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The Impact of Artificial Intelligence on the Future of Construction Estimating

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Earl R. Hall, Executive Director, Syracuse Builders Exchange

The construction industry is entering a transformative era where artificial intelligence (AI) is set to redefine traditional estimating processes. Accurate project cost estimation has always been a critical factor in the success of construction projects.  AI technologies, particularly those involving machine learning and predictive analytics, are poised to enhance the speed, precision, and efficiency of estimating, enabling contractors to remain competitive in an increasingly data-driven market.

Enhancing Accuracy Through Data-Driven Insights

Although many contractors today utilize estimating software, traditional estimating relies heavily on human judgment, historical data, and manual analysis. While experienced estimators bring valuable expertise, human error and time constraints can affect accuracy. AI algorithms, by contrast, can process vast amounts of historical cost data, project specifications, and market trends in seconds.

Machine learning models can identify patterns that humans might overlook, such as subtle correlations between design choices and cost impacts. For example, AI can detect how changes in material supply chains or labor availability in specific regions of New York State influence costs. This level of predictive precision allows estimators to develop more reliable budgets and contingencies, reducing the risk of overruns.

Automation of Repetitive Tasks

One of AI’s most immediate impacts will be the automation of routine estimating activities. Tasks such as quantity takeoffs, data entry, and comparison of vendor quotes can be handled by AI-powered tools. Optical recognition systems can read and interpret blueprints or BIM (Building Information Modeling) files to automatically extract material quantities and specifications.

By automating repetitive functions, estimators can allocate more time to strategic decision-making, negotiation, and client communication activities where human judgment and relationship skills remain critical.

Integration with BIM and Project Management Systems

AI’s synergy with various BIM platforms will further enhance estimating accuracy and collaboration. By linking AI-powered estimating tools directly to BIM models, any design modification can instantly trigger an updated cost estimate. This real-time feedback loop empowers architects, engineers, and owners to make informed decisions earlier in the design phase, when changes are less costly to implement.

Integration with project management software can also enable continuous monitoring of actual costs versus estimates during construction. AI can flag deviations in real time, allowing for proactive adjustments rather than reactive corrections.

Predictive Risk Analysis

AI’s predictive analytics capabilities extend beyond cost estimation into risk forecasting. By analyzing historical project data, AI can highlight potential risk factors such as weather-related delays, supply chain disruptions, or labor issues. Estimators can then incorporate these risks into cost and schedule forecasts, creating more resilient and realistic bids.

This proactive risk assessment can also improve contractor-client relationships by fostering transparency and demonstrating preparedness for unforeseen challenges.

Market Competitiveness

In a competitive bidding environment, the ability to produce accurate, detailed estimates quickly is a significant advantage. AI not only shortens estimating timelines but also enables firms to analyze multiple bid scenarios with ease. Contractors can compare design alternatives, procurement strategies, and schedule adjustments to determine the most cost-effective approach.

Over time, companies that adopt AI in their estimating workflows will likely outperform those relying solely on traditional methods, as they will consistently deliver bids that are both competitive and financially viable.

Challenges and Considerations

While the benefits are substantial, implementing AI in construction estimating is not without challenges. The accuracy of AI models depends on the quality and quantity of data available. Many construction firms will need to invest in digitizing historical records and standardizing data formats. There may also be resistance from experienced estimators who are skeptical of AI’s reliability or concerned about job displacement.

Addressing these concerns will require clear communication that AI is a tool to enhance, not replace, human expertise. Training programs that upskill estimators in AI-assisted workflows will be essential.

Conclusion

AI’s integration into building construction estimating represents a major leap forward in efficiency, accuracy, and strategic capability. By automating routine tasks, enhancing data-driven decision-making, and enabling predictive risk analysis, AI empowers contractors to deliver more reliable bids and manage projects more effectively. While adoption will require investment in technology, data management, and training, the long-term benefits in competitiveness and project success make AI a critical factor in the future of construction estimating.

Edited by Chat GPT

Mental Health Access

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By Kathy Ruscitto

Recent conversations with families seeking mental health resources have highlighted the severe challenges in accessing psychiatric care in our community. What began as routine inquiries have exposed a healthcare system stretched beyond capacity, with primary care physicians increasingly unable to connect patients with psychiatric specialists. The backlog, initially attributed to COVID-19 disruptions and workforce shortages, has reached critical levels that demand innovative solutions.

In consultation with Ann Rooney, Deputy County Executive for Human Services in Onondaga County, the scope of this challenge became clear. The County is actively responding through the Department of Children and Family Services, implementing triage systems designed to prioritize the most vulnerable patients and ensure they receive timely care. Ann also shared a tool the County recommends for physicians to consider called Clinicom (https://clinicom.com/). This algorithm helps providers assess mental health conditions in a timely manner to consider treatment options. Other counties in upstate New York, along with major health foundations from Buffalo to Albany, cite mental health and substance abuse among their top priorities for focus in the next year.

For families with private insurance and financial resources, online mental health platforms offer promising alternatives. Services like Talkiatry and BetterHelp provide access to licensed providers when traditional pathways fail, though they typically operate on a private-pay basis. Online services must be licensed in your state to provide care. While often requiring private payment, they can help individuals navigate next steps and access immediate support.

The mental health system is adapting through tiered care approaches. Psychiatrists focus on the most acute cases, while psychologists and therapists provide ongoing counseling and support for longer-term cases. This model maximizes specialist availability while ensuring comprehensive care. Primary care physicians have become frontline mental health providers by necessity. Many report managing mental health concerns, including substance abuse issues, while patients await specialist access. This reality requires staying current with available resources and access points.

