Preview
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
Cardiac Surgery Decertification
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
Executive Summan:
In accordance with Section 710.1(c)(5) of 10 New York Codes, Rules and Regulations (10 NYCRR),
Mount Sinai Beth Israel (MSBI) is submitting this Service Delivery Limited Review Application that
seeks approval for the decertification of the "Cardiac Surgery - Adult" service at the Hospital. MSBI is
located at First Avenue at 16th Street, New York (New York County), New York 10003.
This project is part of a larger effort of Mount Sinai to create a more integrated healthcare system, and to
more effectively use system resources. Between 2012 and 2015, MSBI performed between 287 and 324
cardiac surgery procedures per year. Through this project, patients who would typically be seen at MSBI
will now be seen at other Mount Sinai facilities within Manhattan - Mount Sinai Hospital (MSH) or
Mount Sinai St. Luke's (MSSL) - that are certified for the "Cardiac Surgery - Adult" service. In
particular, MSBI will put in place agreements with these related facilities for the provision of cardiac
surgery. There is sufficient capacity at MSH and MSSL in Manhattan to be able to serve MSBI's patients
once the service is decertified at MSBI, which is expected to occur on or around March 6, 2017.
Although MSBI understands that some individuals may choose to seek care outside of the Mount Sinai
system, the Hospital believes that this project is in the best interest of patients from a clinical perspective,
given its plans for the transformation of the MSBI campus. In addition, upon closure of the cardiac
surgery service, the cardiac operating rooms will be utilized for other surgical procedures. It should be
noted that the Percutaneous Coronary Intervention (PCI) service and the Electrophysiology (EP) service,
for which the Hospital is currently certified, will continue to be provided at MSBI (with the exception of
left atrial ablations, which will be provided at either MSH or MSSL).
At no point will access to Mount Sinai physicians be interrupted. Additionally, Mount Sinai does not
anticipate any job losses as a result of the closure of the adult cardiac surgery service at MSBI, and it has
already begun meeting and working with its union partners to ensure that the affected union employees
are retrained, if necessary, and offered other union opportunities with equal pay within the Mount Sinai
Health System.
The Total Project Cost for this project is $500 which is comprised solely of the Limited Review
Application fee, and is being submitted as part of initial submission ofthe Application.
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
Limited Review Application
State of New York Department of Health
Office of Primary Care and Health Systems Management
LRA Cover Sheet
Project to be Proposed/Applicant Information
This application is for those projects subject to a limited review pursuant to 10 NYCRR 710.l(c)(5)-(7). Please check the appropriate
box(es) reflective of the project being proposed by your facility (NOTE- Some projects may involve requisite "Construction". If so,
and total project costs are below designated thresholds, then both boxes must be checked and necessary LRA Schedules submitted).
Please read the LRA Instructions to ensure submission o(an appropriate and complete application:
D Minor Construction- Minor construction project with total project costs of up to $6,000,000 (or up to $15,000,000, if not
relating to clinical space- check "Non-Clinical" box below).
Necessary LRA Schedules: Cover Sheet, 2, 3, 4, 5, and 6.
D Equipment- Project related to the acquisition, relocation, installation or modification of certain medical equipment, with
total project costs of up to $6,000,000. (NOT necessary for "1-for-1" replacement of existing equipment without
construction, pursuant to Chapter 174 of the Laws of20ll amending Article 28 of the Public Health law to eliminate limited
review and CON review for one for one equipment replacement)
Necessary LRA Schedules: Cover Sheet, 2, 3, 4, and 5.
181 Service Delivery- Project to decertify a facility's beds/services; add services which involve a total project cost under
$6,000,000; or convert beds within approved categories. (If construction associated, also check "Construction" above.)
Necessary LRA Schedules: Cover Sheet, 7, 8, 10, and 12. *Ifproposing to decertify beds within a nursing home, provide a
description ofthe proposed alternative use ofthe space including a detailed sketch (unless the decertification is being
accomplished by eliminating beds in multiple-bedded rooms).
D Health Information Technology- Project to purchase and implement health information technology or
other information systems, with a total project cost between $6,000,000 and $15,000,000.
Necessary LRA Schedules: Cover Sheet, 2, 3, 9, and 12. Also Include Vendor Co11tract language (Appendix D).
D Cardiac Services- Project by an appropriately certified facility to add electrophysiology (EP) services;
or add, upgrade or replace a cardiac catheterization laboratory or equipment. (If construction
associated, also check "Construction" above.)
Necessary LRA Schedules: Cover Sheet, 7, 8, 10, and 12.
D Relocation of Extension Clinic- Project to relocate an extension clinic within the same service area.
Necessary LRA Schedules: Cover Sheet, 2, 3, 4, a11d 5. Also include a Closure Plan for vacating extension cli11ic.
D Part·Time Clinic- Project to operate, change services offered, change hours of operation or relocate a part-time clinic
site- for applicants already certified for "part-time clinic". (If construction associated, also check "Construction"
above.)
Necessary LRA Schedules: Cover Sheet, 8, 10, 11, and 12.
