Patriot Sons USA: A Certified SDVOB, Providing Experienced Asbestos Abatement

By Elizabeth Landry

Frederick W. Dambach, President and CEO of Patriot Sons USA, has spent a lifetime in service—first to his country, and now to the health and safety of our communities. A U.S. Army veteran who served during both the Vietnam War and Operation Desert Storm, Dambach comes from a proud military family with deep-rooted traditions of service. His father served in World War II, and many of his siblings, cousins, and even his son have followed similar paths.

Throughout his civilian career, Dambach held a diverse range of roles—from working in power plants and building submarines to managing an electrical supply branch, selling computers, and serving as a high-voltage lineman. But it wasn’t until 2015, encouraged by his son, that he charted a new course. He enrolled in the Entrepreneur Bootcamp for Veterans (EBV) at Syracuse University, and in 2019, he founded Patriot Sons USA—a company focused on asbestos abatement and environmental remediation.

Drawing from firsthand experience with asbestos exposure during his early career, Dambach developed a passion for addressing the long-term health and environmental consequences of hazardous materials.

“Back then, we didn’t know the dangers. We worked with asbestos without any protection,” he recalled. “Now, I’ve become educated on the risks—and that knowledge drives our mission every day.”

Today, Patriot Sons USA is a federally registered and New York State-certified Service-Disabled Veteran-Owned Business (SDVOB) offering asbestos abatement, mold and lead remediation, and industrial cleaning services. The company plays a vital role on construction sites, often serving as the first team onsite to create safe working conditions for other trades by removing hazardous materials like asbestos, tile flooring, pipe insulation, or even biological contaminants such as pigeon guano.

We’re in the business of cleaning up dangerous situations,” says Dambach. “Whether it’s abatement in a commercial building or an environmental hazard at a military facility, safety always comes first.”

Though the early years required persistence and patience, the company has seen significant growth in recent years, securing larger contracts across New York State—from Buffalo to Queens. Dambach credits this momentum to an expanding team of skilled professionals and a shared commitment to excellence.

“We’ve brought on some key full-time team members, including a project manager with over 20 years of experience,” Dambach shared. “And I’ve learned a lot from my son. The student has truly become the teacher.”

Patriot Sons USA may still be a young company in the broader construction contracting space, but its mission is grounded in discipline, integrity, and a genuine desire to serve—principles rooted in Dambach’s military background.

“We started out wanting to serve the VA and fellow veterans. That mission has evolved, but our values haven’t. We take pride in our work, prioritize safety, and don’t cut corners. We’re Patriot Sons for a reason—we aim to lead by example.”

Looking ahead, Dambach envisions the company expanding into emergency response services and broadening hazardous material cleanup efforts. More importantly, he hopes Patriot Sons USA will be a family legacy—continued by his children and grandchildren with the same purpose and pride.

“At the end of the day, it’s not just about profit,” he reflected. “It’s about doing work that matters—leaving a legacy of impact, honor, and purpose. In the military, you’re given a mission. In the private sector, you create your own. This is mine, and it feels right.”

From all of us at CNY Publications, Construction Contractor Magazine, and the Syracuse Builders Exchange, we extend our deepest gratitude to Fred Dambach and his family for their continued service—to our country, our industry, and our community.

 

Nexus Requires Compliance and Begins by Filing Tax Returns

Shawn T. Layo, CPA, Dannible & McKee, LLP

“Nexus” is a Latin term that refers to the relationship of a taxing jurisdiction that enables it to subject your business to taxation. In addition to your business’s home state and city, other states and local jurisdictions where you conduct business can have nexus.

Traditionally, nexus was determined by a physical presence such as a branch office or construction location, but e-commerce has extended the definition of nexus. Today, having employees, equipment or even significant sales activity in another state could establish nexus, and with it, a requirement to file tax returns and potentially pay taxes.

Sales Tax Nexus

Sales tax nexus laws vary widely by state and can be triggered by seemingly small activities. For example, if you have an employee in a new state or buy some machinery there, that alone can subject you to sales tax. While these activities may mandate a contractor to file sales tax returns in that jurisdiction, that does not mean the company will owe taxes there. So, it is imperative that you are aware of the administrative burdens of entering new jurisdictions, as non-compliance can be costly. The same state can also have different standards for different taxes, such as income and sales tax.

Construction companies often must collect and remit sales tax on the total charge to the customer for any repair, maintenance and installation services provided. If taxes are not collected and paid, your business will be liable and could face penalties and interest. Many businesses go bankrupt due to unpaid sales taxes and the compounding penalties that follow. Just because a job is small or out of state doesn’t mean it escapes scrutiny.

Income/Franchise Tax

You already file income or franchise taxes in the state and jurisdiction where your company is based. However, if you operate in multiple states through offices, warehouses or employees traveling into another state or generating meaningful sales there, you may need to file tax returns in those states.

It’s critical to stay up to date on filing income/franchise tax returns in all appropriate jurisdictions. If your business ever has to bring a lawsuit in that state, your company must be qualified to do business there as a foreign corporation and filing tax returns supports this qualification. Most states require minimal paperwork and often a certificate of good standing from your home state to register to do business in another state. Your attorney can help you with filings and compliance issues.

When doing business in multiple states, it is imperative to know how each state computes and allocates its overall net income and, subsequently, how that net income is taxed. If you generated $1M of income in a year, but half your sales are attributable to State A and the other half are attributable to State B, does each state tax $500k? Potentially, each state has different rules for computing and allocating income. You may need to track revenue on a job-by-job, state-by-state basis and track the equipment and labor employed in each. How to do this depends on how each state allocates their income and whether they factor in sales, wages and/or property employed in and out of the state.

Voluntary Disclosure Programs

If you find that your construction business has not been properly filing sales or income/franchise taxes, you will likely be liable for back taxes, penalties and interest in each state and/or jurisdiction. A positive note is that the statute of limitations is set at three years after filing, after which the taxing authority can’t audit your return.

