Even before the passage of the Affordable Care Act, the board of governors at Lawrence Hospital Center had established a plan for restructuring the face of health care in the hospital’s surrounding area.
Observing the local healthcare landscape in 2007, the Lawrence Hospital Center Board of Governors identified increasing pressures on private practice physicians, such as decreased reimbursement and increased overhead costs. Seeking to alleviate these pressures, the board began a process that culminated in the inception of Lawrence Medical Associates.
“Our board conducted a physician manpower assessment in Lawrence Hospital’s catchment area and found clear deficiencies in a number of specialties,” explains Gerald Ridge, MD, CEO and Medical Director of Lawrence Medical Associates. “Principal among these were primary care, internal medicine, OB/GYN and orthopedics.”
“The Lawrence Hospital Center board of governors created Lawrence Medical Associates as a vehicle to support physicians already in practice who were struggling because of regulatory and financial issues, to sustain them and help them maintain their practices for the health of the community.”
— Gerald Ridge, MD, CEO and Medical Director of Lawrence Medical Associates
In 2009, the plans became Lawrence Medical Associates, a multidisciplinary medical practice affiliated with Lawrence Hospital Center. Since then, the organization has grown to include eight locations throughout southern Westchester, housing more than 40 full-time providers who offer medical expertise across the care continuum. Currently, Lawrence Medical Associates plans to expand its coverage into Bronxville, Eastchester, Tuckahoe and Yonkers.
The practice was designed to bolster access to primary care in the area. Over time, Lawrence Medical Associates has grown to include a robust specialty roster, including endocrinology, internal medicine, maternal-fetal medicine, medical oncology and hematology, orthopedic, pulmonary medicine, sleep medicine, and surgical oncology.
Lawrence Hospital Center provides convenient access to advanced services, including clinical laboratory testing, palliative care, surgery, rehabilitation programs and state-of-the-art imaging, to meet the needs of an ever-expanding community.
Members of Lawrence Medical Associates Oncology team: Anthony Provenzano, MD, Manasi Shah, MD, Geetha Naik, MD, and Eduardo M. Saponara, MD; Not pictured are Ahmed Asif, MD, and Zahra Shafaee, MD.
“Our primary purpose is to support our community, which spans Yonkers, Eastchester, Tuckahoe and the Bronx,” Dr. Ridge says. “We ensure that the care we provide is the care our community’s residents require.”
A large part of that neighborhood-style approach to medicine involves interaction with referring physicians. Because Lawrence Medical Associates’ physicians respect the relationship between patients and their primary care providers, patients always return to their familiar practitioners with detailed notes regarding care they received, as well as personal phone calls from the physicians who treated them.
In the event that an evaluation identifies an unexpected condition, a Lawrence Medical Associates team member makes an immediate phone call to the referring physician to relate the news. At that time, patients can return to their primary care provider for further consideration, or physicians can work in concert to arrange further specialist care.
The community focus drew Patricia C. Devine, MD, FACOG, to Lawrence Medical Associates, where she serves as Director of OB/GYN with the practice and Director of Maternal Child Health at Lawrence Hospital Center.
“I felt there was a huge local need for access to physicians like me, who specialize in high-risk pregnancies,” Dr. Devine recalls. “Working in a community hospital, I could provide patients safe, specialized care, and support their general physicians, who do not always have access to the resources they need to safely manage complicated cases.”
“We’re a hidden gem in Westchester, providing excellent care in a small community setting. Our outstanding physicians are committed to caring for their patients and forming relationships with them as they face crises in the hospital or deal with a difficult diagnosis. That’s what medicine is all about, and that’s what we do.”
— Deborah Cappell, MD, intensivist with Lawrence Medical Associates, Director of the Sleep Laboratory, Director of Inpatient Palliative Services at Lawrence Hospital Center
Deborah Cappell, MD, intensivist with Lawrence Medical Associates, explains to a patient continuous positive airway pressure (CPAP) therapy.
Likewise, Deborah Cappell, MD, intensivist with Lawrence Medical Associates, recognized the value of providing advanced specialty care in a personal setting.
“I was drawn to Lawrence Medical Associates because they are focused on serving the neighborhood,” she says. “We want to have relationships with patients, so we can be there for them in medical crises.”
As a perinatologist, Dr. Devine is particularly experienced in the evaluation and management of medical issues that can endanger the health of mother and child. Dr. Devine and her team offer specialized care aimed at achieving the best outcome for the pregnancy.
