Health-care providers, insurers, and businesses operating in Central New York say they are dealing with a still-unclear prognosis after the U.S. Supreme Court opted not to pull the plug on the 2010 federal health-care reform law on June 28.

“Most of the provisions of the law take place over time,” says Dr. Paul Kronenberg, president and CEO of the 506-bed Crouse Hospital in Syracuse. “We’re not going to really completely understand this bill and its unintended and intended consequences until we have a better understanding of how these things will become operational.”

The court ruled 5-4 on June 28 that the law’s individual-mandate provision was constitutional under the federal government’s taxing power. The mandate will require almost all Americans to purchase health insurance or pay a penalty starting in 2014.

That decision left nearly all of the law’s other components intact, with the exception of a piece concerning the federal government’s ability to encourage state expansion of the Medicaid program. Still, its long-term prospects are not entirely clear, as Republicans in Congress and presidential candidate Mitt Romney are pledging to repeal the legislation if they are elected in November. 

Even if the law isn’t later repealed or changed significantly, it is not yet apparent how some of its provisions will be implemented. For example, a health-insurance exchange is still taking shape in New York after Gov. Andrew Cuomo, Democrat, ordered its establishment in April. 

Despite the uncertainty, Central New York health-care leaders say they are taking what steps they can to prepare for the law’s requirements. The following is a snapshot of what health-care and business officials say they are watching regarding the law.

Effects on providers

Many hospitals did not wait for the Supreme Court’s ruling to follow the reform law’s lead by focusing on reducing readmissions and coordinating care between providers, according to Kronenberg.

“I would suspect that most of the hospitals in New York State, and maybe even around the country, have sort of been trying to move directionally,” he says. “I think some things just made sense, whether it relates to care efficiency or helping to reduce the cost of care.”

Crouse’s efforts to slash readmissions predate the reform law, Kronenberg says. They include a transition program that aims to make patients leaving the hospital self-sufficient at home — a program that is more than five years old.

One of the law’s funding provisions Crouse is preparing for is a Medicare Value-Based Purchasing program that will tie a portion of hospitals’ Medicare payments to quality-of-care and patient-satisfaction measurements. For the 2013 fiscal year starting in October, hospitals could see their Medicare rates reduced by as much as 1 percent, depending on their performance. 

That would put about $700,000 of annual Medicare funding at risk at Crouse, Kronenberg says. But hospitals aren’t yet sure how much funding they will actually lose.

“It’s hard to know, because the calculations have to get done by the government,” Kronenberg says. “The measurement period for this particular program ended at the end of March 2012. No one’s sent me a letter yet.”

Providers are also bracing themselves for a wave of demand for primary care once the reform law’s individual mandate becomes active. Having more insured New Yorkers is likely to lead to more patients visiting doctors, according to Kathryn Ruscitto, president and CEO of the 431-bed St. Joseph’s Hospital Health Center in Syracuse.

“We just opened a new emergency room, and we have been knocked over by how many patients we have coming to the emergency room who are really in need of primary care and can’t get access,” she says. 

In April, the hospital reported that patient visits to its emergency room were up 15 percent for the first five months of the year, compared to the same period last year. It was on pace to receive 65,000 to 70,000 visits in 2012.

St. Joseph’s is trying to boost primary-care availability, Ruscitto adds. Six physicians who are graduating from residencies at its family medicine program have committed to enter private practice in Syracuse, she says.

Dr. David T. Page, president of the Onondaga County Medical Society, believes the federal government should take steps to encourage more physicians to enter primary care. Loan-forgiveness programs and tuition support could help the physician shortage, he says.

However, doctors should be concerned about more than overflowing waiting rooms, Page adds. They also need to be aware of more stringent anti-fraud and anti-kickback regulations in the health-care reform law, he says. 

“Physicians are going to have to understand about anti-kickback laws,” he says. “And I think we’re going to be under increasing scrutiny for fraud, real or imagined, from the federal government.”

Effects on insurers

Insurers have plenty of work to do to prepare for state-run insurance exchanges, says David Oliker, president and CEO of Schenectady–based MVP Health Care. The insurer, which has a Syracuse office at AXA Tower 2 at 120 Madison St., has 41,000 members in Central New York, according to the 2012 Book of Lists.

