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Protein packs on muscle for LA Fitness juice bar owner

Dire
All Juiced Up! owner Vinny Di Re Jr. keeps his metabolism high by eating, and drinking, protein several times a day. (Robert Kirkham/Buffalo News)


By Scott Scanlon – Refresh Editor

The Buffalo Diet – pizza, pasta, chicken wings – brought Vinny Di Re Jr. into the world of the overweight in the years he owned his former company, Vincent’s Heating and Cooling of Williamsville.

He was 5-foot-10 and 235 pounds in 2007 when he decided to change his look and enter the world of bodybuilding.

He lost 70 pounds in a year, and put on loads of muscle.

In the years since, Di Re has settled quite nicely, thank you, into packed frame of a little under 200 pounds. He’s discovered he can maintain his weight as long as he puts in lots of time at the gym most of the year and sticks to a nutrition plan that involves plenty of protein a half-dozen times a day.

“This is what works for me,” Di Re told me earlier this week for today’s “What are you Eating?” feature in WNY Refresh. “Everybody’s different. I’ve seen people try different diets. One thing works for one person and doesn’t for another person. Everybody’s body reacts differently.

“I still get my cheat days where I eat what I want,” he added. “I don’t deprive myself (all the time).”

Especially on Sundays, when he visits his mom for dinner.

“I’m Italian,” he said. “I’ve got to eat pasta.”

Just not every day.

Di Re said his fitness and nutrition plan has worked even better for him since early last year, after he won the right to open juice bars in the new LA Fitness gyms across Western New York.

His All Juiced Up! shops are tucked into the chain’s locations in Buffalo, Clarence and Niagara Falls and he said he soon will set up nooks in two new planned clubs. His 20-ounce shakes contain up to 40 grams of protein and cost $6.25, except on Wednesdays, when they’re $5.

“I enjoy walking into a gym every morning,” Di Re said. “People are here for one reason only – to improve themselves and feel better – so it’s a positive energy. When you’re helping people achieve their goals, it gives you a better feeling about what you’re doing.”

He worked up his business and menu signs with help from 3G Grafix Printing in Amherst, including his signature “Banana Man,” who touts arms almost as big at Di Re’s. He looks to get facing Banana Man tattoos on the back of his arms in the coming months.

Here’s some of what else he told me during our interview earlier this week in the Elmwood Avenue LA Fitness site:

How did you lose the weight?

High protein, low carbs and the last three months of dieting before the bodybuilding show was zero carbs, which included working out six times a week, cardio twice a day.

It’s got to help to have a business in LA Fitness.

Yep. I spend 10, 12 hours a day in the gym, mostly working.

Over time, you’ve figured out a way to keep your metabolism high. How?

I’m probably snacking every three hours and I have the advantage that a lot of my snacks are protein shakes. Being in the business, I probably consume three or four shakes a day. You’re getting a regular infusion of protein, so that’s keeping up your metabolism ... and the only sugar is the natural sugar in the fruit.

Talk about the shakes.

We start out with a puree. The Vanilla Berry Parfait, for instance, is a four-berry: blueberries, raspberries, blackberries and acai. The company that makes the puree takes all the berries and throws them into a machine, skins, seeds, everything. When I buy it, it’s like a paste, so I have to mix it with water to dilute it. A scoop of granola, a scoop of vanilla and two scoops of protein. Some of our shakes we take an orange and take the orange zest, the skin, which goes in there, too. That’s where a lot of the nutrition is.

We use a bio-whey protein; that’s our standard protein. It’s a good, clean protein. If someone is lactose intolerant, I have a soy protein. We also have a high performance protein called Elite Zero. It has zero fats, zero carbs, zero sugars. It’s a little more expensive because it’s a cleaner protein.

Talk about your typical eating day.

Breakfast is oatmeal and protein. I take three scoops of oatmeal, mix it with milk, a scoop of protein dissolved in and I throw some berries on it, or honey.

Within the hour, I’m back at the gym taking in a shake. The shake I do in the morning is the Body Builder. It’s 8 ounces of milk, 40 grams of  protein and a banana. I drink that about 9:30 in the morning.

I don’t exercise until 6 o’clock at night. Between my three stores, I’m running around, so my time to myself is between 6 and 8 at night.

Lunch is usually about 1 o’clock: broccoli dipped in Italian dressing and chicken breasts. My mid-afternoon snack is another shake, the Blueberry Monster. That has blueberries, bananas, pineapple juice, 40 grams of protein and oatmeal. I use the bio-whey protein. I’m not counting my calories right now.

For dinner, to be honest with you, I eat a sub. I like Firehouse (subs). I like the meatball subs. They have eight different subs. I start with number one and the next night I’ll have the two. So when I get there, they know me. They ask, ‘What number are you on?’

I eat my sub before I work out, and after I work out I have another shake. It’s usually the shake of the month.

Every day, you have at least 120 grams of protein in shakes alone?

Yes, I snack, too, on a protein bar. You’re supposed to consume a gram of protein a day for every pound of body weight (for bodybuilding).

