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Upstate Cancer Center: Improving Cancer Outcomes for All

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BY BECCA TAURISANO

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

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

Multidisciplinary Approach to Care

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

Clinical Innovation

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

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

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

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

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

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

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

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

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

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

Improved Experience for Patients and Staff

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

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

Investment in Technology

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

Research Integration

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

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

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

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

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

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

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

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

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

Mental Health in the Workplace

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By Elizabeth Landry

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

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

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

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

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

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

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

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

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

Workforce Challenges

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BY KATHRYN RUSCITTO, ADVISOR

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

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

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

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

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

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

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

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

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

Upstate Community Giving
Campaign Raises More Than $570,000

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tony Vitagliano, Senior Vice President, Provider Network Engagement

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

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

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

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

St. Joseph’s Health Welcomes
Primary Care Physician

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

Enfoqué Images: The Sky’s the Limit

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Elizabeth Landry

Jackie Vidler’s mother always knew her daughter was an interesting, eclectic, and creative person who did things just a little bit differently. Those characteristics reveal why Vidler has always had an interest in art, specifically photography. However, like many people who have an artistic bent, she never dreamed she would be able to make photography her career.

When Vidler had her own daughter 14 years ago, her passion for photography really took off. She found herself wanting to capture all the special moments as her daughter grew, and photography helped her achieve that goal.

“I was taken aback at how fast time flew by and how quickly one milestone was replaced by the next,” Vidler said.

Shortly thereafter, she accepted a job offer to assist a local photographer, and she eventually became an artistic director. Vidler quickly realized how fulfilling it was to be able to document important moments and memories for others: she photographed weddings, families, pets, and any subjects that came her way.

Never being one to stay complacent with her current situation, though, Vidler knew she needed to branch out on her own. Around 2010, she created Enfoqué Images and became a small business owner herself.  She named her business “Enfoqué,” which means “in focus” in Spanish, as a way to pay homage to her Puerto Rican heritage.

For Vidler, her passion for photography stems from her desire to help others and to capture the progression inherent in life.

“It’s easy to recall the before and the after. But there’s so much more to life than just the beginning and the end. The true beauty of any story lies in the middle,” Vidler explained.

A New Client: The Construction Industry

After several years of operating Enfoqué Images, Vidler found herself wanting to expand the business even further. She began to explore how her business could offer photography services to other local businesses, since she has always had a desire to help others and give back to the community.

“Businesses are ideal clients for me because every great business has a commitment to continuous improvement, leaving so much progress to capture. Documenting a brand’s product or service helps to establish visual representation for that business. It’s my own professional spin on showing a business that we ‘see’ them,” she said.

After completing an extensive application process, Enfoqué Images became a Minority and Women Business Enterprise (MWBE) in 2019. The MWBE certification helped expand the reach of Enfoqué Images, opening up new opportunities in the construction industry, specifically. Although Enfoqué Images had been providing photography services to other local industries in the Syracuse area, Vidler found that construction businesses were the most natural clients because progression is so central to every construction project.

As a full-service photography and videography studio serving the construction industry in central New York, Enfoqué Images assists quality management through outstanding photographic documentation during the entire contract period. Services include photography of existing conditions, mobilization, safety setup, material storage, demolition, construction progress, inspection punch list items and final close-out. Enfoqué Images is certified for government contracting through the City of Syracuse, both federally and statewide. The business is certified with industry codes NAICS, 541922 in commercial photography, NAICS, 512120 in motion picture and video and NIGS, 91572 in photography services.

For Vidler, photographing for construction contracts is especially enjoyable because it allows her to truly focus on the process happening in real-time, and because of its fast-paced nature.

“It’s really cool to see a project come together. We did progression documentation for Industry Standard USA at the Syracuse VA hospital when they were putting in new sidewalks. It was cool to go up weekly and to see the progression over the weeks. And of course, you never know what you’re going to get. I might get a call saying, ‘the pourers are going to be here tomorrow, so we need you here tomorrow’ and we’re ready to go. It’s really exciting. It’s great to see a plan come together and to watch it grow,” she described.

