Health Care

Press release:

Congressman Chris Collins voted today in support of the House Republican Budget, including a provision that he secured to protect Medicare Advantage from future cuts.

“I was proud to vote for a budget that makes necessary reforms and structural changes to Medicare in 2024 to strengthen the current program and sustain it for future generations,” said Congressman Collins. “To protect Medicare Advantage, I personally fought for a provision to prevent cuts to this program so many WNY seniors rely on.”

The Republican House Budget balances in 10 years, saves taxpayers $5 trillion by shrinking big government and cutting wasteful spending, and reduces the country’s historic debt.

"The House Republican Budget does what so few Washington budget proposals do – it actually balances,” Congressman Collins said. “The American people understand we cannot keep borrowing money from China to pay our bills, bankrupting our children and grandchildren’s future in the process.”

In an effort to get the economy moving and leave taxpayers with more of their hard-earned money, the House Republican Budget also includes significant tax reform, including lowering the top individual and corporate tax rates to 25 percent, and eliminating special-interest tax loopholes and the Alternative Minimum Tax. The Budget also protects Americans who have been hurt by ObamaCare.

“The GOP Budget includes tax reform to bring down rates and level the playing field for small businesses and hard working families,” Congressman Collins said. “And it relieves the burdens of ObamaCare for the countless Americans who have seen their premiums skyrocket, their coverage dropped, or their hours cut.”

“Those opposed to the GOP Budget will demonize it and suggest Congress continue to kick the can down the road. The American people want Washington to get its head out of the sand and deal with our out-of-control spending and staggering debt. The House Republican Budget does just that," continued Collins.

The House Republican Budget was passed by a vote of 219 to 205.

The turnout was light, but the discussion was heavy this morning in a seminar for local business owners at Center Centre about the Affordable Health Care Act hosted by Insource Urgent Care.

Bottomline: The cost of health care is continuing to escalate, Obamacare won't fix it, and eventually Washington politicians will push for a single-payer system.

Insource CEO Mark Celmer opened the discussion this morning with a presentation about the bureaucracy created by the Affordable Health Care Act and the expense of emergency room visits vs. patient visits to urgent care centers.

The AHC was originally passed as a 2,500-page piece of legislation four years ago. After 38 amendments and executive orders, it's now more than 20,000 pages and stacked from floor to ceiling, it stands taller -- at 7' 3" -- than Wilt Chamberlain (7' 1").

Hundreds of government agencies have their hands in AHC administration and oversight.

And it does nothing to bring down the cost of health care, Celmer said. But it does make insurance companies richer.

"The Obama Administration has protected all the major insurance companies with the promise of new premium revenues from the 48 million uninsured," Celmer said. "He has written into the law provisions to guarantee revenue to them (the equivalent of a TARP Bailout) in the event insurers' medical payments fail to produce profits. This hidden element of the ACA is called the "risk corridor" and guarantees up to 80 percent of the insurance companies profit. This is the reason that the insurance companies and pharmaceutical companies have remained horribly silent on the negative effects of Obamacare on the middle-class working population."

Dr. Victor DeSa, a retired general surgeon and former member of the UMMC board of directors, spoke at length about why the health care system is broken.

Real problems started with the creation of Medicaid and Medicare in the 1960s. The two programs are rife with fraud, waste and abuse.

"Now you have your insurance card and you can overuse it all you want," DeSa said. "The incentives have changed. When you paid out of pocket, you didn't overuse the system."

Insurance company statistics, Celmer said, that nearly 50 percent of emergency room visits are unnecessary.  People use emergency rooms for dozens of routine ailments that could be better treated by a doctor's office visit or urgent care center.

Millions could be saved if people used ER's less, but in the current system there is no incentive for them to think about the costs because it costs them nothing.

There is a $38 trillion gap between the amount of tax revenue coming in to fund Medicare and its actual liabilities, DeSa said.

"Ninety percent of seniors are blissfully unaware that Medicare is broke," DeSa said.

The cost of funding the run-away expense of Medicaid is borne by local taxpayers. In Genesee County, 80 percent of every property tax dollar raised goes to Medicaid.

DeSa, like Celmer, believes that the AHC is actually intended to fail because the real goal of Washington politicians is to create a political climate where voters will accept a Canada-like, single-payer system.

Obamacare was supposed to usher in an era of health insurance for all, DeSa said, but that's an impossible goal.

Of the some 50 million people in the United States who don't have health insurance, 10 to 15 million are workers in the country illegally. They're supposedly not covered by Obamacare, but they receive taxpayer-subsidized healthcare every time they visit an emergency room because hospitals are mandated by law to treat even those who can't pay the medical bills. They won't sign up for health insurance through the exchanges.

DeSa said he doesn't object to that, however, because these workers contribute greatly to the U.S. economy and are needed by our farmers. As a matter of compassion, they should receive health care.

Then there are 10 to 15 million working poor who earn just enough to be above the Medicaid limit, but still not enough to afford health insurance even under the ACH.

The last group -- the ones Obama really wanted to rope into the system -- are the young workers, another group of about 10 to 15 million people.

"We call them the young, healthy and invincible," DeSa said. "They're they real target of Obamacare. They are supposed to buy insurance to subsidize the high-risk people who sign up through the exchanges who are older and richer. They are asked to pay two and four times what they would nomrally pay for their age and risk factors."

There is very little incentive for them to sign up, DeSa said. Yes, they can be fined -- $75 in the first year, and in a four years as much as $700. But even $700 is a lot less than paying $12,000 or more annually for a health insurance policy.