Although New York’s exchange is not yet online, it is slated to open for state residents to purchase coverage at the beginning of 2014. That leaves about 18 months for MVP to plan, Oliker points out.

“The products have to be designed,” he says. “We need to think about how they’re going to be supported as far as our networks are concerned — that is, the providers that are going to be involved.”

Some plans cannot be solidified yet, Oliker continues. MVP does not yet know the exact rules for insurance sold on New York’s exchange.

“If we had that information, we would certainly run with it,” he says.

An immediate change insurers face is a requirement to provide members and prospective members with “Summary of Benefits and Coverage” documents. Those documents, designed to provide standardized summaries of health plans, will be required starting this September.

Effects on businesses

A key provision of the health-care reform law affecting businesses requires companies with 50 or more full-time employees to offer health insurance starting in 2014 or risk paying a penalty. 

That penalty, which is tied to whether employees receive tax credits for coverage through an insurance exchange, will be $2,000 per year per employee — with a company’s first 30 employees exempted.

Now that the Supreme Court upheld the reform law, some employers are looking at whether they should offer coverage or pay the penalty, according to Hermes Fernandez, a health-law attorney at the Albany office of the Syracuse–based law firm Bond, Schoeneck & King, PLLC.

“I think the largest piece now is, how do employers get out in front, how do they get lined up with the mandate, and how do they get their coverage done?” he says. “How do they make those decisions to provide coverage or pay the tax penalties?”

That employer mandate is likely to have the biggest effect on businesses with just more than 50 employees, says William Killory, a partner at Syracuse–based Dermody, Burke & Brown, CPAs, LLC. Larger employers are probably already offering health insurance, and businesses with fewer than 50 employees are exempt from the penalties, he says.

“It’s really the small employers, restaurant owners, places like that where the margins were pretty thin anyway,” he says. “I think it’s going to be quite a burden for them.”

Killory suggested small-business owners look into tax credits if they plan on offering health insurance for their employees. For example, for small businesses with fewer than 25 employees that provide health insurance, the reform law created a tax credit of up to 35 percent of contributions toward health-insurance premiums. The credit will increase to 50 percent in 2014.

The complexity of the health-care reform law poses a challenge for small-business owners, Mike Durant, the New York State director of the National Federation of Independent Business (NFIB), contends. The NFIB is one of the parties that sued the federal government over the health-care reform law in the case the Supreme Court decided June 28.

“You take that and you layer it on top of all the things we have going on at the state level, and it’s just very difficult to be a small entrepreneur in the state,” Durant says.  

Verizon Wireless’ upstate New York region has a new president.

Chris Felix was named to the position on June 20. He succeeds Russ Preite, who had been president of the upstate region since 2010.

Preite was named president of Verizon Wireless’ northern California, Nevada, and Hawaii region. As regional president, Felix will set the company’s strategic direction and direct its sales, operations, financial performance, and customer relations in upstate New York.

Felix, in an interview, says he’s run all the different business areas that make up the geographic region over the course of his career. That includes retail stores, business to business, and indirect partnerships.

He says the experience has prepared him well to lead a region. Most recently, Felix was vice president for federal government sales at Verizon Wireless. He was responsible  for managing sales and customer service, negotiating agreements, and ensuring compliance in working with federal government accounts nationwide.

Whether for business or retail customers, carriers today must be prepared to offer plenty of options, Felix notes. Customers are looking for packages tailored to their needs.

Felix began working in the wireless business in 1988 for Bell Atlantic Mobile. There was a time when that meant installing a phone in a customer’s car and that was it, he notes.

Now, selling wireless services means acting more as a consultant, helping customers understand their options and creating a program unique to them

“That’s the evolution,” he says. “We have to take our salespeople from being transactional to consultative partners.”

On the business side, that might mean working with companies with employees who want to use their own phones for corporate and personal use. Firms need to know that their internal documents and emails are secure even if they’re accessed on an employee’s personal phone or tablet.

Companies might look to pay for a portion of that employee’s bill as well, Felix says.

