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?"

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

Insource Urgent Care Center of Batavia Receives Certified Urgent Care Designation from the Urgent Care Association of America

Insource Urgent care Center of Batavia, located in the Batavia City Centre, has received the Certified Urgent Care designation which distinguishes it as a true urgent care center.  The clinic provides patients with walk-in, extended-hour medical attention with licensed providers for a large scope of medical conditions and has met all of the Urgent Care Association of America’s established criteria.

The health care environment is changing and it is becoming more and more important for patients to understand their treatment options.

Urgent care is a convenient and viable option for medical conditions that cannot wait for a scheduled appointment with a primary care physician.  Insource Urgent Care accepts unscheduled, walk-in patients during all hours of operation.

When a medical condition cannot be handled by a patient’s regular doctor – such as unexpected cuts, burns, sprains or fractures that do not require a visit to the emergency department, Insource Urgent Care is equipped with x-ray, laboratory services and a licensed provider is always available to perform minor procedures like casting and suturing.

Urgent care fills the gap between primary care and hospital emergency rooms, offering increased convenience and cost savings. 

With its certification, Insource Urgent Care and the Urgent Care Association of America demonstrate their commitment toward providing patients with access to appropriate levels of care.

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.