The range of inpatient beds in local health systems are critical parts of the mental health care system when individuals and families face crisis. These beds are also under severe stress from increasing demand. This adds to the crisis in access when immediate care is needed. Multiple barriers continue to impact access including rural geography limitations, insurance coverage gaps, and evolving telehealth regulations. Staying informed about available resources remains crucial for reducing patient frustration and improving care coordination.

 

Thank you for all you do in supporting families facing mental health crisis.

 

Essential Resources Directory

Online Mental Health Platforms

Note: Many sites exist online. Forbes rated these as among the best.

Provider Assessment Tools

State & County Resources

Children’s Mental Health

  • ACCESS Team
    Phone: (315) 463-1100

Substance Use Services

  • Prevention Network Resources
    Phone: (315) 471-1359

Crouse Medical Practice General Surgery Team: Working Together to Provide Innovative, Patient-Centered Care

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By: Elizabeth Landry

From breast cancer surgery, hernia repairs and laparoscopic surgery, to endocrine surgery, ulcer care, bariatric surgery and more, the Crouse Medical Practice General Surgery team offers a wide array of surgical procedures to help patients return to health and continue enjoying their lives. The team of 12 physicians brings a vast depth of knowledge and experience that combine to create a supportive practice that consistently focuses on patient-centered care. This patient-focused philosophy is built upon collaboration with the team, including primary care providers, as Clinton Ingersol, MD, Hillary McMullin, MD, Benjamin Sadowitz, MD, FACS and Angelina Schwartz, MD each explained in their own words.

“To me, the philosophy of our group revolves around patient-centered care and collaboration. It’s just been a very supportive environment and a supportive team to walk 

into, and I think that really benefits patients,” said Dr. Ingersol, a newer provider within the team who’s been with Crouse for almost two years.

Dr. Sadowitz has been working at Crouse for 10 years. He stated that one of the major reasons he chooses to practice at Crouse is the healthcare organization’s focus on patient satisfaction, making sure that each patient feels supported and valued.

“Patients want to feel like they’re being treated as human beings, and I think Crouse does an exemplary job of that from start to finish. You’ll find that patients are very highly complementary in that respect, and that’s one of the reasons I want to work at Crouse – patients feel that they’re part of a broader family and that they’re going to be taken care of in the same way we take care of our friends or family members,” explained Dr. Sadowitz.

Collaborative Support for Each Other and Patients Alike
Both Dr. McMullin and Dr. Schwartz have been practicing at Crouse for about a year, and they each expressed similar goals of building relationships with patients early on, to help them feel as comfortable as possible throughout the surgery process. Dr. McMullin was inducted into the Gold Humanism Honor Society while attending the University of South Florida, which focuses on managing the patient as a whole and not seeing patients as a series of medical conditions, a philosophy she carries over into her practice at Crouse.

“I find that when patients come into the office, they’re often nervous and scared to be seeing a surgeon at all,” Dr. McMullin said. “They know they’re going to have to be asleep for some portion of their care, and that gives them anxiety. If a surgeon can establish a rapport with a patient and develop a trust in the office before surgery, patients end up doing much better. I bring that philosophy to every patient I see. I think it’s really important to meet people where they are and to put them at ease from a social and emotional standpoint before we even get into the medical aspect of their care.”

Similarly, for Dr. Schwartz, her approach to patient care is focused on open communication and reaching decisions together as a team.

“Whenever a patient comes to see me in the office, we try to have a conversation essentially about what it is that should happen, and what the recommendations are. Ultimately, it’s a decision that I like to think we come together as a team to decide – both patient and doctor together deciding what’s best for that individual person,” explained Dr. Schwartz, adding that the team aims to make the referral and scheduling process as efficient and convenient as possible for patients.

Open lines of communication and support apply not only to patient care, but also to how the team works together to provide optimal healthcare for patients, as Dr.  Schwartz emphasized.

“We have a very collaborative group of surgeons here, and all of us openly communicate with each other. Oftentimes we’re working together very closely in discussion of patient cases. We just really like to work together amongst ourselves and also amongst our colleagues within the hospital and even outside the hospital and in the local community. We try to work pretty closely with everyone around us,” she said.

Dr. Ingersol echoed these ideas, highlighting the streamlined communication process within the Crouse healthcare network specifically. “It’s great for patients when everyone is on the same page and communicating in a multidisciplinary fashion. Especially within the Crouse network, it’s so easy to communicate with our primary care colleagues. We can send direct messages to each other to coordinate patient care and ask questions. Our office staff does a great job of coordinating referrals from primary care offices, making sure that patients are seen according to urgency, and making sure things are followed up on and communicated properly,” he explained.

Collective Experience Paired with a Fresh Perspective
Directly related to the high level of collaboration among the Crouse Medical Practice General Surgery team is the way the providers lean on each other’s diverse experience and unique perspectives. Dr. McMullin highlighted the mix of well established surgeons with younger providers offers immense benefits for patients.

“We have a wide range of practitioners at Crouse General Surgery. Some of our more senior partners have been in practice my entire life. Then we have a few surgeons who have only been practicing for one or  two years. That range of experience really offers a lot of benefits to patients because our more senior partners obviously have a great deal of experience – they’ve seen many different conditions and anomalies, whereas the younger practitioners trained in an era where technology is more common and prevalent – for example, we received robotics training in residency,” said Dr. McMullin. “Our senior partners have been very gracious about including us in their patient care. They really enjoy having us come along and assist with interesting or challenging cases. They also elicit our feedback on some of the cases they’ve managed to see what we would do, with our fresh perspectives.”

