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From Patient to Partner: Judith’s Journey

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When you climb the porch stairs to the front door of Judith’s home, you’re greeted by a woman with a  radiant smile, and immediately sense a palpable warmth. She came to the inner city of Rochester to visit a cousin. While she never imagined she would stay, that’s exactly what she’s done. Her cousin eventually moved away, and Judith found herself alone—her daughter, her closest relative, lives more than five hours away.

Living on her own with no support system, Judith has faced numerous health challenges, including a bilateral knee replacement in 2023. It was during her recovery that she was first connected with a case manager. She didn’t expect her health plan to become a critical means of assistance, but that’s exactly what happened.

“As a former caregiver myself, I never thought I’d be the one needing support. But my care manager at Excellus is everything to me,” Judith says, her voice steady with emotion. “She’s more than just a voice on the phone—she is my lifeline. Whether it’s finding short-term rehab, helping me navigate the health care system, or simply reminding me I’m not alone, she’s there.”

And it’s that care manager who referred Judith to the Community Connections team who are now at her home helping to set up the Excellus BlueCross BlueShield (BCBS) app on her phone, which will allow her to access her identification card, find health care providers, check her medical coverage, track spending, and view claims. But what matters more to Judith is knowing that someone who cares is just a call or a visit away.

In the Field: Bridging the Gap to Better Health

Judith’s experience is just one of thousands. Across upstate New York, the case management and Community Connections teams are working quietly, relentlessly—to meet people where they are, in every sense of the phrase.

While SafetyNet CARE provides personalized phone-based support navigating local community and national resources like Meals on Wheels, Social Security benefits, and Veteran’s Assistance benefits, the Community Connections team takes it further. Established to locate and re-engage hard to-reach, medically fragile Medicaid members, the team is often knocking on doors, walking city blocks, and reaching out to those who’ve lost touch with the care they need and access they deserve. These are individuals who may be homeless, moving between homes, or simply unable to answer the phone.

While Excellus BCBS consists of more than 4,000 employees, the Community Connections team is small. Just seven people serve all 39 counties—yet their impact is immense. Last year alone, they received referrals to reconnect with nearly 6,800 members.

“We are here to serve our communities in any way that is needed to get and keep them healthy – that is the benefit of being a nonprofit, local health plan,” says Dr. Nicholas Massa, vice president medical affairs, commercial products and clinical integration at Excellus BCBS. “Through Community Connections, we may help a member with high blood pressure work with a nurse to keep the member’s health in check, provide special formula for a premature baby to a new mother who may be financially strapped, or acquire beds for family members who may be sleeping on the floor. The ways they are impacting lives are endless … and meaningful.”

Around the holidays, when the world can feel lonely for many, Community Connections shows up with food baskets and kindness. In 2024, they brought Thanksgiving meals to 375 families who might have otherwise gone without.

“Some of the reactions we see from our members when we deliver the baskets are gratitude, excitement, thankfulness, and tears of joy,” says Sylvia Lee, director of outreach and training programs at Excellus BCBS. “We are seeing a lot of food insecurities and a lot of need by individuals … it is such a rewarding feeling that you assisted someone in need.”

Community Connections Thanksgiving Baskets

“Any Day We Connect with a Member is a Good Day”

Dajia Richardson, Community Connections manager for the past six years, understands the significance of this work. She and her team are passionate about addressing health care disparities and improving overall health outcomes in their communities.

“I love that our team is driven by a natural curiosity and finds such satisfaction in making a difference, one member at a time. We don’t just check boxes—we listen, we care, and we persist,” she says. “If we can prevent just one crisis, if we can help someone feel seen, that’s a good day.”

The team has discovered that a personal visit may be more than an official letter or phone call to encourage Medicaid members like Judith. “The work goes far beyond traditional care,” Sylvia says. “It’s about building trust, encouraging prevention, and helping people believe in their own health journey.”

Dajia adds, “I’m proud of the work we do because it centers around increasing access to care, preventive care, and helps reduce long term costs. We make a difference when we catch things sooner rather than later— making certain that members don’t slip between the cracks and connect them to the resources they need.”

A Lifeline That Feels Like Local Family
Before Dajia leaves Judith’s home, Judith turns to her and, with quiet conviction says, “Thank you for giving me hope and being here today. I’ve never seen my care manager’s face, but I know her voice, and when I hear it—I know I’m going to be okay.”

That moment, quiet and deeply human, speaks volumes. “This isn’t about insurance – it’s about people, about showing up and standing beside someone when they need it most, reminding them they are not alone,” says Dr. Massa. “Judith’s care manager and Dajia … they are the faces and the voices of Excellus BCBS. We have a lot to be proud of, thanks to their work. And that’s the heart of our mission.” 

The Healthcare Engagement Team helps to ensure that individuals who are uninsured, underinsured, or have limited access to care due to financial or other barriers maintain access to essential health care services through Medicaid and the Essential Plan. The Case Management team at Excellus BlueCross BlueShield (BCBS) consists of nurses, social workers, mental health counselors and physical therapists that collaborate to provide telephonic comprehensive care to our members. They focus on physical, emotional, and social wellbeing to help members feel confident navigating their personal health journeys.

Community Connections is part of the Case Management team at Excellus BCBS in upstate New York. These employees find hard to- reach members to reconnect them with care management specialists. They travel to member’s homes to help them reconnect with the Health Plan and help offer in-person assistance when necessary. For more information about the Case Management or Community Connections programs, please call 1-877-222-1240.

Claims-made vs. Occurrence Insurance Policies:Understanding the Differences, Benefits, and Drawbacks

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By: Jenn Negley, Vice President, Risk Strategies Company

When it comes to liability insurance for professionals such as doctors, choosing the right type of policy is crucial. Two of the most common forms of coverage for professionals, such as doctors, lawyers, and business owners, are claims made and occurrence  policies. While they both offer liability protection, the way coverage is triggered and how long it lasts differs significantly. Understanding these differences is crucial for individuals and organizations to avoid costly coverage gaps and ensure they are adequately protected.