OPERATING CERTIFICATE NO. CERTIFIED OPERATOR TYPE OF FACILITY
7002002H Mount Sinai Beth Israel Hospital
OPERATOR ADDRESS- STREET & NUMBER PFI NAME AND TITLE OF CONTACT PERSON
First Avenue at 16th Street 1439 Frank M. Cicero, Cicero Consulting Associates
CITY 1 COUNTY ZIP STREET AND NUMBER
New York New York 10003 701 Westchester Avenue, Suite 2IOW
PROJECT SITE ADDRESS- STREET & NUMBER
First A venue at 16th Street
PFI
1439
CITY
White Plains
I
STATE
NY
JZIP
10604
CITY
New York
I
COUNTY
New York
ZIP
10003
TELEPHONE NUMBER
(914) 682-8657
~FAX NUMBER
(914) 682-8895
TOTAL PROJECT COST: $ 500 (Application Fee only) CONTACT E-MAIL: conadmin@ciceroassociates.com
(Re11 S/2014)
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
Limited Review A Iication Schedule LRA 7
State of New York Department of Health/Office of Health Systems Management
Proposed Operating Budget
Budget .Current Year* First Year* Third Year*
(Projected) (Projected)
Revenues
Service Revenue $17,184,370 ($17,184,370) ($17,184,370)
Grants Funds
Foundation
Other
Fees
Other Income
(1) Total Revenues $17,184,370 ($17,184,370) ($17,184,370)
Expenses
Salaries and Wage Expense $6,180,004 ($6,180,004) ($6,180,004)
Employee Benefits $3,028,202 ($3,028,202) ($3,028,202)
Professional Fees $2,167,471 ($2,167,471) ($2,167,471)
Medical & Surgical Supplies $3,287,904 ($3,287,904) ($3,287 ,904)
Non-Medical Equipment
Purchased Services $415,644 ($415,644) ($415,644)
Other Direct Expense $518,511 ($518,511) ($518,511)
Utilities Expense
Interest Expense
Rent Expense
Depreciation Expense
Other Expenses
(2) Total Expense $15,597,736 ($15,597, 736) ($15,597,736)
Net Total - (1-2) -~
$1,586,634 ($1,586,634) ($1,586,634)
*The Current Year represents year 2015 for the cardiac surgery service at MSBI. The incremental Year 1 and
Year 3 operating budget demonstrates that the service will be decertified by MSBI through this project.
(Rev. 7/2015)
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
Limited Review Application
State of New York Department of Health/Office of Health Systems Management
Ischedule LRA 7
* Various inpatient services may be reimbursed as discharges or days. Applicant should indicate which method checkbox.
applies to this table by choosing the appropriate checkbox
Patient Days 0 Patient Discharges
Inpatient Services Source of Total Current Year** First Year Incremental** Third Year Incremental**
Revenue Net Revenue• Net Revenue* Net Revenue*
Patient Patient Patient
Days or Days or %based Days or %based
discharg % Dollars($) discharg on days or Dollars-($) discharg on days or Dollars-($)
es• es* discharges es• discharges
Commercial Fee for
Service
Managed
Care 87 33.3% $8,512,248 (87) 33.3% ($8,512,248 (87 33.3% ($8,512,248
Medicare Fee for
Service 65 24.9% $3,516,409 (65) 24.9% ($3,516,409) (65) 24.9% ($3,516,409)
Managed
Care 46 17.6% $2,473,888 (46) 17.6% ($2,473,888 (46) 17.6% ($2,473,888)
Medicaid Fee for
Service 11 4.2% $370,713 (11) 4.2% ($370,713) (11) 4.2% ($370,713)
Managed
Care 52 19.9% $2,3ll,ll2 (52) 19.9% ($2,3ll,ll2) (52) 19.9% ($2,3ll,ll2)
Private Pay
OASAS
OMH
Charity Care
Bad Debt
All Other
Total 261 100.0% $17,184,370 (261) 100.0% ($17,184,370) (261) 100.0% ($17 ,184,370)
•• The Current Year represents year 2015 for the cardiac surgery service at MSBI. The incremental Year 1 and Year 3 operating budget
demonstrates that the service will be decertified by MSBI through this project.
(Rev. 7/2015) 2
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
Oupatient Services Total Current Year First Year Incremental Third Year Incremental
Source of Revenue Net Revenue* Net Revenue* Net Revenue*
Visits Visits Visits
% Dollars($) % Dollars($) % Dollars($)
Commercial Fee for
Service
Managed
Care
Medicare Fee for
Service
Managed
Care N/A N/A N/A
Medicaid Fee for
Service
Managed
--- --- ·--
Care Inpatient Inpatient Inpatient
Private Pay Project Project Project
OASAS Only Only Only
OMH
Charity Care
Bad Debt
All Other
Total
Total oflnpatient
and Outpatient
Services $17,184,370 ($17,184,370) ($17,184,370
Title of Attachment Filename of Attachment
l. 1n an attachment,
Revenues by payer are
provide the basis and
based upon the
supporting calculations N/A
experience of the
for all revenues by
I payor.
Hospital.
2. In an attachment, Charity Care based on the
provide the basis for experience ofthe N/A
charity care. Hospital.
(Rev. 7/2015) 3
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
Limited Review Application Schedule LRA 8
State of New York Department of Health/Office of Health Systems Management
Staffing
Number of FTEs to the Nearest Tenth
Staffing Categories Current Year* First Year of Third Year of
**** implementation implementation
**** ****
Health Providers**:
Physician Assistant 2.0 -2.0 -2.0
Nurse Practitioner 3.0 -3.0 -3.0
Support Staff***:
Perfusionist 6.0 -6.0 -6.0
Registered Nurse 36.0 -36.0 -36.0
Patient Care Associate 4.0 -4.0 -4.0
Other Support Staff 14.0 -14.0 -14.0
Total Number ofEmplo)'J!es 65.0 -65.0 -65.0
* ..
