Posts by admin

Certificate Of Need Coming For Private Equity?

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By: Marc Beckman and Ben Goldberg

New York State is poised for a significant shift in healthcare oversight with the amendments to the state’s Disclosure of Material Transactions law proposed in Governor Kathy Hochul’s FY 2026 Executive Budget. Previously, with the introduction of PHL Article 45- A, which took effect on August 1, 2023, the New York State Department of Health (“DOH”) was authorized to scrutinize healthcare transactions taking place in New York State. These legislative changes are designed to further regulatory scrutiny over healthcare transactions, aiming to curb rising costs and ensure market stability.

Governor Hochul’s proposed legislation introduces the Cost Market Impact Review (“CMIR”), a framework modeled after similar regulatory mechanisms in states like Massachusetts. The CMIR would empower state regulators to assess healthcare transactions, particularly those involving consolidations, mergers, and acquisitions, to evaluate their potential impact on cost, access, and competition. One change that should be immediately noted is the extension of the required notice of a “material transaction” provided to DOH, which was 30 days under the PHL Article 45- A, and would be increased to 60 days.

Among the components of the CMIR are pre-transaction review, assessment of market impacts, and enforcement measures. During the pre transaction review, healthcare entities engaging in significant transactions will be required to submit documentation for state review. If the “material transaction” will increase a healthcare entity’s gross in state revenue by $25 million or more, notice will have to be provided to the New York State Department of Health (“DOH”) and documentation submitted to the DOH for review. Material transactions include but are not limited to mergers, acquisitions, assignments, sales, other conveyances of assets, voting securities, and membership or partnership interests. It is also important to note that material transactions include contracts, if they increase the revenue by $25 million or more, and entities like managed services organizations that provide administrative services to healthcare entities, even if they don’t provide healthcare services themselves. The $25 million will be based on a 12 month lookback period. This is somewhat straightforward if the transaction is a single transaction. However, should there be a series of related transactions, the revenues associated with each of the transactions will be added together to determine the total impact on New York’s healthcare markets.

Since the intent of the review is to analyze whether a proposed transaction could lead to increased prices, reduced competition, or diminished healthcare access, the notice given to New York’s DOH will include, among other things:

• the names of the parties conducting the transaction and their current addresses,

• copies of any definitive agreements governing the terms of the material transaction, including pre- and post-closing conditions, in-state revenue from practice or operating locations in New York,

• plans to reduce or eliminate services and/or participation in specific plan networks,

• a brief description of the nature and purpose of the proposed transaction

• the anticipated impact of the material transaction on cost quality, access, health equity, and competition in the market locations where the transaction is taking place.

When a transaction is found to have negative cost or market implications, regulators may impose conditions or even prevent the transaction from proceeding.

Key Proposed Amendments Include:

Lowered Reporting Thresholds:
More transactions subject to mandatory disclosure, ensuring greater regulatory oversight.

Expanded Scope: Nonprofit and for-profit healthcare entities, including physician groups and private equity backed organizations, will face increased scrutiny.

Stronger Enforcement Mechanisms:
The state may impose penalties for non-compliance and require additional corrective actions from healthcare organizations.

Potential Impact on Healthcare Providers and Patients
The implementation of PHL Article 45-A and the proposed amendments to the Disclosure  of Material Transactions law could significantly reshape the healthcare landscape in New York State. Providers facing increased regulatory oversight may slow down consolidation efforts, leading to more rigorous due diligence before executing transactions. While enhanced scrutiny could help prevent monopolistic practices and cost increases, among the concerns for patients is that providers may delay or abandon transactions that could improve healthcare access and efficiency.

With heightened scrutiny regarding these transactions, private equity firms and large health systems may face more barriers to market entry and expansion, altering investment strategies in the state’s healthcare sector. Reading the changes to the Disclosure of Material Transactions law generously, it appears the intent behind Hochul’s proposed regulatory reforms is to ensure healthcare transactions do not compromise affordability, access, or market competitiveness. While these measures align with broader national efforts to curb healthcare costs, their implementation will require careful balancing to prevent unintended consequences.

Stakeholders in the healthcare industry should prepare for increased regulatory compliance obligations. As with similar frameworks used to analyze business transactions—such as antitrust statutes and certificate-of-need applications—it is uncertain how forcefully New York will enforce these new CMIR assessments if they are passed by the legislature. Furthermore, it remains unclear what appetite the DOH will have for prohibiting or limiting such transactions.

However, whether or not the DOH takes an aggressive stance if Governor Hochul’s proposals become law, healthcare entities will still need to comply with the submission of notice and the concomitant documents to DOH and should prepare accordingly.

If you have questions pertaining to the proposed legislation and how it may impact you, please reach out to Marc S. Beckman (mbeckman@lippes.com), Benjamin W. Goldberg (bgoldberg@ lippes.com) or a member of the Lippes Mathias Health Care Practice Team.

Contracts: A Guide to Managing Risks

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By Kirsten Shepard, CIC, CISR Elite, Senior Risk Management Consultant – Contractual Risk Transfer, OneGroup

A contract is a formal agreement between two or more parties that creates binding obligations to perform or refrain from certain actions. While contracts establish these obligations, they also introduce potential risks to your organization. Therefore, each time your organization enters into a contract, it should:

  • Evaluate the risks the agreement may pose
  • Decide whether to accept or transfer those risks
  • Determine the method of financing those risks, be it through your organization or the contractor

It’s crucial to scrutinize the terms of any contract thoroughly. While some contracts may appear to contain standardized language, they could include commitments your organization should avoid. We recommend a detailed review to anticipate potential scenarios affected by the contract, such as:

  • Scope of Work: What will the contractor be responsible for?
  • Potential Losses: What types of losses might occur?
  • Financial Impact: What’s the “worst-case scenario” in terms of financial loss?
  • Protection Measures: How can you safeguard your organization?