In addition to managing pregnancies complicated by multiple gestation, abnormal fetal growth or anomalies, placental problems, or preterm labor — all of which can endanger a pregnancy — Dr. Devine provides vigilant surveillance for autoimmune diseases, diabetes, hypertension and thyroid disease, helping manage serious pregnancy complications and protecting the health of the mother and develop-ing baby.
Lawrence Medical Associates’ Orthopedic surgeons: Michael Murray, MD, Patrick V. McMahon, MD, William Unis, MD, and Peter F. Rizzo, MD
Dr. Devine’s team includes a full-time, board-certified genetic counselor who is available to assess families and their developing babies for potential genetic abnormalities and ensure the appropriate screening and diagnostic tests are offered.
“Genetic counseling is a difficult field to keep up with because new technologies or practices are introduced every day,” Dr. Devine says. “It’s important that we have someone with that kind of expertise on our team to ensure we stay abreast of this technology and our patients have access to the best tests available.”
Dr. Devine is also able to dedicate a significant amount of time in a quiet and professional setting to review test options and results with the patient and her family.
Seeing the Smallest Things
Additionally, board-certified ultrasound technologists operate state-of-the-art Voluson ultrasound machines that provide high-resolution images in even the hardest-to-scan patients.
“Lawrence Medical Associates reached out to physicians at university medical centers and brought providers with that level of expertise into the community setting. Those facilities provide excellent care, but the reality is that the overwhelming majority of patients receive medical care in the community setting. We’ve brought academic-level resources, knowledge and support to the community level, where we help providers take care of even the most complicated patients.”
— Patricia C. Devine, MD, FACOG, Director of OB/GYN at Lawrence Medical Associates, Director of Maternal Child Health at Lawrence Hospital Center
Patricia C. Devine, MD, FACOG, performs an ultrasound test on patient. Dr. Devine is the Director of Obstetrics and Gynecology for Lawrence Medical Associates and the Center for Maternal Child Health at Lawrence Hospital Center.
“During the course of a pregnancy, we are charged with assessing the developing baby with tremendous detail,” Dr. Devine says. “Exams can be very challenging, especially in the instance of multiple gestation, maternal obesity, uterine fibroids or abdominal scarring. Sometimes our target structure is on the order of a millimeter. Our ultrasound technicians are extremely experienced in imaging the most challenging patients, and our state-of-the-art ultrasound machines allow us to evaluate fetal anatomy in enough detail to pick up anomalies or abnormalities as early in the pregnancy as possible. This way, we can offer intervention or give parents all the choices they want in terms of pregnancy management.”
Each subsequent phase of pregnancy care depends on precise testing and imaging capabilities, which can only be provided by experts using leading-edge technology.
Extended Delivery Coverage
Lawrence Medical Associates also provides community practitioners and expectant mothers a safety resource available around the clock. Dr. Ridge explains that, for four years, the laborist program has offered emergency OB/GYN care for women going into labor unexpectedly when their primary obstetrician is unavailable.
Board-certified obstetricians providing 24/7 coverage on the labor and delivery floor optimize the unit’s safety and efficiency, and also maximize the capabilities of community providers.
“When patients enter the unit, their personal physicians don’t have to drop everything and rush to the hospital to manage their care,” Dr. Devine says. “Because of the new laborist program, a board-certified obstetrician is always in the hospital to take care of patients in the labor and delivery unit. Private attending physicians can be assured of the safety of their patients until they are able to get to the hospital themselves. While these patients are in our care, they’re watched night and day to ensure mother and child are safe throughout delivery.”
Complications can happen at any time during pregnancy — sometimes with no warning. Dr. Devine recounts how, recently, a laborist received a call from an emergency team about a mother who experienced umbilical cord prolapse after her amniotic sac broke. This patient, whose pregnancy had previously been routine, now faced a situation that endangered the life of her unborn child. According to Dr. Devine, umbilical cord prolapse is a true obstetric emergency that can compromise blood flow to the baby and put the baby at risk for a very poor outcome, including death in utero.
Prior to the establishment of the laborist program, the triage situation allowed for significant delay in accomplishing evaluation and delivery if an obstetrician was not currently in the hospital. These types of cases could prove stressful and challenging for many obstetric units, but much of the confusion and potential delay has now been eliminated with the laborist program.