If you realize after the fact that you should have filed in a tax jurisdiction but did not talk to your tax consultant about filing an amended return, you may also be liable for back taxes, penalties and interest. However, many states have “voluntary disclosure” programs that encourage businesses to catch up by filing outstanding or amended returns. In many cases, penalties are waived, and payment terms can be very favorable. Keep in mind that it is better to voluntarily come forward than to be found out by the taxing authority. If you have any questions about nexus and what it may mean for your business, please contact us.

Shawn T. Layo, CPA, is a tax partner at Dannible & McKee, LLP, a certified public accounting firm with offices in Syracuse, Auburn, Binghamton and Schenectady, NY, as well as Tampa, FL. With more than 24 years of experience, Shawn specializes in providing tax planning and compliance services for a variety of clientele with a focus on construction, architectural and engineering, multi-state corporations and high-net-worth individuals. For more information on this topic, contact Shawn at slayo@dmcpas.com or (315) 472-9127. Visit our website at DMCPAS.com to learn more.

2024 NY Workers’ Comp Bills: What Construction Companies Need to Know

The Lovell Safety Management Executive Team

In 2024, the New York State Legislature passed four workers’ compensation bills that could reshape how claims are managed. Two of these bills were signed into law by Governor Hochul, and two were vetoed. Construction companies, which already operate in high-risk environments, should pay close attention to these changes, especially as they affect claim costs, mental health claims, and treatment protocols.

1.Signed into Law: Limited Mental Stress Claims Expansion (A.5745/S.6635, amended by A.1677/S.0755)

Governor Hochul signed this bill on December 6, 2024, with chapter amendments finalized in January 2025. It expands eligibility for workers’ compensation mental stress claims but only for specific psychiatric diagnoses.

What Changed?
Previously, only police officers, firefighters, and EMTs could file mental injury claims without showing their stress was “greater than” that of a similar coworker. Now, all employees, including those in construction, will be eligible to file a mental stress claim (only in mental-mental injury claims)—as long as their diagnosis fits into one of three psychiatric conditions:

• Post-Traumatic Stress Disorder (PTSD)

• Acute Stress Disorder

• Major Depressive Disorder

To qualify for benefits the employee must prove that:

• The stress arose out of an extraordinary work-related stress that is attributable to a distinct work-related event or series of events that are:

• Directly related to employment and

• Occurring during the performance of the employee’s work duties

Impact on Construction
Construction workers frequently face traumatic events: serious injuries, falls from heights, or fatal accidents. This new law may increase:

• Claims related to mental health after job site incidents.

• Challenges in disputing those claims due to the now-subjective stress threshold.

• Length and complexity of claims, potentially delaying return-to-work timelines.

Recommendation: Immediately investigate and report mental stress claims to Lovell. The new standard applies to specific mental claims and the old standard of the “stress being greater than that of a similar worker” remains in effect for other types of mental stress claims. Legal counsel at Lovell/NYSIF will determine which standard is applicable based on the facts of the case. Train field supervisors to document traumatic events with pertinent information. Strengthen mental health resources for workers and ensure HR is prepared to handle these claims sensitively but rigorously.

2. Signed into Law: Occupational Therapy & Physical Therapy Assistants Now Allowed to Treat Claimants Governor Hochul signed this long-standing bill on September 27, 2024. It authorizes licensed occupational and physical therapy assistants to treat injured workers under supervision of licensed physical therapists and occupational therapists.

What Changed?
Previously, New York law only allowed licensed OT/PT providers to treat injured workers. This bill now permits OT/PT assistants to perform treatment, so long as they work under the supervision of an authorized OT/PT.

Impact on Construction
Many injured construction workers need some form of physical rehabilitation. This change:

• Should improve therapy accessibility.

• Is not expected to increase claim costs significantly, as assistants are already commonly used in comp cases.

3. Vetoed: Out-of-Network Pharmacy Access (A.1219-A/S.1974-A)

This bill would have allowed injured workers to bypass the employer’s designated pharmacy network under certain conditions. Governor Hochul vetoed the bill on December 13, 2024.

Why Was It Vetoed?
The Governor cited:
• Increased litigation over “qualifying” conditions.

• Delays in benefit delivery due to added bureaucracy.

• A rollback of pharmacy cost savings won in the 2007 comp reforms.

Some examples that would have allowed workers to use non-network pharmacies included:

• Delays of more than 72 hours in receiving prescribed meds.

• Denial of reauthorization requests.

• Disputes between treating physicians and IMEs.

Instead of the bill, the Workers’ Compensation Board (WCB) issued new regulations, clarifying when a worker may use a non-network pharmacy at the end of 2024, providing a 60-day comment period and then based on comments, finalization of the new regulations.

Impact on Construction
The veto preserves critical cost controls for employers and carriers. Most construction employers in a Lovell Safety Group will not see major changes as NYSIF already provides first-fill prescriptions pending establishment or acceptance of the claim.

4. Vetoed: Medical Treatment Guidelines Rollback (A.6832-A/S.6929)

This bill was vetoed on November 22, 2024, and would have fundamentally altered how treatment is approved in NY workers’ comp.

What the Bill Would Have Done
• Undermined the Medical Treatment Guidelines (MTGs) by letting providers bypass them.

• Eliminated the Prior Authorization Request (PAR) process.

• Forced carriers to rely on costly Independent Medical Exams (IMEs) for treatment reviews which may delay treatments.

Why It Was Vetoed?
Governor Hochul argued the bill would:

• Lead to over-treatment and questionable procedures.

• Increase litigation and delay care.

• Undo years of reform aimed at improving outcomes and lowering costs.

Impact on Construction
The veto protects construction employers from:

• Skyrocketing treatment costs.

• Legal disputes over unnecessary
or non-evidence-based care.

• System abuse seen prior to MTG
and PAR implementation.

Bottom Line for Construction Employers

The 2024 legislative session brought both relief and risk for New York construction firms in 2025. While some protections were preserved through vetoes, the signed mental stress bill opens the door to more complex, subjective claims.

Key Takeaways:
• Expect more mental stress claims tied to specific traumatic events, especially after serious job site incidents.

• OT/PT assistants can now legally assist in the treatment of injured workers, potentially speeding up recovery.

• Pharmacy access rules are evolving but the cost-saving structure remains in place for now.