Particular attention should be paid to clauses like Limitation of Liability, Hold Harmless, Indemnity, and Insurance. These clauses can obligate you to indemnify another party for property or liability losses. Should you find a contract’s provisions unfavorable, we advise seeking legal counsel.

Transferring risk to other entities helps manage and reduce losses. When feasible, your organization should endeavor to transfer risk through contractual agreements. For example, you might require a vendor to assume all liability for a product they sell to your organization, a term typically embedded in the contract. Your ability to transfer risk often depends on your bargaining power and the nature of the business involved.

Hold Harmless and Indemnity Agreements

Hold harmless and indemnity agreements are essential tools for risk transfer. These may be labeled as hold harmless, waiver and release, save harmless, or indemnity agreements within a contract. Always read contracts meticulously, as these terms can be included without explicit labeling.

In a hold harmless agreement, one party agrees to assume the liability of another. Although often used interchangeably, hold harmless and indemnity agreements differ in the scope and manner of risk transfer. Hold harmless agreements typically pertain to claims between the contracting parties, such as property damage or consequential losses like lost income. These agreements often accompany indemnity agreements because third parties may still file negligence claims against any involved party.

Indemnity agreements shift the responsibility to cover third-party claims. They ensure one party (the indemnitee) can seek reimbursement from another (the indemnitor) for losses, claims, and expenses related to third-party damage claims. A well-crafted indemnity agreement should clearly outline the allocation of responsibilities.

Insurance as a Risk Financing Method

Requiring contractors or service providers to purchase insurance is a practical way to finance loss payments. However, insurance has its limitations and exclusions. For instance, professional liability policies may only cover the insured’s negligence.

When transferring risk, ensure the other party understands the transfer and has the financial resources or suitable insurance to cover potential losses. An indemnity agreement does not absolve your organization from liability; rather, it mandates that the other party covers related costs. If the indemnitor lacks financial stability or insurance, your organization may still be liable.

Including your organization as an additional insured on the contractor’s liability policy offers several advantages:

  • Defense and Costs: The insurer must defend and cover your organization’s defense costs if sued.
  • Obligations: The insurer remains obligated regardless of the named insured’s financial status.
  • Personal Injury Coverage: Typically included under general liability.

However, additional insured status is not a replacement for a hold harmless and indemnity agreement, as insurance policies have limitations and may not cover all claims.

Combining hold harmless and indemnity agreements with insurance provides comprehensive financial security for your organization.

For more information please contact:
Kirsten Shepard, CIC, CISR Elite

315-418-4955

KShepard@OneGroup.com

“Piggybacking” Misapplications by Public Owners

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A New York Court’s Decision to Remedy the Practice

Earl R. Hall, Executive Director – Syracuse Builders Exchange

Over the past few years, some public owners have taken the position that piggybacking is permissible for public work construction projects, capital improvements and other public works contracts associated with conventional construction projects. 

To provide context, piggybacking is a permissible means for municipalities or other public entities (i.e., public schools) to purchase “apparatus, materials, equipment or supplies, or to contract for services related to the installation, maintenance or repair of apparatus, materials, equipment, and supplies…”  In short, it may be proper for the purchase of “things,” but not construction.  Utilizing “piggybacking” in lieu of the competitive bidding process is permissible only if certain conditions have been met; however, none of those conditions include public works construction or capital improvement projects to infrastructure or buildings.

Public works, public works contracts and public works projects include construction or repair projects undertaken by the public owner or municipality on their infrastructure or building project.  Public works construction projects are subject to New York State’s competitive bidding laws consistent with General Municipal Law (GML) Article 5-A.  Article 5-A includes Wicks Law (Section 101) and competitive bidding of public works construction projects (Section 103).

Piggybacking is intended for the purchase of specific classes of “things,” such as apparatus, materials, equipment, and supplies, as well as service contracts related to those specific things.  It does not include public works, public works contracts or public works projects, which the court has interpreted to mean “construction” or “repair projects” undertaken by municipalities which are clearly distinct in nature and scope from apparatus, materials, equipment, and supplies.

A recent case against the Board of Education of the Maine-Endwell Central School District; the Maine Endwell Central School District, Judge Oliver N. Blaise, III determined such piggybacking application and usage on a $64 million capital improvement project for the school district’s various buildings and facilities was impermissible.  The court determined that, in this case, the contract to be piggybacked should have been let in a manner consistent with GML 103, and requiring sealed bid, public advertising of projects and awarded to the lowest responsive and responsible bidder.  Finally, the court determined that the use of the word “vendor” for piggybacking purposes means suppliers of apparatus, material, equipment, supplies, and services related thereto, as opposed to ‘contractors’ seeking to erect, construct, reconstruct or alter buildings…”

The construction industry, including contractors throughout New York State, remain optimistic that future misapplications of the piggybacking provision by public owners will be diminished as a result of this court 2025 decision, as New York’s public bidding laws defined in GML 103 cannot be circumvented on public works construction projects which the courts have defined.

