admin, Author at CNY Publications

The Evolution of Primary Care

Posted on February 21, 2024 by admin

BY KATHRYN RUSCITTO, ADVISOR

For many years we have lived with the concept that primary care is delivered by an office based physician who treats and coordinates all our care. The wisdom and experience primary care physicians have brought to this practice has been remarkable. Over the last several years environmental pressures have brought about an evolution in the Primary Care model leading to unique new access points for patients.

Covid added to an existing workforce shortage and many physicians faced burnout from growing demands. From 2005 to 2015 there was an 11% drop in primary care physicians. Recent tracking suggests that decline has continued.

The result is the evolution of a broader model of primary care access ranging from Urgent Care, Retail Clinics to Online Telemedicine consults, and Paramedicine Pilots.

Heather Drake Bianchi, CEO of Drakos Dynamics, a provider of urgent care and family medicine in CNY underscores the importance of accessibility. In a recent interview she emphasized the value of being available when patients need care, outside traditional office hours, aligning with the shifting demands of today’s workforce and lifestyle.

Another essential change, is that many sub specialties are now seen as key or integral to the primary care provider. Integrated primary care considers the input from Pharmacy, Dental, Mental Health, Physical Therapy and Health coaching in an integrated record. These teams, often system based, believe primary care has to include a balanced view across all providers. The blending of all these perspectives across an integrated team allows for better delivery of care in a patient collaborative model.

Dr. Julie Colvin a busy Family Physician and Medical Director of Northeast Family Physicians at St. Joseph’s HHC states, “Healthcare has to change and evolve, and those options will also give patients and providers more flexibility, and will help the healthcare workforce shortage. We want to make sure that the quality of care in those extended fields is the same as traditional medical care.”

These new access points are exploding using technology, remote access to physicians and even algorithms that direct care based on AI analysis of patients answers to questions.

In many ways these new access points are part of an Integrated Primary Care model. In order for that information to be readily available from any access point, it must be integrated across the medical record, or accessible to providers through the Regional Health Information Organization.

It is not unusual for me to find younger patients using these new access points and not having a primary care physician. For specialty practices I pose the question, have you adjusted your outreach approaches for patients based on these new access points?

The health care environment continues to evolve utilizing the opportunities from technology, and helping patients find the right care, at the right time, in the right setting.

Kruscitto 1/24
Krusct@gmail.com
Board member and advisor

Resources:
Primary Care in the US, a brief history
https://www.ncbi.nlm.nih.gov/books/
NBK571806/#:~:text=New%20models%20
of%20care%2C%20such,of%20quality%
2C%20and%20more%20formally

Primary Care: Past, Present and Future
https://www.medpagetoday.com/opinion/focusonpolicy/
103811

https://www.sjhsyr.org/find-a-service-or-specialty/
primary-care

https://www.drakosdynamics.com/

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

Enhancing Patient Care Through Clinical Research with Velocity

Posted on February 21, 2024February 22, 2024 by admin

In the rapidly evolving landscape of healthcare staying at the forefront of medical advancements is crucial. Velocity Clinical Research, a global leader in conducting clinical trials with almost 100 sites worldwide, offers an

avenue for healthcare professionals in the Central New York region to contribute to this evolution and significantly impact the future of patient care. By referring patients to clinical trials at Velocity Syracuse, you not only provide them with access to next-generation healthcare options but also participate in the advancement of medical knowledge and treatment.

Transforming Patient Engagement with Clinical Research
Velocity Syracuse is currently spearheading several clinical

trials covering a wide range of medical conditions. Current studies include; cognitive decline, Alzheimer’s disease and agitation associated with it, non-alcoholic fatty liver disease, diabetes, secondary treatment of hypercholesterolemia, severe hypertriglyceridemia, gastroparesis, hepatic encephalopathy, obesity, and several vaccine trials.

We are also participating in a unique clinical trial involving the evaluation of a new PET scan tracer to better identify brain changes in early Alzheimer’s disease. The study is looking for patients with a projected life expectancy of less than one year, with and without Alzheimer’s, who are willing to undergo a PET scan and donate their brain postmortem for comparison and evaluation.

A Step Towards Better Healthcare
Referring patients to clinical trials at Velocity is not just about accessing new treatment options, it is about being part of the larger community and movement toward the future of healthcare. It is also an opportunity to contribute to the advancement of medicine while simultaneously enhancing patient care and distinguishing your practice as one that is evidenced based and forward thinking.

These trials are more than just research studies; they are potential advanced treatment options for those patients with conditions not adequately addressed by existing therapies. Referring patients to clinical trials empowers and enables them to play a more active role in their healthcare journey.

Collaboration and Compensation
Participants in all studies receive compensation for their time and effort. Other advantages for individuals who participate in clinical trials include but are not limited to; access to medications irrespective of cost, transportation to/from our office if necessary, and additional medical testing that may not otherwise be available through the course of routine medical care.

We are committed to full collaboration and continuity of care with medical providers and the patients we share. We recognize the importance of sharing this information and the value of working together. We also make every effort to minimize time and work required to make a referral to us. Additionally, Velocity is striving to extend the potential benefits of participation in clinical research to everyone equitably. Historically, minority populations have been significantly underrepresented in research studies. We continue to make efforts to promote diversity in clinical research.

Stay Informed and Involved
We urge you to embrace this possibility to make a significant difference. Join Velocity in shaping the future of healthcare, one patient, one trial at a time.

