Posts by admin

G.M. Crisalli & Associates, Inc.: Celebrating 35 Years of Excellence in Construction Contracting

Posted on by admin

By Elizabeth Landry

When Gary Crisalli first began his own general contracting business in Syracuse in 1989, he was working out of a two-bedroom apartment in Solvay. After the first year and for the next seven years, he and his team operated the business out of a residential home they had renovated to meet their business needs before finally settling into their long-term and current location on Hiawatha Boulevard West. From humble beginnings, Crisalli took on projects in almost every industry, growing the business’s portfolio and demonstrating its commitment to excellence while meeting the needs of a diverse array of clients.

Today, G.M. Crisalli & Associates, Inc. (GMCA) is one of the top general contractors in Central NY, having completed approximately 1,700 projects over the course of the business. With a team of about forty people, the organization works on projects across the entire Northeastern United States, from Wisconsin to Maine to Maryland.

As the company celebrates its 35-year anniversary this year, this important milestone serves as a time to reflect on the growth and accomplishments over the years and to look ahead to the many projects still to come. Between Crisalli, President and Owner, and Rocco Paone, Associate, who joined the company in 1991, the team at GMCA has over one hundred combined years of experience in construction contracting and has achieved much success by focusing on meeting the needs of clients for every project, every time.

Diverse Clients and Industries

Working as a mason when he was just sixteen, and through his college years, Crisalli worked with a large engineering firm, an architectural firm and a construction contracting company before venturing out on his own. Obtaining such valuable field and office experience in his teens and early twenties allowed GMCA to take on any job in many different industries from the first day of business.

“I’ve been telling people since the day we went into business that we build everything except roads and bridges,” said Crisalli. “Due to a past client that Rocco had worked with, GMCA obtained a contract on a very large construction site in our first year. The Solvay cogeneration power plant in Solvay. We were contracted to do a small job at first. The contract exponentially grew as we performed our base contract.  We were asked to work in many areas of the plant. We ended up being there for three years doing anything they wanted us to do, from asbestos abatement to assisting with the walk-down and commissioning of the boilers. That project was a blessing to our company, but it was also a project we knew we could perform well. From day one we did anything that was requested of our company by our client.  The company philosophy is to acquire the knowledge, expertise, and experience to meet any of our client’s construction needs. That philosophy got us in the door and has retained our relationships in many different industries.”

The team at GMCA has completed projects for clients in both the public and private sectors, in industries including education, military, commercial, industrial, medical, retail and grocery, as well as building restaurants and places of worship. Having completed numerous original-build and renovation projects for such a diverse range of clients, Crisalli has a long list of favorite jobs the team has worked on over the years, starting with brick removal and replacement for Onondaga County at the Civic Center in 1991. That same year, the team built the first neuro angiogram room at Upstate Medical Center, which led to numerous build and renovation projects for the health center in the following decades. In 1996, GMCA built the flagship Franklin Covey store in New York City across from the Rockefeller Center. In the early-to-mid 2000s, the company assisted with the building and construction management of the Clarence Jordan Vision Center for Mercy Works in Syracuse, the Island Health & Fitness Center in Ithaca, the Abundant Life Discipleship Training Center and the FedEx distribution center, both in East Syracuse, various five-story college housing projects, and Athletic clubs.  One of the most unique projects GMCA has completed is building the penguin exhibit at the Rosamond Gifford Zoo.

Perhaps the most stand-out project in Crisalli’s list of favorites is the Blodgett Dream Center, a sprawling, one-of-a-kind library located within one of the most impoverished schools in the Syracuse City School District. “Many different artisans worked on this project,” Crisalli explained. “It has a spaceship with twenty-nine computers, a Renaissance-themed area with beautiful arches, a prehistoric-themed space with dinosaurs, a Roman Amphitheater where James Earl Jones read to the Blodgett children on the opening day of the library, and a beautiful Egyptian-themed tiled wall entrance and greeting area. 

Adapting to Change

To continue meeting the diverse range of client needs over the years, the GMCA team has been able to adapt to many different settings and requirements. For Paone, working with such a wide range of clients has been one of the most enjoyable aspects of the business.

“Probably what’s been most exciting for me is meeting so many good customers and diverse clients over the years,” said Paone. “We’ve worked with so many different types of clients and we always strive to adapt to their individual wants and needs. We’ve done a tremendous amount of work in medical institutions and hospitals, which have many layers of requirements, as compared to a client who’s planning a building that’s coming out of the ground. Having the ability to adapt to our clients’ needs and re-educating ourselves for every different project has been so important.”

Alongside diverse client needs, GMCA has been successful in adapting to changes within the industries themselves, related to software, technology, communications and more. Crisalli explained how general societal changes have a large impact on contracting, procurement, and managing projects across industries.

“The construction industry has changed a lot over the years,” Crisalli explained. “Everything moves faster now because of the advancements in communications. Society has changed overall as far as how we communicate with each other from purchasing, procurement of subcontractors, materials, regulations, building systems, construction equipment and processes, just about every aspect of building for our clients.   It has been interesting keeping up with all the changes. The different changes over the years have, in turn, altered the way we approach building in many different ways and areas of the industry.  It’s all a little different than when we started out.  The building process must adapt to our client’s needs. It’s more important to plan and schedule all these items immediately following contract procurement.  Our team obtains all the knowledge necessary to plan out the entire building: pre-construction, construction, and turnover phases in the preconstruction phase of the project, prior to putting a shovel in the ground. This practice has led us in making the construction process efficient and successful.”

“The company’s greatest single asset are the people who meet, adapt, and succeed in navigating the changes to our industry. We are very successful because of our staff of smart, knowledgeable, service-oriented people.” Crisalli continued.

Of course, to keep up with all the moving parts within the contracting space as well as the diverse needs of clients, GMCA’s team needs to remain highly knowledgeable and adaptable.  This makes all the difference with clients and ongoing success. Due to a general shortage of skilled trades, this need can sometimes be challenging, but according to Crisalli, GMCA has been successful in this area because of its focus on ongoing training and education, as well as a unique company culture that combats the stress that often comes along with working in construction.

