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Legislative Session 2024- Workers’ Compensation Bills

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Annette Malpica, VP Claims & Legal Counsel, Lovell Safety Management Co., LCC

Four workers’ compensation bills were passed by the NYS Senate and Assembly during the 2024 legislative session. Once a bill is passed by both chambers, the bills must be presented to Governor Hochul by December 31, 2024. The Governor has the option to 1) sign 2) veto or 3) request chapter amendments to the bill. As of December 22nd, the Governor has signed two bills and vetoed two bills. We anticipate that the bills that were signed will increase benefits, resulting in higher costs for all NYS employers and in some situations, decrease the incentives to return to work. 2024 Workers’ Compensation Bills signed into Law:

Bill A.5745/S.6635 – Amends WCL §10(3)(b) to eliminate the case law requirement that mental stress injuries be based on work related stress that is materially and substantially greater than that experienced by similarly situated workers.  “Where a worker files a claim for mental injury premised upon extraordinary workrelated stress incurred at work, the board may not disallow the claim upon a factual finding that the stress was not greater than that which usually occurs in the normal work environment.”

Bill A.5745/S.6635 was signed by  Governor Hochul on December 6, 2024, subject to chapter amendments. 

As written, A.5745/S.6635 would expand the statutory carve out that applies to police officers, firefighters, and emergency medical technicians who filed a claim for mental injury premised upon extraordinary work-related stress to include all employees. In 2017 the NY legislature, in recognition of the high standard required by the statute for mental stress claims, and the occupational hazards/exposures experienced by first responders during emergencies, removed the restriction that a mental stress claim had to be greater than the stress sustained by a similar worker. As written, the 2024 bill would treat all workers in a manner similar to first responders and would prevent employers from defending claims for mental injury by demonstrating that an employee was not exposed to stress that was greater than that experienced by other employees. Employees will still  have to have experienced “extraordinary” stress. The onus to determine what qualifies as “extraordinary,” a standard that is not defined by statute, will be placed on Law Judges.

The chapter amendments to A,5745/S.6635 were released on January 9 to the public under a new bill number A.1677/S.0755. The chapter amendments sought to clarify the psychiatric (DSM) diagnoses that would be covered under the new legislation and placed specific work-related parameters as to what incidences meet the “extraordinary worker elated stress” standard.

The three psychiatric diagnoses covered under this new law include: post-traumatic stress disorder (PTSD), acute stress disorder, and major depressive disorder. For these specific diagnoses, claimants will not have to demonstrate that the stress experienced at work was “greater than that experienced by a similar worker” to qualify for workers’ compensation benefits. In addition, A1677/S,0755, contains language that mandates a causal nexus between the work-related stress to a distinct work-related event or events directly related to employment occurring during the performance of the employee’s job duties. A.1677/S.0755 becomes effective 180 days after it becomes law.

In 2022, the New York Compensation Insurance Rating Board (NYCIRB) hired an actuarial firm to review the impact of a similar mental stress bill that was passed by both chambers (A.2020-A/S.6373-B) and its impact on NY carriers and employers. Based on NYCIRB’s analysis, the Governor vetoed the bill. In veto memo 191, the Governor noted that the mental stress bill comes with “significant cost,” that was “imprecise” to measure. In order to overcome the Governor’s concern, the legislature negotiated the chapter amendment language noted above to control costs to her satisfaction.

Bill A.1204-A/S.9462-A – Amends WCL §13(b) to permit treatment by Licensed OT/PT Assistant.
“Under the direction and supervision of an authorized occupational therapist, occupational therapy services may be rendered by an occupational therapy assistant. Under the direction and supervision of an authorized physical therapist, physical therapy services may be rendered by a physical therapist assistant.”

The OT/PT bill was signed by Governor Hochul on September 27, 2024. This bill (or similar bills) has been present in every legislative session since 2013. Currently, OT/PT therapy assistants are not permitted to render care under WCL §13. This bill will allow OT/PT assistants who are licensed by the NY State Education Department to render services to claimants under the supervision of an authorized OT/PT. This bill will become effective on the 13th day after it becomes law. We believe that the impact of this bill will be minimal, since workers’ compensation authorized OT/PT therapists are currently using assistants to help render care to claimants.

2024 Workers’ Compensation Bills vetoed by Governor:

Bill A.1219-A/S.1974-A – Amends WCL §13(1) to add a new paragraph that would permit claimants to utilize a non-network pharmacy provider upon a finding of eight factors. “[A] claimant shall not be required to obtain prescribed medicines through a pharmacy with which the employer or carrier has a contract and may obtain prescribed medicines from a pharmacy of his or her choice when…”

Bill A.1219-A/S.1974-A was vetoed by the Governor on December 13, 2024. In her veto memo, Governor Hochul mentioned that: 1) the bill would increase litigation resulting from factual disputes associated with the eight factors that would permit the claimant to utilize a non-employer network pharmacy 2) the bill would add “bureaucratic” steps to the Workers’ Compensation Board (WCB), and 3) the bill if signed would delay benefits to the claimant. A few examples of the eight factors that would permit the claimant to go out of the employers’ contracted pharmacy network for medications are:

  • employer or carrier refused to provide payment for the prescribed medication and the claimant is unable to obtain the medication from the contracted pharmacy within 72 hours.
  • employer or carrier or network pharmacy failed to respond to reauthorization request
  • medications were previously authorized; however, the employer or carrier denies reauthorization because the medical guidelines do not support reauthorization
  •  an IME disagrees with reauthorization

In the veto memo, the Governor mentioned that WCB will be issuing regulations to address the intent of A.1219-A/S.1974-A. The proposed regulation can be found at www.wcb.gov. The regulations will require that the employer or carrier notify the claimant that they may use a non-network pharmacy when the employer or carrier objects to medications for sites of injury that have not been accepted or established by the WCB. The regulations will be published in the State Register on December 31, 2024. Carriers and employers will have 60 days from publication to submit their comments to the WCB. For Lovell clients we do not see this as a major issue since NYSIF already provides firstfill pending establishment or acceptance of the claim. It is also important that employers and carriers are reminded that if signed, this bill would roll back the pharmacy cost benefits that employers negotiated in the 2007 Reform Legislation.

