A unified medical staff

They’re called “mirror committees.” As of February, members of the medical staffs of Benedictine and Kingston hospitals are meeting to make decisions for one hospital. After they adjourn that meeting, the same staff immediately holds a meeting to make the identical decision for the other hospital.

Strange but true. According to the state-sponsored agreement that brought the Kingston hospitals under the same administrative umbrella three years ago, Benedictine and Kingston hospitals aren’t allowed to merge their medical staffs. Nevertheless, a couple of months ago they elected a first-ever unified set of medical officers and physician department heads.

According to anesthesiologist Dr. Martin Cascio, an ex-officio member of the HealthAlliance board of directors and now the first president of the unified medical staff, the medical staffs of the two hospitals meeting separately proved an increasingly cumbersome and repetitious arrangement, with many of the same participants in both meetings.

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Doctors are busy people. “We had so many meetings in the past couple of years,” reported Cascio. “It was a waste of everyone’s time.”

In his unpaid but lofty position, Cascio acts as liaison to the medical staff. His job is to get feedback from the staff and to incorporate the staff in HealthAlliance strategies for encouraging best practices. “If you can get the feeling of team,” he said, “everyone buys in and feels validated.”

Cascio sometimes has mixed emotions about his administrative responsibilities. “It’s great,” he said, “but it’s really hard.” He likened the job of leading doctors to herding cats.

The other new officers include doctors Mark Josefski (vice president), Fabio Danisi (secretary) and Richard McNally (treasurer).

HealthAlliance of the Hudson Valley’s CEO Dave Lundquist expressed support for the new arrangements in a press release. “We applaud and support the efforts of our physicians to work effectively together in providing the physician leadership necessary to establish excellence in our health-care services,” he said.

Dr. Frank Ehrlich, chief medical officer for HealthAlliance, was similarly positive, calling the unified structure “an enormous boon” both to medical functionality and to the interface between administration and physicians. “We have two sets of customers,” said Ehrlich about HealthAlliance, “patients and doctors.” As the only physician on the organization’s executive team, Ehrlich often communicates with Cascio and other members of the doctors’ executive committee.

HealthAlliance is in the beginning steps of creating clinical integration, which can be defined as a connected community of health-care providers sharing patient information, streamlining administration, and increasing the potential for high-quality heath care. The goal is often associated with the increased sharing of computer information in various locations through a secure web portal.

Best practice

Meanwhile, the department heads at HealthAlliance are striving to build and follow best practices within their departments, striving to achieve ever-higher standards of patient care.

“It’s like following a checklist. Sometimes following a checklist doesn’t go well with original thinkers,” conceded Cascio. But studies have shown that repetition of details constitutes the core of best practice. He compared the job of a doctor to that of a pilot: It’s often not good enough to be right 99 percent of the time, he said.

Building a high-quality medical staff, said Cascio, begins with a focus on improving quality. That’s accomplished among other ways by careful attention to recruitment and credentialing. There are two paths leading to the provision of new medical services at HealthAlliance. In some cases, the administration sees an opportunity and reaches out to the medical staff to explore it. In others, physicians discuss opportunities they see with Cascio and other medical staff.

In one example, Cascio worked with Orthopedic Associates of Dutchess County in another institution. This relationship helped lead to one between Orthopedic Associates and the administration of HealthAlliance. A contract was negotiated by which the Dutchess-based partnership would provide on-call emergency orthopedic services in Kingston. Orthopedic Associates, whose website lists 26 physicians, is now occupying a renovated facility on Ulster Avenue, and performs a lot of surgery in Kingston.

Eleven medical department heads were selected at HealthAlliance in February. Fareed Fareed is head of the emergency department, John Anderson is head of family practice. Donald Louie is chair for anesthesiology, Joseph Christiana for internal medicine, Bruce Moor for radiology, and Gerald Kufner for neurosciences. Dominique Delma is chair for obstetrics and gynecology, Casey Rosen-Carole for pediatrics, Richard McNally for pathology, and Carlos Valle for psychiatry. Stephen Maurer and Darren Rohan are co-chairs for surgery.

Dr. Cascio signed contracts to provide anesthesiological services for both hospitals separately back in 1997, when he moved to Rhinebeck. He has served on the executive committee at Benedictine Hospital and was vice-chair of medical staff there.

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