Source:   Daniel J. Lynch, Inc.; Kelly Lynch Individually, and as a Taxpayer; Slavik & Co. Inc.; George J. Slavik, Jr. Individually and as Taxpayer; Andrew R Mancini Associates, Inc.; Louis N. Picciano & Son, Inc. and William H. Lane Incorporated against Board of Education of the Maine-Endwell Central School District; the Maine Endwell Central School District; and Smith Site Development.  Broome County Clerk February 13, 2025.

Leading with Heart and Vision: How President Mantosh Dewan, MD, is Growing Upstate Medical University Today — and for Future Generations

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By Bari Faye Dean

Fifty years ago, in 1965, SUNY Upstate Medical University Hospital, then called “State University Hospital,” opened its doors. Ten years later, Mantosh Dewan, MD, walked through them for the first time.

Back then, the young psychiatry resident, with his mind focused on his patients, wanting to conduct important mental healthcare research and write about it, Dr. Dewan could never have dreamed that someday he would be the guiding force behind the outstanding growth and achievements of the Upstate University Health System.

Upstate is more than just a flagship hospital with many satellite locations throughout Central New York. The medical university boasts four colleges – the Medical College, the College of Health Professions, College of Nursing and College of Graduates Studies. All four colleges are constantly striving to do more to fill the nationwide clinician shortage.

“We are doing everything possible to respond to the healthcare needs we face today,” Dr. Dewan said. “Of course, we are constantly growing, and we will never stop trying to do more for our patients today, while also thinking ahead to what the future holds.”

About Dr. Dewan…

Dr. Dewan is a SUNY Distinguished Service Professor in the Department of Psychiatry at Upstate. He was both director of Undergraduate Education and director of Residency Training. He also served as interim dean of the College of Medicine.

With 35 books and book chapters and 75 papers to his credit, he is well-known and respected for speaking on a wide range of topics from brain imaging to the economics of mental healthcare.

And, a lifetime of caring for others has garnered him myriad accolades: Best Doctors in America, Distinguished Life Fellow of the American Psychiatric Association, recipient of the Scientific Achievement Award from the Indo-American Psychiatrists Association, the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill, and the list continues.

About Dr. Dewan’s Mission…

Dr. Dewan has been the driving force behind increasing Upstate’s employee base, which now employs the largest workforce in Central New York. It’s edging toward 13,000 strong and still growing. Under Dr. Dewan’s leadership, Upstate has become the second-largest revenue producer in the entire SUNY system – to the tune of an economic impact of $3.2 billion across the state.

Impressive numbers, for sure, but unfortunately, that growth isn’t always enough. There are some days, Dr. Dewan laments, when Upstate has to turn patients away; there simply aren’t enough beds. And, with the promise of Micron being built to the west of Syracuse, Dr. Dewan knows the number of Upstate’s prospective new patients will grow significantly in the next decade.

Accommodating that kind of future patient growth, he said, requires adhering to the plan he put in place that “ensures excellence and access” now. It’s a strategy that will also go a long way to meeting the needs of the growing region when the time comes.

“For me, it’s about doing more, better – now,” Dr. Dewan said. “I am focused on hiring the very best people who bring the best in clinical care. We just have to keep doing more because there is such a need.”

And, where there is a need, Dr. Dewan is ready to jump in and help.

A Bit of History

President Dewan took on the role of president at Upstate at the end of 2018 and says 2019 was a transition year. Then came the COVID-19 pandemic.

Dr. Dewan’s strategic vision for growth turned to a singular focus: making sure Upstate clinicians had what they needed to battle what turned out to be some of the darkest days in modern healthcare for the entire world.

“That was a very stressful time for all our clinicians and all our 

academics. I learned something very important about this team at Upstate. I saw a level of kindness and caring that I’ve never seen in my life. You might have expected bad behavior from people under such sustained stress. Not here. All I saw was competence and caring,” he said. “It was like a miracle that 12,000 people stepped up and were so kind.”

Dr. Dewan’s leadership surely led the way; he did whatever was necessary to procure personal protective equipment, including masks, that healthcare facilities around the world couldn’t seem to get their hands on.

“It was a scary time. I committed early on that we would do everything to protect our people,” Dr. Dewan said. “I am very proud to say we did not lose a single employee to COVID.”

Growing Upstate

Upstate is the second largest public university by revenue in New York State; Stony Brook University on Long Island is the largest. “We have been growing and intend to keep growing,” Dr. Dewan said, noting Upstate has a significant direct impact on the economy of this region and state.

Indeed. The previously noted $3.2 billion in economic impact on New York State is nearly double the impact of $1.7 billion in fiscal year 2008.

While Upstate received $65.2 million in direct operational support from the State of New York, the investment enabled Upstate to generate substantial economic activity.    

“We are good stewards of the funding we get from the state,” Dr. Dewan stressed. “For every state dollar we receive in operating support, we make $47. That is only from direct operating costs. I am very proud of this.”

Life-changing Medicine with Novel Inventions

There is plenty of growth – both in infrastructure builds and expansions and healthcare service offerings – on the horizon at Upstate. While he surely would like all of Upstate’s plans to come to fruition, Dr. Dewan said he believes “hope” is not a strategy for growth.

Financial investment and business support for Upstate’s research scientists, he maintained, will continue to turn dreams into reality.

For example, he speaks highly of Frank Middleton, PhD, a professor of neuroscience and physiology at Upstate, who developed a saliva test for COVID that was used at 60 of the 64 SUNY campuses and eventually in the Syracuse public schools. Dr. Middleton also developed a saliva test for autism that has received FDA breakthrough designation.