Dr. Ingersol, who specializes in endocrine surgery, shared how working with the more experienced surgeons in the group has led to an exchange of techniques and strategies that enhances patient care, especially when it comes to making decisions on complex, high-risk cases.

“Our senior partner, Dr. Schu, has been great to work with, has been a very willing mentor, and we frequently do cases together. There’s been a lot of exchange of ideas and techniques because I bring in certain expertise, knowledge and biases and he has this wealth of experience and way of doing things. Having all of that at our disposal to decide what is in the best interest of patients is really valuable,” Dr. Ingersol explained. “Any time I have a case that I anticipate being difficult or may run into something I wasn’t anticipating preoperatively, there’s always someone who’s more than willing to come in and take a look or join me if needed. That’s one of the advantages of a big group that has so much experience.”

Advanced Robotics and Innovative Surgical Techniques
Perhaps one of the most important ways the Crouse Medical Practice General Surgery team sets itself apart from other surgery programs is its focus on advanced surgical procedures, especially robotics, as Dr. Sadowitz explained. He shared how the Crouse administration provided crucial support to surgeons during the time when robotics was starting to take off, and how Crouse’s robotics program today is the largest and most experienced in the region.

“The administrators asked us surgeons, ‘Do you think this is the future?’ and ‘Do you think this is something that we should invest in?’ To their credit, once we told them robotics really is going to be the future for many service lines in surgery, they jumped in with both feet. They made an investment of both time and money because they saw how robotics was going to be better for patients, and they trusted our judgment,” said Dr. Sadowitz, adding that the general surgery team at Crouse now has 11 robots at its disposal, including the DV5, one of the newest systems, as well as an SP robot, Xi systems and a smaller X system.

While all the surgeons on the Crouse General Surgery team are familiar with and comfortable using robotics for surgery, the younger members of the team have the added advantage of having experienced robotic technology in their residencies.

“Dr. McMullin and I happened to go to a residency that is more advanced in its surgical robotic training than most other programs. We came out of training having a really good grasp on robotic techniques. I  think I graduated with more than 100 cases that I had performed on the robot already, which is fantastic,” shared Dr. Schwartz.

In addition to robotics, the Crouse General Surgery team is exploring other exciting advancements in surgical treatments. In the endocrine surgery space, Dr. Ingersol discussed a new treatment of thyroid nodules that’s on the horizon.

“In thyroid care, one thing that we’re starting to look into is a new technology called RFA, or radiofrequency ablation,” Dr. Ingersol said. “We’re not in an active phase yet, but it’s something that’s in the near future across the country and becoming a popular modality of treating thyroid nodules.”

Dr. McMullin also highlighted an exciting new application of laparoscopic surgery aimed at treating patients with bile duct stones. “This type of laparoscopic exploration is something that’s not offered in very many places, and can be really valuable for patients,” she said.

Preparing for the Surgical Needs of Tomorrow
With an administration that invests in cutting edge technologies, and a team of forward-looking surgeons always interested in the latest up-and-coming treatments for patients, it seems the Crouse Medical Practice General Surgery team is well-prepared for the evolving needs of patients and will continue to thrive.

“The future is very bright for Crouse in terms of overall surgery, with many great surgeons and a lot of advanced technology. The administration has made it a priority to make sure we stay technologically ahead of the game, so that’s a big piece of it,” said Dr. Sadowitz. “Crouse has always had the right mindset of ‘patients come first’ from the top down. The hospital always aims to keep very talented people in the hospital doing cases, so that not only are the patients highly satisfied, but the surgeons are, too. It’s a unique mix you really don’t find in many places, and it’s a hard balance to maintain, but Crouse has always excelled at doing just that, and as long as we keep that focus, I think it will continue into the future.”

For the younger providers who will carry the practice on into the next generation, this sentiment is certainly holding true.

“I plan on being here for a long time. It’s a great place to practice,” said Dr. McMullin. “The patient population is fantastic. The healthcare professionals are fantastic. I don’t plan on being anywhere else.”

 

Reflections On The Third Age

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BY: Kathryn Ruscitto, Advisor

Driving across the western side of the Adirondacks, I made my way to a board strategy session held at The Beeches Manor in Rome,  NY—a vibrant place in years past, once known for hosting weddings and proms. I knew it had recently been acquired by Nascentia Health, and I was delighted to see a beautifully restored restaurant and conference center, along with signs of new construction. The site is being transformed into a wellness-focused campus that will eventually offer a variety of assisted living levels and home-like services promoting active aging.

After the session, I wandered the lovely grounds and became intrigued by the site’s future plans. This curiosity led to a conversation with Andrea Lazarek-LaQuay, Chief Clinical Officer of Nascentia.

We spoke about the evolving lifestyles of those entering what some call the “third age”—a time of reflection, purpose, and often changing health or living needs. Many of my friends and colleagues have been wrestling with choices: staying at home, moving into assisted living, or joining a continuum- of-care community that may include nursing home options. Recently, one couple I know researched communities nationwide, visited one that fit their needs, and are now relocating to an assisted living patio home in another state.

When I asked Andrea what guidance she gives clinicians whose patients are aging and asking questions about the future, she emphasized the importance of early planning. Her advice: choose the best housing option early so you can age in place.

