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SOS Orthopedic & Sports Therapy: An Unparalleled Approach to Patient Care

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By Becca Taurisano

Syracuse Orthopedic Specialists (SOS) opened their Orthopedic & Sports Therapy (O&ST) service line eight years ago with a vision to deliver the highest quality patient care. With four convenient locations in Camillus, North Syracuse, East Syracuse, or Liverpool, patients can choose whether to attend sessions close to home or work. SOS’s main goal is achieving superior patient outcomes and by providing clinicians the resources they need to be successful, the SOS team is maximizing care and minimizing cost.

Tools for Success

As a service line within SOS, O&ST has benefited from a significant investment in facilities and technologies that provide clinicians with what they need to treat patients. “You notice the difference in our facilities as soon as you walk in the door,” says Director, Todd Cardi, PT. “Our facilities are top notch,” says Operations Manager, Michael Linkiewicz, PT, “we have enough space to offer a full range of treatment options to our patients to expedite their recovery.”

SOS employs therapeutic technologies including an MLS class IV robotic laser l to treat pain and inflammation and an RPW shock wave machine to stimulate healing and regeneration of injured soft tissue. Therapists have the ability to provide other alternative and specialty treatments including Sound Assisted Soft Tissue Mobilization (SASTM), Functional Capacity Evaluation (FCE), and Canalith Repositioning.

The O&ST department relies on technology to enhance the patient overall education and experience. For patient education, clinicians use a 3D program called Anatomy TV to explain the procedure that was performed or where their injury occurred. “We put a significant emphasis on patient education,” Cardi says, “in the doctor’s office, you may not have time to get an in-depth explanation. We pick up where the doctor left off.”

Clinicians use a home exercise program module to provide patients with better illustrations of exercises they need to perform outside of their sessions. The program allows for real time feedback from the patient as well as monitoring of their compliance. “These technologies will not only ensure better treatment but will also shorten the length of treatment which can help maintain costs at a reasonable level for our patients,” Linkiewicz says.

Philosophy of Specialization
SOS follows a philosophy of specialization for their therapists as well as their orthopedic surgeons. Over half of the O&ST therapists specialize in one area only including Sports Medicine, Total Joint Replacement, Hand/Wrist/Elbow, Foot/Ankle, Spine, and Shoulder/Upper Extremity. “Just like with SOS physicians, when our therapists are only treating one area of the body, they have a higher level of expertise and can provide better care to the patient,” says Cardi.

There is regular interaction between therapists and physicians in each specialty area to discuss protocols, review case studies, and develop communication patterns. “The coordination among the specialties have driven our outcomes to be consistently better than the national average,” Cardi says.

SOS therapists are encouraged to pursue certifications for various specialties such as Certified Hand Therapist, Pain Management, Fall Prevention, Functional Capacity Evaluation Testing, Vestibular Balance Therapy, McKenzie Spine Evaluation and Treatment, Orthopedic Clinical Specialist, and Sports Metrics/Injury Prevention certification. “We support our therapists in becoming certified in specialties, beyond their required continuing education credits to maintain licensure,” says Linkiewicz.

Team Approach to Care

SOS therapists and therapist assistants work together as a team, providing a continuity of care for the patient, creating confidence in the clinicians, and ensuring patient buy-in and compliance. From the initial evaluation, the patient becomes familiar with both the therapist and assistant they will be working with for the duration of their therapy. SOS strives to have a therapy team skilled in at least one specialty area at every one of their four locations for patient convenience. “Having specialists on site who are skilled in making quick decisions on progression is key,” says Linkiewicz.

Both members of the therapy team become familiar with the patient, their case, and the treatment plan, so if one team member is unavailable, the other can easily take over. “Our team approach is invaluable in maintaining continuity of care. It’s seamless to the patient,” says Linkiewicz. Cardi emphasizes that a patient will get face-to-face contact with their therapy team at every appointment. “That interaction with our therapists is really important. Our therapists will ask patients if they have any questions and reiterate the goal we are working toward to make sure they understand,” he says.

Measuring and Monitoring Success

In order to achieve superior patient outcomes and patient satisfaction, SOS uses the largest and most extensive database available in outpatient orthopedic rehabilitation, provided by Focus on Therapeutic Outcomes Inc. (FOTO). This database allows them to measure patient satisfaction and monitor patient outcomes using data from 36,160,000 patient assessments, 9,545,000+ completed episodes of care, 23,700+ clinicians participating across the United States and Canada from 12,600+ clinics. During patient intake, the therapist collects data from the patient, including demographics, comorbidities, and any information that may affect treatment or recovery. The database creates a Risk Adjusted Profile based on this information and compares patients with similar profiles.

By the time the therapist gets into the treatment room on the first visit, they have a prediction of how long the patient should be in therapy and what functional improvement can be expected. If the patient has a better functional improvement than predicted in the same or fewer visits, then the therapist has achieved a superior outcome. The database information also helps therapists set expectations with the patient to see how they compare to other patients with their same risk adjusted profile.

Subsequent surveys collect patient satisfaction information at critical points in the patient’s recovery. If the patient does not understand their condition well or is not satisfied with their progress, the therapist can address that immediately and correct the issue. Thanks to the continuous quality improvement opportunities provided by the real-time survey responses, 98.6% of SOS O&ST patients are satisfied with their results and experience at discharge. This includes feedback from approximately 9,000 SOS O&ST patients discharged in 2021 compared to 1,053,611 patients in total in the FOTO database for that time period. “When they leave, we want them to be fully satisfied,” says Linkiewicz, “the FOTO database enables us to measure both our effectiveness and patient satisfaction.”