To stay updated on the latest studies and how they align with your patients’ needs, you can easily reach out to us at Syracuse@VelocityClinical.com. Your proactive engagement ensures that you are always informed about the latest clinical research opportunities available
for your patients.

Can Paid Medical Experts Guarantee Justice in Medical Malpractice Cases?

Posted on February 21, 2024 by admin

Jennifer Negley

Expert witness testimony is essential to all medical malpractice legal proceedings. Usually, without a medical expert, plaintiffs cannot proceed to trial, and defendants are usually doomed to an adverse jury verdict. Medical experts are recruited in many ways, even from proprietary companies that offer a diverse variety of experts.

Finding these crucial experts varies from direct attorney contact to agencies offering a wide range of specialists. Though they’re key figures in court, their most important job is to be unbiased and help decide the case fairly. Professional organizations like the American Academy of Family Physicians have outlined stringent guidelines:

Unwavering Objectivity:
Physicians serving as expert witnesses must hold themselves to the highest ethical standards, ensuring complete and unbiased information is presented. They are not advocates, but impartial guides illuminating the medical realities of the case.

Adherence to Standards:
Their opinions should reflect the established benchmarks within their specialty, both at the time of the alleged incident and in the present. Thorough familiarization with the case and relevant medical standards is paramount.

Fair Compensation:
Recognizing the significant time and effort involved, reasonable and commensurate compensation for expert witnesses is essential.

In this time of shrinking fees and increased costs, physicians are debating if they should offer their services as a paid medical expert. Many questions arise when considering this path. One prominent national insurance carrier has challenged this matter with a few questions that can be beneficial when evaluating this option. Among them are:

Schedule Balancing:
Can you seamlessly integrate court appearances into your patient care schedule without compromising either?

Case Complexity:
Are you prepared for potentially vast medical records, repeated attorney meetings, lengthy depositions, and extended court battles?

Pressure and Performance:
How comfortable are you with verbal sparring and intense scrutiny in a courtroom setting?

Potential Repercussions:
Could your testimony be used against you in the future?

Maintaining Expertise:
Can you resist the pressure to stretch your opinions beyond your areas of expertise to better suit a particular
side?

Many physicians may not realize that their existing professional liability policies don’t automatically cover them for acting as a paid expert witness. This presents a significant financial risk you shouldn’t ignore. To make an informed decision, consulting your insurance advisor is vital. They can clarify your existing coverage and guide you toward securing any additional protection necessary to enter the world of expert witness testimony.

While the role of medical experts in malpractice cases remains crucial, both plaintiffs and defendants should carefully consider the implications before engaging a physician for compensated testimony. It’s a path demanding specialized skills, significant time commitment, and ethical considerations, necessitating a thorough self-evaluation and consultation with one’s insurance advisor. Ultimately, ensuring responsible and unbiased expertise in the courtroom necessitates understanding the complexities and obligations involved for all parties concerned.

For more information on your insurance options, please contact:

Jenn Negley,
Vice President, Risk Strategies Company
at 267-251-2233
or JNegley@Risk-Strategies.com.

Renaissance Groups: Celebrating 30 Years of Community-Centered Innovation

Posted on January 31, 2024 by admin

By Elizabeth Landry

Sandy Paben has always been drawn to work that helps improve the condition of people in high-needs communities, although that work has taken different shapes and forms over the years. When she came to Syracuse to attend LeMoyne College in the late 1970s, she participated in a program called Projects in the Community, which involved doing volunteer work in Syracuse’s inner-city neighborhoods. Paben eventually went on to teach at Lincoln Middle School, then served as Vice Principal and Prinicpal at several schools in Upstate New York, becoming involved in teacher and staff training focusing on technology in the classroom. In 1994, Paben created Renaissance Groups, an endeavor that allowed her to delve deeper into her true passion of helping people in high-needs communities.

“You’re going to find me in tougher neighborhoods and places where people need a lot of help. Looking back, I’ve realized I was always attracted to working in high-needs communities, but if you had asked me at the time when I started Renaissance Groups, I probably couldn’t have articulated that. This work really has such a huge social worker bent. It’s all about helping people become self-sufficient and independent and helping the world become a better place, even if it doesn’t seem like it has anything to do with that on the surface,” Paben explained.

Since those early days when Paben was finding her true calling and cultivating the company, Renaissance Groups has evolved and grown into the successful change-making force it is today, under her leadership as CEO. Celebrating its 30^th anniversary this year, Renaissance Groups is a NYS Certified Woman Owned Enterprise with offices in Rochester, Syracuse, Buffalo, Albany, New York City and Stockton, California.

The company operates projects in all corners of the country, specializing in three main areas: compliance services, public housing services and educational services. In the construction compliance arena, Renaissance Groups assists clients with tracking minority and women labor utilization, minority and women business enterprise utilization and Section 3 utilization. The company’s public housing clients receive support relating to Section 3 compliance, family self-sufficiency and other ROSS (Resident Opportunity and Self Sufficiency) service coordination, in addition to many other programmatic needs. Stemming from Paben’s roots in teacher and staff training,

Renaissance Group’s services in the educational realm involve 1:1 computer programs, curriculum and other resources that directly benefit both teachers and students alike.