What is a Claims-Made Policy?
A claims-made policy provides coverage only if the claim is made during the policy period and the incident occurred on or after the policy’s retroactive date. The retroactive date is usually the date the insured first purchased a claims made policy and continuously maintained it. For example, suppose a doctor has a claims-made malpractice policy that starts on January 1, 2022, with a retroactive date of January 1, 2020. A patient filed a lawsuit on March 1, 2023, for something that happened in 2021. Because the policy is still active when the claim is made and the incident occurred after the retroactive date, the lawsuit is covered.

Benefits of Claims-Made Policies:

Lower initial premiums:
These policies are often cheaper in the early years because the insurer is only covering claims reported during the policy period, not the full history of a professional’s work.

Customizable tail coverage:
If you retire, take a break from your career, or switch insurers, tail coverage can extend your protection beyond the end of the policy. This helps cover claims that arise later from work you did while the policy was active.

Adaptability:
Claims-made policies are a good fit for professionals whose situations may change, such as a growing practice or changing insurers. However, continuity is key to avoiding coverage lapses.

Drawbacks of Claims-Made Policies:

Tail coverage can be expensive:
If the policyholder retires or switches carriers, they may need to buy tail coverage, which can cost up to 200% of the final year’s premium.

Coverage gaps: If there’s a lapse in policy renewal or the retroactive date changes, claims may be denied.

Complexity:
The nuances of retroactive dates and tail coverage can confuse policyholders unfamiliar with insurance jargon.

What is an Occurrence Policy?
An occurrence policy provides coverage for incidents that occur during the policy period, regardless of when the claim is filed. This means even if a claim is filed years after the policy expires, the insurer will still cover it if the incident occurred during the time the policy was active. For example, if a contractor has an occurrence policy from 2018 to 2020, and a claim is  filed in 2024 for a job completed in 2019, the claim will still be covered.

Benefits of Occurrence Policies:

Long-term peace of mind:
Once the policy is in place, the policyholder is protected for incidents that occurred during the coverage period, even if the claim arises years later.

No need for tail coverage:
This makes occurrence policies especially attractive for professionals who don’t want to worry about coverage after retiring or changing jobs.

Simplicity:
Easier to understand and manage over time, since there’s no concern over retroactive dates or claim reporting timelines.

Drawbacks of Occurrence Policies:

Higher premiums:
These policies usually cost more upfront than claims made policies, reflecting the broader protection they offer.

Limited availability:
Some insurers offer only claims-made policies for specific professions or high-risk fields.

Harder to budget long-term:
Because the insurer assumes longterm liability, the policy’s true cost can be challenging to estimate or predict.

How Do You Decide Which Policy Is Right for You?
Choosing between claims made and occurrence policies often depends on your financial situation, career stage, and risk preferences.

• Early career professionals may prefer claims-made policies for their lower initial cost.

• Established professionals or those nearing retirement might lean toward occurrence policies for their lasting protection.

• Those who switch jobs or insurers frequently must carefully manage claims made coverage to avoid gaps.

Both policy types have their place, and the best choice depends on your specific situation. Consulting with an experienced insurance broker can help ensure your coverage aligns with your needs, career plans, and financial goals.

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

Gato Flooring:Comprehensive Solutions for Flooring, Walls, and Windows

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By Martha Conway

Sofia Gato’s journey in the flooring industry began when she arrived in the United States from Portugal and took a position as an administrative assistant at a flooring company. What started as a job soon became a passion, igniting her ambition to build something of her own. Fourteen years later, Gato Flooring, LLC, stands as a testament to her vision – a certified Woman-owned Business Enterprise that transcends the role of a typical contractor. It is a company built on expertise, reliability, and an unwavering commitment to excellence. Today, Gato Flooring serves a diverse clientele, including educational institutions, municipal buildings, healthcare facilities, commercial kitchens, laboratories, and other specialized spaces across New York state and the greater Tampa Bay Area.

 

“Our team is very strong and knowledgeable,” Gato said. “We’re not just installers; we’re problem-solvers. Whether a client needs a complete buildout or simply the right materials for their project, we deliver solutions tailored to their needs.”

 

With extensive experience in new construction and renovations, Gato Flooring offers full installation services while also acting as a trusted supplier of materials for contractors. This dual capability allows the company to adapt to a wide range of project demands, ensuring clients receive precisely what they require, executed with precision and care.

Gato’s philosophy centers on doing the job right the first time.

“We want potential customers to understand that we pour effort into every installation to ensure there are no callbacks, no punch lists, no lingering issues,” she explains. “That’s our primary objective. We’re meticulous – some might even say overly particular – because quality matters.”

This dedication has earned Gato Flooring a reputation for reliability and attention to detail, qualities that resonate with clients who value durability and performance in their built environments.

Flooring Design: Balancing Purpose and Aesthetics

When it comes to flooring, Gato stresses the importance of aligning design with functionality.

“Before making decisions about flooring, walls, or window treatments, clients must first consider the purpose of the space,” she said. “That’s the cornerstone. Too often, aesthetic is prioritized – beautiful designs that catch the eye – but if they don’t serve the 

space’s practical needs, they’re doomed to fail.”

This pragmatic approach ensures every project delivers not only visual appeal, but also long-term utility.

Gato Flooring offers an extensive array of flooring options to accommodate a wide range of needs in diverse building environments. Beyond conventional carpet and tile, the company provides specialized solutions: acoustic flooring for sound-sensitive environments, artificial turf for recreational spaces, concrete and engineered wood for durability, and polished concrete or quartz for a sleek, modern finish. For fitness centers or indoor sports facilities, Gato Flooring supplies resilient surfaces designed to withstand heavy use.

“We have something for every need,” Gato said, emphasizing the versatility of her offerings.