SOS sees patients for 3.5 fewer visits today than they did when they first began utilizing FOTO, and 2.5 fewer visits than the FOTO predicted average per episode of care. This creates a significant cost savings for patients and payers. “Our main priority is superior outcomes over financial reward,” says Linkiewicz, “this demonstrates exactly what we are trying to achieve and that we are well on our way to achieving it.” This approach is working. SOS O&ST sees approximately 13,000 new patients per year, and many are referrals from other satisfied patients.

Cardi says their main goal is to help people recover and get back to functioning as fast as possible. “We are seeing patients less and achieving better outcomes. That puts our doctors at ease. That’s a direct reflection on them. We are extremely proud of how we are performing.”

Comprehensive Care Now and in the Future – CALLOUT

Utilizing best practices, SOS Orthopedic & Sports Therapy provides comprehensive multidisciplinary care for patients, with an eye to the future for growth and improvement.

  • SOS’s Specialists’ One-Day Surgery Center in North Syracuse is a 23-hour care facility for healthy patients to have total joint replacement, spine surgeries, and other procedures in an outpatient environment. SOS therapists are on staff and on call for post-operative patients when they are in recovery. Therapists run through a checklist of functional safety requirements determining if the patient can get on and off a bed, toilet, and chair, navigate stairs, understand how to use an assistive device, brace, or sling. The SOS therapists do not bill patients for this service at the surgery center. “This is what we have committed to as a group as a best practice,” says Cardi, “it is about delivering the best care and it sets us apart.”

 

  • For patients that have chronic pain, SOS O&ST is working with SOS spine physicians and New York Spine and Wellness physicians to develop protocols for pain management and post injection therapy. Spine therapists certified in pain management can help patients with exercise and activity modification to help keep their pain symptoms at bay and improve their function, in addition to their injections or medications that their pain management doctor can provide.

 

  • This fall, SOS will offer an expanded hand and wrist center including certified hand therapists at their 5719 Widewaters location in East Syracuse, allowing them to further improve the communication and collaboration between doctors and therapists for patients who have had tendon repair, fractures, or other hand surgeries. Patients will be able to see their doctor and walk across the hall to get a custom splint from their therapist the same day.

 

  • SOS has the largest athletic training department in Syracuse, working with over 15 area high schools and secondary colleges. Having an athletic trainer on site expedites care when an athlete sustains an injury. If the athlete requires rehabilitation, they are referred to SOS therapists to get them back to their sport as quickly as possible. When the athlete returns to their school, the athletic trainer is there to work with them to further to facilitate a safe return to sport. “Having all the pieces at our disposal allows us to communicate effectively and smoothly, and improve the overall experience for the athlete,” says Linkiewicz.

2 Top Risks for 2022 and Beyond

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By: Pierre Morrisseau, CEO, OneGroup

In this issue of CNY C-Suite I would like to cover two critical risks for 2022.  The first is Cyber Risk.  We have seen cyber transform from a misunderstood threat that most businesses brushed off as rare and happening to big firms, to a significant and sophisticated threat capable of costing into the millions of dollars—even capable of shuttering companies.

A recent large-scale survey by Allianz Global Corporate and Specialty surveyed more than 2,500 risk management experts from more than 88 countries who ranked cyber risk as the number one threat to business. The war between Russia and Ukraine has made this even more significant in 2022 with Russia targeting computer assets around the world.

It is now more important than ever to have good basic controls in place.  This is also becoming critical to get access to good Cyber coverage as the marketplace is becoming more expensive and particular about what they require. The good thing about a number of the Cyber insurance policies is they come with services that will help you prevent a breach or more effectively respond to a breach if you have one. It is critical that you have a plan.

More surprising is a new threat that evolved out of the pandemic: attracting and retaining top talent. Moreover, it appears that finding not just top talent, but enough talent to sustain growth will continue to be a challenge for years to come.

Protiviti® and North Carolina State University surveyed nearly 1,500 C-suite and board positions around the globe identified attracting and retaining top talent as the second most critical risk of the top ten for 2022 and the foreseeable future. There appear to be no easy solutions finding workers due to the complexity of the forces at work to create the shortage. The Survey sites myriad pressures including lingering impact of Covid and its variants, supply chain disruptions, geopolitical tensions, increasing use of artificial intelligence and automation, remote work option requirements by employees and more.

For service companies like OneGroup, finding and growing top talent is an imperative. We feel we must be creative in every area from recruiting, onboarding, training, personal development, and work-life harmony.

I thought I would share one of our recent efforts to strengthen our workforce while giving us a unique recruiting tool. Perhaps it will provide you with ideas that you, too, can deploy to attract talent.

We recently hosted what we branded “Day of Learning.” In fact, we took over the lower level of Syracuse’s Oncenter for two full days dedicated to letting our employees explore different topics of interest – very little was focused on insurance but instead focused on camaraderie, motivational speakers, and mostly, just enjoying each other’s company.

It was the first time the majority of our people had gathered face-to-face in two years. Participation was over 80 percent with people coming from all of our 18 locations including Florida. Since one of our corporate goals is to have our experts and specialists return to the office to facilitate collaboration, we felt this event would help people feel comfortable being out and together again. It exceeded every expectation and opened the door for a majority to return to the office at least some portion of each week.

