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Updating Payment Releases and Lien Waivers to be Effective

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By Joseph Schuler, Sheats & Bailey, PLLC

It is common construction industry practice for projects to be broken down into a monthly payment schedule. Due to the statutory right for subcontractors to place liens on projects they have supplied materials or labor for, monthly payment applications representing work completed are often approved contingent upon the signing of payment release or lien waiver by a subcontractor. In itself, this practice is sensible. Payment for completed work is exchanged for a subcontractor waiving its right to place a lien on the project for the work allegedly completed.

Where problems often arise is when the scope of the work completed is inconsistent with original contractual obligations, and the payment application and lien waiver process does not coincide with the approval of change orders or construction change directives for the excess work. When a change order has not been properly documented, but an expanded scope of work may have been completed, a payment dispute over the change order can implicate a lien release signed after the extra work was completed.

If a subcontractor feels work outside the original contract scope was completed but has no approved change order in hand, and the general contractor, construction manager, or owner is holding a lien waiver postdating completion of the extra work, a question of whether the lien waiver bars a lien based on the extra work arises.

Traditionally, the legal standard was that a lien waiver was effective against any work completed before the date the lien waiver was signed, and any intent by either the subcontractor or general contractor to resolve extra work payment down the line was irrelevant. However, over the years the legal standards have shifted, and courts have elected to construe the waivers more liberally given the circumstances on each project.

At times, courts have disregarded lien waivers that appear on their face to bar claims to extra work already performed. Courts have more recently construed these waivers to be ineffective against extra work claims in cases where, even after the waiver was signed, the general practice was to pay for some extras performed prior to the waiver. Furthermore, a general contractor simply indicating it was awaiting owner approval to pay for extras can show intent not to enforce a previously signed lien waiver. This may effectively give subcontractors an opening to lien a project based on the extras despite any waiver. In some cases, the waivers have been considered to be no more than a receipt for the payment referenced in the waiver, having little relation to payment for extras.

Ultimately a lien waiver may not provide much protection if it is only effective against work underlying the payment amount referenced in the waiver. This is especially true since the payment released is often limited to an amount contemplated in the original contract for the original scope of work. Those extras outside the original scope that may or may not be properly documented could still be grounds for a subcontractor filing a lien on your project.  That lien waiver you have trusted ever since you came into the business may not mean what you think it does anymore. Unfortunately, it is simply unrealistic to complete a project without any changes and with perfect agreement on scope of work completed. So, given the shifting legal landscape, is there anything you can do?

Fortunately, within the last year, courts have indicated what kind of language is clear enough to work around these relatively new legal doctrines. While it can be frustrating to keep up with the law, it is hard to beat the “cheap insurance” of a truly effective lien waiver. Diligence updating your forms for documenting projects can pay dividends down the road, especially those forms securing payment and releasing potential claims.

The attorneys at Sheats & Bailey, PLLC are experienced with drafting, revising, and litigating construction contracting forms. For more information or assistance with navigating the construction payment release and lien waiver landscape contact Sheats & Bailey, PLLC, Tel: (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.

Merit Apprenticeship Alliance: Building the Foundation for a Skilled Workforce

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Elizabeth Landry

When New York State labor law changed about fifteen years ago and began allowing public owners to require apprenticeship training for all contractors, Penny Hazer saw there was a need for open-shop (non-union) apprentice resourcing within the statewide construction community. In 2007, Hazer created Merit Apprenticeship Alliance, an open-shop, multi-employer, registered apprenticeship program sponsor approved by the NYSDOL for apprenticeship training in the Carpentry, Operating Engineer, Skilled Laborer, Ironworker and Cement Finisher/Mason trades.

As the President of Merit Alliance, Hazer has over 35 years of experience in occupational training and apprenticeship. She has also worked as a carpenter and as a BOCES instructor of vocational agriculture. The many years she’s spent honing her own skills and teaching skills to others instilled in her a passion for helping people gain self-sufficiency through hands-on training.

“I’ve always believed that teaching people to do things gives them a sense of confidence and sustainability that’s really unparalleled. If you teach people to do things, they always have those skills. Nobody can take skills away from you,” said Hazer.

In order to recruit apprenticeship candidates who can benefit from new trade skills, Hazer and her team utilize many avenues: pre-apprentice programs, job fairs, career shows, public job postings, social media, and CBOs, or community-based organizations. The Merit Alliance team screens and trains apprentice candidates and then assigns them to work for one of their contractor partners on an as-needed basis. Apprentices then take part in on-the-job training where they learn valuable skills in their trade. When construction work is more difficult to find, typically in the winter months, apprentices participate in Merit Alliance’s educational branch, Merit Alliance Construction Training Institute, or MACTI, which provides apprentices with NCCER-accredited educational training. MACTI also provides training to other firms and workers interested in expanding skills, improving safety and productivity.

Many of Merit Alliance’s apprentices come from socially and economically disadvantaged communities, and 85% of the apprentices identify as minorities. “Our apprentice population is pretty diverse, and we focus on that. The under-served populations just need an extra hand and they are an untapped resource. They sometimes can’t figure out how to get into an apprenticeship program simply because no one has reached out to them to get them started. They just need someone to tell them, ‘You can do this’,” Hazer explained.

Of course, Merit Alliance’s programs not only benefit apprentices – they also provide high value to the organization’s contractor partners. By working with the Merit Alliance, contractors get to be a part of the training momentum and start to develop a skilled workforce. Participation with Merit Alliance also takes the burden off of contractors to find apprentices that meet their specific trade needs while also meeting the stringent requirements of New York State to bid on public jobs.

Jason Poole, Resource Developer at Merit Alliance, has seen first-hand how the organization’s expertise in meeting the NYSDOL’s apprenticeship requirements has helped contractors gain access to more bids.

