Pathways to Excellence URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
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WINTER 2019
Supporting Community Care F.F. Thompson Hospital draw sites will undergo consolidation and integration with URMC
Rural hospitals across the U.S. are increasingly aware of the pressures that threaten the viability of their clinical laboratories. Since passage of the Protecting Access to Medicare Act (PAMA), which changed the way Medicare reimbursement rates are calculated, hospitals of all sizes have seen their reimbursements steadily decline. But the burden has fallen more heavily on smaller rural hospitals who struggle to stay afloat amidst the changes. For this reason, more local affiliate hospitals are sending non-
acute laboratory work to the University of Rochester Medical Center to avoid slipping into negative financial margins. “There were very drastic cuts to how we get paid for doing the work that we do,” said Melissa Allen, director of operations for Pathology & Laboratory Medicine at URMC. “By centralizing, you are ultimately sending the work to the place that has the lowest cost per test and therefore increases the margin to the system.” Over the last decade, the Medical Center has expanded its reach within Western New York, partnering with affiliate hospitals across the region. Highland Hospital became the first fully-integrated affiliate hospital nearly 15 years ago. Thompson Health and its flagship hospital located in Canandaigua, N.Y. officially became a URMC affiliate in 2012. In the years that followed, other health systems did the same; Noyes Health in Dansville, Jones Memorial Hospital in Wellsville, both in 2015, and St. James Hospital in Hornell in March of 2018. Starting in January of this year, F.F. Thompson Hospital (FFT) will fully integrate with UR Medicine Labs. This means all outpatient specimens from their patient service centers and work collected at their associated provider offices will be sent to URMC for testing while FFT continues to perform all on-campus, inpatient and ED testing onsite. (Continued on Page 3.)
IN THIS ISSUE From the Chair.................................................................. 2
Research News ................................................................. 5
Supporting Community Care ............................................ 3
Years of Service ................................................................ 5
In Memory........................................................................ 4
Focus on Faculty ............................................................... 6
CHAIR’S COLUMN
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“Our laboratories are bursting with energy and productivity.”
am sitting and writing this during a good snowstorm, probably ensuring a white Thanksgiving here in Rochester. Despite the chilly autumn, the department continues to flourish and to be full of energy. The construction of the UR Centralized Laboratory at Bailey Road is nearing completion and will likely be ready for our initial move in before the end of the winter. Thereafter, there will be several months of very busy validation exercises, and by the summer, our new laboratory facilities will be fully functioning. Despite the trepidations, I think that the majority of our workforce sees the necessity for our re-location, as well as the possible advantages to the change. Similarly, our consolidation of laboratory work across the enterprise of affiliated hospitals is continuing quite smoothly. We have developed an organization within our department that is getting better at bringing on new business from new contributors with each successive encounter. The process has been a transformation in the culture from a department that provided the clinical service needs for Strong Memorial Hospital to one that is providing similar clinical services for a network of affiliated hospitals, nonaffiliated hospitals and myriad patient service centers, physicians’ offices and nursing homes. Our laboratories are bursting with energy and productivity. Our educational and research missions have not been overlooked. Our current crop of residents and fellows is as good as any that I can recall. They are quite enthusiastic about the new programs and the depth and breadth of material from which to learn. Working with our faculty, record numbers of abstracts were submitted to and accepted by the USCAP for their upcoming annual meeting. I would like to publicly congratulate Drs. Jennifer Findeis-Hosey and Bradley Turner who were both recently promoted to the rank of Associate Professor. They are burgeoning stars within our department and are taking on increasingly central roles in shaping the department of the future. I am so pleased that their hard work has been recognized and rewarded by the institution. I would also like to welcome two new faculty members, Dr. Li Liu, who is the new associate director for Chemistry and Dr. Rajnish Bharadwaj, who has joined our Neuropathology group. Welcome, and we look forward to working with both of you! We continue to be actively recruiting, hoping to keep up with the pace of the growth in work. Many impressive and promising young candidates have been traveling to Rochester in hopes of finding their ideal job within our department. We remain optimistic that we will again be successful in recruiting future (and present) stars into our department.
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SUPPORTING COMMUNITY CARE (CONT.)