The event was also intended to demonstrate our commitment to our employees’ individual growth and well-being. Again, it far exceeded our expectations as our people eagerly mingled and self-organized impromptu gatherings to learn more about each other. The results of several surveys throughout reinforced their positive attitudes about their work, their co-workers, and the company of which they are an important part.

We are confident that out of the box efforts like Day of Learning are contributing to employee satisfaction and retention. We are also confident that having a stable of happy ambassadors is not only excellent for our business and our clients but will also attract new top talent.

I will be happy to share the details of Day of Learning and other efforts to attract talent, and I would love to hear what you are doing to grow your workforce.

Is Construction the Obvious Solution to Young Workers’ Career Crises?

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By: Hannah Sabitoni

Lazy, entitled and technology-addicted are some of the adjectives you may see used to describe Millennials (those born between 1981 and 1996) and Generation Z (1997 – 2012). Despite the stereotype that this group doesn’t want to work hard, they make up nearly half of the current workforce. As the “Great Resignation,” an unexpected surge in retirements and an aging workforce drive up demand for labor, employers need to find ways to appeal to and recruit these younger workers to stay afloat.

“From new infrastructure funding to plans to replace outdated lead pipe service lines, the construction industry is booming and won’t be slowing down anytime soon,” says LIUNA General Secretary-Treasurer and LHSFNA Labor Co-Chairman Armand E. Sabitoni. “Young people are growing tired of spending thousands on a degree to graduate without any guarantee of a job and a career in construction offers an alternative to this path. LIUNA members get fulfilling careers, they get to work on meaningful projects and can build a better future for themselves and the country.”

The construction industry has been facing a worker shortage, and one projection estimates the industry will need 2.2 million more construction workers in the next three years to keep up with demand. At the same time, the overall economy is seeing masses of people quit their jobs in favor of gigs that pay more, offer better benefits packages, and provide a better quality of life. In other words, younger workers are tired of being underpaid and undervalued and are rethinking what they want – and how much they’ll tolerate – in a career.

In many ways, a career in construction seems like an obvious answer to the pleas of fleeing Millennials and Gen Zers: it provides a stable income without college debt and has a relatively low barrier to entry. LIUNA members and other union construction workers receive comprehensive training, phenomenal health and retirement benefits and career advancement opportunities. In addition, union construction workers enjoy the benefits of collective bargaining and advocacy on the job as well as safer work sites. For generations that value security, high wages and fulfilling work, this sounds like a match made in heaven. Yet a recent survey showed that only three percent of young people currently consider a construction career as an option.

Why the Disconnect?

Cultural factors and stigma surrounding the skilled trades are at least partially to blame for younger generations not yet thinking about construction as a career choice. Growing up, Millennials and Gen Zers were told the only way to make a living was to go to college and get a white-collar job. In this narrative, the skilled trades were meant for people looking for a backup plan. In contrast, older generations like Gen Xers and the Baby Boomers grew up seeing the successes of unions and blue-collar workers.

Gen Zers and Millennials are said to value openness, flexibility and independence at the workplace. They want to feel heard and valued by their employer for their unique perspectives. To those born before 1980, this can come off as entitled, opinionated or lazy. Conversely, Gen Xers and Baby Boomers are said to work long hours and value self-reliance and practicality. On the flip side, younger workers may complain their older colleagues are rigid, close-minded and too traditional.

The problem with this type of thinking is that it’s rooted in stereotypes that aren’t necessarily true or helpful. Differing attitudes across generations are most often a product of circumstances, not age. For example, older Millennials entered the workforce during the Great Recession and therefore place a higher value on job security than Gen Zers. Similarly, older Gen Zers entered the workforce in the midst of a pandemic and therefore prefer flexible work arrangements and digital communication.

Another potential reason for the disconnect is that construction is hard, physical work. A career in the skilled trades is demanding and, as with any other industry, comes with its own physical and mental health risks. But despite these risks, one report found that construction workers are among the happiest employees.

While younger generations want to feel satisfied and fulfilled in their everyday work, they also put a high premium on their health and safety. A lot of young workers aren’t willing to risk their health for the sake of a career. This is an opportunity for construction contractors to call attention to health & safety programs that address young people’s concerns and show they care about workers’ well-being.

How Can the Construction Industry Answer the Call?

The more that young people rack up thousands of dollars in student debt and barely make enough to cover their bills post-graduation, the more they question whether the college path is right for everyone. Younger workers are realizing they don’t have to follow the traditional 9-5 corporate lifestyle to achieve success, and researchers predict interest in the skilled trades will increase in the coming years. It’s now up to the employers to address young people’s concerns, show how trade work aligns with their values and adjust their recruiting strategy accordingly.

Millennials and Gen Z can be part of the change they want to see in the construction industry, including more open discussions about formerly taboo topics like mental healthy or social issues, prioritizing safety and health above a finish-at-any-cost mentality and breaking down the stigma surrounding these jobs. Meanwhile, employers and unions can work to better market apprenticeship programs, robust benefits packages and comprehensive health and safety plans. If there’s one lesson to draw from recent trends, it’s that workers are an employer’s biggest asset and should be treated as such.

Our economy is in a unique moment where five generations currently make up the workforce, so finding common ground and learning to adapt is the best way to attract and retain talent going forward.

