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Private Equity in Health Care and the Impact on Non Profit Care

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BY KATHRYN RUSCITTO, ADVISOR

I have worked my entire career in government or nonprofits. It has led me to see the value of models that protect access to care for those who are underserved. The non profit model uses profits to re-invest in the provision of care in the community. Income is derived from profitable areas of care . Where the cost of care is not covered by insurance or there is no insurance, donors, grants and government subsidies often fill the gap.

For many years in New York State, regulations prevented private equity firms and for profit models to provide health care in some areas.

That’s changing.

Private equity seeks to make a profit. When a private equity firm buys a non profit provider or starts a new health care business, it’s expected to produce income for investors. It’s a common business model in this country.

At the same time we need to provide care to our communities that may not be profitable.

In Plunder, by Brendan Ballou, he provides a good analysis of the growing concerns about the impact of private equity in our society. The book looks at examples of private equity acquisitions in long-term care that drain income to other related corporations, leaving the non profit organization without resources to provide adequate care.

Another important study from the Columbia School of Public Health published this past July, was the first thorough review of global private equity ownership in medical settings. It stated, “Private equity investment was most closely associated with increases in costs for payers and patients in some cases as high as 32%. Private equity ownership was also associated with mixed to harmful effects on healthcare quality, while the impact on health outcomes and operations was inconclusive.”

So is one model preferable over the other, can they co exist or collaborate? Can the efficiencies from a private equity operation help not for profits find ways to reduce overhead for sustainability? Venture Philanthropy seeks to apply the principles of venture capital to achieve charitable objectives. There are several experiments going on where private capital invests in philanthropic goals such as Bain Capital’s , New Profit. Jeffrey Walker in the Stanford Innovation Review, March 2019 says private equity is showing that in order for nonprofits to succeed in this new financial environment they need to demonstrate better measurement of results, and management expertise. Investors are hands on advisors to a business and he suggests that donor expertise is often prevented from transferring their knowledge to the non profit setting.

This is a complicated arena , and one that could change the face of years of community care. Covid has placed great financial pressure on many large providers, and private equity acquisitions are adding to that financial pressure.

We need to continue to watch the impact in our communities of mergers, acquisitions and closures in health care and advocate on behalf of access and delivery of care.

Resources:

Plunder, Brendan Ballou, 2023, Public Affairs

Columbia School of Public Health Publichealth.columbia.edu

The Emerging Capital Markets for Non Profits, Kaplan and Grossmn, hbr.org

Stanford Social Innovation Review, ssir.org

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

The Newest Member of the Syracuse Orthopedic Specialists Neck & Back TeamL Jessica Albanese, MD

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As the newest member of the Syracuse Orthopedic Specialists Neck & Back Team, Jessica Albanese MD brings nearly seven years of experience to the care of spinal conditions and injuries. Dr. Albanese received her bachelor’s degree from Arizona State University and earned her medical degree from the University of Nevada, Reno School of Medicine. She completed her residency at the Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas. Prior to joining SOS in August, Dr. Albanese completed a fellowship in adult spine surgery at the Duke University School of Medicine.

Q What orthopedic specialty do you practice?
Dr. Albanese: I diagnose and care for spinal conditions and injuries from age 12 and up. I treat a variety of spine disorders: degenerative conditions, such as scoliosis, stenosis, degenerative disk disease, deformity. Spinal infection and spinal tumors. Traumatic injuries— fractures and dislocations.

Q Why did you choose the spine?
Dr. Albanese: I actually started orthopedics wanting to treat trauma-fixing broken bones, fractures, acute injuries. But once I learned more about the orthopedic specialties, I discovered I like the spine. I thought the pathology of spinal injuries and conditions was really interesting. There are a lot of complex issues with the spine and a lot of ways to solve a problem. Then there is the surgery itself—I enjoy operating around the spinal cord and the nerves. There is a lot of innovation going on right now, so there are a lot of solutions we can offer patients.

Q Orthopedics in general is a very male-dominated field. In 2022, Medscape’s Physician Compensation Report found that the number of female orthopedic surgeons was at 9 percent. How do you feel about that?
Dr. Albanese: That’s actually starting to change. It’s important for patients to see more diversity, to have more options when seeking care. It’s exciting to be part of that change, growing the number of women in the field.

I’d like to help introduce The Perry Initiative (perryinitiative.org) locally. They offer a Medical Student Outreach Program that provides a hands-on introduction to orthopedic surgery for women in medical school. Participants are connected with local mentors and peers while completing two surgical simulations and participating in discussions. I hope to be a role model and show girls and young women that orthopedics is a viable option for them. Exposure is the largest limiting factor: If you don’t know the opportunity is there, you don’t know to pursue it.

Dr. Albanese is accepting new patients. Appointments can be made by calling 315 251-3232 or visiting sosbones.com to request an appointment.

Returning to CNY: As the Newest Surgeon on the Joint Replacement Team at SOS: David A. Quinzi, MD

David A. Quinzi, MD is returning toCentral New York as the newest surgeon on the Joint Replacement Team at Syracuse Orthopedic Specialists. Dr. Quinzi received his bachelor’s degree from Cornell University and earned his medical degree at Upstate Medical University in Syracuse. He completed his residency at the University of Rochester Medical Center and in July completed a one-year fellowship in adult reconstruction surgery at the Rothman Institute in New Jersey.

