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Rising Interest Rates and the Impact on Your Business

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Kaitlyn H. Axenfeld, CPA/CFF, CFE, Dannible & McKee, LLP

As we move further from the height of the COVID-19 pandemic, we are seeing a drastic hike in interest rates. Over the past fourteen months, the prime rate has increased by 5.00% (3.25% in 2022 to 8.25% as of May 2023). Today’s high rates are expected to stay, if not continue to increase, which means financing is more expensive, and projects are less affordable. Interest rates should be evaluated and considered in all aspects of your business – the cost of equipment, estimating and bidding, cashflows and backlog.

When considering financing or leasing machinery and equipment, it is imperative to look at the interest rate implicit in leasing and financing agreements and compare the cash flow in the short and long term for all available financing and purchasing options. The days of 0% interest rates are gone. Implicit and stated interest rates for equipment financing now typically range from 7% to 20%.

For example, a contract that requires a piece of equipment that costs $500,000, leased or financed over five years with an interest rate of 10%, would require cash flows for interest payments of approximately $42,000 in the first year. It would be approximately $137,000 over the five years. While the average savings account earns 0.39% APY. The $500,000 of cash in a savings account, with compounded interest over the same five years, would earn approximately $16,000 in interest income. The cost of financing the equipment is almost $120,000. It is crucial to evaluate these decisions and consider the best use of available resources and the impact on short- and long-term operations and goals.

When estimating and planning jobs, it is also important to consider borrowing requirements and the impact of interest. As an example, $1,000,000 over five years with an interest rate of 3.25% would result in a monthly payment of approximately $18,000 with a total interest expense of approximately $85,000. This same loan with a rate of 8.25% would result in a monthly payment of approximately $20,000 with a total interest expense of approximately $223,000. In a little over a year, the cost of financing $1,000,000 changed drastically, with an increased monthly payment and interest over the period increasing $138,000. This is important to consider when planning and estimating jobs. What is the expected timing of purchases and outlays compared to billing the customer? Is there an option to bill for significant upfront costs? What is the timing of incurring costs and subsequently receiving billings?  If cash flows are such that borrowings from a line of credit are unavoidable, interest expense would need to be considered into account to ensure coverage of capital outlays. Streamlining payments and billings will help ensure the project stays on track and decrease the chance of liens, delays and unnecessary interest and penalties.

Not only is the contractor affected by rising rates, but interest rates also impact the buying power of investors, businesses and property owners. It’s common to rely on short-term or long-term loans to pay for construction and improvement costs. Rising rates impact the availability and qualifications lenders use to evaluate financing. The overall scope of projects increases as costs increase, but the amount of funding may not. Over time, the number of new projects may start to decrease, and existing projects may be delayed due to higher financing costs. This could lead to increased competition as there are fewer available projects.

Rising rates have a significant impact on daily operations. To remain successful, contractors must ensure that projects are estimated using anticipated interest rates and that projects are profitable enough to cover any increased financing costs. With the uncertainty of continued rate increases, contractors have to re-evaluate their thoughts on financing, specifically cash flow stability as debt becomes more expensive and implement a cash management strategy to ensure the best use of resources during this time.

Dannible & McKee, LLP, is a public accounting firm with offices in Syracuse, Auburn, Binghamton and Schenectady, New York.  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.

Understanding Workers’ Compensation Insurance Rates

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Steven Bell, Vice President, Underwriting & Sales

On May 15, 2023, the New York Compensation Rating Board (NYCIRB) filed with the Department of Financial Services, a 2.6% decrease in the overall loss cost level in New York State, to be effective on October 1, 2023. The proposed loss cost decrease was determined by NYCIRB applying their standard ratemaking methodology.

This marks the seventh consecutive year where NYCIRB has filed for a loss cost decrease. While insurance costs have been on the rise across most lines, Workers’ compensation loss costs have defied inflationary pressures. Since 2017, loss costs in NYS have decreased on average nearly -45%.

 

During the same time, the average weekly wage increased nearly +31.6%.

There are many factors that have been driving the rate decreases such as improved loss experience and development, lower loss frequency, lower loss severity, higher wage trend factors, modest growth in loss adjustment expenses, higher benefit levels, lower catastrophe and disaster premium, and modest industry differentials. While all these factors play a role, calculated future wage trends appear to have had the most significant impact on loss costs during the last seven years. Conceptually, if the entire potential cost of losses for NYS is $5 billion, then loss cost must be set to raise $5 billion in premium. In this example, if wages are expected to increase 5%, and losses remain the same, then loss costs must decrease to generate the same amount of premium.