(He stays at about 200 pounds most of the year, but cuts back significantly on his gym time most of June, July, August. He will eat a bit more pizza and wings then, too. “I might gain a couple of pounds,” he said, “but I get right back into it in the fall and my body picks up right where I left off.”)

What are the other staples of your diet?

I choose lots of chicken. Turkey is my second protein, red meat about once a week. I get the fruits from the shakes, but I do a banana a day, right before I work out. It gives me a boost of energy. It’s a good source of potassium.

How did you start this business?

I sold my (heating and cooling) business and decided to take six months off. Then I hear LA Fitness was coming into town. I went to their presale center on Transit Road and when I walked in, there was a sign at the window that said, ‘Business Opportunity.’ It was for the juice bar. So I called the number, sent my paperwork in for an application and I was awarded the license agreement for Western New York. I lease space.

What was it like getting things up and running? Had you done any juicing before?

Never. I was in the heating business my whole life and this was completely brand new. I was one of those guys that worked out and wasn’t into protein shakes.

Do you feel any differently after a year of incorporating the protein shakes?

I feel great. I’ll be 44 in June ... and this is the best I’ve felt in a long time.

What has the business been like?

Being brand new, it was lots of trial and error. We were trying different shakes. I’ve figured out after a year now what’s working, and I’ve got some new products in. Your staff is very important, too. You’ve got to make sure you have the right people working for you. I have four people at each store.

What tend to be the most popular sellers?

The Peanut Butter Cup. The Strawberry Slam is the most common shake for people who’ve never had a protein shake before. It’s strawberries, bananas and protein. Everybody loves strawberries and bananas.

The Veggie Fusion shakes caught my eye.

Those are vegetable shakes made with freeze-dried spinach and kale, avocado, beets. Each scoop of spinach or kale, it’s two servings of vegetables, so a lot of the shakes have four servings of vegetables. They start off with a pineapple-based puree or a butternut squash or a carrot-orange. It gives you a fruity taste, so you don’t taste the vegetables. We use all the skins, all the pulps. All those nutrients stay in.

Have you seen business grow since LA Fitness bought the BAC coed clubs in December?

I’m just into my second year, so the only thing I’m looking into is January and February from this year and last year, and business is up. I’ve seen an increase in people from the BAC coming through the door.

I see the list of bottled waters that you sell. Is there anything besides those and shakes that you sell?

We sell the add-ins along with the protein that we use. We have people who buy the freeze-dried spinach and kale and have started making their shakes at home. For a bag, it’s $35; they can buy the puree itself for $20 a jug.

How did you come up with the juice bar name?

It all came together working on a Saturday afternoon with Bobby over at 3G signs. We had the banana first. We came up with him, then the name.

What do you see in the future?

There’s two more stores opening this year. One is on Niagara Falls Boulevard and Sheridan; that’s the Amherst store. The other is in Hamburg on Milestrip and McKinley.

Have they asked you to go into any of the former BAC coed locations?

Not yet.

email: refresh@buffnews.com

Twitter: @BNrefresh

ADA’s Tour de Cure set for June 7

The 2014 Buffalo Tour de Cure has announced a fundraising goal of $415,000 for its signature cycling event. The ride, scheduled for June 7 this year, raises money to support the American Diabetes Association.

Each participant, riding either individually or within a team, is asked to raise a minimum of $200.

 “A large amount of the money raised by the Buffalo Tour de Cure stays in Western New York and helps more than 140,000 people affected by the disease right here in our community,” said Mark Eagan, Tour de Cure manager for the American Diabetes Foundation.

The race helps the foundation host 6,500 children at diabetes summer camps; guide more than 175,000 newly diagnosed people through living with diabetes; trains more than 2,200 school staffers to assist children with diabetes; helps 1,400 individuals facing discrimination challenges; and supports 18,000 researchers and clinicians seeking the latest discoveries and breakthroughs.

This year’s ride will start and finish at Niagara County Community College in Sanborn. To register or for more information, click here

- Scott Scanlon

Free seminars this week will focus on healthy living

Take Shape For Life and the Wellness Institute of Greater Buffalo will host two free informational health seminars this week as part of the Get Greater Buffalo Healthy Initiative.

The gatherings – part of a larger effort to stamp out obesity, metabolic syndrome and depression in the region – are open to the public, though advance reservations are required. The first will take place at 6:30 p.m. Wednesday in the Eggertsville-Snyder Public Library, 4622 Main St.; RSVP at AmherstMarch12.eventbrite.com; a second gathering will take place at 6:30 p.m. Thursday in the Clarence Public Library, 3 Town Place, Clarence; RSVP at ClarenceMarch13.eventbrite.com.

“The public is invited to discover the ‘Habits of Health’ needed to discover their own healthy body, healthy mind and healthy finances,” said Dr. Jonathan Yalowchuk, chiropractor, motivational speaker and author of “Your Action Potential.” He will be among the speakers.