With great pride, he also reminds that Stephen Thomas, MD, a full-time faculty member at Upstate, was the lead principal investigator for the world-wide Pfizer/BioNTech vaccine trial. Dr. Thomas presented the findings of the trial to the U.S. Food and Drug Administration to get the first vaccine approved.

But Wait, There’s More – and Upstate Will Be Part of It

Dr. Dewan is less of a talker and more of a thinker and a doer. He is certain that research scientists at Upstate and the 30 to 40 companies operating out of the health system’s Bio Accelerator are working on “the next great things” in medicine and he is determined to support their work fully.

“There is very exciting work going on in cancer research and in neuroscience – specifically looking at dementia and schizophrenia,” he said. “And do you know about all the work being done here in vision research? How about the strong group of scientists doing work in endocrine studies? They are trying to grow pancreatic cells in the lab. This would be a permanent cure for diabetes!”

Though Dr. Dewan is soft-spoken with a calm demeanor – the type you might expect from a successful psychiatrist – he can’t help but show his excitement for the work being done at the Bio Accelerator – a business incubator where the brightest entrepreneurial minds can bring “what’s next” in healthcare to market.

“Seeing the companies in our Biotech Accelerator, as well as initiatives we’ve supported financially with the Upstate Biotech Venture Fund, succeed is so gratifying to me,” Dr. Dewan said, adding this work is extremely important to Upstate’s continued growth trajectory.

With the $5 million Upstate invested in the venture fund and the matching $5 million received by Empire State Development, Dr. Dewan said he is hoping to invest in 20 different projects that will bring new therapies to market quickly.

And, why not? Upstate has a storied history when it comes to being first in healthcare in Central New York. Upstate has the only cancer center in Syracuse treating adults and children and recently opened facilities in Verona and Auburn. “Opening centers where people can get access to cancer care close to home is very important to me. We need to make healthcare as easy and convenient for patients as we can,” Dr. Dewan said.

He is quick to list many more exciting “onlys” and “firsts.” Upstate is CNY’s only Level 1 Trauma Center and is one of only five hospitals in all of New York State to have Level 1 Trauma Centers for both pediatrics and adults.

“We offer 70 healthcare services that aren’t provided elsewhere in CNY, including care for burns, kidney transplants and new efforts for pediatric mental health,” Dr. Dewan said. “For example, Upstate has the only Joslin Center for Diabetes in the state. Upstate has the only inpatient unit for children with autism and behavior problems in the state. The level of stroke care we can provide is unmatched,” he added. “We have the only neurological intensive care unit in the region, and those patients benefit from unique in-patient rehabilitation services as well.”

A Unique Type of Leader

It’s not easy to get Dr. Dewan to talk about himself. He will tell you that getting married to his lovely wife of 50 years is the best decision he has ever made. He is quick to say that he loves to travel to visit his children and grandchildren – in Los Angeles and Miami – and also enjoys taking trips around the world. In the past year he has been to Japan and Egypt and is always looking for his next vacation spot.

But when it comes to talking about his own leadership style, Dr. Dewan smiles and goes right back to being the man with a plan in charge at Upstate.

“I work in a system that has an amazing level of talent. Without exaggeration, if I go to any meeting, say with Upstate neurologists or cardiologists, I know that I’ll always be the least qualified person in the room,” he said. “As president, my job is not to tell them what to do. I lead by supporting them so they can be exactly who they are – the very best.”

Manufacturing Trends – Reshoring

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By: James D’Agostino

In recent years, reshoring manufacturing — the practice of bringing production and supply chains back to domestic soil — has gained significant momentum. The COVID-19 pandemic, geopolitical uncertainties, supply chain disruptions, and rising labor costs in foreign markets have all contributed to the shift in perspective. Now, more than ever, companies are seeing the advantages of manufacturing closer to home.

Supply Chain Resilience and Security

The global pandemic exposed vulnerabilities in international supply chains. Companies that relied heavily on overseas suppliers faced massive delays, port congestion, and shortages of raw materials and finished goods. Reshoring manufacturing mitigates these risks by shortening supply chains and reducing dependence on foreign suppliers. A domestic supply chain ensures greater reliability, better inventory control, and faster response times to fluctuations in demand.

Rising Labor Costs in Offshore Markets / Technological Advancements in Manufacturing

For decades, companies offshored manufacturing to countries with lower labor costs, such as China, Vietnam, and Mexico. However, wages in these regions have been steadily rising, reducing the cost advantages of offshore production. At the same time, advancements in robotics, automation, and artificial intelligence have revolutionized modern domestic manufacturing. Smart factories, 3D printing, and IoT (Internet of Things) technologies allow for more efficient, high-quality domestic production with reduced labor costs. These innovations make it easier for companies to reshore manufacturing while maintaining competitive pricing and operational efficiency.

Tariffs and Trade Tensions / Government Incentives and Policies

The ongoing trade disputes between the U.S. and China, along with other geopolitical challenges and disputes, have made it more expensive and unpredictable to manufacture goods overseas. Tariffs, sanctions, and shifting trade agreements have added costs and complexity to offshore production. By reshoring, companies can bypass these uncertainties, stabilize their pricing models, and avoid expensive trade-related disruptions. At the same time, governments worldwide, particularly in the U.S. and Europe, are encouraging companies to bring manufacturing back home. Incentives such as tax credits, grants, and subsidies are available to businesses investing in domestic production. Additionally, initiatives like the CHIPS and Science Act in the U.S. aim to revitalize key industries such as semiconductor manufacturing. These policies make reshoring a financially attractive option for many businesses.