“Our team will still be servicing the patients. They are the ambassadors of healthcare in this area and that will continue.” - Kurt Koczent, executive vice president and COO of Thompson Health
As part of this transition, URMC will take over management of six FFT patient service centers, which include sites at Farmington, Lima, Macedon, Mendon, Newark and Victor. Staff at all but three sites will formally become employees of URMC. Those at Newark, Farmington, and Lima will remain FFT employees under a UR Medicine Labs management contract. In the future, URMC will look at finding new PSC space that meets requirements for UR Medicine Labs ownership, as outlined by the NYS Department of Health. This transition will take place just ahead of FFT’s shift to URMC’s technology platforms – SoftLab and eRecord – which will bring them into a single, unified reporting system. They plan to go live with both on Feb. 3. Erin McNeil-Szostak, director of laboratory services for Thompson Health, says that using the same software in the lab will ensure consistency across the care network, starting with testing reference ranges. “If I’m a doctor looking at a glucose result, whether it comes from Canandaigua or Rochester, the normal range needs to be the same,” she said. “We were moving in that direction anyways as an affiliate but this consolidation has really kicked that into high gear.” She said the main benefit of consolidating testing to UR Medicine Labs is that it allows FFT and other affiliates to remain financially solvent while preserving access to care for local residents. “We can keep those patients here in our community where their families are,” she said. “That’s the biggest thing.” The consolidation makes financial sense, but it still doesn’t answer the question – will FFT and its patient service centers still 3 URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
feel the same for visitors and staff? Maintaining the culture that they have worked to establish over the years is essential to this initiative’s success, says Kurt Koczent, executive vice president and COO of Thompson Health. “The patients can still expect the compassionate experience they have always had,” he said. “Our team will still be servicing the patients. They are the ambassadors of healthcare in this area and that will continue.” He added that through the partnership, FFT is looking to gain synergies with staffing. “As the supply of medical technologists has impacted laboratories statewide, being able to share resources with our affiliate hospitals has become more essential,” said Koczent. The central lab at Strong Memorial Hospital – which will this year relocate to its own headquarters at Bailey Road – has the staffing and automation capabilities to help relieve the burden for smaller labs like that of FFT. Many see the consolidation as a win-win. With URMC as the central lab, the overall reimbursements and positive margin will go back to the health system as a whole, including affiliates. At the end of the day, McNeil-Szostak says consistency in access and quality of care is what patients and their healthcare team wants most. “The feel of a community hospital is different from that of a medical center,” she said. “The sign on the door is changing but because staff are staying put, that will put regular patients who are ‘frequent flyers’ at ease because they still see the people they want to see there.”
IN MEMORY: LINDA CRANDALL (1973-2018) Linda Crandall was a mainstay and friend to many in our department for more than four decades. She passed away at the age of 69 in April 2018 – at which time Linda had worked in Pathology for 42 years. Her colleagues and friends have shared fond memories of working alongside her. Born in Watertown, N.Y., she studied to become a math teacher and moved to Rochester with her husband Peter, in 1975. Not long after that, she joined the University. She worked in Neuropathology, where she served as supervisor until the office later merged with Autopsy in the mid-1990s and she led that office for the duration of her career. Former colleague Tina Blazey worked closely with Linda over the years, and the two became good friends. Blazey said that at work, Linda was always calm in the midst of chaos and willing to help others.
“When you needed something, Linda was always right there.” - Tina Blazey, friend and former colleague “She was an encyclopedia of knowledge and if she didn’t know the answer to something, she would find out. She never looked stressed – she always looked cool as a cucumber.” Her poise and discipline carried over into other areas of Linda’s life. She managed to finish nursing school while working full time and jointly raising her two sons, Sean and Erik. Blazey noted that family was always most important to Linda, who had a sparkle in her eye whenever she spoke about them. Dr. Leon Metlay, an autopsy pathologist, says he and others miss her presence in the office – and not just because she was highly organized and knowledgeable. “She was just an amazing person,” said Metlay. “Her office was packed with stuff from the beginning but everything was within reach and she knew where everything was,” he said. “She was better than email for getting a message to somebody.” Not only was Linda efficient, she had a great sense of humor. Metlay recalls a time, many years ago, when the hospital required departments to buy their own scrubs. “The autopsy service had a problem at that time of people from other areas coming through the morgue and helping themselves to our supplies (gloves, aprons, etc, as well as scrubs),” said Metlay. “Linda chose to buy prison-jumpsuit orange scrubs
for us. She told us she figured people would be less likely to steal them.” Outside of work, she had three granddaughters – photos of whom covered the walls of her office. She and her husband, who lived in Gates, owned a sailboat when their children were young and enjoyed spending time on it together. Toward the end of her life, Linda suffered from ALS – a neurodegenerative disease that caused her to gradually lose her speech. She continued to work while caring for her husband at home. It’s because of her hard work that the now-combined autopsy and neuropathology service lines are set up for success. Blazey, who is now retired, says her devotion – not just to the job, but to the people she worked with – will be what others remember most about her. “When you needed something, Linda was always right there,” she said.