Last complete year pnor to subnutting apphcatlon
** "Health Providers" includes all providers serving patients at the site. A Health Provider is any staff who can
provide a billable service -physician, dentist, dental hygienist, podiatrist, physician assistant, physical therapist, etc.
"'** All other staff.
****The Current Year represents year 2015 staffing for the cardiac surgery service at MSBI. The incremental Year land
Year 3 operating budget demonstrates that the service wil1 be decertified by MSBI through this project.
Describe how the number and mix of staff were determined:
The number and mix of staff were based upon the fact that the cardiac surgery service will be decertified through this
project. Nevertheless, Mount Sinai does not anticipate any job losses as a result of the closure of the cardiac surgery
service at MSBI, and it has already begun meeting and working with its union partners to ensure that the affected union
employees are retrained, if necessary, and offered other union opportunities with equal pay within the Mount Sinai
Health System.
PLEASE COMPLETE THE FOLLOWING:
1. Are staff paid and on payroll? 181 Yes 0 No
2. Provide copies of contracts for any independent contractor.
3. Please attach the Medical Doctors C.V. Please refer to the Schedule LRA 8 Attachment
4. Is this facility affiliated with any other facilities? 181 Yes D No Please refer to the Schedule LRA
(If yes, please describe affiliation and/or agreement.) 8 Attachment
(Rev. 71712010)
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
MOUNT SINAI BETH ISRAEL
SCHEDULELRA8ATTACHMENT
CURRICULUM VITAE- MEDICAL DIRECTOR
AND
STATEMENT RE: ARTICLE 28 NETWORK
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
John D. Puskas, MD, MSc, FACS, FACC
CURRICULUM VITAE
NAME: John D. Puskas, MD, MSc, FACS, FACC
ADDRESS: Beth Israel Medical Center Mount Sinai Medical Center
350 East 1ih Street, 5 Baird Hall 1190 Fifth Avenue, GP2W
New York, NY 10003 New York, NY 10029
(212) 420-5601 (212) 659-6800
CELL PHONE: 404-273-4014
EMAIL: john.puskas@mountsinai.org
CITIZENSHIP: U.S. Citizen, naturalized
CURRENT TITLES AND AFFILIATIONS:
Academic Appointments:
Primary appointments:
4/2014- Present Chairman, Department of Cardiovascular Surgery
Mount Sinai Beth Israel
New York, NY
Joint and secondary appointments:
4/2014 - Present Professor of Cardiovascular Surgery
Icahn School of Medicine at Mount Sinai
New York, NY
Clinical Appointments:
2014- Present Staff surgeon, Mount Sinai Hospital
2014- Present Staff surgeon, Mount Sinai Beth Israel Hospital
Other Administrative Appointments:
2014- Present Director, Coronary Revascularization Reference Center, Mount Sinai Health System
Director, Cardiac Quality Teams, Mount Sinai Health System
Director, Cardiovascular Clinical Research Unit, Mount Sinai Health System
2005-2014 Chief of Cardiac Surgery, Emory University Hospital Midtown
Associate Chief, Division ofCardiothoracic Surgery, January
Medical Director. Physician Assistant Postgraduate Cardiothoracic Surgery Residency
Program
2005 -Present Director, Founder, Clinical Research Unit, Cardiothoracic Surgery
2005 - Present Director, Emory Center for the Surgical Treatment of Atrial Fibrillation
2005-2010 Director, Cardiothoracic Surgical Intensive Care Unit, Emory Hospital Midtown
2008 - Present Director, Non-Board Track Fellowship Adult Cardiac Surgery, Emory Hospitals
2010 - Present Associate Medical Director, Cardiothoracic Intensive Care Unit Emory Midtown
20 10 - Present Quality Officer, Division of Cardiothoracic Surgery, Emory Hospitals
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
John D. Puskas, MD, MSc, FACS, FACC
Page 2 of34
LICENSURES/BOARDS:
Georgia Medical Board
Specialty Boards:
1994 - Recert./2004 American Board of Surgery
1997- Recert./2007 American Board ofThoracic Surgery
EDUCATION:
1974 1978
k Diploma; Upper Canada College
1978- 1982 A.B. Degree Summa Cum Laude; Biology, Princeton University
1982- 1986 Medical Degree; Harvard Medical School
1989- 1991 Master of Science; Surgical Science, University of Toronto
POSTGRADUATE TRAINING:
1986 - 1993 Harvard University, Department of Surgery, Massachusetts General Hospital
General Surgery Residency Program, Gerald Austen, MD
1989- 1991 University of Toronto Research fellowship, Division of Thoracic Surgery,
Toronto General Hospital, G. Alexander Patterson, MD
1993 Massachusetts General Hospital, General Thoracic Surgery, Hermes C. Grillo,
MD
1993- 1996 Emory University Residency and Fellowship Cardiothoracic Surgery, Robert A.