Holistic health practitioner sees more acceptance in WNY medicine

J.colosimo
Jo Ann Colosimo, an adult nurse practitioner at Invision Health in Williamsville, practices "functional medicine" and works with patients who have hormonal imbalances, chronic conditions and, often, are overweight. (John Hickey/Buffalo News)


By Scott Scanlon – Buffalo News

Jo Ann Colosimo is among those in the Western New York holistic health field who have begun to see a crack in traditional medical care in the region.

It’s still a fairly thin one, compared to many other parts of the country, Colosimo said, but it shows itself when patients come into the practice where she works and say something like this:

“The primary doc says whatever you’re doing seems to be working, so go ahead.”

Holistic medicine seeks to get to the root causes of health conditions, most of them chronic, that have come to plague modern Americans: obesity, diabetes, heart disease. The vast majority have their genesis in lifestyle choices and create nasty inflammation that wreaks havoc on our bodies, including hormonal imbalances, arthritis and other joint disease, and a host of gastrointestinal challenges.

Colosimo, an adult nurse practitioner and subject of today’s “What are you Eating” feature in WNY Refresh, is the latest person in holistic medicine to tell me such medical treatment in the region is about to bubble into a groundswell.

The Buffalo native who lives in Cambria – heart of Niagara County wine country – has worked in both the traditional and non-traditional medical fields in the region, including at hospitals and primary care offices. She has bachelor’s and master’s degrees from the University at Buffalo and worked at the school for a decade.

She’s focused on holistic medicine for the last half-dozen years, the last 18 months with Dr. Sylvia Regalla at Invision Health in Williamsville. The duo practice “functional medicine,” which is designed to use better eating, nutritional supplements and regular exercise as part of a regimen toward better health.

“I work with a lot of people with hormone imbalances, so I do a lot of thyroid, adrenal, women’s hormones and weight loss. Those are my big buckets,” she said.

They work closely with a nutraceutical company treatment plan called Metagenics FirstLine Therapy, which is designed to treat patients with “pre-chronic diseases” that include “metabolic syndrome,” a combination of maladies that combined raise the risk of diabetes, heart attack and stroke (read more about it here). An estimated one in four Americans has this syndrome.

“In the holistic realm,” Colosimo said, “we look at the whole person: genetics, environment, family history, hormonal imbalance, what are you eating, exercise, things like that.

“Ninety-nine percent of all chronic disease is based on inflammation. Then you begin that journey, Why do you have that inflammation and what can you do about it? A lot of times, food insensitivities may be causing chronic inflammation, so you work on the nutrition and eating healthier.”

Here’s what else she told me on Monday about her job:

What’s your sense of how holistic health professionals are seen in the Western New York medical community and if insurance has jumped aboard in terms of helping with the cost of some of your work?

I work with Invision Health and I can actually bill insurance.

In terms of the traditional medical community, I think there is skepticism. ... I’ve had more and more patients recently who tell me, ‘The primary doc says whatever you’re doing seems to be working, so go ahead.’ It’s a sort of a hands-off approach. I attend to more women than men, and doing a lot of thyroid, and they’re primary care says, ‘Jo Ann orders your thyroid medication, so I’ll leave that (to her). So it’s not so much acceptance as a little more tolerance of it. They don’t quite understand it.

Invision Health has done some education and done some talking. The group is sending more referrals. We can spend more time, try alternative stuff for some disease, and people are referring to hormones, weight loss, that sort of thing, and are becoming quite accepting.

In other parts of the country, it’s much more accepted. Buffalo’s very conservative, even more than in Rochester (when it comes to medicine). They don’t know enough about whether it’s a good or a bad thing, so it just seems to be more passivity right now.

Talk about leaky gut syndrome.

If you have food sensitivities, you develop inflammation in your gut. In time, as the inflammation builds and builds and builds, the inflammatory things get out, they sneak out. And in the lining in the intestine, some of the cells separate out and you get this leaky gut. You can get any of your itises – thyroiditis, arthritis, any of your inflammatory diseases. That’s where we go and treat where we think the (challenges are). We are very interested in food sensitivity.

What would you do when someone comes in overweight with leaky gut syndrome or similar condition, someone with inflammation?

We would do a complete history and physical. We have a nice little machine called a bioimpedance analysis and this little machine gives me a reading and tells me about body composition so I can measure that fat and lean mass, water balance. I can look at their metabolic rate and it tells me how many calories they’re burning at rest, the BMI (body mass index). We usually do some lab testing; there’s markers for inflammation that we can do. We would evaluate cholesterol levels. For food insensitivities, it would depend on symptoms – how severe, how long? Often what we might do is put them on a 30-day elimination diet. Then what we do is have them reintroduce a couple of the foods that most likely would be their allergen, and keep track of their symptoms. Then we kind of go by that. Or sometimes we send out and have food sensitivity testing done.

We usually start them right away making sure they’re on a good probiotic. We have a couple of things, like our medical foods. They’re like a protein powder drink but they have additives in there to help calm the inflammation and help heal the gut. We usually start them right away on that.