Bill A.6832-A/S.6929 – Amends WCL §13-a to allow for treatment costing less than $1,500 without the need for pre-authorization. The bill will also prevent carriers and employers from using the Medical Treatment Guidelines (MTG) to deny any treatment not within the Guidelines. “Such list of pre-authorized procedures (MTG) shall not prohibit varied treatment, nor shall the list be used as a basis to deny treatment not contained therein.”

“Any special diagnostic tests, x-rays examinations, magnetic resonance or other radiological examinations or test costing more than one thousand five hundred dollars performed by a provider who is not a member of the carrier’s, selfinsured’s or state insurance fund’s diagnostic network…shall be entitled to payment at the negotiated network rate.”

The Governor vetoed A.6832-A/S.6929, the Medical Treatment Guideline (MTG) bill on 11/22/2024. In Veto Message No. 62, she noted that this bill dismantles the standard of care contained in the Medical Treatment Guidelines. The veto message also emphasizes that the Medical Treatment Guidelines were premised on evidence-based medicine to create a uniform standard of care that would serve to improve medical outcomes to injured workers while also reducing disputes regarding whether treatment is necessary and appropriate. The MTG has also been credited with reducing costs to the workers’ compensation system. As for treatments greater than $1500, the veto message noted that the carrier will be required to obtain an IME, which would cause further delays to treatment that is currently authorized without any litigation in 94% of prior authorization requests.

A.6832-A/S.6929 was the most impactful of all the bills that were passed by the legislature during the 2024 legislative session. This bill would essentially dismantle the MTG and the Prior Authorization Request (PAR) process that the WCB spent years and millions of dollars to create as part of the comprehensive Business Process Reengineering (BPR), which included PAR and OnBoard. If signed, this bill would have opened the door to dramatically increased costs for employers if providers advanced questionable medical treatments. In addition, the cost of litigation would increase significantly as employers and carriers sought to limit unwarranted medical costs. We do not need to go far into the past to recall the abusive submissions of hundreds of bills by certain medical providers for treatments that were questionable and, in some cases, injurious to claimants.

Common Construction Accounting Risks and How They Can Be Prevented

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Robert C. Reeves, CPA, CFE, Dannible & McKee, LLP

The construction industry has experienced a significant amount of growth post-pandemic. While increased job activity is a positive, several risks have become more prevalent, which could negatively impact job performance if overlooked. Implementing efficient accounting practices can prevent companies from experiencing deteriorating margins and assist in mitigating the following common risks, helping companies gain a stronger understanding of bidding processes and projected job performance.

  1. Inaccurate Cost Estimates: With numerous jobs available for bid, construction industry experts face a rising risk of inaccurate cost forecasts. Poor estimates lead to underbidding and cost overruns. Contractors should use detailed, line-item estimates for each job site activity, including labor, materials, and equipment hours. These costs should be continuously evaluated and adjusted as the project progresses and work scopes change. Regular evaluation of estimates and comparison of budgeted to actual costs enables accurate forecasting of the job’s trending performance and helps refine estimates in future projects.
  1. Overhead Overlook: Overhead costs are a notable expense in the construction industry. Fixed overhead costs, such as office rent or insurance, are straightforward to account for, whereas variable overhead costs, such as labor burden, repairs and maintenance, and advertising, can fluctuate and be easily overlooked. Common pitfalls include not considering indirect costs and overhead during the bidding process and not allocating these costs to the work-in-process schedules on a timely basis when evaluating a job’s performance. To prevent overhead overlook, companies should utilize a variety of formulas to allocate indirect costs and overhead. Allocation formulas most commonly used include, but are not limited to:
  • Allocate indirect costs and overhead based on direct labor;
  • Allocate indirect costs and overhead based on material costs; and
  • Allocate indirect costs and overhead based on equipment use.

Tracking construction project costs is already time-consuming without factoring in overhead and direct costs. However, it is crucial for companies to understand and track the difference between direct, indirect, and overhead costs on each job, starting from the bidding stage and on a continuing basis as projects progress.

  1. Increased Market Prices: Post-pandemic, the construction industry has faced extreme cost volatility. Since 2020, average hourly wages have risen approximately 17%, and overall construction input costs have surged by 40.7%. Costs throughout the industry are expected to continue increasing for the foreseeable future, requiring companies to take into consideration and adjust their budget and bidding processes accordingly. They can even look for other avenues to help mitigate inflationary costs, including:
  • Requesting deposits to purchase and store materials before construction of a project begins.
  • Incorporating percentage change clauses in contract agreements that allow cost overruns from price increases to be billed back to the project’s owner.
  1. Cash-Flow Overruns: Rising costs can also lead to cash flow shortages, which can create materials and equipment delays. When materials and equipment have delayed deliveries, companies may need to postpone projects, which can have various negative impacts. To prevent this, companies should establish strong budgeting and accounting estimates of cash flows. Estimating when certain milestones will be met will help you develop and track a proposed payment schedule and provide a good idea of how cash inflow will correlate with cash outflow on jobs.
  2. Out-of-Scope Work: It is inevitable that construction projects will face unexpected changes, such as poor weather, last-minute changes, punch list items and job add-ons. It is essential to consider and account for out-of-scope work during the bidding process and when forecasting the project’s expenses and performance. Project managers should maintain open communication with the accounting department to continuously compare actual costs with estimates throughout the life of the project. Identifying lower-than-expected margins early provides management time and justification to refuse extra work or work with the project’s owner to find a suitable middle ground. Having strong accounting procedures and controls, such as budgeting, tracking job performance, accurate cost allocation, cash flow projection, and many more, helps mitigate these risks and their negative impact on job performance and a company’s bottom line. Paying attention to the numbers and prioritizing the accounting and financial aspects of jobs can be a crucial factor in increasing margins and advancing your company’s success.