• The veto of Medical Treatment Guidelines (MTG) rollbacks is a win for employers concerned about runaway treatment costs.

The Governor also passed two workers’ compensation bills in her Budget that would expand access to treatment. Those bills will allow for residents and fellow physicians in a Graduate Medical Program to treat claimants and permit carriers to pay for medical treatment pending a decision on compensability. 

Lovell Safety Management closely monitors legislative developments, actively working to reduce the impact of potential negative changes on the members of our five construction and eight general industry workers’ compensation safety groups. Our programs are designed to return profits to members in the form of dividends, and to date, Lovell safety group members have received over $1.28 billion in dividend savings. The 2025 legislative session closed in mid-June, and we will provide a full update on any new developments or additional legislative changes in early 2026.

In summary, the 2024 legislative session brought both relief and risk for New York construction firms in 2025. While some protections were preserved through vetoes, the signed mental stress bill opens the door to more complex, subjective claims. For any questions regarding workers’ compensation and the legislation, please contact Lovell at 1-800-556-8355.

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NYS 2025 Workers’Compensation Updates

Brett Findlay, Vice President, Business Risk Specialist, OneGroup

 Overview of 2025 Workers’ Compensation Changes in New York State
New York State continues to see positive trends in workers’ compensation. For the tenth year in a row, an aggregate rate decrease is expected. Additionally, the New York State Assessment dropped again in January 2025. With these encouraging trends setting the tone for 2025, let’s take a closer look at the specific updates to workers’ compensation rates and assessments that could impact employers across New York State.

Upcoming Rate Reduction
On May 8, 2025, the Board of Governors for the New York Compensation Insurance Rating Board (NYCIRB) announced they voted to file their annual loss cost indication with the New York State Department of Financial Services. This filing, once reviewed and approved, will take effect on October 1, 2025.

The proposed change reflects a 13.2% average decrease in the overall loss cost (or rate) level. This figure is based on NYCIRB’s standard ratemaking methodology and applies to policies renewing on or after the effective date.

However, this 13.2% reduction is an aggregate average—the actual impact will vary depending on the classification codes used in your policy. Some businesses may see more significant savings, while others may experience smaller changes or even increases depending on their specific risk profile and claims history.
The workers’ compensation market remains soft overall, but volatility continues due to the experience modification rating (EMR) formula changes introduced in 2022. These changes can significantly affect individual policy premiums, especially for businesses with fluctuating claims experience.

If you have questions about how these changes might affect your policy or renewal timeline, consider reaching out to OneGroup and see if they can help you review your coverage and workers’ compensation plan.

Policy Timing and Planning
These rate changes only apply to policies renewing on or after October 1, 2025. If your policy renews before then, the new rates won’t apply until your next renewal. It’s a good idea to review your classifications now to better forecast future costs.

New York State Assessment Decrease
In January 2025, the New York State Assessment rate dropped from 9.2% to 7.1%, marking the largest single-year reduction in several years. This assessment is a mandatory surcharge applied to all workers’ compensation policies in New York to fund the state’s Workers’ Compensation Board and related programs.

This latest decrease continues a multi-year trend of declining assessment rates:

• 2021: 11.8%
• 2022: 10.2%
• 2023: 9.8%
• 2024: 9.2%
• 2025: 7.1%

Since 2021, the assessment rate has dropped by nearly 40%, resulting in a cumulative reduction of almost 20% in aggregate costs to policyholders. This trend reflects improved system efficiency and reduced administrative costs at the state level.

For employers, this means lower overall premium costs, even before factoring in the upcoming rate reductions. However, the actual savings will depend on your total payroll, classification codes, and claims history.

If you’re unsure how this impacts your current or future premiums, contact us we can help you analyze your policy and identify opportunities for savings.

What This Means for Contractors
These changes can significantly impact your insurance costs. For personalized guidance, reach out to OneGroup’s team of specialists dedicated to risk management and construction industry insurance.

For more information on renewing your insurance, you may reach out to Brett Findlay at 315-280-6376 or by email at BFindlay@OneGroup.com

If You Work On Both Public And Private Projects, You Must Understand The Concept Of Annualization.

By Gabrielle Kehoe, Sheats and Bailey, PLLC

As you all know, if you work on public projects, either New York or Federal, you must pay prevailing wages.  The prevailing wage rate is based on geography and classification of the work being performed.  Prevailing wages consist of two things: hourly wages and supplemental (or fringe benefit) wages.  The former is the wage paid to the employee in his/her check and supplemental wages are meant to represent the hourly value of benefits like health insurance, retirement contributions or paid time off.

Supplemental wages, what counts?

If your company contributes to a retirement plan, provides health insurance, disability insurance, sick leave or vacation pay, training or apprenticeship programs, or more, those qualify as supplemental benefits or “bona fide” benefit contributions.  However, statutorily required payments such as social security, workers’ compensation, or reimbursements for travel expenses are not included in fringe benefits.

What weight do these benefits bear on prevailing wages?

Under both New York and federal law, contributions to bona fide benefits can offset the prevailing wage’s supplemental wage allocation.  If your company contributes to a bona fide benefits plan, you can deduct these contributions from that supplemental wage allocation.  However, New York and federal projects differ on how to calculate these contribution deductions.

New York’s calculation

Under New York’s Labor Law, annualization is used to calculate deductions. Annualization requires that all qualifying benefits paid to an employee to be identified and totaled for the year.  Then, that total must be divided by the total hours the employee worked on both public and private projects. Once that is calculated, the hourly rate for the annual bona fide benefits paid to an employee is found.  This number should be compared to the supplemental fringe benefits set on the prevailing wage schedule, and the difference between the two must be paid weekly to the employee.

For example: Let’s say the total annual contributions to a bona fide benefits plan for one employee equals $10,000 and that employee worked full time on both public and private projects for a total of 2,080 hours.  Meaning, there was $4.80 paid ($10,000/2080 hrs) to that employee in fringe benefits every hour on top of their hourly rate over the past year.  Now consider that the hourly supplemental benefit rate is $39.80 on top of the basic hourly wage rate.  Only $35.00 needs to be paid on top of the basic hourly wage to satisfy the prevailing wage rate.

