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Revive: The Wellness Magazine of Refuah Health Winter 2018

Refuah Health warmly welcomes you back to our newest Revive edition, bursting with

useful information. The Revive Team has handpicked health material addressed to

individuals at every stage of life. Take a break from the cold weather and settle in with the

Revive winter edition. We hope you’ll enjoy!


We are super excited to have you meet our newest adult endocrinologist, Dr. Marcia

Palace, MD, in our feature article. Join us for a glimpse into the world of Diabetes and other

endocrinological disorders. Dr. Palace’s unique personality and passion for her patients’

wellbeing makes for a pleasurable read as she shares her vast medical knowledge with

you. Read about the newest updates in technology as well as the latest research in this

fascinating field.


Antibiotics: to give or not to give? Hear from Dr. Behnam, MD, a longtime pediatrician at

RefuahHealth, on the proper usage of this multi-faceted lifesaving tool.

Peek into the lives of our dedicated employees, Malka Steinmetz, RN, and Esther

Lowenstein, RN. Share in the inspiration that drives them to continue helping our patients

improve their health and quality of life.


Things have been moving at a fast pace here at RefuahHealth. Over the past six months,

we’ve added a new wing to our New Square site and expanded our team to include many

new top-tier professionals, allowing us to provide enhanced services to our various



Additionally, our senior patients can now benefit from our Refuah Home Health agency.

Thanks to a strong connection between our aides and health providers, our patients feel

secure, receiving the utmost care in the comfort of their home. Check out our senior care

safety tips by Cathy Zikorus, NP, on how to protect seniors in their home environment.


It was gratifying hearing your response to our previous issues; keep the comments and

suggestions coming.


Enjoy the read!

The Revive Team

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Refuah Redefines Everyday Care

Over 25 years ago a group of local residents concerned with the lack of quality, affordable healthcare providers in New Square, New York and the surrounding area joined together to foster change in their community. They began a grassroots movement that culminated in the founding of the Refuah Health Center in 1992. The clinic was originally composed of 20 staff and providers, focused on delivering primary medical care. Refuah became a cornerstone of the healthcare community, providing culturally competent, high-quality individualized treatment for all patients.

Today Refuah serves over 62,000 patients across four locations. With over 400 providers and staff, the Center offers comprehensive medical care, dental care, behavioral healthcare, and a number of specialty medical services. While Refuah has grown, the organization remains committed to its patients on the individual level—continuing to provide the patient centered, high-quality care characteristic of Refuah since its inception.

With a commitment to meet every patient in their time of need, Refuah offers urgent care services and extended hours, including evenings and most holidays. Increased accessibility means more patients can get the care they need when they need it.

Mr. Mendy Spilman is one of the patients who experienced first-hand the benefits of Refuah’s extended services and hours. After a mishap in his garage on the Fourth of July, Mr. Spilman sought urgent medical care for his badly cut fingers.

While other local clinics and provider offices were closed—it was a national holiday and a Sunday—Refuah’s doors remained open and its providers available. As a result, Mr. Spilman received prompt care from a team of experienced providers at Refuah’s Twin Site. Meanwhile, the Patient Services Department simultaneously coordinated with the providers overseeing his treatment and arranged for his follow-up care. Due to the assistance provided by Patient Services, Mr. Spilman was able to focus on his recovery. He stated: “The staff was so helpful…calming me down and helping me to be comfortable and to minimize my pain and anxiety.”

After receiving care at the Twin Site, Mr. Spilman transferred back to Refuah’s main location where he was surprised to learn that his provider had followed him to ensure he received x-rays and to check the scans personally. Together, Mr. Spilman’s provider and the Patient Services Department scheduled an examination with an outside specialist to ensure that Mr. Spilman received additional care if needed.

Refuah Health Clinic began with only a handful of providers united in care for an underserved community. Today Refuah remains committed to providing a warm and compassionate environment with an equal emphasis on the quality of care and patient experience. Mr. Spilman attests to the compassion of Refuah Health Center’s expert team of practitioners, stating “this is the kind of loving and caring service for patients Refuah does every single day of the year.”

Refuah understands that life events—from birth to injury—don’t hold office hours. Of the four locations a patient can access, our doors are open over one hundred hours a week. At Refuah, accessible high-quality care is an everyday experience.


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We’re Making it Easy to Access Care

To address the needs of our target population, Refuah Health Center employs an extensive, and free, Patient Shuttle service, with eight shuttles and over one hundred forty designated stops in Rockland County. The shuttle Dispatch Call Center is open 24/7 and offers assistance in English, Spanish, Russian, Hebrew, and Yididish.

PATH (Patient Access to Healthcare), started in 2016, is a partnership between Refuah Health Center and local community-based organization, Konbit Neg Lakay. The program provides free transportation to all patients who do not reside or work near a shuttle route.