If it’s weight loss, it depends on how severe. Sometimes we might try to give them a month or two to calm down the leaky gut ... With our little BIA, we can say what they’re resting metabolic rate is. We use that calorie amount and look at their activity level and we can give them a calorie-per-day recommended nutrition program.

The FirstLine Therapy Program is modified Mediterranean: lean protein, very low carbs, your good omegas – lots of good oils, nuts and sees, which are good anti-inflammatories – and lots of vegetables and fruits.

We pretty much personalize each thing, and we can do lab testing and can give any kind of recommendation nutritionally. We have a gluten-free program.

We can give them so-called medical foods (through Metagenics). If they have a flexible spending account, they can the cost it out of there.

You see a lot. What have you learned from your work experience when it comes to eating better?

Offering this modified Mediterranean diet, I’ve learned over the years to eat much more like that. Carbs and myself have never been good friends anyway, and over the years, I saw Atkins and some of the horrible stuff that was being offered, so learning more about the modified Mediterranean diet and the lean protein, and the healthy protein, has been important. The benefit of the omega-3s as anti-inflammatories I think is just huge. I tell my patients if I was on an island and could only have one thing, I would have my fish oils because they’re so great. I also think we have a huge epidemic of people who are either pre-diabetic or diabetic. Years ago, whether is was whole grain, healthy fat or whatever, it was better. Today, we just eat way too much sugar. The low-glycemic index is really very important. I just had a lady tell me today that she eats a banana every day. It’s not that bananas aren’t good, it’s just that they’re the highest in sugar (of all fruits).

Is there any food you can’t resist, even though you know you should?

I do dark chocolate because it’s good for you and sometimes I think I do too much. And even sometimes with the nuts. But now I count them out and put them in baggies. My weakness is potato chips. ... I may ask someone to move them away if I’m at a party.

emal: refresh@buffnews.com

Twitter: @BNrefresh

Every day, these friends gather at the barre

B.centric
"My dreams are here," Giavana de Zitter, left, says about her return two years ago to Clarence, where she opened Barre Centric fitness studio with her childhood friend, Rachael Hughes, right. (Charles Lewis/Buffalo News)


By Scott Scanlon – Refresh Editor

Like many folks who leave Western New York, Rachael Hughes and Giavana de Zitter got a great taste of the outside world, drank it in and then decided to return to what may be one of the most underrated and underappreciated places in America.

The nice thing about such returns is that few who re-nest in the region come back empty handed.

Hughes and de Zitter, both 25 and subject of Saturday’s “In the Field” feature in WNY Refresh, honed their dancing skills at Ohio State and on a pair of Royal Caribbean cruiseliners, respectively, before their return. Then they opened Barre Centric, the first barre (pronounced Baar) studio in Western New York.

What was it like working aboard the Vision and the Grandeur?

“It’s like another world, another planet,” de Zitter told me during our recent interview. “It was so much fun. Being a member of the crew you just have your own room, your own space. I was on the ship to perform and rehearse and I had free time, so during the day, I got off the ship and saw things. Sometimes you have days where you’re stuck on the ship. You read a lot of books and watch movies, and exercising to keep dancing.”

What was a typical show like?

“I did a tango show, I did a ‘70s show, I did a Broadway show, a lot of partnering work. There’s six guys, six girls, then there’s four singers: two guys, two girls. The dancers always lip synch to every single song. You do two shows back-to-back, so it’s two shows high intensity, hour and hour.”

De Zitter said Stockholm, Sweden was among the most beautiful places in the roughly 30 countries she visited.

“The whole Scandinavian area was really cool,” she said. “And Estonia. And I loved Israel. They have beautiful beaches and Jerusalem is amazing. I got to see the Dead Sea and float in the water there. And South Africa is one of my favorite places in the world.

She and her husband, Calvin, who met aboard one of the Royal Caribbean cruise ships, thought about staying in South Africa, she said, “but my dreams are here and my family’s way bigger than his, and it’s an easier move here and he’d be making more money.”

“We can own a condo there, hopefully, some day,” she said.

Their relationship has connected two families half a world away.

“His family has been here twice,” she said, “and we just went to South Africa for Christmas. I had a wonderful partner to keep the business running.”

Hughes smiled. Then the two best friends continued to talk about Barre Centric. Here are some excerpts that didn’t make print:

Who came up with the name?

Same time: We both did.

Hughes: Gia’s favorite color is red and mine’s turquoise, so we usually wear those colors.

de Zitter: I like to think about the red as strengthening and empowering and the blue as stretching and cooling down.

Centric is like center. Everything in the class is working from your core. And we like to think of this as the center of your health, too.

Would somebody who takes Zumba or a cardio class recognize the movements?

Hughes: It’s kind of it’s own thing, but definitely has roots in ballet, pilates and yoga.

Most people stay on the perimeter, at the barre?

de Zitter: Most people come to the center of the room for warm-ups, but for the majority of the class, we’re at the barre. A lot of the things are small movements. By the end of the exercise – maybe 2 minutes, 3 minutes in the same position – you’re legs will maybe be feeling a little shaky. You’ll come out of it and stretch it out, so a lot of this is strengthening and lengthening. You could be facing the side, or away from the barre. You could be seated on the floor. We use the weights in the center of the floor.