In addition to flooring materials, Gato Flooring provides essential interior accessories – wall base, trim, adhesives, cleaners, and transition pieces – to ensure seamless integration and a polished final result. This comprehensive approach simplifies the process for clients, offering everything they need under one roof.

Specialized Wall Solutions: Engineered for Performance

Gato Flooring’s expertise extends beyond floors to include advanced wall solutions tailored to highly specialized environments. The company specializes in hygienic PVC wall cladding, a critical component for spaces requiring sterile or seamless conditions, such as laboratories, healthcare facilities, and commercial kitchens.

“Our team is certified to install these walls with major manufacturers such as Altro and Gerflor,” Gato said. “These walls aren’t like standard drywall or fiberglass-reinforced panels. They’re purpose-built materials, engineered to meet stringent hygiene and durability standards.” Unlike traditional finishes, hygienic cladding resists impact, inhibits bacterial growth, and maintains integrity in high-moisture or high-traffic areas.

For clients undertaking combined flooring and wall projects, integrating these systems streamlines construction and enhances functionality. The compatibility of flooring and wall materials allows for a unified installation process, reducing seams and potential weak points. It also eliminates the problems associated with trying to retrofit these systems after the fact.

Beyond functionality, Gato Flooring offers customizable wall panels that blend practicality with creativity.

“We can reproduce custom images or artwork onto durable panels,” Gato said. “These are vibrant, long-lasting designs available in various formats to suit specific client needs.”

This option appeals to businesses or institutions aiming to make a statement using their branded graphics in a corporate lobby or educational institutions using murals in a school, while ensuring the robustness required for commercial use.

Window Treatments: Enhancing Efficiency and Style

The scope of Gato Flooring’s expertise doesn’t end with floors and walls; the company also provides premium window treatments that elevate function, form, durability, and beauty. Offerings include blinds, shades, drapes, and shutters, each designed to optimize light control, reduce energy costs, and enhance privacy.

“These aren’t just decorative,” Gato emphasizes. “They’re engineered to manage heat, glare, privacy, and insulation, all while complementing the space’s unique aesthetic.”

Available in a wide range of styles and materials, these treatments cater to diverse tastes, from minimalist designs to bold, statement-making installations. This holistic approach – addressing floors, walls, and windows simultaneously – positions Gato Flooring as a one-stop solution provider, capable of transforming entire interiors with cohesive, high-quality professional results.

Floor Preparation: The Foundation of Success

A successful flooring installation hinges on meticulous subfloor preparation, an area where Gato Flooring possesses unparalleled proficiency. The business invests in state-of-the-art materials, tools, and equipment to assess, prepare or repair subfloors, addressing issues such as cracks, unevenness, or moisture infiltration before installation begins. The preparation process may involve cleaning, leveling, grinding, sealing, or replacing plywood to meet manufacturer specifications. Moisture, in particular, poses a persistent threat; undetected during installation, it can lead to significant damage later. Gato Flooring mitigates this risk through rigorous inspection, testing, and remediation to ensure a stable, durable base.

“Our goal is a flawless foundation,” she said. “That’s what guarantees longevity.”

Commitment to Excellence

At the heart of Gato Flooring’s operations is a dedication to exceeding customer expectations.

“We have an excellent, professional and well-trained team to ensure project success and consistent, top-tier results,” Gato said, explaining that this commitment to pursuing perfection often manifests in added value for clients. “It’s our way of showing we care about their experience and the outcome.”

In addition to being a certified New York State Woman-owned Business Enterprise, Gato Flooring is a certified WBE with the Port Authority of New York and New Jersey, as well as a certified Disadvantaged Business Enterprise.

Headquartered at 839 Broad St., Suite 2, Utica, and with a second location in Tampa, Fla., at 8270 Woodland Center Blvd., Suite 101, Gato Flooring serves all of New York state and the Tampa Bay region. Offices are open from 7 a.m. to 4 p.m.

“Though the company focuses exclusively on commercial projects, walk-ins are welcome,” Gato said.

For more information, visit gatoflooring.com or call 315.790.5508.

Lien Law Trusts:  More Value Than A Mechanic’s Lien?

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Lien Law Trusts can be more powerful than a mechanic’s lien and can help you get paid when you take on a construction project.  When a contractor doesn’t get paid, one of the first things they can do is get a mechanic’s lien in place.  A lien can be a valuable tool to enforce the right to get paid.  However, a mechanic’s lien can come with a minefield of problems and expenses.  An alternative for companies to consider is Lien Law Trusts.  

In common law, a trust is created when one party seeks to protect assets.  A parent might set up a trust for their child.  The parent is the grantor and the child is the beneficiary.  The parent might designate an attorney, bank or some other representative to manage the trust. 

A trustee is charged with legal responsibility for taking care of the beneficiary, which is a duty of trust and fidelity.  Their motive must always be in the best interests of the beneficiary, not themselves.  If they take money from the trust, they are responsible, and in some cases can be charged with larceny under the Penal Law. 

This concept of a trust between a trustee and beneficiary applies to construction projects in New York.  In NY, a contractor that receives payment on a project becomes trustee of those funds.  As a trustee, the contractor must apply the trust fund assets for the trust purposes before the contractor applies the money to its own overhead or profit.  Trust purposes include payment of subcontractors, vendors, and labor.  If the trustee/contractor uses trust funds for some purpose other than the payment of trust fund obligations, then the contractor may have diverted trust funds. 

A diversion of trust funds can carry serious legal implications, like personal liability for the individuals that were knowingly diverting trust funds.  The corporate form does not protect these individuals from personal liability.  Strong public policy reasons encourage the liability of corporate principals and officers who knowingly and willfully participate in the diversion.  They have taken money that belongs to another and spent it in violation of the trust.  A diversion of trust assets can be a criminal larceny.  A diversion of trust assets can be criminal because the diverting trustee has taken funds which are not its property and applied them for some purpose other than those defined by statute.  