Loss Costs, Rates and Premium
In New York State, workers’ compensation pricing begins with the creation of what is known as a loss cost. NYCIRB collects payroll and loss data divided into approximately 580 classes of businesses such as plumbers, electricians, and painters. The loss cost is created by determining the total losses and payroll for those in a similar class of business. The result is a loss cost, which is an average unit of cost that can be charged for each one hundred dollars of payroll exposure. Carriers in NYS then apply a loss cost multiplier to the loss cost to create their rate. The multiplier, generally greater than one, is based upon each carrier’s expenses and loss experience and covers the carrier’s expenses and profit. Workers’ compensation premium is then determined by multiplying the amount of payroll (divided by 100) for each class code/business type by the carrier’s rate.

There are many factors that drive your final premium. In addition to manual rates, the final cost you pay is affected by your experience modification, the size of your payroll, the construction premium adjustment program, the payroll limitation, scheduled rating and the carrier discount. The experience rating modification is designed to adjust the manual rate to better fit an individual employer’s loss experience compared to all other employers in their class. You may have seen a larger credit or debit on your renewal due to NYCIRB’s recent change to the methodology for determining your experience modification. The construction premium adjustment program (CPAP) develops a credit for those employers who pay higher hourly wages for construction operations. Its purpose is to address premium differences between high–wage and low–wage paying construction employers. In addition to the CPAP program, employers performing commercial construction are also eligible to apply a payroll limitation equivalent to the NYS average weekly. Schedule rating credits and debits along with carrier discounts are also applied in many cases but are subjective and applied by your carrier based on their assessment of your operation. The maximum schedule rating credit/debit is 5% and private carriers can also apply a premium discount, which generally ranges from 1-15% of premium based on premium size. NYSIF can apply discounts and differentials based on their assessment of each individual insured. Policies that perform poorly may be debited and employers who are performing better than average, such as employers in a NYSIF safety group, receive as much as a 30% upfront discount.


If Loss Costs are Down 45%, Why Aren’t My Premiums?

The likely answer to the question is a combination of many of the factors noted above. Given the yearly increases in other lines of insurance, you may not be looking hard at your workers’ compensation costs as your premium may not be increasing. This is human nature, as we tend to focus on those items that are increasing in cost. However, it is wise to periodically market your insurance. If your payrolls have not gone up significantly and all other factors are equal, then your workers’ compensation renewal may be a place where savings awaits you!

For more information on workers’ compensation, contact Lovell at 1-800-5 LOVELL or visit online www.Lovellsafety.com.

 

Latest NLRB Rule Restricts Language Employers Can Use in Employee Contracts

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By Darby Peters and Abigayle Garrett

It is common for employers to have a contract such as a non-compete or severance agreement with an employee.  On February 21, 2023, the National Labor Relations Board (“NLRB”) issued a decision that restricts what an employer can put in severance agreements and other employer-employee contracts. This NLRB decision applies to both unionized and non-unionized workers, protecting employees’ rights to make public statements, communicate about the workplace, self-organize, and form unions if they wish to do so.

Although this decision can impact any contract an employer offers an employee, some of the contracts that will be under the most scrutiny include severance agreements, offer letters, non-compete agreements, non-solicitation agreements, and confidentiality agreements. Generally, the agreements require the employee to waive certain rights in exchange for employment or receiving a severance package. Employers use such agreements as useful tools to protect their companies. Employers often ask employees to agree to a non-disclosure or non-compete agreement when the employee could be privy to information that could harm the company if the information was shared with competitors, such as bidding techniques. Similarly, employers often offer severance agreements to terminated employees that contain broad liability releases, which attempt to waive the employee’s rights to sue the company in the future.

However, the February 21, 2023 decision by the NLRB limited the scope of rights an employer-employee contract can waive. Now, if an employer is not careful and the agreement language is too broad, the agreement will be a violation of the decision and will be void. Overly broad language that infringes on an employee’s rights is strictly prohibited, such as limiting an employee’s rights to make public statements or communicate with other current or former employees. Examples of such overly broad language may be a non-disparagement clause that prohibits employees from making statements that could disparage or harm the image of the company, or a confidentiality clause that prohibits employees from disclosing the terms of the agreement to anyone besides a professional advisor or spouse. It is important to note that merely offering a contract of this nature is now a violation of the Act, regardless of whether the employee signs it.

This NLRB decision is effective immediately and applies retroactively to previously executed agreements. The NLRB recommends employers with contracts that may be unlawful to contact the affected employees and notify them that provisions that are overly broad are null and void. Doing so could help the company later on, if it finds itself litigating over such agreements because a judge would be more likely to rule favorably towards a company that attempted to comply with the new Rule. Before taking any action, each employer should evaluate their own company’s circumstances and consult an attorney if necessary to decide what steps should be taken.

While this decision changes what language can be included in employer-employee contracts, it does not totally prohibit employers from offering them. Severance agreements, non-disclosure clauses, and other contracts can still be legal and binding if carefully crafted. A lawful agreement must be narrowly tailored to the specific issues it wishes to address, rather than broadly banning an employee’s rights to communicate with the public or each other. The agreement should also have a temporal limitation where it binds the employee for a certain period of time based on legitimate business justifications, but does not bind the employee indefinitely. Finally, a lawful agreement should avoid overly broad language such as prohibiting “all disputes,” making “any statement that may harm the company,” or prohibiting disclosure of the terms of the agreement.