Would somebody who grew up taking dance classes – tap or ballet – recognize a lot of what you’re doing?

de Zitter: When we say, ‘We’re going to start in first position,’ or ‘We’re going to start in parallel,’ a lot of the principles of dance are there.

Hughes: But we always stress you don’t need dance experience to come into the class. We have all ages, all fitness levels (Regulars include those from ages 17 into their 70s). We don’t recommend it for little girls; it requires some focus.

Can you talk about how barre developed as an exercise program and if there’s a certification program that you need?

Hughes: Even though everyone calls it a new craze, it was started way back in the ‘70s by a dancer who was going through an injury – Lotte Berk – and couldn’t dance any more. She came over from Germany. A lot of the core exercises were developed in rehab, so they’re very rehabilitative on the body. That’s why the whole class is low-impact. It’s not jumping, it’s not anything intense on your joints. When she brought it over, she made it popular in New York City and other major metropolitan areas. The past few years, it’s gone up and up. That’s why we wanted to bring it here.

Did they have something like this at Ohio State?

de Zitter: We took our first class together there.

Hughes: A girl on the cheerleading team opened up a barre studio after graduation. I always thought Columbus and Buffalo were very similar cities. When I saw they had a studio, that was kind of the clicking point for me.

de Zitter: There’s lots of franchises now. When it came to certifications, a lot of times they were from pilates instructors who were dance majors or cheerleaders. So they came up with their own methods starting with the Lotte Berk method. We figured, ‘Why can’t we do this on our own?’ So Rachel and I came up with our own technique. We took my dance major, my pilates (Body 1 Studio) certification; she’s certified in group fitness (AFAA) and was a dance minor. We took our knowledge and we went out and took barre classes in other parts of the country. She took some in California and New York City; I went to Chicago for one.

Do you work with any of the other local gyms?

de Zitter: Stretch Pilates. We just did an event with them. My husband works at Alessi Fitness and he sends his women from there, here.

Hughes: We’re partnering in a TRX Studio in Orchard Park to hold barre classes there, because we’ve had a lot of requests from the Southtowns. One of our instructors teaches a class at Fisher-Price on Thursdays and last summer we held some free classes down at Canalside. We used the railings as barres. So you really never know when a barre class can pop up; they have railings everywhere. You only need a steady support and you can do a whole class.

What kind of music do you use?

Hughes: It’s always kind of upbeat, more Poppy. We keep a consistent 128 BPM (beats per minute) in all of classes. Other than that, we’re always downloading new music, new DJs, looking for new remixes of songs. If there’s a holiday, we’ll make it themed. We’ll call it ‘Throwback Thursday’ and play songs from the ‘80s.

There are 14 fitness studios up and down this stretch of Transit. Do you ever worry about that much competition?

Hughes: Most big box gym memberships kind of compliment ours. A lot of our members belong to a gym. In a lot of the big cities, and you’re seeing this more and more, a lot of people are moving from big box gyms to boutique studios, whether it’s spinning, CrossFit, pilates, yoga. I think Buffalo’s just starting to experience that.

What do you charge for classes?

de Zitter: You can choose. You can have unlimited classes, per class, or you can have a five-class pack. It caters to your schedule.

Hughes: Our classes range from $13 to $18, depending on how many you purchase. Our new client special is $100 unlimited classes for a month. We’re always doing promos and student special rates.

We find people like the smaller group classes and boutique experience. It’s more than just a class, it’s more of a community. It’s really comfortable.

email: refresh@buffnews.com

Twitter: @BNrefresh

Colorectal cancer screening kits available today at many Tops Markets

In recognition of March as Colorectal Health Awareness Month, several Tops Markets in the region will offer free cancer screening kits today.

Tops Pharmacy staff will don blue apparel and blue balloons will adorn each checkout line.

FIT Kits will be distributed to eligible adults aged 50 to 75 to aid in early detection of colon cancer.

The kit “is a simple, convenient and cost-effective screening option that does not require any diet or medication adjustments. It involves collection of a very small sample and can be performed in just minutes,” supermarket chain officials said in a news release.

The FIT Kit is covered in full by most major health insurance plans and will be provided at no cost to residents without insurance.

Tops joined forces with the Cancer Services Program of Erie County for the effort. To find a FIT Kit distribution location, visit TopsMarkets.com, and to learn more about Colorectal Cancer Awareness events in the region, visit CSPWNY.org.

Register now for Ride For Roswell

Registration is now open for this year’s Ride For Roswell, which organizers hope will involve up to 10,000 bike riders, volunteers and supporters, and raise more than $4 million.

The fundraiser, the largest of its kind in the nation in terms of participation, will include an opening ceremony June 27 and the ride, rolling out of the University at Buffalo Amherst campus June 28.

To register, visit rideforroswell.org.