The New York trust fund statutes permit an unpaid beneficiary to demand a complete accounting from its trustee.  The accounting must be verified under oath, and provide a detailed analysis of all trust fund assets received by the general contractor.  The accounting will include a detailed check-by-check analysis of all payments made with trust fund assets.  They require that each check be identified, together with the check number, date, payee and payee’s address. 

Discovery in trust fund litigation should include a complete report from the contractor’s cost accounting system.  These are programs where contractors enter all costs assessed against a project.  Cost accounting programs will show labor dollars paid, materials purchased and application of project funds to overhead.  Overhead may include a contractor’s general conditions such as the project site trailer, site storage facilities, vehicles dedicated to the site and project manager.  Remember that a trustee must first apply trust funds for payment of the beneficiaries.  A trustee which takes trust assets to pay its overhead or profit may be diverting trust assets.  The information contained in a complete job cost accounting report can be beneficial to the subcontractor or vendor. 

Whenever a subcontractor or vendor is unpaid, they should consider utilizing the trust fund statute. 

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.

Legislative Session 2024- Workers’ Compensation Bills

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Annette Malpica, VP Claims & Legal Counsel, Lovell Safety Management Co., LCC

Four workers’ compensation bills were passed by the NYS Senate and Assembly during the 2024 legislative session. Once a bill is passed by both chambers, the bills must be presented to Governor Hochul by December 31, 2024. The Governor has the option to 1) sign 2) veto or 3) request chapter amendments to the bill. As of December 22nd, the Governor has signed two bills and vetoed two bills. We anticipate that the bills that were signed will increase benefits, resulting in higher costs for all NYS employers and in some situations, decrease the incentives to return to work. 2024 Workers’ Compensation Bills signed into Law:

Bill A.5745/S.6635 – Amends WCL §10(3)(b) to eliminate the case law requirement that mental stress injuries be based on work related stress that is materially and substantially greater than that experienced by similarly situated workers.  “Where a worker files a claim for mental injury premised upon extraordinary workrelated stress incurred at work, the board may not disallow the claim upon a factual finding that the stress was not greater than that which usually occurs in the normal work environment.”

Bill A.5745/S.6635 was signed by  Governor Hochul on December 6, 2024, subject to chapter amendments. 

As written, A.5745/S.6635 would expand the statutory carve out that applies to police officers, firefighters, and emergency medical technicians who filed a claim for mental injury premised upon extraordinary work-related stress to include all employees. In 2017 the NY legislature, in recognition of the high standard required by the statute for mental stress claims, and the occupational hazards/exposures experienced by first responders during emergencies, removed the restriction that a mental stress claim had to be greater than the stress sustained by a similar worker. As written, the 2024 bill would treat all workers in a manner similar to first responders and would prevent employers from defending claims for mental injury by demonstrating that an employee was not exposed to stress that was greater than that experienced by other employees. Employees will still  have to have experienced “extraordinary” stress. The onus to determine what qualifies as “extraordinary,” a standard that is not defined by statute, will be placed on Law Judges.

The chapter amendments to A,5745/S.6635 were released on January 9 to the public under a new bill number A.1677/S.0755. The chapter amendments sought to clarify the psychiatric (DSM) diagnoses that would be covered under the new legislation and placed specific work-related parameters as to what incidences meet the “extraordinary worker elated stress” standard.

The three psychiatric diagnoses covered under this new law include: post-traumatic stress disorder (PTSD), acute stress disorder, and major depressive disorder. For these specific diagnoses, claimants will not have to demonstrate that the stress experienced at work was “greater than that experienced by a similar worker” to qualify for workers’ compensation benefits. In addition, A1677/S,0755, contains language that mandates a causal nexus between the work-related stress to a distinct work-related event or events directly related to employment occurring during the performance of the employee’s job duties. A.1677/S.0755 becomes effective 180 days after it becomes law.

In 2022, the New York Compensation Insurance Rating Board (NYCIRB) hired an actuarial firm to review the impact of a similar mental stress bill that was passed by both chambers (A.2020-A/S.6373-B) and its impact on NY carriers and employers. Based on NYCIRB’s analysis, the Governor vetoed the bill. In veto memo 191, the Governor noted that the mental stress bill comes with “significant cost,” that was “imprecise” to measure. In order to overcome the Governor’s concern, the legislature negotiated the chapter amendment language noted above to control costs to her satisfaction.

Bill A.1204-A/S.9462-A – Amends WCL §13(b) to permit treatment by Licensed OT/PT Assistant.
“Under the direction and supervision of an authorized occupational therapist, occupational therapy services may be rendered by an occupational therapy assistant. Under the direction and supervision of an authorized physical therapist, physical therapy services may be rendered by a physical therapist assistant.”

The OT/PT bill was signed by Governor Hochul on September 27, 2024. This bill (or similar bills) has been present in every legislative session since 2013. Currently, OT/PT therapy assistants are not permitted to render care under WCL §13. This bill will allow OT/PT assistants who are licensed by the NY State Education Department to render services to claimants under the supervision of an authorized OT/PT. This bill will become effective on the 13th day after it becomes law. We believe that the impact of this bill will be minimal, since workers’ compensation authorized OT/PT therapists are currently using assistants to help render care to claimants.