“New York State law allows public owners to require contractors to participate in registered apprenticeship training. A lot of contractors bypass these bids because they don’t want to deal with the apprentice requirements. My goal is to educate as many contractors as possible that they don’t have to pass on these bids. Our multi-employer apprenticeship program can help them meet the bid requirements and this allows many smaller, newer contractors to consider a wider scope of bids,” Poole explained.

In order to ensure that their contractors continuously meet the public owner’s strict apprenticeship requirements, Merit Alliance operates with a high level of operational integrity. Hazer emphasized that transparency and integrity is at the heart of everything they do. 

“We work with about 130 contractors across New York state and New Jersey. We’ve got about 50 apprentices currently. Our mission is to make sure our apprentices get the highest level of training possible – in full compliance with NYSDOL regulations, and with the NCCER – our national accreditation agency. In my mind, the most significant piece we do is maintain integrity to the rules. If we manage all elements of the program true to the standards, our contractors can rely on the Alliance 100%. Alliance staff commit to working with apprentices and contractors to ensure that both succeed. Apprentice graduation rates are well above 50% for three trades – this helps our partners be more competitive in the bidding market, and our apprentices secure sustainable careers in construction,” said Hazer.

“Our goal is not to be the biggest apprenticeship program for open-shop contractors – just the best.  We believe our contractors are among the ‘best of the best’, and an asset to owners,” she added.

Clearly, when apprentices are successful, contractors are in turn successful. Perhaps the best way to measure the success of Merit Alliance’s programs is to consider how many apprentice’s lives have been changed for the better. Both Hazer and Poole had numerous stories to share about apprentices whose journeys demonstrate the value the organization brings to so many people.

“A young woman had spent a significant amount of time in a federal corrections facility. We assigned her to work for various contractors throughout the course of her program. There were times when we struggled, but we ultimately succeeded. The apprentice finally landed with a company in eastern New York and we celebrated her graduation with her and her many family members. She is currently the crew leader for traffic control for one of our very respected contractors. She found her fit and she’s happy. She’s every bit of rough and tumble but now she’s grounded and enjoying life,” Hazer recalled.

Looking to the future, although Merit Alliance may not be the biggest apprenticeship sponsor program, it’s Hazer’s mission that it will continue to be among the best. “Integrity is our mantra,” she said. “We’ll continue to grow with contractors who are committed to safety and quality, just like we are.”

Understanding the New Experience Rating Formula

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Steven Bell, VP Underwriting & Sales, Lovell Safety Management Co., LLC

When I started in insurance nearly 33 years ago, I was asked to train 100 colleagues on experience rating. New to the industry, I remember looking at the old formula and wondering how I was going to explain it to a group of non-actuaries. I solved the problem by not explaining the actual formula but the underlying concepts.

Insurance had its start in the Guilds and maritime trade of Europe. Tradesmen in Guilds would pay into a pool to cover loss due to fire, theft, or disablement. Underwriters would buy shares of a ship’s cargo, thereby spreading their risk of loss among multiple ships. Workers’ compensation insurance attempts to solve a similar risk of loss by spreading the cost of worker injuries over many employers in similar trades or businesses.

In New York State, workers’ compensation rating begins with the creation of what is known as a loss cost for 580 classes of businesses such as plumbers, electricians, and office workers. The loss cost is created by taking the total losses for those in a similar class of business and dividing it by the total payroll for those same businesses. The result is the loss cost, which is an average unit of cost that can be charged for each one hundred dollars of payroll exposure.

If we know one thing about averages, it is that they can be unfair, because not everyone is average. The experience rating formula attempts to solve this problem by tailoring the cost of insurance through an additional credit or debit for each employer based on their individual loss experience.

Effective 10/01/2022 NYCIRB implemented a new simplified Experience Modification Formula

=   Actual Primary Losses  +  Expected Excess Losses
        Expected Losses

Why was the old experience modification formula changed?

The New York Compensation Rating Board performed a study which revealed that the prior experience rating plan was not equitable. The inequity can be best illustrated in what is known as a quintile test. NYCIRB placed each employer into one of 5 quintiles. The goal of the new plan was to produce, for each quintile, a loss ratio of 100%, meaning for each dollar of loss there should be a dollar of premium.

 

NYCIRB Actuarial Explanation Memo, Exhibit 2

Based on the study’s results, the new plan appears to address the inequities, however, the overall adjustments for those in quintiles 1 and 5 can be quite significant.

What does the new Experience Rating Formula mean to the average employer?

The new plan will likely result in larger credits and debits depending on your loss experience. In addition to the formula change, the new plan makes all New York businesses eligible for experience rating and it eliminates the Merit Rating Program and the use of interstate ratings. The plan introduces a novel variable split point and claim capping procedure to make sure the new plan doesn’t result in too large a swing.

Claim Capping Procedure

Number of Claims

Maximum Experience Modification

1

1.12

2

1.40

3

1.75

4 or more

2 + (.000003  x  Expected Losses)

In year one of implementation, the experience modification will be the lowest of either the new formula, the claim capping procedure, or the old formula plus 30 points. In year two, it will be the lowest of the new formula or claim capping procedure.

There are two core principles that apply to both the old and new formula. First, larger businesses with more employees and higher payrolls are more likely to produce consistent results. Second, the fact that a loss occurred has higher predictive power than the relative cost of a given loss.

Practical Example

Let’s compare three small residential carpentry contractors with the same payroll ($500,000) in each year of the formula.

Contactor

# Claims

Actual Losses

Primary Losses +

Expected Excess Losses /

Expected Losses =

Calculated Exp. Mod.

Max. Exp. Mod.