Elevating Communities Through Affordable Housing

Although Paben began her journey with Renaissance Groups in the education and staff training fields, she has come to be incredibly passionate about the company’s work in affordable housing. By focusing on community development through compliance and oversight of projects that are building affordable housing and improving neighborhoods, Renaissance Groups is able to make a tangible, positive impact in high-needs communities. The company partners with housing authorities, developers, and contractors in many locations in order to carry out compliance management, working to track spending and labor requirements that come along with funding sources. Affordable housing projects over the past three decades have been completed in Florida, up the East Coast to Boston, throughout New York State and even in California.

For Paben, the drive behind this work is the immediate human impact these projects have within the community. “Affordable housing is my absolute passion because it helps folks who are usually incredibly rent burdened. We encounter folks who are one step away from being homeless. The opportunity to be able to work on projects that I know are going to give people safe, comfortable housing – it really is my passion,” Paben said.

When Renaissance Groups takes on a new affordable housing project, the local community is bolstered in many ways. It’s not only the local residents in need of affordable housing that are positively impacted, but also the local contractors who come from a diverse background, many of whom are women or minorities, that receive new opportunities that expand their professional horizons. Additionally, the local laborers who work on the construction site are often paid a prevailing wage that directly benefits their financial well-being.

Recalling moments when she has experienced the direct results of Renaissance Groups’ affordable housing projects, Paben further illustrated the human impact of the company’s work. “I can remember, 25 years ago a single mom who was able to move out of an extremely unfit, deplorable apartment into a beautiful, brand-new apartment, and it still makes me cry to talk about it. This work also allows us to help people of color and women to get opportunities to bid on these jobs, and it’s absolutely life-changing for them. Recently at a conference, I ran into a former client who we helped to start a janitorial business and is getting real jobs now. He said to me, ‘This would never have happened if it weren’t for you. You actually spend time with us,’ and that’s such a big deal for me. I’ve been so blessed that I’m able to make a difference in people’s lives,” stated Paben.

Opportunities to Advance Through Green Jobs

One of the most exciting and innovative projects underway at Renaissance Groups is the recent opening of a Green Economy Lab in Stockton, California in conjunction with the Housing Authority County of San Joaquin. Utilizing a 20,000-square-foot building purchased by the Housing Authority County of San Joaquin, Renaissance Groups is offering a 5-tier training program to help people get access to knowledge and skills needed to attain green economy jobs.

Paben explained the purpose of the training facility as well as the benefits to those who participate in the program. “It’s a place where folks who don’t have an invitation to the party can get involved,” she said. “Right now, we have a 5-tier program to get access to training. For example, if someone doesn’t have a high school diploma, we’ll help them get one. We offer a customer service class. We have an EV charging station installation and maintenance class. We have an EV car mechanic boot camp in which we offer an associate’s degree needed to become an EV car mechanic. Our goal is to get these folks ahead of the curve in this industry and it’s very exciting to get them trained on how to install an EV charging station, for example, because that’s really in its infancy right now.”

Going hand-in-hand with the innovation of the Green Economy Lab, Paben highlighted that the Renaissance Groups team regularly asks for feedback from high-needs communities to find out what they need in order to take advantage of the new opportunities at their doorstep. As part of a 2019 Jobs Plus grant for the Housing Authority in the County of San Joaquin, residents identified three needs they needed help with: transportation, training, and childcare. The grant wrapped up in August of 2023 and through the support offered to the residents that addressed their needs, the average income went up 44%.

Paben explained that this feedback from the community is what kick-started a new wave of strategy to help communities participate in cutting-edge technology and become more self-sufficient. “We started to tackle these needs one-by-one. The training piece is what led to the Green Economy Lab. We’re also really focusing on the transportation piece. By the end of next year, every single public housing site in the area will have a car share service. Even though it’s based in public housing, anyone in the community can rent a car for $4 an hour or $35 for 24 hours. This service, in addition to a van carpool we’re considering, is a huge benefit to the community because the public transportation system isn’t practical for these folks. How are you supposed to get a job if you don’t have reliable transportation? I would say these projects are what really make us innovative, because we’re helping them get what they need so they’re in a position to be at the cutting edge of technology coming down the pike,” Paben emphasized.

Keeping an Open Mind in an Ever-Changing Future

With 30 years of experience under her belt, Paben has learned that a good business plan includes the understanding that new innovations and compliance requirements can change things quickly. “Even though it’s uncommon in the world of business, I’ve never really had a master plan for Renaissance Groups,” said Paben. “In the compliance world, things can change really quickly. In terms of what the future looks and sounds like, I’m following my instincts in terms of what’s coming next. If you had told me five years ago that we’d be opening up a Green Economy Lab, I would have thought you were crazy.”

One plan Paben does have for the future is to hopefully take what the company has learned through its projects in California and implement similar projects in high-needs communities throughout Upstate New York. “I’m a Syracuse girl at heart. If I can figure out a way to bring some of this back to Syracuse and collaborate with people who are forward thinking, that would be monumental,” she said.

No matter what the future holds for Renaissance Groups, however, Paben is committed to remaining true to the goal of helping the people who are at the heart of every project. According to Paben, the way to continue doing just that is by keeping an open mind and being flexible when new challenges and opportunities arise.

“I want people to stop for a minute and think about what’s possible,” Paben said. “There are so many ways to change the world. We just have to think outside the box and be innovative, and really think about how we can use the infrastructure funding that’s out there to change people’s lives. If it’s important, you figure out a way.”