Guyton, MD
COMMITTEE ME:MBERSHIPS:
National and International:
1999-2002 Committee on New Technologies, Member, Society of Thoracic Surgeons
2001-2003 Program Committee, Member, International Society for Minimally Invasive
Cardiac Surgery
2003-2005 Program Committee, Member. The Society ofThoracic Surgeons
2003-2010 Program Committee, Reviewer, The Society ofThoracic Surgeons
2003-2008 Publications Committee, Chair, International Society for Minimally Invasive
Cardiac Surgery
2003-2010 Board of Directors, Member, International Society for Minimally Invasive
Cardiac Surgery
2004 - Present Society of Thoracic Surgeons Workforce on Adult Cardiac Surgery, Member
2004-2005 Program Committee, Member, American Association for Thoracic Surgery
2004-2011 Education Committee, Member, American Association for Thoracic Surgery
2004 - Present Program Committee, Chair, International Society for Minimally Invasive Cardiac
Surgery
2004 Consensus Conference, Chair, International Society for Minimally Invasive
Cardiac Surgery
2004 In-Training Examination Committee, Member, American Board of Thoracic
Surgery
2004 Education Committee. Member, Thoracic Surgery Foundation for Research and
Education
2004 Working Group on Future Directions in Cardiac Surgery, Member, National
Institutes of Health
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
Limited Review Application Schedule LRA 10 _
State of New York Department of Health/Office of Health Systems Management
Impact of Limited Review Application on Operating Certificate
(services specific to the site)
Instructions:
"Current". Column: Mark "x" in the box only if the service currently appears on the operating certificate (OpCert) not
including requested changes
"Add" Column: Mark "x" in the box this CON application seeks to add.
"Remove" Column: Mark "x" in the box this CON application seeks to decertify.
"Pro osed" Column: Mark "x" in the box corres ondin to all the services that will ultimate!
~ateswrv/Authorized Service Code Current Add Remove Pronosed
Ambulatory Surgery- Multi-Specialty ~ D D [gl
Audiology 0/P rgJ D D ~
Cardiac Catheterization- Adult Diagnostic rgJ D D rgJ
Cardiac Catheterization- Electrophysiology (EP) ~ D D [gl
Cardiac Catheterization - Percutaneous Coronary Intervention (PCI) ~ D D rgJ
Cardiac Surgery - Adult rgJ D rgJ D
Chemical Dependence - Rehabilitation 0/P rgJ D D rgJ
Chemical Dependence- Withdrawal 0/P rgJ D D 18]
Clinic Part Time Services rgJ D D rgJ
Clinical Laboratory Services ~ D D [gl
Comprehensive Psychiatric Emergency Program rgJ D D rgJ
CT Scanner rgJ D D ~
Dental 0/P rgJ D D ~
Emergency Department rgJ D D 18]
Family Planning 0/P 18] D D rgJ
Linear Accelerator ~ D D rgJ
Lithotripsy ~. il D rgJ
Magnetic Resonance Imaging ~ D D rgJ
Medical Services - Other Medical Specialties rgJ D D rgJ
Medical Services - Primary Care rgJ D D 18]
Medical Social Services rgJ D D 18]
Methadone Maintenance 0/P ~ D D rgJ
Nuclear Medicine- Diagnostic rgJ D D [gl
Nuclear Medicine - Therapeutic rgJ D D rgJ
Pediatric 0/P rgJ D 0 rgJ
Prenatal 0/P 18] D D rgJ
Radiology - Diagnostic rgJ D 0 [gl
Radiology- Therapeutic rgJ D D rgJ
Rental Dialysis - Acute rgJ D D [gl
Respiratory Care rgJ D 0 [gl
Therapy - Occupational 0/P rgJ D D rgJ
Therapy -Physical 0/P 18] 0 D [gl
Therapy- Speech Language Pathology tEl D D rgJ
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
ITherapy - Vocational Rehabilitation 0/P D D
Does the applicant have any previously submitted Certificate of Need (CON) applications that have not been
completed involving addition or decertification of beds?
0No
[8:1 Yes (Enter CON numbers to the right) 162406-L I 162405-L I
(Rev. 717/2010)
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024
"'!:':'L-:-im~it--=e:::-d-=-R=--e-:-v_ie~w~A-:-:'?p~p~l_ic-=-=a~t-:-:'io-::':"n_--:--:-_ _ _--1 Schedule LRA 12 ~-
state of New York Department of Health/Office of Health Systems Management
Assurances
The undersigned, as a duly authorized representative of the applicant, hereby gives the following assurances:
a) The applicant has or will have a fee simple ot· such other estate or interest in the site, including necessary easements and
rights-of-way, sufficient to a$Sure use and possession for the purpose ofthe construction and operation of the facility.
b) The applicant will obtain. the approval of the Commissione.r of Health of all required submissions, which shall conform to the
standards of constructio11 and equipment in Subchapter C of Title 10 (Health) of the Official Compilation of Codes, Rules
!llld Re~ulations of the State of New York (Tide 10).
c) The applicant will submit to the Commissioner of Health final working drawings and specifications, which shall conform to
the standards of construction and equipment of Subchapter C of Title 10, prior to contracting for construction, unless
otherwise provided for in Title .10. ·
d) the applicant will cause the project to be completed in accordance with the application and approved plans and
specifications. ·
e) The applicant will provide and maintain competent and adequate architectural and/or engineering inspection at the
construction site to insure that .the completed work conforms to the approved plans and specifications.
t) If the project is an addition to a facility already in existence, upon completion of construction all patients shall be removed
from areas of the facility that are not in compliance with pertinent provisit>ns of Title 10, unless a waiver is grante~ by the
Commissioner of Health, under Title l 0. ·
g) The facility will be operated and maintained in accordance with the standards prescribed by law.
h) The applicant will comply with the provisions of the Public Health Law and the applicable provisions ofTitle 10 with respect
to the operation of all established, existing medical facilities in which the applicant has a controlling interest.
i) The applicant understands and recQgnizes that any approval ofthis application is not to b:e construed as an approval of, nor
does it provide assurance of, reimbursement for any costs identified in the application. Reimbursement for all cost shall be in
accordance with and subject to the provisions of Part 86 of Title 10.