Consumer Demand for ‘Made in America’ / Sustainability and Environmental Benefits

Consumers are becoming more conscious of where products are made and are increasingly prioritizing domestically produced goods. The ‘Made in America’ label carries a sense of quality assurance, ethical labor practices, and environmental responsibility. Brands that manufacture domestically benefit from increased consumer trust and loyalty, leading to a stronger market presence and competitive edge. Reshoring manufacturing also supports sustainability goals by reducing the carbon footprint associated with long-distance shipping and transportation. Shorter supply chains mean lower greenhouse gas emissions, less energy consumption, and a reduced environmental impact. Additionally, domestic manufacturing tends to adhere to stricter environmental regulations, contributing to more responsible and eco-friendly production processes.

In conclusion, reshoring manufacturing is no longer just a patriotic move — it is a smart business strategy. With increasing supply chain vulnerabilities, rising overseas labor costs, government incentives, and technological advancements, now is the ideal time for companies to bring manufacturing back home. By doing so, businesses can improve efficiency, strengthen supply chain resilience, meet consumer demands, and contribute to sustainable growth. The future of manufacturing is local, and companies that act now will reap the long-term benefits.

TDO is a consulting and training organization based in Liverpool, NY. Our mission is to grow the local economy by helping Central NY manufacturers and technology companies drive operational excellence and cultural transformation to reach their full potential. TDO’s support of the local mission generated $265 million in economic impacts in the last contract period supporting jobs, investments, cost savings, and profitable growth. If you are a small or mid-size manufacturer and would like to talk further, TDO’s team is experienced and fully certified to help. Reach out today to learn more and schedule a free consultation!

Leaders are Entering a New Year with Optimism and a Close Eye on Risks

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By: Pierre Morrisseau, CEO, OneGroup

Upstate New York is heating up with myriad projects and market growth, bolstering confidence that 2025 will be a positive and productive year yet planning for typical and unknown new risks. Meanwhile, we are in the grip of another northeast winter that brings with it additional potential claims such as auto accidents, property damage and slip-and-fall to name a few.

Our clients are telling us they are entering the new year with renewed optimism while continuing to struggle with the larger issues of employee acquisition, engagement, and retention, reading the regulatory landscape in a rapidly changing business environment, and grappling with the continued high cost of insuring against risks.

On the employee front, we are also focused heavily on strategies for attracting the best and brightest while retaining our long-term employees who possess deep product and institutional knowledge. The balancing act is far from easy, as the workplace dynamic has dramatically changed since the pandemic. For example, Korn Ferry research revealed that managers are being asked to do more because Gen-Z employees—future leaders—do not want to assume roles in management. Adding to the challenge, the research found that 45% of employees over 55 have not spoken to a Gen-Z at work over one year, and only one in five Gen-Z employees have engaged with employees over 50. Of course, there are generations up and down the scale, but this example points to the challenges we, as leaders, face when trying to build a high-productivity, cohesive workforce.

This bifurcation in the workplace contributes to erosion of communication and transparency, all of which can create a lack of trust—the enemy of collaboration and esprit de corps. While we have a robust human resource consulting division to assist us in employee engagement, it remains a top-level priority for us as it does for many of our clients and leaders I have spoken with.

On the risk management front, the cost of insurance remains high and companies are looking for ways to reduce costs while retaining adequate coverage to protect their assets.

I recently shared that insurance rates continue to climb as the cost of repairs, replacement, and litigation soars. I also shared that there are strategies that you and your insurance broker can employ to reduce your cost through risk analysis and mitigation.

One timely example of recognizing and mitigating the cost of risk is water damage and freezing. According to the Insurance Information Institute (III), together, these risks represent the second-most cause of property claims annually, followed by wind and hail. From 2018 to 2022, about 25% of home insurance claims were due to water damage or freezing, with an average repair cost of over $14,000. Just one inch of water in a typical home can cause $25,000 or more in damage, and the number is increasing yearly according to III. Despite this large risk, Consumer Affairs indicates that fewer than 20% of homeowners take precautionary steps to protect their assets, including purchasing the correct insurance coverage.

This illustrates the importance of not only creating an annual plan to check hoses, pipes, and faucets regularly, but to list mitigating steps such as monitoring your water bill, clean gutters, protect pipes from freezing and inspect/replace your water heater to name a few. Additionally, new technologies make it easy to prevent water leaks and the high cost of repairs. For instance, several insurance companies offer customers free sensors and 24/7 monitoring and support or discounted premiums when installing leak detection sensors. These new programs are helping clients to avoid hundreds of thousands of dollars in losses.

Smart system water flow detection devices are affordable and are most effective when you combine several components including: leak detectors, water monitors, water shut-off valves and freeze sensors.

This is a simple example yet points to the importance and rewards of meeting with your insurance professional to create a mitigation plan and researching all the potential savings. It’s the smartest step for both homeowners and business owners/managers.


“Piggybacking” Misapplications by Public Owners A New York Court’s Decision to Remedy the Practice

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Earl R. Hall, Executive Director – Syracuse Builders Exchange

Over the past few years, some public owners have taken the position that piggybacking is permissible for public work construction projects, capital improvements and other public works contracts associated with conventional construction projects. 