The White House has said 7.1 million people have signed up for health insurance through the exchanges, but DeSa said that's a tricky number. We really don't know how many of those people were the previously uninsured. Contained within that number are people who had private health insurance and switched plans through the exchange. There's also the group of people who liked their plan, but found they couldn't keep it. DeSa was critical of the Obama Administration for not releasing the actual number of newly insured people.

DeSa expects young people who haven't signed up yet to "game the system." If a young person develops a medical problem that requires expensive treatment, he or she will sign up for insurance, get treatment and then drop the insurance. He said that has taken place in Massachusetts, which instituted an insurance program similar to Obamacare when Mitt Romney was governor.

In three years, insurers will no longer be eligible for government subsidies, and that's when premiums will start climbing and consumers will start complaining and Obamacare will start failing.

"Obamacare is really a two-phased system," DeSa said. "The first phase, the phase we're in now, is designed to fail. It will drive insurance rates way up and then the politicians can say, 'we told you, the insurance companies are the bad guys.' "

That will create a climate more receptive to a single-payer system.

Celmer said insurance companies bought into Obamacare because they didn't realize it was really a system designed to put them out of business.

DeSa likened the government's handling of Medicare and Medicaid to "the gang that couldn't shoot straight" and he wonders how the feds can handle a single-payer system.

"Medicare and Medicaid are broke," DeSa said. "What gives you the confidence they could run single payer?"

Press release:

United Memorial Medical Center and MVP Health Care® are pleased to announce that they have reached an agreement which will allow United Memorial to be included as a network facility for MVP health insurance products purchased through the New York State of Health Exchange. The agreement was reached today, December 31st and will go into effect tomorrow, January 1, 2014.

As part of the Affordable Care Act, people who do not have health insurance through their job, or cannot afford the plan offered by their employer, now can use the “Healthcare Exchange” or “Marketplace” to compare plans and sign up. In New York State, residents are provided a list of insurance companies and plans to select from, based on their county of residence.

“We greatly appreciate the patience and understanding of our community as we are working to address the sweeping changes brought on by healthcare reform,” stated United Memorial’s CEO Mark C. Schoell. “I am pleased that we were able to bring the negotiation with MVP Health Care to a successful conclusion.”

Matthew MacKinnon, vice president, Network Operations, MVP Health Care said, “We are happy that United Memorial Medical Center is a participating provider for MVP products in Genesee County, including new Exchange coverage, and we look forward to continuing to serve residents of the Batavia area.”

Press release:

United Memorial Medical Center, the only acute care hospital in Genesee County, has been excluded as an “in network” provider by the insurance company MVP for its Healthcare Exchange insurance products following several attempts by United Memorial to negotiate a reimbursement rate structure. It is important to note that this only pertains to the MVP plans available on the Exchange. United Memorial does have contractual agreements with MVP for all of their other commercial, Medicare, and Medicaid insurance products.

Adding to the confusion for individuals when selecting a plan, is that many Genesee County physicians are listed as part of the MVP network; including several United Memorial Medical Center employed physicians, while the hospital is not included as a facility.

“We are disappointed that our efforts to be included in the MVP network of providers have not been successful,” said Mark C. Schoell, CEO of United Memorial. “We will continue to work with MVP to bring this situation to positive conclusion.”

As part of the Affordable Care Act, people who do not have health insurance through their job, or cannot afford the plan offered by their employer, can use the “Healthcare Exchange” or “Marketplace” to compare plans and sign up. In New York State, residents are provided a list of insurance companies and plans to select from, based on their county of residence. There are several companies and a range of options available on the Web site: nystateofhealth.ny.gov. With the exception of MVP, United Memorial has contractual agreements with all insurance companies listed on the site for Genesee County. Those contracts include: Fidelis, Independent Health, Blue Cross of Western New York, and Univera. People have until December 23rd to purchase a plan through the exchange in order to have seamless healthcare coverage beginning January 1st.

Individuals in Genesee County, who are purchasing their healthcare insurance through the exchange, should make sure that their physicians and hospital facility are both included in the insurance company’s network. If not, their care may be viewed as out-of-network, and most of the exchange plans do not cover out-of-network care. Application counsellors are available at United Memorial to assist with process of signing up for healthcare insurance coverage and to answer questions. Please call (585) 344-5428 with any concerns.

United Memorial has never turned anyone away from receiving the care they need based on their ability to pay and remains committed to providing quality care to the residents of our region.

Previously: Individuals who buy MVP health plans through new exchange reportedly not covered in Genesee County

NOTE: If you purchased MVP through the exchange (and only through the exchange), we might want to talk with you about your experience. E-mail howard@thebatavian.com

Customers signing up for an MVP health insurance plan through the new government-run exchange might find they can't get treatment from doctors in Genesee County.

A local healthcare provider was alerted to the potential hole in coverage and he said he's confirmed it with MVP representatives.

The lack of local coverage arose after UMMC declined to sign a reimbursement agreement with MVP.

The situation affects only customers who sign up for individual plans through the exchange. People who get any type of group coverage through MVP or who get MVP health insurance directly from the company (rather than through the exchange) are not affected.

An MVP spokesman has not responded to a request for an interview.

Jeff Baldick, at Genesee Orthopedic, alerted The Batavian to the hole in coverage and said he has spoken directly with MVP about the situation and confirmed with the insurance provider that his patients who purchased insurance from MVP through the exchange will not be covered.

He said MVP told him that it is not providing coverage for any patient in Genesee County who purchased insurance through the exchange.

According to Bob Chiavetta, CFO for UMMC, the hospital was presented with a take-it-or-leave-it reimbursement plan by MVP some months ago for patients covered by insurance through the exchange.

The hospital rejected the reimbursement agreement because the health care reimbursements are significantly lower than those of other insurance providers, even lower than what MVP reimburses for group coverage and Medicaid.