Date
I~
Signature '
IKenneth L. Davis, M.D.
Name (Please Type)
President and CEO, Mpunt Sinai Hospitals Group
Title (Please Type)
(Rev. 717120/0)
Preview
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 Cardiac Surgery Decertification FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 Executive Summan: In accordance with Section 710.1(c)(5) of 10 New York Codes, Rules and Regulations (10 NYCRR), Mount Sinai Beth Israel (MSBI) is submitting this Service Delivery Limited Review Application that seeks approval for the decertification of the "Cardiac Surgery - Adult" service at the Hospital. MSBI is located at First Avenue at 16th Street, New York (New York County), New York 10003. This project is part of a larger effort of Mount Sinai to create a more integrated healthcare system, and to more effectively use system resources. Between 2012 and 2015, MSBI performed between 287 and 324 cardiac surgery procedures per year. Through this project, patients who would typically be seen at MSBI will now be seen at other Mount Sinai facilities within Manhattan - Mount Sinai Hospital (MSH) or Mount Sinai St. Luke's (MSSL) - that are certified for the "Cardiac Surgery - Adult" service. In particular, MSBI will put in place agreements with these related facilities for the provision of cardiac surgery. There is sufficient capacity at MSH and MSSL in Manhattan to be able to serve MSBI's patients once the service is decertified at MSBI, which is expected to occur on or around March 6, 2017. Although MSBI understands that some individuals may choose to seek care outside of the Mount Sinai system, the Hospital believes that this project is in the best interest of patients from a clinical perspective, given its plans for the transformation of the MSBI campus. In addition, upon closure of the cardiac surgery service, the cardiac operating rooms will be utilized for other surgical procedures. It should be noted that the Percutaneous Coronary Intervention (PCI) service and the Electrophysiology (EP) service, for which the Hospital is currently certified, will continue to be provided at MSBI (with the exception of left atrial ablations, which will be provided at either MSH or MSSL). At no point will access to Mount Sinai physicians be interrupted. Additionally, Mount Sinai does not anticipate any job losses as a result of the closure of the adult cardiac surgery service at MSBI, and it has already begun meeting and working with its union partners to ensure that the affected union employees are retrained, if necessary, and offered other union opportunities with equal pay within the Mount Sinai Health System. The Total Project Cost for this project is $500 which is comprised solely of the Limited Review Application fee, and is being submitted as part of initial submission ofthe Application. FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 Limited Review Application State of New York Department of Health Office of Primary Care and Health Systems Management LRA Cover Sheet Project to be Proposed/Applicant Information This application is for those projects subject to a limited review pursuant to 10 NYCRR 710.l(c)(5)-(7). Please check the appropriate box(es) reflective of the project being proposed by your facility (NOTE- Some projects may involve requisite "Construction". If so, and total project costs are below designated thresholds, then both boxes must be checked and necessary LRA Schedules submitted). Please read the LRA Instructions to ensure submission o(an appropriate and complete application: D Minor Construction- Minor construction project with total project costs of up to $6,000,000 (or up to $15,000,000, if not relating to clinical space- check "Non-Clinical" box below). Necessary LRA Schedules: Cover Sheet, 2, 3, 4, 5, and 6. D Equipment- Project related to the acquisition, relocation, installation or modification of certain medical equipment, with total project costs of up to $6,000,000. (NOT necessary for "1-for-1" replacement of existing equipment without construction, pursuant to Chapter 174 of the Laws of20ll amending Article 28 of the Public Health law to eliminate limited review and CON review for one for one equipment replacement) Necessary LRA Schedules: Cover Sheet, 2, 3, 4, and 5. 181 Service Delivery- Project to decertify a facility's beds/services; add services which involve a total project cost under $6,000,000; or convert beds within approved categories. (If construction associated, also check "Construction" above.) Necessary LRA Schedules: Cover Sheet, 7, 8, 10, and 12. *Ifproposing to decertify beds within a nursing home, provide a description ofthe proposed alternative use ofthe space including a detailed sketch (unless the decertification is being accomplished by eliminating beds in multiple-bedded rooms). D Health Information Technology- Project to purchase and implement health information technology or other information systems, with a total project cost between $6,000,000 and $15,000,000. Necessary LRA Schedules: Cover Sheet, 2, 3, 9, and 12. Also Include Vendor Co11tract language (Appendix D). D Cardiac Services- Project by an appropriately certified facility to add electrophysiology (EP) services; or add, upgrade or replace a cardiac catheterization laboratory or equipment. (If construction associated, also check "Construction" above.) Necessary LRA Schedules: Cover Sheet, 7, 8, 10, and 12. D Relocation of Extension Clinic- Project