THANK YOU FOR GIVING BACK We are grateful for philanthropic support that allows us to maintain and accelerate clinical, educational, and research initiatives. To make a tax-deductible gift today or as part of your estate plans, please visit www.pathology.urmc.edu and click the “Make a Gift” button, or contact Matt Haag at (585) 276-3638 or matthew.haag@rochester.edu. 4 URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
BREAKTHROUGH IN AML RESEARCH MAY STEER GENE-TARGETED THERAPY A collaborative Wilmot Cancer Institute study led by researchers from Pathology & Lab Medicine uncovers how a single gene could be at fault in acute myeloid leukemia (AML), one of the deadliest cancers. The breakthrough offers hope that a gene-targeted therapy could improve AML survival rates. The gene, known as EVI1, rewires the entire panoply of blood-forming cells and tissues by binding to certain DNA molecules and wreaking havoc. Knowing where EVI1 locks into the genome helps scientists understand the mechanisms that drive the disease at its core. Now, researchers can envision a new approach to treating AML, focused on blocking EVI1’s ability to bind to other genes, according to the study, published in Nature Communications. “It’s not so pie-in-the-sky anymore to think we can interrupt the process within the genome that leads to leukemia,” said senior author Archibald Perkins, M.D., Ph.D. professor of Pathology and Laboratory Medicine at URMC. Co-senior author Yi “Stanley” Zhang, Ph.D., is a research associate professor of Pathology and Laboratory Medicine. Wilmot investigators and co-authors
Laura Calvi, M.D., and James Palis, M.D., and those who work in their labs, contributed substantially to the latest insights, Perkins said, by offering new perspectives on the hematopoietic system. The collaboration allowed the Wilmot team to discover the importance of what happens after EVI1 is over-expressed and turned on permanently. Funding was provided by the National Institutes of Health, NYS Stem Cell Science, the Wilmot Cancer Institute, and the Clinical and Translational Science Institute at the University of Rochester. Other URMC contributors include: co-first authors Edward Ayoub, a Pharmacology graduate student in Perkins’ lab and Michael P. Wilson, Ph.D., a postdoctoral research associate in the Perkins lab; Kathleen McGrath, Ph.D., research associate professor in Pediatrics and in the Center for Pediatric Biomedical Research and a longstanding member of Palis’ lab; Allison Li, a graduate student in Calvi’s lab; and Benjamin Frisch, Ph.D., research assistant professor in Medicine and a member of Calvi’s lab. -Leslie Orr
RECOGNIZING AND CELEBRATING MANY DECADES OF SERVICE More than 80 staff were celebrated at the department’s annual Years of Service Recognition Luncheon held at Helen Wood Hall on Nov. 9, 2018. This event, held annually, honors staff who have surpassed a work milestone of 10 or more years in Pathology & Laboratory Medicine. The 83 employees collectively banked more than 1,600 years among them. Congratulations, honorees, and thank you for all you have done and continue to do!
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URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
Department of Pathology and Laboratory Medicine University of Rochester Medical Center 601 Elmwood Avenue, Box 626 Rochester, NY 14642
FOCUS ON FACULTY: AARON HUBER, D.O. Dr. Aaron Huber has become a familiar face to many in the department. He was a GI fellow (2013-14) and later joined the GI faculty in 2015. Much like his personal journey, his professional journey involved a lot of moving from place to place. Aaron was born in Oxford, Mississippi. His father was a pharmacist, medicinal chemistry professor and researcher who moved their family around, from Louisiana to Texas, Michigan, and Florida. Aaron started his education as an undergraduate at the University of Mississippi, where he earned his pharmaceutical sciences and doctorate degree (Pharm.D.). He married his wife, Traci, and worked briefly as a pharmacist while she finished school. They then moved to Kansas City where he attended medical school at the Kansas City University of Medicine and Biosciences College of Osteopathic Medicine. It was there that Aaron says he was inspired to go into pathology by the charismatic Dr. Ed Friedlander, known by many as “The Pathology Guy.” Friedlander was just one of many mentors who helped steer Aaron toward a future in pathology. Aaron earned his D.O. in 2004 and moved to Maryland for an internship at Walter Reed National Naval Military Medical Center. He then went to the west coast for his residency at Naval Medical Center San Diego. In 2010, after Aaron had recently finished his residency, he was deployed to Afghanistan and served as a military doctor for
seven months. While there, he did general practice at a base and participated in medical outreach to some of the nearby villages. He says despite the dangers of working in a war zone, it was a great experience that gave him a fresh perspective. “It’s a different world,” he said. “I guess it makes you feel a bit more grateful for all that we have.” Upon returning to the U.S. he went back to San Diego and practiced pathology at the Naval Medical Center for four years. He then came to URMC as a fellow, worked for a year in private practice, and returned when a faculty position became available. Today, he is part of the clinical service in GI, which is one of the busiest in the department. Aaron is also the director of the GI fellowship – coming full circle at URMC. He is very active as both a collaborator and mentor on research projects with colleagues and trainees, though he’s quick to point out others on the team who do the same. “As far as our [GI] group goes, we have a lot of collegiality and work together on many things, which makes the work a lot better,” he said. Research wise, he has a special interest in mesenchymal polyps, which he describes as small, incidental, benign GI polyps that differ from more common epithelial types. He and Dr. Diana Agostini-Vulaj (also a GI fellow-turned-faculty) are working on a series of studies on this topic. He has also collaborated with Dr. Christa Whitney-Miller on HER2 in gastric and GE junction cancers and will likely explore that further in the future. Outside of work, Aaron and Traci live in Brighton with their 11-year-old son, Warren. They all play tennis competitively at their home court, Midtown Athletic Club.
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