Highly trained physicians in Cardiology Services at Saint Joseph’s Medical Center and its allied facilities provide advanced, culturally sensitive care for patients in Yonkers and the Bronx, taking into account the totality of patients’ socioeconomic conditions and other circumstances.
“We are a trusted partner in the comprehensive, lifelong care of patients in the communities we serve,” says Stuart Moser, MD, FACC. “We work with underserved populations in many cases, and we treat all patients compassionately and with respect, offering them excellent services.”
Saint Joseph’s cardiology practices are unique in that they give board-certified, academically affiliated cardiologists on staff at Montefiore Medical Center an opportunity to treat patients who would not otherwise receive the personalized care often found at private physicians’ practices. The cardiologists practice at Saint Joseph’s Medical Center as well as Saint Joseph’s Cardiovascular Center and Saint Joseph’s Medical Practice PC. As an Article 28 Center, Saint Joseph’s Cardiovascular Center can see Medicaid patients on the same footing as any other patient, Dr. Moser explains.
“Our arrangement lets people on Medicaid who can’t see private physicians visit us like any other patient,” Dr. Moser says. “At other facilities, they might see a resident or fellow, but with this program, they can be treated by experienced, well-trained cardiologists — it’s something no one else offers in Yonkers.”
“We all offer something different in terms of our expertise and backgrounds, but we are all well-trained cardiologists who treat this patient population with care and respect.”
— Stuart Moser, MD, FACC
An exchange between Jose Taveras, MD, FACC, attending cardiologist and Assistant Professor of Medicine at Albert Einstein College of Medicine, and Stuart Moser, MD, FACC
Healing a Population in Need
Saint Joseph’s cardiologists engage daily with patients as whole people — people whose lives have often been challenging and whose experience with the medical system has been sporadic. Typical patients may have poor or no health insurance. They may have encountered few clinicians who speak their native languages, which include Spanish and Eastern European languages. Further, as a result of low socioeconomic status, many patients may be at higher risk for poor outcomes after cardiovascular events, such as myocardial infarction.
“Some of our patients have not received medical care in their lives,” Dr. Moser says. “Some may have diabetes, high blood pressure or congestive heart failure, yet, until they experienced chest pain or a cardiac event, they had no idea they were even sick.”
Saint Joseph’s physicians have deep roots in the community that enable them to recognize, understand and address their patient populations’ unique medical needs. Three of the cardiologists at Saint Joseph’s Medical Practice have been part of the local medical landscape for decades. Dr. Moser notes that his practice was established in Yonkers in 1990; his colleague Richard Feldman, MD, FACC, Co-Chief of Cardiology Services at Saint Joseph’s Medical Center, joined the practice in 1994. Richard Greif, MD, FACC, Co-Chief of Cardiology Services at Saint Joseph’s Medical Center and Assistant Professor of Clinical Medicine at New York Medical College, has been part of Saint Joseph’s since 1981.
“I’ve been practicing cardiology in this community since 1988. When I joined Saint Joseph’s, I had a large private practice; most of my patients stayed on as outpatients, and the long-standing relationships that have developed have been gratifying. I’ve known many of my patients for decades.”
— Richard Feldman, MD, FACC, Co-Chief of Cardiology Services at Saint Joseph’s Medical Center
Richard Feldman, MD, FACC, Co-Chief of Cardiology Services at Saint Joseph’s Medical Center, and staff echo tech Carlos Lopez attend to a patient in Saint Joseph’s Cardiovascular Center.
A new colleague, Jose Taveras, MD, FACC, attending cardiologist and Assistant Professor of Medicine at Albert Einstein College of Medicine, joined recently but has a long history in the community. Dr. Taveras’ personal background and sense of purpose dovetail with those of Saint Joseph’s Medical Center.
“Saint Joseph’s is Catholic; they have a very specific mission of care,” he says. “My own story is that I was planning to become a priest at one time. When I decided on hospital training, I started at St. Vincent’s, the mothership of Catholic hospitals in New York City. Saint Joseph’s is part of the same tradition; both were founded by the Sisters of Charity.”
A native Spanish speaker with Dominican and Puerto Rican heritage, Dr. Taveras feels at home shuttling around Yonkers and the Bronx to Saint Joseph’s, the Cardiovascular Center and the other practice locations.