“It’s more realistic now to think about remaining at  home,” she shared, “with services delivered to you from meals, to telemedicine, to remote health monitoring.”

Nascentia is actively working with physician practices to support patients as they transition from hospital to home, acting as a vital link in the care continuum. They offer a wide array of services, including:

• Home Health Care
• In-Home Primary Care
• A Medicare Advantage Health Plan
• Future 55+ living options at the former Beeches campus More at: nascentiahealth.org

Of course, health status, finances, and caregiver support influence these decisions. But those who  plan early are more likely to live the life they envision in their third age.

A growing concern is the increasing number of aging adults on Medicaid or limited incomes. Without sufficient public support, their choices may narrow. Nonprofits like Nascentia, Loretto, The Eddy, and others will play an even more critical role in serving these seniors in the years ahead.

As our population ages, options for aging are more robust than ever before. But with these options comes responsibility—for individuals, families, and healthcare providers.

How is your practice thinking about partnerships to support these changing demographics?

LOCAL & NATIONAL RESOURCES FOR AGING OPTIONS
Local Resources
• Nascentia Health
• Loretto (Syracuse-based elder care services) https://lorettocny.org/
• The Eddy (Albany and Capital Region services) https://www.eddyseniorliv ng.com/

Out-of-Area and National Tools
• A Place for MomFree service matching families with communities based on care needs, location, and budget.

• Caring.comConsumer reviews, pricing tools, and guides to senior care.

• SeniorHousingNetListings for independent and assisted living, CCRCs, and memory care.

•RetirementLiving.comState-by-state directories, amenities, and lifestyle planning.

• 55places.com Focused on active adult (55+)
communities with virtual tours and
floorplans.
• Seniorly Concierge services, virtual tours,
and price transparency tools.

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

Cyber Threats In Health Care: The Case For Comprehensive Cyber Insurance

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By: Jenn Negley, Vice President, Risk Strategies Company

Technology plays a major role in the healthcare sector’s ability to store and handle private patient data. This has improved the efficiency of healthcare delivery, but it has also increased the susceptibility of healthcare providers to cyberattacks. The healthcare industry has witnessed a rise in cyber threats, including ransomware attacks, phishing scams, and data breaches. As a result, medical professionals need to take precautions against online threats to both themselves and their patients. A comprehensive Cyber insurance policy is one way to accomplish this.

Because medical records are so valuable on the black market, cybercriminals target the healthcare sector. The name, address, social security number, and medical history of a patient are all contained in their medical record. Medical fraud, identity theft, and other nefarious activities may be committed using this information. Healthcare professionals have a duty to safeguard the private information of their patients; otherwise, they risk legal action, government fines, and damage to their reputation.

The rising danger of cyberattacks in the medical field
The cybersecurity situation in the healthcare industry is still woefully inadequate, according to recent statistics. According to the Verizon Data Breach Investigations Report for 2025, 1,542 of the 1,710 security incidents that occurred in the healthcare sector were verified as data leaks. In a single year, over 630 ransomware incidents targeted healthcare organizations, marking a significant increase in ransomware attacks. These attacks frequently result in serious operational issues, including canceled appointments, delayed patient care, and even ambulance diversions. The healthcare sector is now the costliest industry for data breaches, with an average cost of $9.8 million, according to IBM’s 2024 Cost of a Data Breach Report. This figure encompasses both indirect costs, such as lost revenue and reputational harm, and direct costs, including the cost of the investigation and recovery.

The significance of having a good cyber insurance plan
One of the most effective ways to mitigate the risks associated with cyberattacks is through cyber insurance. Typically, incident response expenses include paying for legal counsel, recovering data, and notifying customers. Certain policies also provide companies with resources to help them prevent attacks, such as risk assessments and staff training.

Cyber insurance plans vary from one another. Many healthcare providers assume that the cyber insurance bundled with their medical malpractice insurance will cover them in any instance. Regretfully, this isn’t always the case.

Bundled Cyber Insurance Drawbacks
When offered as a “bells and whistles” supplement to medical malpractice insurance, cyber insurance frequently falls short in a few critical areas:

• Coverage Gaps: Some cyber incidents, like ransomware attacks and phishing scams, might not be covered by these policies. For example, although thirdparty vendor data breaches make up 15% of all incidents, a policy may not cover them.

• Inadequate Limits: Bundled policies frequently have coverage limits that are not enough to pay for the entire cost of a significant cyberattack. Given that a ransomware attack typically costs $1.85 million, healthcare providers are at risk when they have a policy with a $500K limit.

• Absence of specialized assistance: Bundled policies might not grant access to specialized cybersecurity tools, like those employed by ransomware negotiators or forensic investigators. This can lengthen the time it takes to respond and make an attack more powerful overall.

• Regulatory Fines Exclusions: Many policies don’t cover fines and penalties for regulatory infractions, like those under HIPAA. The United States Department of Health and Human Services fined $12.84 million for data breach-related HIPAA violations in 2024 alone.

The Path Forward: Comprehensive Cyber Insurance
To fully protect themselves against the growing threat of cyberattacks, healthcare providers must acquire customized cyber insurance policies tailored to their specific needs. These regulations ought to have:

• Broad Coverage: Verify that the policy includes coverage for a variety of cyber incidents, such as phishing, ransomware, and breaches by third parties.

• Sufficient Limits: Select coverage amounts that account for the possible expenses of a significant cyberattack.

• Regulatory Compliance: Provide coverage for penalties and fines associated with data breaches.