Robert C. Reeves, CPA, 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. He has over eight years of experience at the firm providing audit, review, compilation and consulting services to a variety of clients with a focus on the construction, architectural and engineering industries. For more information on this topic, you may contact our firm at (315) 472-9127 or visit online at www.dmcpas.com.

Upstate University Hospital: A Regional and National Leader in Healthcare Innovation

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By Elizabeth Landry

As Central New York’s only academic medical center, Upstate University Hospital is paving the way for much of the region’s healthcare needs. In fact, many of the hospital’s programs and facilities are blazing new trails of innovation, regionally and often nationally, as well.

“We think a lot like a private enterprise, even though we’re public, and that has helped us think innovatively and do well financially,” explained Robert J. Corona, DO, CPE, MBA, FCAP, FASCP who has served as CEO of Upstate University Hospital since 2018. Dr. Corona has been associated with Upstate in various capacities for over 30 years, completing his residency and fellowship at the hospital in the 1980s, serving as an educator periodically, becoming Chair of the Pathology Department in 2012, and serving as Chief Innovation Officer shortly after.

For Dr. Corona, continuing to lead the way in innovation is a core strength of Upstate, and his vision of innovation in health care encompasses new ways of incorporating machines, software, programs and buildings. “We need to be state of the art as a teaching hospital to be able to provide our trainees with the best technology and the latest innovations, so they can see how high-quality care is delivered,” he said.

Technological Innovations at the Forefront

Perhaps one of the most visible avenues in which Upstate utilizes cutting edge technology within its healthcare system is the use of drones and robots, which have combined to become the Autonomous Machines Department. Upstate began using drones around 2013, when Dr. Corona was the Chair of Pathology, but this technology has ramped up since he became CEO. The drones, which can fly over 40 trips per day, save the  organization time and costs by transporting medications and specimens for testing through the air rather than relying on couriers on the ground. Upstate is well on its way to reaching the goal of flying the drones between all its institutions. In addition to the time and cost savings, the innovative technology has also led to increased efficiency and satisfaction of patients.

“We use drones in our ‘Meds to Beds’ program, which means when you’re in the hospital and you get discharged, we provide you with your discharge medication so that you don’t have to go to the pharmacy. The order goes over to the retail pharmacy across from Community Hospital and then the drone flies the medication over to the hospital and we give it to patients when they’re discharged,” Dr. Corona said. Robots, the other piece that forms the Autonomous Machines Department, became part of the organization’s operations to help with staffing shortages, Dr. Corona explained.

“I worked with an engineer and found out that nurses spent 

about a third of their day chasing down supplies, moving food, picking up things in the cafeteria, bringing things to the lab, bringing sheets and any kind of supply, which is really not having nurses work to the top of their license. So, we ended up getting over a dozen robots that now deliver supplies and food.”

Dr. Corona added that such use of these machines has put Upstate at the forefront of healthcare technology not only regionally, but nationally. “I don’t know of any other institution that has a combined program of robotics and drones in an autonomous machines group,” he said. 

Another milestone of technological innovation at Upstate has been the recent opening of the Throughput Operations Center. A sort of central command center for the organization located in the former Telergy Building off Carrier Circle, the center features 22 live-feed monitors and 28 computer stations
that provide hospital officials with a real-time view of operations, including capacity demands, bed census, open beds, COVID information and patient transport status. The center is aimed at reducing bottlenecks, streamlining patient flow, and improving patient outcomes across the hospital network. Dr. Corona explained how the center is helping with capacity challenges and may even grow to include external healthcare organizations.

“We’ve had preliminary discussions with the Department of Health to see if we could coordinate with hospitals that have capacity and we would help them manage the patients if needed,” he said. “We’ve had interest in what I call a ‘virtual hospital system,’ where the Throughput Center would see all the participating facilities and help manage and balance the load.”

New Programs Directly Benefitting Providers

Upstate is one of only a handful of academic medical centers to offer a new Hospital Administration Leadership and Management Fellowship accredited by the Accreditation Council for Graduate Medical Education, or ACGME. This fellowship provides the opportunity for physicians to gain certification in this field.

“The physicians will spend time learning finance, operations, physician management and other skills leading to board certification in healthcare leadership,” explained Dr. Corona. Another significant, yet very different way Upstate is investing in innovations that directly benefit healthcare providers is through a recent safety initiative called “Respect and Heal,” a collaborative effort with other local healthcare entities. It was proposed by Dr. Corona after he and other regional CEOs wanted to address violence against healthcare workers.

“We are united in zero tolerance for abuse and are committed to sharing best practices to end harassment and assaults. We held a half day conference last year, which was standing room only, and we are moving to a full-day conference this year to share innovations and research,” said Dr. Corona. Upstate took on the role of coordinating and hosting the conference, which is offered to staff and leadership at the dozen hospitals that have committed to the principles of Respect and Heal.

Widespread Innovations in Healthcare Facilities

The team at Upstate has been on the forefront of innovative facilities and buildings for several years, with structures like the Upstate Nappi Wellness Institute, a building that’s been both LEED certified, signifying its sustainability, and Well certified, related to its eco friendly status. The building’s beautiful design is what Dr. Corona described as “friendly to the human experience.”

Another innovative space that has been approved is a new pathology building that will be built next to the Upstate Bone & Joint Center on Fly Road in East Syracuse. Dr. Corona elaborated on how pathology has become more innovative at Upstate over time, and why the new building is needed.

“When I returned to Upstate as the pathology chair after 16 years in the industry, I had experience in digital imaging and developing medical products,” he said. “The new facility
is going to leverage recent research in digital pathology, molecular diagnostics, applications of AI relevant to diagnostics, and quantum computing.”

Another recent facilities development at Upstate is a plan to build an annex which will include a new Emergency Department and a new Burn Unit. The team at Upstate is also exploring the development of a cellular therapy center reflecting recent innovations in

 stem cell technology.

The Upstate Cancer Center at Verona is unique due to the organization’s collaboration with the Oneida Nation, a relationship that Dr. Corona explained is one of the first of its kind.