So while the hospital continues -- as it alway has -- to accept patients covered by these other MVP products, it has no agreement with MVP for reimbursements of patients who purchased MVP insurance through the exchange.

"We communicated to them that those rates were not adequate," Chiavetta said. "They told us they were trying to work on their network and would get back to us, but we never heard anything back from them. We never received a letter or any written communication that we were being excluded. Then a week and a half to two weeks ago, we started hearing from patients that we were not listed as a network provider. When we heard that, we spoke with them and we're trying to work through something."

Chiavetta is hopeful an agreement can be reached soon with MVP to provide adequate reimbursements for patients who purchase MVP insurance through the exchange.

MVP is the only insurance provider, Chiavetta said, who significantly lowered reimbursements for patients coming through the exchange. All of the other insurers, he said, provide reimbursements to the hospital that are consistent with policies obtained outside the exchange.

It was Chiavetta's understanding that MVP was providing coverage on the exchange product to patients in Genesee County up to the point the patient might get referred to UMMC, but Baldick said MVP told him explicitly that no Genesee County patients would be covered because any doctor's office visit could potentially result in a referral to the local hospital.

Across the board, Chiavetta said, the Affordable Health Care Act, is leading to lower reimbursement rates for the hospital, but that won't affect the quality of care at UMMC.

He's more concerned, he said, about the higher out-of-pocket expenses some patients might encounter if they purchase health insurance through the exchange.

The lower premium plans have deductibles as high as $6,500 annually.

He said people planning to purchase health insurance through the exchange should look very closely at those plans and ensure they are adequate to meet their needs. Just because a monthly premium is as low as $200 doesn't mean it's the right plan for an individual.

"I can see where it's attractive to them," Chiavetta said. "The only thing I would say is for people who are actively looking for insurance on the exchange is be very aware of what the cost is going to be. A lot of people are gravitating toward the lower premium plans, but that's a risk. It doesn't take much of an illness to cost a lot of money.

"A product for $200 a month might work great for some, but they might be better off paying more if they picked a higher plan. You've got to take your own health care needs into account."

The hospital has three people going through training next week on how to help people navigate the exchange.

"As patients come to us who are uninsured, just as we do now, we will help them understand financial assistance, Medicaid, and we will add to that help in getting through the exchange and selecting a health care product that is out there that is appropriate for them," Chiavetta said.

Anyone with questions now are welcome to call Sue Brown, director of patient financial services, at (585) 344-5428.

Insource Urgent Care, the revolutionary health care provider that chose Batavia for the first location for its new chain of clinics, held its official grand opening today.

The celebration included a ribbon-cutting ceremony with Insource President Mark Celmer, center, Dr. Magdi Credi and VP of Operations Melissa Marsocci.

Glossary

Disruptive Innovation: An innovation through technology or process that takes root in an underserved portion of the market to create new business opportunities.

Incumbent: The market-leading business in an industry.

Unmet Need: When a business planner identifies a hole in the marketplace, where consumers -- either consciously or unconsciously -- have a need that a new product or service can meet.

Job to be Done: Much like an unmet need, the jobs-to-be-done metaphor helps a business planner target a market segment for a new product or service. The job-to-be-done metaphor is based on the idea that customers don't really buy a product or service, they hire the product or service to help with a specific task they want to accomplish.

Clayton  Christensen: Harvard Business School professor and creator of the term "disruptive innovation." His groundbreaking works are "Innovator's Dilemma" and "Innovator's Solution." He's also written a book on innovation in health care, "The Innovator's Prescription."

From the perspective of the folks who run Insource Urgent Care in Downtown Batavia, their first-of-its-kind clinic is apparently seen as a competitive threat by the executives at United Memorial Medical Center.

A threat that must be crushed.

If their perception is correct, it highlights the fear disruptive innovators can strike in the hearts of incumbent businesses, especially if that business has enjoyed a monopoly position in the market.

Since UMMC officials are not talking about the tensions between Insource and UMMC, we only have the perspective of Insource's owners, which they're willing to discuss, and is also part of a federal anti-trust suit filed by Insource on June 25.

The suit alleges that UMMC conspired with HealthNow, the region's BlueCross BlueShield franchise, to eradicate the hosptial's pesky new competitor.

UMMC, according to the lawsuit, has even tried to muscle other health care providers in the county in an effort to deny Insource the partners it needs to deliver its services.

HealthNow is the dominant health insurance company in Western New York and UMMC has held a monopoly position for emergency and hospital care in Genesee County since the year 2000 merger of Genesee Memorial and St. Jerome's.

Melissa Marsocci, VP of operations for Insource, who is a native of Batavia and well versed in the literature of disruptive innovation, said she wasn't surprised by the response from UMMC to the arrival of her new company. She wishes it had been different, that cooperation rather than competition would have been the watchword, but that's not the case.

"Being from here and knowing the corporate culture over there, I knew we weren't going to be welcomed with open arms," Marsocci said. "Whenever I go anywhere else (to open a clinic), I don't know that, but here, we're just little bugs to them."

Insource is a company designed around innovation. It's model uses more efficient processes for delivering patient care and employs technology to reduce costs while improving quality.

Insource is also willing and able to deliver what it believes is world-class care while accepting lower profit margins per patient.

The result, according to Marsocci, is faster and easier access to top specialists and lower costs for uninsured patients.

The Lawsuit

Key points raised in Insource Development Services of Batavia, LLC. vs. HealthNow New York, Inc. and United Memorial Medical Center.