Structured Routines for Operational Excellence and Daily Continuous Improvement

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

In recent articles, I have written extensively about the need for manufacturers to invest more heavily in technology, innovation, automation, and workforce development to counter the issues they continue to face due to the pandemic. Even when manufacturers find the raw materials they need for their operations, and they invest in their equipment and people, and successfully perform all the other daily “blocking and tackling” of manufacturing operations management.  Many companies still find themselves stuck in neutral and searching for answers to move the proverbial needle. How do these types of manufacturers find growth in productivity and sales? How do they sustain their continuous improvement efforts? Today I will share an incredibly impactful approach to operational excellence and daily continuous improvement that progressive manufacturers are using to reach that next level of performance.

When problems are visible, manufacturers can utilize well-established lean tools and techniques to solve them. However, when the issues are less visible and their root causes are not as obvious, a systematic, scientific way of thinking and acting is required to solve them and sustain the improvements. For this, we need managers as the teachers of that system. Scientific thinking is a basis for successfully pursuing seemingly unattainable goals in complex systems. This type of thinking also enables teams to make decisions close to the action and maneuver effectively and efficiently. Scientific thinking is a routine of intentional coordination between what we think will happen (theory), what actually happens (evidence), and adjusting based on what we learn from the difference.

Katas are structured routines that are practiced deliberately so that their patterns become second nature and leave the practitioners with new abilities that are meant to be built upon. The word “Kata” has roots in martial arts, where they are used to train participants in fundamental moves, but the idea of a Kata can be applied in manufacturing operations. Katas are for learning fundamental skills that you can build on.  They are a way of transferring skills and developing shared abilities and mindset in a team or organization. Combining a scientific pattern with structured practice routines contributes to the development of effective problem solvers.  Improvement Kata and Coaching Kata make scientific thinking a skill that anyone can learn by combining a four-step scientific pattern along with simple, structured routines for practicing the pattern.

How does it work in actuality? The four-step scientific pattern is as follows: 1- Set the direction or challenge for the organization. 2- Grasp the current conditions. 3- Establish your next target condition that represents a step toward the direction or challenge. 4- Conduct experiments to achieve that next target condition. And what do you do once you successfully reach that next target condition?  Establish another incremental target condition that represents yet another step toward the direction or challenge. Once this routine is practiced enough, it becomes second nature. When employees at all levels of an organization are performing in this systemic manner, it quickly transforms into a high-performance culture able to tackle any obstacle it encounters.  Some of you reading this might be thinking that this type of an approach is probably best suited for larger manufacturers, but Kata can be practiced in organizations of any size. In reality, some of the most impactful results actually come from small to mid-sized manufacturers.

As mentioned previously, when the issues are less visible, we need a systematic, scientific way of thinking and acting to solve problems and sustain the improvements. Kata is an incredibly powerful approach to daily continuous improvement. TDO’s team is fully certified to help manufacturers learn and implement these skills and develop the necessary coaches to sustain the habits. Reach out today to learn more and schedule a free consultation.

In Protection of Growth

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

There is a reason cybersecurity is recognized as one of the critical issues facing businesses today. The security of your personal finances is just as important and this area of financial planning needs much more attention than it is getting in large part because most advisors do not take the time to get a full understanding of their client’s full wealth.  Outside of adjusting your investments when the market seems shaky, when was the last time you really thought about mitigating risk for you and your family?  If you have thought about this recently, did you take any steps to address it?

Below are a number of items that we often overlook, yet in many cases are easy to address.

Umbrella Liability Policy:  You would be surprised at the number of families we come across that either still do not have one or they have one that does not come close to adequately covering their level of risk.  Does your insurance agent know your net worth? Have you discussed ALL the risks of liability in your life with them?  It’s not uncommon for insurance agents to be given enough information to get their policies in place, then move towards a “set it and forget” position and it’s too late when they find out their coverage isn’t adequate.

Credit Freeze:  Recall the 2017 Equifax breach? This is an institution that serves as the gateway to our credit score and therefore has all our precious information.  It is becoming our standard practice to take a hands-on approach with our clients and put credit freezes in place. If left to their own volition to handle, it typically doesn’t get done.  We do this because it has gotten much easier to temporarily “thaw” your credit and re-freeze when you decide to look at new lines of credit.

Credit Card Alerts: Generally, credit card companies will cover you in the case of fraudulent expenditures.  However, if you are not paying close enough attention the process may become onerous when you catch charges months down the road.  As a way to be more proactive, set alerts on your card(s) to receive text messages when they are used.  Consider setting low limits for the alerts as fraudsters tend to test their scalping of card information with some small purchases before they go for the big one.

Footprint: We are often conditioned to think “don’t put all your eggs in one basket.”  Have you applied that concept to the number of financial institutions with which you have relationships?  You might have, even inadvertently.  You think that if there is a breach with one of those companies, you still have others available to you.  What if you turned your thinking and made yourself harder to find in the first place?  Reducing the spread of your information and financial transactions may be a more secure way to operate.

What else? Our advice and work with clients in this area goes further and is an active part of our relationship. Here are a few other ideas for you to consider:

  • Virtual Private Network (VPN) on personal devices: Yes, this can be very beneficial. There are companies both very well-known and lesser known with great subscription options to protect your online dealings through personal devices, including your cell phone and tablet.
  • Credit Monitoring Service: Maybe.  You would be providing a substantial amount of personal information to yet another company.  We have worked with clients to set up simple systems to monitor this on their own, without the use of one of these companies, with a combination of tactics mentioned above in addition to some others not mentioned.
  • Two Factor Authentication whenever available: Yes, and the old advice of changing passwords regularly still applies as well.

I believe this area of financial planning does not get enough attention and it needs to get much more.  You see, we believe in protection planning first, then growth. Why? You cannot grow what is not there.