“To the best of our knowledge, this is the first collaboration where a public New York state hospital has worked with a native nation to build a health facility. It’s been a wonderful relationship – they’ve been amazing to work with.”

Providing Cutting-Edge, High-Quality Care
The Verona Cancer Center is one of Upstate’s several cancer centers, with other locations in Syracuse, Oswego, Auburn and at Community Hospital. These widespread resources reflect Dr. Corona’s focus on providing healthcare where people in the community need it most.

“I see us as having a responsibility to grow and provide state-of-the-art care locally for our community, so people don’t have to leave the area for exceptional cancer care, cardiac care or stroke care. We have an obligation to really drive outstanding quality, and to incorporate the most relevant tools and approaches to do so.”

For Dr. Corona and the team at Upstate, that’s what innovation is all about. 

The new Upstate Throughput Center features 22 live-feed monitors and 28 computer stations that provide hospital officials with a real-time view of operations, including capacity demands, bed census, open beds, and patient transport status to streamline care.

Research and Teaching: What Sets Upstate Apart

The two pillars of Upstate University Hospital that perhaps most distinguish the organization from other hospitals in the region are research and teaching. These components stem from the hospital’s role in the overarching Upstate Medical University. Academic medical universities like Upstate include a medical school and a research enterprise as part of their core mission, along with patient care.

Every research project at Upstate is focused on finding cures and improving human health. Current research initiatives and projects include tumor cell invasion and immunotherapy for treating cancer, exploring the genetic bases of neurological and psychiatric disorders, and utilizing AI and machine learning for advancements in pathology diagnoses. Patients benefit from access to clinical trials, and every patient at the Upstate Cancer Center is assessed for their potential to participate in a clinical trial.

Focusing on education, Upstate’s role as a teaching hospital ranges from faculty educating third- and fourth year students on their clerkship rotations, to medical residents and fellows arriving for their training, to offering continuing medical education and grand rounds that are open to area physicians.

Agility In Recruitment In Health Settings

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BY KATHRYN RUSCITTO, ADVISOR

During Covid I watched a hospital in Florida implement a variety of new positions based on specific tasks. From the basic welcome to a room with detailed instructions done by a patient tech to a full assessment being done remotely by a nurse.. The goal being to reduce clinical time at the bedside from tasks that paraprofessionals and professionals could accomplish rather than the bedside nurse. It worked well.

More recently some hospitals are using remote Nurses to support community based nurses. Access to experts in Diabetes, Wound Care and cardiac care are active across the country. When done with care and training, it gives nurses specialized back up they might not have immediate access to on a local level. 

Agility during times of workforce stress is working for many organizations. Placing an emphasis on innovation is key for health leaders. The strategic issues confronting healthcare feed into the workforce shortages.

Rising costs, lower reimbursements, financial
implications from value based care, cybersecurity, and introduction of new technologies like AI are all contributing to high turnover rates.

Many health care employers are opening new points of access for existing employees to increase education and training . In addition they are working with community colleges and job transition programs as people see layoffs in other areas to transition to health training programs. From military transitions, to immigrants these recruitment paths are helping.

Recently I met an Administrator, Rosemarie Tamunday- Casanova, from Right Accord, who has recruited nurses from the Philippines. We discussed that foreign born recruitment has and is being done primarily in acute settings. We pondered whether surgery centers and private offices might also be an option for these nurses.

Finally, the use of AI and digital strategies to reach broader audiences and make your organization known is essential in recruitment. There is no question that agility in essential in and professionals recruitment. There are successes and best practices evolving if we are open to their adoption.

Background:
https://www.hhs.gov/health are/workforce/recruit- train retain/index.html#get-grant

https://www.aha.org/aha center-health-innovation- market-scan/2022-12-06 how-build-yourfuture-workforce-pipeline

https://magazine.hcahealthc re.com/people/career- and development/creating workforce-solutions- and-advancing-healthcare professionals/

https://www.nga.org/public tions/preparing- the-next generation-of-the-healthcare workforce-state-strategies-for-recruitment-and-retention/

https://www.kornferry.com/ bout-us/events-webinars/talent-acquisition-trends-2025

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

Help Me… HELP YOU.

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by Jenn Negley, Vice President, Risk Strategies Company

Throughout my career, I have often had those thoughts in my head while trying to assist medical groups or individual physicians resistant to working with an agent or broker. While some skepticism is warranted, and we acknowledge that any industry has both positive and negative aspects, there are specific factors to consider in medical malpractice insurance that can increase the likelihood of achieving positive results. How can you determine the professionalism of an agent you are working with, such as myself, and help us assist you effectively?

Several factors should be considered, starting with an individual’s approach and the carrier and policy solutions they recommend. In most instances, these factors have significant consequences and can help you determine if this is an individual you should work with.

Malpractice insurance is a highly specialized market with significant financial implications. If you have an agent pitching you other coverages and adding malpractice insurance at the last minute, I would be wary. Sticking with someone who focuses on medical malpractice insurance is always best; not only will you benefit from their knowledge, but it often impacts the carriers they have access to, which leads us to the second item to keep an eye out for. If an agent is pushing one carrier, this is always a red flag. The most qualified agent should be able to provide you with multiple alternatives, giving you a nonbiased view of what is available. Another consideration is whether the carrier has an A rating from A.M. Best. In the insurance world, it is advisable to avoid lesser-rated companies, and I would not rely on ratings from any rating agency other than A.M. Best, which is the gold standard.

The type of policy an agent pushes might also be a cause for concern. If an agent is asking you to change your coverage type from occurrence to claims made to save money, they are doing you a disservice. While this will generate savings in the first 2 to 3 years, the scheduled premium increases will bring you back to your original cost and possibly more. In group settings, you will often have to amend employment contracts to address who is responsible for tail costs when a provider leaves your group. If your practice ever sells, most buyers will likely require you to purchase a tail for the entire group, and the cost can range from 100% to 200% of your current premium.