“This is a true obstetric emergency requiring immediate delivery,” Dr. Devine says. “The ambulance called on its way to the unit, and the laborist on the floor was able to greet the emergency medical technicians as they came in, get the patient directly to the operating room, and delivered immediately, within minutes of entering the hospital. We had a healthy baby and a healthy mom and a really great outcome for our unit.”
Your Eyes in the Hospital
Last year, Lawrence Medical Associates initiated a new 24/7 hospitalist program, providing hospitalized patients continuous access to medical expertise.
Sanin Syed, MD, speaks with Rowena Manabat, RN, about a patient. Dr. Syed is a member of Lawrence Medical Associates and also the Medical Director of the Adult Hospitalist program at Lawrence Hospital Center.
Sanin Syed, MD, leads the program, which offers primary care the opportunity to work more efficiently and optimize the hospital care they provide, according to Dr. Cappell, who serves as Director of the Sleep Laboratory at Lawrence Hospital Center in addition to her work as an intensivist.
“Patients and their families appreciate our hospitalists because they provide access to medical care at all times,” she says. “Their internists, whose patient loads pull them in many directions, can focus on patients in their offices. They no longer have to worry about coming to the hospital at all hours of the day or night to answer patient questions.”
Internal medicine specialists at Lawrence Medical Associates include Debabrata Dutta, MD, Angel Rodriguez, MD, Tatyana Morton, MD, Gerald Ridge, MD, and Thomas Camisa, MD. Not pictured are Valneo Buttari, MD, Louis Caragine, MD, Braulio Flores, MD, Gary Guerrino, MD, Oana Hantar MD, Cheryl Pensiero, DNP, and Susan Santry, MD.
Before the hospitalist program, internists often took turns covering hospitalized patients, and because many of the physicians were located proximally, the arrangement provided a certain level of care. But Dr. Cappell notes that the hospitalists offer patients an increased sense of security.
“The new program elevates the patients’ hospital experience,” she says. “Previously, the internists were able to provide coverage, but for patients, there’s comfort in knowing physicians charged with their care are on the hospital floor.”
“Dr. Syed just started our hospitalist program in October,” Dr. Ridge adds. “We’ve already been inundated with requests from community practitioners who want to use our services.”
Contemporary Intensive Care
In similar fashion, Lawrence Hospital Center restructured its intensive care unit to fit with changes in the broader medical field.
“Responding to changes in the healthcare delivery paradigm, we revamped the intensive care unit at the hospital and brought on full-time critical care physicians,” Dr. Ridge says. “We now have certified specialists available 24/7.”
Having intensivists on the ICU floor at all times enables more efficient protocol implementation when emergencies occur and provides an established method of operations that wasn’t possible with a fluid staff of part-time attendants.
“ICU models are moving toward more in-house intensivist coverage, which means there’s always someone here when patients need them,” Dr. Cappell says. “If a patient’s condition abruptly turns, an intensivist is here for immediate care. We still consult with specialists and involve surgeons and primary care physicians, but when patients are sick enough to be in the ICU, we take over the management of their care.”
Physicians in and outside of Lawrence Medical Associates’ umbrella can count on the expertise of its multidisciplinary pediatric and adult specialists. This care network extends coverage to patients from all stages of life.
Dr. Cappell, who is also the Director of Palliative Care Services, helms inpatient hospice care at Lawrence Hospital Center. Two dedicated nurse practitioners synthesize information from physicians and patients to assist patients and their families through difficult times.
“Our nurse practitioners interface with the oncologists, cardiologists and internists treating the patient, ” Dr. Cappell explains. “They help patients and their families frame what their physicians tell them, as well as the patients’ feelings about hospitalization and illness, in the context of their own family dynamic.”
When physicians deliver a terminal prognosis, a growing body of literature encourages early involvement by palliative care specialists. While oncologists focus on deploying curative modalities, palliative care providers work to ensure patients face diseases on their own terms.
Members of Lawrence Medical Associates clinical and support staff (from left): Marie Dwyer, Kimberly Connery, Felicia Hodgson, Doreen McLaughlin, Stephanie Dos Santos, Denise Polgano, Eliana Asif and Lilani Cometta
“Patients who receive palliative services feel better about the care they receive,” Dr. Cappell says. “Because palliative care focuses on symptomatology and prognoses, we offer patients and their families the chance to think about what they want as they cope with a potentially terminal diagnosis.”
For more information about how Lawrence Medical Associates can help you or your patients, please visit www.lawrencemed.com.