“This is where I’m supposed to be; caring for this population is what I’m supposed to be doing,” Dr. Taveras says. “It’s like a dream come true. Everybody around here accuses me of being too happy.”
To meet the many needs of Saint Joseph’s patients, the physicians have cultivated skills of empathy, working to identify with patients and embracing strategies to bridge any cultural divides that might exist. Families are welcome to attend outpatient visits, Dr. Greif says, because they can provide information and help patients carry out their physicians’ medication instructions and lifestyle recommendations. When additional assistance is needed, Saint Joseph’s has social and behavioral services that can offer specialized psychosocial care.
“We work to meet patients’ medical needs, while also taking their cultural and socioeconomic backgrounds into account,” Dr. Taveras says. “We want them to feel comfortable with us so they’ll return. We provide the same care here as wealthy patients at an elite location might receive. We’re very sensitive to the need to make patients feel welcome, no matter where they’re from.”
Inpatient Cardiology at Saint Joseph’s Medical Center
All four cardiologists see patients both in-hospital at Saint Joseph’s and at the Cardiovascular Center or other clinic locations; however, Dr. Greif and Dr. Feldman focus primarily on inpatient cardiology. Dr. Feldman describes their hospital cardiology practice as following a hospitalist model. Originally, a hospitalist was an internal medicine physician who provided care principally for hospitalized patients. However, over time, the hospitalist model grew to include hospitalist obstetricians and now hospitalist cardiologists. Dr. Feldman relates that he and Dr. Greif innovated a hospitalist cardiology model at Saint Joseph’s before realizing they were ahead of the curve in an approach that would become a national trend.
Richard Greif, MD, FACC, Co-Chief of Cardiology Services at Saint Joseph’s Medical Center and Assistant Professor of Clinical Medicine at New York Medical College, provides care to his patient.
A cardiologist is on-site at all times at the hospital, supporting the Emergency Department and any other areas of the hospital that might need cardiology services. The on-site cardiologist can respond to a page or call and provide face-to-face care in any location in the hospital within minutes.
“We were early in adopting the hospitalist model,” Dr. Feldman says. “The ED, operating room and intensive care unit have virtually instantaneous access to us, whether we are rounding on patients, performing stress tests or conducting appointments. This is a valuable service in contrast to many community hospitals, where cardiologists round on patients in the morning and then leave to see patients elsewhere.”
Dr. Feldman and Dr. Greif confer over a medical case.
Both Dr. Greif and Dr. Feldman are critical care specialists, providing treatment in the combined cardiac care unit/ICU. Many patients in the ICU for other conditions also have cardiovascular complications, the physicians point out, and Saint Joseph’s cardiac hospitalists are involved at some level in the care of almost every patient in the ICU.
That care often includes the wide array of cardiac testing available at Saint Joseph’s Medical Center. The service line includes diagnostic cardiology, which encompasses EKGs, echocardiograms, Holter monitors and stress tests, such as treadmill, nuclear, pharmacological and stress echocardiograms.
“We also offer coronary CT angiograms as a way of noninvasively obtaining information without the need for catheterization,” Dr. Greif says. “In the ICU, we care for all kinds of acute issues, such as heart attack, heart failure, arrhythmias and hypertension. We also perform cardiac telemetry for heart rhythm monitoring.”
Drs. Feldman and Greif spend time training and supervising nascent physicians as well.
“Saint Joseph’s has a family medicine residency program, and we work closely with those physicians, especially during ICU and cardiology rotations,” Dr. Greif says. “We supervise them and they consult with us; it’s a big part of what we do and has been very enjoyable. For 37 years, I’ve helped teach, train and supervise about 10 residents every year, so that’s close to 400 physicians who are out there now.”
“The mission of Saint Joseph’s is to provide compassionate care with attention to the patient and the family. Everyone from the dietary staff to the physicians engages in an intense, coordinated effort to make it a welcoming, satisfying and understandable experience for each patient.”