A

1

$50,000

$11,000

$35,154

$45,300

1.02

1.12

B

5

$50,000

$50,000

$35,154

$45,300

1.88

2.14

C

0

$0

$0

$35,154

$45,300

0.78

NA

The first two examples show the impact of loss frequency. While both A & B have $50,000 in actual losses, B has a much higher experience modification due to 5 claims. Let’s assume each of the 5 claims were valued at $10,000, for a total of $50,000. It is conceivable that each of the 5 claims could have been $50,000 for a total of $250,000 in losses. But the severity of claims is less impactful, as the formula caps the amount of losses based upon payroll size.

What can an employer do to impact their experience rating?

The obvious answer is stop having losses. This is easier said than done but should be the primary goal as the cost of an injury is much greater than the impact to your insurance costs. The losses and exposure used in the formula generally consist of 3 years, so if your policy renews on 4/1/23, the three years used in the formula are 4/1/19 through 4/1/22. This means actions taken today won’t impact your experience modification for another couple of years.

Creating a culture of safety will pay dividends beyond the reduction of losses. One key strategy involves considering paying for non-reportable injuries as set forth in section 110 of the NYS WC Law. To summarize, if an injury requires two or less first aid treatments, no loss time beyond the work shift, and is not permanent in nature or involves injury to the face, then you as an employer have the option to self-pay. If the injury requires further treatment or loss of time, you can report it at that time noting you initially treated it as a first aid claim.

What have we learned about the new experience modification formula?

The new formula attempts to correct the imperfections of the old formula by rewarding the top 20% of businesses with lower experience modifiers while punishing the bottom 20% of businesses with higher costs. While the formula itself is simpler, the system is still quite complex. Practically, it means that many employers will see significant swings in their experience modifications. Whether this is good or bad for you as an employer depends on whether the swing is a credit or a debit.

Major Retirement Plan Changes in the SECURE 2.0 Act of 2022

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Nicholas L. Shires, CPA, Dannible & McKee LLP

On December 29, 2023, President Biden signed the Consolidated Appropriations Act of 2023, which contained the Setting Every Community Up for Retirement Enhancement (SECURE) 2.0 Act of 2022 (also known as SECURE 2.0). Included in SECURE 2.0 are dozens of retirement-related provisions that are intended to enhance provisions from the original SECURE Act of 2019. This article summarizes a few key provisions.

Expanding Automatic Enrollment in Retirement Plans

Beginning in 2025, new 401(k) plans must automatically enroll participants when they become eligible. However, the employees may opt out. The initial automatic enrollment contribution amount is at least 3% but no more than 10%. Then, the amount is automatically increased every year by 1% until it reaches 10%. All current 401(k) and 403(b) plans are grandfathered, meaning the requirement does not apply to plans established before the applicable date. There is also an exception for small businesses with 10 or fewer employees, new businesses (i.e., have been in business for less than three years), church plans and governmental plans.

Increasing the Age for Required Minimum Distributions

Employer-sponsored qualified retirement plans, traditional IRAs and individual retirement annuities are subject to required minimum distribution (RMD) rules, which require that accumulated benefits begin to be distributed by the Required Beginning Date. SECURE 2.0 increases the required minimum distribution age to 73 starting on January 1, 2023, and boosts it to 75 starting on January 1, 2033. This change allows people to delay taking RMDs and paying tax on them.

The law also relaxes the penalties for failing to take full RMDs, reducing the 50% excise (or penalty) tax to 25%. If the failure is corrected in a “timely” manner, the penalty would drop to 10%.

Higher Catch-up Contributions

Defined contribution retirement plans under Code Sec. 401(k), Code Sec. 403(b) or Code Sec. 457(b) are permitted, but not required, to allow participants who are age 50 or older to make additional pre-tax elective deferrals, known as “catch-up” contributions. Catch-up contributions are elective deferrals that, among other things, are not subject to the annual elective deferral dollar limit ($22,500 for 2023). The annual dollar limit on catch-up contributions is $7,500 for 2023.

Deferrals under Savings Incentive Match Plan for Employees (SIMPLE) plans are subject to a reduced annual elective deferral dollar limit ($15,500 for 2023). The annual dollar limit on catch-up contributions to SIMPLE plans is $3,500 for 2023.

Beginning January 1, 2025, individuals who are ages 60 to 63 can make catch-up contributions up to the greater of $10,000 ($5,000 for SIMPLE plans) or 50% more than the regular catch-up amount in 2024 (2025 for SIMPLE plans). The statutory dollar amounts are indexed for inflation commencing in 2026.

Eliminating Unnecessary Plan Requirements Related to Unenrolled Participants

Under both the Codes and ERISA, employees that are eligible to participate in a defined contribution plan must receive numerous intermittent notices and explanations of their rights and options under the plan, such as an explanation of available investment options. These intermittent notice requirements generally apply even where eligible employees have opted not to participate in the plan.

The Act amends the Code and ERISA to provide that defined contribution plans are exempt from intermittent notification requirements concerning eligible participants that elect not to participate, who have already received a summary plan description and any other notices related to initial eligibility to participate in the plan (unenrolled participants). Intermittent notifications include disclosures, notices and plan documents. However, an unenrolled participant must still receive: (a) an annual reminder notice of their eligibility to participate in the plan, as well as any applicable plan deadlines; and (b) any document they request that they would be entitled to receive under existing law absent this Act provision. This provision applies to plan years beginning after December 31, 2022.

Conclusion

SECURE 2.0 is one of the broadest pieces of retirement plan legislation in decades and will have lasting impacts on all types of retirement plans. It is important for employers to review existing retirement plan documents to ensure compliance with the above rules and other rules included in SECURE 2.0. There may be required amendments needed to bring retirement plans into compliance on the various compliance dates.

