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Public Employee Press
One-stop health care for city workers By GREGORY N. HEIRES Jim Tucciarelli calls his doctor visits "one-stop shopping." At the AdvantageCare Physicians medical office at 1050 Clove Road on Staten Island, he can count on dealing with most of his medical needs, except very serious emergency care. His primary care physician, cardiologist and other care providers are in the building. And he doesn't have to worry about the hassle of traveling several miles away for lab work or X-rays. "What I like is the fact that just about everyone you need is under one roof," said Tucciarelli, who is the president of Sewage Treatment Workers and Sr. STWs Local 1320 and a trustee of the DC 37 Health & Security Plan. Another plus is that the office is near his home. The Clove Road office is one of two AdvantageCare sites on Staten Island. AdvantageCare has 34 other centers in New York City and Nassau and Suffolk counties and plans to open additional centers in the metropolitan area. EmblemHealth, which includes the HIP and GHI health-care plans used by most city employees and retirees, is encouraging its subscribers to take a look at ACP's network of medical offices, which opened about a year ago. Municipal unions are working with EmblemHealth to inform members and retirees about the new option for getting their health-care services. "AdvantageCare is not for everyone," DC 37 Executive Director Lillian Roberts said. "But we do urge members and retirees to give it a good look." "It's an attractive option for people who would like the convenience of comprehensive services in one location," said DC 37 Associate Director Henry Garrido, who has toured the centers. By providing comprehensive services in one facility, the AdvantageCare centers help EmblemHealth cut costs. The greater efficiency will count toward the $3.4 billion in health-care savings planned under a recent agreement between the city and municipal unions. The health-care deal, which opened the way for DC 37 to negotiate a new economic agreement, allowed the city to continue to offer its basic health insurance coverage without requiring participants to pay a premium. The agreement saved HIP participants from a co-pay and GHI participants from increased co-pays. Team-based medical care Medical groups - a common health-care service model - also achieve savings by putting physicians under one roof or in an office complex. But medical groups generally don't offer as many services as AdvantageCare facilities in their main buildings or watch costs so closely. Significantly for patients, medical groups generally don't follow the team-based approach to health-care delivery that AdvantageCare uses. Patients of AdvantageCare have primary care physicians who work with a medical assistant, registered nurse and licensed practical nurse, a nurse practitioner, a "patient ambassador" and an on-site coordinator at hospitals. At the Clove Road facility, patients can see their primary care physicians and specialists. A building-wide computer network ensures that caregivers have a full picture of their patients' health-care needs and encourages doctors to print out test results on the spot. Patients' lab work is done at Clove Road. The facility has a sleep apnea center (which Tucciarelli used). Physical therapy, diabetes care, asthma treatment, and radiology tests (including MRI exams) are all done on site. (Radiology tests are processed in Brooklyn rather than being sent abroad, a common practice in our increasingly globalized world.) Physicians perform chemotherapy, bone marrow and colonoscopy procedures in the building, which has a gynecology office and a pediatric clinic with three full-time pediatricians. There is a suite for minor surgery, such as urological and other ambulatory procedures. Patients don't have to go through repeated interviews because doctors have quick access to their medical histories. Patients have access to their records and can make appointments online through "myACP," a patient portal. The office follows up visits with patient surveys. By centralizing lab work, AdvantageCare is addressing one of the wasteful and sometimes corrupt practices in the country's profit-driven health-care system. Some doctors drive up costs by having testing done at their own labs (without disclosing their economic interest in the practice). Also, physicians often don't share lab results, leading to wasteful additional testing. AdvantageCare avoids that waste by keeping the work on site. Dr. Wilfredo Velez, ACP's Staten Island regional medical director, said AdvantageCare also helps cut costs significantly by providing basic urgent-care services, such as handling dog bites, broken limbs and the flu. A visit to a hospital emergency room can easily run up a bill of $6,000 for injuries or illnesses that are not life-threatening, Velez noted. At Clove Road, patients just make their regular co-pay and aren't stuck with a hefty deductible payment. In a back-of-the-envelope estimate, Velez suggested that emergency rooms can charge up to 20 times as much as AdvantageCare. The group's urgent care service has led to an 8.6 percent reduction in ER visits. Largest physician-led network in New York Tucciarelli recalled receiving a frantic call from his daughter-in-law about his granddaughter, who had broken a bone. On his advice, she took her 5-year-old daughter to the other AdvantageCare center in Staten Island, where she was treated right away and avoided a likely wait of several hours for treatment at Staten Island University Hospital. "There was no $100 payment for a hospital visit," Tucciarelli said. "The only expense was the $20 GHI co-pay." AdvantageCare calls itself the largest physician-led medical practice in New York. Its network includes 450 physicians and covers 20 medical specialties. Many of its 2,300 employees are unionized. The centers generally offer extended night and weekend hours. The typical waiting time for patients is 10 minutes. "I am really happy with the service I get there," Tucciarelli said. "We need to be aware about health-care spending, but that doesn't mean you have to compromise the quality of care you receive," Tucciarelli said. "I don't feel I'm being short-changed, and I like the comprehensive and convenient care I am getting. I certainly wouldn't have referred my 5-year-old granddaughter to AdvantageCare for urgent treatment if I didn't have enough faith in them."
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