Expanding Horizons with Drone Photography and Videography

In order to further progress and evolve as a business, Vidler became interested in utilizing drone technology to add aerial photography and videography services to Enfoqué Images’ repertoire. She knew that utilizing aerial technology would expand her business’ opportunities even further, but by no means was obtaining the needed certification simple or easy.

“I made the investment in purchasing drone equipment. I researched and studied the ins and outs of aerial documentation. After almost a year of extensive and intensive studying, I made it happen, passing my drone pilot license testing and obtaining my Part 107 UAS Remote Pilot Certification in 2019,” Vidler stated.

While flying a drone may seem intuitive to some, Vidler described how the knowledge she gained during her certification process is complex and covers many topics.

“The drone license test is very interesting. It’s certainly not simple for the everyday person to understand,” she said. “I had to learn about the different types of clouds, learn how to read different types of maps, know about the different air spaces and remember not to fly the drone above 400 feet, for example. It’s pretty intense.”

Although obtaining her drone photography certification was strenuous, Vidler knew it would be essential in order for Enfoqué Images to flourish in the company’s work with construction contracts. The construction industry had already experienced tremendous benefits from utilizing drone technology, and she wanted to be able to help local construction efforts by offering aerial photography and videography services herself. Drones provide a new vantage point in the sky that improves the visual documentation of any construction project. Aerial documentation benefits many aspects of construction, including the mapping, planning, surveying, safety, inspecting and service needs that are integral to project success.

The safety benefits of drone technology have been a major draw for Enfoque Images’ construction clients. “I was talking to a potential client recently and I mentioned that I do drone photography and videography. He said, ‘Wow, that’s really great – so, my guys wouldn’t have to get up on the scaffolding and scale the side of the building to check out some corrosion, it would just be sending up a camera?’ It helps save the companies manpower and can even help avoid injuries, which is great,” Vidler explained.

In her research into drone photography and videography, she also found reports that showed construction companies that utilize drones have experienced significant improvement in their operational efficiency and reduced overall costs. Drone technology allows photographers to capture aerial data easier and faster, and allows for improved decision-making, more thorough identification of worksite issues and greater predictability for project schedules.

Vidler explained how she takes great pride in offering these state-of-the-art services to her construction clients. “As a drone photographer, I can offer contractors the best images available to help attain their goals. They’ll be able to use their photos to show the various angles of the project and to demonstrate their abilities to meet the requirements of the hiring agency,” she said.

Onward and Upward

From its humble beginnings over 10 years ago, Enfoqué Images has grown leaps and bounds into the small business it is today. Although the business’s capabilities and services have expanded and evolved in many ways, the core passion behind Vidler’s work has remained the same: to help others through photography and to support the local business community.

Over the next several years, Enfoqué Images will continue to grow and help highlight the progress demonstrated by local industries. For the construction industry specifically, Vidler emphasized that progress should be documented both on and off the jobsite. “With construction, obviously documentation of the actual physical project is a huge part of it, but it’s important to note we also offer headshots and social media content, for example. Those services may not be directly related to the jobsite but there’s always a way I could help the businesses and support them through photography and videography,” she said.

As the business offerings expand, Vidler is also looking forward to growing the Enfoqué Images team. “I will be extending the Enfoqué Images brand as an umbrella to cover all aspects of photography. I want to onboard other photographers and provide a space for each of them to take the lead in the industry areas they have a passion for,” she stated.

When asked about the overall reach of the business in the future, Vidler expressed her excitement about the possibilities, but emphasized that Enfoqué Images will always be ingrained in the central New York business community. “Enfoqué Images, at its core, will always stay a local business. I will always be connected and giving back within the community that’s home to me. But for the future reach of Enfoqué, I feel it is limitless. I take pictures in the sky now, so I can confidently say ‘the sky’s the limit’.”

Research and Development Credits Within the Construction Industry

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Nicholas L. Shires, CPA , Abby K. Sweers, CPA, Dannible & McKee, LLP

When taxpayers think of research and development (or R&D), most picture scientists in long white coats mixing liquids in a laboratory. However, the meaning of research and development in the tax world goes far beyond that. While the construction industry may not be the first that comes to mind when thinking about R&D, it certainly contains its fair share of qualified projects. For construction companies that take advantage of these R&D projects, changes are on the way.