• UMMC operates two urgent care clinics, one at St. Jerome's and one in Le Roy. The suit alleges these clinics keep irregular hours and are frequently closed.
• Services offered by these clinics are allegedly limited and patients are frequently referred to UMMC's emergency room.
• HealthNow allegedly entered into discussions with Insource two years ago about opening an urgent care clinic in Batavia and encouraged Insource to take on the project. When Insource and HealthNow -- which covers 50 percent of the insured in Genesee County -- were about to agree to terms for rates, the suit alleges, HealthNow broke off communications unexpectedly and without explanation.
• The suit alleges ER care at UMMC costs at least $1,500, below the now-common high-deductable plan of $3,000, and Insource provides the same service for $150.
• The suit alleges that HealthNow and UMMC entered into an agreement to restrict competition in Genesee County.
• UMMC allegedly used anti-competitive practices to drive Lakeside's urgent care clinic out of Le Roy.
• UMMC has used "agents" to contact healthcare providers in Genesee County to discourage their cooperation with Insource.
• Insource alleges that UMMC is acting to protect its monopoly position in Genesee County.

In its lawsuit, Insource claims a typical emergency room visit to UMMC costs at least $1,500. The same service through Insource would cost $150.

"I think people deserve a choice," Marsocci said. "Isn't free enterprise what America is all about? Competition is good. It ups the quality, or should, so why not? Why should United Memorial have a monopoly?"

The typical urgent care model is kind of like a doc-in-the-box. The clinics are usually only opened in high-volume communities -- such as well-populated suburbs or densely populated urban neighborhoods. They treat minor injuries and illnesses and do very little in the way of referrals. They're not the place to go if you're seriously ill.

Insource can provide health care as basic as a physical for a high school athlete, up to arranging a consultation with a heart surgeon.

In other words, from a patient perspective, the company can do everything UMMC does, but without the overhead.

When a business planner with an eye toward disruptive innovation looks at a potential opportunity, the planner will try to identify an unmet need and a job to be done.

The unmet need in Genesee County, according to Marsocci, is the lack of top-tier specialists. It's not that they're not here, but there are fewer of them.

And, many local residents -- like it or not, it's true, notes Marsocci -- also lack faith in specialist referrals through UMMC.

This isn't a problem unique to Genesee County or UMMC. It's common in rural counties across the United States.

For the local patient who needs or wants care with a top-tier specialist, the only option until now has been to drive 30 or 40 minutes to Rochester or Buffalo.

"The care here, unfortunately, and I can say this because I've lived in Genesee County all my life, the care here has been substandard for years," Marsocci said. "I don't mean that disparagingly, but I'm saying, call a spade a spade. When I need care beyond primary care, I travel. I have been in those situations where I used a local specialist and it didn't end positively for me, and I've had those times where I was lucky. But you learn through a couple of experiences and you're not going to do it again, so I go east or west."

The job to be done, then, for Insource, is to connect patients who need specialized service with specialists without making them drive for miles and miles.

Computers, laptops, smartphones, tablets, closed-circuit cameras, LCD screens and the Internet -- all the tools of telemedicine -- means those miles, and the wasted time that goes with them, disappear.

The example Marsocci used was of a patient who came to Insource in early Jully complaining of debilitating back pain.

Initially, the concern was that he had a kidney stone, but a CT scan found a growth on his spine. A surgeon and specialist in spinal problems who will soon be one of Insources subtenants was consulted using telemedicine tools. The doctor confirmed the diagnosis and told Insource to have the patient call him on his mobile phone the next day -- July 4 -- for a follow-up consultation.

Two weeks ago, the patient had surgery to remove the growth.

"If that man had gone to any other urgent care, they would not have wanted to spend any more time on him than they had to," Marsocci said. "If they didn't have access to a CT then they knew they were wasting time on him and not getting paid. They would just want to get him out the door.  He would have to go to the emergency room then, which means he's going to spend a lot of money for something we did perfectly well here."

"It's pretty exciting to say he had surgery probably before he even would have seen the spine surgeon had he went anywhere else," Marsocci added.

All of these improvements -- better access to specialists, lower costs -- just make good business sense.

"Why can't the people in this community have the same level of care as the people in Buffalo or the people in Rochester?" Marsocci asked.

The response from local doctors to Insource, even those associated with UMMC, has been uniformly positive, Marsocci said. Insource refers patients to local doctors and to UMMC on a daily basis. The goal is to get the patient the best treatment possible, and that often means local doctors and local specialists are the best resources for local patients.

And local health care providers have found Insource a valuable resource, even referring patients to Insource, she said.

If all this makes so much sense, why aren't established urgent care companies around the nation providing the same service? Why isn't UMMC?

Mark Celmer

Yesterday, Mark Celmer, president of Insource, spoke with The Batavian's news partner, WBTA, about the lawsuit. Here's what he said.

“I do find it absolutely reprehensible that any member of Genesee County that’s insured by HealthNow can travel 40 miles to Erie County and go to any of 22 urgent care sites and be fully covered for their urgent care visit, but they cannot come to the newest one on Main Street, Batavia. I find that just absolutely reprehensible.”

“I would like HealthNow to say, ‘Genesee County residents: if you want to go to the urgent care center at the Jerome Center, if you want to go the urgent care center in Le Roy, if you want to go to the emergency room at United Memorial, or if you want to go to Insource Urgent Care Center on Main Street, Godspeed, let’s get going.’ ”

As we said, we lack UMMC's perspective on this competitive climate, but we do know about the patterns of disruptive innovation.

In any classic case of disruptor vs. the disrupted, the incumbents either under-value the disruption or feel trapped by their established business model. The incumbent sees no way to extricate itself from its present business model, no matter how threatening the disruptive innovation might be.