Q What type of orthopedic specialty do you practice?
Dr. Quinzi: I am a joint replacement surgeon for the hip and knee, performing joint replacement for hip and knee arthritis whether for general wear and tear or other reasons such as post traumatic arthritis. I also perform revision hip and knee arthroplasty for dysfunction or wear of previously replaced joints. I think that joint replacement as a sub-specialty has an innate ability to get people active again and doing what they like to do. Arthritis is a big quality of life killer, and giving people new joints is a great way to get people active and back to enjoying life and the things they like to do.

Overall, knee arthritis is more common than arthritis in the hip, although both are prevalent. The bulk of joint replacement surgeries are performed for arthritis whether it’s standard wear and tear (think tires wearing out), or arthritis related to previous trauma. Avascular necrosis can cause joint collapse and pain as well.

Q How has robotic technology changed the way you perform surgeries?
Dr. Quinzi: Robotics is the more modern way to perform knee replacements. It was available toward the mid-portion of my residency, and in fellowship it was a large portion of my training. Fifty percent of the knee replacements I performed used robotic technology. I think it adds benefit in patients that have arthritis with significant deformities. It further helps with planning how a surgeon will perform the surgery and allows you to more accurately rotate the components for a more “patient” specific technique.

Q Are there other ways joint replacement surgery has changed?
Dr. Quinzi: There are multiple approaches to hip replacement— posterior, anterior and lateral—and there has been a shift towards the anterior approach overall which is the approach I utilize. With the direct anterior approach you use a pathway between muscle planes so you don’t cut muscles which I think helps with early recovery. It’s also easy to obtain x rays intraoperatively, which helps with positioning and sizing the components as well as leg length restoration.

Q Do you have a philosophy about patient care you’d like to share?
Dr. Quinzi: Medicine today can be very mechanical and robotic. I try to keep it
very conversational with my patients. I like to talk about their day-to-day activities and find commonalities with them. I treat their conditions with those activities in mind. I try to stay away from typing notes while I’m with the patient and make it more informal.

Q You are from Upstate New York. Where did you grow up and why did you decide to return?

Dr. Quinzi: I from Rochester and my wife is from Fayetteville. We attended medical school for four years here at Upstate Medical University. She’s an anesthesiologist and we were lucky enough to couples-match together at the University of Rochester Medical Center. We love it here, so we decided to come back, settle down and raise our family. We just had a baby in August and we have another daughter who is 2 1/2. My wife is taking a little time off and will start back to work in November as an anesthesiologist in town.

Dr. Quinzi is accepting new patients. Appointments can be scheduled by calling 315 251-3100, extension 9814 or by visiting sosbones.com to request an appointment.

Grieving Families Act: Necessary Adjustment to an Antiquated Statute or Disastrous for New York Health Care?

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Round two of the Grieving Families Act has slight changes but is substantially the same one vetoed by Gov. Kathy Hochul earlier this year, citing the need to evaluate the “impact of these massive changes to the economy, small businesses, individuals, the state’s complex healthcare system.”

The sponsors wrote in their justification on NYSenate.gov, “New York’s wrongful death statute is over 175 years old, and it is unfortunately out of step with nearly every other state because New York’s laws prohibit grief-stricken families from recovering damages for their emotional suffering from the death of their loved one.”

The current law, which awards compensation for pecuniary loss only, impacts most harshly on children, seniors, women and people of color – people who often have no income, significantly less income or who have been traditionally undervalued in our society.

How does the act change the current wrongful death statute? The act changes who can file suit from relatives in line for direct inheritance to include those with a close relationship to the decedent. Clearly, it greatly expands those given the right to sue with little clarification on the definition of “close relationship.” Also, lawsuits previously included a single request for compensation tied to economic damages; now grief, loss of consortium and sympathy may be included.

While proponents note that the emotional component is part of most other states’ wrongful death statutes, it neglects the fact that, unlike the Grieving Families Act, most states have a cap on this type of compensation. With no cap, quantifying grief will lead to astronomical payouts. Adding to the speed at which these payouts will come to fruition, the changes will be applied to any cause of action that accrues after July 1, 2018.

Although one can see the merits of the justification noted above, it ignores the realities of its impact on the state. The state leading in claims and payout amounts will be a windfall for plaintiffs’ attorneys. Malpractice carriers are already struggling with upticks in claim frequency and the dramatic rise in award amounts. The act will add to the pressures already in play. To maintain solvency, carriers and the Insurance Department will keep a close eye on
these trends, which might indicate the
need for increased rates.

As we all know, the healthcare sector in some ways is still recovering economically. The margins that most hospitals and small practices operate under are often slim. Any increase will have a significant impact on the ability of dedicated healthcare workers to provide quality care. The sad truth is that underserved or undervalued individuals – the ones the act intends to help – will be the ones to suffer disproportionately from the misguided attempts to correct the current statute.

Most involved feel the act will be approved by Gov. Hochul in some form; it is such a high-profile legislation that garners a great deal of sympathy, and it is incumbent upon everyone to reach out to ensure any change is done in a manner that will not harm those it is meant to help. I leave you with this final thought from New York State Medical Society President Paul A. Pipia, M.D.