Originally introduced as a temporary credit in the Economic Recovery Tax Act of 1981 (ERTA), the R&D credit was made permanent in 2015 with the passing of the Protecting Americans from Tax Hikes (PATH) Act. For construction companies that qualify for the R&D credit, thousands of dollars in credits can be claimed on the associated income tax returns, depending on the level of qualified expenses. While the R&D credit has been around for several years, effective for tax years beginning after December 31, 2021, as part of the Tax Cuts and Jobs Act (TCJA) of 2017, the treatment of qualifying research expenses used in the credit are undergoing a major change.

Generally, for projects to qualify for the R&D credit, they must be technological in nature, and their application must be intended for use in developing a new or improved business component or process for the taxpayer. In addition, substantially all the activities of the research must be elements of a process of experimentation relating to a new or improved function, performance, reliability or quality. Within the construction industry, these research projects could include developing new processes that would reduce the time spent on site, creating new materials for use in projects with unique conditions, designing or improving tools and equipment that would lead to improved job efficiency and many more. For example, say a contractor is working on a road in an area that endures heavy snowfall. If they were to develop a new mix of materials (asphalt, concretes, etc.) that would experience less wear and tear from the snow, that would be considered R&D.

The qualifying research expenses can be broken down into two categories: (1) in-house research expenses and (2) contract research expenses. The in-house research expenses include wages paid to an employee for engaging in qualified research, amounts paid for materials and supplies used in the conduct of qualified research and any amounts paid to another person for the right to use a computer in the conduct of qualified research. Contract research expenses include 65 percent of any amount paid to another person, other than an employee, for qualified research.

As previously mentioned, the way that these R&D expenses are to be treated by the taxpayer is altered for tax years beginning after December 31, 2021. The TJCA amended Internal Revenue Code (IRC) § 174, which outlines the treatment of research and experimental expenditures. Previously, taxpayers were allowed to immediately deduct their qualifying research expenses in the year they were paid or incurred. Based on the amendments to IRC § 174 included in the TCJA, taxpayers must now capitalize these expenses and amortize them over five years.

For example, assume a taxpayer has $200,000 of qualified research expenses for the 2022 tax year. Prior to the TCJA amendments, the taxpayer could expense all $200,000 of these expenses in the year they were incurred. Under the new rules, the taxpayer must capitalize these expenses and would be entitled to an amortization expense of $20,000; $200,000 divided by 5 years and applying a midpoint to amortization to cut the first full year expense in half, as specifically stated in the code section.

Although these changes may appear to make the credit less lucrative, this should not deter taxpayers from pursuing the credit as it’s still very beneficial to those that qualify. The Internal Revenue Service has been known to look further into these credits when claimed by taxpayers, so it is important to contact your tax professional early to ensure that proper substantiation is being maintained throughout the process of each qualifying project.

Nicholas L. Shires, CPA, is the partner-in-charge of tax services and Abby K. Sweers, CPA, is a tax manager with Dannible & McKee, LLP, a public accounting firm with offices in Syracuse, Auburn, Binghamton and Schenectady, New York.  The firm has specialized in providing tax, audit, accounting and advisory services since its inception in 1978.  For more information on this topic, you may contact them at (315) 472-9127 or visit online at www.dmcpas.com.

A-Frame Ladders Vs Platform Ladders

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Wael Khalil, CSP  Safety Representative Lovell Safety Management Co., LLC

Have you noticed in recent years that more general contractors are requiring platform ladders instead of standard A-frame ladders? As a matter of fact, some general contractors (GCs) will not allow ladder usage on their jobsite, period. On some construction sites, A-frame ladders have become a tool of last resort when performing work at an elevation. Most GCs would prefer that employees use manlifts, scissor lifts, boom lifts or other elevated work platforms rather than ladders. The main reasoning behind this philosophy is to eliminate a primary source of costly fall injuries.

FALLS CONTINUE TO BE THE LEADING CAUSE OF DEATH AND SEVERE INJURY IN CONSTRUCTION. In 2020, there were 351 fatal falls to a lower level out of 1,008 construction fatalities (BLS data). A 2014 study published by the Centers for Disease Control and Prevention (CDC) cited ladders as being a leading cause of workplace injuries. According to the study, an estimated 81% of construction-related falls treated in U.S. emergency rooms involved a ladder. The most common ladders used on construction sites to perform work are A-frame ladders. When these ladders are used in accordance with required safety work practices dictated by manufacturers and regulating bodies, they can be a very useful and safe piece of equipment. Unfortunately, A-frame ladders are misused more often than we would like to admit.