Additionally, the Rockland Access to Transportation Project is coordinated by DSRIP PPS Refuah Community Health Collaborative. The Project provides free transportation services to mental health outpatient programming located outside of Rockland County. Key community partners, in collaboration with the Rockland County Mental Health Department, work together to reduce transportation barriers for those in need.


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Refuah Home Health: Strengthening the Continuum of Care

As the American population ages, living longer with more acute and chronic conditions, home health providers are becoming invaluable components in the delivery of patient-centered coordinated care.

In September of 2017, Refuah Home Health began offering in-home health aides for the elderly and persons with disabilities who are homebound. Home Health Aides (HHA) provide traditional in-home health services such as assistance with bathing, dressing, grooming, skincare and wound prevention, and feeding. Other offered services include assistance such as medical reminders and escorts to and from doctor visits. Additionally, Refuah HHAs provide companionship, personalized exercise programs, shopping and errand management, and communal meal preparations.

A recent study completed by the Alliance for Home Health Quality and Innovation reported that an overwhelming majority of Medicare patients wish to stay in their own homes. The study further concluded that the majority of patients utilizing home healthcare services are older, suffer from multiple chronic conditions, and live alone. These high-needs patients are often dependent on family to bridge the gap between home and the doctor’s office, placing an increasing financial and emotional burden on younger generations.

Refuah Home Health seeks to fill this gap as an active partner in coordinated care. “We aim to support the efforts of our patients and their families to keep loved ones living at home in a comfortable and familiar environment,” says Home Health Director, Esther Lowenstein. To this end, Lowenstein underscores the importance of incorporating home health into a patient’s provider team: “We will work in-step with our patients’ primary care physicians, to provide clinically appropriate and cost-effective practices, allowing more patients to avoid hospitalization and become active members of community life.” This team-based approach allows Refuah to better manage patient care and bolsters the organization’s ability to achieve Medicare’s Triple Aim goals: improve patient experience of care, increase the health of populations, and reduce the per capita cost of healthcare.

According to Lowenstein, Refuah Home Health evolved out of the pronounced and growing needs of the clinic’s aging population. “We want to help patients improve or remain as healthy as possible,” she says.

“The Home Health Aide is a connector from the clinic to home,” says Lowenstein. “This seamless approach allows us to identify and report health issues before they become urgent, and provide immediate intervention within the comfort of our patients’ own homes.” Lowenstein continues, “This will have a direct effect on a patient’s health outcomes. We can now give our older patients what they crave—independence through responsive and respectful quality care.”

With this approach, Refuah Home Health goes beyond traditional post-acute care management, making home health a key partner in improving health outcomes, reducing access barriers, and lowering healthcare costs.

“Our patients’ health is at the core of what we do,” Lowenstein concludes. “We believe the addition of home health services will allow us to provide increasingly effective and responsive treatment that has a material impact on our patient health and overall quality of life.”


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Summer Camp Revisited: Refuah offers clinical rotations through Columbia University’s Nurse Practitioner Program

During the summer months, Sullivan County’s population swells as seasonal residents abandon the city and travel upstate.  Since 2011, Refuah Health Center has been serving this rural community year round, helping shore up the healthcare infrastructure in an area that is already medically underserved.  Offering primary medical care, Refuah employs high-quality physicians and mid-level practitioners at the rural site.

Nurse practitioners (NP) are a good fit for this community, effectively bridging the gap in an area often characterized by physician recruitment and retention challenges. National trends indicate a steady rise in NP graduation rates, and it is estimated that by 2025 the number of practicing NPs will double.  Refuah recognizes the importance of supporting NPs through quality training opportunities and employment.  In partnership with Columbia Presbyterian’s School of Nursing, Refuah Health Center offers a six-day intensive preceptorship at its satellite site in Sullivan County.  Every week during the summer, Refuah welcomes five new students, houses them onsite, and incorporates them into its team of providers. This summer boot camp is intense, with Refuah providers seeing an increased number of patients per day.  Students are thrown into the mix, gaining invaluable hands-on experience during their non-traditional clinical rotation in Sullivan.

“Students are highly integrated with our providers,” says Michael Kaplan, NP, coordinator of Refuah’s NP preceptor program.  “On the mobile, there is no place to hide,” he jokes. “Students must participate as a part of the medical team—they are doing exams, and working in-step with the provider to diagnose and prescribe.”

Students spend their days traveling aboard the mobiles through camps, bungalow communities and local townships, providing primary care and urgent care services alongside Refuah practitioners. In a safe environment and under the supervision of a qualified provider, students hone their ability to evaluate and assess patients. “This is more than shadowing,” adds Kaplan. Students also rotate through Refuah’s South Fallsburg clinic, or “basecamp” as Kaplan calls it. 

On any given day, these NPs-in-training see patients at all stages of life, from pediatric to geriatric.  According to Kaplan, this full-spectrum family practice is unusual in most clinical rotations and as an NP himself, he recognizes the value.