To provide context, piggybacking is a permissible means for municipalities or other public entities (i.e., public schools) to purchase “apparatus, materials, equipment or supplies, or to contract for services related to the installation, maintenance or repair of apparatus, materials, equipment, and supplies…”  In short, it may be proper for the purchase of “things,” but not construction.  Utilizing “piggybacking” in lieu of the competitive bidding process is permissible only if certain conditions have been met; however, none of those conditions include public works construction or capital improvement projects to infrastructure or buildings.

Public works, public works contracts and public works projects include construction or repair projects undertaken by the public owner or municipality on their infrastructure or building project.  Public works construction projects are subject to New York State’s competitive bidding laws consistent with General Municipal Law (GML) Article 5-A.  Article 5-A includes Wicks Law (Section 101) and competitive bidding of public works construction projects (Section 103).

Piggybacking is intended for the purchase of specific classes of “things,” such as apparatus, materials, equipment, and supplies, as well as service contracts related to those specific things.  It does not include public works, public works contracts or public works projects, which the court has interpreted to mean “construction” or “repair projects” undertaken by municipalities which are clearly distinct in nature and scope from apparatus, materials, equipment, and supplies.

A recent case against the Board of Education of the Maine-Endwell Central School District; the Maine Endwell Central School District, Judge Oliver N. Blaise, III determined such piggybacking application and usage on a $64 million capital improvement project for the school district’s various buildings and facilities was impermissible.  The court determined that, in this case, the contract to be piggybacked should have been let in a manner consistent with GML 103, and requiring sealed bid, public advertising of projects and awarded to the lowest responsive and responsible bidder.  Finally, the court determined that the use of the word “vendor” for piggybacking purposes means suppliers of apparatus, material, equipment, supplies, and services related thereto, as opposed to ‘contractors’ seeking to erect, construct, reconstruct or alter buildings…”

The construction industry, including contractors throughout New York State, remain optimistic that future misapplications of the piggybacking provision by public owners will be diminished as a result of this court 2025 decision, as New York’s public bidding laws defined in GML 103 cannot be circumvented on public works construction projects which the courts have defined.

Source:   Daniel J. Lynch, Inc.; Kelly Lynch Individually, and as a Taxpayer; Slavik & Co. Inc.; George J. Slavik, Jr. Individually and as Taxpayer; Andrew R Mancini Associates, Inc.; Louis N. Picciano & Son, Inc. and William H. Lane Incorporated against Board of Education of the Maine-Endwell Central School District; the Maine Endwell Central School District; and Smith Site Development.  Broome County Clerk February 13, 2025.

Benefits of Content Marketing

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Generated by ChatGPT Edited by Michael T. Brigandi, CNY C-Suite, Publisher

Increased Brand Awareness

  • Consistently publishing valuable and relevant content helps to increase visibility. As your content reaches a larger audience, more people become familiar with your brand.

Establishes Authority and Expertise

  • By providing high-quality, informative content, you position your business as an authority in your field. This helps build trust and credibility with your audience.

Improved SEO and Organic Reach

  • Quality content that is optimized for search engines (SEO) can help your website rank higher on search engine results pages (SERPs). This boosts your organic traffic.

Engagement with Audience

  • Content marketing encourages interaction with your audience, whether through comments, shares, or likes. This helps in building a community around your brand.

Lead Generation

  • Well-crafted content can help attract potential customers and drive them down the sales funnel. Offering valuable content, like whitepapers or ebooks, in exchange for email subscriptions can be an effective way to gather leads.

Cost-Effective Marketing

  • Compared to traditional forms of advertising, content marketing can be a more affordable long-term strategy. Once content is created, it can continue to generate value over time without ongoing costs.

Better Customer Relationships

  • Content allows you to directly communicate with your audience, answer their questions, and address their pain points. This strengthens customer loyalty and satisfaction.

Supports Other Marketing Channels

  • Content marketing supports various other marketing efforts, like printed media, social media, email marketing, and paid ads. For example, blog posts can be shared on social media, driving traffic to your website.

Increased Conversion Rates

  • Engaging and relevant content can help move prospects closer to conversion by addressing their specific needs and demonstrating how your products or services can solve their problems.

Long-Term Results

  • Content that continues to provide value can work for you over time, generating leads and traffic long after it’s published. Blog posts, videos, and infographics can attract new audiences months or even years after they’re created.

Builds Trust and Relationships

  • By offering useful, honest, and relevant information, your brand can build long-lasting relationships with its audience. This trust can eventually convert into higher customer loyalty and advocacy.

In summary, content marketing helps you build stronger relationships with your audience, boosts your printed and online visibility, and can be more cost-effective than traditional advertising, all while providing long-term benefits.

Reset with Nature “Going to the Mountains is going home.”

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Kathy Ruscitto    

It is easy to get stressed from a variety of things.

Sometimes all it takes to reset is by engaging the outdoors.

In , “The Fundamentals of Environmental Neurosciences,” is a summary of current research that looks at the relationship between people and their environments. The premise is that urban design must take into account the importance of green space and its impact on the mind and body.

It doesn’t matter where I am when I share that I live part of the time in the Adirondacks, immediately people smile and often share a story of the Adirondacks from their childhood. Recently a customer service agent in another state started singing the jingle from the waterpark in Old Forge over the phone!

A drive to the Adirondacks can reduce anxiety, improve health, mental health, creativity and inspire new ideas.

I am hoping to plant some seeds for a day or an overnight in nature for you and your family.