When working with a specialty broker, you also gain the advantage of a service team that knows how to navigate the processes for each carrier because of the volume of business they place. With that volume, you typically have a dedicated underwriting team that builds strong relationships, allowing for more collaborative efforts to provide solutions that would not usually be available. In competitive markets, this could result in increased savings, and in a challenging market, it could limit rate increases. Don’t be fooled into assuming that large-name brokerages are the best solutions. Typically, it comes down to the volume that a particular office does, not what the brokerage does as a whole, and again circles back to the question of whether they specialize in this coverage. 

We are all too aware of the financial stress healthcare is under. Still, there are professionals readily available to serve as an honest partner in alleviating those pressures in a way that protects your longterm security and meets your needs. I hope these market insights, in a small way, help you in your future endeavors. r practice, and your patients, depend on it. 

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

Dr. Hadley Narins Fills a Gap in Patient Care with a Focus on Quality of Life

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By Bari Faye Dean

Hadley Narins, M.D., never set out to become a specialist in  female urology, but as she progressed through her medical training, she saw a significant gap in care. “Nearly 50 percent of the patients coming in were women, yet so few urologists were specializing in female pelvic health,” the board-certified, fellowship trained urologist said. When she was a medical student, she didn’t see any women residents in urology, making the field feel male-dominated. But instead of being deterred, she found an opportunity to make a difference.

Although she initially considered a focus on general urology and cancer, her experiences in training opened her eyes to the pressing need for female pelvic health specialists. “Few men want to focus on female urology,” she explains. “Most gravitate toward prostate and kidney cancer.”

Dr. Narins earned her medical degree from Thomas Jefferson Medical College in Philadelphia, then completed a General Surgery internship and Urology Residency at SUNY Buffalo, finishing in 2017.

Practicing since 2018 at Associated Medical Professionals of New York, Dr. Narins specializes in treating women suffering from voiding dysfunction and pelvic organ prolapse and reconstructive surgery with minimally invasive techniques, including robotic sacrocolpopexy.

Transforming Lives, One Surgery at a Time
Urologic surgeries for women might not be lifesaving—but they are life-changing. “The most rewarding part of my job is meeting with a patient post operatively and seeing how happy they are,” Dr. Narins said. “Many experience almost immediate relief.”

Her practice serves a vast region, extending from the Canadian border to the rural areas of Central New York. “There is a huge need for specialists like me in Syracuse,” she said. “We all need to clone ourselves two or three times to meet the demand, especially as the Baby Boomer generation ages.”

While many of her patients are women who have had children, some experience significant pelvic floor disorders despite never giving birth. In addition to primary surgeries, she performs revision surgeries for patients who have experienced recurrence or complications following prior treatments. She conducts robotic surgeries at Crouse Hospital, where she played a key role in developing the Female Urology and Pelvic Reconstruction program. Routinely, she performs many procedures at Intrepid Lane Ambulatory Surgery Center, the facility owned by her practice.

A Patient-Centered Approach
Dr. Narins prioritizes building relationships with her patients. “I want to take care of them clinically, but I also want to know who they are as people,” she said. “What’s important to them? What is their family life like? I genuinely care about my patients and want them to feel heard and valued.”

Her team includes a physician assistant, nurse practitioner and dedicated nurse, ensuring patients receive comprehensive, evidencebased care. “We stay up to date with the latest literature and make sure our patients not only get the best clinical outcome but also feel supported throughout their journey.”

Life Beyond the Operating Room
Outside of work, Dr. Narins leads a full life with her husband and three children, ages 8, 5 and 2. Married in 2016, she credits her husband —a stay-at-home dad—with keeping their household running smoothly. “He does all the cooking,” she said, laughing.

Gardening is her sanctuary. “Work is work. I get a lot of gratification from it, but it’s stressful. When I’m in my garden, I’m physically working hard, but my mind is in a calm, contemplative state,” she said, noting she even starts her  mornings in the garden before heading to surgery.

Her family grows tomatoes, cucumbers, green beans, eggplant, okra, Swiss chard, and squash, with the children eagerly picking their favorites to eat raw. “They can identify so many different flowers,” Dr. Narins said. “When the weather is nice, I come home from work, change out of my scrubs, and we stay outside until the mosquitoes come out.”

Many of her patients are gardeners, too, allowing her to foster an unexpected but meaningful connection. “It’s a common passion. When I talk to my patients, I see them as people, not just cases. And I think that makes a difference.”

Certificate Of Need Coming For Private Equity?

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By: Marc Beckman and Ben Goldberg

New York State is poised for a significant shift in healthcare oversight with the amendments to the state’s Disclosure of Material Transactions law proposed in Governor Kathy Hochul’s FY 2026 Executive Budget. Previously, with the introduction of PHL Article 45- A, which took effect on August 1, 2023, the New York State Department of Health (“DOH”) was authorized to scrutinize healthcare transactions taking place in New York State. These legislative changes are designed to further regulatory scrutiny over healthcare transactions, aiming to curb rising costs and ensure market stability.

Governor Hochul’s proposed legislation introduces the Cost Market Impact Review (“CMIR”), a framework modeled after similar regulatory mechanisms in states like Massachusetts. The CMIR would empower state regulators to assess healthcare transactions, particularly those involving consolidations, mergers, and acquisitions, to evaluate their potential impact on cost, access, and competition. One change that should be immediately noted is the extension of the required notice of a “material transaction” provided to DOH, which was 30 days under the PHL Article 45- A, and would be increased to 60 days.

Among the components of the CMIR are pre-transaction review, assessment of market impacts, and enforcement measures. During the pre transaction review, healthcare entities engaging in significant transactions will be required to submit documentation for state review. If the “material transaction” will increase a healthcare entity’s gross in state revenue by $25 million or more, notice will have to be provided to the New York State Department of Health (“DOH”) and documentation submitted to the DOH for review. Material transactions include but are not limited to mergers, acquisitions, assignments, sales, other conveyances of assets, voting securities, and membership or partnership interests. It is also important to note that material transactions include contracts, if they increase the revenue by $25 million or more, and entities like managed services organizations that provide administrative services to healthcare entities, even if they don’t provide healthcare services themselves. The $25 million will be based on a 12 month lookback period. This is somewhat straightforward if the transaction is a single transaction. However, should there be a series of related transactions, the revenues associated with each of the transactions will be added together to determine the total impact on New York’s healthcare markets.