The attorneys at Sheats & Bailey, PLLC are experienced with drafting and revising employer-employee agreements such as non-compete agreements, offer letters, confidentiality agreements, non-solicitation agreements, and severance agreements. For more information or assistance with navigating the NLRB’s most recent decision regarding employer-employee agreements, contact Sheats & Bailey, PLLC, at (315) 676-7314.

The information provided in this article does not, and is not intended to, constitute legal advice; instead, all information, content, and materials are for general informational purposes only. Readers of this article should contact their attorney to obtain advice with respect to any particular legal matter. No reader of this article should act or refrain from acting on the basis of information in this article without first seeking legal advice from counsel in the relevant jurisdiction.

How’s Your Cyber Hygiene?

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Brett Findlay, Vice President, Business Risk Specialist 

Dennis Ast, Senior Account Executive, Cyber Risk Specialist

Recently, there have been multiple instances of cyber-attacks in the news – Colonial Pipeline, JBS, CNA Insurance, and Kaseya, to name a few – and yet, many attacks of this nature do not get reported.  It is important to remember regardless of the type of organization you own or work for, all are at risk of cybercrime.

This recent increase in cyber-attacks has had a dramatic impact on the cyber insurance marketplace. Gone are the days when cyber insurance could be quoted and bound with minimal information – cyber underwriters are now requiring a full application and ransomware supplemental, as well as the completion of a cyber assessment on new placements and renewals. Organizations that have developed good cyber hygiene and resiliency can obtain the best coverages and limits. Organizations that have poor controls in place are finding it more difficult to obtain proper coverages and limits and some are being declined by most, if not all, cyber carriers.

Cyber carriers are looking for businesses to have multi-factor authentication (MFA), endpoint detection and response (EDR), and backups, as well as securing all remote access. Developing and implementing a proper cybersecurity program can take many months. One cyber carrier, Coalition, has developed a cybersecurity checklist to assist businesses in protecting themselves from a cyber incident. Utilizing Coalition’s cybersecurity checklist will help businesses understand which controls cyber carriers are looking for, while also helping organizations protect themselves from a cyber-attack.

Below is a list of quick tips from Coalition to keep your business safe from cyber-attacks:

  1. Increase email security.
  2. Implement Multi-Factor Authentication (MFA).
  3. Maintain full data backups.
  4. Enable secure remote access.
  5. Update your software regularly.
  6. Use a password manager.
  7. Scan for malicious software.
  8. Encrypt your data.
  9. Set up a security awareness training program.
  10. Purchase cyber insurance.

Our experts would encourage you to take some time to review the current status of your cybersecurity program and find where improvements can be made. In doing so, you will not only refine your underwriting profile for cyber carriers, but you will also minimize the impact of a potential cyber event on your organization.

For more information please contact Dennis Ast, Senior Account Executive, Cyber Risk Specialist at (716) 572-2410 or DAst@OneGroup.com.

This content is for informational purposes only and not for the purpose of providing professional, financial, medical or legal advice. You should contact your licensed professional to obtain advice with respect to any particular issue or problem. Please refer to your policy contract for any specific information or questions on applicability of coverage.

Please note coverage cannot be bound or a claim reported without written acknowledgment from a OneGroup Representative.

ROME HEALTH:Enhancements and expansion for community-centered care

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by Elizabeth Landry

Aerial view of Rome Medical Center, opened November 2022

Rome Health has always strived to provide excellent health care for those in the local community. As the tagline says, Rome Health aims to deliver “The best care out there. Here.” 

Over the past few years, the organization has taken its approach to health care to a whole new level by redefining what it means to offer community-based health care that provides accessible and efficient care to all patients in the local community. The brand new, state-of the- art Rome Health Medical Center opened to patients in November 2022, and Rome  Health has launched several other team-based initiatives that all contribute to enhancing the overall experience for everyone involved in the health care system.

When the team at Rome Health set out to begin enhancing the way health  care is provided to the local area, everything centered on what would ultimately be most beneficial to those in the community.

“As we engage the local community here, it was clear very early on that what the community desired was to receive high-quality, cost effective care here locally without having to travel to other regions of the state or elsewhere,” said Cristian Andrade, M.D., and Chief Medical Officer at Rome Health. 

“When we designed the medical center and the other projects we’re working on currently, really the central focus was the patient and local community needs.”

The new Medical Center delivers convenient care for patients by serving as a centralized entry point to all services, including primary care, pediatrics, specialty care, imaging needs and lab work. Many members of the team at Rome Health have seen first-hand how this accessible, efficient approach to health care has been a boon for patients in the community.