Nicholas L. Shires, CPA, is the partner-in-charge of tax services at Dannible & McKee, LLP, 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 Nick at (315) 472-9127 or visit online at www.dmcpas.com.

The State of The Regional Construction Industry

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By Earl Hall, Executive Director, Syracuse Builders Exchange

2022 proved to be a good, but challenging year for construction industry employers.  Buoyed by both private and public sector investments throughout central New York, the industry enjoyed an abundance of work but saw tighter margins as competition remained strong.  Employers endured supply chain issues, a thin labor market with labor shortages and sky-rocketing inflation that impacted material costs.  In the end, 2022 was a good year for most contractors, but of course their attention has quickly shifted to future opportunities and challenges.

Opportunities

Over the next 1-3 years, central New York will enjoy an extraordinary amount of capital investment by both public and private sectors; however, many of the private sector projects will be subsidized by various governmental entities.  While the normal, routine, and periodic construction work in higher education, public education, hospitals and medical facilities, manufacturing facilities and the service industry will continue, new projects of significance will draw most of the attention of the general public and many contractors.

Besides the well-publicized Micron Corporation’s 20-year investment in their Clay, NY facility, expected to break ground in 2024, contractors will be focused on Onondaga County’s new $90 million aquarium in the Inner Harbor; a $100 million STEAM school in downtown Syracuse; the $2.3 billion Route 81 reconstruction project in and around the city of Syracuse: the $108 million investment in and around Onondaga Lake/Inner Harbor; and $1 billion for development of a new Syracuse neighborhood near Route 81 in the city of Syracuse.  This anticipated construction, in addition to the Davis-Bacon federal infrastructure projects such as sewer and water treatment plants, and highway and bridges reconstruction, will provide employers with an abundance of building and heavy/highway bidding opportunities over the next 3 years.     

Challenges

Labor shortages and lack of skilled labor remains a huge problem with no immediate solution.  Many of the new craftspeople entering the commercial, industrial, and institutional sectors of the construction industry are not skilled or trained to be productive for employers competing in those markets.  In many cases, contractors are being very selective on the projects they bid and occasionally choosing not to bid on projects for fear of a lack of a skilled, productive work force.  While employers and unions alike are investing in future training facilities, such will take time to properly attract and train the next generation construction worker.

Inflation continues to adversely impact contractors’ material costs, as uncertainty remains when bidding on projects.  Anticipating the cost of materials 6-9 months prior to the project starting remains a challenge for estimators and project owners alike.

Wages will increase significantly over the next 3 years.  One of the many features which attracted Micron to central New York is the relatively low cost of labor.  With labor shortages already at historically low levels, demand for skilled labor will increase wages.  Many employers are already experiencing such today, often paying premiums above those wages negotiated in collective bargaining agreements.   Although many of the New York State prevailing wage rates for construction are derived from the Construction Employers Association of Central New York’s collective bargaining agreements, many believe employers will continue to pay above those rates to not only attract new employees, but to retain their current workforce.

Conclusion

Although contractors across the country are experiencing many of the above-noted opportunities and challenges, central New York is well positioned to take advantage of the capital, institutional and governmental investments in our region of New York.  These opportunities do not come without challenges, but what history has shown is that construction industry employers throughout upstate New York are innovative, resilient, and determined.  This region of New York state enjoys some of the best specialty subcontractors, suppliers, general contractors, and construction managers in the United States.  Project owners are fortunate to have access to such contractors as the on-time, on-budget deliverer of construction goods and services will continue despite any challenges the future may hold.  Contractors relish in challenges as opportunities and solutions are often created when challenges are presented.

Upstate Cancer Center: Improving Cancer Outcomes for All

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BY BECCA TAURISANO

On our cover: The Upstate Cancer Center has been continuously accredited by the ACS Commission on Cancer since 2006 and is supported by services to meet its mission. Clockwise from top: the Clinical Pathology Lab on the fifth floor of the Cancer Center provides advanced testing and diagnostics. • Upstate’s mammovan covers 10 CNY counties. • TrueBeam technology provides precision radiotherapy at nearly any angle. • Interiors of the Cancer Center reflect the theme of healing supported by nature. • A dedicated nursing team at the Cancer Center location at Community Hospital. • The newest Cancer Center site in is opening in Verona, NY, this summer. • The infusion area at the Cancer Center at Community site on Onondaga Hill. • Surgeons provide leading-edge treatments and participate in the Cancer Center’s many tumor boards.

THE UPSTATE CANCER CENTER has a role that extends far beyond providing state-of-the-art care. Its mission to improve outcomes in the community is further supported by delivering preventative education and services, conducting biomedical research and clinical trials, and improving access for underserved populations. By expanding locations and support services, along with investing in cancer-fighting technology, the Upstate Cancer Center offers interdisciplinary treatments that are on par with national cancer centers and aligned with the Cancer Moonshot goal to cut the death rate from cancer by 50% over the next 25 years. 

Multidisciplinary Approach to Care

With a team of more than 90 board-certified physicians, the Upstate Cancer Center organizes cancer care into tumor-specific programs. While all types of cancer are treated, there are multidisciplinary programs for bladder; breast; gynecology oncology; head and neck; kidney; liver, gallbladder, and pancreas; melanoma; neuro oncology; prostate; thyroid and thoracic oncology. Tumor boards for the programs are comprised of surgeons, medical oncologists, radiation oncologists, radiologists, pathologists and other specialists, as well as a dedicated research associate to identify and recruit patients for clinical trials. “Patients who require decision-making that spans these disciplines are discussed at our tumor boards,” says Interim Director Thomas J. VanderMeer, MD, FACS. “The multidisciplinary team determines the best course of care involving multiple modalities.” The high degree of specialization and frequency of the tumor boards at Upstate Cancer Center is not found elsewhere in Central New York.