To learn more about what John G. Ullman & Associates, Inc. can do for you, visit www.jgua.com or email info@jgua.com

Meeting Patients Where They Are

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Robert J. Corona DO, MBA, is CEO of Upstate University Hospital in Syracuse, NY

In our health system, we are making an ongoing commitment to meet people “where they are.” This is not just a physical location. It is also where they are in their age, health trajectory and personal lives — as well as what they expect from the care they are receiving.

It is also the basis for our strategic direction. Hockey great Wayne Gretzky made this statement famous: he skated “to where the puck was going.”

For us in healthcare, that will mean anticipating the direction and getting in place to meet our patients where they are now and where they will be.

In particular, we want to treat people sooner — to meet them before they have the acute needs that require a hospital stay. We want to keep people out of the hospital and treated in a less acute care setting so only the most seriously ill are in a hospital bed. Toward that end, we are working on new programs that allow patients to schedule their own follow ups and to have an easier path to a telehealth appointment within our electronic medical record system. The more we can help busy people schedule the type of medical appointment that suits them best, the more likely they are to keep the visit and learn if there is any health issue that needs to be addressed at its earliest point.

This year, we also launched a “hospital at home” initiative that allows a discharge to home while still being cared for as a hospital patient. This is different from a telehealth visit, as the patient has more equipment and monitoring, but the ideas are similar. Changes like these allow care to be delivered — when medically possible — in the manner closest to what a patient wants for his or her care.

At Upstate University Hospital, we have also decided not to talk about the “hospital of the future.” This wording makes the next entity sound remote — as if it is in some far off state, detached from what we are doing today — when, in fact, it is emerging all around us.

These are the components of hospital-based healthcare we are delivering today:

  • Inpatient: patients in the traditional hospital setting
  • Ambulatory: patients seen in a doctor’s office or outpatient center
  • Virtual: telehealth visit using a phone, tablet or computer
  • Hospital-at-home care: where the patient is ill enough to need hospital treatment but stable enough to have it delivered in the home setting.

New directions for where this care takes place are tied to our overall strategic pillars of quality, experience, innovation and sustainability. These pillars have survived the stressors of an intense time in healthcare and will support us in a post-pandemic world as well.

In March, I attended a conference with other academic hospital CEOs. We all face the same issues with staffing and capacity, so solutions are necessary to create a new workforce model that delivers safety and quality. We will support this with more automation for routine jobs (such as using robots instead of staff for deliveries and improving computer-based AI) and enabling staff to use that time gained back to allow them to work to the top of their license. We also realize that these professionals answered the call at a time like no other. I hope every person at our hospital — within its walls or beyond them — realize how extraordinary they are.

I recently read “The Hero Code” by Admiral William H. McRaven.  Our extraordinary people have followed that code with a duty to each other, courage in the face of danger, significant sacrifice, perseverance and compassion in a defining moment in history.

Robert J. Corona DO, MBA, is CEO of Upstate University Hospital in Syracuse, NY and is the John B. Henry Professor and Senior Associate Dean of Clinical Affairs in the College of Medicine.  Previous roles at Upstate include Chief Innovation Officer and Associate Dean for Industry and Academic Relations, and the endowed chair for the Department of Pathology and Laboratory Medicine. He also served for many years as chief medical officer and vice president of Medical and Scientific Affairs at Welch Allyn Inc.

Glass Doctor of Syracuse has a Clear Advantage Over the Competition

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Aaron Look, Owner of Glass Doctor of Syracuse and Watertown has been in the glass business for 22 years, first working for a local glass company and then starting his own business in 2004. With two locations in Syracuse and Watertown, Glass Doctor performs full-service glass work for home, auto, and commercial customers either in their shops or onsite with a fleet of mobile glass vans. A locally owned and operated company, Glass Doctor prides itself on creating both a family-friendly workplace and an exceptional customer experience.

Family First Work Environment

One of Look’s main goals as an entrepreneur is to create a business where his employees are happy, and that means putting them and their families first. “I don’t want to own a business where there is no community,”

says Look, “the reason I wanted to be an entrepreneur was to employ people, give them a career, and put them in a position that’s good for them.”

Glass Doctor follows a Code of Values which includes Respect, Integrity, and Customer Focus. These values inform how they operate and how their employees conduct themselves on and off the job. By creating an environment where employees feel respected and valued, Look says they will enjoy coming to work. “If your employees are happy, then your customers will be happy too.”

Frank Watson, Director of Sales and Marketing for Glass Doctor has been with the company since 2019. Watson says Look understands the importance of family because it’s important to him as well. In fact, Look’s mother Katie has been working at Glass Doctor in billing and accounting for the past six years.

Look maintains an excellent relationship with his 14 employees by going out on jobs when they need an extra pair of hands. He also will work with employees to make sure their schedule meets the needs of their families, such as getting home in time to be with their children after school. “He focuses on the future and wants his employees to be healthy and happy,” says Watson, “and in return, his employees work hard for him.

Specialized Knowledge and Expertise

Look prides himself on having the best people for the job. “We use the term specialist instead of technician,” says Look. Expertise is at the core of being a specialist and Glass Doctor employees are trained to answer any question a customer may have. If an employee does not know the answer immediately, Look says, someone in the organization will. All Glass Doctor specialists focus either on flat glass or auto glass and while a job may require someone to cross over to another area, they try to keep specialists within their area of expertise. “The lead specialist on any job is an expert,” says Watson, “we only hire the best.”