“We urge Gov. Hochul to veto this legislation again and call for the creation of a workgroup that can develop balanced legislation that will expand the rights of grieving families without devastating our healthcare system in the process.”

I encourage you to reach out to Gov. Hochul (@govkathyhochul) on Facebook, Twitter and Instagram.

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

Syracuse Community Health: Continued Expansion Under New Leadership

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Over the past five-and-a-half years, Syracuse Community Health has undergone significant change and laid the groundwork for exciting transformations still to come. Led by Mark Hall, who joined Syracuse Community Health as interim President and CEO in 2018 and came on full-time in 2019, the health care organization has been serving the Syracuse community since the 1960s. With Hall at the helm over the past several years, Syracuse Community Health has begun efforts to expand care into surrounding areas in Onondaga County, is nearing the completion of a brand-new, state-of-the-art building and is planning a family medicine residency program, all while maintaining the central mission of serving patients and those who have difficulty accessing quality health care.

This year will mark the beginning of another new chapter for Syracuse Community Health when Keith Cuttler takes over as President and CEO on November 1. Cuttler joined Syracuse Community Health in 2021 as Chief Operating Officer and also took over the role of Chief Business Development Officer in 2022. His over twenty years of experience working in health care has included leadership roles at several local hospitals, including serving as the President and CEO of East Hill Medical Center in Auburn, NY.

As Hall prepares to hand over the baton to Cuttler, he outlined the achievements from his tenure at Syracuse Community Health (SCH) that have laid the groundwork for continued growth and success for the organization under Cuttler’s leadership, to expand its footprint throughout Onondaga County.

“One success we’ve experienced over the past several years has been the financial turnaround. A little over five years ago, we were in a dire financial position, but now we’re very much on solid footing. Secondly, we’re excited to see the fruition of our plans to construct a new building at 930 South Salina Street, which will be opening to the public over the next month. Thirdly, we have pulled together a strong management and senior executive team, which includes Keith, who we were blessed to have join us almost two years ago. SCH now has a great foundation on which to grow under Keith’s leadership,” said Hall.

Evolving Care Through New Construction and a Residency Program

As a Federally Qualified Health Center (FQHC), Syracuse Community Health centers around a mission to provide individuals with access to quality health care services. While never losing sight of this foundational purpose, Cuttler is looking forward to continuing the growth of the organization that was initially spearheaded by Hall. “I’m excited to continue efforts toward providing access to quality care to a much larger population than has traditionally been the case. There’s strong recognition that there are folks all over Onondaga County and in Central New York that are suffering from poverty. We don’t just have poverty located within three small zip codes and everyone outside those zip codes is in the middle or upper class. We have poverty everywhere and people who need access to health care everywhere,” Cuttler explained. 

The brand-new, state-of-the-art medical facility opening soon at 930 South Salina Street is the first major component of Syracuse Community Health’s expansion into offering care to a wider population in need of health services. Looking further down the road, the planned Family Medicine Residency Program that will begin in 2024 will transform Syracuse Community Health into a teaching health center where primary care physicians will receive specialized experience from learning at a Federally Qualified Health Center. For Cuttler, these developments at Syracuse Community Health will launch the health center into a new stage in its evolution.

“The opening of the new building at 930 South Salina Street is effectively turning a page and starting a new chapter for Syracuse Community Health,” Cuttler said. “It is there that we show the greater community that Syracuse Community Health is an ambulatory care provider that’s multi-disciplinary and provides extraordinary health care in an exceptional environment with stateof- the art equipment. Beyond that, we’re very excited about the new residency program and about the transformation of the organization into a teaching health center. I believe we’ll be only the third teaching FQHC in the State, and we’ll be the primary trainers of family medicine physicians going forward. Both the new building and the upcoming residency program give us that leg up and that opportunity to really open up our services to a much broader audience.” 

A Continuum of Success into the Future 

Cuttler emphasized that although these changes are publicly taking place alongside a shift in leadership at Syracuse Community Health, the outcomes are by no means resulting from the transition of Hall to himself as President and CEO. 

“It’s sort of like growing a plant: you plant a seed and the roots grow first, but it’s only later that you see the flower come up. What the public will begin to see as we transition leadership has actually been growing and taking place over the last five plus years, and particularly with the new building. Those plans languished on a shelf for years and years and Mark was the one that gave that project life. We wouldn’t be opening a new building next month if he hadn’t made executing on those plans a priority,” Cuttler stated. 

As for Hall, he isn’t retiring, but rather shifting his focus back to the business he created 18 years ago, M.S. Hall + Associates. Even though he’s resigning from his official role at SCH, his connection with Syracuse Community Health is one that won’t be completely ending anytime soon. 

“My connection to the health center will always be strong, being that this is where I received care when I was a child when my parents would bring me here,” said Hall. “I’ll always be connected, whether directly or indirectly, formally or informally as we move into the future.”

Drakos Clinical Dynamics

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Enhances Healthcare Accessibility with Expanded Services in Central New York

In a healthcare landscape teeming with both challenges and opportunities, Drakos Dynamics has emerged as a pivotal player in Central New York, with successful healthcare services like a dedicated pediatric urgent care in Liverpool (Clay Medical Center). Drakos Pediatric Urgent Care opened in May as a unique option to help address the shortage of accessible pediatric healthcare in Central New York. 