2024 Workers’ Compensation Bills vetoed by Governor:

Bill A.1219-A/S.1974-A – Amends WCL §13(1) to add a new paragraph that would permit claimants to utilize a non-network pharmacy provider upon a finding of eight factors. “[A] claimant shall not be required to obtain prescribed medicines through a pharmacy with which the employer or carrier has a contract and may obtain prescribed medicines from a pharmacy of his or her choice when…”

Bill A.1219-A/S.1974-A was vetoed by the Governor on December 13, 2024. In her veto memo, Governor Hochul mentioned that: 1) the bill would increase litigation resulting from factual disputes associated with the eight factors that would permit the claimant to utilize a non-employer network pharmacy 2) the bill would add “bureaucratic” steps to the Workers’ Compensation Board (WCB), and 3) the bill if signed would delay benefits to the claimant. A few examples of the eight factors that would permit the claimant to go out of the employers’ contracted pharmacy network for medications are:

  • employer or carrier refused to provide payment for the prescribed medication and the claimant is unable to obtain the medication from the contracted pharmacy within 72 hours.
  • employer or carrier or network pharmacy failed to respond to reauthorization request
  • medications were previously authorized; however, the employer or carrier denies reauthorization because the medical guidelines do not support reauthorization
  •  an IME disagrees with reauthorization

In the veto memo, the Governor mentioned that WCB will be issuing regulations to address the intent of A.1219-A/S.1974-A. The proposed regulation can be found at www.wcb.gov. The regulations will require that the employer or carrier notify the claimant that they may use a non-network pharmacy when the employer or carrier objects to medications for sites of injury that have not been accepted or established by the WCB. The regulations will be published in the State Register on December 31, 2024. Carriers and employers will have 60 days from publication to submit their comments to the WCB. For Lovell clients we do not see this as a major issue since NYSIF already provides firstfill pending establishment or acceptance of the claim. It is also important that employers and carriers are reminded that if signed, this bill would roll back the pharmacy cost benefits that employers negotiated in the 2007 Reform Legislation.

Bill A.6832-A/S.6929 – Amends WCL §13-a to allow for treatment costing less than $1,500 without the need for pre-authorization. The bill will also prevent carriers and employers from using the Medical Treatment Guidelines (MTG) to deny any treatment not within the Guidelines. “Such list of pre-authorized procedures (MTG) shall not prohibit varied treatment, nor shall the list be used as a basis to deny treatment not contained therein.”

“Any special diagnostic tests, x-rays examinations, magnetic resonance or other radiological examinations or test costing more than one thousand five hundred dollars performed by a provider who is not a member of the carrier’s, selfinsured’s or state insurance fund’s diagnostic network…shall be entitled to payment at the negotiated network rate.”

The Governor vetoed A.6832-A/S.6929, the Medical Treatment Guideline (MTG) bill on 11/22/2024. In Veto Message No. 62, she noted that this bill dismantles the standard of care contained in the Medical Treatment Guidelines. The veto message also emphasizes that the Medical Treatment Guidelines were premised on evidence-based medicine to create a uniform standard of care that would serve to improve medical outcomes to injured workers while also reducing disputes regarding whether treatment is necessary and appropriate. The MTG has also been credited with reducing costs to the workers’ compensation system. As for treatments greater than $1500, the veto message noted that the carrier will be required to obtain an IME, which would cause further delays to treatment that is currently authorized without any litigation in 94% of prior authorization requests.

A.6832-A/S.6929 was the most impactful of all the bills that were passed by the legislature during the 2024 legislative session. This bill would essentially dismantle the MTG and the Prior Authorization Request (PAR) process that the WCB spent years and millions of dollars to create as part of the comprehensive Business Process Reengineering (BPR), which included PAR and OnBoard. If signed, this bill would have opened the door to dramatically increased costs for employers if providers advanced questionable medical treatments. In addition, the cost of litigation would increase significantly as employers and carriers sought to limit unwarranted medical costs. We do not need to go far into the past to recall the abusive submissions of hundreds of bills by certain medical providers for treatments that were questionable and, in some cases, injurious to claimants.

Common Construction Accounting Risks and How They Can Be Prevented

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Robert C. Reeves, CPA, CFE, Dannible & McKee, LLP

The construction industry has experienced a significant amount of growth post-pandemic. While increased job activity is a positive, several risks have become more prevalent, which could negatively impact job performance if overlooked. Implementing efficient accounting practices can prevent companies from experiencing deteriorating margins and assist in mitigating the following common risks, helping companies gain a stronger understanding of bidding processes and projected job performance.

  1. Inaccurate Cost Estimates: With numerous jobs available for bid, construction industry experts face a rising risk of inaccurate cost forecasts. Poor estimates lead to underbidding and cost overruns. Contractors should use detailed, line-item estimates for each job site activity, including labor, materials, and equipment hours. These costs should be continuously evaluated and adjusted as the project progresses and work scopes change. Regular evaluation of estimates and comparison of budgeted to actual costs enables accurate forecasting of the job’s trending performance and helps refine estimates in future projects.
  1. Overhead Overlook: Overhead costs are a notable expense in the construction industry. Fixed overhead costs, such as office rent or insurance, are straightforward to account for, whereas variable overhead costs, such as labor burden, repairs and maintenance, and advertising, can fluctuate and be easily overlooked. Common pitfalls include not considering indirect costs and overhead during the bidding process and not allocating these costs to the work-in-process schedules on a timely basis when evaluating a job’s performance. To prevent overhead overlook, companies should utilize a variety of formulas to allocate indirect costs and overhead. Allocation formulas most commonly used include, but are not limited to:
  • Allocate indirect costs and overhead based on direct labor;
  • Allocate indirect costs and overhead based on material costs; and
  • Allocate indirect costs and overhead based on equipment use.

Tracking construction project costs is already time-consuming without factoring in overhead and direct costs. However, it is crucial for companies to understand and track the difference between direct, indirect, and overhead costs on each job, starting from the bidding stage and on a continuing basis as projects progress.