• Specialized Resources: Legal advice, forensic investigators, and cybersecurity specialists are available.

Because cyber threats are constantly evolving, healthcare providers must be proactive in safeguarding  both their patients and their organizations. Having medical malpractice and cyber insurance alone is no longer sufficient. Purchasing comprehensive standalone cyber insurance can help healthcare providers reduce the operational and financial risks associated with cyberattacks.

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

The Corporate Practice Of Medicine

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by Marc Beckman and Benjamin Goldberg

Almost two years ago, New York enacted PHL Article 45 A, which took effect on August 31, 2023. One of the intents behind this law was flagging large business consolidation in the healthcare field, potentially allowing New York’s Department of Health to regulate the increased transaction prices, reduced competition, or narrowed access to healthcare for residents of the state. Please see our previous article formore information on PHL 45-A here. Importantly, New York’s statute includes Managed Services Organizations (“MSOs”), even though they do not provide healthcare services themselves, as part of any healthcarerelated transaction subject to review.

New York is not the only state to take steps, even if small ones, toward reinvigorating the Corporate Practice of Medicine (“CPOM”) doctrine, and the common law, statutes, regulations, and ideas that had previously undergirded it. In 2025 alone, 12 states, from California to Indiana to South Carolina, have introduced at least one bill each, intending, in some way, to revive CPOM doctrine and update it for the current century. As an example, one of the bills introduced in Connecticut is titled “An Act Prohibiting A Private Equity Firm From Acquiring, Owning Or Controlling A Health Care Provider’s Practice Or Health Care Facility And Requiring The Disclosure Of A Change In Ownership Of Such A Practice Or Facility.”

There are two obvious routes by which legislatures can strengthen statutory opposition to such corporate control of medical practices: 1) focus on the MSOmedical practice nexus by which previous CPOM doctrines have been circumvented, and 2) provide more tools for anti trust enforcement on the state level in order to give regulators the power to halt the industry consolidation. Taking New York’s PHL 45-A as an example, that law, in essence, provided some anti-trust regulatory power to the New York State Department of Health as it focused on the consumer harms of reduced competition. The other route, focusing on MSOs and their control of medical practices, is seen in proposed legislation in North Carolina and Vermont.

The North Carolina bill would prohibit common stakeholders between medical practices and MSOs. The bill also expressly reserves the right to make medical decisions for physicians under contract with an employer or working as independent contractors. Furthermore, the bill sets out that after receiving a complaint, the onus will be on the organization in question to prove, by explanations of the business structure and  affirmations, that the physicians are in control of the medical decisions. And recently, on June 9, 2025, Oregon signed into law “An Act Relating to the Practice of Health Care,” which is taking aim at the MSO practice model by prohibiting MSOs from having the ultimate authority over things like hiring physicians, setting work schedules and compensation, setting policies for billing and collection, and negotiating contracts with third-party payors. Another interesting aspect of the Oregon bill is that it takes direct aim at restrictive covenants. Restrictive covenants are a typical way for the MSO medical practice model to control the ability of physicians to break away from their current employer, and as such, are a powerful tool in the arsenal of private equity and other nontraditional business organizations that have moved in the healthcare industry seeking profits.

Finally, physicians are also beginning to push back. In Am. Acad. of Emergency Med. Physician Grp., Inc. v. Envision Healthcare Corp., No. 22-CV-00421-CRB, 2022 WL 2037950 (N.D. Cal. May 27, 2022) and Hosp. Internists of Austin, P.A. v. Quantum Plus, LLC, No. 1:18-CV-466-RP, 2019 WL 1922051 (W.D. Tex. Jan. 23, 2019), physicians have sued business organizations affiliated with Kohlberg Kravis Roberts (KKR) and Blackstone, winning the case in Texas and forcing a strategic withdrawal from the KKR group from the entire California market rather than lose the case and face continued scrutiny.

While the last decade or more has seen the increasing financialization of the healthcare field, with private equity groups and even Amazon angling for a portion of the approximately four trillion dollars that flows through the US healthcare industry, there appears to be more and more signs that states and physicians are taking steps, even if halting and uneven, to return power and force to CPOM doctrines by updating statutes and increasing regulatory power in order to combat the means of control used by those non-medical organization that have bought their way into the healthcare field and exerted control over physicians.

While it is still too early to tell how this will shake out on a national scale for the healthcare industry, private equity, and other large corporate interests, it will be important to keep an eye on the developments in this arena over the next several years. It should also be noted that these recent developments, the new bills, and the strengthening of the CPOM doctrine do not easily break down along the partisan lines in the United States. With widespread polling showing sustained dissatisfaction with the healthcare industry in its current form, this could be a rare bipartisan focus for the future. 

If you have questions pertaining to the aforementioned changes, please contact Marc S. Beckman (mbeckman@lippes. com), Benjamin W. Goldberg (bgoldberg@lippes.com) or another one of our qualified Health Care Practice Team members at Lippes Mathias.

Virtual Physical Therapy, Real Results: Excellus BCBS Members Report Better Function and Less Pain

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A new Excellus BlueCross BlueShield benefit is helping members overcome one of the nation’s most debilitating health conditions, while also working to reduce the rising costs of health care.

Kelly Nye, an Excellus BCBS member in Jamesville suffered from shooting pains down her leg and numbness in her thigh. Her pain prevented her from doing the things she loves, like going for walks. Determined to overcome her pain, she enrolled in Vori Health* a virtual physical therapy program available to Excellus BCBS members.