Clinical Innovation

The Upstate Cancer Center has numerous innovations in medical oncology, radiation oncology and surgery. Gennady Bratslavsky, MD, Deputy Director of the Upstate Cancer Center and chair of Urology, says the robotic surgery program has initiated novel surgeries not done elsewhere in the world, such as the first-ever robotic replacement of the vena cava and a level III inferior vena cava thrombectomy first performed here 10 years ago. Such technical advances on the surgical side allow patients to receive modern care as well as faster recovery and return to home.

“Our clinical pathways are very strong,” says Dr. Bratslavsky. “The expertise of our surgeons is unparalleled for the area.”

For radiation oncology, physicians offer numerous approaches in improved targeting, which minimizes potential damage to nearby healthy tissue and offers improved and shorter treatment regimens. “The radiation team offers treatment
with such precision the approach is on par with that of our surgical team,” says Dr. Bratslavsky. Radiation Oncology also works with several departments to provide opportunities for theranostics: a novel approach combining therapy with diagnostics. The radiation is delivered intravenously, only released at the molecular level where the tumor cells are located. “Theranostics is only just now becoming a concept in medical therapy, and yet at Upstate, our first patient was treated well over two years ago with this approach,” says Dr. Bratslavsky.

On the medical oncology side, the Upstate Cancer Center has committed to innovations in both preventative care and combination cancer therapy, currently serving as a site for cancer vaccine clinical trials. Oral chemotherapy is prevalent as well, allowing patients to take chemotherapy at home under the guidance of the Upstate Cancer Center. 

Expanded Locations and Telemedicine Options
In order to make cancer care more convenient for patients, the Upstate Cancer Center has expanded to several new locations and offers follow-up appointments by telemedicine. Upstate Cancer Center Associate Director, Richard J. Kilburg says “Our strategy was to establish satellite offices that could provide the same high-quality care, treatment and advanced research as our main cancer center location. That care is now closer to home for many patients.”

This summer, a new location in Verona will provide patients in Oneida and Rome nearby access to radiation oncology and medical oncology and, due to its proximity to the New York State Thruway, the location will be convenient to additional communities as well. A comprehensive Upstate Cancer Center offering radiation oncology and medical oncology is scheduled to open by January 2024 at Auburn Community Hospital, underscoring the importance of regional partnerships

Opening this summer, Verona is the newest Cancer Center location providing a convenient location for residents of Madison and Oneida counties. The 30,000-square-foot facility is located off NYS Thruway Exit 33 and will provide medical oncology, radiation therapy, radiology, laboratory, pharmacy and consultative services. The Verona site will provide multidisciplinary care with surgeons, medical oncologists, radiation oncologists and other specialists who consult together to manage each patient’s specific treatment and provide information back to referring physicians.

The Upstate Cancer Center Hematology/ Oncology location at Upstate Community Hospital has been open for just over a year and is already outpacing third-year projections. The location allows Upstate to provide life-saving cancer treatments for the southern

suburbs of Syracuse and as far away as Ithaca.  At the Madison-Irving Building in Syracuse, an Upstate Gynecology Oncology location has been open for nearly two years. This office specializes in gynecologic cancers and offers patients surgery and infusion therapy treatment options. “In all our satellite offices, we provide that convenience and state-of-the-art care available at our main campus,” says Kilburg.

During COVID, it became necessary to limit patients from coming into the
hospital if they were not receiving treatment. “It was evident that we needed
to treat more people from home,” says Kilburg. “We established the technology and moved many follow up visits to telemedicine.” While limitations have been lifted, telemedicine continues to be popular with patients who like the option for their follow-up appointments.

Improved Experience for Patients and Staff

Besides telemedicine and satellite offices, there are a wide array of support services to improve the patient experience. Services like integrative therapies, financial counseling, nutritional counseling, genetic counseling, palliative care, spiritual care, support groups, survivorship, tobacco cessation and free valet parking help patients and their families feel supported during treatment. The Upstate Cancer Center has expanded its look and feel to all its satellite offices, including integrating music and art in a healing way for patients. “Our patient satisfaction ranks us in the top 1 or 2% in organizations across the country,” says Dr. VanderMeer. “Cancer is a difficult disease to take care of, but our staff never let the challenges they face affect the patient experience. We want our employees to be able to provide excellent care to our patients.”

Dr. Vandermeer says a focus on clinical operations at the cancer center and regional sites is also key for the patient and staff experience. “We want to make this a people-first organization,” he says. “That goes for patients as well as healthcare providers.” A new Director of Clinical Operations at the Cancer Center, JJ Yakowec, DrPH, MPH, is helping improve workflows and making processes more efficient for the entire team. “Thanks to Dr. Yakowec’s efforts, we are already establishing improvements saving time and space to see patients in a more efficient manner,” says Kilburg. “That kind of operational efficiency is important to our patients and staff.”

Investment in Technology

Offering the latest technologies to treat patients ensures fewer side effects and better quality of life. “Our cancer treatment and quality of care is excellent as evidenced by our American College of Surgeons Commission on Cancer accreditations 18 consecutive years,” says Kilburg. Radiation oncologists are able to deliver radiation with extreme precision, even to difficult-to-reach areas in the body, using CT Simulators to plan and Varian TrueBeam linear accelerators to treat. “We are able to treat within millimeters of accuracy and spare vital surrounding tissue and organs.” The main campus of the Upstate Cancer Center houses three linear accelerators, and each satellite office will have a linear accelerator as well. Next year, they are planning to add a Magnetic Resonance Imaging Guided Linear Accelerator (MRI-LINAC) which has specific advantages in treating soft tissue tumors. The Cancer Center also offers the latest in cancer-fighting drug therapies that can be delivered orally or by infusion.

