Saint Joseph’s Medical Center: Primary Care for the Full Spectrum of Life

By Jennifer Webster
Monday, May 14, 2018

With practices spreading from Yonkers across Westchester County, Manhattan and the Bronx, Saint Joseph’s Medical Center offers expansive, high-level primary care that treats the family as a whole. Saint Joseph’s family care physicians and their colleagues focus on keeping patients out of the hospital and empowering wellness through education and outreach.

Saint Joseph’s Medical Center has a big footprint in the region and a growing roster of board-certified family medicine and specialty providers, meaning patients can find the care they need close to their doorstep, usually on the same day. The clinical benefit? Fewer hospitalizations and stronger patient-provider relationships.

“Geographical distribution, combined with depth of services, affords convenience for patients to access our satellite clinics,” says Elizabeth Natal, MD, family medicine physician and Medical Director of the Family Health Center, Saint Joseph’s flagship primary care clinic. “Instead of the patient traveling to a hospital cardiologist, for instance, he or she can access state-of-the-art cardiology care at a clinic without having to contend with transportation.”

Faculty of the fully ACGME-Accredited Family Medicine Residency Program, from left: Rita Aszalos, MD; Elizabeth Natal, MD, Medical Director of the Family Health Center; Shadi Sayegh, MD; Sonia Velez, MD, Program Director; Robert Samaniego, MD; Mike Menla, MD; Rodika Coloka-Kump, DO; and Jennifer Ringstad, MD

The seven Saint Joseph’s clinic locations are the product of a carefully executed plan of purchases and building out, according to Pamela Tripodi, MBA, Director for Ambulatory Services at Saint Joseph’s. The newly affiliated clinics share Saint Joseph’s commitment to patient-focused medicine.

“All our ambulatory services and primary care sites are patient-centered medical homes,” Tripodi says. “Here at the hospital, we’ve held the National Committee for Quality Assurance designation for five years. We’ve been a forerunner, reaching PCMH Level 3 designation and maintaining it all these years.”

That means the practice meets rigorous standards for patient care. These include:

  • Same-day appointment-setting
  • Rapid electronic communication
  • Interpretation services
  • EHR use
  • Patient choice and empowerment
  • Screening and immunization practices
  • Preventive and chronic care
  • Evidence-based medicine
  • Regular medication-list reconciliation
  • Special care plans for patients with complex conditions
  • Educational resources
  • Appropriate behavioral-health referrals
  • Information-sharing across locations of care

“We look at the patient, not just the disease or complaint,” Tripodi explains, distilling the myriad complex tasks that underlie the PCMH model. “We treat the whole person. We take into account every factor that affects the disease process, including the resources — in the clinic and the community — to help the patient overcome the disease and live a healthier life overall.”

A warm exchange between Dr. Natal and her patient

True Family Medicine

“Family medicine” is a term often used interchangeably with “primary care,” but that loses a vital distinction: Family medicine providers view families as interconnected groups. That perspective informs clinical care, whether the concern is disease transmission, dietary habits or anything else.

Sonia A. Velez, MD, JD, Director of the Family Medicine Residency Program

“One privilege of being a family medicine physician is you are the primary care provider for all the family,” says Sonia Velez, MD, Director of Saint Joseph’s Family Medicine Residency Program and Interim Chair of Family Medicine at New York Medical College Department of Family and Community Medicine. “That’s the premise of a family doctor.”

Dr. Natal illustrates this principle: “You may start with one patient. Then she becomes pregnant and now you care for the baby, too. They form a bond with you. Then the patient’s grandmother hears about you and wants to come in. You may see all three in a session, while caring for each as an individual. You see the patients in the context of the support system that helps them with their challenges and struggles.”

“When someone presents with a viral illness and we know other family members may be exposed, we can talk about those family members coming in for evaluation,” she adds. “Or if one family member tests positive for lead, we want to be aware of other children or adults in the household who may also be exposed.”

Chronic conditions with genetic, behavioral or environmental components, such as diabetes, also can be managed effectively through family-centered medicine. At-risk family members may benefit from counseling, while a whole-group look at behaviors can identify opportunities. For instance, a patient with diabetes may benefit from nutritional counseling provided to a different family member who buys groceries or prepares food for the household. Careful, community-rooted monitoring of chronic conditions may also help patients avoid hospitalizations — a key objective for Saint Joseph’s.