The company is now furthering its commitment to the region with ambitious plans that are not only expansive but also strategically focused. The company will be opening Drakos Urgent Care in Cicero with an expanded portfolio that will provide comprehensive care for the entire community, including adults, as part of Drakos’ mission to continue addressing gaps in healthcare, one of those most critical being increasing access to high quality care. These services include urgent care services, a full vaccination program, X-rays, ADHD screenings, weight loss and metabolic health management, a comprehensive lab onsite, full respiratory panels, sexual health, and more.

“Since opening Drakos Pediatric Urgent Care in May, we’ve provided care for more than 1,000 patients,” says Drakos Founder and CEO Heather Drake Bianchi. “With the urgent care in Cicero, it’s not just about expanding our services, it’s about access. It’s about ensuring that we continue to fill crucial gaps in the healthcare system here in Central New York. This is a data-driven decision. We’ve reviewed the epidemiological trends and identified a need. It’s proactive healthcare delivery, aligned with regional demands, to help address current and future shortages.” 

As many local urgent cares are closing temporarily or shutting permanently, Drake Bianchi is passionate about the company’s responsibility to serve the community, especially as experts already see the start of another challenging respiratory season.

Drakos Pediatric Urgent Care observed an early uptick in both COVID-19 and strep infections, starting as early as the end of August – much earlier than normal. Local teachers shared that schools were grappling with significant numbers of students falling ill with COVID-19, strep throat, or influenza, even before October had arrived. This pattern immediately raised concerns about another potentially challenging respiratory season, impacting both kids and parents alike.

“We want to be a resource to truly anyone in our community in need of outstanding, convenient care, and to other healthcare facilities by helping ease the stress in emergency rooms and across the healthcare system at large,” says Drake Bianchi. “We’re here for the long haul to serve this community.”

Drakos has other major plans, too. The company’s ethos has always been to provide healthcare without walls— innovating to overcome barriers and bring quality healthcare to people when and where they need it. The company began in 2020 with its subsidiary, CineMedics, which focused on providing medical testing and services on medical sets.

Now Drakos is adapting what it learned with CineMedics and designing mobile care to reach underprivileged and remote areas, along with anywhere that suffers from access issues. According to the Urgent Care Association, 89 percent of the U.S. population can drive to an urgent care in 20 minutes or less, but only 15 percent of urgent cares are in urban areas and only 9 percent are in rural areas – a gap that contributes to healthcare
access challenges.

“Our origin story is rooted in mobile care. Mobile clinics are redefining healthcare accessibility,” says Drake Bianchi. “That matters in a community that has one of the highest rates of segregated poverty in the country and underserved immigrant communities and is surrounded by rural areas where regional hospitals have closed at alarming rates. The entire Drakos team is incredibly motivated to use our skills to serve people in our community who struggle to access healthcare.”

Despite being one of the most technologically advanced and affluent nations globally, the United States falls short in terms of healthcare access both locally and nationally. That’s why Drakos is also committed to using mobile healthcare, as well as the physical locations in Cicero and Liverpool, to address these healthcare disparities.

Data from the New York State Department of Health 2021 Behavioral Risk Factor Surveillance System (BRFSS) Health Indicators by County and Region reveal that 1 in 10 Central New Yorkers don’t have a regular health care provider, 1 in 7 struggles with mental health more than 14 days per month, and 1 in 10 report overall poor physical health. Additionally, of those who do have a primary care provider, nearly 25 percent don’t see their doctor for a checkup each year.

“If we really want to improve our fellow citizens and neighbors, everyone needs regular care for their physical and mental health,” says Drake Bianchi. “We understand that mobility issues, geographic hurdles, and other challenges can hinder timely and appropriate access to healthcare services for everyone. One of our lessons from working in Hollywood is that a lack of time can be a major healthcare access issue for everyone. Although their access to wealth and specialized care obviously differs greatly, one thing a parent working two jobs struggling to make a living and a movie star working on set for 16 hours per day often have in common is the feeling that they just don’t have time to see a doctor. We look at all the factors impacting healthcare access and think, ‘where can our skills help?’”

As Drakos works toward its goal of becoming a long lasting part of the region’s healthcare infrastructure, the team is working with local nonprofits and businesses to create new alliances that will increase healthcare for all.

“All of our plans focus on innovative solutions that incorporate a network of physical brick and mortar locations, mobile, and virtual care. We aim to set a precedent for agile, effective healthcare delivery,” states Drake Bianchi. “At our core, the Drakos team is passionate about bringing together data, science, and action to drive decisions and create a more accessible, convenient healthcare network in Central New York, so everyone can receive high quality healthcare when they need it.”

For healthcare leaders seeking to understand the future contours of healthcare in Central New York, Drakos serves as a case study in thoughtful expansion and effective communication. By strategically widening their services and using innovative technologies and approaches, they are not just serving the community —they are actively helping to shape it. Their data driven, communityfocused approach promises to make them a lasting fixture in Central New York’s healthcare. 

For more information, please see www. drakosdynamics.com

Syracuse Community Health: Providing High-Quality Care for All

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By: Elizabeth Landry

When Mark Hall was a child living in Mulberry Square housing along with his parents and several siblings, his family often came to the nearby Syracuse Community Health Center at 819 South Salina Street in Syracuse for their medical needs. He remembers coming to the center for dental services, pediatrics and related care. In March 2018, Hall returned to the health center he used to visit as a child, but this time he took on the role of interim President and CEO, roles which he eventually took over full time in 2019.