State of Construction Industry

Posted on January 31, 2024 by admin

Earl R Hall, Executive Director – Syracuse Builders Exchange

By most measures, 2023 was a strong year for construction industry employers throughout upstate New York. Measuring growth can be subjective, however, the increase in membership at the Syracuse Builders Exchange is one standard metric which is objective. Membership increased to 970 at the end of 2023, with 42 new member employers joining during the year. Today, the Syracuse Builders Exchange remains the largest construction industry Association in the state of New York.

Another metric used to measure growth is the total number of building projects for bid compared to 2022. Building projects for bid increased 3.6% from 5,064 in 2022 to 5,244 in 2023. The increase was driven by continued public investment in the medical, secondary and higher education markets, coupled with strong private capital investments in the industrial, multi-family residential, and commercial markets.

Central New York is poised to continue sustained construction growth into 2024 with many regional project owners beginning work on such projects as:

Onondaga County STEAM School
MICRON
Turning Stone Expansion
Onondaga County Aquarium
Syracuse Inner Harbor Development

The continued optimism associated with regional economic development, coupled with increased construction bidding opportunities, is somewhat tampered by a potential recession, lack of adequate skilled labor, increased material costs and aggressive project schedules. The construction industry is not immune from periodic challenges, but contractors have proven to be resilient over the past century as they continue to deliver finished projects to owners.

Labor will continue to be the most concerning matter going into 2024 as the lack of skilled craftsmen and craftswomen may impact contractors’ abilities to bid additional work and/or to complete tight schedules on time. Although the building trades’ unions and non-signatory employers have been aggressively attempting to recruit, train, and retain construction workers, such efforts have not produced a labor pool large enough to accommodate the current projects scheduled to being in 2024. There remains much optimism the abundance of work will attract skilled craftspeople from other geographies throughout the United States.

Labor wages continue to increase at rates upstate New York has rarely seen. Wage increases vary by trade but have averaged close to 4% per year in the past two years, and in some cases higher. Such wage increases have been driven by high inflation, huge demand for skilled labor and significant increased costs associated with food, gas, and clothing. Labor costs and the availability of skilled labor will continue to be of concern throughout the year.

The anticipated economic development to hit central New York will be led by the construction industry. Although many leaders in the secondary and higher education arenas are focused on careers inside these yet to be built new buildings and facilities, those project owners need to first build those facilities. Most suburban school districts are a decade behind in developing career and technical education programs, in particular construction career pathways. And while regional BOCES programs remain vital to the construction industry, those student seats are limited. The need for a four-year construction curriculum is essential in developing the next generation skilled workforce contractors and project owners desperately needed. The only way to meet the incredible economic development opportunities that await central New York is to have the skilled work force to build those projects.

These issues are not unique to upstate New York as such is prevailing throughout the country. Although such headwinds are anticipated to continue in the short term, contractors and project owners alike remain resilient and will explore developing alternative methods to deliver a finished project.

Navigating an Uncertain Economy: Forecasting Manufacturing Needs

Posted on January 31, 2024 by admin

By: Jim D’Agostino

Manufacturers are no strangers to economic uncertainties. Whether facing global financial crises, recessions, trade disruptions, or unexpected events like pandemics, the ability to accurately forecast manufacturing needs becomes even more critical during turbulent economic times. In this quarter’s column, we’ll explore the best strategies to forecast manufacturing needs effectively in an uncertain economy.

Data-Driven Decision-Making: In uncertain economic times, relying on data-driven decision-making is paramount. Manufacturers should invest in advanced analytics and data collection tools to gather real-time data on production, inventory levels, customer orders, and market trends. By leveraging this data, businesses can make informed decisions about production schedules, inventory management, and resource allocation, thereby minimizing risks associated with economic fluctuations.

Scenario Planning, Contingency Planning, and Risk Mitigation: Scenario and contingency planning involves creating multiple hypothetical scenarios based on different economic outcomes. Manufacturers should develop a range of scenarios, from optimistic to pessimistic, to understand the potential impacts of economic changes on their operations, and then they should identify potential risks, assess their impact on production, and develop strategies to mitigate these risks. This proactive approach allows companies to adjust their production strategies swiftly and efficiently in response to different economic scenarios, ensuring resilience in the face of uncertainty. These plans may include workforce adjustments, temporary production slowdowns, or alternative sourcing strategies.

Supply Chain Diversification: Manufacturers often rely on global supply chains, which can be vulnerable during uncertain economic times due to disruptions in transportation, logistics, or raw material availability. Diversifying supply chains by sourcing materials from multiple suppliers or considering localized sourcing options can help mitigate risks associated with supply chain disruptions. This strategy ensures a more reliable flow of materials, reducing the impact of economic uncertainties on manufacturing operations.

Collaboration and Communication: Effective communication and collaboration between various departments within a manufacturing company are crucial during uncertain economic times. Cross-functional teams should regularly share insights and updates regarding market conditions, customer demands, and supply chain disruptions. This collaborative approach helps identify potential bottlenecks and allows for quick adjustments to production plans and inventory levels.