Research Integration

Upstate’s integration of research supports both discovery at the bench as well as treatments at the bedside, and every patient is evaluated for clinical trials. Upstate has streamlined its research focus to three areas: Cancer Cell Biology and Genetics, Cancer Therapeutics, and Cancer Prevention and Population Health. Leszek Kotula, MD, PhD, the Associate Director for Basic and Translational Research at Upstate Cancer Center says it is important to connect knowledge that is gathered in the laboratory to create potential treatments and diagnostic procedures at the bedside. “The number one requirement for novel medicine is help patients; not harm them. Clinical trials are so important because they allow us to understand side effects and provide improvement for treatment and prolong patients’ lives,” Dr. Kotula says. With over 72 open clinical trials at the Upstate Cancer Center, patients have the opportunity to participate in research to improve efficacy of treatment. Serving an area with two million people in population the Upstate Cancer Center is the only medical university in Central New York and has the highest participation and enrollment in clinical trials in the region. The integration of clinical innovation and research allows for the same therapies found at national cancer centers. One such innovative program utilizes immunotherapy to treat metastatic disease. “We can take cells from the patient, modify them in vitro, introduce genes or disrupt genes as needed, and then use them as a drug to treat the patient’s cancer,” says Dr. Kotula. “The big promise of immunotherapy is that we will be able to successfully treat metastatic cancer. Thanks to basic, clinical and translational research, we are able to use cutting-edge therapies at Upstate.”

In addition to the weekly tumor boards, a monthly molecular tumor board is run by Jeffery Ross, MD, world-renowned pathologist and co-founder of Foundation Medicine. Dr. Bratslavsky says the program is able to profile cancers in their advanced stage and identify specific genetic mutations that could be responsible for prognosis as well as response to therapies. “The molecular genetics language is agnostic to a specific tumor type, and we learn that many drugs can be effective in more than one cancer type when a specific gene mutation is present. Through this unique program we have been able to identify certain genetic mutations that allow us to alter the therapy and prolong patients’ lives,” says Dr. Bratslavsky.

One of the Upstate Cancer Center’s key new hires is Director of Clinical Operations JJ Yakowec, DrPH, MPH. As a key member of SUNY Upstate’s Cancer Center, she is leading the development, implementation and growth of its operational excellence program. This program supports continuous and sustainable operational improvements to benefit staff and patients. Dr. Yakowec has a background in data-driven strategic planning, process re-design, and was previously at Dana-Farber Cancer Institute in Boston, most recently as the senior manager for health systems improvement.

Reducing Disparities
Christopher Morley, PhD, Chair of the Department of Public Health and Preventative
Medicine and Telisa Stewart, DrPH, Associate Professor of Public Health and Preventative Medicine are working to reduce disparities among the rural, urban and refugee communities that Upstate serves. Each group has distinct challenges, ranging from financial factors, lower health literacy, historic mistrust of the healthcare industry, transportation issues or geographical distance from primary and specialty care. Studying and monitoring data at the population level helps to both identify social determinants of cancer rates in populations, as well as to design preventive interventions. “We can use large national data sets to examine the presence of different risk factors in different subsets of the population,” says Dr. Morley. “We can also use qualitative data by having conversations with people to explore what barriers people experience in their communities.” 

Data surveillance plays a part as well. If the data show an uptick in one kind of cancer, the researchers will determine where those instances of cancer are occurring and determine whether interventions could be put in place. Merging data analysis and community partnership is important for communities to adopt change and for there to be behavior modifications in health. “When you build community partnerships for cancer- based interventions, they are more successful,” says Dr. Stewart. “It has been proven you will have better adherence to certain behaviors, screening and treatment if you work with those communities to identify what works for them.” Upstate offers several programs in the community, including She Matters and We Matter for breast and colon cancer prevention and to reduce disparities, and
a mobile mammography van covers 10 counties for screenings.

By utilizing artificial intelligence and natural language processing, researchers can scour medical records and connect eligibility criteria to identify clinical trials and increase enrollment for patients in underserved populations. “We are making cancer prevention and control a priority for programmatic development to understand how to reach those populations more effectively,” says Dr. VanderMeer. “Part of providing cancer care is ensuring that you are meeting your constituents where they are.”

Meeting Cancer Moonshot Goals
In 2022, President Biden highlighted new national goals for the Cancer Moonshot program: to reduce the cancer death rate by half within 25 years and improve the lives of people with cancer and cancer survivors. As the academic medical center for the region with nationally and internationally renowned physicians and an emphasis on clinical trials, the Upstate Cancer Center is providing the groundbreaking cancer research the Cancer Moonshot is seeking. “At Upstate, we are addressing disparities in care and finding cures,” says Dr. VanderMeer. “We are recruiting basic and translational researchers so we can improve outcomes. All of the things we are doing to improve outcomes in our region, we are ensuring everyone experiences the gains.” 

For more information, please go to upstate.edu/cancer

The staff on Upstate’s Mobile Mammography van brings screenings to residents of 10 counties in CNY, many of whom would otherwise might not have access to care. The mammovan provides the same 3-D mammography available at all Upstate’s breast imaging locations and the images are read by board-certified radiologists. In addition, fecal immunochemical tests are provided in conjunction with We Matter, an outreach program to provide colon cancer screening.

Mental Health in the Workplace

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By Elizabeth Landry

Over the past several years, many in the U.S. have suffered poor mental health and suicide rates have remained steady. Working people tend to be affected by these issues at a high rate. A rise in remote employment leading to feelings of isolation as well as high-stress, fast-paced work environments are contributing factors to these patterns.