Most injuries associated with A-frame ladders occur when employees climb higher than the 3rd step from the top, when overreaching to the side of the ladder, missing or slipping off the bottom step/rung, and using a worn or damaged ladder. Many of these hazards can be significantly minimized by using platform ladders instead of standard A-frame ladders.

On a platform ladder, you are typically standing on a 1’x1.5’ (or larger) platform, not a 3” ladder rung. This provides the use of a firmer and more stable surface to stand on, which minimizes fatigue and subsequently slipping off ladder rungs. The elimination of the ladder cap and second rung eliminates the potential hazard of climbing too high on the ladder. In addition, the fact that the user is standing firmly in the center within the framing of the ladder, the potential of falls due to reaching to the sides of the ladder is minimized.

 

While platform ladders will not eliminate all ladder fall hazards, they can be another tool that can significantly help minimize the potential for fall-related injuries when used properly. As employers, we still need to practice the fundamentals of hazard prevention through steps outlined in the same 2014 CDC Article:

1) plan the work to reduce or eliminate the need for using ladders by apply­ing safety-in-design and constructability prin­ciples to finish as much of the work as possible on the ground;

2) provide alternative, safer equipment for extended work at elevation, such as aerial lifts, supported scaffolds, or mast climbing work platforms;

3) provide properly selected and thoroughly inspected ladders, that are well-matched to employee weight, task, and location;

4) when applicable, provide proper accessories to supplement safe ladder use; and

5) provide adequate ladder safety information and training for employees.

Familiarity and compliance with the provisions of safety regulations, such as recognizing ladder types and conditions, and using ladder positioning and other safe ladder practices, are crucial to reducing injuries from ladder falls.

LSM Group Members Can Contact Their Local LSM Safety Representative for Further Assistance Regarding Proper Ladder Selection or Ladder Alternatives.”

Building an Effective Job Site Safety Program

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Paul Coderre, Vice President of Risk Management Services, OneGroup

If you’re a contractor, your job sites present the most consistent and, in most cases, the greatest potential for employee, subcontractor and visitor injuries. While your shop, yard and office can generate occasional accidents, most injuries occur on the job site. The reason isn’t mysterious – your job sites carry the greatest risks and hazards. For the most part, those risks and hazards are known and recognized by site superintendents, foremen, and workers.

So, why do we still have incidents and injuries if most of the hazards are known? It comes down to the level of risk that you, and in turn your supers and employees, are willing to accept in order to get the job done. Other than asteroid strikes, earthquakes, and locust swarms, if we recognize something as a hazard, we can reduce or eliminate the risk of an injury. Now that you’ve rolled your eyes, let me say that I agree with you. If we want to get anything done; on a construction site, or getting to work, or walking across the street, we must accept a certain level of risk. We can’t escape risk; it is inherent to life.

However, the level of risk we accept is not an all-or-nothing proposition. In construction, deciding the level of risk we will accept is a dynamic part of our decision-making process. As business leaders, you make those decisions. If your job requires an excavation, there is risk associated with that part of the job. Your risk acceptance decision could range from high-risk (excavation without a trench box or cut-back) to low or moderate risk, in which you apply controls to minimize the potential for collapse or cave-in. The accident and injury results that your organization faces are an outcome of your risk mitigation decisions.

But how do we keep people on our job sites from taking decision making into their own hands? We are all familiar with the employee who works on the roof without a harness and lanyard; or the one that operates a saw without the guard; or the one that uses the unsteady scaffold, on the brink of falling over. That’s where we come back to the fact that this is your company. You decide the level of risk that your company is going to accept. The trick is getting that message out and making sure your decisions are followed.

Easy job site safety fixes can be tempting – do some inspections, hold a couple toolbox talks and – boom – your job sites are safe. Unfortunately, job site safety is more involved than that. If you leave the decisions up to your employees without any guidance, then your job site and your results are uncontrolled. The level of risk being accepted is being left to the person you hired yesterday.