  1. Increased Market Prices: Post-pandemic, the construction industry has faced extreme cost volatility. Since 2020, average hourly wages have risen approximately 17%, and overall construction input costs have surged by 40.7%. Costs throughout the industry are expected to continue increasing for the foreseeable future, requiring companies to take into consideration and adjust their budget and bidding processes accordingly. They can even look for other avenues to help mitigate inflationary costs, including:
  • Requesting deposits to purchase and store materials before construction of a project begins.
  • Incorporating percentage change clauses in contract agreements that allow cost overruns from price increases to be billed back to the project’s owner.
  1. Cash-Flow Overruns: Rising costs can also lead to cash flow shortages, which can create materials and equipment delays. When materials and equipment have delayed deliveries, companies may need to postpone projects, which can have various negative impacts. To prevent this, companies should establish strong budgeting and accounting estimates of cash flows. Estimating when certain milestones will be met will help you develop and track a proposed payment schedule and provide a good idea of how cash inflow will correlate with cash outflow on jobs.
  2. Out-of-Scope Work: It is inevitable that construction projects will face unexpected changes, such as poor weather, last-minute changes, punch list items and job add-ons. It is essential to consider and account for out-of-scope work during the bidding process and when forecasting the project’s expenses and performance. Project managers should maintain open communication with the accounting department to continuously compare actual costs with estimates throughout the life of the project. Identifying lower-than-expected margins early provides management time and justification to refuse extra work or work with the project’s owner to find a suitable middle ground. Having strong accounting procedures and controls, such as budgeting, tracking job performance, accurate cost allocation, cash flow projection, and many more, helps mitigate these risks and their negative impact on job performance and a company’s bottom line. Paying attention to the numbers and prioritizing the accounting and financial aspects of jobs can be a crucial factor in increasing margins and advancing your company’s success.

Robert C. Reeves, CPA, CFE, is an audit partner at Dannible & McKee, LLP, a public accounting firm with offices in Syracuse, Auburn, Binghamton and Schenectady, NY, and Tampa, FL. He has over eight years of experience at the firm providing audit, review, compilation and consulting services to a variety of clients with a focus on the construction, architectural and engineering industries. For more information on this topic, you may contact our firm at (315) 472-9127 or visit online at www.dmcpas.com.

Upstate University Hospital: A Regional and National Leader in Healthcare Innovation

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By Elizabeth Landry

As Central New York’s only academic medical center, Upstate University Hospital is paving the way for much of the region’s healthcare needs. In fact, many of the hospital’s programs and facilities are blazing new trails of innovation, regionally and often nationally, as well.

“We think a lot like a private enterprise, even though we’re public, and that has helped us think innovatively and do well financially,” explained Robert J. Corona, DO, CPE, MBA, FCAP, FASCP who has served as CEO of Upstate University Hospital since 2018. Dr. Corona has been associated with Upstate in various capacities for over 30 years, completing his residency and fellowship at the hospital in the 1980s, serving as an educator periodically, becoming Chair of the Pathology Department in 2012, and serving as Chief Innovation Officer shortly after.

For Dr. Corona, continuing to lead the way in innovation is a core strength of Upstate, and his vision of innovation in health care encompasses new ways of incorporating machines, software, programs and buildings. “We need to be state of the art as a teaching hospital to be able to provide our trainees with the best technology and the latest innovations, so they can see how high-quality care is delivered,” he said.

Technological Innovations at the Forefront

Perhaps one of the most visible avenues in which Upstate utilizes cutting edge technology within its healthcare system is the use of drones and robots, which have combined to become the Autonomous Machines Department. Upstate began using drones around 2013, when Dr. Corona was the Chair of Pathology, but this technology has ramped up since he became CEO. The drones, which can fly over 40 trips per day, save the  organization time and costs by transporting medications and specimens for testing through the air rather than relying on couriers on the ground. Upstate is well on its way to reaching the goal of flying the drones between all its institutions. In addition to the time and cost savings, the innovative technology has also led to increased efficiency and satisfaction of patients.

“We use drones in our ‘Meds to Beds’ program, which means when you’re in the hospital and you get discharged, we provide you with your discharge medication so that you don’t have to go to the pharmacy. The order goes over to the retail pharmacy across from Community Hospital and then the drone flies the medication over to the hospital and we give it to patients when they’re discharged,” Dr. Corona said. Robots, the other piece that forms the Autonomous Machines Department, became part of the organization’s operations to help with staffing shortages, Dr. Corona explained.

“I worked with an engineer and found out that nurses spent 

about a third of their day chasing down supplies, moving food, picking up things in the cafeteria, bringing things to the lab, bringing sheets and any kind of supply, which is really not having nurses work to the top of their license. So, we ended up getting over a dozen robots that now deliver supplies and food.”

Dr. Corona added that such use of these machines has put Upstate at the forefront of healthcare technology not only regionally, but nationally. “I don’t know of any other institution that has a combined program of robotics and drones in an autonomous machines group,” he said. 

Another milestone of technological innovation at Upstate has been the recent opening of the Throughput Operations Center. A sort of central command center for the organization located in the former Telergy Building off Carrier Circle, the center features 22 live-feed monitors and 28 computer stations
that provide hospital officials with a real-time view of operations, including capacity demands, bed census, open beds, COVID information and patient transport status. The center is aimed at reducing bottlenecks, streamlining patient flow, and improving patient outcomes across the hospital network. Dr. Corona explained how the center is helping with capacity challenges and may even grow to include external healthcare organizations.

“We’ve had preliminary discussions with the Department of Health to see if we could coordinate with hospitals that have capacity and we would help them manage the patients if needed,” he said. “We’ve had interest in what I call a ‘virtual hospital system,’ where the Throughput Center would see all the participating facilities and help manage and balance the load.”

New Programs Directly Benefitting Providers

Upstate is one of only a handful of academic medical centers to offer a new Hospital Administration Leadership and Management Fellowship accredited by the Accreditation Council for Graduate Medical Education, or ACGME. This fellowship provides the opportunity for physicians to gain certification in this field.

“The physicians will spend time learning finance, operations, physician management and other skills leading to board certification in healthcare leadership,” explained Dr. Corona. Another significant, yet very different way Upstate is investing in innovations that directly benefit healthcare providers is through a recent safety initiative called “Respect and Heal,” a collaborative effort with other local healthcare entities. It was proposed by Dr. Corona after he and other regional CEOs wanted to address violence against healthcare workers.