“My commitment to the health center and my relationship with the health center go back to when I was a child. It didn’t take much for me to decide that I wanted to come back to Syracuse Community Health. Ever since I was a child, the health center has been part of my life and part of my family, and that’s when my passion for its mission began. I know first-hand what the health center means to families who might not otherwise have access to health care,” said Hall.

Today, the health center in the heart of Syracuse is known as Syracuse Community Health, and Hall has been leading an initiative to expand, improve and revitalize the center’s buildings that are spread throughout Onondaga County. The health center’s locations include the original building at 819 South Salina Street, additional buildings on East Fayette Street and Oswego Street, care centers within several schools in Syracuse and a brand-new building opening soon at 930 South Salina Street, which is kitty-corner to the original building. Through each of these locations, Syracuse Community Health serves as a “one-stop shop” for patients, providing everything from primary care, pediatrics, dentistry, OB/gyn,

 podiatry and eye care/eye wear to women’s health, radiology, lab, urgent care, psychiatric and addiction services, pharmacy and care management services.

Serving Patients as a Federally Qualified Health Center

Originating in the 1960s as the Neighborhood Health Center, Syracuse Community Health has evolved over many decades to continue to meet the needs of patients in the central New York community. In 1978, the health

 center was designated as a Federally Qualified Health Center, or FQHC, a status that remains at the center of its functions today.

FQHCs are different from other health care centers because they receive federal funding in order to meet the needs of under-served populations in economically depressed areas.

“The intention of the FQHC legislation was to address many of the problems that were brought to the surface during the 1960s. There was a lot of social unrest within the black community specifically, intertwined with violence and a lot of unemployment.

“These issues were spread throughout the country, and they also affected Syracuse. FQHCs were born out of the desire to address many of these social and economic issues,” Hall explained.

It’s important to note that Syracuse Community Health, like all other FQHCs, is not a free clinic. Syracuse Community Health has an obligation to provide services for any patient who seeks health care within its facilities, and there is a sliding fee scale for all patients based on income. However, care could be provided for free if a patient has no or very low income. Additionally, although Syracuse Community Health traditionally treats an inner-city patient population that is low-income, under-insured and under-employed, the health center also has a segment of more commercial patients who receive Medicaid.

Since Syracuse Community Health receives patients from many walks of life within central New York, it will not turn any patient away, Hall emphasized how the health center has become an important pillar within the community.

“We serve all of Onondaga County, and anybody can come to Syracuse Community Health. There’s a common misconception that poverty only exists in the city, but we have the same problem in the suburbs and rural areas. Poverty is not limited to a race of people or a segment of people, but rather it’s a problem that our country must deal with. The mission of the health center has always been to ensure that everyone has access to care as we address the many social determinants of health, from lack of food and unemployment to transportation, childcare needs and even violence,” said Hall.

Revitalizing Through State-of-the-Art Design

A major way the leadership at Syracuse Community Health is continuing to fulfill the mission of the organization is by revitalizing and modernizing the health center’s buildings, including the brand-new construction located at 930 South Salina Street. Deemed the “930 Project,” the new $25 million site includes 56,000 square feet and will open to patients in September. Located within convenient walking distance to the original building, Hall emphasized how this new location offers ample space for patient exam rooms, provides an open, inviting atmosphere and maintains a more seamless patient experience.
“When I came on board at Syracuse Community Health, a renovation of the original building at 819 South Salina Street was being planned, but I changed that immediately,” he said. “New construction was the best decision simply based on the flexibility of designing a new layout.

“We’re able to see more patients in the new building, which has 38,000 square feet of patient-seen space versus the original building, which has 78,000 square feet. Additionally, if we were to renovate the original building, it would have caused a lot of problems. If you’re renovating existing space and having patients come in daily, parts of the building would be sealed off and wayfinding could change daily and sometimes hourly, making it difficult for patients.”

Along with a layout that makes the best use of the space, the new building features a state-of-the-art design that focuses on energy efficiency. Forty geo-thermal wells that run 200 feet beneath the parking lot will be used to heat and cool the premises year-round. The building is also net-zero-ready, with accommodations for future installation of solar panels that would produce a net-zero carbon footprint.

More than anything else, however, the construction of the new building is aimed at providing a calming, healing atmosphere for the patients who come through the doors. Numerous windows and sky lights flood the space with natural light and artwork by local artists will hang on the walls, creating a beautiful, aesthetic experience for patients that Hall likens to that of a spa.

“We’re really excited about the design – it’s a very inviting space,” Hall said. “There’s so much natural light coming to all four sides of the building. This will create a healing atmosphere within the health center, and the crown jewel will be our women’s mammography center. It’s an absolutely beautiful space that literally looks like a spa. There has been much talk within the healthcare industry on healthcare equity and social determinants of health. At Syracuse Community Health, we’re really taking the steps to make health care available to patients who would not normally have the economic means to take advantage of a high-end spa. The space in the women’s mammography center does exactly that, and we’re really proud of how it all turned out. When considering the design for the new building, we really wanted to drive home the point that people who come to the health center are deserving of quality health care within a quality setting.”