Here are the key elements of an Effective Job Site Safety Program:

  • Commitment
  • Understanding
  • Communication
  • Accountability

Consistently applying these elements of risk management to your organization will result in a risk level that you have decided is acceptable.

Commitment: Do your site supervisors manage the risk on your site (to your expectations), or do they go through the motions? I often go into organizations as a safety consultant, and am handed a three-ring binder, and am told, “This is our safety program.” It typically requires the supers to hold daily toolbox talks, document their safety inspections, hold workers accountable for everything from wearing hard hats to lifting with their legs, and more. The jobsite usually engages in some variant of the program described, but very rarely do they enforce every step of that program.

When you develop your safety program, make sure it is your program. We put together program templates for companies all the time. Each time we put together a program template for a company, we tell the owner to go through the program and make it their own; eliminate the things that don’t apply to their operations and even more importantly, eliminate or modify the things they do not intend to do. Once the program is built to accommodate an acceptable level of risk, commit to it. Make that program the rule by which you, your supervisors and your employees will live by. This is by far the most important aspect of keeping job sites safe.

Understanding: After building your safety program, you must make sure that everyone in the organization (particularly your managers and supervisors) understand your expectations. They should know, and be able to apply, the protocols you established in the plan without having to reference it (because it’s at the office or in the trailer, not out on the job).

If you have certain requirements for inspections or training or PPE, the supervisors should know the requirements and why they are in place. They must also know your level of commitment to those requirements. Only then will they understand that they must maintain that acceptable level of risk on your site, because that level of risk will yield the results you are looking for. And only then will your supervisors understand the need for them to administer those protocols over the job.

With the understanding built among the supervisors, they will also extend that understanding to the employees. Again, if the employee group doesn’t understand the expectations, they can’t be expected to work within them. Building this understanding takes both continuous training (upon hire and periodically during the project) and constant reinforcement by the supervisors – which brings us to our next element.

Communication: Risk management is a very broad discipline, particularly in construction. Minimizing the possibility of an accident or injury can include everything from health exposures (i.e., silica), to mechanical (i.e., power tools), to electrical (i.e., arc flash), to falls (i.e., ladders and scaffold) and many other risks. We cannot expect employees to intuitively know or understand all our expectations. Therefore, we must commit to continuous communication of those expectations as the demands arise. If a job involves work from elevations, then we must build understanding in those risks. If it involves a chemical exposure, then that must be trained (establish the expectation) and reinforced with continuous reminders.

Much the same as establishing the expectations for production results, your supervisors must continuously be present to build understanding of the safety protocols, and to provide appropriate reinforcement to workers based on observation. The term “reinforcement” brings us to our next element.

Accountability: The term accountability has developed a negative slant in recent years. Holding your staff accountable is really just making sure they are operating to your expectations, which isn’t a bad thing. Accountability, driven by the process of providing feedback and reinforcement to people, is the most important way to make sure they understand what you desire for your company and for their safety. Holding someone accountable could mean providing positive feedback or acknowledging that an individual (or group) executed their jobs successfully. On the other side, accountability can also mean providing feedback if the group did not perform as expected, requiring you to restate your expectations or provide additional education or training on an issue that was missed. If your expectations continuously go unmet, you can make risk-based decisions as you find appropriate.

However, you look at it, holding people accountable and providing feedback is the best way to ensure that your expectations (safety program) are being followed. Don’t shy away from routinely providing feedback.

Summary

The bottom line is that job site safety isn’t rocket science (unless you’re building a launch pad). Effective job site safety is based on deciding what you are trying to get done and the level of risk that you are willing to accept to do it (commitment), teaching your people about your expectations (understanding), continuously reinforcing those expectations (communication), and letting people know whether or not they are meeting those expectations.

Nothing will be as effective as creating a thorough and realistic safety plan and making sure it is enforced at all times. For those just getting started on Building a Job Site Safety Program, here are few items:

  • Get a Safety Program Template
  • Train your employees
  • Conduct site inspections
  • Do accident investigations, and
  • Maintain the appropriate documentation.

This is a much shorter list of things to do, you’ll notice that the title was also shortened by taking out the work “Effective.” The only way to have an effective job site safety program is to take a comprehensive approach and follow through with it.