Federal calculations

Federal law differs from New York in that there are two different ways to calculate supplemental wage deductions.  The choice between the two relies on whether the employee has immediate eligibility (or are expected to become eligible) and immediate 100% vesting (i.e., there are no conditions to be satisfied to receive the contributions to the plans) of the prevailing wage contributions for their bona fide benefit plans or if the employee has not yet and is not expected to qualify for the plans due to being a member of an excluded class.

First is the dollar-for-dollar method. This method can be used toward fringe benefit obligations for contributions to eligible retirement plans.  To be eligible the retirement plan must require that the employee be immediately eligible for the plan and 100% vesting (i.e., has complete ownership) of the plan contributions.  This formula excludes hours worked on non-governmental or ineligible projects. This method allows full credit for the amount of contributions made on Davis-Bacon Work.

For example: an employee worked 1,000 hours on Davis-Bacon projects and the fringe benefit rate is $10 an hour for the year.  The employer contributes $7.00 an hour to a fully vested, immediately eligible retirement plan for an employee working on a Davis-Bacon project, the employer can then credit the full $7.00/hour or $7,000.00 a year toward their fringe benefit obligation. Please note this dollar-for-dollar method cannot be used when calculating a credit on fringe benefits for NYS prevailing wage projects.

Second, like New York, the annualization method is used when an employee does not have immediate or expected eligibility to the bona fide benefits plan.  This formula allows for all hours worked on both eligible government projects to be balanced against the total hours worked on ineligible projects.

This will look like New York’s annualization calculation from the previous section.

How can fringe benefits be paid to laborers?

Under New York and federal law, these benefits can either be paid in weekly cash wages, or on a bona fide benefits plan, such as a retirement account.  However, those who work both State and Federal Jobs need to make sure they do not apply the dollar-for-dollar federal method when determining contribution credits on New York prevailing wage jobs.  The dollar-for-dollar method can only be applied to federal projects, and New York only uses the annualization method to calculate prevailing wages.  Misapplying the dollar-to-dollar method on New York jobs can lead to underpayment of fringe benefits and result in a DOL audit and costly fines. 

The information provided in this article is not intended to serve as specific legal advice for any particular situation. Competent legal and experienced counsel should be consulted.

 

St. Joseph’s Health Hernia Center of Excellence: SRC Accredited for Optimal Patient Care

By Elizabeth Landry

For patients suffering with a hernia, the pain, discomfort and disfiguration can be all too familiar. A hernia is essentially a hole in the abdominal or pelvic wall through which tissue can protrude, and while hernias are considered common, they can often be complex depending on the situation. However, regardless of complexity or severity, the team at the Hernia Center of Excellence at St. Joseph’s Health provides high quality care to all patients needing surgery due to a hernia.

The team includes five board-certified, fellowship trained general surgeons with decades of experience and expertise providing minimally invasive, laparoscopic and robotic hernia repair: Beata E. Belfield, MD, FACS; James J. Giannone, DO, MS, FACS, FACOS; C. Melinda Stevens, DO; Travis P. Webb, MD, FACS; and Balasubramaniam Sivakumar, MD, FACS.

“The center aims to coordinate the care process among all team members through the Center of Excellence, facilitating the sharing of best practices and driving continuous improvements.

This ensures patients receive the most current, evidence-based techniques and fully integrated care at every level,” explained Dr. Sivakumar (Dr. Kumar), a well-established surgeon who’s been with St. Joseph’s Health for 42 years. 

Recent Designation as an SRC Center of Excellence 

In the Spring of 2025, St. Joseph’s Health received accreditation from the SRC (Surgical Review Corporation) as a Center of Excellence for hernia care. The SRC is a nonprofit, patient safety organization that completes independent facility inspection and accredits the top healthcare facilities and surgeons worldwide. SRC accreditation is a third party verification that recognizes providers who meet internationally recognized standards of excellence.

“Our team has achieved a high level of collaboration by implementing a streamlined care plan process, ensuring optimal patient care delivery,” stated Dr. Kumar. “We also hold the distinction of having the most extensive experience with robotic surgery over nearly two decades, consistently delivering the highest quality care. Our recent accreditation survey by the SRC highlights our team of dedicated, passionate surgeons and unwavering commitment to patient outcomes, which we believe sets us apart from other organizations.” Amine Hila, MD, Chief Medical Officer of Acute Care at St. Joseph’s Health, explained why the healthcare organization sought this designation, and how it highlights St. Joseph’s Health as the hernia care provider of choice in the region.

“We sought this designation because it’s a program that is rigorous in making sure that we are providing high quality, safe care to our patients, and allows us to demonstrate that not only are we providing that level of excellence, but that we also maintain it,” Dr. Hila explained. “For things like a hernia, usually it’s not an emergency. The majority of the cases are what we call elective cases. So, the patient has a choice, and we want them to choose us as their destination, having the confidence that this is the best choice in our area.”

The SRC Center of Excellence designation adds to the list of similar Center of Excellence accreditations previously attained by St. Joseph’s Health in orthopedics and cardiac care. By verifying the use of standardized, evidence based surgical protocols, the SRC accreditation optimizes the care pathway for quality, efficiency and higher patient satisfaction, as Dr. Hila pointed out.

“To achieve this designation, not only do you have to put a program together and make sure that you’re complying with all of the quality metrics patients are interested in, but you also have to maintain that quality over time. It’s not a one-time effort. You have to continue to monitor the quality of your care, the metrics and the outcomes of your care, and maintain them at a high level to keep that certification,” Dr. Hila said. “That gives patients the peace of mind that this is one of the areas that the hospital, the surgeons, nursing, everybody involved is paying active, persistent, acute attention to.”

Cutting-Edge Technology in Hernia Care

The Hernia Center of Excellence at St. Joseph’s Health includes 16 operating rooms and four surgical robots, which the practitioners use to provide minimally invasive procedures for hernia patients. In fact, the team of surgeons at St. Joseph’s Health has been on the forefront of surgical innovation for years – they were the first team in the Central New York region to use da Vinci robotic surgery in an outpatient setting, leading the way for many more advances to come.