Wherever you are in eastern or western , New York State, you are close to the most amazying natural resource, the Adirondack Park.

The drive to the Park pulls in views that are soothing and beautiful. A winter visit with a warm fireplace and a great dinner improves sleep and the ability to manage stress. A summer visit and kayak or swim in the many beautiful lakes and rivers, adds to reducing stress during busy office practice months. It might not be possible to take a long vacation, but planning some reset breaks adds to your health.

It requires focus on creating the time on your calendar and some research to decide where. When our daughter was young we called these exploration days, no work, just family time to do something new. Often we chose Adirondack locations such as Moss Lake, Cascade Mountain, Saranac Lake or our favorite ,Hemlock Hall. No tv, electronics or cell service. Just peace and quiet.

It’s not just about hiking, although there are some of the best trails anyplace in the US. From Old Forge to Inlet to Long Lake to Saranac, Elizabethtown and Lake George. Unique villages, great small libraries and excellent restaurants. Fishing, biking,camping, or just communing with nature can lead to a healthier sense of well-being.

Here are resources to help your planning!

The Adirondacks

Drives

https://visitadirondacks.com/what-to-do/scenic-drives-byways

Views

https://visitadirondacks.com/

Events

Saranac Lake WInter Carnival

Old Forge Winter Carnival

Raquette Lake Winter CarnivalFrozen Fire and Lights, Inlet

Wild Lights at the Wild Center

More at https://www.iloveny.com/search/?q=Adirondacks

Restaurants by region

https://www.adirondack.net/restaurants/all/

 

Nephrology Associates Of Syracuse, PC:Remaining Dedicated to Superior Kidney Carein a Dynamic Medical Landscape

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By: Elizabeth Landry

In the post-Covid-19 pandemic world, healthcare continues to evolve with new challenges and innovations alike. Nephrology Associates of Syracuse, PC (NAS) has been on the forefront of the treatment and management of kidney disease in Central New York for more than 45 years and remains dedicated to addressing challenges in healthcare head on while also utilizing the latest in medical technology.

At the practice’s main office located on Buckley Road in Syracuse and at several satellite offices located in nearby communities, NAS offers access to high-quality, specialized kidney care when 

patients are referred by their primary care provider. The office’s five dedicated physician owners and seven advanced practitioners are all experts in the field of kidney care, working with patients one-on-one to deliver 

personalized care for each individual. The team also provides hospital care at Crouse Hospital and St. Joseph’s Hospital Health Center in Syracuse, offers hemodialysis care at six locations in Onondaga County, and facilitates home hemodialysis and peritoneal dialysis at the DaVita and Fresenius Dialysis home/PD centers.

The team at NAS works collaboratively to ensure patients receive superior nephrology care, while actively participating in programs and medical enhancements that make managing kidney disease more efficient for patients, help lower overall costs, and that are aimed at decreasing hospitalizations. Although keeping all factors in balance can be a challenge, the NAS team is confidently rising to the occasion and continues to demonstrate a strong commitment to excellence in the field of kidney care.

CATCHING KIDNEY DISEASE – Early is Critical

For many years, NAS has worked to educate patients about kidney disease – in fact, the practice’s vision statement specifically includes “efforts to increase awareness and early detection.” Kidney disease is often described as a “silent killer” and many of the physical symptoms of the disease aren’t recognized by the general population until the disease has severely progressed, unfortunately, as nephrologist Philip Ondocin, MD, who joined the practice in 2002, explained.

“Patients won’t know they have kidney disease unless their blood or urine is checked,” Dr. Ondocin said. “Oftentimes, people just equate kidney function with urine output. Patients will tell us they’re making a lot of urine, but even still they may not be clearing toxins. So, it’s only through a physician or provider visit with blood work and urine tests that we can identify how well the kidneys are functioning. Kidney disease is largely asymptomatic until it’s very late, so people need to be screened.”

Along with screening for kidney function, primary care referrals to NAS are also imperative in catching kidney disease before it progresses. The NAS providers have strong relationships with local referring physicians and providers, and they encourage all patients who have learned of a potential risk for kidney disease to heed new-patient referrals and not delay meeting with a nephrologist to determine an individualized kidney care plan.

To make the referral process more efficient and help ensure new patients can be seen as soon as possible, NAS has partnered with Phreesia, a vendor partner, which provides an online dedicated new patient referral toll-free fax line and online new referral submission form. NAS nephrologist Antoine Azar, MD, who’s been with the practice since 2016, described how these tools that help streamline new referrals are complemented by the strong communication between office staff and providers to help ensure patients are seen in a timely manner and with urgency that matches the severity of their kidney health concerns.

“Phreesia is a tool that helps with rapid review of new referrals, but our front office staff is also educated about knowing when to check with providers if they notice something is off with the referral,” explained Dr. Azar. “They know that if they see a referral with higher creatinine, which means worse kidney function, they need to check with a physician. Every day in the office there’s a physician available they can confer with. We always try to risk stratify the referrals, so for more stable patients we can usually see them within a few weeks, but for more urgent referrals we can usually see patients within a week.”

Dr. Azar added that the practice is also careful not to accept referrals for patients who don’t currently need to be seen by a nephrologist. “Sometimes we’ll find that a patient may need to be seen by a urologist or a vascular surgeon instead, so in those cases we’re honest with the patient that they were referred to us by mistake. We try to avoid unnecessary referrals in order to save patients time and money, and we make sure to communicate back to their primary care office, so they understand, too,” he said.