The Right Tools for the Job

In order to do a job right, Look believes you must have the right tools. Glass Doctor specialists can do a job onsite using mobile flat glass and mobile auto glass vans.

The vans are mobile workstations, completely stocked with all the supplies a specialist needs to complete the job successfully.

Auto glass vans are equipped to do work on the road, but Look says, he does not send his specialists out in challenging weather conditions. “I am not going to put my employees in an environment where they can’t perform their job properly,” Look says. In instances of heavy rain, snow, or extreme cold, customers can bring their vehicle to the Syracuse or Watertown shops to have work done, or specialists will come to their home or business if they have a garage. “We can do work inside our shop or in their garage. We can supply heat if we go to a customer site and we bring all the tools we need. We try to accommodate our customers as best as possible,” says Look.

Glass Doctor’s flat glass vans are set up with lighting, work benches, and heaters. Specialists can work right inside the van, regardless of weather. “We have the newest technology and our specialists have the best tools,” says Watson.

Exceptional Customer Experience

Look’s second goal as a business owner is to provide Glass Doctor customers with an exceptional customer experience, which begins with excellent communication over the phone and continues when the Glass Doctor specialist arrives at the job site. All of Glass Doctor’s vans are fully wrapped with company branding and are clean and presentable. Glass Doctor specialists are in full uniform and wear a badge to easily identify them. Specialists are also drug tested and background checked. The specialist will lay down a branded Glass

Doctor doormat and put on boot covers before entering a home. “Our service starts on the phone, but where we really shine is when we are in the house,” says Look.

Watson says every Glass Doctor specialist is a sales representative for the company. “They are the ones doing face to face with customers and contractors. We understand the importance of doing a great job, doing it on time, and if there is an issue, we address it and make it go away.” Solving problems for customers is a key part of how Glass Doctor operates. “If we are supposed to complete a job today, we have to deliver when we promise a certain time frame. Delivering the product on time is as important as a fair price,” says Watson.

Look wants his customers to be 100% satisfied with the end result, calling customers personally to thank them for their business and see if there are any issues he can help resolve. “I can’t sleep at night if someone is upset with our work,” says Look. That customer focus is essential to Glass Doctor’s company culture. “It’s great to have growth,” Watson says, “but the key to growth is to retain the customers you already have. It goes back to making a commitment, doing what you promise, and following through. You have to keep those customers happy that made the phone ring in the first place.”

A Clear Advantage for Home, Auto, and Business

Glass Doctor specialists are able to customize and install glass products for home, auto, and business customers. For homeowners, they make tabletops, design  and  install  frameless  and  semi-frameless

showers, insulated glass units, foggy glass, glass handrails, and replace windows and glass doors. “When a customer breaks a window,” says Look, “they think they have to replace the entire window. In reality, they might just be able to replace the glass and that can save them time and money.”

Glass Doctor Specialists do all auto glass, windshield glass, door glass, back glass, and ADAS calibration for cars, fleets, and trucks. Glass Doctor guarantees their windshield replacement for one year, something that sets them apart from their competitors. “If we replace a windshield for you and something happens to it, whether it’s a day later or 364 days later, we will replace it for free,” Look says.

In the last five years, the auto industry has changed remarkably and in the next five years, Look predicts at least 90% of new vehicles will have Advanced Driver Assistance System (ADAS) features. ADAS features include auto assist, lane departure, and forward collision alert, for example. These features are controlled by a camera behind your rearview mirror, says Look, and when a car windshield is replaced, the camera has to be uninstalled and remounted after the work is done. “When you reinstall the camera,” says Look, “you need to ensure it is recalibrated so that the safety features will work properly. We can do ADAS recalibration in house, so drivers do not have to go to the dealership after their windshield is replaced.”

For business customers, Glass Doctor specialists install glass for storefronts, tabletops, commercial doors and provide lock repair and maintenance, emergency service, and board ups. For large office and commercial buildings or apartment buildings, Glass Doctor offers an apartment advance measuring service. Look explains that large commercial buildings have many of the same window size. “We measure them and manufacture some in advance, so when a window is broken, we can go and replace them same day, instead of having to wait a week or more to have one made,” Look says.

Building the Future for Glass Doctor

The home shower business is Look’s next focus, hoping to double or triple his business in the next year or two. “We come right to your home with samples and provide a full CAD drawing of what the shower would look like. There is so much customization that is possible with shower glass,” says Look.

A recent project included 70-80 showers for the lofts at

300 East Washington Street in Syracuse. “We are available to work with contractors and builders when they need to build out showers or mirror work,” says Look.

Since 2020, Look says they have experienced 600% growth in their business. Look attributes their massive growth to hard work and the right employees. Things have been going so well, they are considering opening a third location in Utica.

Watson says, “Glass Doctor supplies the best technology, the best tools, new vans, and safety protocol for specialists going into people’s homes. We take the extra steps to make people feel comfortable and want to do business with us.”

Glass Doctor has locations in Syracuse and Watertown. For more information, visit glassdoctor.com/syracuse-ny.

Sarah Arnold, Insurance Agent and Glass Doctor Customer

Sarah Arnold is a Glass Doctor customer and an insurance agent. When Arnold and her

husband were building a home, she chose Glass Doctor to build her glass showers. “They were fairly and competitively priced. They are easy to work with and educated me  on  all  the  glass

options available. I was extremely impressed when the owner came to do the install himself. It’s clear that they want every customer to have a great experience.”

Arnold says any time she has an insurance client in need of glass repair whether auto or home, she doesn’t hesitate to refer them to Glass Doctor. “They are professional, timely, and clean,” she says, “Glass Doctor is great to work with.”