Newspapers, for example, have found it difficult to transition to an online news model because higher profits are found in their dead tree editions. 

While it costs less to produce digital news, the revenues are also substantially lower -- The New York Times publisher once said it was like converting print dollars into digital dimes -- and profit margins are slender to nonexistent (especially if newspapers want to maintain their current newsroom cost structure). Even as readers flee from printed newspapers, incumbent publishers are loathe to go to an online-only business model.

It's very difficult for an incumbent to give up a profitable line of business in favor of a business model that means lower revenue and less profit, especially when successful models are few and far between.

Sailing ship builders couldn't do it when the steam engines came along; Detroit couldn't do it when Japanese cars hit the market; mainframe computer makers couldn't do it when personal computers were first being sold; and, Kodak couldn't do it when digital cameras became popular (and Kodak INVENTED the digital camera).

"We're trying to make sense of where everything should be -- lowering costs, improving quality, improving satisfaction, improving access," Marsocci said. "That's where we find ourselves as disruptive innovators. Nobody in the urgent care business wants to spend the amount of time that we did putting together a formal telemedicine program or the way we do things with continuity of care, having subtenant specialists in our center.

"They want the low-hanging fruit," she added. "It can be a very lucrative business, so they want to find a place in a heavy-traffic shopping plaza and just put up a center and see how many patients they can see each day and make as much money as they possibly can. Where we're really focused on what we're preaching. Continuity of care."

NOTE: Early yesterday evening, The Batavian sent an e-mail to Colleen Flynn, spokeswoman for UMMC, and outlined the nature of the article we were writing about the lawsuit and invited UMMC to comment on the topics raised in this article. The Batavian received no response to the e-mail.

A new urgent care clinic opening Wednesday in City Centre will not only be state-the-art but be a true revolution in how health care is provided, according to its top executives, Mark Celmer and Melissa Marsocci.

"This is a health care delivery model that doesn't exist, to my knowledge, anywhere in the country," said Celmer, who is president of Buffalo-based Insource Healthcare Solutions. "We coordinate health care back to pediatricians, specialists, primary care physicians. We have advanced telemedicine which is state-of-the-art. We can get patients seen faster and with more related services than anybody short of the Cleveland Clinic."

For years, Insource has developed urgent care facilities for the owner of multiple urgent care centers, but Marsocci said Insource had its own vision about how to provide health care and decided to start opening its own urgent care units.

Batavia is the first of four locations being opened in New York and Pennsylvania over the next two months.

The clinic is between Genesee Dental and Steve Hawley's insurance office. It's a location used for a long time by DENT Neurological Institute, which will continue to rent office space there.

Insource is not coming to town to compete with any existing physicians or the hospital, said Marsocci, who grew up in Le Roy and lives in Batavia.

"We're not going to steal anybody's patients," she said.

Following a patient's visit to Insource, the patient will be referred back to his or her primary care physician or the appropriate specialist with all of the patient's records shared with that doctor.

For patients, the wait time to see a medical care professional will be less than 15 minutes and most patients will be in and out of the clinic within an hour.

Typically, when a patient visits an urgent care clinic, once they're taken into an exam room, they "own that exam room," Marsocci said. At Insource, the patient will be given an exam and then wait in a "results waiting room," which has comfortable chairs and a TV. That frees up the exam room for other patients.

Celmer and Marsocci are particularly excited about the telemedicine model they've developed.

Here's how Marsocci described it:

Let's say you came in and you had a fractured hand. We can certainly treat that, but upon a view of your X-ray, it looks pretty severe. We say, "this looks serious, so let's get a second opinion from an orthopedic." Maybe you need some screws in it. Maybe it needs immediate attention, maybe not. You come into the telemedicine room and the orthopedic comes in on that flat screen.

He can talk to you and you can talk to him. He might ask the provider to move your hand around and at the same time we can push that X-ray through to him.

We just lowered your cost of care because typically you would have gone to that orthopedic and he would have redone your X-ray, also exposing you to radiation. Now it's just one X-ray.

A consulting physician can dial into the telemedicine center through a secure line using a desktop, laptop or even an iPad or smartphone.

Even if a doctor is away from his office -- maybe on the golf course -- he can use an app to consult with a patient in the telemedicine room.

The quality of the pictures sent to the doctor is amazingly accurate and detailed, Marsocci said.

Insource has hired six full-time employees and all of them live in Genesee County.

With a range of specialists sharing the Insource space -- including neurologists, orthopedics, pediatricians, cardiologist and urologists -- Calmer and Marsocci say the concept will do a lot to reduce the cost of medical care.

One insurance company is so excited by the idea, Marsocci said, thet they want to see more Insource clinics built in Pennsylvania.

For patients who must pay for services with cash or credit card, they will find a visit to Insource a lot less expensive than going to the emegency room. An ER visit can run into the thousands of dollars, but a typical visit to Insource will cost about $180.

Using technology, there will even be cases where patients can save on super expensive ambulance rides to a hospital in Rochester and Buffalo, if that's needed. If the patient doesn't need to be on an ambulance, but still needs to be monitored while by driven to the hospital by a family or friend, Insource can provide the patient with an iPad to monitor his or her condition during the ride.

Insource also plans to set up a telemedicine center at the county nursing home, which will save the county money on providing medical care to patients there.

"These are common sense approaches to reforming health care instead of doing things that don't make sense," Marsocci said.

UMMC has long partnered with Rochester General Hospital on patient care, and the two hospitals are exploring ways to work together more closely, according to hospital spokeswoman Colleen Flynn.

But, she said, contrary to a rumor reportedly circulating among staff, there are no merger discussions taking place.

