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Tuesday, October 28, 2014 at 3:10 pm

Insource Urgent Care is now Genesee Urgent Care and other changes are in the works

post by Billie Owens in business, Health Care

Insource Urgent Care is now Genesee Urgent Care, and there are other changes in store for the acute healthcare provider that opened in Batavia just last year.

For one, Melissa Marsocci is now the sole owner of the business, located Downtown at 35 Batavia City Centre. (Three other locations were sold earlier this year to urgent care groups in Philadelphia and Auburn.) And as head of the company, Marsocci has "really innovative plans."

"Batavia has always been 'the model' for the characteristics I've wanted," said the 30-year-old lifelong Genesee County resident.

One of those is the expansion of telemedicine. The center has a contract with Genesee Community College to augment its student health services. Marsocci donated desktop telemedicine equipment to the college to enable Genesee Urgent Care to see students as patients virtually, seven days a week.

They are planning to roll out a telemedicine system the week before Thanksgiving. If a student isn't feeling well, he or she could go to the telemedicine area, which would have a nurse on duty, and there a dialog could take place with Genesee Urgent Care about appropriate care.

Marsocci calls this the "hub-spoke model."

She sees it as having global applications.

"We are researching putting in a (telemedicine) clinic to help a Christian missionary in Haiti and the Dominican Republic to provide care for people," Marsocci said.

The company is making a big push into occupational medicine, too, and negotiations are under way with two orthopedic groups.

Genesee wants to partner with a psychiatrist for "telepsychiatry," and to sublease space to an oncology group to see patients on site.

A Downtown daycare center in the building wouldn't be a bad idea either.

"I would like to get support for other medical businesses in the building so we could offer (daycare) as a service to patients," Marsocci said.

Genesee has teamed up with another firm to craft a commonsense healthcare option that would "give employers a means of circumventing Obama Care." Because she wants to trademark the plan, which targets self-funded health plans, she is keeping pretty tight-lipped about it.

Awhile back, she said the company was briefly without a healthcare plan for its employees and the available options were a sorry lot.

"My premiums went up 20 percent," she said. "Employees who were used to paying $20 to $40 deductibles, were now paying for an office visit because of high-deductible plans."

The lawsuit with Health Now, the BlueShield BlueCross franchise for WNY, is settled and Genesee Urgent Care now takes their insurance.

As regards staffing, there's a new medical director. Dr. Tom Malinich has replaced Dr. Magdi Credi, but for the foreseeable future Credi will remain on staff and continue to be a valuable mentor. Dr. Henry Moscicki, DNP, is at the clinic once a week.

"He blends into the hybrid model we've always prided ourselves on," Marsocci said.

There are no other changes to speak of but the center is in hiring mode.

"We still promise to see patients within 15 minutes," Marsocci said. "We have no intention of replacing primary care doctors. But it is important that patients needing acute care be followed."

(The sign currently on the outside of the building in City Centre will soon be replaced. The job is out to bid locally.)

Friday, April 11, 2014 at 5:44 pm

Collins votes to protect Medicare Advantage from future cuts

post by Howard B. Owens in chris collins, Health Care, Medicare, NY-27

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.

Friday, April 11, 2014 at 4:31 pm

Seminar focuses on broken health care system and failures of Obamacare

post by Howard B. Owens in Health Care, Insource Urgent Care, Obamacare

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?"

Tuesday, December 31, 2013 at 5:00 pm

UMMC, MVP come to terms on coverage for insurance bought through exchange

post by Howard B. Owens in business, Health Care, UMMC

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.”

Friday, December 20, 2013 at 4:19 pm

UMMC has yet to reach agreement with MVP on health insurance bought through the exchange

post by Howard B. Owens in Health Care, MVP, UMMC

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 [email protected]

Friday, December 6, 2013 at 1:24 pm

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

post by Howard B. Owens in Health Care, Obamacare, UMMC

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.

Thursday, August 1, 2013 at 9:49 pm

Photos: Grand Opening of Insource Urgent Care

post by Howard B. Owens in batavia, business, downtown, Health Care, Insource Urgent Care

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.

Thursday, August 1, 2013 at 2:58 pm

Insource and UMMC appear to be classic case of the disruptor vs. the disrupted

post by Howard B. Owens in batavia, business, Health Care, Insource Urgent Care, UMMC

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.

Friday, May 31, 2013 at 2:45 pm

Execs from urgent care company say new clinic in Batavia to be first of its kind in nation

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.

Tuesday, January 22, 2013 at 9:44 am

UMMC increasing ties with Rochester General, but no plans for formal partnership or merger

post by Howard B. Owens in batavia, business, Health Care, UMMC

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."

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