“Over the years, the training processes that we use have changed completely. Now, we train our team on software as well as procedure, making sure everyone has the skills they need to successfully execute jobs. Not only do we train our employees on our own software programs, but we also train them on our clients’ various software programs to help us assimilate into different markets. Although we make sure the team has the knowledge and training to succeed on every site, the construction industry culture can sometimes be stressful. Many of our employees have been with us for over 10 years, and they appreciate that we try to alleviate stress through working as a team and humor. We have a small company atmosphere that works. Someone is always willing to help when another person’s workload suddenly increases.   I really think that helps,” said Crisalli.

Charitable Giving in the Community

Another important aspect of the company culture at GMCA is a great sense of pride in supporting the causes of several organizations and charities throughout many communities. The company facilitated a golf tournament to support Mercy Works’ at The Clarence Jordan Vision Center last year, raising approximately $50,000. Crisalli is a past president of the Baldwin Fund, and GMCA continues to support this charity.  The company has also supported the Fellowship of Christian Athletes (FCA) every year, as well as local organizations such as In My Father’s Kitchen and Francis House.

One charitable organization that’s especially meaningful to Crisalli is Marvelous Ways International in Lakeland, Florida. GMCA supports a golf tournament for this organization each year, which was founded by a couple from Central New York, Mark and Christin Haywood. Marvelous Ways International uses different developmental programs, teams of trained individuals and innovative technology to help monitor and improve outcomes for impoverished youth in Nicaragua, Costa Rica, and Honduras. “This organization helps kids who don’t have many great options in life to succeed. They give these children and teens a hope for the future by monitoring and guiding them through these youthful years and assisting each individual allowing them to choose a path for a successful life. It’s working out well and really making a difference in the life story of many who had few options for success. I am proud we can volunteer our time and resources to help make a positive difference in the lives of others,” said Crisalli.

Looking to the Future

Having worked with an impressive list of diverse clients for 35 years and always leaning into re-evaluation of the business, learning and constructive change along the way, GMCA is moving into the future with a goal of continued progress, growth, and adaptability.

“We always try to take a snapshot of what our economy is doing – what’s hot and what’s not,” said Paone. “We’ll continue to adapt our business corresponding with changes in the economy. Everyone knows the buzzword in Syracuse – Micron – and we’re certainly keeping our eye on that industry so we can adapt our business to service that industry successfully.”

Although change is always certain, especially in the construction contracting marketplace, one thing that will continue to remain constant for GMCA is its centralized mission of focusing on client needs above all else.

“Having been in business for 35 years is a real blessing. During that time, we’ve instilled in our team a sense of slow but steady growth, and conveyed the importance of covering our bases so we can ensure the best possible outcomes for our clients,” said Crisalli. “In our industry, it really comes down to this: if you please your clients, you’ll always succeed.”

CECL Explained: What Construction Companies Need to Know

Posted on by admin

Kaitlyn H. Axenfeld, CPA/CFF, CFE

The CECL model’s main change from current accounting rules is a requirement to incorporate forward-looking information while estimating credit losses. Construction companies typically have several types of financial assets that are subject to the ASU, including contract receivables, contract retainage and contract assets. You will now be required to forecast the total expected credit losses of these types of financial assets over the entirety of the asset’s life rather than when the loss meets the probable threshold or when incurred. This forecast is based on a wider scope of data that includes past events, current conditions, and reasonable and supportable estimates for the future. As a result, companies will have to invest more time in reviewing past write-offs, past bad debts, creditworthiness, etc., to calculate a reasonable and fair estimate for future bad debts.

A common approach to estimating future bad debts is to review aging categories for receivables. These aging categories can then be assigned reserve percentages based on delinquency, prior bad debts, knowledge of who owes what, etc. Those values are then combined to determine an entity’s allowance or reserve for bad debts.

When estimating future bad debts for financial assets subject to ASC 326, management should also evaluate and consider consumer credit risk scores, credit ratings, credit risk grades, debt-to-value ratios, collateral, collection experience, or other internal metrics.

The new standard requires enhanced disclosures to provide transparency on credit risk management, methodology, and the impact on financial statements. This enables financial statement users to assess the credit quality of financial assets and understand changes in expected credit losses over time.  

For each class of financial assets, a reporting entity should describe the credit quality indicator that it is using and then disclose the amortized cost basis of the asset, grouped by indicator.

Footnotes on an ongoing basis are required to include:

  • A description of how expected loss estimates are developed.
  • The entity’s accounting policies and methodology to estimate the allowance for credit losses.
  • Factors that influenced management’s current estimate and relevant risk characteristics.
  • Changes in the factors influencing management’s current estimate of expected credit losses and the reasons for those changes.
  • Changes to the entity’s accounting policies and reasons for significant changes in the amount of write-offs, if applicable.

CECL may not have a significant impact on a company’s allowance for credit loss, but it will require management to make new judgments and calculations to comply with the new standard. Entities should also consider updating their policies and procedures to ensure the necessary data is accurately captured. Once implemented, CECL will require ongoing monitoring to ensure that the methods and assumptions used for the initial credit loss calculations continue to reflect current conditions and variables. Forecasting should be a continuous process, and those factors will continue to evolve. 

It is also important to consider the impact of CECL when entering into new transactions or relationships, as well as when economic conditions change. CECL could negatively impact liquidity measures and ratios, which could affect lending, bonding, and other insurance.

 

Kaitlyn H. Axenfeld, CPA/CFF, CFE, is an audit partner at Dannible & McKee, LLP, a public accounting firm with offices in Syracuse, Auburn, Binghamton and Schenectady, NY, and Tampa, FL. The firm has specialized in providing tax, audit, accounting, and advisory services since its inception in 1978. For more information on this topic, you may contact Kaitlyn at (315) 472-9127 or visit online at www.dmcpas.com.

Membership has its Benefits – SBE and Workers’ Compensation Insurance Safety Group #469

Posted on by admin

Steven Bell, Vice President, Underwriting & Sales

To compete in the ever-changing and competitive landscape of the construction ndustry requires a low-cost, reliable, and comprehensive workers’ compensation insurance solution. In keeping with SBE’s mission of providing members with valuable programs and services, Lovell worked with employers in the construction industry in 1960 to create a workers’ compensation insurance safety group program. With over 64 years of history, this fully insured program known as Safety Group #469 – The NYS Construction Industry, operates on a non-profit basis, providing low upfront costs while delivering financial returns through dividends. Since its inception, Safety Group #469, has returned over $620 million in cash dividends to membership.   

