Insource Urgent Care

Residents who have a run in with a potentially or known rabid animal will have another option for treatment starting June 1.

On Monday, the Human Services Committee approved a contract with Insource Urgent Care that would allow the County Public Health Department to refer clients to Insource.

The contract isn't exclusive. Patients would still be able to go to the emergency room at UMMC or the urgent care clinic at St. Jerome's if they wished.

"Insource offers a lower rate and the feedback we've been getting is it's a better experience," said David Whitcroft, environmental health director. "It's a faster in and out for the patients."

Whitcroft said Insource had sought out the contract and this was an opportunity "to enter into a contract more favorable to us.

The county pays for the initial exam and the first round of treatment, but booster shots are provided by the health department at County Building #2.

"St. Jerome's has worked out really well for us and we have a good relationship, but this is one more option," Whitcroft said.

The full County Legislature will be asked to approve the arrangement at its next meeting.

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?"

Insource Urgent Care Center of Batavia is offering a free seminar for the greater Genesee County Business and Professional Community:

The following topics will be discussed in an Open Community / Town Hall Forum:

• The impact of the Affordable Care Act on Employers and Patients
• Telemedicine and Telehealth improving Access and Quality
• Obama Care...from the physician's perspective (special guest, Dr. Victor DeSa)
• Services offered to the community by Insource

Date: Friday, April 11

Registration: 8 a.m.; Continental Breakfast 8:15-8:45

Seminar: 8:45-10 a.m.

Location: Homestead Event Center in the City Centre.

Please RSVP to Tina Wilcox via e-mail at tinawilcox@insourcehealth.com or by phone 585-750-2794

This week's question: What’s the difference between Type 1 and Type 2 diabetes and is either one reversible / curable?

In Diabetes Type 1, the body does not produce insulin. This occurs when a person's own body has destroyed the insulin-producing beta cells in the pancreas. This is where a person does not produce insulin which takes glucose into cells for growth and energy. In Type 1 diabetes, your own immune system destroys cells in your pancreas, so little if any insulin is made. This type of diabetes is also known as juvenile diabetes or childhood diabetes. This type of diabetes is not preventable and not related to lifestyle. It makes no difference whether a person is fat, thin, fit or unfit in regards to a person developing Type 1 diabetes. People with Type 1 diabetes need to take insulin daily, either injected or through an insulin pump. However, research is currently being undertaken to find a way to reverse Type 1 diabetes, and a vaccine is currently being developed which may help to reverse this disease. There is no way to reverse Type 1 diabetes at this time.

In Diabetes Type 2, the cells do not respond correctly to the insulin. People with Diabetes Type 2 have one of two problems, and sometimes both. Either not enough insulin is being produced, or the insulin is not working properly, which is known as insulin resistance. The vast majority of patients who develop Type 2, did so because they were overweight and unfit for some time. This type of diabetes tends to appear later on in life and often called adult onset diabetes. However, there have been more and more cases of people in their 20s developing Type 2, but it is still relatively uncommon. Approximately 85 percent of people who have diabetes have this type of diabetes. Lack of physical activity, being overweight, and some genetic factors make it much more likely that the cells build up insulin resistance more quickly. It is important to remember that insulin resistance is not the insulin responding properly, but the cells not responding properly to the insulin. With time and dedication, Type 2 diabetes can be reversed and the results can be very rewarding with less tiredness and better all-round health. Loss of body weight and exercise can be particularly beneficial in helping to reverse the progression of diabetes. In some cases, people may find they are able to come off medication, although blood sugar levels should be checked regularly as reversing progression of diabetes is not a cure.

If you have further concerns you should contact your doctor for more information regarding your condition.

Dr. Magdi Credi

Ask the Local Doctor is sponsored by Insource Urgent Care, 35 Batavia City Centre, Batavia, (585) 250-4201. To submit a question to Ask the Local Doctor, e-mail askthedoc@thebatavian.com. To submit your question anonymously, if you wish, you can use our online form.

Question: Last June I accidentally rolled over my left foot while standing on uneven ground. There was an audible pop from the knee and I felt something let go. To make a long story short, I have seen a local doctor and had X-rays taken. They showed a torn meniscus in the left knee. I was given a shot of cortisone in the knee joint and not much else. I have been taking NSAID on a daily basis and an occasional hydrocodone pill for the pain. The joint gets sore and stiff at night after being on it during the day. Rubbing it down at night and in the morning with Bengay does help. My question is: What is the short-term and long-term diagnoses of this condition in the terms of healing. Can this condition heal itself without surgery? If not, can this condition be corrected through an arthroscopic procedure? I am a 65-year-old male and have been told, my knee joints are pretty much worn out. I don't look forward to spending the rest of my life limping around. It has slowed me down, but has not stopped me from my normal daily activities.