“I think just having new construction at Rome Health is very invigorating for the community,” said Ankur Desai, M.D., Chairman of the OB/GYN department. “It fortifies the fact that we have a very strong hospital system under our leadership. That’s very important for a hospital serving a local community. And the area we serve is rather large – it’s not just Rome. Having that new, modern construction is very important.

“Consolidating the services also enhances quality of service in terms of giving the patients flexibility and making it easy for them to get to where they need to go, not only for seeing their providers, but also with the ancillary services such as radiology, lab work and so on.”

This new space at the heart of Rome Health and the further innovations being planned also bring together providers from across the health care spectrum, allowing them to work together more cohesively in a truly team-based environment. The benefit of this setup is not only for the patients but also for the staff and the providers, themselves.

“We’re aiming to provide not only a better patient experience but also a better overall experience,” Ryan Thompson, Chief Operating Officer at Rome Health said. “It’s a better experience for the patients, the providers and the staff, which really makes it perfect for a thriving community. When you think about it, we’re not just approaching it from the perspective of one point of view, but rather it’s a holistic perspective for enhancing the entire care environment.”

Multidisciplinary Health Care Enhancements
Since Rome Health offers a robust care network including primary care, surgery and various specialties including, but not limited to, bariatrics, maternity, neurology, orthopedics, pulmonology and urology, it’s no surprise the variety of planned enhancement projects are multidisciplinary in nature and by design.

 

One of the planned enhancements at Rome Health is a new c-section suite that’s set to open at the end of spring or in early summer. Currently, patients who need a c-section have to go down four floors in order to reach the existing c-section suite. The new suite will be located adjacent to the maternal child services department on the fourth floor, providing a much more convenient and accessible experience for both patients and staff.

Thompson explained how Rome Health’s multidisciplinary approach was instrumental in getting the plans correct from the beginning of the process. “When we started the c section suite, we brought together teams from maternity, the OR, our central sterile department, building services, environmental services and many others,” he said. “In doing so, we were able to come up with a design that is thoughtful based on multistakeholder input.”

Another significant infrastructure improvement being planned at Rome Health also relates to surgery. About eight months ago, the team began putting designs together for a brand new operating room facility. In February 2023, Rome Health received a $26-million award from the New York State Department of Health, which will allow the current 1950s-era operating rooms to be replaced by a state-ofthe- art suite that will better match the high quality of surgical services Rome Health has offered to patients for many years. The new suite will include four operating rooms and will accommodate continuous advancements in surgical technology, including robotics and other complex surgical procedures.

“The benefit to the hospital and to the community of being able to modernize the infrastructure of our operating rooms is going to be tremendous,” said Dr. Desai. “We are doing the most modern surgery with the team of doctors and surgeons we have at present, and now that’s going to be reflected in the location in which we do our surgery. That’s a great injection of positivity for our community and for the hospital.”

Similar to the planning process for the new c section suite, the new operating room design plans have been multidisciplinary, with input from many different teams at Rome Health. “We had discussions with anesthesia providers, surgeons and many others right from the start,” said Ashley Edwards, MSN, RN, CCRN-K, NE-BC, Chief Nursing Officer at Rome Health. “We did some mock-ups and then revised them based on all the stakeholders’ feedback. Everyone has had input as to what is going to work best from the time patients are coming in the door all the way to the time they are either discharged or admitted upstairs.

It’s definitely been a multidisciplinary process, and we’re really excited for the final result.”

Also on the list of enhancements to surgery related spaces at Rome Health is the recent renovation of an entire section of patient care rooms in the Surgical Acute Care Unit on the second floor. The setup of the rooms wasn’t ideal for bariatric surgery patients specifically, so the team at Rome Health renovated the rooms from top to bottom, ensuring they would meet the needs of those patients
during their entire stay.

Additionally, new vital sign machines will be installed in patient rooms throughout Rome Health that will download directly into the electronic health record. These new machines will replace the current machines that have to be rolled from room to room, greatly improving efficiency and saving valuable time for the whole team.

However, perhaps the most significant investment at Rome Health has been focused on the actual team carrying out so many services for patients, as pointed out by Dr. Andrade. “One of the things we’ve invested in is our people,” he said. “We’ve put a lot of investment into provider recruitment, particularly in surgical sub-specialties that weren’t present locally here in Rome. We’ve also increased our access to primary care by recruiting primary care providers, both nurse practitioners and physicians, and we’ve also made sure we positioned ourselves to be able to recruit the highest talent and the most qualified folks to this community.”

National Recognitions for Quality Patient Care

In order to find evidence that Rome Health’s continued investments into its high-quality health care have been successful, you don’t have to look very far. The diverse team’s effort to implement processes that support consistent delivery of evidence-based care has been recognized by major organizations for several years. 