Keeping Patients in the Community

Saint Joseph’s Medical Center takes seriously New York State’s mandate to provide care that keeps patients out of the hospital whenever possible and promotes the best outcomes. This imperative is articulated by numerous stakeholders — most notably the Department of Health, whose Value Based Payment Roadmap prioritizes reducing avoidable hospital readmissions.

In that endeavor, clinical skills include people and organizational skills — a truth both Dr. Velez and Dr. Natal emphasize. Excellent outpatient care, which ranges from sound medical practice to rigorous follow-up and warm connection-building, is essential to keeping patients healthy in their homes and communities.

“Our primary goal is to keep patients in good health,” Dr. Velez says. “We achieve that through counseling them, making ourselves available after hours and holding extended hours, as well as remaining current on screening practices and preventive measures.”

“When patients aren’t feeling well but it’s due to a non-emergent condition, we accord them same-day appointments and walk-in visits,” Dr. Natal adds. “Of course, severely ill patients may need emergent care, but if someone can be treated in the healthcare center to avoid getting sicker, we make every effort to care for them at that moment.”

“At Saint Joseph’s Medical Center, we have been successful in reducing avoidable hospitalizations and emergency department visits. We identify patients whom we term ‘super utilizers’ of emergency care. In working with area programs, specifically dialysis programs, we have been able to reduce the number of repeat emergency department visits by 70 percent. To achieve this, we refer patients to the appropriate providers within our system where they can obtain the level of care they need.”
— Pamela Tripodi, MBA, Director for Ambulatory Services at Saint Joseph’s Medical Center

Hands-on training by our board-certified family medicine faculty

When patients do transition between care settings, Saint Joseph’s integrated EHR streamlines the process.

“With the same EHR across all our hospital- and community-based practices, we stay connected so we can all view results,” Tripodi says. “That helps us avoid repeated testing. All of our sites also participate in our New York State Regional Health Information Organization. Using the healthcare information exchange system, we ensure our patients’ records are always available. This speeds treatment if, for example, they present at an emergency room in another part of the state.”

Integrated EHR also helps make sure all providers are on the same page about patients’ desires and treatment plans. Patient wishes can be disseminated from the PCMH outward, while the primary care provider has an up-to-date record of all specialty care, giving the care team a full picture of a patient’s status.

“With our affiliation with our sister clinics and our shared access to records, the provider in charge of a patient’s primary care can look at those records and partner with our specialists to ensure the patient understands what’s being done for them,” Dr. Velez says. “Often, patients want their primary physician to further explain what a specialist is asking them to do. We can bridge that gap in understanding and clarify areas in which they need additional information. And of course, if the patient requires further management or follow-up, the lines of communication are open.”

A Renovated Primary Care Clinic

The Family Health Center is undergoing a significant renovation this year in order to advance Saint Joseph’s commitment to offering the broadest possible range of treatment to patients in the community. Drawing on a New York State grant aimed at reducing hospital readmissions and ED visits among Medicaid patients, the health center is markedly increasing its services and resources, according to Tripodi.

Dr. Menla providing medical care to his patient
“We are a committed group of compassionate, well-trained, comprehensive physicians who work collaboratively and put in a lot of time and hard work to ensure we give the best care to our patients. Our goal is not only to heal them, but to keep them healthy.”
— Sonia Velez, MD, Director of Saint Joseph’s Family Medicine Residency Program and Interim Chair of Family Medicine at New York Medical College Department of Family and Community Medicine

The changes cover every area, from clinical offerings to front-office interactions. New kiosks will speed patient check-in, Tripodi says. A revamped triage area will facilitate walk-in appointments and streamline patient throughput, since vitals will be taken immediately in triage, before patients are taken to an examination room. An expanded phlebotomy area will reduce wait time for blood draws. A patient education area will house courses on prenatal health, diabetes, asthma and more.

“We’re very excited about our new patient education area,” Tripodi says. “Our nurse educators will teach patients and families about their conditions and how best to care for themselves. We’ve found that patients with the same disease do well in groups of five or six, sharing experiences and suggestions for healthier lifestyles.”

Dr. Natal, who recently arrived at Saint Joseph’s, has experience in group patient visits and will spearhead that endeavor. She anticipates filling the waiting area with interesting activities — for example, a cooking class that teaches patients to prepare familiar dishes in more healthful ways.

Behavioral health — and now especially child and adolescent behavioral health from a partner group — is another key facet of the broad care offered at the Family Health Center.