What is a Workers’ Compensation Safety Group?

Safety Groups were established in New York State to serve the business community.  Safety groups are a collection of businesses who are in the same trade or industry who group together to reduce their workers’ compensation costs.  This grouping enables the members of a safety group to spread the risk of loss from the individual policyholder to all members of the group. These fully insured, not-for-profit programs combine members’ annual workers’ compensation premiums and then deduct the costs of claims and administrative charges.   Any money left over after accounting for these expenses is available for payment of a dividend.  To reduce the cost of workers’ compensation insurance, safety group managers encourage and assist members in instituting measures to prevent accidents and make the workplace as safe as possible.

Who is eligible for Workers’ Compensation Safety Group #469?

All SBE members with primary business operations in New York State are potentially eligible for Safety Group #469.  In business, occasional losses are inevitable. To ensure the success of the program, it is imperative that group members as a whole achieve good loss results.  Although eligibility extends to all members with primary operations in New York State, qualification is based on historical loss trends, underscoring the significance of a steadfast dedication to safety practices.

Recognizing the diverse footprint of businesses in the construction industry, the program can extend workers’ compensation insurance coverage to other states. This coverage enables members to manage their workers’ compensation insurance through a single invoice, simplifying the complexities associated with overseeing coverage in multiple states.

How does Membership in Safety Group #469 Benefit Construction Industry Employers?

Joining Safety Group #469 presents construction industry employers with a host of compelling advantages. Members enjoy an advance discount of up to 32.5% on their workers’ compensation insurance costs. In addition, any underwriting profits that the group earns are available to pay dividends.  The dividend for the most recent year was 27.5% of premium.    The combination of these dividends and discounts makes the program virtually unbeatable in the marketplace.  The benefits of membership are more than just financial; the safety group also provides access to industry leading safety, claim and underwriting expertise.  

 

How is Workers’ Compensation Safety Group #469 managed?

Group #469 is managed by Lovell Safety Management Co., LLC and by a committee of its members. Lovell Safety Management Co., LLC has been the market leader in managing workers’ compensation safety groups since 1936. As safety group manager for Group #469, Lovell provides comprehensive services to ensure the program’s success.    

Lovell’s team of experts provide loss prevention services to control losses, claims management services to mitigate the cost of claims, and underwriting services to ensure each member is priced at the lowest possible cost.    These services produce underwriting profits that get returned to members through upfront discounts and dividend payments. 

Summary:

The strategic partnership between the SBE and Lovell Safety Management Co., LLC serves as a testament to SBE’s commitment to providing unparalleled benefits for members. The combination of the SBE’s and Lovell’s respective expertise ensures that members can navigate the complexities of workers’ compensation insurance and the construction industry with confidence.

To learn more about Safety Group #469, please contact Lovell directly at 1-800-556-8355.

Overview of OSHA Updates in 2024

Posted on by admin

As of January 2024, OSHA released an update to the maximum penalty costs to adjust for the cost-of-living increases over the past few years as well as changes to some of their National Emphasis Program’s. Below, we’ll outline some of those changes.

Penalty Cost Adjustments

Changes to maximum penalty costs to violations in serious, other than serious, and posting violations categories increased to $16,131 per violation. Failure to abate violations are $16,131 per day (generally limited to 30 days) beyond the abatement date. Willful or repeated violations are $161,323 for each violation. The higher gravity of the violation, the higher the cost of the fine will be. 

Types of OSHA Citations:

  • Serious: Violation of situations in which a hazardous condition could lead to death or serious harm of an employee.
  • Other Than Serious: Violation of situations in which a hazardous condition could lead to a direct and/immediate injury/illness but would not cause death or serious harm to the employee. This category also covers failures in recordkeeping, posting and electronic reporting.
  • Failure to Abate: Violation in which previously cited hazards were not brought into compliance since the previous inspection.
  • Willful: Employer intentionally disregards OSHA requirements or demonstrates indifference to health & safety of employees.
  • Repeated: Violation of a previously cited hazard. These violations were corrected at one point in time but found again in a new inspection.

It is important to note that in January of 2023, OSHA issued an expansion on their Instance-By-Instance (IBI) citations which outlines that if an employer has multiple violations, those citation fees will be individualized instead of grouped together as they might have been in the past. To give an example, if a company has multiple work sites with the same hazards identified, OSHA will cite each site with the violation, not the company as a whole. This can lead to very hefty fees for a company. 

What is an NEP?

A National Emphasis Program (NEP) is a temporary specific hazard awareness program which OSHA focuses their resources on. These hazards can be seen in the general industry or can be in targeted industries. For example, in 2021 OSHA issued an NEP on Covid-19 which covered general industry, and then was revised to focus on the healthcare industry as they were at the most risk for exposure. The NEPs will provide directives for employers to follow to ensure workers are protected from the focused hazard. OSHA inspections will typically focus on industries with the highest exposures to the hazard identified in the NEP.

What is an LEP?

In addition to a National Emphasis Program, Regional OSHA offices can develop Local Emphasis Programs (LEP) as well. For example, as of October 2023, Region II which covers NJ, NY, Puerto Rico, and VI, implemented an LEP focused on construction work sites with a purpose “to identify and reduce or eliminate hazards at local construction projects.” This LEP outlines that programmed (OSHA planned) inspections will be determined through collecting local information regarding construction projects and will identify which establishments (addresses) they will inspect. OSHA will also continue their Unprogrammed (unplanned) inspections after a trigger such as a fatality or catastrophe, complaints, or referrals.

What are the current NEPs and LEPs in place that could impact a construction site?

In addition to the LEP of Construction Work Sites:

  • NEP – Combustible Dust – started in January 2023 with no expiration date.
  • NEP – Falls – started in May 2023 with no expiration date.
  • NEP – Outdoor & Indoor Heat-Related Hazard – started in April 2022 with a planned expiration of April 2025.
  • NEP – Respirable Crystalline Silica – started in February 2020 with no expiration date.
  • LEP – Noise Hazards – started October 2019 with a planned expiration date of Sept 2024.