A 3-mile family ride along the Amherst Bike Path – even for kids on tricycles – and a new 10-mile route for teens will be part of the event, said Carolyn Human, a volunteer on the Ride for Roswell Marketing Committee.

“This year, the organizers of the race are really focusing on telling the stories of those who ride,” Human said. “It’s incredibly inspirational to talk to riders on race day about why they are there and what motivates them.” The website will provide that opportunity.

Since it started in 1996, The Ride For Roswell has raised nearly $25 million for Roswell Park Cancer Institute. 

Rachel's Challenge is tonight at St. Martin's

The Catholic Charities In-School Social Work Program is hosting Rachel's Challenge today at Notre Dame Academy, including a free presentation open to parents and the community at 6:30 this evening in St. Martin of Tours Church, 1140 Abbott Road, across the street from the school.

Rachel’s Challenge started in memory of the first victim of the 1999 Columbine high school shootings in Colorado, and looks to inspire individuals to turn from violence, bullying and negativity and toward respect, kindness and compassion. The evening presentation will focus on how to inspire, equip and empower children and teens to make lasting, positive change. Several other schools in the region also participate in the challenge. For more information, visit rachelschallenge.org.

Urgent care doctor looks to work with his primary care colleagues

M.pundt
"There’s a lot more work that’s spent these days in a primary care office on chronic disease and preventative care, so they have less time for episodic, unanticipated, unscheduled care," says Dr. Mark Pundt is the CEO of the Medical Division of the MASH Urgent Care Network. (Sharon Cantillon/Buffalo News)


By Scott Scanlon – Refresh Editor

Dr. Mark Pundt has spent more than 20 years as an emergency room doctor in the Western New York medical field.

The North Tonawanda native and Lancaster resident has watched emergency medicine change since his early medical years – and has reacted to the transformation by looking to help fix the logjam in in the region’s emergency rooms.

He did so by becoming an early pioneer in the urgent care movement in the region – one that has arrived, and mushroomed, with its critics.

Today’s “In the Field” feature in WNY Refresh focuses in part on what prompted this new segment of health care and, generally, how urgent care centers operate.

Pundt and I talked on Monday morning in the MASH Urgent Care site on Transit Road in Clarence, The 8,000-square-foot center is a sort of flagship of the seven-site MASH Urgent Care network that Pundt leads – find all the locations at mashurgentcare.com – but it shares a similar model and flow to all the others.

He compared it to a Tim Horton’s. “You know what you’re going to get when you walk in.”

The flooring is a hardwood-style laminate, the walls neutral in color. The patient exam rooms are clean, warm and quiet, with small flatscreen TVs. The goal is to get patients into one of these rooms within five minutes of arrival. An attending nurse or medical assistant then wheels a laptop and credit card payment machine into the room, takes general information – including for your malady and insurance – and handles things quickly.

If blood is needed, it’s drawn ASAP. Nurses and radiation technologists have been cross-trained to conduct the testing ASAP. If a cut needs to be closed or a sprain or fracture X-rayed, the procedure room is right around the corner.

The setup allows for efficient flow, Pundt said, and 95 percent of patients are in and out within an hour.

This Clarence site also has an in-house pharmacy staffed by Mobile Pharmacy Solutions, and other sites also are served by the company, so patients in need of prescriptions can have them filled on-site, or delivered to their homes at no additional charge. An occupational therapy office also sits at the back of the site for workers comp cases and pre-employment testing.

The regional medical establishment was hestitant at first about places like this, particularly primary care doctors who saw the concept as a professional threat. Many still do. But in the decade since Pundt and a group of nine other ER docs founded MedFirst, the concept continues to gain steam.

Pundt today is CEO of the medical side of the MASH Care Network, which MedFirst folded into in 2012, as well as Professional Emergency Services, which staffs three regional emergency departments and helps several medical groups with billing.

He wants the medical consumer to understand this – patients will bear a greater portion of their health costs in years to come, so it benefits them to make good wellness choices and plug into a system designed to address access, efficiency and cost when it comes to necessary care.

During our interview, he talked in detail about the transformation of emergency care. He also answered concerns that the growing number of urgent care centers in the region threatens primary care providers, which was the subject of a recent front page story by Buffalo News Medical Reporter Henry L. Davis.

“The standard urgent care model, other than us locally or nationally, is a walk-in center that does compete with everyone else in the region – the primary care doctors, the hospital emergency docs, other urgent cares, specialists,” Pundt told me. “Our model is collaborative. We approach other primary care doctors to act as an extenstion of their practice.”

Below are excerpts from our interview.

What was your experience like working as an emergency room doctor back in the mid-1990s compared to what it’s like now as you’re helping to staff emergency rooms?

As emergency medicine became recognized as a profession – it didn’t become a medical board specialty until the late ‘80s – more and more of the initial treating and screening and testing was done in the emergency department. When I was training, my first few years out, you would take care of everything you could treat and discharge. But other patients you would triage, stablize and admit, and the admitting doctors would do all the testing.