There aren't even immediate plans to form a formal partnership, known as a ACO (accountable care organization) under the Affordable Healthcare Act.

RGH has long helped UMMC recruit doctors and provide patients with specialized care, and the two hospitals are looking into ways to share those services even more, but that's as far as the talks are going, Flynn said.

An ACO, according to Wikipedia, is a coordinated group of heath care providers who commit to standards of quality care in order to reduce the total cost of health care and reimbursements.

UMMC is always looking for ways to improve patient care and provide more specialized care, Flynn said.

"We're an independent community hospital and we're going to be an independent community hospital," Flynn said. "We look for larger organizations to partner with because we're small."

To help address a possible shortage of primary care physicians in the future, UMMC today announced a partnership with Lake Erie College of Osteopathic Medicine to transform the local hospital into a teaching hospital.

UMMC completed a credentialing process by American Osteopathic Association in August and will begin accepting medical students in residence in 2013.

“This is an exciting moment for United Memorial Medical Center,” said President and CEO Mark C. Schoell (top photo). “As a teaching hospital, United Memorial will be at the forefront of the latest medical developments and be able to provide improved quality of care; advanced treatment therapies; a shorter length of stay for major illnesses; and achieve superior outcomes and survival rates for our patients.”

Dr. Anna Lamb, herself an osteopathic doctor, said the announcement today is "awesome" news for Batavia.

"We need to grow our own," Lamb said. "We’re going to have significant primary care shortage in the next few years as some of our physicians are getting a little older. We have to grow our own. Batavia is just not on people’s radar, so we have to get people in here to see it, to like it, and as Dr. Terry said, 'if we grow our own, they’ll stay here.'"

Dr. Richard Terry also said that local kids with medical aspirations will now have a way to complete their education locally and stay in their hometown, if they choose that route.

UMMC will use a variety of incentives, such as student loan repayment, to help convince residents to stay in Batavia and become primary care physicians.

Many young doctors, Schoell said, no longer want to go into private practice and would rather work for a medical institution.

The reason, he said, are reductions in government medical reimbursements, increasing regulation and the difficulty inherent in owning and running your own business.

There will be four residents accepted for each year of the program (for an eventual total of 12). They will reside in the community and receive compensation and benefits from United Memorial while participating in the program.

Serving as program director for United Memorial is Laurie Kilbury-Taylor, D.O.  Dr. Kilbury-Taylor is an emergency room physician at United Memorial with the group FDR Medical. She is a graduate of the New York College of Osteopathic Medicine and holds additional degrees including a master of science degree from the State University of New York-Roswell Park Division, and bachelor of science degrees in Biology and Engineering.

The first year of residency emphasizes the inpatient experience. For second-year residents,a significant emphasis is placed on taking more clinical responsibilities and enhancing decision-making skills. There are four months of inpatient medicine where residents are the primary physicians for their patients.

Each resident will manage his/her own inpatient service with supervision by an attending physician. The third-year resident has a significant role in teaching and supervising junior residents and assumes direct responsibility for leading the Medicine Teaching Service and Family Medicine Inpatient Teaching Service.

Individuals who have completed a baccalaureate program and wish to pursue a career as a physician in the United States must be accepted to and complete an additional four-year course of study at an accredited osteopathic medical school in order to continue in the osteopathic residency program.

Already burdened by a seemingly intractable unfunded mandate in Medicaid, Genesee County isn't being burdened much by the Affordable Healthcare Act, according to County Manager Jay Gsell.

Even the provisions treating the county as an employer, which have been in effect for two years, Gsell said, have had negligible impact on the budget.

While the act, often referred to as Obamacare, is increasing the size of the pool of local residents who have health care coverage under Medicaid, Gsell said if the state follows through on seeking funding from the federal government, county taxpayers won't be shouldering that burden.

The act requires states to offer Medicaid to people with annual incomes of 133 percent of the poverty rate or less, Gsell said, and NYS already offers Medicaid at 150 percent of the poverty rate.

Also, Gov. Andrew Cuomo has already instituted insurance exchanges.

With those two criteria being met, the state should receive funding from Washington to cover increases in Medicaid coverage, if the state applies for it.

The state will cover the increases in administrative costs, Gsell said, for new Medicaid recipients.

Gsell said the new group of people who will be covered by Medicaid have traditionally just gone without medical coverage, meaning they get no preventative care and seek only emergency care that the hospital can only write off as "charity care."

Now these people can establish a relationship with a doctor or clinic, get check ups and physicals and better monitor their health concerns.

"From a community standpoint, I think that's better health care," Gsell said.

This entry concludes Sunday's article on the comments of Victor DeSa, M.D., who spoke to senior citizens at Batavia's First United Methodist Church last week.

Please remember, this is a summary of DeSa's presentation and does not necessarily reflect the views of The Batavian:

Medicare, Medicaid and senior services

By requiring insurance companies to expand coverage, the new health care law will drive costs up, according to DeSa. The government has told consumers that these costs will be offset by subsidies for people making less than $80,000 per year.

These subsidies will be coming, in part, from a $500 billion cut from Medicare -- and that's where senior citizens and others eligible for Medicare should be concerned.

But this is not the only problem. Both Medicare and Medicaid, which DeSa called "the original two public options," have met with disaster. Medicaid has already failed, and Medicare is on the brink of failure.

"The government has no idea how to handle the rising costs. Their idea of handling the costs is to take a machete to (the programs) and cut."

The result is the "doctor fix," a 21-percent cut in doctors' reimbursements. This could be disastrous in a system where the cost of providing services is already greater than what the doctors receive in compensation.

For that reason, many doctors no longer accept Medicare. The Mayo Clinic in Arizona has already determined that because of the new health care legislation, it will no longer deal with the program.