“The robot is not autonomous – it doesn’t do anything on its own. But the ability to see things so clearly and to have the precision with the instruments and to be able to do things that are much simpler – it’s a lot easier to do procedures on the robot versus how we were doing it before the technology was available,” said Dr. Giannone.

For hernia repair specifically, Dr. Belfield, a surgeon at St. Joseph’s Health since 2020, highlighted how the technologically advanced surgical options offered at the center make an important difference in patient outcomes.

“The procedures that we offer at St. Joseph’s are very specialized and advanced,” said Dr. Belfield. “There is not another hospital in Syracuse that has a surgeon, to my knowledge, who does minimally invasive component separation – a buzzword for getting a very big hernia closed. By doing it robotically or through minimally invasive surgery, we can help that patient get through the hospital in many fewer days than if it had been an open procedure.”

Dr. Stevens, who’s been with St. Joseph’s Health for 12 years, described the many benefits of robotic, minimally invasive surgery for patients, and emphasized the transformative effect of hernia repair surgery.

“Whenever it’s appropriate to do robotic surgery, it yields shorter hospitalization, less post operative pain, faster return to your life and more cosmesis, which is important,” she said. “With hernia repair, it’s basically like taking a puzzle and putting it back together with the realization that you’re missing a couple of pieces. You have to figure out how to make it work anyway. In many cases, we’re able to get patients back to living a more normal life in a short period of time when they may have been suffering with pain for years.” 

Multidisciplinary Team Providing Personalized Patient Care

Dr. Belfield explained how the view of hernia surgery within the field of general surgery has evolved over recent years, with technological advances revealing the need for providers to be highly specialized in hernia repair.

“Previously, in general surgery, hernias were sort of regarded as a thing that everybody can do. More recently, hernia
repair has exploded in techniques and isbeing seen more as a subspecialty, rather than something that just anyone can take on,” she explained.

Each member of the team at the Hernia Center of Excellence does ventral and groin hernia repair, with each provider on the team having extra specialization in other kinds of hernia surgery, including upper abdominal surgery and large abdominal wall reconstruction procedures. As Dr. Giannone described it, on their multidisciplinary team, “everyone can do the regular procedures, plus something extra.”

“I think that’s a huge asset of the group because I don’t think a day goes by when we’re not saying to each other, ‘What do you think about this? Can you see this? Can you check this out?’” Dr. Giannone continued. “So, when it comes to really complex hernias that patients might have, there is usually somebody in the group that says, ‘I’ve done that before – no problem, we can take care of that here,’ which is great for patients, since they don’t have to go somewhere else for care.”

Whether a patient’s hernia is considered common or complex, however, a main priority of the group is to ensure each patient receives highly personalized care that’s best for their unique situation. Working with a large team of perioperative nurses, surgical PAs, pharmacists, and nurse managers, the entire group of providers is aligned around providing hernia patients with a personalized experience and clear communication throughout their journey.

“My goal for every patient is to provide a durable hernia repair through an approach that is appropriate for their belly,” Dr. Belfield said. “So, if someone is a candidate for minimally invasive surgery, that is offered to them. And if a different approach is more appropriate for another patient, for example, open surgery, then we offer that to them. Every procedure we do is tailored to the patient in front of us.”

Streamlined Process from Referral to Recovery

At the Hernia Center of Excellence, and within St. Joseph’s Health at large, patient pathways are aimed at ensuring efficient pre operative education, minimally invasive surgery options whenever possible, fast recovery times and high patient satisfaction scores. The pathway begins with a streamlined referral process, which includes easy access to the general surgery department, a quick turnaround time for consults and
surgical scheduling.

“When the primary care doctor refers to our office for any type of hernia, depending on the type of hernia it is, we’ll determine which one of us the patient is going to see. But usually within a week or two, patients can be seen in the office. We try to process referrals as quickly as possible so we can determine if the patient needs surgery or not and get them back to work or back to their regular routines,” explained Dr. Stevens.

The team of surgeons at the Hernia Center of Excellence values ongoing communication with referring providers and the patients themselves, which helps achieve continuity of care extending through the time when patients return to seeing their primary care physicians.

“Ultimately, patients are anxious to get the help they need and get back home, and we want them to have a very good experience here,” said Dr. Belfield. “So, patients can expect a consistent experience in our office with good communication about what they can do to prepare for surgery, what’s going to happen during surgery and how they can recover best from surgery. The goal at our center is to provide the most durable and most appropriate option for each patient who comes through our doors.”

As a trusted leader in patient care since 1869, with a long-standing history of innovation and excellence in surgical care, St. Joseph’s Health continues to be a regional and national leader in exceptional care for patients, including those seeking hernia repair. Now with the SRC Center of Excellence designation, the Hernia Center of Excellence continues to be another reason why St. Joseph’s Health is consistently ranked among the Best Regional Hospitals by U.S. News & World Report and recognized as the #1 hospital in the Syracuse Metro area.

For Dr. Giannone, such excellent care for patients all comes down to the quality of the team.

“Coming to work here, it’s really apparent from tip to tail that my other partners are tremendous. It’s rare that you get to be a part of a department where there’s not one person who doesn’t go above and beyond,” he said.

To those wondering how to navigate their need for hernia repair, Dr. Stevens’ message is simple: “Patients may or may not need surgery, but they certainly shouldn’t suffer in silence. We’re here to help.”

For referral information to St. Joseph’s Health Hernia Center of Excellence, visit sjhsyr.org/robotics. Direct lines and EMR referral workflows are available. Consultations, co management discussions, and facility tours for referring providers are welcomed.

 

Robotic Surgery at Crouse: Innovation Backed by Leadership and Expertise

By: Bari Faye Dean

Dr. Benjamin Sadowitz

When Crouse Health acquired its first da Vinci surgical robot in 2008, it marked the beginning of a journey that would reshape surgical care across Central New York.

Two years before the first robotic case was even performed at Crouse, administrative leadership made growing the hospital’s robotic surgery program a strategic priority. Now, with 40 surgeons who specialize in robotics, Crouse has built a collaborative, multidisciplinary program. The hospital’s commitment has resulted in the largest, most advanced robotic surgery program in the region.