to relocate an extension clinic within the same service area. Necessary LRA Schedules: Cover Sheet, 2, 3, 4, a11d 5. Also include a Closure Plan for vacating extension cli11ic. D Part·Time Clinic- Project to operate, change services offered, change hours of operation or relocate a part-time clinic site- for applicants already certified for "part-time clinic". (If construction associated, also check "Construction" above.) Necessary LRA Schedules: Cover Sheet, 8, 10, 11, and 12. OPERATING CERTIFICATE NO. CERTIFIED OPERATOR TYPE OF FACILITY 7002002H Mount Sinai Beth Israel Hospital OPERATOR ADDRESS- STREET & NUMBER PFI NAME AND TITLE OF CONTACT PERSON First Avenue at 16th Street 1439 Frank M. Cicero, Cicero Consulting Associates CITY 1 COUNTY ZIP STREET AND NUMBER New York New York 10003 701 Westchester Avenue, Suite 2IOW PROJECT SITE ADDRESS- STREET & NUMBER First A venue at 16th Street PFI 1439 CITY White Plains I STATE NY JZIP 10604 CITY New York I COUNTY New York ZIP 10003 TELEPHONE NUMBER (914) 682-8657 ~FAX NUMBER (914) 682-8895 TOTAL PROJECT COST: $ 500 (Application Fee only) CONTACT E-MAIL: conadmin@ciceroassociates.com (Re11 S/2014) FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 Limited Review A Iication Schedule LRA 7 State of New York Department of Health/Office of Health Systems Management Proposed Operating Budget Budget .Current Year* First Year* Third Year* (Projected) (Projected) Revenues Service Revenue $17,184,370 ($17,184,370) ($17,184,370) Grants Funds Foundation Other Fees Other Income (1) Total Revenues $17,184,370 ($17,184,370) ($17,184,370) Expenses Salaries and Wage Expense $6,180,004 ($6,180,004) ($6,180,004) Employee Benefits $3,028,202 ($3,028,202) ($3,028,202) Professional Fees $2,167,471 ($2,167,471) ($2,167,471) Medical & Surgical Supplies $3,287,904 ($3,287,904) ($3,287 ,904) Non-Medical Equipment Purchased Services $415,644 ($415,644) ($415,644) Other Direct Expense $518,511 ($518,511) ($518,511) Utilities Expense Interest Expense Rent Expense Depreciation Expense Other Expenses (2) Total Expense $15,597,736 ($15,597, 736) ($15,597,736) Net Total - (1-2) -~ $1,586,634 ($1,586,634) ($1,586,634) *The Current Year represents year 2015 for the cardiac surgery service at MSBI. The incremental Year 1 and Year 3 operating budget demonstrates that the service will be decertified by MSBI through this project. (Rev. 7/2015) FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 Limited Review Application State of New York Department of Health/Office of Health Systems Management Ischedule LRA 7 * Various inpatient services may be reimbursed as discharges or days. Applicant should indicate which method checkbox. applies to this table by choosing the appropriate checkbox Patient Days 0 Patient Discharges Inpatient Services Source of Total Current Year** First Year Incremental** Third Year Incremental** Revenue Net Revenue• Net Revenue* Net Revenue* Patient Patient Patient Days or Days or %based Days or %based discharg % Dollars($) discharg on days or Dollars-($) discharg on days or Dollars-($) es• es* discharges es• discharges Commercial Fee for Service Managed Care 87 33.3% $8,512,248 (87) 33.3% ($8,512,248 (87 33.3% ($8,512,248 Medicare Fee for Service 65 24.9% $3,516,409 (65) 24.9% ($3,516,409) (65) 24.9% ($3,516,409) Managed Care 46 17.6% $2,473,888 (46) 17.6% ($2,473,888 (46) 17.6% ($2,473,888) Medicaid Fee for Service 11 4.2% $370,713 (11) 4.2% ($370,713) (11) 4.2% ($370,713) Managed Care 52 19.9% $2,3ll,ll2 (52) 19.9% ($2,3ll,ll2) (52) 19.9% ($2,3ll,ll2) Private Pay OASAS OMH Charity Care Bad Debt All Other Total 261 100.0% $17,184,370 (261) 100.0% ($17,184,370) (261) 100.0% ($17 ,184,370) •• The Current Year represents year 2015 for the cardiac surgery service at MSBI. The incremental Year 1 and Year 3 operating budget demonstrates that the service will be decertified by MSBI through this project. (Rev. 7/2015) 2 FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 Oupatient Services Total Current Year First Year Incremental Third Year Incremental Source of Revenue Net Revenue* Net Revenue* Net Revenue* Visits Visits Visits % Dollars($) % Dollars($) % Dollars($) Commercial Fee for Service Managed Care Medicare Fee for Service Managed Care N/A N/A N/A Medicaid Fee for Service Managed --- --- ·-- Care Inpatient Inpatient Inpatient Private Pay Project Project Project OASAS Only Only Only OMH Charity Care Bad Debt All Other Total Total oflnpatient and Outpatient Services $17,184,370 ($17,184,370) ($17,184,370 Title of Attachment Filename of Attachment l. 1n an attachment, Revenues by payer are provide the basis and based upon the supporting calculations N/A experience of the for all revenues by I payor. Hospital. 