Vori Health is ideal for members like Kelly who are suffering from certain musculoskeletal disorders, such as back, neck, or joint pain.

“It has really helped. I’m back to walking and I don’t have pain anymore,” says Kelly.

Virtual Physical Therapy
Musculoskeletal disorders are a leading cause of disability and increased health care costs in the U.S. More than one in three people are impacted by the disease.

To help members suffering from chronic pain, in January 2024, Excellus BCBS partnered with Vori Health to bring members a new virtual physical therapy option. Members are supported by a team of specialty medical providers, physical therapists, health coaches and nutritionists. At Kelly’s first appointment, she met virtually with a doctor and physical therapist. She’s continued to work virtually with the physical therapist, focusing on exercises she could do on her own time.

“I could do it in my pajamas. I didn’t have to drive anywhere,” explains Kelly. She accessed prescribed exercises through her personal portal and performed them with the assistance of video and motion tracking. “It is such a cool technology. You can really see if you’re doing things the right way.”

A Flexible Way to Access Care
“Virtual physical therapy can make it easier for patients to stay engaged by bringing care directly into their homes,” said Ankit Garg, MD, Excellus BCBS VP of Medical Affairs. “Early results are promising, and we’re proud to offer a program that supports members’ health goals. We’re excited for even more members to take advantage of this convenient option going forward.”

Members are encouraged to consult with their medical provider to find out what treatment options are best for them. In 2024, more than 3,000 Excellus BCBS members enrolled in Vori Health with:
• 75% noting improvement in pain
• 59% feeling that their function had improved
• 70% seeing an improvement in depression
• 64% experiencing an improvement in anxiety

Musculoskeletal treatments are also a top driver of rising health insurance costs.

“An added benefit of this program is its potential to curb rising health care costs by helping members avoid more invasive – and often more expensive – treatments in the future,” Dr. Garg said.

Curing Pain with Lifestyle Changes
Kelly also discussed lifestyle changes with her physical therapist. “He gave me ideas of how to best sit in my car. We talked about shoes that were good for me and how I might walk and maybe avoid some of the high hills I was doing. “It was just so thorough about my whole lifestyle.”

Vori Health is available to members enrolled in Medicare Advantage and in many employer health plans. Benefits and coverage can vary. See this member flyer for more information and watch more of Kelly’s story in this video.

*Vori Health is an independent company that offers virtual physical therapy to Excellus BlueCross BlueShield members. Excellus BlueCross BlueShield, an independent licensee of the Blue Cross Blue Shield Association, is a nonprofit health plan with about 1.5 million upstate New York members. The company’s mission is to help people live healthier and more secure lives through access to high-quality, affordable health care. Its products and services include cost saving prescription drug discounts, wellness tracking tools and access to telemedicine. With about 4,500 employees, the company is committed to attracting and retaining a diverse workforce to foster innovation and better serve its members. It also encourages employees to engage in their communities by providing paid volunteer time off as one of many benefits.

To learn more, visit ExcellusBCBS.com.

See this member flyer for more information: CLICK HERE

Watch more of Kelly’s story in this video link WATCH HERE

Patriot Sons USA: A Certified SDVOB, Providing Experienced Asbestos Abatement

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By Elizabeth Landry

Frederick W. Dambach, President and CEO of Patriot Sons USA, has spent a lifetime in service—first to his country, and now to the health and safety of our communities. A U.S. Army veteran who served during both the Vietnam War and Operation Desert Storm, Dambach comes from a proud military family with deep-rooted traditions of service. His father served in World War II, and many of his siblings, cousins, and even his son have followed similar paths.

Throughout his civilian career, Dambach held a diverse range of roles—from working in power plants and building submarines to managing an electrical supply branch, selling computers, and serving as a high-voltage lineman. But it wasn’t until 2015, encouraged by his son, that he charted a new course. He enrolled in the Entrepreneur Bootcamp for Veterans (EBV) at Syracuse University, and in 2019, he founded Patriot Sons USA—a company focused on asbestos abatement and environmental remediation.

Drawing from firsthand experience with asbestos exposure during his early career, Dambach developed a passion for addressing the long-term health and environmental consequences of hazardous materials.

“Back then, we didn’t know the dangers. We worked with asbestos without any protection,” he recalled. “Now, I’ve become educated on the risks—and that knowledge drives our mission every day.”

Today, Patriot Sons USA is a federally registered and New York State-certified Service-Disabled Veteran-Owned Business (SDVOB) offering asbestos abatement, mold and lead remediation, and industrial cleaning services. The company plays a vital role on construction sites, often serving as the first team onsite to create safe working conditions for other trades by removing hazardous materials like asbestos, tile flooring, pipe insulation, or even biological contaminants such as pigeon guano.

“We’re in the business of cleaning up dangerous situations,” says Dambach. “Whether it’s abatement in a commercial building or an environmental hazard at a military facility, safety always comes first.”

Though the early years required persistence and patience, the company has seen significant growth in recent years, securing larger contracts across New York State—from Buffalo to Queens. Dambach credits this momentum to an expanding team of skilled professionals and a shared commitment to excellence.

“We’ve brought on some key full-time team members, including a project manager with over 20 years of experience,” Dambach shared. “And I’ve learned a lot from my son. The student has truly become the teacher.”

Patriot Sons USA may still be a young company in the broader construction contracting space, but its mission is grounded in discipline, integrity, and a genuine desire to serve—principles rooted in Dambach’s military background.