U.S. News & World Report has named Rome Health as a High Performing hospital for Maternity Care (Uncomplicated Pregnancy), which is the highest award a hospital can earn from U.S. News & World Report for maternity care. The same organization also recognized Rome Health as a Best Nursing Home for the fourth year in a row.

Excellus Blue Cross Blue Shield has selected the hospital as a Blue Distinction Center for several specialties, including spine surgery, bariatric surgery and maternity care. The Blue Distinction Center label signifies a commitment to delivering high-quality patient safety and better health outcomes, based on objective measures determined by input from leading accreditation and quality organizations, as well as the medical community.

Speaking specifically about the maternity care awards, Dr. Desai highlighted how the team-based approach is at the heart of the great health care Rome Health provides. “These awards really tell you through and through about our team approach,” he said. “High performance has to do with patient care, with our delivery success, with breastfeeding and newborn care. So it incorporates not just what the providers do during deliveries, but the team approach with the nursing staff, as well. I don’t think one facet can work well without the other, and that is what gives us the good fortune of receiving such awards.”

Continuous Improvements Still to Come

Certainly, with many awards and accreditations under its belt, several enhancements already completed and even more planned for the future, Rome Health is delivering on its promise to provide excellent health care that meets the specific needs of patients in the local community. The multidisciplinary and team based approach for achieving accessibility and efficiency for patients in the community has laid the foundation for continuous improvements into the
future.

For Thompson, summing up Rome Health’s plans going forward is really quite simple. “We’re going to continue to redefine what community-based health care means,” he said. “For us, our plan is to continue to engage in the community and find out where the needs are, and then align what we can do to help meet those needs,” he said. “I think it’s important to always go back to the context of our mission. Our mission is to provide quality health care with compassion. As a system, we want to ensure the best care out there is here, meeting the needs of the people in our community.”

RomeHealth.org

 

It’s Tick Season: Be Tick Aware

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BY KATHRYN RUSCITTO, ADVISOR

Ticks can carry a variety of illnesses. The past few years, we are seeing new varieties of ticks with higher infection rates. The diseases they carry are often missed or mistaken for other illness and can quickly turn dangerous.

According to Dr. Kristopher Paolino, MD, assistant professor of medicine and assistant professor of microbiology and immunology at SUNY Upstate Medical University – our local clinical expert in Tick Borne diseases – anaplasmosis is spreading in the deer tick population in our area.

“We’ve seen several dozen in the Syracuse region over the past two years,” Paolino said. “Patients generally present within a week of a tick bite, with high fevers, headaches and flulike illness. Labs show low platelets and WBC. Liver enzymes (AST and ALT) are moderately elevated. Many will have some vague GI upset. They can go downhill quickly if doxycycline isn’t started, and it can be lethal.

“Luckily, doxycycline usually results in improvement within one to two days after starting it. It’s the closest thing to a magic trick I can do. I think the big thing is to be aware of anaplasma and babesia in our area due to tick borne diseases.”

During 2011 through 2019, a total of 16,456 cases of babesiosis were reported to the Centers for Disease Control by 37 states; New York reported the largest number of cases – 4,738 total, an average of 526.4 per year.

Why is this increase happening? According to ESF Assistant Professor of Epidemiology & Disease Ecology Dr. Brian Leydet, MPH, our regional research expert on ticks, global climate change and other factors are making new habitats suitable for the blacklegged ticks survival resulting in increases in reported cases of human Lyme disease in areas we didn’t see much disease 15 20 years ago.

So what can we do about this increased risk? We recommend prevention education with patients and community groups.
• Be tick aware
• Avoid areas where ticks hide (wood piles, high grasses, leaves)
• Wear light-colored clothing when hiking
• Apply approved repellants
• Remove any ticks you find embedded and send for testing
• Examine yourself and other members of your household – and don’t forget the pets
• When returning from a hike, put clothing in the dryer for 15 minutes on high.

For more information, visit globallymealliance. org/about-lyme/prevention/
be-tick-aware/.

Locally, the CNY Lyme and Tick Borne Disease Alliance offers community education for groups, camps and clubs. For more information, contact Elizabeth Balfour at cnylymealliance.org/ or 315.551.2551. Ticks are here, and we need to protect ourselves and our families through prevention and quick action when a tick bite occurs. Be tick aware, and help educate your patients and teams. 

Resources
1. cdc.gov/ticks/longhorned-tick/index.html

2. cdc.gov/mmwr/volumes/7 /wr/mm7211a1.htm?s_cid=mm7211a1_w

3. Central NY Lyme and Tick Borne Disease Alliance cnylymealliance.org/

4. Dr. Brian Leydet, Jr., MPH leydetlabesf.weebly.com

5. Dr. Kris Paolino, Infectious Disease upstate.edu/id/healthcare/ida/physicians-
staff-profile.php?empID=paolinok

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

Auburn Community Hospital Awarded $21M Grant By New York State

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Statewide Health Care Facility Transformation III Program Supports Essential Health Care Services.