Over the last 20, 21 years, now in the emergency department, someone comes in and all the initial testing and treatment is started before it’s handed over to the inpatient doctors. That is why there’s greater slower through-puts, because before, if someone was short of breath, we’d do a quick X-ray and say, ‘Yes, they have pneumonia’ and admit them,’ or ‘Yes, they have congenital heart failure’ and admit them. Now, we’ll do CT scans if we need them, MRI scans if they need them, and have to start all the antibiotics and initial treatments in the emergency department before they go into the inpatient side, so emergency care is much more involved...

They’ve decreased the number of beds in inpatient settings through the Berger Commission, so there’s a greater backup of admitted patients in the emergency department. There’s not beds to move them to because we can’t move them out and up.

So at some point, you saw an opportunity?

As the amount of work we had to do on the inpatients increased, we saw that the less ill, or the ones we knew would be treated and sent back home, were waiting longer because you have to take care of higher acuity cases in the emergency department or you’ll have worse outcomes.

So we said, ‘Can we create a venue we can move patients through much more efficiently, and maintain or enhance the quality of an emergency department?’ At that point, we realized that medicine was going in the direction that if we don’t do something about it, it’s going to injure the economy, locally and beyond. So we started to look for ways to lower the cost of care and provide that care at not only a more efficient time frame for the patients but a more efficient cost to the (health insurance) payers, the community and to the patient.

How did you go about gathering physicans who felt the same way to invest, as well as convincing insurers and health agencies this was a good idea?

The physicians were straightforward. We had started the staffing company for emergency medicine, we had all worked as a group of about 10 of us at the time who were co-owners of the staffing company, and we all agreed we would take some time and staff the urgent care. They all worked with me and saw the need as I did.

From the standpoint of the health insurers, they were trying to develop more of the after-hours care models in primary physicians' practices. They were concerned, at first, with trying to start an alternative venue of care. However, because we were working in partnership with some of the primary doctors, as well as looking at reducing costs, they agreed that the model made sense to them.

We also approached our partners at the time, and started our first MedFirst site (at the Dent Tower) in September of 2004.

This particular realm in health care has snowballed since. Why?

Part of the growth is because of convenience and part is the affordable costs. As we hit the Affordable Care Act days, that’s going to grow.

Part of the problem with emergency departments is, very simply, they are the safety net of medicine. When a patient cannot get care anywhere else, they go to emergency departments, whether they need it or not. If they need care with a primary doctor, don’t have one or can’t get an appoinment, the old default was the emergency department. Now, there’s a new default: urgent care. The public also is being educated that if they don’t need an emergency department, urgent care is there.

It will continue to grow because as the Affordable Care Act enrolls more and more people in insurance, they’ll want more and more care but we will have a greater and greater shortage of primary care doctors. It’s either going to go to the emergency department or urgent care. With the growth of urgent care networks in the country and in the region, urgent care networks will become that safety net for non-emergencies.

Are you involved in more than urgent care?

The MASH Care Network also has non-emergency medical transportation, which does transportation to and from hospitals, doctors offices, dialysis units. We do a lot of work with the developmentally disabled, getting them to their work and home. We have a division that manages the transportation not only for our non-emergency transportation vehicles but others in the region. The emergency medicine practice is part of the MASH Care System as well, MASH Emergency Services. The last subsidiaries are the MASH Physician Services (ER docs and billing) and the Occupational Health Division of MASH Urgent Care.

There are about 150 employees n the MASH Urgent Care sector of the 600-worker MASH Care Network.

Can we talk about ownership?

The MASH Care Network is a group of physicans I started with a holding company, and that holding company owns half of the MASH Care Network; Snyder Corp. owns the other half of the network. They brought in the transportation side and we brought in the medical entities. That occurred March 1, 2012. That was  another reason we rebranded (from MedFirst), to get all of this under one network. My role is CEO of the medical division, which is overseeing the urgent care, the emergency medicine side and the shared services that supports the medical groups.

What kind of doctors do you have at MASH Urgent Care?

We have a blend of emergency doctors and family practice doctors, board certified. The reason we choose those is they’re educated in their training from conception to end of life, so they can take care of any age patient who walks in. It’s probably staffed about 50-50 by both.

What percentage of the docs you have in here are working somewhere else at least part of the time?

About 50 percent. Our emergency docs pick up both and then we have some family docs who moonlight with us. Most of the family practice docs are urgent care only.

What are your hours?

We open at 8:30 a.m. and provide medical care from 9 a.m. to 9 p.m.; it functions like a restaurant, as long as you walk in by 9 p.m., you’re seen. And that’s 365 days a year across all seven sites. (A “global fee” of $135, which covers all services offered in-house is charged to those without insurance; those with insurance see a co-pay generally one-third to one-half of emergency room co-pays).

What have you discovered to be the busiest times of day?

We find it’s early in the morning until about 11 a.m. and it ramps up again from 4 o’clock until close, when people are coming home from work and school.

What about the busiest days of the week?

Generally Friday through Monday.

Some primary care doctors express concern that urgent care centers are trying to replace them. Do you see yourself as an extension of the primary care office?