Demand Forecasting and Predictive Analytics: To forecast manufacturing needs accurately in an uncertain economy, manufacturers should invest in demand forecasting tools and predictive analytics. These technologies use historical data, market trends, and customer behavior analysis to predict future demand more accurately. Implementing predictive analytics can help businesses adjust production schedules, optimize inventory levels, and align their resources with expected market fluctuations. Manufacturers should not view their forecasting strategies as static; instead, they should continuously monitor economic indicators, market trends, and customer behavior. By staying vigilant and adaptable, companies can respond swiftly to changing economic conditions and adjust their production plans accordingly. This ongoing monitoring allows for more accurate forecasting in the face of uncertainty.

Lean Manufacturing and Inventory Management: Lean manufacturing principles focus on minimizing waste and optimizing resource utilization. During uncertain economic periods, it’s essential to adopt lean practices to enhance flexibility and reduce costs. Efficient inventory management is a critical component of lean manufacturing, as it ensures that materials are readily available while minimizing excess inventory that can become a financial burden during economic downturns.

Customer-Centric Approach: A customer-centric approach is vital for manufacturers looking to successfully navigate uncertain economic waters. Close communication with customers and a deep understanding of their evolving needs can help manufacturers tailor their production efforts to meet changing demands. This customer-focused strategy not only enhances customer satisfaction but also improves forecasting accuracy.

In uncertain economic environments, forecasting manufacturing needs is a challenging yet essential task. By adopting data-driven decision-making, scenario planning, collaboration, demand forecasting, supply chain diversification, lean manufacturing principles, continuous monitoring, contingency planning, and a customer-centric approach, manufacturers can position themselves to thrive amidst economic uncertainty. These strategies allow manufacturers to adapt, mitigate risks, and make informed decisions, ultimately ensuring their resilience and success in turbulent economic times.

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

Happy New Year—In Your Companies!

Posted on January 31, 2024 by admin

Pierre Morrisseau

While 2024 will present many of the usual business challenges and, I’m sure, some novel ones, I believe there is much to be excited about and new opportunities for growth and success.

In my last installment I shared interesting viewpoints on how incorporating happiness in our careers and workplaces has a major positive impact on employee attraction, retention, and performance. I also shared what I learned about how the brain can be rewired through repetitive reinforcement to achieve a positive mindset.

As we head into a new year, I want to share what we’ve learned from implementing changes in our own workplace to increase happiness, and ultimately, results.

We started the process with a focus on helping leadership understand and embrace the psychology and goals of promoting the power of happiness in our workplace. They needed to know that the science supported what we were about to embark upon. After all, it would be a major challenge to have our leadership adopt the behavior of being always positive and continually sharing that positivity and enthusiasm with their teams if they themselves had negative views of what we were trying to achieve. Of course, it all had to start with senior-most leaders.

I can share that it was a clear challenge amidst all the negativity, division and bad news that seems to be pervasive in our society. However, by forcing myself to stop and find the good in each situation and finding what author and happiness expert Shawn Achor calls the Third Path. By always looking for the Third Path, our leadership team was able to avoid either/or, this or that, or worse, or else situations that paralyze employees and submarine true collaboration.

I am pleased to see as our leaders evolve, there is far more positivity in our workplace, more collaboration, and increased empathy for each other which has led to far greater desire to help one another—all of which has had a clear impact on the happiness factor in our workplace.

Since implementing (changing our attitudes may be a better way of saying it) our initiative, we have seen a marked improvement in turnover, better candidates being attracted to our company, and, while a bit early to attribute increased sales results to increased happiness, we are experiencing healthy growth above our norm. Certainly, in our minds, happier employees tend to make our clients happier. Data analysis throughout 2024 will provide a clearer picture and I look forward to sharing our findings.

Here is what our roadmap for changing attitudes and creating an environment of trust and happiness looks like:

Pause: find the good in every situation and individual;
Use clear, direct, open, honest communication and active listening;
Invite participation (proactive inquiry) encourage feedback;
Value input and adopt suggestions;
Encourage risk-taking and making mistakes as positive learning experiences (what Achor calls Falling Forward);
Engage only in productive disagreement;
Nurture a learning, growth, mentoring/coaching environment.

While this might seem a forbidding list of actions, it turns out the psychological science is correct: when you begin with one behavior—seeing the positives everywhere around us—we naturally progress to the next step in the process.

I have a strong belief in creating happiness in the workplace and I’m driven to achieve a happiness culture. The opportunities and rewards are simply too great. The potential of people working together in harmony is very powerful. Together we are able to achieve amazing things. We are well on our way. And for that I am happy!

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

Corporate Transparency Act

Posted on January 31, 2024 by admin

by Benjamin Goldberg

On January 1, 2024, a new federal law, the Corporate Transparency Act (“CTA”), will go into effect. The main purpose of the CTA is to crack down on the proliferation of shell companies used as shields in money laundering, tax avoidance, and similar activities. However, the new reporting requirements will also compel most businesses created by filing documents with the Secretary of State to provide the information outlined in the CTA. Any business entity that must report to FinCEN is called a “reporting company” in the language of the CTA. The information will have to be reported to the Financial Crime Enforcement Network (“FinCEN”), which is part of the Department of Treasury.

There are three main parts to the new reporting requirements: beneficial ownership information (“BOI”), company applicants, and information about the reporting company itself.