This names a few, but there can be more depending on the type of construction a business is doing. The OSHA.gov website lists out all the NEPs and LEPs and provides resources to comply with these emphasis programs.

An employer may not be able to avoid an OSHA inspection, but there are things that can be done to ensure the process runs as smoothly as possible. Have a plan for the event which outlines who should meet with the inspector, how to determine what the inspector needs to see and what information needs to be provided immediately.  As always, OneGroup is available to help put a plan together and/or work on safety related programs to ensure employee health and safety is prioritized. For more information contact Brett Findlay at, BFindlay@OneGroup.com, Megan Coville at MCoville@OneGroup.com, or Paula DeStefano at PDeStefano@OneGroup.com.

 

Need to spell out first time

Employment Laws Taking Effect in the Spring of 2024 That Will Impact Your Business.

Posted on by admin

By: Sarah Smith

A. Social Media Protection Act

The Social Media Protection Act, which comes into effect on March 12, 2024, aims to establish regulations and safeguards to protect users’ privacy rights on social media platforms. It seeks to ensure that individuals have control over their personal information shared online.

Under this new act employers are prohibited from requesting, requiring, or coercing any current employee or applicant for employment to:

1) Disclose their usernames and passwords for accessing personal social media accounts.

2) Access their personal social media accounts in the presence of an employer.

3) Reproduce in any manner photographs, videos, or other information contained within a personal social media account.

Employers are prohibited from retaliating against an employee or applicant who refuses to disclose any prohibited information related to their personal social media accounts.  

The act does not prohibit employers from accessing an employee’s public social media information.  This act does not prohibit employers from requiring employees to disclose any username and password used by an employee to access employer provided social media accounts, as long as the employee was given notice of the employer’s right to request this information.

This act also allows employers to access an employee’s electronic communications on a device paid for by an employer, where the provision of, or payment for, such device is conditioned upon the employer’s right to access the device and the employee was notified and consented to such access.  Please note that the act prohibits employers from accessing any personal social media accounts contained on employer provided devices. 

Employers should review and update their social media policies to provide the required employee notices and ensure that their current policies do not require access to personal social media accounts.

B. Increased Wage Protections

Effective March 13, 2024, wage protections under Labor Law §§ 190 et. al. will be increased. The Department of Labor (“DOL”) previously rejected wage theft claims from executive, administrative, or professional employees making more than $900 a week. Employees above this earnings threshold were solely limited to pursuing a private action in civil court.

This change to the Labor Law seeks to correct this inflexible approach by increasing the weekly wage threshold from $900 to $1,300 per week. As such, executive, administrative, and professional employees making $1,300 or less per week will no longer be confined to commencing a lawsuit in civil court to recover owed wages and may bring an action with the DOL.

In addition to increasing the weekly wage threshold, the following provisions will also apply to executive, administrative, and professional employees making less than $1,300 per week:

1) Frequency of Pay (Labor Law §191): non-manual workers making less than $1,300.00 a week need to be paid no less than biweekly.

2) Cash payments of wages (Labor Law §192): Requires employers to obtain advance

employee consent for payment by direct deposit.

3) Benefits or wage supplements (Labor Law §198-c): Requires employers to timely pay

all amounts and benefits owed to employees under company policy and sets forth penalties for an employer’s non-compliance.

Though this act does not alter the salary thresholds for classifying employees as exempt from overtime, the DOL has updated their regulations to increase the salary threshold to be classified as an exempt employee. 

Certain executive and administrative employees who meet both the duty and salary requirements are exempt from overtime pay requirements. The salary threshold for classifying an employee as exempt from overtime has been increased as follows: 

  1. In New York City, Westchester, Nassau, and Suffolk Counties from $1,125.00/week to $1200.00/week ($62,400.00/year),
  2. In the rest of New York State from $1064.25/week to $1,124.20/week ($58,458.40/year).

 If an employee’s salary does not meet the new threshold, the employer will not be able to claim the overtime exemption for that employee, which could result in increased labor costs.

The above changes will provide increased wage protections for employees. The above changes will allow DOL to commence wage theft investigations for any individual making less than $1,300.00 a week.  The above changes to Labor Law §§190 et. al. and the increased salary threshold for overtime may lead to an increase in DOL audits and wage theft litigation. Employers should review their payroll practices to ensure compliance with these changes to avoid potential litigation.

For more information, contact Sheats & Bailey, PLLC; a law firm dedicated to serving the construction industry.  Tel: (315) 676-7314.  www.TheConstructionLaw.com.

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

 

Succession Planning…

Posted on by admin

Earl R. Hall, Executive Director – Syracuse Builders Exchange

Succession planning is never easy and generally not a topic construction industry employers want to think about – until they have to.  In my tenure as Executive Director of New York’s largest construction industry Association, I have assisted employers during their succession planning exercise, which has provided perspective on our members and what options they evaluate as they prepare to assure their business continues. 

Hanging up one’s hard hat for the last time should be a rewarding experience.  Whether you are a business owner, superintendent, foreman or journeyman, reflecting on your career and the industry you leave behind will generate a wide range of emotions.  For business owners, knowing you have a succession plan will provide peace of mind, financial security, and a sense of accomplishment, especially if family is involved in the plan.

Professionals such as accountants, attorneys, bankers, and investment advisors should be engaged during the due diligence process.  Obtaining professional advice is essential in developing a plan, identifying potential options, and avoiding unforeseen issues which might adversely impact the execution of a succession plan.   Additionally, such advisors will help one navigate how to implement the succession plan and what role, if any, the business owner will have during and/or after the transition.

Understanding the assets and liabilities of the business is essential, keeping in mind the company’s greatest assets may be the leadership team and employees.  Identifying potential successors to transition the business in many cases comes from within, so explore such options with those within the company, including employees and family members.  Communicating with those employees and/or family members will provide valuable feedback relative to interest in exploring a succession plan.  From there one can determine whether or not a business consultant or broker may be necessary to identify additional external options.