Planning for the Future with New Leadership

Looking beyond the new building and into the future for Syracuse Community Health, additional changes will be coming to further enhance the ability of the health center to serve more patients.

Plans to begin a family medicine residency program in July 2024 will allow the organization to become a teaching health center. With many practitioners choosing to specialize in specific areas of medicine, a high demand for primary care providers has developed. The planned “4-4-4” residency program will bring a new group of four primary care practitioners to Syracuse Community Health each year over a period of three years, opening the health center up to many learning opportunities and resources that will benefit both the providers and the patients.

Perhaps the most significant change coming to Syracuse Community Health in the near-term, however, is new leadership to continue the mission of the health center. Over the next few months, Mark Hall will be passing the baton to Keith Cuttler, who will be taking over as Interim President and CEO of Syracuse Community Health. With more than 34 years of experience in health care, Cuttler came to Syracuse Community Health two years ago as both the Chief Operating Officer and the Chief Business Development Officer. He took over these roles after serving as the President and CEO of the East Hill Medical Center in Auburn for several years, a health care center that also shares the designation of being an FQHC.

One of the main reasons Cuttler decided to come to Syracuse Community Health is because of the exciting new construction taking place. “The new building is a bright, extremely well-laid-out, open-concept, state-of-the-art medical center. One of my frustrations with the health care system that I’ve witnessed over my three-plus decades involved is that those who are of a lower socio-economic class than others are often relegated to less than desirable environments and medical equipment. To me, this project is a tremendous opportunity to shake that off and provide our population with access to a new, clean facility that offers updated equipment and the same great staff in a beautiful facility that has light pouring into it. I think folks who start receiving care in this facility are going to be blown away when they walk in. Many, I would imagine, are going to quietly feel that they don’t deserve this, but in fact, they absolutely do. Taking over the build of this project from Mark has been one of the most fulfilling projects of my entire career,” he said.

As he steps into this new role, Cuttler also plans to advance the efforts that Hall has begun to expand the reach of Syracuse Community Health beyond its immediate urban site and out into suburban and even rural areas, where patients are also in need of affordable, accessible, quality healthcare.

“FQHCs like Syracuse Community Health have a first and foremost mission to provide access to the under-served populations in their communities, but they aren’t limited to treating only that population. We have patients that come from other counties to see us,” Cuttler said.

“I think we’re really going to shed a new light on what Syracuse Community Health is and what it’s becoming, and that is a state-of-the-art health center for everyone, not just the adjacent communities that we will always be committed to serving.

“We’re looking forward to providing anyone who comes to Syracuse Community Health with outstanding care in a really great environment for many years to come.”

New York State’s Empire State DevelopmentConducting MWBE Disparity Study

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By: Earl Hall, Executive Director, Syracuse Builders Exchange

New York State’s Empire State Development (ESD) is conducting a Disparity Study (study) to determine whether there is disparity between the use of minority and women-owned businesses (MWBE) and the availability of those firms throughout upstate New York (state).  Through the collection of qualit ative or anecdotal data, the Study seeks to determine if there is evidence of discrimination in the various geographic regions of upstate New York in which the State is the construction project owner.

In addition, the Study will look to determine the effects of race, ethnicity, and gender on businesses’ ability to do business with the State, acquire capital or bonding and win contracts or subcontracts in the markets in which the State does business. The Study will determine if there are barriers preventing diverse businesses from working with the State or the State’s prime vendors and identify how processes could be more accessible and inclusive for all businesses.

ESD conducted a similar Study in 2015, which was released in 2016. ESD’s 2015 Request for Proposal stated in part that its purpose was, “increasing participation of MWBEs on State’s contracts” among others, although the Study did not identify any New York State procurement discrimination during the 5-year period examined. Consistent with the 2015 RFP, some construction industry leaders concluded the Study assumed discrimination, and did not attempt to evaluate whether:

• Discrimination connected with any specific contract/subcontractor award had occurred;

• The actions of any agency, state employee or contractor were discriminatory;

• Lenders, sureties or insurers engaged in discrimination.


The 2016 Study concluded that a disparity in fact existed throughout upstate New York, which may lead one to conclude that the State had been discriminatory in their contract awards on public projects. The Study also concluded that 53.05% of available prime construction contractors, and 53.48% of available subcontractors, were certified MWBE employers. As a result, the State subsequently adopted a 30% MWBE goal on public work projects throughout upstate New York.

Today, ESD is conducting another Study for the construction industry. During my September 2023 interview with Brian Ansari & Associates, Inc., regarding ESD’s new Study, I challenged the interviewer to consider the questionable outcomes of the 2016 Study and those factors used by the 2015 vendor to reach those conclusions.

Additionally, I shared with the interviewer my opinion on the uniform 30% MWBE goals throughout upstate New York, as such a disparity throughout the region is not possible. While one may argue a 30% disparity exists in Monroe County and/or Onondaga County, the same disparity percentage may not exist in Lewis County or St. Lawrence County. To determine whether a disparity exists, such needs to be studied individually by region for the reason above.

MWBE capacity varies by region, and while the Syracuse Builders Exchange continues our efforts to build MWBE capacity in the central New York region via our Construction Company Growth Accelerator program, MWBE Showcase, and new mentorship program, there still remains challenges with the availability of certified contractors to bid and self-perform on public work projects.