Reporting companies must submit the information of everyone possessing beneficial ownership. A beneficial owner is defined in the CTA as an “individual who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, exercises substantial control over the entity, or owns or controls 25 percent or more of the ownership interests of the entity or receives substantial economic benefits from the assets of the entity.[1]” While owning or controlling over 25 percent of the business entity is fairly straightforward, the definition of “substantial control” is less obvious. Within the CTA, the definition of substantial control is expansive. It includes, but is not limited to, any senior officers of the company, persons having authority over the appointment or removal of any senior officer or a majority of board members, persons who direct or have substantial influence over important decisions made by the entity or have control over an intermediary entity that exercises substantial control over a reporting company. Since the definition of a beneficial owner is expansive, careful consideration will have to be given to make sure everyone who meets the definition of a beneficial owner has their BOI entered into the FinCEN site.

A “company applicant” is the individual who files the application with the Secretary of State and, in addition, the person who directs or controls the filing if more than one individual is involved. However, at least at this point in time, there can only be two company applicants. The company applicants might not be anyone who works for or controls the reporting company in question. The company applicant could, for instance, be the lawyer and paralegal hired to help bring the entity into existence. The company applicant information will only have to be submitted once.

The reporting company will need to disclose its 1) legal name, 2) DBA names, 3) business address, 4) state of formation, and 5) Taxpayer Identification Number.

The beneficial owners of the reporting company will have to disclose their 1) legal name, 2) date of birth, 3) residential address, 4) unique number from an acceptable document such as a U.S. passport, state ID, or driver’s license, and 5) an image of that document.

The company applicants will need to disclose the same information as the beneficial owners with one potential difference: if the company applicant is registering the company in the course of the applicant’s business, such as lawyers, paralegals, or others, then the business address of the law firm will be substituted for the residential address. Also, the company applicant information will be required only for business entities that are formed on or after Jan. 1, 2024. The BOI will be required of all entities that are reporting companies regardless of their date of formation.

Businesses already in existence on Jan. 1, 2024, will have one year to file an initial report. For Businesses formed on or after Jan. 1, 2024, and before Jan. 1, 2025, an initial report must be provided to FinCEN within ninety days of formation. On and after Jan. 1, 2025, businesses will have to submit the required information within thirty days of formation. Another thing to note is that changes in beneficial ownership will need to be filed. Any changes in ownership or changes in organizational structure will require subsequent filings to keep the BOI up-to-date.

Certain businesses are exempt from the reporting requirement, but most of these businesses are those in heavily regulated areas of finance. Otherwise, the important exemption to note is the “large operating company.” To qualify as such, a company needs 1) more than 20 full-time employees, 2) more than 5 million dollars in gross receipts/sales in the US, and 3) a commercial, physical street address in the US. All three of these elements must be met. For example, a business that operates online with no commercial, physical street address will not qualify for the exemption even if it has more than 20 employees and over 5 million dollars in gross receipts or sales. The other exemptions will be listed at the end of this post.

While this legislation has mostly flown under the radar and might come as a surprise to many business owners, there is still time to prepare the necessary information. CCBLaw is here to help answer any questions and assist your business to ensure compliance with the CTA.

In the meantime, to avoid potential civil and criminal penalties, entities that will qualify as reporting companies should make determinations as to who will be considered a beneficial owner under the CTA and gather the necessary information to submit to the FinCEN portal once it is active. Importantly, reporting companies will also want to consider who will have the responsibility of updating any changes in BOI to FinCEN because, as addressed above, as beneficial ownership changes, BOI is required to be updated within 30 days of any such change.

Artificial Intelligence

Posted on January 31, 2024 by admin

By: Kathryn Ruscitto

We are planning a Heritage trip and have spent hours doing research. My daughter pulled up Chat GPT, gave it a few directions and in 30 seconds it listed an itinerary, things to visit, and lots of other info for consideration.

In a moment it became clear to me how Artificial Intelligence can augment my work. I still had to decide who, what, where, and when, but AI took the data that exists, boiled it down and gave me options to start with. It saved time, and while not perfect, gave me info I had not looked at prior.

Can AI do the same thing in health care? From chronic illness , to assisting in the development of new devices and drugs, can AI supplement clinicians work flow? Can it review charts and data, predict at risk patients, and match patients to treatments?

The current use of AI in some phone processes, has proven to be a barrier when a question did not fit the algorithms.

In time, those early designs will be improved. For AI to work in health care, it needs to be integrated into clinician workflows, not added as yet another step.

The debate about AI replacing human decisions is concerning and deserves consideration. But more likely it will free the workforce from analytical tasks and move to higher level thinking. In addition, other concerns relate to the bias of the data. But the advancement of AI will likely be similar to the integration of computers, smart phones and laptops into our daily lives. They didn’t replace humans, but a human without a smart phone or laptop does not have the advantages in easily accessing info and education. If AI can improve care for patients, by adding to the analytical knowledge of clinicians in an era of accelerated information and inventions, it will advance care.

I looked for some examples where AI is integrated in health care and found specialists are using AI in nephrology and cancer treatments. “Penny” at UPenn is helping clinicians with complex patients between visits, “The technology has the potential to improve patient health by guiding them through complex medication schedules, keeping clinicians routinely updated about a patient’s condition, and enabling clinicians to step in at early signs of trouble.”

https://www.aamc.org/news/how-ai-helping-doctors-communicate-patients

Additionally there are many applications already in use for detecting disease through programs that analyze bacteria, and other disease criteria to lead to diagnosis and treatment in radiology, pathology and cancer treatments.