2. In an attachment, Charity Care based on the provide the basis for experience ofthe N/A charity care. Hospital. (Rev. 7/2015) 3 FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 Limited Review Application Schedule LRA 8 State of New York Department of Health/Office of Health Systems Management Staffing Number of FTEs to the Nearest Tenth Staffing Categories Current Year* First Year of Third Year of **** implementation implementation **** **** Health Providers**: Physician Assistant 2.0 -2.0 -2.0 Nurse Practitioner 3.0 -3.0 -3.0 Support Staff***: Perfusionist 6.0 -6.0 -6.0 Registered Nurse 36.0 -36.0 -36.0 Patient Care Associate 4.0 -4.0 -4.0 Other Support Staff 14.0 -14.0 -14.0 Total Number ofEmplo)'J!es 65.0 -65.0 -65.0 * .. Last complete year pnor to subnutting apphcatlon ** "Health Providers" includes all providers serving patients at the site. A Health Provider is any staff who can provide a billable service -physician, dentist, dental hygienist, podiatrist, physician assistant, physical therapist, etc. "'** All other staff. ****The Current Year represents year 2015 staffing for the cardiac surgery service at MSBI. The incremental Year land Year 3 operating budget demonstrates that the service wil1 be decertified by MSBI through this project. Describe how the number and mix of staff were determined: The number and mix of staff were based upon the fact that the cardiac surgery service will be decertified through this project. Nevertheless, Mount Sinai does not anticipate any job losses as a result of the closure of the cardiac surgery service at MSBI, and it has already begun meeting and working with its union partners to ensure that the affected union employees are retrained, if necessary, and offered other union opportunities with equal pay within the Mount Sinai Health System. PLEASE COMPLETE THE FOLLOWING: 1. Are staff paid and on payroll? 181 Yes 0 No 2. Provide copies of contracts for any independent contractor. 3. Please attach the Medical Doctors C.V. Please refer to the Schedule LRA 8 Attachment 4. Is this facility affiliated with any other facilities? 181 Yes D No Please refer to the Schedule LRA (If yes, please describe affiliation and/or agreement.) 8 Attachment (Rev. 71712010) FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 MOUNT SINAI BETH ISRAEL SCHEDULELRA8ATTACHMENT CURRICULUM VITAE- MEDICAL DIRECTOR AND STATEMENT RE: ARTICLE 28 NETWORK FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 John D. Puskas, MD, MSc, FACS, FACC CURRICULUM VITAE NAME: John D. Puskas, MD, MSc, FACS, FACC ADDRESS: Beth Israel Medical Center Mount Sinai Medical Center 350 East 1ih Street, 5 Baird Hall 1190 Fifth Avenue, GP2W New York, NY 10003 New York, NY 10029 (212) 420-5601 (212) 659-6800 CELL PHONE: 404-273-4014 EMAIL: john.puskas@mountsinai.org CITIZENSHIP: U.S. Citizen, naturalized CURRENT TITLES AND AFFILIATIONS: Academic Appointments: Primary appointments: 4/2014- Present Chairman, Department of Cardiovascular Surgery Mount Sinai Beth Israel New York, NY Joint and secondary appointments: 4/2014 - Present Professor of Cardiovascular Surgery Icahn School of Medicine at Mount Sinai New York, NY Clinical Appointments: 2014- Present Staff surgeon, Mount Sinai Hospital 2014- Present Staff surgeon, Mount Sinai Beth Israel Hospital Other Administrative Appointments: 2014- Present Director, Coronary Revascularization Reference Center, Mount Sinai Health System Director, Cardiac Quality Teams, Mount Sinai Health System Director, Cardiovascular Clinical Research Unit, Mount Sinai Health System 2005-2014 Chief of Cardiac Surgery, Emory University Hospital Midtown Associate Chief, Division ofCardiothoracic Surgery, January Medical Director. Physician Assistant Postgraduate Cardiothoracic Surgery Residency Program 2005 -Present Director, Founder, Clinical Research Unit, Cardiothoracic Surgery 2005 - Present Director, Emory Center for the Surgical Treatment of Atrial Fibrillation 2005-2010 Director, Cardiothoracic Surgical Intensive Care Unit, Emory Hospital Midtown 2008 - Present Director, Non-Board Track Fellowship Adult Cardiac Surgery, Emory Hospitals 2010 - Present Associate Medical Director, Cardiothoracic Intensive Care Unit Emory Midtown 20 10 - Present Quality Officer, Division of Cardiothoracic Surgery, Emory Hospitals FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 John D. Puskas, MD, MSc, FACS, FACC Page 2 of34 LICENSURES/BOARDS: Georgia Medical Board Specialty Boards: 1994 - Recert./2004 American Board of Surgery 1997- Recert./2007 American Board ofThoracic Surgery EDUCATION: 1974 1978 k Diploma; Upper Canada College 1978- 1982 A.B. Degree Summa Cum Laude; Biology, Princeton University 1982- 1986 Medical Degree; Harvard Medical School 1989- 1991 Master of Science; Surgical Science, University of Toronto POSTGRADUATE TRAINING: 1986 - 1993 Harvard University, Department of Surgery, Massachusetts General Hospital General Surgery Residency Program, Gerald Austen, MD 1989- 1991 University of Toronto Research fellowship, Division of Thoracic Surgery, Toronto General Hospital, G. Alexander Patterson, MD 1993 Massachusetts General Hospital, General Thoracic Surgery, Hermes C. Grillo, MD 1993- 1996 Emory University Residency and Fellowship Cardiothoracic Surgery, Robert A. Guyton, MD COMMITTEE ME:MBERSHIPS: National and International: 1999-2002 Committee on New Technologies, Member, Society of Thoracic Surgeons 2001-2003 Program Committee, Member, International Society for Minimally Invasive Cardiac Surgery 2003-2005 Program Committee, Member. The Society ofThoracic Surgeons 2003-2010 Program Committee, Reviewer, The Society ofThoracic Surgeons 2003-2008 Publications Committee, Chair, International Society for Minimally Invasive Cardiac Surgery 2003-2010 Board of Directors, Member, International Society for Minimally Invasive Cardiac Surgery 2004 - Present Society of Thoracic Surgeons Workforce on Adult Cardiac Surgery, Member 2004-2005 Program Committee, Member, American Association for Thoracic Surgery 2004-2011 Education Committee, Member, American Association for Thoracic Surgery 2004 - Present Program Committee, Chair, International Society