Auburn Community Hospital (ACH) has been awarded a $21 million Statewide Health Care Facility Transformation Grant. ACH applied for $21 million dollars to fund two major projects that address significant community health care needs. Auburn will use the funding to develop an outpatient Cardiac Care Institute on its campus and to expand and modernize its operating rooms and surgical services.

The ACH Cardiology Institute will include a hospital-wide multidisciplinary team of health professionals linking Admissions, the Emergency Department, the Cardiac Catheterization Team, Intensive Cardiac Care Unit, Inpatient Telemetry, Outpatient Testing, the Laboratory, Imaging Services and Cardiovascular Rehabilitation. This will allow ACH to provide outpatient cardiac services which is a significant need in Cayuga County. Cayuga County has an increasingly elderly population with the inherent cardiac issues that accompany aging, as well as its emergent and longterm cardiac repercussions for patients who suffered from COVID-19.

In addition, this funding will allow ACH to modernize the OR rooms and expand its surgical services. ACH will expand the size and capacity of its operating area, including three new state-of-the-art operating rooms and one new procedure room. These ORs and procedure room will allow ACH to increase the number of surgeries and interventional radiology procedures. The volume increase encompasses hip and knee surgery, orthopedic sports surgeries, ENT and bariatric surgeries, and is directly related to new surgeons and specialists ACH has hired. This also complements ACH’s collaboration with the SUNY Upstate faculty practice to permit their surgeons to schedule additional surgeries at ACH. The additional OR capacity will also allow ACH to dedicate certain rooms for ambulatory surgery versus inpatient or emergency surgeries and allows for interventional radiology procedures in partnership with the University of Rochester Medical Center. 

“We are delighted to receive this news from the State of New York. A great deal of support has been provided by Governor Hochul and the NYS Health Department for ACH and its transformation. We are also thankful to our NYS legislators and community leaders for their support of our hospital. The creation of our Cardiac Institute, combined with the new cancer center, and the OR expansion will provide the essential care that our community needs and that today they may have to travel long distances to receive these services. These services will now be accessible in our own backyard by our worldclass doctors, nurses, and health care professionals.” explained Scott Berlucchi, CEO. 

The NYS funding is solely dedicated to capital projects and cannot be used for operations. 

Auburn Community Hospital Auburn Community Hospital (ACH) is a notfor- profit, 99-bed acute care facility with a mission to provide compassionate quality care to our community. ACH is the sole provider of acute and general hospital services in Cayuga County and the surrounding areas located in the Finger Lakes region of Central New York including the only 5-Star Long Term Care and Rehabilitation Center in the state. 

AuburnHospital.org

SOS Hand & Wrist Center Expedites Patient Care

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By Molly English-Bowers

It’s been a busy few months at Syracuse Orthopedic Specialists’ Hand & Wrist Center. Last fall, physicians moved into new space on the second floor at 5719 Widewaters Parkway, DeWitt. And just over a month ago in March 2023, physical and occupational therapists moved into the same location. 

“Bringing everyone who treats hand, wrist and elbow injuries under one roof means better collaboration between therapists and doctors,” said director of hand therapy at SOS Benjamin Brightman, MS OT/L, CHT, of the move from 5823 Widewaters Parkway, East Syracuse. “It also allows patients to have easier, same day services. If a patient is being fitted for a custom splint and needs therapy the same day, we’re able to accommodate them more easily. It was more complicated for patients to leave one office and go to another. Our new location gives us and them immediate access, which is better for the patient. We’re better able to streamline our processes and have better protocols, so everyone on the team knows what is expected and what the outcome should be.” 

Now, when a patient sees a physician for a post-operative appointment, that patient can  cross the hall to visit PT or OT during the same appointment, if need be. Likewise, if a therapist needs a doctor’s expertise, a patient can walk across the hall. It’s comprehensive treatment in one location. Both departments share a waiting room, with doctor offices on one side and therapy offices on the other. 

The new hand center has two dedicated X-ray machines and state-ofthe- art equipment, allowing for a more efficient continuum of care and even better patient outcomes. 

The Hand & Wrist Center’s treatment team includes six fellowship-trained orthopedic hand and wrist surgeons and five certified hand therapists and assistants. One of those physicians, Devon Ryan, MD, joined SOS in August 2022 as the newest member of the medical team. He’s been very pleased with his transition to the practice. “Everyone working at the Hand Center, from the front desk to the other hand surgeons, has been incredibly accommodating and helpful, so getting my practice up and running has been as streamlined as possible.” 

“I think part of our expansion is population-driven within the broader Syracuse area, and with Amazon expanding and Micron on the way, our population will only get larger as more people move here for jobs ” said Ryan. 