When to begin exploring a succession plan may vary depending on a range of unique facts and circumstances, so developing a plan with an adequate time frame is essential to obtain goals and objectives.  Planning for the unexpected is being proactive, so working with the company’s executive leadership team, family members and professionals will provide an initial strategic road map for the future.  While there is no certain age to begin succession planning, one should always have at a minimum a business plan in place which would address the “unexpected” event that would impact the ownership of a business.

While the process of succession planning may be similar for all construction industry employers, those employers’ signatory to one or more construction collective bargaining agreements must be aware of potential issues.  Such issues may impact one’s ability to sell the business and/or transition the business to family members.

Union contractors will need to evaluate the termination dates of all collective bargaining agreements and determine how such agreement may or may not impact a succession plan.  Generally, in a business transition or new ownership situation, existing collective bargaining agreements are also transitioned to the new owners of the business, unless the agreements have been properly terminated. Obtaining advice from an attorney familiar with the construction industry and labor agreements will be critical to assist in the decision-making process.

In determining whether or not terminating one or more collective agreements is necessary to effectuate the succession plan, one should consider the impact of any employer withdrawal liability relative to a signatory union’s pension fund or funds.  Determining the employer’s unfunded withdrawal liability should be done by requesting the union pension fund actuary calculate the employer’s withdrawal liability in the event such is triggered by terminating the collective bargaining agreement.  This disclosure may impact the decision-making process or impede one’s ability to implement a preferred or potential succession plan.

Developing a succession plan can be an arduous exercise; however, it is necessary if the desire is to continue the business in the unlikely event of an unexpected matter or while considering retirement.  Surrounding yourself with a great support team of professionals and other invested individuals who care about the employer will pay dividends during the succession planning process.

Every Second Matters St. Joseph’s Health Stroke Care Program Saves Time and Lives

Posted on by admin

In the event of a stroke, time is critical as any delay in treatment can result in irreversible brain tissue damage. Swift action is paramount to achieving successful outcomes for patients. With this knowledge, the stroke care team at St. Joseph’s Health has implemented crucial time and life-saving measures to ensure their patients are getting the best possible care, when every second counts. By providing 24/7 availability to critical services, utilizing innovative medical advancements, and offering outpatient neurological care in a convenient location, the Primary Stroke Center at St. Joseph’s Health offers top-tier stroke care in Central New York.

“As the leading cardiac care program in the region, our team has a profound understanding of the link between heart disease and the elevated risk of stroke,” said Dr. Fahed Saada, neurologist and stroke program director.

St. Joseph’s neurology team diagnoses and treats a variety of neurological disorders in both inpatient and outpatient settings including Alzheimer’s disease, Amyotrophic lateral sclerosis, concussion, migraine, epilepsy, multiple sclerosis, Parkinson’s disease, and stroke. They see patients with acute neurological symptoms at the main campus on Prospect Avenue in Syracuse as well as outpatient follow-up and new patient referral at the neurology clinic on W. Genesee Street in Camillus.

Commitment to Quality Since 2018, St. Joseph’s Health Hospital has been designated a Primary Stroke Center by the New York State Department of Health and DNV GL Healthcare, dedicated to upholding the highest standards of stroke care, leading to improved outcomes for their patients.

“Patients at St. Joseph’s Health often prefer to continue their care with us, especially those receiving cardiac treatment, due to the increased risk of stroke associated with heart conditions,” said Dr. Saada. “It’s important that we cater to the needs of these patients who wish to remain within our care network. Our foremost goal is to deliver the highest level of care to our patients.”

This commitment to excellence is an important driver for maintaining the Primary Stroke Center certification.

As a Primary Stroke Center, St. Joseph’s Health meets these criteria:
• Brain imaging scans 24/7;

• Neurologists available to conduct patient evaluations and use clotbusting medications such as TNK when appropriate;

• A rapid response stroke team and specially trained physicians and nurses to administer immediate care;

• A stroke care unit for inpatients with specially trained nursing staff;

• Post-stroke recovery services and support;

• Stroke education provided to patients and their families by a stroke program coordinator, helping them understand stroke, rehabilitation, and prevention, usually an advanced practice nurse or nurse practitioner;

• Physical, speech, and occupational therapy to help patients regain movement and function and to prepare them for rehabilitation;

• Nutrition services to help patients make positive lifestyle decisions;

• Social work services to help patients and families cope with their neurological deficits. “We are proud to have the Primary Stroke Center Certification because it affirms that our medical team expertly addresses the full spectrum of stroke care

– diagnosis, treatment, rehabilitation, and education – and establishes clear metrics to evaluate outcomes,” said Meredith Price, senior vice president, acute operations at St. Joseph’s Health Hospital. “When someone suffers from a stroke, it is critical to get them to a hospital with expert understanding of the nuances for stroke care. This certification underscores our proven track record and unwavering dedication to excellence, reassuring our community that we operate at the highest level.”

In 2023, St. Joseph’s Health Hospital was awarded the American Heart Association’s Get With The Guidelines® – Stroke Gold Plus quality achievement award. This honor is given to hospitals for their commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines, ultimately leading to more lives saved and reduced disability. The stroke team meets monthly to review the guidelines and ensure they are continuing to meet the requirements set forth by the American Heart Association.

“This award is important because it highlights our ability to deliver evidence based care of the highest caliber to our patients. This is a testament to the unwavering dedication, hard work, and commitment of our exceptional staff,” said Price.

Multidisciplinary Team Effort
“Stroke care is a team effort that requires careful coordination and constant communication,” said Dr. Saada. “Collaboration with other services is really the heart of our approach.”

The multidisciplinary stroke care team at St. Joseph’s Health includes neurologists Syed Shah, MD and Savita Kumari, MD, as well as radiologists, CT technicians, laboratory technicians, nurses, pharmacists, and rehabilitative service providers like physical therapists, occupational therapists, and speech and language pathologists. These team members work in unison to provide a comprehensive care plan tailored to each patient’s recovery.

“The most important factor in caring for our patients is to facilitate teamwork and communication between the emergency room physician, neurologist, and radiologist to diagnose the stroke in a timely fashion,” said Dr. Kumari. “Our goal is to reduce the risk of long term disability.”