The program has an unmatched record, grounded in teamwork and experience. The program began with a single da Vinci robot and the ambitious goal of reaching 300 robotic surgeries a year within three years. That benchmark was quickly exceeded.

Today, the program is home to 11 robots, including nine da Vinci Surgical Systems used in gynecology, urology, colorectal, cardiothoracic, bariatrics and general surgery.

The da Vinci platform has “arms” that provide surgeons with greater dexterity and range of motion as compared to traditional surgical instruments. Further, the da Vinci’s high-definition 3D vision system provides surgeons with a clear, magnified view of the surgical area.

Crouse also has two Mako robotic guidance systems which use an “arm” as well as advanced imaging to guide orthopedic surgeons during procedures like spinal surgeries and joint replacements. Again, these robots allow for minimally invasive surgeries and, especially important in orthopedics, ensure the precise placement of implants.

Crouse surgeons affiliated with the da Vinci program perform an average of 2,500 robotic surgeries annually and over 20,000 da Vinci cases have been completed at Crouse to date.

For physicians, the program offers more access to robotic equipment, shorter case times and the ability to work with seasoned professionals across disciplines. Additionally, the hospital has an Advanced Robotics Steering Committee that gives physicians a seat at the leadership table when it comes to making decisions about growing the program and staying on top of the latest technology.

Dr. Seth Kronenberg, CEO, Crouse Health

The Power of Volume and Experience
Having more robots, very simply, means Crouse completes more robotic surgeries than other healthcare organizations in the region, said general surgeon Ben Sadowitz, MD.

And volume directly correlates with improved outcomes. “High-volume programs consistently have better outcomes,” added Dr. Sadowitz. “That’s not just about the surgeon’s skill, but the collective experience of the entire operating team.”

The importance of a seasoned team cannot be overstated. From physician assistants and anesthesiologists to scrub techs and OR nurses, everyone involved in the robotic surgery process at Crouse is highly trained and invested in delivering outstanding care. Mary J. Cunningham, MD, who specializes in complex gynecologic oncology cases, including surgeries for ovarian and endometrial cancers, has seen the benefits of this across-the board experience first-hand. She performed the first robotic surgery at Crouse in 2008.

“The whole team must be committed and able to develop their expertise. This affects everything from reducing operating times to lowering the risk of complications to improving outcomes.”

Crouse’s high performance doesn’t stop when the surgery is completed. The hospital has built a comprehensive postoperative care model that supports minimally invasive surgery patients from start to finish, explains David Nesbitt, MD, a colorectal surgeon who has been performing robotic surgeries at Crouse for 16 years. He opened his Syracuse-based colorectal medical practice 21 years ago.

“There’s a very specific protocol on how patients are supposed to progress after robotic surgery,” he said. “We even have a dedicated floor for these patients, and the nurses know the care plan inside and out. That makes a big difference in patient satisfaction and outcomes.”

And that team commitment runs deep. From physician assistants and anesthesiologists to scrub techs and nurses, Crouse has cultivated a culture where every team member plays a key role. This team based culture has made Crouse a destination for visiting surgeons from across the country, who come to observe a program where every member of the surgical team plays an integral role.

Patient Benefits: Smaller Incisions, Faster Recovery
For patients, Crouse’s leadership in robotics means access to minimally invasive surgery, which results in shorter recovery times and improved outcomes.

“Patients who opt for robotic surgery typically experience less pain and a reduced need for narcotics pain relief. This means patients who choose Crouse are able to return to their lives faster,” explains Dr. Nesbitt, who has performed 2,000 robotic cases at Crouse. “The difference in recovery is night and day,” he said. “Patients used to stay in the hospital seven to nine days after a colon resection. Now they go home far more quickly.”

 Only One Incision Needed
Robotic surgery has transformed patient care across all the specialties at Crouse. Procedures that once required large incisions and lengthy hospital stays are now performed through small incisions.

Board-certified urologist Po Lam, MD, is able to do robotic surgery with a single two-centimeter incision. He specializes in treating patients with prostate cancer, kidney cancer, bladder cancer and difficult kidney stones with the da Vinci SP – a single port robot. Crouse is the only hospital in the region with a da Vinci SP.

During his more than two decade career, Dr. Lam has performed over 3,000 robotic surgeries in Central New York. Since Crouse obtained the da Vinci SP, he has performed more than 500 urologic surgeries on Crouse patients.

Single port robotic surgery is an emerging field in urology. “In fact, single port robotics is the future of surgery. It will advance and truly change the way surgery is performed across all specialties,” he said. 

Dr. Po Lam

There are several reasons why Dr. Lam is focused on using the da Vinci SP. It allows for a smaller incision and quicker recovery for the patient. “Single port surgery allows me to focus on the very specific small area I need to access and it allows me to access areas that I cannot reach with the multi port robot,” he said. 

This is because the da Vinci SP has a flexible camera and instruments. “I can see around corners and there is minimal interaction with major abdominal organs. There’s no question about it,” Dr. Lam said, “using the da Vinci SP results in far fewer complications for the patient.”

Dr. Lam also commented that he has chosen to keep his practice at Crouse because of the outstanding support the robotics program gets from senior leadership.

At Crouse, Commitment to Robotics Starts at the Top

Indeed, unwavering support from hospital leadership is one of the most important contributors to the success of Crouse’s robotics program. Crouse’s administration has not only invested in robotic technology but has made it a strategic priority.

“They’ve worked with us to grow the program from the beginning,” said Dr. Sadowitz. “We’ve carved out a niche as a robotics institute, and that comes from long-term support at every level.”

CEO Kronenberg joined Crouse’s medical staff 25 years ago. He has watched the organization grow from the days when robotics was new technology to today when it’s the standard of care and is proud to say Crouse was an early adopter of robotics technology. He and senior leadership at the hospital fully believe in growing the program’s multidisciplinary approach and ensuring surgeons have access to the best tools and ongoing training.

Staying on the Cutting Edge

At Crouse, that growth includes investments in the latest technology. The transition from the da Vinci Xi to the newer DV5 system has brought improvements not only in surgical capabilities but also in surgeon ergonomics.