VALUE-BASED CARE FOR INCREASED QUALITY AND COST-SAVINGS

One of the biggest challenges facing all physicians who provide care to Medicare and Medicare Advantage patients, in both primary care and specialty care, is the continued decline of the Medicare Physician Fee Schedule.

In looking at data from 2013 – 2023, the Consumer Price Index increased by 29.3% from 2013 to 2023. Inflation adjusted, per-visit Medicare Physician Fee Schedule payments decreased by 12.2% for outpatient office visits and 19.1% for inpatient visits from 2013 to 2023. Adjusted for inflation, national health expenditures increased by 33.9% for physician services from 2013 to 2021. In comparison, Medicare Physician Fee Schedule payments over the same time period, 2013 to 2021, increased by 1.3% for outpatient office visits but decreased by 10.6% for inpatient visits.1 Dr. Ondocin highlighted how the practice works together to face this challenge, which often leads to rising expenses for operations, clinical supplies and more.

“The Medicare fee schedule changes every year and there’s not much we can do about that. Some physician groups like the American Medical Association lobby for adjustments, but it’s really out of our control. Anne Zaccheo, our practice director, is very good at making sure our office runs as lean as possible, which helps sustain our practice considering these challenges. We’re also fortunate to stay in private practice because we’re autonomous and we can care for patients the way we prefer. We still do 20-minute follow up visits and onehour consultations. So, we feel we can maintain the quality of our practice even with the challenges,” stated Dr. Ondocin.

Another way the practice aims to save on costs while still providing high-quality health care to patients is by engaging in several value-based care (VBC) initiatives. NAS has contracted with both KidneyLink and Excellus BlueCross BlueShield REACH Kidney Care, two VBC offerings which seek to prevent unplanned trips to emergency departments and hospitals. While KidneyLink is for patients with traditional Medicare Part B who have stage 4 or 5 chronic kidney disease and those on dialysis, REACH is for Excellus members in Medicare, Medicaid, commercial and those self-insured employers who opt to include the program in their annual benefit offerings.

“These programs focus on patients with advanced kidney disease,”
said Dr. Azar. “So, mainly patients with less than 30% kidney function. We focus on trying to delay progression, delay starting dialysis and delay hospitalizations, which are ways to help save on costs down the road while also ensuring we maintain great care for our patients.”

CONTINUING PROVEN CARE STRATEGIES

Although the practice strives to help patients avoid acute kidney concerns, hospitalizations due to kidney injury and disease do occur. NAS is continuing to prioritize timely, thorough care after a hospitalization, which, as Dr. Azar explained, can help prevent rehospitalizations. 

“Care after a hospitalization is very, very important,” he said. “A lot of patients get discharged with medication changes and instruction changes, but they’re so sick at the time and overwhelmed, they don’t follow through. We try to get every one of our patients who end up in the hospital to come and see us within a week, or a maximum of two weeks, after discharge so we can take their blood pressure, see how they’re doing, check their medications, make sure their labs are steady and make sure their kidneys are tolerating any new medications. There are a lot of cases where we catch something a little earlier and have prevented re hospitalization.” 

Another program NAS is  continuing to offer is Chronic Care Management, also known as Connected Care. Designed to support patients with two or more chronic, life-threatening diseases, this program involves monthly care support through a personalized care manager who reviews medications with patients, makes sure they’re getting their medications refilled, talks to them about weight gain, and much more. Dr. Ondocin shared that the program “is great – it’s kind of like an extension of our practice. All the gathered information is incorporated directly into our electronic health record.”

NEW ADVANCEMENTS TO SUPPORT KIDNEY HEALTH

In addition to continuing these proven programs, the team at NAS is always staying informed on the latest research and innovations in the field of nephrology, such as increased access to home dialysis for patients with acute kidney injury, kidney regeneration technology and policy changes aimed at expanding living donor support for kidney transplants. The practice plans to roll out a new initiative this year called remote patient monitoring (RPM), which provides physicians with real- time, in-home blood pressure and weight status, saving valuable time for patients and physicians alike and helping to prevent emergencies and hospitalizations.

“In nephrology, we manage a lot of hypertension. RPM is the gold standard for managing hypertension in patients,” said Dr. Ondocin. “The blood pressures and weights will be stored with AccuHealth, a new vendor partner, and then shared with us in our electronic health record. So, we’ll actually have real-time home monitoring data for these patients, and we’ll have access to more data points so we can better manage our patients with hypertension.”

While these new ways of managing risk factors and  supporting kidney health are exciting, the team at NAS continues to emphasize screening for kidney health concerns and caring for overall health as the primary ways to 

prevent or slow down the progression of kidney disease. The National Kidney Foundation recommends regular screenings, following a healthy diet, focusing on hydration, taking medications  as directed, managing stress, and exercising as ways that individuals can support their kidney health.

Similarly, for the NAS team, supporting kidney health all comes back to awareness, education, and proactive care.

“We try to educate folks about early detection and prevention of kidney disease, including our referring physicians,” said Dr. Ondocin. “We really try to educate people as much as possible about what their level of kidney dysfunction is, what to look out for, what labs to follow – how to most help themselves. That’s our thing, we just try to keep our patients healthy.” 

1https://pubmed.ncbi.nlm.nih. gov/38262816/

To refer patients to Nephrology Associates of Syracuse, P.C. in Syracuse or a satellite location, visit nephrologysyracuse.com/ contact or call 315-478-3311.