 good, long-term jobs.”

The upstate nuclear power plants to be bailed-out under the plan would be FitzPatrick, Nine Mile Point 1 and 2 and Ginna.

Reported Tim Knauss of the Post-Standard of Syracuse: “Industry watchers say New York would be the first state to establish nuclear subsidies based on environmental attributes, a benefit typically reserved for renewable energy sources such as wind and solar.” The ‘zero emission credits’ would be paid to nuclear plants based on a calculation of the economic value of avoiding greenhouse gas emissions that contribute to climate change.” Cuomo “directed the PSC to create subsides for upstate reactors,” he wrote.  

Reuters has reported that the nuclear “industry hopes that if New York succeeds, it could pressure other states to adopt similar subsides” for nuclear plants. The headline of the Reuters story: “New York could show the way to rescue U.S. nuclear plants.”

The two Indian Point nuclear power plants 26 miles north of New York City are not now included in the plan but it “leaves the door open to subsidies” for them, says Ms. Azulay.

This would mean “the costs [of the bail-out] will rise to over $10 billion.”       

Cuomo has called for a shutdown of the Indian Point plants in the densely populated southern portion of the state, although boosting the continued operation of the nuclear plants in less populated upstate. “Nuclear has a role,” he declared at a press conference last month. “Unless we’re willing to go back to candles, which would be uncomfortable and inconvenient, we need energy generation.”

Still, the consequences of a Fukushima or Chernobyl-level accidents at the upstate plants could have major impacts. In a 1982 report, “CRAC-2,” done at Sandia National Laboratories for the U.S. Nuclear Regulatory Commission, the consequences of a meltdown with breach of containment at every nuclear power plant in the United States were estimated. These included these in upstate New York. The analysis projected “early fatalities,” “early injuries,” “cancer deaths” and “scaled costs” covering “lost wages, relocation expenses, decontamination costs, lost property, and interdiction costs for property and farmland” (in 1980 dollars). The projections for the upstate plants: for FitzPatrick (located in Scriba): 1,000 “early fatalities,” 16,000 “early injuries,” 17,000 “cancer deaths” and $103 billion in “scaled costs.”  For Nine Mile Point 1 (also in Scriba) the figures were:1,400; 26,000, 20,000 and $66 billion. For Nine Mile Point 2: 1,400, 26,000, 20,000 and $134 billion. For Ginna (in Ontario, N.Y): 2,000, 28,000, 14,000 and $63 billion. 

Andrew Cuomo’s father, the late former Governor Mario Cuomo, was a leader in the fight against the Shoreham nuclear power plant, located 17 miles from Smithtown. The plant, although completed, was stopped from going into commercial operation by governmental and public opposition. The now defunct Long Island Lighting Company had planned to build two more nuclear plants at the Shoreham site, and also four in Jamesport, further east along the Long Island Sound. 

The battle against the construction of the nuclear power plants in Suffolk focused on their dangers and especially on what was concluded in an extensive study commissioned by county government: the inability of Suffolk residents to evacuate in the event of a major nuclear plant accident.  

John V. N. Klein of Smithtown, when he was Suffolk County executive, positioned Suffolk government against the Shoreham plant following the Three Mile Island nuclear plant accident. Mr. Klein, who also had been Smithtown Town supervisor and presiding officer of the Suffolk Legislature, as county executive led a county delegation in a visit to the area around the Three Mile Island plant after the March 1979 accident at it.

With Mr. Klein’s departure from public office the next year, a leader in Suffolk government’s anti-nuclear efforts became Gregory Blass, a newly elected county legislator who went on to fill the position Mr. Klein was the first to serve in a decade earlier, legislative presiding officer. Mr. Blass commented last week that the PSC bail-out of the upstate nuclear power plants was “deeply troubling.”  He said the PSC move is “another formality that keeps Albany in step with the [nuclear] industry.”