“We are united in zero tolerance for abuse and are committed to sharing best practices to end harassment and assaults. We held a half day conference last year, which was standing room only, and we are moving to a full-day conference this year to share innovations and research,” said Dr. Corona. Upstate took on the role of coordinating and hosting the conference, which is offered to staff and leadership at the dozen hospitals that have committed to the principles of Respect and Heal.

Widespread Innovations in Healthcare Facilities

The team at Upstate has been on the forefront of innovative facilities and buildings for several years, with structures like the Upstate Nappi Wellness Institute, a building that’s been both LEED certified, signifying its sustainability, and Well certified, related to its eco friendly status. The building’s beautiful design is what Dr. Corona described as “friendly to the human experience.”

Another innovative space that has been approved is a new pathology building that will be built next to the Upstate Bone & Joint Center on Fly Road in East Syracuse. Dr. Corona elaborated on how pathology has become more innovative at Upstate over time, and why the new building is needed.

“When I returned to Upstate as the pathology chair after 16 years in the industry, I had experience in digital imaging and developing medical products,” he said. “The new facility
is going to leverage recent research in digital pathology, molecular diagnostics, applications of AI relevant to diagnostics, and quantum computing.”

Another recent facilities development at Upstate is a plan to build an annex which will include a new Emergency Department and a new Burn Unit. The team at Upstate is also exploring the development of a cellular therapy center reflecting recent innovations in

 stem cell technology.

The Upstate Cancer Center at Verona is unique due to the organization’s collaboration with the Oneida Nation, a relationship that Dr. Corona explained is one of the first of its kind.

“To the best of our knowledge, this is the first collaboration where a public New York state hospital has worked with a native nation to build a health facility. It’s been a wonderful relationship – they’ve been amazing to work with.”

Providing Cutting-Edge, High-Quality Care
The Verona Cancer Center is one of Upstate’s several cancer centers, with other locations in Syracuse, Oswego, Auburn and at Community Hospital. These widespread resources reflect Dr. Corona’s focus on providing healthcare where people in the community need it most.

“I see us as having a responsibility to grow and provide state-of-the-art care locally for our community, so people don’t have to leave the area for exceptional cancer care, cardiac care or stroke care. We have an obligation to really drive outstanding quality, and to incorporate the most relevant tools and approaches to do so.”

For Dr. Corona and the team at Upstate, that’s what innovation is all about. 

The new Upstate Throughput Center features 22 live-feed monitors and 28 computer stations that provide hospital officials with a real-time view of operations, including capacity demands, bed census, open beds, and patient transport status to streamline care.

Research and Teaching: What Sets Upstate Apart

The two pillars of Upstate University Hospital that perhaps most distinguish the organization from other hospitals in the region are research and teaching. These components stem from the hospital’s role in the overarching Upstate Medical University. Academic medical universities like Upstate include a medical school and a research enterprise as part of their core mission, along with patient care.

Every research project at Upstate is focused on finding cures and improving human health. Current research initiatives and projects include tumor cell invasion and immunotherapy for treating cancer, exploring the genetic bases of neurological and psychiatric disorders, and utilizing AI and machine learning for advancements in pathology diagnoses. Patients benefit from access to clinical trials, and every patient at the Upstate Cancer Center is assessed for their potential to participate in a clinical trial.

Focusing on education, Upstate’s role as a teaching hospital ranges from faculty educating third- and fourth year students on their clerkship rotations, to medical residents and fellows arriving for their training, to offering continuing medical education and grand rounds that are open to area physicians.

Agility In Recruitment In Health Settings

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BY KATHRYN RUSCITTO, ADVISOR

During Covid I watched a hospital in Florida implement a variety of new positions based on specific tasks. From the basic welcome to a room with detailed instructions done by a patient tech to a full assessment being done remotely by a nurse.. The goal being to reduce clinical time at the bedside from tasks that paraprofessionals and professionals could accomplish rather than the bedside nurse. It worked well.

More recently some hospitals are using remote Nurses to support community based nurses. Access to experts in Diabetes, Wound Care and cardiac care are active across the country. When done with care and training, it gives nurses specialized back up they might not have immediate access to on a local level. 

Agility during times of workforce stress is working for many organizations. Placing an emphasis on innovation is key for health leaders. The strategic issues confronting healthcare feed into the workforce shortages.

Rising costs, lower reimbursements, financial
implications from value based care, cybersecurity, and introduction of new technologies like AI are all contributing to high turnover rates.

Many health care employers are opening new points of access for existing employees to increase education and training . In addition they are working with community colleges and job transition programs as people see layoffs in other areas to transition to health training programs. From military transitions, to immigrants these recruitment paths are helping.

Recently I met an Administrator, Rosemarie Tamunday- Casanova, from Right Accord, who has recruited nurses from the Philippines. We discussed that foreign born recruitment has and is being done primarily in acute settings. We pondered whether surgery centers and private offices might also be an option for these nurses.

Finally, the use of AI and digital strategies to reach broader audiences and make your organization known is essential in recruitment. There is no question that agility in essential in and professionals recruitment. There are successes and best practices evolving if we are open to their adoption.

Background:
https://www.hhs.gov/health are/workforce/recruit- train retain/index.html#get-grant

https://www.aha.org/aha center-health-innovation- market-scan/2022-12-06 how-build-yourfuture-workforce-pipeline

https://magazine.hcahealthc re.com/people/career- and development/creating workforce-solutions- and-advancing-healthcare professionals/

https://www.nga.org/public tions/preparing- the-next generation-of-the-healthcare workforce-state-strategies-for-recruitment-and-retention/

https://www.kornferry.com/ bout-us/events-webinars/talent-acquisition-trends-2025

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

Help Me… HELP YOU.

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by Jenn Negley, Vice President, Risk Strategies Company

Throughout my career, I have often had those thoughts in my head while trying to assist medical groups or individual physicians resistant to working with an agent or broker. While some skepticism is warranted, and we acknowledge that any industry has both positive and negative aspects, there are specific factors to consider in medical malpractice insurance that can increase the likelihood of achieving positive results. How can you determine the professionalism of an agent you are working with, such as myself, and help us assist you effectively?

