Urgent Care Centers Fill In Some of the Gap For Former St. Vincent's Patients

by David Gibbons For many observers, the closing of St. Vincent's Hospital-one of the oldest community hospitals in the nation and a New York City icon throughout the 20th century-was a disaster, a disgrace, a moral failure, an avoidable tragedy. After its demise at the end of April 2010, professionals in other downtown medical centers noted a surge in ER visits and ambulance runs. Now, just over two years later, the question is: Have the others been able to fill the gap? The two major area players are Beth Israel Medical Center, part of Continuum Health Partners (CHP), and the North Shore-LIJ Health System. Beth Israel had already doubled the size of its emergency room after the closing of Cabrini Medical Center in 2008, so it was well prepared for the St. Vincent's surge; other local hospitals also expanded and adapted to pick up the slack. Meanwhile, both CHP and North Shore-LIJ, as well as several independent partnerships of doctors, have begun to offer more options for urgent care. In March, 2011, North Shore-LIJ partnered with VillageCare to open an urgent care center at 121A W. 20th St. Around the same time, North Shore-LIJ announced its trump card; plan to convert the O'Toole Building-the white wedding cake-like landmark on 7th Avenue between 12th and 13th streets that was part of the St. Vincent's complex-into "the first stand-alone emergency and ambulatory facility in the New York City metropolitan area." "We developed what we felt was a realistic proposal to restore comprehensive health care to the West Side," said Terry Lynam, a North Shore-LIJ spokesperson. "We're investing $110 million to build a true community resource that will go a long way toward giving people access to health care that has been lacking since the closing of St. Vincent's." It is scheduled to open as The Lenox Hill Hospital Center for Comprehensive Care in early 2014. "North Shore is doing a commendable job trying to rebuild some services," said Dr. Fred Hyde, clinical professor at Columbia University's Mailman School of Public Health and an expert on management and policy. "Still, the closing of a hospital is irrelevant to the utility of urgent care centers, since hospitals were never much good at outpatient care in the first place. Urgent care is a substitute for available primary care physicians, of which we may have too few-local, state and national." Hyde estimates that an individual physician, depending on how "muscular" a schedule he or she is willing to tackle, can serve a primary care base of 2,000 to 2,500 patients. These figures, together with a projection from the Urgent Care Association of America of one clinic per every 40- to 50,000 people, suggest that roughly 50 hardworking doctors staffing urgent care clinics in an area the size of southern Manhattan could have a significant impact. "If St. Vincent's was like a lot of hospitals, it had an ER half-full of non-emergency patients who could have been treated in an urgent care clinic," said Lou Ellen Horwitz, the Urgent Care Association's executive director. "So while urgent care can't replace hospital beds, it can create access for a lot of patients who would have gone to an ER." CHP's strategy is to build neighborhood primary and specialty care practices that accept walk-ins, one of the many ways it strives to meet the needs of the community, according to spokesman Jim Mandler. Marked by their familiar awnings with the blue Beth Israel logo, they are currently located in the West Village (222 W. 14th St.), Chelsea (202 W. 23rd St.) and lower Midtown (55 E. 34th St.). The Chelsea practice is expanding and will relocate to the northwest corner of 23rd Street and 8th Avenue on Sept. 1 with 12,000 square feet of space on two floors. Tom Poole, vice president of Continuum Medical Groups, who oversees development and operation of CHP's community medical centers around Manhattan, calls it "our newly renovated state-of-the art facility for walk-in primary and specialty care, one-stop shopping sorely needed to serve Chelsea and Penn South," a neighborhood development with a large elderly population. In November, Continuum will open another new Beth Israel facility on 8th Street in the West Village, able to handle 36,000 patient visits per year at full capacity. "Our model for the future is easy, open access," said Poole. "We've found this is what patients increasingly expect; they don't want to wait six weeks to see their doctor. We aim to treat patients who need immediate or urgent care and create an environment that provides a satisfactory experience for everybody. To put it simply: We want happy patients, happy physicians and happy staff." "We're able to see this with our practice on 14th Street, and we hope it will continue with the new locations on 23rd and 8th streets," Mandler added. Poole says he feels a year from now will be a good time to re-evaluate the success of this new model; he also expects the increasing demand for urgent care to grow hand in hand with new housing development along the West Side. (For more information on Beth Israel's practices, visit www.bethisraelmedicalgroup.com or www.wehealny.org.) At CityMD (www.citymd.net), they are equally bullish: "From our perspective, we see a major need for quality urgent care throughout the city and particularly in the downtown area," said COO Dr. Nedal Shami, adding that business is good. The company opened its new Flatiron branch at 37 W. 23rd St. on May 8 of this year, has another scheduled to open on 67th Street in the fall and is actively seeking a location in Tribeca or the Financial District for the near future. Other private partnership practices along the lines of Beth Israel's primary care walk-ins are opening up, among them the One Medical Group (www. onemedical.com), which has five locations, including in the West Village, at 408 W. 14th St., and the Wall Street area, at 30 Broad St. Additional urgent care options in Manhattan's Lower West Side include New York Doctors Urgent Care, 65 W. 13th St.; Emergency Medical Care, 200 Chambers St. (www.emcny.com), and Medhattan Immediate Medical Care, 106 Liberty St. (www.medhattan.com). According to rules of thumb and guesstimates from several experts, it appears that southern Manhattan's urgent care needs are being addressed, and that the closing of St. Vincent's, in the cold light of history, may one day be considered more of a transition than a debacle.