“We started out wanting to serve the VA and fellow veterans. That mission has evolved, but our values haven’t. We take pride in our work, prioritize safety, and don’t cut corners. We’re Patriot Sons for a reason—we aim to lead by example.”

Looking ahead, Dambach envisions the company expanding into emergency response services and broadening hazardous material cleanup efforts. More importantly, he hopes Patriot Sons USA will be a family legacy—continued by his children and grandchildren with the same purpose and pride.

“At the end of the day, it’s not just about profit,” he reflected. “It’s about doing work that matters—leaving a legacy of impact, honor, and purpose. In the military, you’re given a mission. In the private sector, you create your own. This is mine, and it feels right.”

From all of us at CNY Publications, Construction Contractor Magazine, and the Syracuse Builders Exchange, we extend our deepest gratitude to Fred Dambach and his family for their continued service—to our country, our industry, and our community.

 

Nexus Requires Compliance and Begins by Filing Tax Returns

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Shawn T. Layo, CPA, Dannible & McKee, LLP

“Nexus” is a Latin term that refers to the relationship of a taxing jurisdiction that enables it to subject your business to taxation. In addition to your business’s home state and city, other states and local jurisdictions where you conduct business can have nexus.

Traditionally, nexus was determined by a physical presence such as a branch office or construction location, but e-commerce has extended the definition of nexus. Today, having employees, equipment or even significant sales activity in another state could establish nexus, and with it, a requirement to file tax returns and potentially pay taxes.

Sales Tax Nexus

Sales tax nexus laws vary widely by state and can be triggered by seemingly small activities. For example, if you have an employee in a new state or buy some machinery there, that alone can subject you to sales tax. While these activities may mandate a contractor to file sales tax returns in that jurisdiction, that does not mean the company will owe taxes there. So, it is imperative that you are aware of the administrative burdens of entering new jurisdictions, as non-compliance can be costly. The same state can also have different standards for different taxes, such as income and sales tax.

Construction companies often must collect and remit sales tax on the total charge to the customer for any repair, maintenance and installation services provided. If taxes are not collected and paid, your business will be liable and could face penalties and interest. Many businesses go bankrupt due to unpaid sales taxes and the compounding penalties that follow. Just because a job is small or out of state doesn’t mean it escapes scrutiny.

Income/Franchise Tax

You already file income or franchise taxes in the state and jurisdiction where your company is based. However, if you operate in multiple states through offices, warehouses or employees traveling into another state or generating meaningful sales there, you may need to file tax returns in those states.

It’s critical to stay up to date on filing income/franchise tax returns in all appropriate jurisdictions. If your business ever has to bring a lawsuit in that state, your company must be qualified to do business there as a foreign corporation and filing tax returns supports this qualification. Most states require minimal paperwork and often a certificate of good standing from your home state to register to do business in another state. Your attorney can help you with filings and compliance issues.

When doing business in multiple states, it is imperative to know how each state computes and allocates its overall net income and, subsequently, how that net income is taxed. If you generated $1M of income in a year, but half your sales are attributable to State A and the other half are attributable to State B, does each state tax $500k? Potentially, each state has different rules for computing and allocating income. You may need to track revenue on a job-by-job, state-by-state basis and track the equipment and labor employed in each. How to do this depends on how each state allocates their income and whether they factor in sales, wages and/or property employed in and out of the state.

Voluntary Disclosure Programs

If you find that your construction business has not been properly filing sales or income/franchise taxes, you will likely be liable for back taxes, penalties and interest in each state and/or jurisdiction. A positive note is that the statute of limitations is set at three years after filing, after which the taxing authority can’t audit your return.

If you realize after the fact that you should have filed in a tax jurisdiction but did not talk to your tax consultant about filing an amended return, you may also be liable for back taxes, penalties and interest. However, many states have “voluntary disclosure” programs that encourage businesses to catch up by filing outstanding or amended returns. In many cases, penalties are waived, and payment terms can be very favorable. Keep in mind that it is better to voluntarily come forward than to be found out by the taxing authority. If you have any questions about nexus and what it may mean for your business, please contact us.

Shawn T. Layo, CPA, is a tax partner at Dannible & McKee, LLP, a certified public accounting firm with offices in Syracuse, Auburn, Binghamton and Schenectady, NY, as well as Tampa, FL. With more than 24 years of experience, Shawn specializes in providing tax planning and compliance services for a variety of clientele with a focus on construction, architectural and engineering, multi-state corporations and high-net-worth individuals. For more information on this topic, contact Shawn at slayo@dmcpas.com or (315) 472-9127. Visit our website at DMCPAS.com to learn more.

2024 NY Workers’ Comp Bills: What Construction Companies Need to Know

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The Lovell Safety Management Executive Team

In 2024, the New York State Legislature passed four workers’ compensation bills that could reshape how claims are managed. Two of these bills were signed into law by Governor Hochul, and two were vetoed. Construction companies, which already operate in high-risk environments, should pay close attention to these changes, especially as they affect claim costs, mental health claims, and treatment protocols.

1.Signed into Law: Limited Mental Stress Claims Expansion (A.5745/S.6635, amended by A.1677/S.0755)

Governor Hochul signed this bill on December 6, 2024, with chapter amendments finalized in January 2025. It expands eligibility for workers’ compensation mental stress claims but only for specific psychiatric diagnoses.