Brightman has worked at the Hand and Wrist Center for almost six years. He supervises two occupational therapists and two occupational therapy assistants who treat more patients year over year. “There’s more awareness within the general population, so they seek care more,” he said. “We’ve grown every year that I’ve been here. Before we moved in, it was more complicated for patients to leave one office and drive to another. Our new facility gives them and us immediate access.”

Wrists and hands present a variety of conditions, both chronic, like Carpal Tunnel Syndrome and trigger finger, and acute, such as sprains and fractures. It’s that variety that appeals to Ryan. “I really like the complexity; there’s quite a bit of intricate anatomy involving the hand and wrist,” he said. “You work with all different tissue types—more than skin and bones.”

Among the conditions treated by physicians at SOS are ganglion cysts, finger dislocation, trigger finger and tendon injuries. Carpal Tunnel Release is the most common operation performed at SOS. In 2022, over 1,600 carpal tunnel surgeries were performed at The Specialists’ One-Day Surgery Center. The cause of Carpal Tunnel Syndrome, however, isn’t always as simple as occupational or repetitive motions such as typing at a computer keyboard.

“It’s hard to know for sure if those are the causes,” said Ryan. “What’s more clear is that those types of activities worsen the symptoms. I suspect that mild Carpal Tunnel Syndrome is more symptomatic than it was 10 or 20 years ago given the increasing usage of computers and smartphones. In addition, 30 to 40 years ago, the surgery for Carpal Tunnel Syndrome was a bigger deal; there was a larger incision and longer recovery.” 

Now most of these surgeries are endoscopic, with a single 1/2-inch incision in the wrist. “Recovery is often as short as a 2-3 days, which allows for a quicker return to work,” Ryan said. “Sometimes the full recovery can take a few months, but the typical patient sees almost immediate relief. A lot of patients, when they finally pull the trigger on Carpal Tunnel surgery, say they wish they had taken the leap sooner.”

Indeed, according to clevelandclinic. org, the success rate for carpal tunnel surgery is 95 percent. If you need treatment for hand and wrist ailments, contact the SOS Hand & Wrist Center at 315-251-3162 or visit sosbones.com. There you will find information on the center’s physician and therapy team, as well as conditions
treated. 

 

Left:  Devon J. Ryan, MD

Right: Benjamin Brightman, MS, OT/L, CHT

Seven Steps To Medicaid Compliance Program Readiness

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By Maureen Dunn McGlynn

The mission of the New York Office of The Medical Inspector General (OMIG) includes enhancing the integrity of the Medicaid program by preventing and detecting fraudulent, abusive and wasteful practices within the Medicaid program. Pursuant to this mission, New York implemented compliance program requirements in 2009. Recently, amended regulations were adopted governing the implementation and operation of effective compliance programs for certain required Medicaid providers. These revised regulations include significant changes to the original regulations and will require affected Medicaid providers to review and revise their existing compliance programs. So, what steps should Medicaid providers take now to meet these new requirements?

1. Determine whether you are a required provider. As a condition of receiving payment under the Medicaid program, a “required provider” must adopt, implement and maintain an effective compliance program that satisfies the new regulations. “Required providers” include providers subject to Articles 28 or 36 of the Public Health Law, Articles 16 or 31 of the Mental Hygiene Law and managed care providers or managed long term care plans (MMCOs). Also included are providers who provide care services or supplies under the Medicaid program for which the Medicaid program is or should be reasonably expected by a provider to be a “substantial portion” of their business operations. A substantial portion of business operations means the provider claimed or received $1 million in any consecutive 12-month period, directly or indirectly from the Medicaid program.

2. Identify your risk areas. A required provider’s compliance program must apply to the provider’s risk areas. Risk areas are areas of the provider’s operations that are or should with due diligence be identified by the provider through its organizational experience. Areas of operations included in a compliance program must include billings, payments, medical necessity and quality of care, governance, mandatory reporting, credentialing, ordered services and contractor, subcontractor, agent or independent contractor oversight. An effective compliance program should be designed to be compatible with the provider’s characteristics (i.e. size, complexity, resources and culture) and be well-integrated into the provider’s operations.

3. Review and update your written policies and procedures and review them at least annually. Compliance programs must have written policies, procedures and standards of conduct accessible to everyone affected by the provider’s risk areas, including employees, chief executives and other senior administrators, managers, contractors, agents, subcontractors, independent contractors and governing body and corporate officers. The policies and procedures must describe compliance expectations, the provider’s fundamental principles, values and commitment to conduct its business in an ethical manner. In addition, the policies and procedures must include specific guidance on dealing with potential compliance issues, identify methods and procedures for communicating compliance issues to the appropriate compliance personnel and describe how potential compliance problems are investigated and resolved.

4. Appoint a compliance officer and plan compliance training. The compliance officer, who is not required to be an employee, reports directly to the chief executive or other senior administrator and periodically reports directly to the governing body. The compliance officer leads and coordinates the compliance committee, which is required to meet at least quarterly, have its own charter and consist of senior managers. Compliance training must be provided annually and must be part of orientation for new employees and occur promptly upon hiring.