Key Considerations in Valuing a Construction Company

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Deborah E. Finch, CPA/ABV, CVA, CDA, Dannible & McKee, LLP

As the owner of a construction company, there are many possible reasons for needing to know the value of your business. Whether you are contemplating a sale or merger, planning for internal ownership succession, considering gifting stock to family members, or obtaining financing, determining what your company is worth is one of the first steps in the process. Just as importantly, understanding how your company is valued can provide valuable insight into the measures that you can undertake to enhance the value of your business over time.

Traditionally, there are three primary approaches to valuing a business

  • Market-based approaches, which look to transactions involving the sale of similar companies in the same line of business in order to derive multiples of sales, earnings or other metrics to apply to the company to be valued.
  • Asset-based approaches, which value a business based on the fair market value of its assets less its
  • Income-based approaches, which value a business by looking to the future earnings or cash flows it is expected to generate in the future.

Market-Based Approach

Since most construction companies are closely held businesses, obtaining information on transactions that have occurred in the market can prove difficult. So too can obtaining the necessary information to determine the true comparability between two construction companies before applying valuation multiples under the market approach. As a result, most valuations of construction companies focus on either the asset approach or the income approach.

Asset-Based Approach

For construction companies with significant equipment and facilities, such as a highway contractor, the asset-based approach may yield the highest value in a transaction. In addition, since many heavy equipment contractors are required to be the low bidder on many of their contracts, they are often poor candidates for employing an income-based approach.

In determining value under an asset approach, the company’s financial assets, such as accounts receivable and unbilled contracts in process are revalued based on the amount that is likely to be realized in cash. Similarly, tangible assets are revalued to their fair market value based on the current cost to acquire or reconstruct a replacement asset of comparable utility. After determining the fair market value of the company’s financial and tangible assets, the existing liabilities of the company are subtracted from this value, resulting in the entity’s Adjusted Book Value.

In some instances where significant intangible assets value may exist in addition to the value of the company’s “hard” assets, these intangible assets may also be separately valued and added to the Adjusted Book Value. Examples of intangible assets include contract backlog, name recognition/reputation, a trained and loyal workforce, and strong client and vendor relationships. These intangible assets are generally reflected as “goodwill” in the context of a business valuation. Valuing the goodwill component of a construction company is generally accomplished through an income approach such as the capitalization of earnings.

Income-Based Approach

For general contractors or specialty contractors with fewer assets and a higher reliance on credit, the income-based approach is generally preferred. This approach to valuation is based on the company’s expected future annual returns to an investor. Where reasonable future cash flows of the company can be projected, these future cash flows are converted into current value. This is accomplished by discounting the future cash flows to today’s dollars using a discount rate based on the risk inherent in an investment in the company. In essence, the discount rate reflects a safe rate of return, plus an additional return that will compensate the investor for the risk of achieving the projected future cash flows.

As an alternative to discounting future cash flows, historic earnings or cash flows can be adjusted and capitalized. Where earnings are used in lieu of cash flows, the earnings measure most often utilized is EBITDA (Earnings Before Interest, Taxes, Depreciation and Amortization). Regardless of the measure used, the company’s historic earnings or cash flows must be “normalized” in order to reflect the benefit stream an investor can expect to receive in the future. Typical normalization adjustments include owner’s compensation and fringe benefits, related party transactions, and nonrecurring or extraordinary items. Once an average annual earnings stream has been determined, this amount is converted into value by dividing it by a capitalization rate (a derivative of the discount rate) that reflects risk and future growth.

As you can see, there is no single approach or simple formula to valuing a construction company. Just as every construction company is unique, so too must the analysis

of the company be in order to select the best valuation approach, discount or capitalization rate and other valuation adjustments. Engaging a professional with the experience and expertise in valuing entities in the construction industry is critical to arriving at the true value of your company.

Deborah E. Finch, CPA/ABV, CVA, CDA, is a tax partner at Dannible & McKee, LLP, a public accounting firm with offices in Syracuse, Binghamton and Albany. The firm has specialized in providing tax, audit, accounting and advisory services to the construction industry since its inception in 1978. Debbie has extensive experience providing business valuation and succession planning services. For more information on this topic, you may contact her at dfinch@dmcpas.com or (315) 472-9127 x160.

The Critical Role of Apprenticeship and CTE Programs in the Construction Industry

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Earl R. Hall, Executive Director Syracuse Builders Exchange

Labor shortages continue to plague the construction industry both regionally and nationally, with such issues happening long before the COVID-19 pandemic. Although the pandemic has increased the shortage of workers, the long-term solutions to solving the labor shortage in construction remain complex. Two such solutions which have proven to be effective are the apprenticeship programs offered via the many local building trade unions and the Career and Technical Education programs offered by local school districts.

There is a renewed focus on apprenticeship and training programs by the trades across upstate New York. Apprenticeship programs combine classroom and industry-related instruction provided by the union, with on-the-job learning provided by employers. All apprenticeship programs are registered with the New York State Department of Labor and governed by a Board of Trustees which include both employer and union representation.

Capital investments into new or existing apprenticeship and training centers can be seen right here in central New York. The North Atlantic States Regional Council of Carpenters Local 277 built a state-of-the-art training center in 2018 in Syracuse. During 2021, the union recruited 250 apprentices and new journey men/women into the union. As a result, the union is planning to expand the training center to not only accommodate the new apprentices, but to provide the delivery of additional training and education.