Since the intent of the review is to analyze whether a proposed transaction could lead to increased prices, reduced competition, or diminished healthcare access, the notice given to New York’s DOH will include, among other things:

• the names of the parties conducting the transaction and their current addresses,

• copies of any definitive agreements governing the terms of the material transaction, including pre- and post-closing conditions, in-state revenue from practice or operating locations in New York,

• plans to reduce or eliminate services and/or participation in specific plan networks,

• a brief description of the nature and purpose of the proposed transaction

• the anticipated impact of the material transaction on cost quality, access, health equity, and competition in the market locations where the transaction is taking place.

When a transaction is found to have negative cost or market implications, regulators may impose conditions or even prevent the transaction from proceeding.

Key Proposed Amendments Include:

Lowered Reporting Thresholds:
More transactions subject to mandatory disclosure, ensuring greater regulatory oversight.

Expanded Scope: Nonprofit and for-profit healthcare entities, including physician groups and private equity backed organizations, will face increased scrutiny.

Stronger Enforcement Mechanisms:
The state may impose penalties for non-compliance and require additional corrective actions from healthcare organizations.

Potential Impact on Healthcare Providers and Patients
The implementation of PHL Article 45-A and the proposed amendments to the Disclosure  of Material Transactions law could significantly reshape the healthcare landscape in New York State. Providers facing increased regulatory oversight may slow down consolidation efforts, leading to more rigorous due diligence before executing transactions. While enhanced scrutiny could help prevent monopolistic practices and cost increases, among the concerns for patients is that providers may delay or abandon transactions that could improve healthcare access and efficiency.

With heightened scrutiny regarding these transactions, private equity firms and large health systems may face more barriers to market entry and expansion, altering investment strategies in the state’s healthcare sector. Reading the changes to the Disclosure of Material Transactions law generously, it appears the intent behind Hochul’s proposed regulatory reforms is to ensure healthcare transactions do not compromise affordability, access, or market competitiveness. While these measures align with broader national efforts to curb healthcare costs, their implementation will require careful balancing to prevent unintended consequences.

Stakeholders in the healthcare industry should prepare for increased regulatory compliance obligations. As with similar frameworks used to analyze business transactions—such as antitrust statutes and certificate-of-need applications—it is uncertain how forcefully New York will enforce these new CMIR assessments if they are passed by the legislature. Furthermore, it remains unclear what appetite the DOH will have for prohibiting or limiting such transactions.

However, whether or not the DOH takes an aggressive stance if Governor Hochul’s proposals become law, healthcare entities will still need to comply with the submission of notice and the concomitant documents to DOH and should prepare accordingly.

If you have questions pertaining to the proposed legislation and how it may impact you, please reach out to Marc S. Beckman (mbeckman@lippes.com), Benjamin W. Goldberg (bgoldberg@ lippes.com) or a member of the Lippes Mathias Health Care Practice Team.

Contracts: A Guide to Managing Risks

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By Kirsten Shepard, CIC, CISR Elite, Senior Risk Management Consultant – Contractual Risk Transfer, OneGroup

A contract is a formal agreement between two or more parties that creates binding obligations to perform or refrain from certain actions. While contracts establish these obligations, they also introduce potential risks to your organization. Therefore, each time your organization enters into a contract, it should:

  • Evaluate the risks the agreement may pose
  • Decide whether to accept or transfer those risks
  • Determine the method of financing those risks, be it through your organization or the contractor

It’s crucial to scrutinize the terms of any contract thoroughly. While some contracts may appear to contain standardized language, they could include commitments your organization should avoid. We recommend a detailed review to anticipate potential scenarios affected by the contract, such as:

  • Scope of Work: What will the contractor be responsible for?
  • Potential Losses: What types of losses might occur?
  • Financial Impact: What’s the “worst-case scenario” in terms of financial loss?
  • Protection Measures: How can you safeguard your organization?

Particular attention should be paid to clauses like Limitation of Liability, Hold Harmless, Indemnity, and Insurance. These clauses can obligate you to indemnify another party for property or liability losses. Should you find a contract’s provisions unfavorable, we advise seeking legal counsel.

Transferring risk to other entities helps manage and reduce losses. When feasible, your organization should endeavor to transfer risk through contractual agreements. For example, you might require a vendor to assume all liability for a product they sell to your organization, a term typically embedded in the contract. Your ability to transfer risk often depends on your bargaining power and the nature of the business involved.

Hold Harmless and Indemnity Agreements

Hold harmless and indemnity agreements are essential tools for risk transfer. These may be labeled as hold harmless, waiver and release, save harmless, or indemnity agreements within a contract. Always read contracts meticulously, as these terms can be included without explicit labeling.

In a hold harmless agreement, one party agrees to assume the liability of another. Although often used interchangeably, hold harmless and indemnity agreements differ in the scope and manner of risk transfer. Hold harmless agreements typically pertain to claims between the contracting parties, such as property damage or consequential losses like lost income. These agreements often accompany indemnity agreements because third parties may still file negligence claims against any involved party.

Indemnity agreements shift the responsibility to cover third-party claims. They ensure one party (the indemnitee) can seek reimbursement from another (the indemnitor) for losses, claims, and expenses related to third-party damage claims. A well-crafted indemnity agreement should clearly outline the allocation of responsibilities.

Insurance as a Risk Financing Method

Requiring contractors or service providers to purchase insurance is a practical way to finance loss payments. However, insurance has its limitations and exclusions. For instance, professional liability policies may only cover the insured’s negligence.

When transferring risk, ensure the other party understands the transfer and has the financial resources or suitable insurance to cover potential losses. An indemnity agreement does not absolve your organization from liability; rather, it mandates that the other party covers related costs. If the indemnitor lacks financial stability or insurance, your organization may still be liable.