Discrimination of any form has no place in society and is strongly opposed by industry leaders and others engaged in the construction industry. Fair, ethical, responsible and competitive bidding on private and public projects is vital to upholding the integrity of the bidding process and the contract awards thereof.

Upstate New York construction industry associations, industry leaders, contractors and elected officials should work collaboratively to address any disparities that may exist in particular regions of New York and develop solutions to address such disparities. Simply applying a uniform percentage for public projects is doing a disservice to all legitimate contractors.

I am excited to see the results of the 2023 Study and remain hopeful the disparities identified in the 2016 Study have decreased significantly or have been eliminated. While I am not optimistic elected officials will see the benefits of performing individual disparity studies in regions of New York, I remain optimistic that efforts to eliminate disparities in all industries will continue until such time none exist.

 

Structured Routines for Operational Excellence and Daily Continuous Improvement

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By: James A. D’Agostino, CEO, MEP Center Director

In an era of rapid technological advancement, the manufacturing industry is undergoing a transformation that is changing the way businesses operate. One of the key drivers of this transformation is automation. Manufacturers who invest in automation are not only staying competitive but also reaping numerous benefits that can have a profound impact on their bottom line and long-term success. In addition to enhanced productivity and efficiency, there are a number of compelling reasons why manufacturers should embrace automation as an essential component of their operations.

Skilled Workforce Augmentation: Contrary to the misconception that automation eliminates jobs, it can enhance the roles of human workers. Automation can take over repetitive and physically demanding tasks, freeing up employees to focus on more valuable and creative aspects of their jobs, such as problem-solving, innovation, and process optimization. This augmentation of the workforce can lead to higher job satisfaction and a more skilled and adaptable workforce. Also, with the ongoing workforce shortage, automation can help to fill critical resource gaps.

Cost Reduction: While the initial investment in automation technology may seem substantial, the long-term savings are significant. Automation leads to productivity improvements, optimized resource usage, minimized material waste, and lower energy consumption, all of which contribute to impactful cost reductions over time. Also, as we have discussed in recent articles, there are lucrative sources of funding for capital equipment.

Global Competitiveness: In an increasingly globalized marketplace, staying competitive is a constant challenge. Manufacturers that invest in automation are better positioned to compete on a global scale. Automated processes can sometimes operate 24/7, providing the capacity to meet international demand and scale production as needed. This scalability is a crucial advantage when competing with companies from around the world.

Flexibility and Adaptability: Modern automation systems are highly flexible and adaptable to changing production needs. Unlike fixed assembly lines that require extensive reconfiguration to accommodate new products or processes, automated systems can be reprogrammed or reconfigured relatively easily. This flexibility allows manufacturers to respond quickly to market shifts and customer demands, enabling them to stay relevant and competitive in a dynamic business environment.

Data-Driven Insights: Automation generates a wealth of data about production processes, product quality, and equipment performance. This data can be captured for real-time monitoring and analysis. Manufacturers can use this information to identify bottlenecks, optimize processes, and make data-driven decisions to improve overall efficiency and productivity. Furthermore, predictive maintenance can be employed to prevent equipment breakdowns, reducing downtime and associated costs.

Improved Quality Control: Quality control is paramount in manufacturing. Automation can contribute significantly to achieving consistent product quality. Automated systems are programmed to adhere to strict quality standards, ensuring that each product meets the required specifications. By reducing human errors and variability, manufacturers can minimize defects and the associated costs of rework or recalls.

Enhanced Safety: Safety is critical, and automation can be used to handle tasks that are dangerous or pose health risks to employees. By automating such tasks, manufacturers can create a safer work environment, reduce workplace accidents, and minimize workers’ compensation claims.

Environmental Benefits: Automation can contribute to a more sustainable manufacturing industry. By optimizing resource use, minimizing waste, and reducing energy consumption, automated processes have a smaller environmental footprint compared to traditional manufacturing methods. This not only benefits the planet but also aligns with the growing demand for eco-friendly products and practices among consumers.

Manufacturers who invest in automation can unlock a plethora of benefits that can transform their operations. From increased productivity and quality control to cost savings and environmental sustainability, the advantages of automation are compelling. Embracing automation is not a matter of if, but when, for manufacturers looking to thrive in the ever-evolving landscape of modern manufacturing. Those who hesitate risk falling behind in an industry that is moving forward at an unprecedented pace.

If you are a small or mid-size manufacturer and would like to further the discussion, TDO’s team is fully certified to help. Reach out today to learn more and schedule a free consultation.

The Best Practices of Financial Planning …And Why They Aren’t as Complex as You Think They Are.

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By: Jason D. Nickerson, CFP®, EA, President & Chief Operating Officer, John G. Ullman & Associates

We have all heard of the KISS acronym; “Keep It Simple Smarty Pants!” as Ted Lasso so eloquently put it.  You see, the world only continues to grow more complex, and managing our personal finances is no exception;  however, at the root, there are many basic foundations we can apply that stand the test of time.  This is not to suggest that all things in our planning are simple, but if you remember some simple core concepts, you can do pretty well. We all have heard the Financial Talking Heads talk about things like “save more, spend less,” “create a budget,” “invest,” blah, blah, blah.  They all seem to say the same thing.  These might hit a little differently: 
 
• Use debt as an asset, but smartly:  If you have a good credit score, it may be in part because you have already done this.  Do not be afraid to use debt as an asset.  My favorite example is buying a home.  You can certainly go overboard and make yourself house poor;  however, before you make it your goal to pay off your house, ask why that is your goal.  Using debt to finance your home allows you to leverage free cash flow and other assets for investments to hopefully, over time, outperform the interest you are paying the bank.  Other financial professionals can be anti-debt.  I say use it smartly; it is okay.
 