— Richard Greif, MD, FACC, Co-Chief of Cardiology Services at Saint Joseph’s Medical Center and Assistant Professor of Clinical Medicine at New York Medical College
Accessible Care, Close Collaboration
Patients can see Saint Joseph’s cardiologists at four outpatient locations, the flagship of which is Saint Joseph’s Cardiovascular Center. Open for less than five years, the large space features a parking lot for patients and is also accessible via major highways and bus routes. Three cardiologists staff the center, which offers extended office hours throughout the week. At the Cardiovascular Center, patients can undergo virtually any test their cardiologist might recommend, including echocardiography, nuclear cardiology, stress testing, vascular ultrasound and event monitoring.
Patients come to the center through referral by a family physician, or they may be referred after recovering from a cardiac event at Montefiore Medical Center or at Saint Joseph’s. Others discover the Cardiovascular Center by word of mouth.
Dr. Moser reviews a noninvasive evaluation of the heart with Carlos Lopez to provide care to a patient.
Dr. Taveras reviews a noninvasive nuclear cardiology evaluation for abnormalities prior to reviewing it with his patient.
While the cardiologists at the Cardiovascular Center judiciously avoid over-testing, they are swift in ordering the right tests to help patients understand their condition. Generally, any test will generate same-day results, which are sent immediately to the referring physician. Saint Joseph’s outpatient cardiologists stay in regular contact with patients’ internal medicine or family medicine practitioners, making sure each patient’s treatment plan is comprehensive and well-understood by all members of the care team.
Same-day testing is just one aspect of the Cardiovascular Center’s commitment to enabling patients to receive consultation, testing and treatment recommendations all in one place, on the same day if possible. Especially among patients for whom travel is expensive or difficult, combining medical visits can ensure they get the necessary follow-up tests and care after their initial visit.
Those patients who are obtaining outpatient cardiology services for the first time following a heart attack or other cardiac event may require thorough health education, Dr. Taveras explains.
“In the U.S., somebody has a heart attack every 30 seconds,” he says. “Every minute and a half, someone dies of a heart attack. Often, when they have a heart attack, they had a condition they were never aware of and therefore never addressed; the heart attack is the end result of a cycle that began years before. And the patient may have a host of additional unrecognized medical conditions as well.”
Newly discharged, these patients receive carefully crafted treatment plans from the cardiologists at Saint Joseph’s, the Cardiovascular Center or an affiliated clinic. The cardiologist may refer patients to an internal medicine provider if needed, and all the cardiologists are glad to help patients who are unfamiliar with the medical world, in order to put their minds at ease.
“I was talking with a lady who protested, ‘I’ve never taken medicine and I don’t want to,’” Dr. Taveras says. “I said, ‘I’ve never met anyone who wants to take medication.’”
Poised for Further Expansion
The Cardiovascular Center is not finished growing. Dr. Moser says there are plans to expand services and open a cardiac rehabilitation program in which patients can build up their heart health in close collaboration with physicians with whom they are familiar. Another goal is a patient education program that will more deeply integrate health awareness into patient care, says Dr. Taveras, who already engages patients and the broader public through a blog he founded to address topics such as cardiovascular disease and diabetes. Establishing a hypertension clinic at the Cardiovascular Center is also under consideration.
Working together, the cardiologists of Saint Joseph’s Medical Center, the Cardiovascular Center and the associated community cardiology offices have created a seamless network of care in which meeting patients where they are is a vital component of providing effective, compassionate diagnosis and treatment.
“Sometimes patients do not relate to their physician because they are members of a different community or don’t speak their language. We work very hard at bridging that gap here at Saint Joseph’s so patients can receive care they feel comfortable with and are more likely to return.” — Jose Taveras, MD, FACC, attending cardiologist and Assistant Professor of Medicine at Albert Einstein College of Medicine
Saint Joseph’s Medical Practice PC’s David Mandel, Director, Physician Practice Management (center) meets with Robin Kaufman, Practice Manager, and members of the Saint Joseph’s Cardiovascular Center team. From left: Iris Lopez, Carlos Lopez, Keila Carrasco, Mandel, Kaufman, Awilda Colon, LPN, and Cheri Moses
“We bring those patients who are often on the fringes of the healthcare system when we first encounter them into a more cohesive system of care,” Dr. Feldman says. “We aim specifically to link inpatient and outpatient care so there is a commonality between the physicians in the medical practice and those who are working in the hospital. We provide as much continuity as possible so we can continue to serve our patients once they’re discharged.”
For more information, visit saintjosephsmedicalpractice.com.