For clinicians to be comfortable with machine learning, or language learning that reads patient records and integrates info to recommend treatment, they will want a clear understanding of the quality of the ap’s learning. Also, it’s track record in making accurate diagnosis, and their ability to integrate their own clinical history and knowledge. The AMA cautions clinicians about bias and inaccuracy in todays AI algorithms, but notes it will continue to improve and tomorrows physicians will see a reduction in paperwork burden and back room operations from chart reviews to billing. https://www.ama-assn.org/practice-management/digital/why-generative-ai-chatgpt-cannot-replace-physicians

In the past 100 years we have moved from an agrarian society, to an industrial society, to an age of information. We have now entered what is being called the age of knowledge, or the creative age. Understanding AI’s potential is our best advantage to adapting it in applications for health care.

Resources

https://www.jnj.com/innovation/artificial-intelligence-in-healthcare?&utm_source=goog

AI Won’t Replace Humans

https://hbr.org/2023/08/ai-wont-replace-humans-but-humans-with-ai-will-replace-humans-without-ai

The Current State of AI in Healthcare:

https://healthtechmagazine.net/article/2022/12/ai-healthcare-2023-ml-nlp-more-perfcon

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

Abscope Environmental, Inc. Celebrates 35-Year Anniversary

Posted on January 17, 2024January 17, 2024 by admin

by Becca Taurisano

Abscope Environmental, Inc. is a Canastota, New York-based, full-service remediation firm in its 35th year of business, thanks to a proud legacy started by founders John Romagnoli and his son, Jack. Beginning in 1989 as solely an asbestos abatement company, Abscope expanded into more comprehensive environmental remediation services in 1994 and fast tracked its growth in 2004 when Jack’s brother Jerry came on board. Planning for their succession, Jack and Jerry looked to their youngest brother, Bob Romagnoli, to take the reins. Bob became President of Abscope in 2019 and later, CEO, in 2020 as both brothers retired. While the company has experienced tremendous growth since its founding, Bob and his partners are now poised to expand into new geographical regions, offer new and innovative services, and most importantly, sustain the business for the next generation.

An Experienced Leadership Team

With more than 25 years of environmental consulting experience, Bob Romagnoli is an engineer by trade, but brought a vast array of leadership and operational skills to help Abscope redefine itself as a more state-of-the-art organization. During his career, Romagnoli led multi-million-dollar Superfund sediment remediation programs and developed turn-key environmental strategies for Fortune 100 companies, serving as Sr. Vice President at Arcadis and Managing Director at TIG Environmental.

Working closely with Romagnoli are three key long-time Abscope employees: Executive Vice President Rob Gray, Executive Vice President Robert Duffy, and General Manager, Steve Mitchell. All three have been with the company for decades and are part owners of the firm.

Rob Gray joined Abscope in 1995 when he started as an estimator. Over time his role grew into a managerial one and he currently serves as the Executive Vice President of the Environmental Remediation and Geotechnical Services division. Gray has extensive experience in Manufactured Gas Plant (MGP) remediation, hazardous waste remediation, stream sediment removal, In-Situ Stabilization (ISS), sheet pile installation, deep excavations, and site development projects.

Executive Vice President Robert Duffy and General Manager Steve Mitchell lead the Asbestos Abatement and Industrial Decontamination division. They oversee the removal, encapsulation, enclosure, transportation, and disposal of asbestos-containing materials, building demolition, and lead and mold remediation. Duffy has been part of the Abscope team since its inception in 1989 and has been crucial to its success and growth. He is responsible for estimating, proposal development, submittal generation, waste disposal coordination, and final report development, not to mention business development.

Mitchell has been with the company 30 years and is responsible for coordinating manpower across both divisions, a task that can be very challenging, especially in today’s environment. “Stevie’s attention to detail is second to none” says Romagnoli. “He’s the ultimate team player and always puts the company’s interests first.”

Romagnoli said it took some time for the leadership team to learn how to best work together but have now struck the right balance. “These three guys have been here for decades and have significantly contributed to the success of this company,” said Romagnoli. “My role is to allow them to continue building on that success, while bringing a new perspective on operational and strategic matters.”

A Fresh Perspective

After joining Abscope, Romagnoli immediately identified several key areas for improvement, the most evident of which was in-house technology. While IT changes are never easy to implement, Romagnoli felt they were imperative to keeping Abscope at the forefront of the industry.

As an example, Abscope invested heavily in upgrading their take-off and estimating systems. The conversion to InSite and HeavyBid allowed for higher productivity and more accurate results. According to Romagnoli, the value was apparent from day one. “Our PMs have done a great job in assimilating to these new systems which in turn have allowed them to be much more productive. Given the complexity of the new platforms, we’ve only scratched the surface of their potential. I’m excited to see how much more we can extract and use to our benefit.”

Abscope also upgraded the GPS equipment on their “yellow iron” with the latest, most cutting-edge Trimble™ technology, including Trimble™ TSC7 v2s and R780 bases and rovers. The new equipment delivers the latest in field technology, optimizing efficiency and most importantly, accuracy. Abscope’s fleet is extensive, consisting of approximately 30 pieces of heavy equipment.

On the administration side, Abscope recently converted the invoice approval and payment process from paper-based to digital. “It is much more efficient for our PMs to digitally approve vendor invoices versus dealing with mounds and mounds of paper,” said Romagnoli. “The system has also minimized duplicate or erroneous payments.” Field Superintendents are also joining in Abscope’s IT revolution, now using tablet apps to track time, significantly reducing transcription errors within the accounting department.