Several factors should be considered, starting with an individual’s approach and the carrier and policy solutions they recommend. In most instances, these factors have significant consequences and can help you determine if this is an individual you should work with.

Malpractice insurance is a highly specialized market with significant financial implications. If you have an agent pitching you other coverages and adding malpractice insurance at the last minute, I would be wary. Sticking with someone who focuses on medical malpractice insurance is always best; not only will you benefit from their knowledge, but it often impacts the carriers they have access to, which leads us to the second item to keep an eye out for. If an agent is pushing one carrier, this is always a red flag. The most qualified agent should be able to provide you with multiple alternatives, giving you a nonbiased view of what is available. Another consideration is whether the carrier has an A rating from A.M. Best. In the insurance world, it is advisable to avoid lesser-rated companies, and I would not rely on ratings from any rating agency other than A.M. Best, which is the gold standard.

The type of policy an agent pushes might also be a cause for concern. If an agent is asking you to change your coverage type from occurrence to claims made to save money, they are doing you a disservice. While this will generate savings in the first 2 to 3 years, the scheduled premium increases will bring you back to your original cost and possibly more. In group settings, you will often have to amend employment contracts to address who is responsible for tail costs when a provider leaves your group. If your practice ever sells, most buyers will likely require you to purchase a tail for the entire group, and the cost can range from 100% to 200% of your current premium.

When working with a specialty broker, you also gain the advantage of a service team that knows how to navigate the processes for each carrier because of the volume of business they place. With that volume, you typically have a dedicated underwriting team that builds strong relationships, allowing for more collaborative efforts to provide solutions that would not usually be available. In competitive markets, this could result in increased savings, and in a challenging market, it could limit rate increases. Don’t be fooled into assuming that large-name brokerages are the best solutions. Typically, it comes down to the volume that a particular office does, not what the brokerage does as a whole, and again circles back to the question of whether they specialize in this coverage. 

We are all too aware of the financial stress healthcare is under. Still, there are professionals readily available to serve as an honest partner in alleviating those pressures in a way that protects your longterm security and meets your needs. I hope these market insights, in a small way, help you in your future endeavors. r practice, and your patients, depend on it. 

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

Dr. Hadley Narins Fills a Gap in Patient Care with a Focus on Quality of Life

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By Bari Faye Dean

Hadley Narins, M.D., never set out to become a specialist in  female urology, but as she progressed through her medical training, she saw a significant gap in care. “Nearly 50 percent of the patients coming in were women, yet so few urologists were specializing in female pelvic health,” the board-certified, fellowship trained urologist said. When she was a medical student, she didn’t see any women residents in urology, making the field feel male-dominated. But instead of being deterred, she found an opportunity to make a difference.

Although she initially considered a focus on general urology and cancer, her experiences in training opened her eyes to the pressing need for female pelvic health specialists. “Few men want to focus on female urology,” she explains. “Most gravitate toward prostate and kidney cancer.”

Dr. Narins earned her medical degree from Thomas Jefferson Medical College in Philadelphia, then completed a General Surgery internship and Urology Residency at SUNY Buffalo, finishing in 2017.

Practicing since 2018 at Associated Medical Professionals of New York, Dr. Narins specializes in treating women suffering from voiding dysfunction and pelvic organ prolapse and reconstructive surgery with minimally invasive techniques, including robotic sacrocolpopexy.

Transforming Lives, One Surgery at a Time
Urologic surgeries for women might not be lifesaving—but they are life-changing. “The most rewarding part of my job is meeting with a patient post operatively and seeing how happy they are,” Dr. Narins said. “Many experience almost immediate relief.”

Her practice serves a vast region, extending from the Canadian border to the rural areas of Central New York. “There is a huge need for specialists like me in Syracuse,” she said. “We all need to clone ourselves two or three times to meet the demand, especially as the Baby Boomer generation ages.”

While many of her patients are women who have had children, some experience significant pelvic floor disorders despite never giving birth. In addition to primary surgeries, she performs revision surgeries for patients who have experienced recurrence or complications following prior treatments. She conducts robotic surgeries at Crouse Hospital, where she played a key role in developing the Female Urology and Pelvic Reconstruction program. Routinely, she performs many procedures at Intrepid Lane Ambulatory Surgery Center, the facility owned by her practice.

A Patient-Centered Approach
Dr. Narins prioritizes building relationships with her patients. “I want to take care of them clinically, but I also want to know who they are as people,” she said. “What’s important to them? What is their family life like? I genuinely care about my patients and want them to feel heard and valued.”

Her team includes a physician assistant, nurse practitioner and dedicated nurse, ensuring patients receive comprehensive, evidencebased care. “We stay up to date with the latest literature and make sure our patients not only get the best clinical outcome but also feel supported throughout their journey.”

Life Beyond the Operating Room
Outside of work, Dr. Narins leads a full life with her husband and three children, ages 8, 5 and 2. Married in 2016, she credits her husband —a stay-at-home dad—with keeping their household running smoothly. “He does all the cooking,” she said, laughing.

Gardening is her sanctuary. “Work is work. I get a lot of gratification from it, but it’s stressful. When I’m in my garden, I’m physically working hard, but my mind is in a calm, contemplative state,” she said, noting she even starts her  mornings in the garden before heading to surgery.

Her family grows tomatoes, cucumbers, green beans, eggplant, okra, Swiss chard, and squash, with the children eagerly picking their favorites to eat raw. “They can identify so many different flowers,” Dr. Narins said. “When the weather is nice, I come home from work, change out of my scrubs, and we stay outside until the mosquitoes come out.”

Many of her patients are gardeners, too, allowing her to foster an unexpected but meaningful connection. “It’s a common passion. When I talk to my patients, I see them as people, not just cases. And I think that makes a difference.”