Delivering Care in a Timely Manner
One of the most important ways St. Joseph’s Health streamlines stroke care is by quickly mobilizing the team. Upon a patient’s arrival at the hospital via the Emergency Department or while en route with Emergency Medical Services, a Code Stroke is initiated. This prompts immediate action from the Emergency Department and expedites imaging studies and a neurological consultation.

“Every second counts and we want to make sure our patients receive the best care from the outset,” said Dr. Saada. Patients receive a CT scan within minutes of arrival, determining if the patient has Looking at the past nine months of data, the average time for a patient to arrive at the CT scanner (or ‘Door to CT’) at St. Joseph’s Health Hospital is 18 minutes, exceeding New York State’s Department of Health goal of 25 minutes.

“There is a four-and-a-half-hour window of opportunity to treat the stroke, in order to reduce neurological deficits,” said Dr. Shah. “This timeframe gives the greatest chance of our patients returning to normal life post stroke.”

Ischemic stroke patients receive intravenous thrombolytic, or clotbusting medication, at the CT scanner as long as they’re still within that four and-a-half-hour window since the onset of symptoms. The medication breaks up and disperses a clot before it has an opportunity to prevent blood from reaching the brain. If there is any brain bleeding at all, the patient is not a candidate for thrombolytic.

Once the patient is admitted to the hospital, they undergo further imaging studies like MRI and echocardiogram help the team develop a care plan.

“These imaging studies allow us to quickly assess and respond to every stroke and obtain the most accurate diagnosis in the shortest period of time,” said Dr. Kumari.

Nurses, certified by the National Institutes of Health (NIH) in stroke care, monitor patients round the clock and are trained to identify neurological changes and deficits. 

Advanced and Innovative Treatments 

Since joining St. Joseph’s Health in 2016, Dr. Saada has implemented several advanced and innovative tools and technologies. One such change is the use of tenecteplase (TNK tPA) as the preferred thrombolytic over other alternatives like alteplase. Recent trials have shown higher efficacy with tenecteplase in treatment of acute ischemic stroke.

“The use of tenecteplase instead of alteplase has changed our patients’ outcomes significantly with fewer complications and better outcomes,” Dr. Saada said.

In the last two years, St. Joseph’s Health Hospital has added two weight measuring beds to their stroke care toolkit, allowing providers to obtain an accurate patient weight as soon as they come into the CT scanner. TNK tPA is a weight-dependent medication so having these beds immediately available for our stroke patients is essential to being able to administer it as quickly as possible.

“Investing in specialized equipment, such as weight measuring beds dedicated to stroke patients, reflects a commitment to providing tailored care that meets the specific needs of stroke survivors,” said Price. “These beds are crucial for patient safety aiding in their recovery process.”

Dr. Kumari’s subspecialty is electrodiagnostic studies. She performs electroencephalography (EEG) to diagnose seizure disorder and nerve conduction studies/electromyography (EMG) to diagnose and treat conditions like neuropathy and muscle disorders. 

“Some patients with stroke develop seizures and sometimes seizure can mimic stroke symptoms. We can perform testing like the EEG or longterm brain rhythm monitoring to accurately diagnose seizures and treat the patient appropriately,” said Dr. Kumari.

Before 2023, patients having seizures who required an EEG after hours or on weekends would have to wait for an EEG technician to be called into the hospital.  Today, St. Joseph’s Health Hospital has partnered with Ceribell, an EEG Point of Care company. Electrodes are attached to a headband which can easily be placed on a patient and providers can see results within two minutes.

“This is breakthrough technology, and we have it available 24/7,” said Dr. Saada. “Many patients are waiting as long as two to three months to receive these neurophysiology services at other facilities.”

Access to Care Around the Clock

St. Joseph’s neurologists are available 24/7 to assess inpatient and emergency department patients. Outside of normal working hours, a Tele Stroke program uses telemedicine through HIPA compliant software solution, Jabber. Neurologists virtually assess patients in as few as four to five minutes. The availability of this technology not only expands the reach of stroke care, but also ensures that neurologists can provide high quality care without being overwhelmed, sustaining the program’s effectiveness and efficiency.

St. Joseph’s Health Hospital also partners with Upstate University Hospital to assist with covering this service outside of normal working hours, as well as providing mechanical thrombectomy if the patient has a large enough clot preventing blood from getting to the brain (only necessary in about 10% of stroke patients).

“We collaborate with the Comprehensive Stroke Centers at Crouse and Upstate in case of an occlusion,” said Dr. Shah. “They are our partners and at the end, the ultimate goal is excellent patient care.”

Since October 2018, regional hospitals have been able to rapidly airlift emergent cardiac and stroke patients directly to St. Joseph’s Health Hospital’s helipad. The St. Joseph’s Health CareFlight program significantly reduces transit time, ensuring patients receive world-class care as quickly as possible, thereby greatly enhancing their chances of positive outcomes.

“Our expert team can treat patients from surrounding counties who are facing life threatening stroke and cardiac emergencies much faster than if they were transported by ambulance,” said Price. “Every minute a stroke remains untreated results in the loss of millions of brain cells. By slashing transit time, we ensure patients receive world-class care at the earliest possible moment, dramatically enhancing their chances of a favorable recovery.”

Investment in Stroke Education and Training
Scott Ward, Clinical Program Director of the Stroke Care Program, delivers stroke care training and education, especially for new nurses on the dedicated stroke unit. Course offerings include how to call a Code Stroke, identifying neurological deficits, administering tenecteplase, understanding ischemic vs. hemorrhagic strokes and their treatment, and using the NIH Stroke Scale to assess patients and relay this information to the  neurologists.

“Allocating time for nurses to  receive specialized education on stroke care is a priority,” said Ward. “This ensures that the nursing staff is well-versed in the latest stroke care protocols and techniques, enhancing patient outcomes.”

As a Primary Stroke Center, St. Joseph’s also works to educate members of the community on identifying the signs of stroke. 

“Stroke is preventable,” said Ward. “But people have to know what to look for.” Stroke can present with classic symptoms and an easy way to remember common stroke symptoms is using the acronym

“BE FAST.”
B = Balance: sudden loss of balance.
E = Eyes: Sudden loss of vision.
F = Face: Facial asymmetry or numbness on one side of the face.
A= Arm: Weakness or numbness of one arm or leg.
S= Speech difficulty: Sudden change in the speech, slurred speech or word finding difficulty.
T= Time: Time is important for stroke care; call 911 immediately if any of the above neurological symptoms develop.