What Changed?
Previously, only police officers, firefighters, and EMTs could file mental injury claims without showing their stress was “greater than” that of a similar coworker. Now, all employees, including those in construction, will be eligible to file a mental stress claim (only in mental-mental injury claims)—as long as their diagnosis fits into one of three psychiatric conditions:

• Post-Traumatic Stress Disorder (PTSD)

• Acute Stress Disorder

• Major Depressive Disorder

To qualify for benefits the employee must prove that:

• The stress arose out of an extraordinary work-related stress that is attributable to a distinct work-related event or series of events that are:

• Directly related to employment and

• Occurring during the performance of the employee’s work duties

Impact on Construction
Construction workers frequently face traumatic events: serious injuries, falls from heights, or fatal accidents. This new law may increase:

• Claims related to mental health after job site incidents.

• Challenges in disputing those claims due to the now-subjective stress threshold.

• Length and complexity of claims, potentially delaying return-to-work timelines.

Recommendation: Immediately investigate and report mental stress claims to Lovell. The new standard applies to specific mental claims and the old standard of the “stress being greater than that of a similar worker” remains in effect for other types of mental stress claims. Legal counsel at Lovell/NYSIF will determine which standard is applicable based on the facts of the case. Train field supervisors to document traumatic events with pertinent information. Strengthen mental health resources for workers and ensure HR is prepared to handle these claims sensitively but rigorously.

2. Signed into Law: Occupational Therapy & Physical Therapy Assistants Now Allowed to Treat Claimants Governor Hochul signed this long-standing bill on September 27, 2024. It authorizes licensed occupational and physical therapy assistants to treat injured workers under supervision of licensed physical therapists and occupational therapists.

What Changed?
Previously, New York law only allowed licensed OT/PT providers to treat injured workers. This bill now permits OT/PT assistants to perform treatment, so long as they work under the supervision of an authorized OT/PT.

Impact on Construction
Many injured construction workers need some form of physical rehabilitation. This change:

• Should improve therapy accessibility.

• Is not expected to increase claim costs significantly, as assistants are already commonly used in comp cases.

3. Vetoed: Out-of-Network Pharmacy Access (A.1219-A/S.1974-A)

This bill would have allowed injured workers to bypass the employer’s designated pharmacy network under certain conditions. Governor Hochul vetoed the bill on December 13, 2024.

Why Was It Vetoed?
The Governor cited:
• Increased litigation over “qualifying” conditions.

• Delays in benefit delivery due to added bureaucracy.

• A rollback of pharmacy cost savings won in the 2007 comp reforms.

Some examples that would have allowed workers to use non-network pharmacies included:

• Delays of more than 72 hours in receiving prescribed meds.

• Denial of reauthorization requests.

• Disputes between treating physicians and IMEs.

Instead of the bill, the Workers’ Compensation Board (WCB) issued new regulations, clarifying when a worker may use a non-network pharmacy at the end of 2024, providing a 60-day comment period and then based on comments, finalization of the new regulations.

Impact on Construction
The veto preserves critical cost controls for employers and carriers. Most construction employers in a Lovell Safety Group will not see major changes as NYSIF already provides first-fill prescriptions pending establishment or acceptance of the claim.

4. Vetoed: Medical Treatment Guidelines Rollback (A.6832-A/S.6929)

This bill was vetoed on November 22, 2024, and would have fundamentally altered how treatment is approved in NY workers’ comp.

What the Bill Would Have Done
• Undermined the Medical Treatment Guidelines (MTGs) by letting providers bypass them.

• Eliminated the Prior Authorization Request (PAR) process.

• Forced carriers to rely on costly Independent Medical Exams (IMEs) for treatment reviews which may delay treatments.

Why It Was Vetoed?
Governor Hochul argued the bill would:

• Lead to over-treatment and questionable procedures.

• Increase litigation and delay care.

• Undo years of reform aimed at improving outcomes and lowering costs.

Impact on Construction
The veto protects construction employers from:

• Skyrocketing treatment costs.

• Legal disputes over unnecessary
or non-evidence-based care.

• System abuse seen prior to MTG
and PAR implementation.

Bottom Line for Construction Employers

The 2024 legislative session brought both relief and risk for New York construction firms in 2025. While some protections were preserved through vetoes, the signed mental stress bill opens the door to more complex, subjective claims.

Key Takeaways:
• Expect more mental stress claims tied to specific traumatic events, especially after serious job site incidents.

• OT/PT assistants can now legally assist in the treatment of injured workers, potentially speeding up recovery.

• Pharmacy access rules are evolving but the cost-saving structure remains in place for now.

• The veto of Medical Treatment Guidelines (MTG) rollbacks is a win for employers concerned about runaway treatment costs.

The Governor also passed two workers’ compensation bills in her Budget that would expand access to treatment. Those bills will allow for residents and fellow physicians in a Graduate Medical Program to treat claimants and permit carriers to pay for medical treatment pending a decision on compensability. 

Lovell Safety Management closely monitors legislative developments, actively working to reduce the impact of potential negative changes on the members of our five construction and eight general industry workers’ compensation safety groups. Our programs are designed to return profits to members in the form of dividends, and to date, Lovell safety group members have received over $1.28 billion in dividend savings. The 2025 legislative session closed in mid-June, and we will provide a full update on any new developments or additional legislative changes in early 2026.

In summary, the 2024 legislative session brought both relief and risk for New York construction firms in 2025. While some protections were preserved through vetoes, the signed mental stress bill opens the door to more complex, subjective claims. For any questions regarding workers’ compensation and the legislation, please contact Lovell at 1-800-556-8355.

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