“Many patients have mental health concerns but fear the stigma of being referred to a mental health program,” Tripodi says. “We have integrated behavioral health personnel in our primary healthcare site. It helps patients get the service at the same time they meet with their medical provider. There’s no need for them to schedule a follow-up appointment elsewhere, so they get care faster.”

“We are committed to and excited about bringing behavioral care into the primary health component,” Dr. Natal says. “As we expand into child and adolescent behavioral health, we will be able to provide care for a broader segment of the population.”

Physicians conferring over a medical case, from left: Shadi Sayegh, MD; Osama Sayegh, MD; and Kawarjeet Singh, MD

Saint Joseph’s is opening new clinics at other locations, as well, such as the Harrison clinic at St. Vincent’s Hospital Westchester — another campus of Saint Joseph’s Medical Center. Additionally, at the cardiovascular center on Yonkers Avenue, Saint Joseph’s is developing a cardiac rehabilitation center, making it convenient for patients to exercise and see their cardiologist in the same location.

“We offer an extraordinary breadth and depth of care,” Tripodi says. “From primary care to our cardiology and multispecialty clinic, we’re committed to expanding ambulatory care. We offer podiatry, urology, nephrology, vascular surgery, otolaryngology and gastroenterology close to where patients live and work. We enable them to stay part of the Saint Joseph’s family, rather than receive uncoordinated care from unfamiliar providers. Additionally, the unified care ecosystem means the specialists can easily access patients’ medical history, provide prompt diagnosis and return them to their primary care physician. Saint Joseph’s Medical Center is eager to expand those services and to provide the best care we can in our community.”

A Family of Highly Qualified Physicians

The Family Health Center is also a training ground for an exceptional set of residents. Frequently, patients have physicians who are on faculty at New York Medical College, Saint Joseph’s sponsoring institution — an agreement that has been in place 20 years, benefiting generations of patients and physicians. Physicians have access to the New York Medical College library, Dr. Velez notes, enabling them to perform population-based or disease-specific research.

St. Joseph’s Medical Practice, P.C., family physicians, from left: Dr. Samaniego, Dr. Singh, Dr. Coloka-Kump, Dr. Osama Sayegh and Dr. Shadi Sayegh

“We have ongoing communication with colleagues in other clinical departments,” she says. “These alliances between our colleagues and other specialists benefit our patients, as well.”

The residency program also enables Saint Joseph’s to attract gifted young physicians eager to match at institutions with a strong reputation in family care.

“The program is highly competitive,” Tripodi says. “We have 30 slots. We receive about 3,000 applications annually, and of that number, we match 10 residents. Early on, we identify residents we believe will be successful in their careers, whether they stay in Yonkers or move to other areas of the country.”

All faculty are board-certified, and residents pass their family medicine boards before they graduate. For the past three years, the pass rate has been 100 percent.

But academic excellence is just the tip of the iceberg for these providers. Dr. Natal, Dr. Velez and other faculty members inculcate the values of rapport and mutual understanding in new physicians. Foundational to that rapport is communication skills, both between colleagues and between patient and physician.

“There’s an art in documenting the patient medical record,” Dr. Velez says, adding that communication is equally valuable in one of her professional interests — medical legal writing. She and her colleagues share information vividly, accurately and concisely with providers within Saint Joseph’s and beyond.

“It’s crucial that the provider clearly document the patient’s plan of care and findings,” she says. “That way the next provider can pick up where we left off. I take pride in ensuring our residents graduate knowing how to provide excellent, confident, evidence-based care and that it’s reflected in their patients’ EHR.”

“We want to hear from patients about what they need from us. It’s wonderful to provide them effective treatments, but we also ask, ‘What can we do for you?’ In the patient-centered medical home, the physicians and staff have thorough knowledge of their patients. It’s a hub for specialists, a place for coordination of care. It’s the patients’ voice to make sure everybody along the continuum of care understands what patients need from them.”
— Elizabeth Natal, MD, family medicine physician and Medical Director of the Family Health Center

Even more important is physician-patient communication. Patients want providers who take the time to listen, who respond openly to their concerns and who speak clearly to them — in their own language whenever possible. In fact, Saint Joseph’s prefers to hire bilingual physicians, especially those who are fluent in English and Spanish.

“Patients won’t go back to a provider they can’t talk to,” Dr. Velez says.

Saint Joseph’s physicians build lifelong relationships with patients, families and the community.

“We see patients from birth to the twilight age,” Tripodi says. “Entire families come to us. We see kids who are born with us, come to us through high school, and grow up and bring their own families to us.”

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