Felix also notes that smartphones are no longer brand new technology. Users’ have become more comfortable with them in recent years and so their demands are changing.

“People aren’t afraid of a smartphone anymore,” Felix says. “It’s really how do I manage it, how do I use it, how do I incorporate it into everything I’m doing.”

Data continues to drive the mobile marketplace, he adds. But simply granting access is not enough. It’s about quality, speed, and reliability, he says.

Felix previously held various leadership positions in corporate and government sales at Verizon Wireless, as well as retail sales and operations for the company’s Washington-Baltimore-Virginia region. He also served as director of corporate sales in the Carolinas and Tennessee region.

He holds a bachelor’s degree in business administration from James Madison University.

Verizon Wireless is a joint venture of Verizon Communications (NYSE, NASDAQ: VZ) and Vodafone (LSE, NASDAQ: VOD). The company employs 80,000 people nationwide and serves 93 million retail customers.

Verizon Wireless has more than 2,500 employees in the upstate region.   

DeWITT — Growth at the DeWitt–based Empire State Agency has continued through the first half of 2012 after it was named last year’s top agency in Prudential Financial, Inc.’s (NYSE: PRU) agency distribution sales organization. 

This spring, Prudential named Empire State Agency and its managing director as the winner of its President’s Trophy for 2011. The Newark–based financial-services firm awards that trophy based on agencies’ hiring, retention, and sales performance, according to Matthew Dauksza, Empire State Agency’s managing director.

“Usually the top agency in the country isn’t in upstate New York or other small markets,” he says. “It’s usually your Manhattans, Chicagos, Los Angeleses.”

Not only did Empire State Agency top all other Prudential agencies last year, Dauksza says, but it is leading them for the 2012 trophy through the first half of this year.

In the first 26 weeks of 2012, the agency hired 11 new employees, he says. It has only lost two employees, resulting in a net nine new positions. And, its sales are up 26 percent so far, according to Dauksza, who declined to provide specific revenue totals.

That follows 2011, when Empire State Agency hired 18 employees. It only lost four workers, including retirees, for a net gain of 14 new positions last year. The agency’s sales grew by 8 percent last year.

Empire State Agency has had two opportunities to celebrate last year’s President’s Trophy, according to Dauksza. It had a trophy dinner with Prudential leaders at the Crowne Plaza Syracuse hotel on April 26. Then, in the third week of July, many of its employees will attend the presentation of the trophy at Prudential’s President’s Club Conference in Palos Verdes, Calif.

Dauksza took over as managing director at Empire State Agency in October 2010. His recent ascent to that position makes the Prudential award special, he says.

“From what they tell us, we were the first agency in company history to win the President’s Trophy in the first full year of the managing director,” he says.

Dauksza has been with the agency since 2000. He believes its ability to retain employees is a big part of its success.

“Our retention, I think, is the real story,” Dauksza says. “Sometimes retention is an issue in our industry. We can hire, but the trick is to retain your people.”

Empire State Agency has a two-year retention ratio of 92.1 percent, he adds. He estimates its retention ratio to be about 55 percent over four years, which he says is about three times higher than the industry average.

The agency’s aptitude for keeping its people stems from its hiring, according to Dauksza.

“The people we hire now are sometimes MBAs, lawyers,” he says. “When you bring on good people, I think that’s the true story of how you get to be number one in your marketplace or your company.”

Empire State Agency employs a total of 138 people. It has three locations — DeWitt, New Hartford, and Amherst. The agency’s DeWitt headquarters, located in 22,000 square feet of leased space at 5786 Widewaters Parkway, is the base for 48 employees. Its remaining employees are about evenly split between New Hartford, Amherst, and 30 private offices scattered around upstate New York, Dauksza says.

Between 70 percent and 80 percent of the agency’s business comes from retirement planning, he adds. Meeting the investment needs of baby boomers is a major part of that activity, he says.

Dauksza anticipates Empire State Agency continuing to hire and expand in the future.

“As we continue to grow, more of those financial planners find clients,” he says. “It’s a bottom-line increase.”

The agency also sells a variety of insurance products, including life insurance, annuities, and long-term-care insurance.