Other symptoms which may not be easily recognizable include headache, dizziness, blurring of vision, confusion, and a change in level of consciousness. “Even if there is the slightest suspicion of a stroke, you have to immediately seek medical attention,” said Dr. Shah. “I have seen cases where a patient’s speech is impaired, but they waited for two to three days to seek care. Or their arm is numb, and they think they slept wrong. As a society, we need to educate people, especially the older population, on what to look for and the importance of not delaying treatment.”

Outpatient Care in a Convenient Location
With the establishment of an outpatient neurology clinic in Camillus, Drs. Saada, Kumari, and Shah see patients very soon after they’ve been released from the hospital. They also provide 

treatment for a variety of other neurological conditions such as Alzheimer’s disease, amyotrophic lateral sclerosis, concussion, migraine, epilepsy, multiple sclerosis, Parkinson’s disease, and myasthenia gravis.

“The clinic benefits both our program and our patients,” said 

Dr. Shah. “We educate them on their condition and provide them with care in a comfortable, compassionate setting. Our patients are treated with kindness and care, and we are completely focused on their needs. When they leave their appointments, they understand their conditions and the treatment plan better. This goes a long way in ensuring their long term health.”

One of the most rewarding aspects for the neurologists is the ability to follow up with their patients post-stroke and see the results of their rapid response in the hospital.

“The best thing about our stroke program is when you see a patient after they have had a stroke and there is no disability because someone made the decision to give them clot busting medication,” said Dr. Shah. “I had a patient in his late 40s who had a significant stroke and his left side was compromised, but with PT and OT, he is back to 80%. Now he is thinking of going back to work. It is very fulfilling to see that.” “I am so proud that our team works incredibly well together and provides such excellent care to our patients,” said Dr. Kumari. “It’s very rewarding to know we are helping so many people live long, fulfilling lives.”

As the program grows, St. Joseph’s Health plans to add a physician’s assistant to the team.

“Our vision is a world where the devastating impact of stroke is minimized through excellence in care, compassionate education, and a relentless pursuit of better outcomes,” said Dr. Saada. “We are not just treating conditions, we are caring for individuals, supporting families, and educating communities to recognize and respond to strokes.”

Drs. Saada, Kumari and Shah are accepting referrals for patients with any neurological concerns. Call (315) 833- 9901.

For air transportation for emergency cardiac and stroke cases, regional hospitals may call the St. Joseph’s Health Hospital Transfer Center at 315-726-6120.

Paramedicine: Creating a first line of access and follow-up in our communities

Posted on by admin

By: Kathryn Ruscitto, Advisor

Definition: “Community paramedicine is a relatively new and evolving healthcare model. It allows paramedics and emergency medical technicians (EMTs) to operate in expanded roles by assisting with public health and primary healthcare and preventive services to underserved populations in the community.” Rural Health Information Hub

Recently I wrote about new models developing in primary care. From telemedicine to urgent care, access for certain conditions can be met as an adjunct to the traditional primary care physician .

Paramedicine has been developing in many states since 2009. Every community has different needs, and Paramedicine programs look different from community to community.

What these programs have in common is identifying what will help the existing health care system in that area by addressing unmet needs.

A scan of existing programs suggests common focus areas include:

  1. 911 triage to prevent dispatching an ambulance crew.
  2. Chronic Care management in the home, in collaboration with home care, hospice, health departments or primary care practices.
  3. Preventing readmissions or ER visits by offering some chronic care education services in the home and facilitating communications with providers.
  4. Helping patients get to the right setting and identifying resources to support them.
  5.  
  6. Supporting the frail elderly in remaining at home with extra support.

In NYS there are pilots underway to look at Paramedicine as part of the health landscape. In others states these programs have long been a successful part of health care. Florida in particular has a compete manual for ambulances to approach certification and to train ALS paramedics.

The current demonstrations in NYS were funded by the Mother Cabrini Health Foundation, awarding grants to the Iroquois Association and the NYS Home Care Association. These pilots are about to expand from three to six. They have worked best in areas where a champion within the department takes lead in the community collaboration. Gary Fitzgerald the CEO of Iroquois notes, “EMS providers can be used more effectively in our communities.”

I spoke with the pilot in Jefferson County that is working in collaboration with their Health Department and home care agency. Paul Barter, the Jefferson County EMS Director was enthusiastic about the impact of their pilot program in Jefferson County. He stressed how excited his providers are in helping patients better understand their disease, medications, and have a better quality of life. A review of their data tells them they are reducing calls to 911 and transports to emergency rooms.

These pilots are particularly important in areas where primary care has contracted, or the local ER has closed. Workforce shortages have also hit Ambulance Corps and foundations and the Health Department should look at investments and incentives to help EMS providers expand through Incentives, including scholarships and tax credits.

There are so many positives to community based care in improving health outcomes. Paramedicine is one part of a growing system of options for communities to consider. The NYS Health Deportment should make these programs a permanent option in the NYS Healthcare landscape.

References:

https://www.ruralhealthinfo.org/topics/community-paramedicine

https://www.flexmonitoring.org/sites/flexmonitoring.umn.edu/files/media/bp34.pdf

https://paramedicnetwork.org/mce/

https://emsa.ca.gov/community_paramedicine/

https://www.iroquois.org/

Kathryn Ruscitto, Advisor, can be reached at linkedin.com/in/kathrynruscitto or at krusct@gmail.com

 

Velocity Clinical Research Syracuse Our focus on Alzheimer’s Disease Research

Posted on by admin

Robert C. Cupelo, MD, Principal Investigator

Estimated to currently affect over 6.2 million Americans and expected to increase as the population ages, Alzheimer’s disease is a devastating illness, not only for patients, but also for their family and caregivers. In addition, the condition disproportionately affects underserved medical communities, including low-income populations and people of color, who tend to be diagnosed later in the disease and often find it more difficult to obtain medical care and support. Despite this large prevalence and years of study, there are still very few effective options available for treatment.