"So Medicare patients are going to have fewer and fewer choices of who is going to take care of them."

With fewer doctors available, waiting periods will increase. So the direction Medicare is taking presents seniors with a double disadvantage.

The government "carved the 21-percent doctor fix out of the bill" in order to avoid upsetting America's seniors, but that doesn't mean they've addressed the cost. They are simply pushing it to the side and will have to deal with it later.

"Six months down the road, they have to still come up with a fix for this 21-percent cut that they are going to make on Medicare payments to the doctors."

So that's the story with Medicare and Medicaid. As far as insurance for retired citizens goes, people who worked in the public sector should be okay (although DeSa said it's not impossible that this could change, because "anything is possible" with what the government is doing), but people in the private sector should be concerned.

What to do?

When asked how we can change the course we've taken, DeSa answered: "We've got to kick out the guys who did this."

He appealed to the power of senior citizens -- which he became two years ago -- who are "feared in Washington because we vote."

Many seniors were suspicious when the government said that $500 billion had to be cut from Medicare to cover health care.

"If they really addressed costs the way we asked them to do, a person making $40,000 a year be able should be able to afford health care coverage without subsidies, don't you think?"

Failure to address the problem of cost in the current system was one of DeSa's main critiques of the health care bill. He said that in looking for alternative plans, we need to look for one that does address them.

Counting the costs 

There are three main factors driving health care costs:

1) Overuse

Back in the old days, when there was usually only one doctor in town and he had to go to patients' homes to treat them, people only went to the doctor when there was something really wrong.

Now, with easy access to medical examination and treatment, people will go to the doctor -- and even to the emergency room -- whenever they have a minor health concern.

"We have to change that if we want to truly address the cost of health care."

But it's not just patients -- doctors sometimes overuse the system, too.

"I hate to admit it, but there's greed in every profession. There are bad apples in every bunch, and you've got to admit it."

2) The fact that people have insurance in the first place

Strange as this may sound, this can be a problem.

"Insurance is like a credit card, but you don't have to pay every month. So there's no incentive for you to be prudent with the costs. You don't even want to know what the cost is, you just want the health care."

DeSa believes that while insurance cannot be eliminated altogether, people should reduce their dependence on it. For health purposes, they should only turn to insurance in times of emergency.

Generally speaking, the way people take care of this part of the cost is by having "skin in the game."

"If you shop around for a car or a house, why shouldn't you be able to shop around for a doctor? Especially in this day and age, with the Internet and everything."

3) Liability

"Everything from a Band-Aid to a heart valve has a mark-up depending on the risk."

In other words, the more dangerous the a product or its failure can be -- and, therefore, the greater the likelihood of a lawsuit -- the more expensive the product.

Because the liability cost is factored into the price of the product itself, "the little guy gets it in the neck every time."

DeSa fully supports the patient's right to sue when a doctor has done something wrong or is incompetent, but he also believes that the whole liability issue should be looked at when considering the cost.

Government out, skin in (the game)

Costs are going down for procedures that are not covered by insurance (Lasik surgery is one example). The reason?

Competition.

"Costs come down if there are market forces in place."

DeSa saw this in his native India, which had a socialized health care system until the early 1990s.

When he was studying at Jabalpur University in the mid '60s, the Indian government had total control of health care and sent all competing forces out of the country.

The effect of this was what DeSa called a "brain drain."

"The best and the brightest (doctors) were all leaving the country."

He sees the same thing happening here in Western New York, where there is a serious shortage of doctors.

"Over 80 percent (of young doctors surveyed at Western New York teaching institutes) say they'll train here, but they're not going to stay in New York to work. We are known as one of the most heavily taxed and over-regulated states in the country."

Our response to this situation should mirror the response taken in India back in 1990. At that time, India began to default on its World Bank loans. Finance Minister Monmohan Singh -- who is now India's Head of State -- saw that the system was not working and started the country on a different path.

"He got rid of the government, encouraged entrepreneurship and lowered taxes."

Above all, the patient must take responsibility and be in control of his/her own health care. It can't fall to the federal government to make important decisions regarding people's health care, no matter how well-intentioned they might be.

Déjá vu

In addition to drawing from the experience of his native country, DeSa also discussed two other examples of what he sees as a health care system set up for failure.

The U.S. government's new health care model is based on the Massachusetts health care model, which DeSa called "an abject failure." He cited problems related to his comments about young, healthy citizens abusing health insurance.

"Just Google 'Massachusetts Health Law -- success or failure?'"

Socialized health care has proven disastrously ineffective in Britain as well.

"Just this month, Britain recognized that its system is a failure and said they are going to change the whole thing."

Part of that change will be a shift in power from bureaucrats -- of which there are 1.5 million overseeing the United Kingdom's National Health System -- to the doctors. As good as this sounds, DeSa fears it may be too late for it to work.

"The doctors (in the UK) have no business experience. Up to this point, the government has been taking care of everything."

His concern is that U.S. doctors will share a similar fate. As his presentation drew to a close, he told everyone that under the government's new plan, there will be over 120 new bureaucracies controlling health care.

DeSa admitted right at the start of his presentation that he had a bias as a health professional. He encouraged everyone to do their own research and decide for themselves whether or not the new health care reforms are to be welcomed or feared.

Dr. Victor DeSa talked with seniors Friday about the federal government's new health care legislation. This followed his hour-long presentation, sponsored by the "Older Adult Ministries" program of Batavia's First United Methodist Church.

DeSa is a retired surgeon who had a private practice in Batavia for many years and currently serves on the United Memorial Medical Center Board of Directors. He is well renowned and respected in the community and very knowledgeable about how the health care field works -- including the role of legislation and the relationship between health care and the government.