for Minimally Invasive Cardiac Surgery 2004 Consensus Conference, Chair, International Society for Minimally Invasive Cardiac Surgery 2004 In-Training Examination Committee, Member, American Board of Thoracic Surgery 2004 Education Committee. Member, Thoracic Surgery Foundation for Research and Education 2004 Working Group on Future Directions in Cardiac Surgery, Member, National Institutes of Health FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 Limited Review Application Schedule LRA 10 _ State of New York Department of Health/Office of Health Systems Management Impact of Limited Review Application on Operating Certificate (services specific to the site) Instructions: "Current". Column: Mark "x" in the box only if the service currently appears on the operating certificate (OpCert) not including requested changes "Add" Column: Mark "x" in the box this CON application seeks to add. "Remove" Column: Mark "x" in the box this CON application seeks to decertify. "Pro osed" Column: Mark "x" in the box corres ondin to all the services that will ultimate! ~ateswrv/Authorized Service Code Current Add Remove Pronosed Ambulatory Surgery- Multi-Specialty ~ D D [gl Audiology 0/P rgJ D D ~ Cardiac Catheterization- Adult Diagnostic rgJ D D rgJ Cardiac Catheterization- Electrophysiology (EP) ~ D D [gl Cardiac Catheterization - Percutaneous Coronary Intervention (PCI) ~ D D rgJ Cardiac Surgery - Adult rgJ D rgJ D Chemical Dependence - Rehabilitation 0/P rgJ D D rgJ Chemical Dependence- Withdrawal 0/P rgJ D D 18] Clinic Part Time Services rgJ D D rgJ Clinical Laboratory Services ~ D D [gl Comprehensive Psychiatric Emergency Program rgJ D D rgJ CT Scanner rgJ D D ~ Dental 0/P rgJ D D ~ Emergency Department rgJ D D 18] Family Planning 0/P 18] D D rgJ Linear Accelerator ~ D D rgJ Lithotripsy ~. il D rgJ Magnetic Resonance Imaging ~ D D rgJ Medical Services - Other Medical Specialties rgJ D D rgJ Medical Services - Primary Care rgJ D D 18] Medical Social Services rgJ D D 18] Methadone Maintenance 0/P ~ D D rgJ Nuclear Medicine- Diagnostic rgJ D D [gl Nuclear Medicine - Therapeutic rgJ D D rgJ Pediatric 0/P rgJ D 0 rgJ Prenatal 0/P 18] D D rgJ Radiology - Diagnostic rgJ D 0 [gl Radiology- Therapeutic rgJ D D rgJ Rental Dialysis - Acute rgJ D D [gl Respiratory Care rgJ D 0 [gl Therapy - Occupational 0/P rgJ D D rgJ Therapy -Physical 0/P 18] 0 D [gl Therapy- Speech Language Pathology tEl D D rgJ FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 ITherapy - Vocational Rehabilitation 0/P D D Does the applicant have any previously submitted Certificate of Need (CON) applications that have not been completed involving addition or decertification of beds? 0No [8:1 Yes (Enter CON numbers to the right) 162406-L I 162405-L I (Rev. 717/2010) FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 02/07/2024 "'!:':'L-:-im~it--=e:::-d-=-R=--e-:-v_ie~w~A-:-:'?p~p~l_ic-=-=a~t-:-:'io-::':"n_--:--:-_ _ _--1 Schedule LRA 12 ~- state of New York Department of Health/Office of Health Systems Management Assurances The undersigned, as a duly authorized representative of the applicant, hereby gives the following assurances: a) The applicant has or will have a fee simple ot· such other estate or interest in the site, including necessary easements and rights-of-way, sufficient to a$Sure use and possession for the purpose ofthe construction and operation of the facility. b) The applicant will obtain. the approval of the Commissione.r of Health of all required submissions, which shall conform to the standards of constructio11 and equipment in Subchapter C of Title 10 (Health) of the Official Compilation of Codes, Rules !llld Re~ulations of the State of New York (Tide 10). c) The applicant will submit to the Commissioner of Health final working drawings and specifications, which shall conform to the standards of construction and equipment of Subchapter C of Title 10, prior to contracting for construction, unless otherwise provided for in Title .10. · d) the applicant will cause the project to be completed in accordance with the application and approved plans and specifications. · e) The applicant will provide and maintain competent and adequate architectural and/or engineering inspection at the construction site to insure that .the completed work conforms to the approved plans and specifications. t) If the project is an addition to a facility already in existence, upon completion of construction all patients shall be removed from areas of the facility that are not in compliance with pertinent provisit>ns of Title 10, unless a waiver is grante~ by the Commissioner of Health, under Title l 0. · g) The facility will be operated and maintained in accordance with the standards prescribed by law. h) The applicant will comply with the provisions of the Public Health Law and the applicable provisions ofTitle 10 with respect to the operation of all established, existing medical facilities in which the applicant has a controlling interest. i) The applicant understands and recQgnizes that any approval ofthis application is not to b:e construed as an approval of, nor does it provide assurance of, reimbursement for any costs identified in the application. Reimbursement for all cost shall be in accordance with and subject to the provisions of Part 86 of Title 10. Date I~ Signature ' IKenneth L. Davis, M.D. Name (Please Type) President and CEO, Mpunt Sinai Hospitals Group Title (Please Type) (Rev. 717120/0)