Velocity Clinical Research in Syracuse started as Clarity Clinical Research in 2017 with the mission of advancing the study of diagnostic tools, preventative measures, and therapeutic options for people, not only with Alzheimer’s disease, but also at high risk of the disease. Although we have since expanded into other clinical areas, including fatty liver disease, metabolic and cardiovascular conditions, and vaccines, our focus on advancing the understanding of Alzheimer’s disease remains a core passion of our site. Over the past seven years we have completed or are currently conducting 16 studies involving these aspects of Alzheimer’s dementia.

In 2022, Clarity joined Velocity, an international organization committed to optimizing the clinical research process by improving collaboration between research study sponsors and clinical sites, and by streamlining and supporting the performance of studies at those sites. At that time, we moved to new facilities at Crouse Medical Building at Brittonfield in East Syracuse. This allowed us to grow and diversify. An accommodating and close knit staff, including study coordinators, research assistants, pharmacy technicians, and nurses work together to enhance the experience of participating in clinical research. Studies are closely monitored by our investigators, including physicians, Dr. Robert Cupelo and Dr. Barbara Connor, along with Dr. Nathan Hamm, DC, FNP-C and Joanne Speicher, FNP-C, all of whom have many years of clinical experience, along with deep roots in the Central New York medical community. Participants in our studies universally find involvement in clinical research at our site to be not only interesting and fulfilling, but also a very pleasant experience.

Current studies underway at Velocity Syracuse include an oral medication meant to disrupt the formation of beta amyloid and other disease promoting elements in the brain, a non-medical treatment involving daily gamma frequency audiovisual stimulation, and investigational medications for Alzheimer’s patients with agitation which are potentially safer than those currently used. We also have an upcoming study involving a next-generation anti-amyloid antibody infusion for early-stage disease. Finally, in another study, we are seeking people both with and without Alzheimer’s disease who have a life expectancy of less than one year to help validate a next generation PET scan tracer for the tau protein which accumulates in patients with Alzheimer’s disease. This tracer has potential to accurately diagnose the condition earlier in the course of the condition so that therapeutic options can be started sooner and be more effective. We continue to actively search out more study opportunities.

Velocity provides a high quality of care, delivered with compassion and kindness, while advancing the knowledge of medicine through research. Our vision is to improve lives by making clinical research more accessible to all, including communities traditionally underserved, their caregivers, and the medical community charged with their care. We work to achieve our goal to be a recognized strategic option for care in the Central New York healthcare community.

To stay updated on the latest studies and how they align with your patients’ needs, you can reach us at 315-760-5905 or velocityclinical.com.

New Leadership Continuing the Vision for Syracuse Community Health

Posted on by admin

By Elizabeth Landry

2024 marks the start of another new chapter for Syracuse Community Health, with Ofrona Reid, MD, MBA, MS taking the helm as Interim President and CEO this past January. Reid was previously the Chief Medical Officer at Oneida Health, having re-located to Oneida from the Bronx, where he grew up. His experiences in his youth have contributed to his sense of passion for leading Syracuse Community Health, a vital health care organization in Central New York that serves those who are uninsured, disadvantaged or who face other obstacles to receiving quality healthcare.

“Growing up in the same type of community with similar struggles, barriers and exposures gave me a sense of what’s needed in the greater Syracuse community, as well as the desire to really make a change,” Reid said. “My ultimate passion and vision are to design and deliver a high-quality care model that focuses on providing health equity to patients who unfortunately are vulnerable and under-served in our community.”

Reid and the leadership team at SCH have laid plans for several initiatives aimed at increasing access to quality healthcare for the impoverished communities in Central New York. SCH will be expanding the Quick Care center to increase walk-in access for patients. According to Reid, these walk-in services are critical to the goals of the organization.

“If we have a patient coming into Quick Care for foot pain, for example, we can screen them for other underlying conditions like high blood pressure or diabetes, and then tunnel them to a primary care provider for further care. This process allows us to identify and help close health care disparities in the community,” Reid explained.

Related initiatives involve collaboration with other community-based organizations. To help address food insecurity, SCH is working with the CNY Food Bank to distribute 200 boxes of fresh produce each month, available to anyone in the community. A collaboration with Food Access Healthy Neighborhoods Now, or FAHNN, as well as the Mary Nelson Program, will also help SCH alleviate the food desert in Central New York. Additionally, SCH will be partnering with Brady Market to offer a café space in the new building at 930 South Salina Street, offering fresh, healthy food options for patients and staff alike. The team at SCH also has plans to partner with Catholic Charities, the Rescue Mission, and Dr. David Lehmann from Upstate Hospital to help provide quality health care to the sheltered and unsheltered homeless population in Syracuse.

Helping to achieve the vision for SCH this year is the executive team made up of John Milligan, Chief Financial Officer and Jessica Yoxall, Chief Operating Officer. According to Reid, one of the most important requirements for achieving the goals laid out in 2024 and beyond is a strong, supportive leadership team. “Without my staff and clinical teams, there’s no way I’d be able to go after my vision for the organization,” Reid said.

Certainly, this emphasis on teamwork also resonates with the executive leadership team at SCH. “What I enjoy most about working at Syracuse Community Health is our team,” said Yoxall. “Everyone at SCH has a shared vision to provide high-quality care to improve health outcomes for the patients we serve. The employees at SCH are constantly going above and beyond to meet the needs of our patients and organization.”

With the team aligned on strategies for making material improvements in healthcare access in the community, even more changes are coming down the pike at SCH. Planned building expansions include a second Quick Care location, a new clinic on the Onondaga Community College campus and enhancements to the original SCH location at 819 South Salina Street. These developments will further improve patient experience as demonstrated by the brand-new, state-of-the-art location at 930 South Salina Street that recently opened in December of 2023.

“We are so proud of our new 930 building,” said Milligan. “It was specifically designed to enhance the patient’s experience. The natural lighting, open spaces and easy transitions between care areas really improve the patient flow and experience.”

Whether at the new building, the Quick Care center, in Syracuse elementary schools or in the streets of the community, the team at SCH will continue to focus on achieving healthcare equity for all.

“I really feel that if we’re going to close the healthcare gap, we can’t sit back and wait,” explained Reid. “We’re going to make the necessary moves to close the gap and bring high-quality healthcare to those who need it the most.”