According to Dr. Omar Colon, Medical Director of Behavioral Services at Oswego Health, there are several warning signs employers can monitor for to help recognize workers who may be suffering and at risk for suicide. Arriving late to work, working excessive hours, increased stress at work or at home, mentioning access to weapons and generally any behavior out of the norm for a specific person are all red flags indicating an employee may be suffering poor mental health.

Addressing these issues in the workplace can seem daunting due to the unfortunate stigma that often surrounds mental health and suicide. However, Dr. Colon emphasized it’s important for gatekeepers in the workplace, such as managers and HR personnel, to help break down this stigma by simply asking their employees how they’re feeling and offering a welcoming environment where workers can feel comfortable having discussions about what’s happening in their lives.

“When we see these red flags in our work, we have to pay attention as gatekeepers and be ready to receive these messages. We need to be thinking, ‘Wait a minute – does this person need some help? Are we making it easy for this person to access the help they need?’” explained Dr. Colon.

In addition to identifying when employees may be at risk for poor mental health or even suicide, employers can strive to boost mental well being in the workplace by encouraging employees to practice good mental health habits when they encounter stressful situations.

“We’ve been focused on creating a culture where it’s OK to take a break from stress at work and come back refreshed, even if that means just a five-minute walk,” said Alissa Viscome, Employee Engagement Manager at Oswego Health.

The COVID pandemic has also created additional mental health-related difficulties in the workplace. An increase in remote employment, virtual meetings, masks and physical occupancy limitations have all made it more difficult for employees to create important bonds with one another.

The staff at Oswego Health has been working to create more opportunities for employees to connect with one another, even if those connections must be virtual. Employees at Oswego Health have participated in activities like sharing photos of pets with one another on National Pet Day and collectively taking part in self-care opportunities during the different themed months of the “Action for Happiness” calendar. Although these initiatives may seem simple, they can make a big impact that encourages interpersonal connections and helps boost mental wellness among teams in the workplace.

Residents of Oswego County and beyond can find treatment resources at one of several inpatient and outpatient facilities, including the brand-new Lakeview Center for Mental Health and Wellness. Additionally, the Oswego Health website offers a Wellness Library where employers can find educational awareness articles about mental health and suicide as well as practical tips to help support general mental well being both in the workplace and at home.

Workforce Challenges

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BY KATHRYN RUSCITTO, ADVISOR

My mother has encountered the hospital, rehab and homecare-based workforces over the past several months; it has allowed me to see up close the challenges that have developed in the healthcare workforce. From food service to transportation to nursing, all areas have been impacted. This results in a number of bumps in care delivery for a 98-year-old patient: Lost dentures, lost hearing aids, lost glasses, missed meals, delayed appointment arrivals and delayed bathroom stops.

It has made our family more aware and ready to advocate when she need better support. I complained a lot, but this is really not the fault of the organizations and their current workforce; COVID broke our systems and put undue burden on the remaining healthcare workers. Employees are looking for us to do better in finding new approaches to recruitment and training to rebuild their teams.

These workforce issues are also coming at the very time we are seeing a dramatic increase in the age of our community residents. How do we solve these challenges?

I am spending some of my time talking to my foundation and donor contacts and demonstrating that workforce development funding is essential right now. Programs that fund scholarships, training, support entry into the health field by offering day care support to employees while in school and other incentives are desperately needed.

Ultimately, recruiting outside traditional employee segments and reaching out to other countries may be in our future. Syracuse University is working to connect veterans with opportunities, and LeMoyne College is focused on growing nurses, clinical affiliates and the physical therapy workforce. LeMoyne also is retraining foreign-trained health employees through HARC (www.lemoyne.edu/Values/In-the Community/Healthcare-Advancement-Resource-Center).

SUNY Upstate, St. Joseph’s Health and Crouse Health continue growing nursing and medical staffs. In one organization, they have found a shift to part-time positions drew in employees who would not consider full-time work. Remote work for others has helped with backroom operations. Technology is allowing for expertise of one nurse or physician to be spread across many states.

Particularly successful are several demonstrations around the state drawing foreign-born health workers into retraining; others are reaching out to high schools to create work-study slots while still in school with a seamless progression to a job. In talking to Gwen Crosett, founder of Constant Care247 – a provider of home-based care, she said many caregivers never finish nursing school because they are too busy working to keep a roof over their families’ heads.

“Recently, I sponsored a graduate from nursing school who was having a difficult time passing her boards,” Crosett said. “She did not have the money and resources to hire a tutor. ConstantCare247 invested in a tutor, bought her the books and, hopefully, mid-year she will be able to call herself an RN.  I feel, as an employer, investing in her success will help all of us in the long run.”

This environment requires unique approaches and creativity to draw new candidates into the health-care workforce. Reaching out to schools, welcoming refugees to our community and drawing retirees back to unique models is in all our futures.

Upstate Community Giving
Campaign Raises More Than $570,000

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More than 1,200 members of the Upstate community donated more than $570,000 to Upstate’s 2022 Community Giving Campaign, bringing Upstate’s total giving to the CGC to $13.5 million since Upstate began the campaign in 1986. 

“Upstate’s engagement with the community and its role in helping people have a brighter future continues to impress,” said Campaign Chair Lawrence Chin, MD, professor and dean of Upstate’s Norton College of Medicine. 

New donors to Upstate’s Community Giving Campaign rose 44 percent in 2022, bringing the number of new donor employees to 277. More than half of all new donors were nursing employees. 

“Our nursing staff goes above and beyond every day to serve our patients and this commitment extends to this campaign,” said Chief Nursing Officer Scott Jessie.

The success of the campaign is due, in large part, to the 163 employees who served as department representatives. They help promote the campaign within their departments and answer employee questions about the campaign. A complete list of department representatives is available.

