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Pushing money to prevention

Adirondack Home Medical Pilot hopes to improve the region’s primary care and bring in physicians

February 4, 2009
By EMILY HUNKLER, Enterprise Staff Writer

SARANAC LAKE - Doctors in the North Country will soon have a monetary incentive to provide more effective care to their patients, where before the incentive was mostly moral or ethical.

"Right now, the system is volume based," said Dr. William Viscardo Jr., vice president of medical affairs at the Adirondack Medical Center. "I get paid based on the number of patients I see; it doesn't matter how well I do, at least from a reimbursement, insurance or any other monetary standpoint."

However, the Adirondack Home Medical Pilot project, to be funded through enhanced Medicaid reimbursement from the state and beginning this July, hopes to sway health-care emphasis from seeing the most patients to providing the best care - namely, primary and preventative care.

Article Photos

State Health Commissioner Dr. Richard Daines, center, talks with Dr. William Viscardo Jr., right, and Dr. Dennis Weaver, left, at Adirondack Medical Center Thursday night to discuss the Adirondack Medical Home Pilot. Viscardo is AMC’s president of medical affairs, and Weaver is a consultant for the pilot project.
(Photo courtesy of AMC)

According to Viscardo, the pilot project is the result of a grassroots effort by Adirondack region doctors, health-care networks and hospitals to address the shortage of primary-care physicians in this region.

State Health Commissioner Dr. Richard Daines met with participating individuals and groups to discuss the project during his tour of the North Country last week.

"Primary care is threatened in this region, and across the state," Daines said. "We wanted to do the pilot in this region that has three or four hospitals, because this way we can feel like we really have our arms around it and can truly gauge the results."

The pilot project is set to receive $4.5 million over two years through the enhanced Medicaid reimbursements.

The increased reimbursements are expected to be offset by decreased costs from fewer hospitalizations, less frequent referrals to specialists and overall better health.

In order for doctors to receive the reimbursements, their practice will have to meet a set of criteria that will measure their standard of care, including coordination of care and management of chronic diseases, improved communication with patients, including patient reminders for check-ups and screenings, developing and using electronic health records and prescriptions, and adhering to quality and safety standards.

The hope is that, with the increased reimbursements, primary-care practices will be able to recruit doctors more effectively.

"We do know that we've lost a huge number of primary-care physicians and nearly every practice in town is not accepting new patients," Viscardo said, adding that the AMC health centers in Lake Placid, Tupper Lake and Keene now have four-and-a-half primary-care doctors all together when there used to be seven.

According to the state Department of Health Web site, the preventable chronic disease hospitalizations that are affecting the Tri-Lakes region the most are angina and diabetes complications including lower extremity amputation.

Daines said that once the pilot project gets off the ground, new numbers will be compared to see if the project has truly had an effect on chronic disease management and preventative care.

"These doctors want to reduce those unnecessary, preventable hospitalizations," Daines said. "That's what's costing them money."

Viscardo agreed that preventable hospitalizations will improve health care across the board.

"Last year alone, we had 6,000 less patient visits to our health centers," Viscardo said. "This suggests that people are not getting the primary care they need, and that affects the surgeons, it affects the radiologists, it affects everyone."


Contact Emily Hunkler at 891-2600 ext. 24 or



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