“At our basecamp, students get to participate in an integrated family practice,” he explains. “Students are getting the benefit of practicing medicine in an intimate environment and in a culturally diverse community.” As a Columbia graduate who has experienced the NP job market first hand, Kaplan adds “The daily—hourly—hands on experience will make them more marketable and get them better placement after graduation.”

Kaplan describes the program as a “win-win.”  Students get first hand experience, and Refuah is able to add registered nurses to each mobile where they act as knowledgeable physician extenders.  Kaplan also explains that this is an “ideal audition” for future employment, giving Refuah the ability to assess and flag NPs for potential job offers.

As the first summer of the NP clinical program draws to a close, Refuah is working with Columbia to become a clinical site for the Doctorate of Nurse Practitioner (DNP) rotation. In the coming year, Columbia’s School of Nursing will transition from a Master’s program to a Doctoral program, with students receiving two additional years of schooling.  DNP students will participate in clinical rotations for a full semester at Refuah’s service sites in Spring Valley. As with the NP program, DNP students will be closely integrated with Refuah providers and will have the opportunity to benefit from participating as providers in the full spectrum of primary care services.​


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Going Above and Beyond for Patients and Providers

The world of healthcare is changing, encouraging innovation and flexibility. Organizations strive to adapt and balance patient and provider needs, while maximizing reimbursement and hitting performance measures. These pronounced challenges, give way to new opportunities like the prospect of improving patient health outcomes and quality of life. 

As the tides shift, redefining the healthcare industry, patients continue to face traditional barriers to care—costs, transportation, accessible hours, and more. Changing insurance practices, complicated billing procedures, and increased documentation requirements compound these challenges and limit access.

“We started to see that some patients were simply overwhelmed,” says Leah Nussbaum, Director of Patient Services at Refuah Health. “They’d present to an appointment and wouldn’t be able to read and complete the forms. Or they would come in and not know how to pay or if they’d be able to pay for services. We wanted a better experience for our patients. We wanted them to feel like they had an advocate and ally in this ‘fight.’”

As a result, the Refuah Health Patient Services Department was created, evolving out of the desire to boost quality of care and improve patient experience. On any given day, Department employees provide clinical and non-clinical support to both patients and providers. Services include assisting patients to identify resources, scheduling and expediting specialty appointments or imaging services, and connecting patients to rehabilitation services and day programs. Patient Services also advocates for patients facing unjustly denied insurance claims, connects uninsured patients with health insurance enrollment assistance, and schedules individualized, flexible payment plans. As Nussbaum states, “Our goal is to make the experience as simple as possible. We try to shoulder some of the burden so patients can concentrate on what is really important—their health.”

The Department routinely offers essential, non-clinical support, Nussbaum describes:

A provider comes to me and says he has a patient that is homeless and living in her car. At that point, everything else becomes secondary and we focus on fulfilling the patients most basic needs—shelter, a clean bed, nutritious food.

In this situation, Patient Services contacted a local shelter and helped the patient make appropriate arrangements. This is but one example of the department’s role in providing whole-patient care. Patient Services regularly acts as a connector to outside social services. The department also provides assistance to families suffering from food insecurity and abused spouses in need of intervention.

“Our job doesn’t begin and end in the exam room,” Nussbaum asserts, speaking of Refuah’s commitment to all patients on the individual level. Patient Services also ensures proper follow-up with appointment reminders, referral arrangement, and scheduling.

Patient Services also offsets much of the legwork that hampers provider productivity and decreases quality of care. To increase accessibility, the Department is fully integrated—both physically situated within the clinic and available over the phone and through Refuah’s electronic medical records (EMR) portal. Communication through the EMR allows providers to “talk” with Patient Services and share notes about a patient’s medical and social needs, such as the need for an appointment with a specialist or assistance from social services. Patient Services can immediately begin coordinating this assistance. Additionally, Patient Service representatives work with Refuah providers to coordinate care and follow-up appointments with outside physicians. This fosters an open, active line of communication, helps expedite appointments, and increases collaboration between Refuah and outside facilities.

According to Dr. Tamir Katz, Refuah providers have noticed a change: “The introduction of the Patient Services Department is a boon to patients and providers alike. It has allowed primary care providers to focus on the clinical aspects of a patient’s care by off-loading much of the time consuming administrative burden of medicine.”

Nussbaum assures that moving forward, the Department will remain committed to its primary purpose: to simplify the healthcare process for patients and providers so they can focus on what is really important—staying well.

I have no words to describe how thankful we are for what the patient navigator did for us and am afraid to think what could have been. She not only was able to arrange the emergency CAT scan that the gastroenterologist ordered and find a surgeon who would take us right away, but then she met us at the highway with the disk on our way to the surgeons office! I am astounded with the care and support we got from start to finish.
– Mother of S.W., Refuah Patient


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