Serving on the 2022 Campaign Committee were Dr. Katherine Beissner, Tammy Blackburn (ad-hoc) Catherine Cadley, Leah Caldwell, Tree Carter, Dr. Lawrence Chin, Mark Congel, Dr. Mantosh Dewan, Kelly Dolan, Amy Green, Zanette Howe, Michael Longo, Katherine Magnarelli, Nancy Prott, Linda Veit. Serving on the committee from United Way of Central New York were Nancy Kern Eaton and Meghann Sandak.

Upstate has won numerous honors awards for its Community Giving success from the United Way of Central New York, including the Spirit of Caring Award for Campaign Excellence, Leadership Development Award, Volunteer Service Award, and Campaign Volunteer of the Year Award.

Excellus BCBS appoints three new senior leaders
Excellus BlueCross BlueShield has appointed three new members to its senior leadership team. Mona Chitre, PharmD; Lisa Harris, M.D.; and Tony Vitagliano will take on new roles as part of the health plan’s Population Health Engagement leadership team working to ensure equitable access to high-quality, affordable
care. Meet our staff on the next page;

Mona Chitre, PharmD, Chief Pharmacy Officer, President Pharmacy Solutions

Mona Chitre, PharmD has been named President of Pharmacy Solutions, in addition to her role as Chief Pharmacy Officer. In her expanded role, Dr. Chitre will focus on delivering clinically sound pharmacy solutions to enable growth and diversification and bolster investments and innovation in all areas of the rapidly changing pharmacy landscape. She joined the health plan in 2000.

Chitre oversees Excellus BCBS’ pharmacy program, focusing on ways to drive affordable drug costs, quality outcomes, and appropriateness of care for the health plan’s 1.5 million upstate New York members.

Under Chitre’s leadership, the health plan’s pharmacy program has developed numerous programs to improve the health and well-being of the communities it serves. The introduction of the innovative RxConcierge savings outreach program and initiatives focusing on generic medications, medication adherence, and specialty medications have helped members access quality, affordable medications and earned the health plan national recognition. During her tenure, the health plan’s Medicare Part D prescription drug plan has received a 5-star rating from the Centers for Medicare and Medicaid Services, its highest rating, for seven consecutive years, making it the longest leading, and one of only two 5-star plans in the nation.

Lisa Harris, M.D., Senior Vice President and Corporate Medical Director

Lisa Harris, M.D. has been appointed Senior Vice President and Corporate Medical Director for Excellus BlueCross BlueShield. In her new role as SVP Corporate Medical Director, she will work closely with senior leaders to drive engagement, innovation, clinical quality, equitable access, and affordability, as well as enable efficiency and satisfaction among the health plan’s provider partners. Dr. Harris joined the health plan in 2018.

Harris previously served as Vice President of Medical Affairs for Commercial Lines of business where she was closely aligned with the sales team serving as a clinical liaison for the commercial side of business and leading the clinical affordability strategy. 

During her career at Excellus BCBS, Harris maintained a focus on the larger strategy of improving health care for all as she collaborated on innovative solutions including a clinical queries system allowing key stakeholders to receive a coordinated response to clinical questions within 24 hours. She worked with a team to develop a high-cost claimants team – a multifunctional team designed to engage case managers earlier on in the member experience.

Tony Vitagliano, Senior Vice President, Provider Network Engagement

Tony Vitagliano has been named Senior Vice President, Provider Network Engagement. In his new role, Vitagliano will continue to focus on the health plan’s provider partnership strategy in addition to now leading the areas of payment integrity, medical policy, and risk adjustment. He will also serve as a member of the health plan Executive Team. Vitagliano joined the health plan in 1993.

Tony Vitagliano Vitagliano began his career with the health plan as an Actuarial Analyst and has held several positions during his time with the organization. Most recently, he served as Vice President, Provider Network Management and Operations leading teams dedicated to provider contracting, provider relations, value-based payments, and reimbursement.

During his career, Vitagliano led the development of Excellus BCBS’ Accountable Cost & Quality Agreement (ACQA) model, providers partnership strategy, and the alignment of clinical quality and efficiency.

“Through their partnership with our providers and community members, each of these leaders has made a significant impact in achieving our health plan’s mission of ensuring equitable access to affordable, high-quality care,” said Jim Reed, President and CEO of Excellus BCBS. “I’m excited to see our efforts in the area of population health engagement continue to grow under the strategic leadership of these highly skilled and experienced individuals.”

St. Joseph’s Health Welcomes
Primary Care Physician

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St. Joseph’s Health is pleased to welcome Dr. Kathleen Farry-Leggiero, MD, to St. Joseph’s Physicians Primary Care. In her role, Dr. Farry-Leggiero will provide patients with high-quality, personalized health care. Primary care physicians diagnose and treat a variety of illnesses in pediatric and adult patients, while also providing routine and preventative care to improve their health. Dr. Farry-Leggiero is passionate about applying her medical knowledge and skills to enhance the health of our community. “Having gone to medical school in Syracuse, I’ve had the opportunity to explore Central N.Y. and I have grown to appreciate the pleasantries that it provides,” she said. “I am excited to work for St. Joseph’s Health and provide care to people from all walks of life.” Dr. Farry-Leggiero is a board-certified family physician. She completed her residency at St. Joseph’s Health, earned her Doctor of Medicine from SUNY Upstate Medical University and her Bachelor of Science in Biology from Siena College in Loudonville, NY. Dr. Farry-Leggiero is accepting new patients at St. Joseph’s Primary Care in Liverpool at 5100 West Taft Road, Liverpool, N.Y. To schedule an appointment, please call: (315) 452-2828