• Start saving early: We have all probably seen or heard this and have even seen it illustrated.  If you start saving today for the next ten years and then stopped, you will have the same or more 30 years from now as if you started saving 10 years from now and saved the same amount for the next 20 years after that.  Compound earnings are one of the most powerful financial forces in the universe.
 
• Invest with a purpose, and it is usually not to maximize returns: The investing world has only become more accessible to the everyday person.  And it seems that we are all chasing the big win.  I implore you to have a different approach.  When you hear of everyone’s big wins, notice what you are not hearing about are their big losses.  So please, invest with a purpose in mind.  This means having a plan and your plan should not be maximizing returns.  You should be investing for adequate returns to support the achievement of a goal.  If you constantly aim for the highest return, you will likely take more risk than you should and likely end up with some big losses along the way, some that you may never be able to recover from. 
 
• Save more than you think: I am telling you that you need to save more for your future than you think you do.  This is pretty common advice, but people are living longer, and they want flexibility earlier in life.  Saving earlier will allow for that flexibility.
 
• Live for today, plan for tomorrow: A mentor taught me this early in my career and it has stuck with me.  We can get overly consumed with saving for a future that may never come.  Make sure you enjoy today, while still adequately planning for tomorrow.  It is all about balance.
 
Coming from someone who makes a living helping people in this area, it would seem I am writing myself out of a job.  That is not the case.  These are just some basics that everyone can use to get started and fall back on when things get more complex.  When the moment is right, seek help from a qualified professional, but that doesn’t mean you still can’t… 
Keep It Simple Smarty Pants! 

Tetris Anyone?

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By: Pierre Morrisseau, CEO, OneGroup

We are entering an exciting time of the year with emphasis on family, holidays and camaraderie with friends and coworkers. At the same time, it can be a very stressful time as we approach year-end results and forward planning. Additionally, most of us are feeling bombarded with a steady stream of negative news and social discourse that at times make the world feel upside-down. The perfect time to change our thinking about how we define and achieve happiness.

Last quarter, I shared some valuable insight I had gained from several sources, particularly from Shawn Achor, author of The Happiness Advantage, about the effects of happiness on one’s self as well as on an entire enterprise. I also shared some startling statistics about how few employees feel happy and fulfilled at their jobs. The solution, it turns out, is changing our view of “the chicken or the egg.” By that I mean most business leaders and productivity pundits advise us that if we just work harder, we will achieve happiness. That is, thinking of happiness as a goal. In fact, the science of positive psychology has proven that it’s the other way around: Happiness is actually the catalyst that allows our brains to achieve goals—often incredible goals. This was eye-opening. Consider the various results of scientific studies of achieving a “positive brain”:


• Students do better on tests
• Employees do better at work
• Improves brain health
• Increases energy by up to 31%
• Decreases heart disease by up to 30%
• Decreases fatigue-related symptoms by up to 23%
• Reduces the chance of depression by up to 31%


This isn’t about irrational optimism. It turns out that we are not born with a predetermined positive or negative mindset. Neuroscience has shown us that our brain can change at any age. This was underscored by reading about Tetris. For those unfamiliar with Tetris, it is a game where four kinds of shapes fall from the top of the screen and the player works to arrange the shapes in a way to create an unbroken horizon line. And it’s addictive.

In a Harvard Medical School study, Tetris players played for multiple hours a day for three days in a row. Even after they stopped, their minds continued to see shapes everywhere—in the supermarket, sidewalks, skylines—that they could not stop trying to assemble to fill in the “gaps.” This was dubbed the “Tetris Effect.”

What I learned was that the brain can be rewired in just a few days to achieve a positive mindset. Where we typically operate with a two-option view: Maintain the status quo (safety), or fail and lose (vulnerability), there is a third option: Embrace failing knowing it will help catapult us to success (positivity). The latter is what Achor calls “falling up.” He defines it this way: “In the midst of defeat, stress and crisis, our brains map different paths to help us cope and succeed. If our Tetris Effect is to view all that has or could go wrong, then that is all we see. If, on the other hand, our Tetris Effect is to see the opportunity in it, then suddenly we see many other options to fall upward. Our mindset can create blind spots, or it can expand our vision.

This led to my epiphany that if I and others could train our brains to continually see things through a positive lens and continually share our positivity and enthusiasm with others, we could create our own version of the Tetris Effect leading to better success, better employee engagement and better mental health. The great news is this is contagious, and you can leverage one of the most important elements; creating a strong social support network in your workplace.

We are just at the beginning of this journey but excited about how well people are attracted to this approach. We are clearly better together. As we build more champions of positivity, we individually and collectively become better—and happier—every day. That’s the goal.

As always, I am most interested in learning about what others are doing to solve business challenges.
I would love to hear your thoughts!