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Source: Asbury Park Press, N.存倉J.Sept. 25--In a nondescript office park in Manalapan, Dr. Marc Feingold added computers to his newly acquired practice, where he decided they would help him track the progress of patients' health.The year was 2010."He was practicing medicine the old way," Feingold, 43, said of the doctor whose practice he took over. "It was all paper appointment books, paper charts."Three years later, Feingold and other primary-care doctors at the Shore are at the center of the Affordable Care Act, commonly known as Obamacare, and the nation's $2.7 trillion health care industry.They are getting from the ACA new tools and personnel -- money to help them buy computers, connect to the Internet and add nurses and dietitians to their practices to help keep their patients healthier -- to slow the skyrocketing cost of health insurance.The new-found focus on preventing illnesses is long overdue, observers said. But for doctors it comes at a price. The government and private insurers -- both through the ACA and on their own -- are testing new payment models that would reward doctors not for how many procedures they perform, but for the outcome of their patients' health. And even their best efforts to convince their patients to, say, lose weight, can fall on deaf ears."Primary care is actually the linchpin of reform," said David Knowlton, president and chief executive officer of the New Jersey Health Care Quality Institute, a Pennington-based research group. "It's probably the most significant change."Do you need coverage? Visit our interactive health care section and guide to coverageAt least one patient at Feingold's office noticed a big difference. John Sabo, 64, of Manalapan said doctors used to ask what was wrong, write a prescription and be on their way. Feingold, he said, spent more time with him, going over results of his blood work and making sure he was exercising.Sabo said he exercises three times a week, a lesson he learned from an uncle who lived to be 94. But Feingold's approach doesn't allow him to forget."I know he's going to ask me questions about my health," Sabo said. "I better have the answers."For all of the money Americans have spent on health care, it hasn't translated to better health. U.S. life expectancy increased from 75.2 years in 1990 to 78.2 years in 2010, but it didn't keep up with other prosperous countries, according to a report by the Institute for Health Metrics and Evaluation at the University of Washington.With the exception of stroke, the U.S. ranked worse than its peers addressing the leading causes of premature mortality. One example: Only nine counties nationwide saw obesity rates decline between 2001 and 2009, and even those weren't statistically significant, the study found.The Affordable Care Act is trying to address that. It is requiring millions of uninsured consumers to buy health insurance. And it is steering them -- and those who already have insurance -- to their primary-care doctors by making sure their policies pay for annual visits and other preventive services such as blood pressure screening, cholesterol screening, depression screening and mammograms.The reason: It is more affordable for consumers to watch their diet and exercise than to develop diabetes and land in the emergency room when they get sick, Knowlton said.For every $1 spent per person on smoking cessation, better nutrition and exercise, the government and insurers can expect to save $6 in long-term medical care, or about $16 billion, according to Trust for America's Health, a physician-led pu儲存lic health organization.Primary-care practices at the Shore have found themselves on the leading edge. Some 70 practices in New Jersey have signed up to be part of a pilot program by Medicare and five insurers in the state. It gives them seed money to hire staff. And it pays doctors bonuses for helping their patients meet benchmarks.Integrated Medicine Alliance, a Shrewsbury-based company that has seven primary-care offices, received $700,000. It used the money to hire five care coordinators and one registered dietitian, whose unified goal is to keep patients healthy and out of the hospital.It also added a family physician to care for homebound patients in what is akin to old-fashioned house calls. The idea could indirectly help hospitals that face steep penalties from Medicare if patients return shortly after they are discharged.Feingold was persuaded by his office manager, Erin Angelicola, to join the pilot project, too, in part because it would help him generate more revenue even as Medicare begins to scale back its reimbursements. Instead of following the path that many other physicians at the Shore have taken and become employees of hospitals, it helped him remain independent.When Feingold bought the practice, he knew it was the medical equivalent of a fixer-upper. The office didn't have a computer database of its patients' addresses. He couldn't even send his new patients notices to introduce himself.So he spent upward of $7,000 for an electronic medical-record system to help him share data with laboratories and hospitals and to help him track patient data (cholesterol, weight, allergies) without fumbling through paper charts. He brought on a patient-care coordinator to report patient data to Medicare and the insurers. And he hired a registered dietitian."It's definitely an exciting time," Feingold said. "It's also scary."Indeed, his office isn't for everyone. He pointed out a comment on a social media website from a patient who was less than complimentary. To the patient, Feingold's questions about diet and exercise seemed to miss the point of the visit -- to cure the illness for which he was there.Will Obamacare work? Will it provide better access to more affordable care and finally put the brakes on a system that grew unabated?The potential potholes are numerous. The uninsured may decide to forgo insurance, pay a fine instead and continue to go to the emergency room for treatment -- a strategy that makes up at least part of the $675 million in charity care New Jersey taxpayers will set aside this year to reimburse hospitals. The website they have been encouraged to use to sign up for coverage may run into technical glitches. There may not be enough primary-care doctors to accommodate their patients. And the drive for profits by drugmakers and medical device companies will only continue.From Feingold's perspective, Americans might not change their behavior. Will they stop smoking? Will they eat healthier food? Will they wear sunscreen, exercise at least three times a week and get a flu shot?It falls on Feingold and other primary-care doctors and their offices to make sure they do."I think what we were doing before is not sustainable," he said. "What the future looks like, I don't know. But I'm glad to be in the position to make changes and move people in a positive direction. Moving is better than not moving."___Michael L. Diamond: 732-643-4038Copyright: ___ (c)2013 Asbury Park Press (Neptune, N.J.) Visit the Asbury Park Press (Neptune, N.J.) at .app.com Distributed by MCT Information Servicesself storage