New Horizons

From the types of projects, the size and scope of the work, and even the geographical location, much has changed at Abscope since its beginning in 1989. Most recently, there has been a surge of projects in the alternative energy space and Abscope has provided civil works for commercial-scale solar and wind projects. The work generally includes preparing the site for ultimate component installation by others and consists of earthwork, installation of storm water drainage, development of access roads, crane pads, and various other site features.

“Alternative energy has exploded for us, and it is not something that we necessarily expected,” said Romagnoli. “Smaller, more local opportunities have opened us up to much larger and broader opportunities nation-wide.” In fact, there has been so much growth, Abscope is considering the creation of a new division to execute the work.

Abscope’s job size and scope

has changed too over the years. In the early years, jobs were $500,000 or less lasting up to a month, but now jobs range from $10 to $12 million lasting six months to a year. “The diversity of our projects shows how we have grown,” said Gray. “Today our projects are more complicated and the systems we have been installing are much more sophisticated.”

Geographically things are changing as well. Gray recalls in the early days, most of the work was within a two-to-three-hour radius, but not lately. Remediation projects are bringing Abscope’s crews to the Mid Atlantic, Midwest, Southeast, Southwest, and as far away as Puerto Rico. In 2022, they successfully completed a challenging six-month project in Dallas, TX with a world-renowned chemical manufacturer, where Abscope remediated asbestos contaminated soil on residential and small commercial properties. “We are now set up well to handle these larger, more complex projects,” said Romagnoli. “It is exciting to see such large and iconic companies/clients view us as a trusted partner.”

Thanks to the successful completion of the Dallas project, the very same Fortune 500 client selected Abscope for a large PCB soil remediation project in Puerto Rico in 2024. “We are grateful to them for giving us this unique opportunity to assist in such a highly visible and intricate project, especially in a geographic location that’s not necessarily familiar to us.” Abscope has invested a significant amount of time and money to make sure the project goes off without a hitch. “Ideally we’d love to leverage this opportunity to do other work (e.g., emergency response and disaster assistance) in Puerto Rico in future years, but for now, we need to keep our eye on the ball and ensure that this critical project is successful” said Romagnoli.

With Romagnoli’s experience

in sediment removal, stream remediation, and shoreline stabilization, Abscope has been doing more work in those markets as well. “We most recently did a shoreline stabilization job in Lackawanna along Lake Erie,” said Gray. “With all the erosion from wind and waves, shoreline stabilization has been a big area of focus for us.” The addition of wetland and stream remediation is one example of how complex their current projects are due to the adherence to regulations with the Environmental Protection Agency (EPA) and the Department of Environmental Conservation (DEC) on the plantings, soils, and rocks required during the restoration process.

As work around the country continues to grow, Romagnoli and Gray are considering an expansion into new office locations. “We are looking to expand in the near future and discussing our growth plans for the Mid Atlantic area,” Gray said. With upcoming work in Puerto Rico, Romagnoli could see an office location in Florida as well to support the Southeast and Caribbean. “There is a lot of potential there, just a question of if and where,” he said.

Safety First

From environmental remediation to asbestos abatement, sediment dredging to shore stabilization, deep excavation to restoration, safety is Abscope’s number one priority. Duffy was instrumental in the creation of project-specific health and safety work plans for Abscope’s company-wide, behavior-based Health and Safety program. His daily interaction with clients, regulatory personnel, subcontractors, and project engineers as well as having managed or supervised over 3,500 asbestos abatement projects gives him a keen understanding of the safety issues facing field workers. “There are so many things that could go wrong on a job,” said Duffy. “We have to get ahead of it and make sure everyone is as safe as possible.”

On project sites, Abscope superintendents hold Toolbox Talks or safety meetings every morning to discuss the particulars of the job, what protective equipment is required, and what to do if something goes wrong. “Our guys in the field are very diligent when it comes to safety; they know there are no short cuts,” said Romagnoli.

The leadership team, Project Managers, and employees in the field also attend monthly safety calls to share stories about “good catches;” things on the job that could cause an injury. Good catches are recognized on the monthly safety calls and quarterly safety awards are given out to employees who are most focused on safety. “We rank health and safety here above everything else,” said Gray. “We take it very seriously.”

Investing in the Future

One of Romagnoli’s other priorities has been to bolster Abscope’s employee benefits and incentives. Romagnoli is focused not only on employee retention but attracting new talent as well. As an example, Romagnoli established a 401(k) program for the company back in 2020 to help employees help themselves. Abscope also provides a generous match. In addition, Romagnoli also set up a tuition reimbursement program that is meant to

encourage staff to continuously improve their skills. “We’re always looking to get better, but we want to make sure to take care of those that continue to make this company what it is,” he said.

Looking ahead to the future, Romagnoli would like to see the company grow to $25-30 million over the next five years. From acquisitions to new office locations, he is focused on building out systems and services to benefit the next generation. “My Dad would be bursting with pride seeing that the company has stayed in the family and become so much more than what he anticipated it to be,” he said. There is the potential for other family members to join the company at some point, but for now, Abscope is flourishing under current ownership. By honoring the past and continuing the proud legacy of the Romagnoli family into the future, Abscope is poised to be sustainable for generations to come.