For more information, please contact Paul Coderre, Vice President of Risk Management Services at PCoderre@OneGroup.com.

MAJOR CHANGES COMING REGARDING CERTIFICATION AS A VETERAN OWNED SMALL BUSINESS (“VOSB”) AND SERVICE-DISABLED VETERAN OWNED SMALL BUSINESS (“SDVOSB”)

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Diana Plue, Esq. Sheats & Bailey, PLLC

The United States government has promoted veteran owned businesses as essential for the U.S. economy.  Each year the federal government and NYS awards a portion of contracting dollars on federal projects to certified veteran and service-disabled veteran owned small businesses.

The federal government had two programs that provided federal agencies authority to set aside government contracts for exclusive competition among veteran owned small businesses.  Those programs were 1) A self-certification program under the Federal System for Award Management (SAM.gov) that gave access to non-VA government contracts set aside exclusively for SDVOSBs and VOSBs; and 2) the Veterans First Contracting Program, which required VOSBs and SDVOSBs, who wanted to bid on VA government contracts set aside for veteran owned businesses, to be certified by the VA’s Center for Verification and Evaluation (“CVE”).   

As of January 1, 2023, there will no longer be two separate programs. There will no longer be a self-certification program under the Federal System for Award Management and the CVE will no longer be certifying businesses as VOSB or SDVOSB.  Instead, starting January 1, 2023, all veteran owned small businesses will be required to apply for and be certified as a VOSB or SDVOSB by the Small Business Administration (“SBA”).

What does this mean for businesses currently certified by the CVE and for businesses currently self-certified? For businesses currently certified by the CVE they can continue to bid on VA and other government veteran set aside contracts until the end of their three-year approval term, at which time they would then need to recertify with the SBA. 

A self-certified VOSB or SDVOSB must apply for certification with the SBA by December 31, 2023. A self-certified SDVOSB that applies for certification with the SBA within this period may continue to compete for non-VA veteran set-aside contracts until the SBA has acted upon the application for certification. 

To be certified by SBA as a SDVOSB or VOSB the following criteria must be met:

  1. At least 51% ownership by one or more veterans or service-disabled veterans.
  2. The service-disabled veteran owners must have a service-connected disability.
  3. Veteran or service-disabled veteran ownership must be real, substantial, and continuous. The Veteran or Service-disabled veteran owners must have the authority to independently control the day-to-day operations of the business and make long-term decisions for the business and must run the business.
  4. Must be a small business according to SBA’s size standards.
  5. The veteran or service-disabled veteran owners must share in the profits equal to their ownership interest.
  6. The veteran or service-disabled veteran owner must hold the highest officer position in the company.

In addition to Federal SDVOSB certification a business can also apply for New York State SDVOSB certification. NYS has its own SDVOSB program ran by the Office of General Services.  NYS has legislated that 6% of state contracts be directed to NYS certified SDVOSB companies. The requirements for certification under the NYS SDVOSB program are similar to the Federal Program requirements but there are some differences as follows: 1) NYS defines small business as having 300 or less employees; 2) NYS requires the SDVOSB be located within NYS or have significant business presence in NYS; and 3) NYS requires the business to be operating for one year prior to application.

Before certifying as a VOSB and SDVOSB it is imperative that a business understands the control and ownership requirements of VOSB and SDVOSB certification. The business must be unconditionally owned and controlled by a veteran or service-disabled veteran. This unconditional control must be reflected in the business’ controlling documents and everyday operation of the business.

Procuring contracts that are set aside for VOSB or SDVOSB when the business is not unconditionally owned and controlled by a veteran is a violation of the False Claims Act and can have dire consequences such as prison time, large civil fines up to triple the profit earned on improperly gained contracts as well as debarment for five years from future federal contracting opportunities.

The process for VOSB and SDVOSB certification has many nuances. The attorneys at Sheats & Bailey, PLLC are experienced with these processes, and always ready to lend a hand to applicants filing for certification or businesses facing False Claim Act charges and debarment.  For more information or assistance contact Diana Plue, Esq. Sheats & Bailey, PLLC, Tel: (315) 676-7314, www.TheConstructionLaw.com.

The information provided in this article is not intended to serve as specific legal advice for any particular situation.  Competent legal and experienced counsel should be consulted.