Apprenticeship programs remain attractive to young men and women as they provide a career pathway without having to incur debt to pay for the training and education. The “learn while you earn” concept is a delicate balance of providing apprentices with required training and on the job work. As a trustee on many of these Funds, I see firsthand the immediate benefit of this model for both the career-minded apprentices and those employers who hire them.

Pre-apprenticeship programs attract candidates who may  explore  the  construction  industry  at  a  very elementary level while deciding if it is a career for them, and if so, what trade is of most interest. In central New York the Syracuse Builders Exchange has partnered with Syracuse Build’s Executive Director Christopher Montgomery to place those students who graduate from their pre-apprenticeship program. Graduating students may be placed directly into the workforce with a construction industry employer or may be placed into one of the many union apprenticeship and training programs to further develop their careers.

Career and Technical Education (“CTE”) programs have increased in high schools throughout upstate New York. As a member of the Syracuse City School District’s CTE advisory board, I witness the impact such programs have on impressionable, young students who see themselves entering their chosen career upon graduation from high school. Although the Syracuse City School District’s CTE program was the first of its kind in upstate New York, the model developed by the Syracuse City School District is now being reviewed and considered by other school districts.

While construction, welding and electrical are just a few of the career pathways offered by the CTE program, new offerings such as Construction Management will be delivered to students in September 2023 when the new STEAM (science, technology, engineering, and mathematics) school opens in downtown Syracuse. The Construction Management curriculum is being developed by a committee of executives of construction management companies from throughout central New York.

While no one solution will solve the labor shortage issues plaguing the construction industry, initiatives such as apprenticeship and pre-apprenticeship programs, and CTE programs in high schools provide employers with optimism that the next generation of construction worker is actively being recruited. The question is, will there be enough workers to fill all the positions anticipated over the next few years? Most likely not.

Case Study: Caught with his Hands in the Till?

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Annette Malpica, Vice President, Director of Claims & Legal Counsel, Lovell Safety Management Co., LLC

In recent years, employers have seen a rise in the number of claims for work-related occupational repetitive    stress    injuries     (“RSI”).     Occupational diseases, unlike accidents, which occur suddenly and unexpectedly, usually develop over an extended period. The increases in occupational RSI claims were most notable after the 2007 Workers’ Compensation Reform legislation set in motion increases in the weekly rate of compensation, from $400 in January 2007 to $1063 a week as of July 1, 2021. It is not uncommon for RSI claims to be filed by employees who claimed no lost time from employment, continue to work without any limitation, and require minimal medical treatment. The cost of RSI claims ballooned post reform. NYCIRB’s State of the System 2021 Report found that permanent partial disability (“PPD”) claims accounted for over 73.4% of losses, even though they represented only 18.6% of the claims filed in 2021.

The RSI case of JT is not unusual. JT, a laborer for a construction company, filed an occupational disease claim in 2019, after being terminated from employment. He alleged RSI to both elbows, hands, and bilateral carpal tunnel due to jackhammering and shoveling. According to his doctor, the injuries occurred within two months of the claimant’s employment. The claimant never received any treatment, surgery or lost any days from work during his employment since the diagnosis of occupational injuries occurred post-termination. He is seeking $145,000 in a schedule award. The Workers’ Compensation Board (“WCB”) must determine whether the claimant’s conditions meet the legal requirements for an occupational disease entitling him to a schedule loss of use award (“SLU”).

Repetitive Strain Injuries as Occupational Disease

Workers’ Compensation Law § 2(15) defines an “occupational disease” as “a disease resulting from the nature of employment and contracted therein.” Occupational diseases that meet this legal standard are compensable under the WCL. In Goldberg v. 954 Marcy Corp., 276 N.Y. 313 (1938), New York’s highest court defined an occupational disease as:

[c]onditions to which all employees of a class are subject, and which produce the disease as a natural incident of a particular occupation, and attach to that occupation a hazard which distinguish it from the usual run of occupations…

Occupational RSI are often diagnosed as: carpal tunnel, tendinitis, bursitis, or cubital tunnel syndromes. Symptoms range from pain or tenderness, stiffness, or joint restriction, tingling or numbness, cramping and swelling of the extremity.

Claimants who had established RSI claims may be entitled to permanent partial disability or, SLU awards. The skyrocketing cost of SLU awards was an area of contention that the 2017 Reform legislation attempted to address by requiring updated Impairment Guidelines.

The 2017 Reform Legislation and Skyrocketing Cost of SLU

The 2017 Reforms directed the WCB to create new SLU impairment guidelines (the prior guidelines were issued in 1996) to reflect “advances in modern medicine that enhance healing and result in better outcomes.” Unfortunately, the 2017 Guidelines represent a missed opportunity to modernize the system. The new guidelines produced SLU outcomes comparable to the 1996 Guidelines with some clarification regarding ranges of motion and other special considerations. The Guidelines, however, lacked objective measurements, were subject to manipulation and failed to adequately reflect medical advancement in treatments. Had such factors been considered, they would have often resulted in findings of minimal or no permanent loss to a claimant’s earning capacity.

As for JT, whether he was caught with his hands in the till or ultimately awarded a SLU based on his disability, one thing is for certain – the ever-skyrocketing costs of occupational RSI.

Annette Malpica R.N., Esq, is VP, Director of Claims & Legal Counsel at Lovell Safety Management Co., LLC. For more information on workers’ compensation, contact Lovell at 1-800-5-LOVELL or visit online www.Lovellsafety.com.