Answer: As with any injury in the body, when the meniscus is damaged, irritation occurs. If the surface that allows the bones to glide over each other in the knee joint is no longer smooth, pain can occur with each flexion or extension. The meniscus can be damaged because of a single event or it can gradually wear out because of age and overuse.

A torn meniscus is damage to the cartilage that sits on top of the tibia and allows the femur to glide when the knee joint moves. Physical examination and magnetic resonance imaging (MRI) is the test of choice to confirm the diagnosis of torn meniscus.

Because there is different blood supply to each part of the meniscus, knowing where the tear is located may help decide how easily an injury might heal (with or without surgery). The better the blood supply, the better the potential for recovery. Blood supply to knee cartilage also decreases with age, and up to 20 percent of normal blood supply is lost by age 40.

The risk of developing a torn meniscus increases with age because cartilage begins to gradually wear, lose its blood supply and its resilience. Increasing body weight also puts more stress on the meniscus. Routine daily activities like walking and climbing stairs increase the potential for wear, degeneration, and tearing.

Some meniscus tears can be treated conservatively without an operation (less than 5 percent) using anti-inflammatory medications and rehabilitation to strengthen muscles around the knee to prevent joint instability. Orthotics may be useful to distribute the forces generated by walking and running.

If conservative therapy fails, surgery may be a consideration. Knee arthroscopy allows the orthopedic surgeon to assess the tear within the meniscus and repair it. Options include sewing the torn edges together or trimming the torn area and smoothing the injury site.

In older patients with degenerative joint disease (alo known as osteoarthritis), where the cartilage wears out, treatment options may be considered over a longer timetable. Exercise and muscle strengthening may be an option to protect the joint and maintain range of motion. As well, anti-inflammatory medications may be considered to decrease swelling and pain arising from the knee joint.

Cortisone medication injections into the knee joint may be used to decrease joint inflammation and to bring temporary symptom relief that can last weeks or months. A variety of hyaluronan preparations are approved for mild to moderate knee arthritis and include hylan G-F 20 (Synvisc) and hyaluronan (Orthovisc).

As a last resort, joint replacement may be an option with substantial degeneration of the knee if conservative measures fail and symptoms of pain and decreasing joint range of motion affect quality of life and prevent the patient from performing routine daily activities.

There is no cookie-cutter approach: The treatment of a meniscus tear depends on its severity, location, and underlying disease within the knee joint, as well as patient circumstances. Consult your doctor to determine what’s the best course of action for you.

Todd Lorenc, M.D.

Ask the Local Doctor is sponsored by Insource Urgent Care, 35 Batavia City Centre, Batavia, (585) 250-4201. To submit a question to Ask the Local Doctor, e-mail askthedoc@thebatavian.com. To submit your question anonymously, if you wish, you can use our online form.

NOTE: This is The Batavian's first "Ask the Local Doctor" column sponsored by Insource Urgent Care. We announced the column and then no questions came in, or so we thought. Their e-mail forwarding wasn't set up right so we didn't see the questions. We actually received about a dozen questions. Those questions have been forwarded to the professional staff of Insource Urgent Care and will be considered for next week's column and subsequent columns.

This column is by Dr. Magdi Credi and it answers the question, should I get a flu shot?

The influenza season is upon us.

Here at Insource Urgent Care the vaccine is being offered for those who are 4 years and older. Unbeknownst to many, influenza is still the most prevalent disease in the United States of all the vaccinated diseases.

About 200,000 persons in the United States will be hospitalized yearly due to influenza. Up to 49,000 deaths occur yearly on American soil due to the flu. Because of this, we here at Insource are doing our best to protect you.

The Center for Disease Control currently recommends all persons older than 6 months be vaccinated. The more persons vaccinated the less chance of the flu.

In particular, two groups are strongly encouraged to obtain the flu shot: those who are at high risk of complications (i.e. pneumonia) and those who care for others at high risk. This would include the following: Parents and caretakers of children less than 6 months of age, pregnant women, persons less than 5 years old or older than 65 years old, and persons with chronic illnesses such as diabetes, asthma, and COPD to name a few. This list is not all inclusive and can be checked out on the CDC’s Web site www.cdc.gov for more information.

If still unsure of your risk or need, please stop by our medical office for clarification. We are here to provide top medical care for you and to protect both you and your family.

This post is sponsored by Insource Urgent Care, 35 Batavia City Centre, Batavia, (585) 250-4201. To submit a question to Ask the Local Doctor, e-mail askthedoc@thebatavian.com.

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.