5. Create and maintain effective lines of communication to ensure confidentiality. It is important that lines of communication directly to the compliance officer are publicized and available to all staff and Medicaid recipients of service by the provider, including a method for anonymous reporting of potential fraud, waste, abuse and compliance issues. With certain exceptions, the confidentiality of the reporter must be maintained.

6. Monitor and respond to compliance issues. A key component of an effective compliance program is a system for routine monitoring and identification of compliance risks. Monitoring activity results should be promptly shared with the compliance officer and appropriate compliance personnel. It is crucial that compliance issues are promptly investigated and corrected.

7. Take advantage of available resources. There are several resources available to assist in meeting compliance program obligations on the OMIG website (omig.ny.gov), including a compliance library, webinar, Compliance Program Review Module and OMIG’s Compliance Program Guidance. 


Maureen Dunn McGlynn is a member at
CCB Law, a boutique law firm focused
on providing counsel to physicians and
healthcare professionals. She can be reached
at 315.477.6276 or mmcglynn@ccblaw.com.

Medical Malpractice Insurance Expert Provides Tailored Risk Protection For Physicians

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Jenn Negley, Vice President, National Healthcare Practice at Risk Strategies

By Becca Taurisano

For the past 30 years, Jenn Negley has worked in medical malpractice insurance, currently serving as Vice President of the National Healthcare Practice at Risk Strategies, a top, national independent specialty insurance brokerage firm. Along the way, she learned every facet of the business from managing accounts to production and brings that detailed expertise to her clients in New York state. 

With 6,000 clients representing over $120,000,000 in physician premiums nationwide, Risk Strategies represents every major medical malpractice insurance carrier in the market and offers programs designed for independent physicians, self insured programs, large practices and hospitals. In addition to medical malpractice, Risk Strategies provides managed care stop loss and reinsurance protection, property and casualty coverage and customized programs for employee benefit plans. “We are specialists with in-depth knowledge of healthcare and the carriers that serve the industry,” said Jenn. “That experience is beneficial for delivering the right protection for our clients so they can prepare for the unexpected.” 

Experts like Jenn ensure that providers have the necessary coverage in an everevolving field. If a provider were to go directly to an insurance carrier, they may not know all the questions to ask to make sure they are completely covered. Insurance brokers work to protect their clients but are paid directly by the insurance carriers. The coverage required varies by specialty, size of practice, and can even vary by provider within a practice. Jenn monitors issues that providers or practice managers may not consider, until a malpractice claim brings it to their attention. “That’s when it’s too late,” she said. “We are foremost advocates who know the specifics of your practice, make sure your coverage is appropriate, free up your staff for more important tasks, and provide cost effective coverage with the discounts you deserve from your carrier.”

Jenn is keenly aware of market trends that impact her clients. When office visits were down during the pandemic, she actively engaged practices to make the appropriate adjustments to their policies, so they were not overpaying for coverage when their income was impacted. Jenn also understands how to keep her clients in compliance with the terms of their malpractice policy. Restrictions on telemedicine appointments that were rolled back during the pandemic, are now being put in place again. If a provider doesn’t inform the carrier that they are still doing telemedicine, they might unintentionally void their coverage.

In New York state, working with medical malpractice insurance brokers is fairly new. “The state had been a closed market with a limited number of options for so long, that few practices were being provided the unbiased and independent market evaluations we offer,” added Jenn. As practices evolve, the coverage that worked a decade or more ago may no longer be sufficient. Risk Strategies works with every medical malpractice carrier in New York such as MLIMC, EmPro(PRI), The Doctors Company (TDC), HIC, and risk retention groups like MedPro RRG, Coverys RRG, ProAssurance RRG, TDC RRG, and AMS RRG. Jenn works with the carriers to determine what is the right solution for each client. While the New York insurance market is changing to be more physician-friendly, it is still difficult for providers to navigate alone. “As specialists, we are well versed in the benefits of the carriers we represent,” said Jenn. “One point of emphasis is always the financial strength of the carrier and the specific protection for the practice based on their needs.”

The Risk Strategies Healthcare Practice is currently rolling out a unique discount program for practice managers and administrators who are members of the New York Medical Group Management Association. The best-in-class protocols practice managers employ before a patient even sees a doctor are a front line in reducing claims. The program was approved at the end of 2022 and provides a 10% discount for physicians who qualify, potentially generating significant savings. “We are proud to bring this discount to NYMGMA members and look forward to assisting practices in signing up,” said Jenn. “Understanding our industry is what allows us to find creative ways to deliver premium relief.”.

For more information on insurance program for your practice, contact Jenn Negley at 267- 251-2233 or jnegley@risk-strategies.com.