“Standard laparoscopic surgery can be hard on a surgeon’s neck and back,” said Dr. Nesbitt. “Each new version of the robot allows us to operate more comfortably, which translates into better focus and performance in the OR.”

While robotic platforms offer unmatched precision, it’s the surgeon and team who make the real difference. The equipment may change over time, as will technique. But success in robotics will always be connected to the interaction between people in the hospital and their commitment to success.

A Destination for Referrals

For physicians referring patients to Crouse, the message is clear: they are in good hands. When you send a patient to Crouse, you can be confident they’ll be cared for by a team that’s done this thousands of times.

Dr. Sadowitz, who has observed robotic programs at other institutions, believes Crouse offers a rare combination of access and experience. “At many hospitals, it can be hard for a surgeon to get access to a robot. Here, we have the equipment, the volume and the teams to make it all work seamlessly.” 

For more information about the Crouse Institute for Robotics, please visit: https://www.crouse.org/services/robotic-surgery/

 

Mental Health Access

By: Kathryn Ruscitto, Advisor

Recent conversations with families seeking mental health resources have highlighted the severe challenges in accessing psychiatric care in our community. What began as routine inquiries have exposed a healthcare system stretched beyond capacity, with primary care physicians increasingly unable to connect patients with psychiatric specialists. The backlog, initially attributed to COVID-19 disruptions and workforce shortages, has reached critical levels that demand innovative solutions.

In consultation with Ann Rooney, Deputy County Executive for Human Services in Onondaga County, the scope of this challenge became clear. The County is actively responding through the Department of Children and Family Services, implementing triage systems designed to prioritize the most vulnerable patients and ensure they receive timely care. Ann also shared a tool the County recommends for physicians to consider called Clinicom (https://clinicom.com/). This algorithm helps providers assess mental health conditions in a timely manner to consider treatment options. Other counties in upstate New York, along with major health foundations from Buffalo to Albany, cite mental health and substance abuse among their top priorities for focus in the next year.

For families with private insurance and financial resources, online mental health platforms offer promising alternatives. Services like Talkiatry and BetterHelp provide access to licensed providers when traditional pathways fail, though they typically operate on a private pay basis. Online services must be licensed in your state to provide care. While often requiring private payment, they can help individuals navigate next steps and access immediate support. 

The mental health system is adapting through tiered care approaches. Psychiatrists focus on the most acute cases, while psychologists and therapists provide ongoing counseling and support for longer-term cases. This model maximizes specialist availability while ensuring comprehensive care. Primary care physicians have become frontline mental health providers by necessity. Many report managing mental health concerns, including substance abuse issues, while patients await specialist access. This reality requires staying current with available resources and access points. 

The range of inpatient beds in local health systems are critical parts of the mental health care system when individuals and families face crisis. These beds are also under severe stress from increasing demand. This adds to the crisis in access when immediate care is needed. Multiple barriers continue to impact access including rural geography limitations, insurance coverage gaps, and evolving telehealth regulations. Staying informed about available resources remains crucial for reducing patient frustration and improving care coordination. 

Thank you for all you do in supporting families facing mental health crisis.

From Patient to Partner: Judith’s Journey

When you climb the porch stairs to the front door of Judith’s home, you’re greeted by a woman with a  radiant smile, and immediately sense a palpable warmth. She came to the inner city of Rochester to visit a cousin. While she never imagined she would stay, that’s exactly what she’s done. Her cousin eventually moved away, and Judith found herself alone—her daughter, her closest relative, lives more than five hours away.

Living on her own with no support system, Judith has faced numerous health challenges, including a bilateral knee replacement in 2023. It was during her recovery that she was first connected with a case manager. She didn’t expect her health plan to become a critical means of assistance, but that’s exactly what happened.

“As a former caregiver myself, I never thought I’d be the one needing support. But my care manager at Excellus is everything to me,” Judith says, her voice steady with emotion. “She’s more than just a voice on the phone—she is my lifeline. Whether it’s finding short-term rehab, helping me navigate the health care system, or simply reminding me I’m not alone, she’s there.”

And it’s that care manager who referred Judith to the Community Connections team who are now at her home helping to set up the Excellus BlueCross BlueShield (BCBS) app on her phone, which will allow her to access her identification card, find health care providers, check her medical coverage, track spending, and view claims. But what matters more to Judith is knowing that someone who cares is just a call or a visit away.

In the Field: Bridging the Gap to Better Health

Judith’s experience is just one of thousands. Across upstate New York, the case management and Community Connections teams are working quietly, relentlessly—to meet people where they are, in every sense of the phrase.

While SafetyNet CARE provides personalized phone-based support navigating local community and national resources like Meals on Wheels, Social Security benefits, and Veteran’s Assistance benefits, the Community Connections team takes it further. Established to locate and re-engage hard to-reach, medically fragile Medicaid members, the team is often knocking on doors, walking city blocks, and reaching out to those who’ve lost touch with the care they need and access they deserve. These are individuals who may be homeless, moving between homes, or simply unable to answer the phone.

While Excellus BCBS consists of more than 4,000 employees, the Community Connections team is small. Just seven people serve all 39 counties—yet their impact is immense. Last year alone, they received referrals to reconnect with nearly 6,800 members.

“We are here to serve our communities in any way that is needed to get and keep them healthy – that is the benefit of being a nonprofit, local health plan,” says Dr. Nicholas Massa, vice president medical affairs, commercial products and clinical integration at Excellus BCBS. “Through Community Connections, we may help a member with high blood pressure work with a nurse to keep the member’s health in check, provide special formula for a premature baby to a new mother who may be financially strapped, or acquire beds for family members who may be sleeping on the floor. The ways they are impacting lives are endless … and meaningful.”

Around the holidays, when the world can feel lonely for many, Community Connections shows up with food baskets and kindness. In 2024, they brought Thanksgiving meals to 375 families who might have otherwise gone without.

“Some of the reactions we see from our members when we deliver the baskets are gratitude, excitement, thankfulness, and tears of joy,” says Sylvia Lee, director of outreach and training programs at Excellus BCBS. “We are seeing a lot of food insecurities and a lot of need by individuals … it is such a rewarding feeling that you assisted someone in need.”