Including your organization as an additional insured on the contractor’s liability policy offers several advantages:

  • Defense and Costs: The insurer must defend and cover your organization’s defense costs if sued.
  • Obligations: The insurer remains obligated regardless of the named insured’s financial status.
  • Personal Injury Coverage: Typically included under general liability.

However, additional insured status is not a replacement for a hold harmless and indemnity agreement, as insurance policies have limitations and may not cover all claims.

Combining hold harmless and indemnity agreements with insurance provides comprehensive financial security for your organization.

For more information please contact:
Kirsten Shepard, CIC, CISR Elite

315-418-4955

KShepard@OneGroup.com

“Piggybacking” Misapplications by Public Owners

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A New York Court’s Decision to Remedy the Practice

Earl R. Hall, Executive Director – Syracuse Builders Exchange

Over the past few years, some public owners have taken the position that piggybacking is permissible for public work construction projects, capital improvements and other public works contracts associated with conventional construction projects. 

To provide context, piggybacking is a permissible means for municipalities or other public entities (i.e., public schools) to purchase “apparatus, materials, equipment or supplies, or to contract for services related to the installation, maintenance or repair of apparatus, materials, equipment, and supplies…”  In short, it may be proper for the purchase of “things,” but not construction.  Utilizing “piggybacking” in lieu of the competitive bidding process is permissible only if certain conditions have been met; however, none of those conditions include public works construction or capital improvement projects to infrastructure or buildings.

Public works, public works contracts and public works projects include construction or repair projects undertaken by the public owner or municipality on their infrastructure or building project.  Public works construction projects are subject to New York State’s competitive bidding laws consistent with General Municipal Law (GML) Article 5-A.  Article 5-A includes Wicks Law (Section 101) and competitive bidding of public works construction projects (Section 103).

Piggybacking is intended for the purchase of specific classes of “things,” such as apparatus, materials, equipment, and supplies, as well as service contracts related to those specific things.  It does not include public works, public works contracts or public works projects, which the court has interpreted to mean “construction” or “repair projects” undertaken by municipalities which are clearly distinct in nature and scope from apparatus, materials, equipment, and supplies.

A recent case against the Board of Education of the Maine-Endwell Central School District; the Maine Endwell Central School District, Judge Oliver N. Blaise, III determined such piggybacking application and usage on a $64 million capital improvement project for the school district’s various buildings and facilities was impermissible.  The court determined that, in this case, the contract to be piggybacked should have been let in a manner consistent with GML 103, and requiring sealed bid, public advertising of projects and awarded to the lowest responsive and responsible bidder.  Finally, the court determined that the use of the word “vendor” for piggybacking purposes means suppliers of apparatus, material, equipment, supplies, and services related thereto, as opposed to ‘contractors’ seeking to erect, construct, reconstruct or alter buildings…”

The construction industry, including contractors throughout New York State, remain optimistic that future misapplications of the piggybacking provision by public owners will be diminished as a result of this court 2025 decision, as New York’s public bidding laws defined in GML 103 cannot be circumvented on public works construction projects which the courts have defined.

Source:   Daniel J. Lynch, Inc.; Kelly Lynch Individually, and as a Taxpayer; Slavik & Co. Inc.; George J. Slavik, Jr. Individually and as Taxpayer; Andrew R Mancini Associates, Inc.; Louis N. Picciano & Son, Inc. and William H. Lane Incorporated against Board of Education of the Maine-Endwell Central School District; the Maine Endwell Central School District; and Smith Site Development.  Broome County Clerk February 13, 2025.

Leading with Heart and Vision: How President Mantosh Dewan, MD, is Growing Upstate Medical University Today — and for Future Generations

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By Bari Faye Dean

Fifty years ago, in 1965, SUNY Upstate Medical University Hospital, then called “State University Hospital,” opened its doors. Ten years later, Mantosh Dewan, MD, walked through them for the first time.

Back then, the young psychiatry resident, with his mind focused on his patients, wanting to conduct important mental healthcare research and write about it, Dr. Dewan could never have dreamed that someday he would be the guiding force behind the outstanding growth and achievements of the Upstate University Health System.

Upstate is more than just a flagship hospital with many satellite locations throughout Central New York. The medical university boasts four colleges – the Medical College, the College of Health Professions, College of Nursing and College of Graduates Studies. All four colleges are constantly striving to do more to fill the nationwide clinician shortage.

“We are doing everything possible to respond to the healthcare needs we face today,” Dr. Dewan said. “Of course, we are constantly growing, and we will never stop trying to do more for our patients today, while also thinking ahead to what the future holds.”

About Dr. Dewan…

Dr. Dewan is a SUNY Distinguished Service Professor in the Department of Psychiatry at Upstate. He was both director of Undergraduate Education and director of Residency Training. He also served as interim dean of the College of Medicine.

With 35 books and book chapters and 75 papers to his credit, he is well-known and respected for speaking on a wide range of topics from brain imaging to the economics of mental healthcare.

And, a lifetime of caring for others has garnered him myriad accolades: Best Doctors in America, Distinguished Life Fellow of the American Psychiatric Association, recipient of the Scientific Achievement Award from the Indo-American Psychiatrists Association, the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill, and the list continues.

About Dr. Dewan’s Mission…

Dr. Dewan has been the driving force behind increasing Upstate’s employee base, which now employs the largest workforce in Central New York. It’s edging toward 13,000 strong and still growing. Under Dr. Dewan’s leadership, Upstate has become the second-largest revenue producer in the entire SUNY system – to the tune of an economic impact of $3.2 billion across the state.

Impressive numbers, for sure, but unfortunately, that growth isn’t always enough. There are some days, Dr. Dewan laments, when Upstate has to turn patients away; there simply aren’t enough beds. And, with the promise of Micron being built to the west of Syracuse, Dr. Dewan knows the number of Upstate’s prospective new patients will grow significantly in the next decade.

Accommodating that kind of future patient growth, he said, requires adhering to the plan he put in place that “ensures excellence and access” now. It’s a strategy that will also go a long way to meeting the needs of the growing region when the time comes.