The standard urgent care model, other than us locally or nationally, is a walk-in center that does compete with everyone else in the region – the primary care doctors, the hospital emergency docs, other urgent cares, specialists. Our model is collaborative. We approach other primary care doctors to act as an extenstion of their practice. We work with them so they will communicate to us ahead of time if a patient is coming in, what they’re coming in for – their allergies, medications, previous medical problems. We will see the patient and if they’re acute we will communicate verbally with that primary care doctor and make a plan to treat. If it’s something more straightforward, once we close our encounter documentation, it immediately is routed to that primary physician, either by fax or electronic medical record, so they have the information of what we did for the patient.

We also use their referal patterns, so if a patient comes in and needs an orthopedic doctor or an ear, nose and throat specialist, or admission to the hospital, we follow the pattern of the primary care doctor, so we act as an extension of their practice.

With that collaboration, primary care doctors see us as a partner. What they’ve experienced is that although the larger practices can afford to stay open after hours or on weekends, most of the smaller practices (find it more difficult). When primary care practices do that, they only attract patients from their own practices, therefore they’re adding overhead without much more patient flow, so it becomes difficult for them to survive, so they need partners who can provide this after-hours service, but they need collaborative partners. So we work patients to call their doctor first, to go to their doctor with the sore throats and sinus infections. When their doctor directs them to us, or if their doctor is unavailable, we’re here.

Are you involved with any particular groups or primary care docs?

We have a pilot project with some of the Catholic Medical Group doctors (seven practices and 30 physicians). We also collaborate with the Buffalo Medical Group ... (and) the Primary Connection out of Independent Health.

With that collaboration, are there financial incentives?

No, it’s all clinical incentives. It’s for the clinical care for the patient.

What would you say to a primary doctor who says, ‘I just went to medical school, put up all this money and put up a shingle and now I’m going to be losing some of my patients to urgent care?’

I tell them the facts. The first fact is they want a lifestyle that is more than work. If they’re keeping their office open all hours, guess who has to staff it? Guess who’s getting calls through the night when they’re trying to have family time? We’re trying to offload that and make their lifestyle better. We’ve even had some practices call and say, ‘We’re very busy today, we don’t have any slots in our schedule, can you cover any of these unanticipated calls, can I send them to you?’ So we help them with that.

On top of that, there’s a lot more work that’s spent these days in a primary care office on chronic disease and preventative care, so they have less time for episodic, unanticipated, unscheduled care.

The literature shows that primary physicians have lost 1 percent of their patient volume to urgent cares but there’s 10 times as many patients waiting for chronic management doctor visits; 30 percent of our patients do not have a primary care doctor, so we can help build a practice. We need primary care doctors to refer to so we can help build a practice, as well.

With that type of collaboration, we make their lifestyle better, their practice life better – and by the way, you get paid more for a chronic disease visit than an episodic care visit – so you actually can enhance your practice income, not directly by giving them money but how we can help the patient flow.

The other thing we can do is increase patient satisfaction because they now have seven sites they can go to – eight when their doctor’s office is opened.

So you don’t tell patients, ‘You can come back for a well patient visit?’

We do the opposite. We refer those type of things to the primary care doctor. We sometimes do sports physicals, that type of thing, if the patient doesn’t have a primary care doctor or if the primary care doctors, like pediatricians at the beginning of school, will call us asking for help.

So the bottom line is you saw a need and filled it.

We found a need, filled it, and we’re being asked to fill other niches, as well. We saw the transporation niche. We’re filling the occupational niche. But we’re doing it in collaboration and we’re helping build a new medical delivery system that has more access, high quality, but is more cost-effective and time efficient than the previous model.

Collaboration is the key thing. We have strong relationships with the big three local payers. We meet monthly for sure, sometimes weekly. They’re very happy with our ways to fill that niche.

Looking out five years, do you think most urgent care centers are going to be using the model you’re using now, and what is health care going to look like then in Western New York?

From the beginning, we derived the urgent care part of our network plus our transportation as being the glue to something called the ‘patient centered medical home’ or the ‘accountable care organization.’ Being the glue to support getting the people where they need to be, see people when it’s unanticipated when they need care.

Today, the urgent care network is looking for the dominant platform. It hasn’t found one because the other platforms are all competing with the provider platforms and other stakeholders in the community. We believe our platform will be the model of the future because it’s integrative and collaborative. It creates a new delivery model that creates greater access, high quality care at a lower cost. We believe this will be the model not just regionally but beyond.

The payers are all in, the health systems are all in and more and more community doctors are finding out what we’re all about.

email: refresh@buffnews.com

Twitter: @BNrefresh

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About The Refresh Buffalo Blog

Scott Scanlon

Scott Scanlon

Scott Scanlon is an award-winning reporter and editor who has covered various topics in his quarter-century as a journalist in South Florida, Syracuse and Buffalo. He is aiming to pass along what he is learning these days about health, fitness, nutrition and family life.

@BNRefresh | refresh@buffnews.com

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