There is a lot of misinformation about the new health care law and how it could affect  people -- especially Medicare and Medicaid recipients.

The doctor expressed disappointment in the mainstream media's handling of the topic.

"The people in the media are not doing their job," DeSa said. "The media used to look out for the common man, but now they have a bias and a preference. (Consequently), the news we get is filtered and we don't have all the information we need in order to make informed decisions."

For those who could not be there, here's the gist of DeSa's presentation (it will be divided into two parts for the reader's convenience) -- it reflects the arguments he made based on careful and meticulous research, and does not necessarily reflect the opinion of The Batavian.

Health care: rights and responsibilities

The question of whether health care is a right or a privilege came up early in the presentation. This language, said DeSa, is problematic. The real question is this:

"Is health care a right, or is it a personal responsibility?"

He pointed out that health care is considered a right in socialist countries, where people "have abrogated their rights to the government" so that the government "will take care of (them) from the cradle to the grave -- and that includes health care."

"The United States is not yet a socialist country," he said (and yes, he did emphasize yet), "so here, health care is a personal responsibility."

What he meant by this, is that each person has a certain amount of control over his/her own health (diet, exercise, etc). For instance, if someone chooses to live on bacon, cheeseburgers and cigarettes all the time, then he/she is indirectly "choosing" to have weight problems, heart problems, high blood pressure, etc.

"If I'm responsible for my own health, should everybody pay for it or should I?"

Misconceptions about U.S. health care

DeSa assured his listeners that we here in the U.S. do, in fact, have the best health care in the world. To prove it, he spent some time debunking two popular myths that lead people to believe the contrary: that our infant mortality rate is higher than in countries with socialized health care, and that lifespan is shorter in the United States than in said countries.

On infant mortality, he said: "We (in the U.S.) over-report infant deaths, while other countries under-report them. Here, we're so meticulous about reporting, that if a baby takes a couple breaths and has a couple heartbeats after birth, it's reported as infant mortality. But in developing countries, a baby dies an hour or two after being born and it's reported as a stillbirth."

He also pointed out that a large percentage of infant deaths take place in the inner-cities, where there are a lot of crack cocaine and AIDS babies.

"These babies die in spite of very good health care. Their deaths are due to social problems, not medical problems."

As far as lifespan goes, he said that longevity is about the same in this country as in those that have socialized health care; what doesn't get factored in with lifespan studies is the fact that the U.S. is the "murder and accident capital of the world."

"If you took the murders and deaths from accidents in Chicago, Detroit or New Orleans in one month, they are more than the deaths of our soldiers in Iraq or Afghanistan in one month."

In short, the evaluation of U.S. life and health often ignores social problems and unfairly puts all the blame on health care.

Universal care vs. universal insurance

...Wait a minute, aren't they the same thing? Not according to DeSa.

"We do have universal care in the U.S. The EMTALA Law ensures that no one who comes into the emergency room will be refused care -- even illegal immigrants. That's the right thing to do, the humane thing to do and the moral thing to do, and I support it."

He says there is a "subtle but important difference" between this and universal insurance, which we don't have. There are currently 47 million Americans uninsured.

The Congressional Budget Office predicts that as a result of the new health care legislation, 32 million people who were previously uninsured will be insured at the end of 10 years. However, there will still be 21 million people uninsured -- and this is in spite of the fact that the new law will require people to buy insurance!

Who are these 21 million uninsured, you ask? Young, healthy people making between $35,000 to $82,000 a year.

"When you're young, and you're starting a family, and you have mortgage payments, you have a whole host of other host of things you have to worry about. You're going to say, 'Well, I'm young, and I'm invincible...maybe I won't fall ill. I'll take the chance and hold off on buying health insurance.'"

This is going to have a couple of important consequences. First of all, DeSa said, "the IRS is going to need about 16,000 new agents to track them down."

Even if they do track them down, not much is likely to change.

"If I'm a young person," DeSa said, "and a federal agent tells me I have a choice between a fine -- which starts at $95 and over the course of seven years will go up to about $700 -- and purchasing health insurance for $12,000-$13,000, it's a no-brainer."

Secondly, these people will cycle in and out of insurance programs. Faced with a serious condition like cancer, a young person will go to an insurance company for coverage -- and they cannot be refused under the new law. But when they get better, they will forego the insurance.

"People will abuse the system. That's just human nature."

While uninsured, these individuals will be able to make partial payments for hospital visits about 27 percent of the time; the rest will be covered by the state's "uncompensated care pool," into which each hospital in the state pays.

But even this won't cover the whole cost. To whom does the remainder of the cost shift? The taxpayers.

"This varies from state to state depending on the percentage of uninsured they have, but the average each person pays is $300."

The second and final part of the article will be up soon.

In the little town of Scituate, Rhode Island, everyone has primary health coverage -- even the people who can't afford health insurance.

No, Scituate hasn't become an experiment in some single-payer scheme. People in the town banded together and figured out how to make it happen.

The people of Scituate, Rhode Island did it themselves.

No, we don’t give away health insurance – that’s too darn expensive. Instead, we make sure everyone who lives here has primary care (which only costs $25 a month). By coupling together grants, and a little money from the town, and doing bake sales and walk-a-thons, something called the Scituate Health Alliance decided, 10 years ago that we could fix the health care system ourselves – or, more accurately, build one from scratch — by providing primary care medical for everyone in town who doesn’t have insurance. (We also do flu shots for anyone in town who wants one and organize prenatal classes for anyone who is pregnant.)

While the effort isn't without taxpayer support (read, grants and money from the town), it does show how a community can come together to provide a service.