“For me, it’s about doing more, better – now,” Dr. Dewan said. “I am focused on hiring the very best people who bring the best in clinical care. We just have to keep doing more because there is such a need.”

And, where there is a need, Dr. Dewan is ready to jump in and help.

A Bit of History

President Dewan took on the role of president at Upstate at the end of 2018 and says 2019 was a transition year. Then came the COVID-19 pandemic.

Dr. Dewan’s strategic vision for growth turned to a singular focus: making sure Upstate clinicians had what they needed to battle what turned out to be some of the darkest days in modern healthcare for the entire world.

“That was a very stressful time for all our clinicians and all our 

academics. I learned something very important about this team at Upstate. I saw a level of kindness and caring that I’ve never seen in my life. You might have expected bad behavior from people under such sustained stress. Not here. All I saw was competence and caring,” he said. “It was like a miracle that 12,000 people stepped up and were so kind.”

Dr. Dewan’s leadership surely led the way; he did whatever was necessary to procure personal protective equipment, including masks, that healthcare facilities around the world couldn’t seem to get their hands on.

“It was a scary time. I committed early on that we would do everything to protect our people,” Dr. Dewan said. “I am very proud to say we did not lose a single employee to COVID.”

Growing Upstate

Upstate is the second largest public university by revenue in New York State; Stony Brook University on Long Island is the largest. “We have been growing and intend to keep growing,” Dr. Dewan said, noting Upstate has a significant direct impact on the economy of this region and state.

Indeed. The previously noted $3.2 billion in economic impact on New York State is nearly double the impact of $1.7 billion in fiscal year 2008.

While Upstate received $65.2 million in direct operational support from the State of New York, the investment enabled Upstate to generate substantial economic activity.    

“We are good stewards of the funding we get from the state,” Dr. Dewan stressed. “For every state dollar we receive in operating support, we make $47. That is only from direct operating costs. I am very proud of this.”

Life-changing Medicine with Novel Inventions

There is plenty of growth – both in infrastructure builds and expansions and healthcare service offerings – on the horizon at Upstate. While he surely would like all of Upstate’s plans to come to fruition, Dr. Dewan said he believes “hope” is not a strategy for growth.

Financial investment and business support for Upstate’s research scientists, he maintained, will continue to turn dreams into reality.

For example, he speaks highly of Frank Middleton, PhD, a professor of neuroscience and physiology at Upstate, who developed a saliva test for COVID that was used at 60 of the 64 SUNY campuses and eventually in the Syracuse public schools. Dr. Middleton also developed a saliva test for autism that has received FDA breakthrough designation.

With great pride, he also reminds that Stephen Thomas, MD, a full-time faculty member at Upstate, was the lead principal investigator for the world-wide Pfizer/BioNTech vaccine trial. Dr. Thomas presented the findings of the trial to the U.S. Food and Drug Administration to get the first vaccine approved.

But Wait, There’s More – and Upstate Will Be Part of It

Dr. Dewan is less of a talker and more of a thinker and a doer. He is certain that research scientists at Upstate and the 30 to 40 companies operating out of the health system’s Bio Accelerator are working on “the next great things” in medicine and he is determined to support their work fully.

“There is very exciting work going on in cancer research and in neuroscience – specifically looking at dementia and schizophrenia,” he said. “And do you know about all the work being done here in vision research? How about the strong group of scientists doing work in endocrine studies? They are trying to grow pancreatic cells in the lab. This would be a permanent cure for diabetes!”

Though Dr. Dewan is soft-spoken with a calm demeanor – the type you might expect from a successful psychiatrist – he can’t help but show his excitement for the work being done at the Bio Accelerator – a business incubator where the brightest entrepreneurial minds can bring “what’s next” in healthcare to market.

“Seeing the companies in our Biotech Accelerator, as well as initiatives we’ve supported financially with the Upstate Biotech Venture Fund, succeed is so gratifying to me,” Dr. Dewan said, adding this work is extremely important to Upstate’s continued growth trajectory.

With the $5 million Upstate invested in the venture fund and the matching $5 million received by Empire State Development, Dr. Dewan said he is hoping to invest in 20 different projects that will bring new therapies to market quickly.

And, why not? Upstate has a storied history when it comes to being first in healthcare in Central New York. Upstate has the only cancer center in Syracuse treating adults and children and recently opened facilities in Verona and Auburn. “Opening centers where people can get access to cancer care close to home is very important to me. We need to make healthcare as easy and convenient for patients as we can,” Dr. Dewan said.

He is quick to list many more exciting “onlys” and “firsts.” Upstate is CNY’s only Level 1 Trauma Center and is one of only five hospitals in all of New York State to have Level 1 Trauma Centers for both pediatrics and adults.

“We offer 70 healthcare services that aren’t provided elsewhere in CNY, including care for burns, kidney transplants and new efforts for pediatric mental health,” Dr. Dewan said. “For example, Upstate has the only Joslin Center for Diabetes in the state. Upstate has the only inpatient unit for children with autism and behavior problems in the state. The level of stroke care we can provide is unmatched,” he added. “We have the only neurological intensive care unit in the region, and those patients benefit from unique in-patient rehabilitation services as well.”

A Unique Type of Leader

It’s not easy to get Dr. Dewan to talk about himself. He will tell you that getting married to his lovely wife of 50 years is the best decision he has ever made. He is quick to say that he loves to travel to visit his children and grandchildren – in Los Angeles and Miami – and also enjoys taking trips around the world. In the past year he has been to Japan and Egypt and is always looking for his next vacation spot.

But when it comes to talking about his own leadership style, Dr. Dewan smiles and goes right back to being the man with a plan in charge at Upstate.

“I work in a system that has an amazing level of talent. Without exaggeration, if I go to any meeting, say with Upstate neurologists or cardiologists, I know that I’ll always be the least qualified person in the room,” he said. “As president, my job is not to tell them what to do. I lead by supporting them so they can be exactly who they are – the very best.”