Community Connections Thanksgiving Baskets

“Any Day We Connect with a Member is a Good Day”

Dajia Richardson, Community Connections manager for the past six years, understands the significance of this work. She and her team are passionate about addressing health care disparities and improving overall health outcomes in their communities.

“I love that our team is driven by a natural curiosity and finds such satisfaction in making a difference, one member at a time. We don’t just check boxes—we listen, we care, and we persist,” she says. “If we can prevent just one crisis, if we can help someone feel seen, that’s a good day.”

The team has discovered that a personal visit may be more than an official letter or phone call to encourage Medicaid members like Judith. “The work goes far beyond traditional care,” Sylvia says. “It’s about building trust, encouraging prevention, and helping people believe in their own health journey.”

Dajia adds, “I’m proud of the work we do because it centers around increasing access to care, preventive care, and helps reduce long term costs. We make a difference when we catch things sooner rather than later— making certain that members don’t slip between the cracks and connect them to the resources they need.”

A Lifeline That Feels Like Local Family
Before Dajia leaves Judith’s home, Judith turns to her and, with quiet conviction says, “Thank you for giving me hope and being here today. I’ve never seen my care manager’s face, but I know her voice, and when I hear it—I know I’m going to be okay.”

That moment, quiet and deeply human, speaks volumes. “This isn’t about insurance – it’s about people, about showing up and standing beside someone when they need it most, reminding them they are not alone,” says Dr. Massa. “Judith’s care manager and Dajia … they are the faces and the voices of Excellus BCBS. We have a lot to be proud of, thanks to their work. And that’s the heart of our mission.” 

The Healthcare Engagement Team helps to ensure that individuals who are uninsured, underinsured, or have limited access to care due to financial or other barriers maintain access to essential health care services through Medicaid and the Essential Plan. The Case Management team at Excellus BlueCross BlueShield (BCBS) consists of nurses, social workers, mental health counselors and physical therapists that collaborate to provide telephonic comprehensive care to our members. They focus on physical, emotional, and social wellbeing to help members feel confident navigating their personal health journeys.

Community Connections is part of the Case Management team at Excellus BCBS in upstate New York. These employees find hard to- reach members to reconnect them with care management specialists. They travel to member’s homes to help them reconnect with the Health Plan and help offer in-person assistance when necessary. For more information about the Case Management or Community Connections programs, please call 1-877-222-1240.

Claims-made vs. Occurrence Insurance Policies:Understanding the Differences, Benefits, and Drawbacks

By: Jenn Negley, Vice President, Risk Strategies Company

When it comes to liability insurance for professionals such as doctors, choosing the right type of policy is crucial. Two of the most common forms of coverage for professionals, such as doctors, lawyers, and business owners, are claims made and occurrence  policies. While they both offer liability protection, the way coverage is triggered and how long it lasts differs significantly. Understanding these differences is crucial for individuals and organizations to avoid costly coverage gaps and ensure they are adequately protected.

What is a Claims-Made Policy?
A claims-made policy provides coverage only if the claim is made during the policy period and the incident occurred on or after the policy’s retroactive date. The retroactive date is usually the date the insured first purchased a claims made policy and continuously maintained it. For example, suppose a doctor has a claims-made malpractice policy that starts on January 1, 2022, with a retroactive date of January 1, 2020. A patient filed a lawsuit on March 1, 2023, for something that happened in 2021. Because the policy is still active when the claim is made and the incident occurred after the retroactive date, the lawsuit is covered.

Benefits of Claims-Made Policies:

Lower initial premiums:
These policies are often cheaper in the early years because the insurer is only covering claims reported during the policy period, not the full history of a professional’s work.

Customizable tail coverage:
If you retire, take a break from your career, or switch insurers, tail coverage can extend your protection beyond the end of the policy. This helps cover claims that arise later from work you did while the policy was active.

Adaptability:
Claims-made policies are a good fit for professionals whose situations may change, such as a growing practice or changing insurers. However, continuity is key to avoiding coverage lapses.

Drawbacks of Claims-Made Policies:

Tail coverage can be expensive:
If the policyholder retires or switches carriers, they may need to buy tail coverage, which can cost up to 200% of the final year’s premium.

Coverage gaps: If there’s a lapse in policy renewal or the retroactive date changes, claims may be denied.

Complexity:
The nuances of retroactive dates and tail coverage can confuse policyholders unfamiliar with insurance jargon.

What is an Occurrence Policy?
An occurrence policy provides coverage for incidents that occur during the policy period, regardless of when the claim is filed. This means even if a claim is filed years after the policy expires, the insurer will still cover it if the incident occurred during the time the policy was active. For example, if a contractor has an occurrence policy from 2018 to 2020, and a claim is  filed in 2024 for a job completed in 2019, the claim will still be covered.

Benefits of Occurrence Policies:

Long-term peace of mind:
Once the policy is in place, the policyholder is protected for incidents that occurred during the coverage period, even if the claim arises years later.

No need for tail coverage:
This makes occurrence policies especially attractive for professionals who don’t want to worry about coverage after retiring or changing jobs.

Simplicity:
Easier to understand and manage over time, since there’s no concern over retroactive dates or claim reporting timelines.

Drawbacks of Occurrence Policies:

Higher premiums:
These policies usually cost more upfront than claims made policies, reflecting the broader protection they offer.

Limited availability:
Some insurers offer only claims-made policies for specific professions or high-risk fields.

Harder to budget long-term:
Because the insurer assumes longterm liability, the policy’s true cost can be challenging to estimate or predict.

How Do You Decide Which Policy Is Right for You?
Choosing between claims made and occurrence policies often depends on your financial situation, career stage, and risk preferences.

• Early career professionals may prefer claims-made policies for their lower initial cost.

• Established professionals or those nearing retirement might lean toward occurrence policies for their lasting protection.

• Those who switch jobs or insurers frequently must carefully manage claims made coverage to avoid gaps.

Both policy types have their place, and the best choice depends on your specific situation. Consulting with an experienced insurance broker can help ensure your coverage aligns with your needs, career plans, and financial goals.

For more information, please contact Jenn Negley, Vice President, Risk Strategies, at 267-251-2233 or JNegley@RiskStrategies.com.