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An E.R., Not a Hospital, Is Set to Open at St. Vincent’s Site

Published: July 14, 2014

Publication: The New York Times

By Kate Taylor

Residents of the West Village will soon see something unusual arriving at the shiplike building on Seventh Avenue that used to house part of St. Vincent’s Hospital: ambulances.

Christopher Gregory for The New York Times

The shiplike building on Seventh Avenue that used to house part of St. Vincent’s Hospital is reopening in the coming days as a stand-alone emergency room and medical care center.

Four years after St. Vincent’s closed, the hulking white building, between West 12th and West 13th Streets, is reopening in the coming days, not as a hospital, but as a free-standing emergency room.

“We’ve given back the community the No. 1 thing we think the community needed the most when St. Vincent’s Hospital closed,” said Dr. Warren B. Licht, the medical affairs director for the new emergency room, which will be run by the North Shore-Long Island Jewish Health System.

The new E.R., however, is part of a trend that has as much to do with a hospital’s bottom line as it does with providing acute care.

Free-standing emergency rooms — which are distinct from urgent care centers, which treat non-life-threatening illnesses and injuries at low cost — have sprouted up around the country in recent years, driven by competition to capture lucrative markets, like the neighborhoods around Greenwich Village.

Christopher Gregory for The New York Times

Operators of free-standing emergency rooms, like the new Lenox Hill HealthPlex in the West Village, say they fill an important void in areas without full hospitals.

They can bring in significant revenue, since they are allowed to charge the same high fees that hospitals charge while having lower overhead. And, since half of admissions come from the emergency room, free-standing E.R.s can funnel patient business to their parent hospitals.

“These hospitals need to keep their beds filled, and they need to have patients who have need for their very high-technology services like heart surgery and brain surgery and transplants,” said Dr. John W. Rowe, a professor at Columbia University’s Mailman School of Public Health and former chief executive officer of both Aetna and Mount Sinai Hospital.

He added: “What you’re seeing in New York, now that a couple of hospitals have closed, is a kind of scramble for that territory.”

The first free-standing emergency room in New York State opened in the Bronx last year, and three more have opened since. In New York City, two are opening in prosperous neighborhoods where community hospitals, which were left behind by the areas’ gentrification, closed amid heavy financial losses.

There will be the one in the West Village, called Lenox Hill HealthPlex, to denote its relationship to Lenox Hill Hospital, North Shore-Long Island Jewish Health System’s hospital on the Upper East Side. And, as part of a deal signed this month, NYU Langone Medical Center will take over the emergency room of Long Island College Hospital in Brooklyn and run it as a free-standing operation. As happened at St. Vincent’s, most of the rest of the Brooklyn hospital property will be taken over by a developer and turned into apartments.

Since St. Vincent’s closed, residents of the West Village and Chelsea have had to go either across town to Mount Sinai Beth Israel, Bellevue Hospital Center or NYU Langone, or up to Mount Sinai Roosevelt on 10th Avenue and 58th Street. (Other than Bellevue, a public hospital, all those are run by the North Shore system’s competitors.)

Operators of free-standing emergency rooms like the HealthPlex say they fill an important void in areas without full hospitals. But the HealthPlex also appears designed to be an advertisement for the larger North Shore system, and to attract the kind of wealthy West Village residents who avoided St. Vincent’s.

The waiting room, which the emergency medicine director, Dr. Eric Cruzen, referred to as the “arrivals lounge,” is decorated in soothing blues and beiges and features a large display of orchids. Natural light enters from the street through a wall of glass bricks. It looks like a very pleasant place to wait, but Dr. Cruzen said that it was intended only for patients’ family members and visitors, since the goal is for all patients to be seen within 15 minutes.

“We hope that none of our patients will ever have to sit down here,” he said.

Inside, in the 26 private rooms, screens over the beds offer Internet access, DirecTV and Skype. Next to the beds are high-resolution telemedicine devices so that specialists can examine a patient remotely.

There are two critical-care rooms, a self-contained “forensic unit” with its own unmarked entrance for sexual assault victims, a CT scanner and X-ray machines. A lab downstairs can perform the 60 most common tests. The six-story building will eventually include other outpatient services, like an ambulatory surgery suite.

Ambulances will not bring patients suffering major trauma, head or spinal cord injuries, heart attacks, acute strokes, psychiatric disturbance or pregnancy-related complications, among other maladies, to the HealthPlex. But Dr. Cruzen said that if someone with any of these conditions walked through the door, the doctors at the HealthPlex would do everything that would be done in a hospital-based emergency room to stabilize the person and then transfer the patient by ambulance to the nearest appropriate hospital — in most cases, Mount Sinai Beth Israel and, for trauma patients, Bellevue.

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