Published: July 14, 2014
Publication: The New York Times
By Kate Taylor
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.Photo
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.CreditChristopher Gregory for The New York Times
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.Photo
Employees receiving training at Lenox Hill HealthPlex. CreditChristopher Gregory for The New York Times
“The care that saves your life is the care you get immediately,” Dr. Cruzen said. “If you have a bad infection, it’s how quickly you get antibiotics that make the difference whether you live or die, not how quickly you get to a bed upstairs.”
Arthur Z. Schwartz, a local Democratic district leader who brought an unsuccessful suit to force the state to build a full-service hospital in the neighborhood, said that the HealthPlex “looks like a magnificent facility” but that he worried about its inability to treat the most acute cases.
“All it’s going to be capable of doing is attempting to stabilize someone while they stick them back in an ambulance and ship them off to a hospital,” he said.
Dr. Howard Mell, a spokesman for the American College of Emergency Physicians, said that in about 1 percent of cases, minutes could make the difference between a good outcome and a bad one, and the extra time for the transfer might be detrimental.
But, he said, there were also cases in which getting to an emergency room sooner — because a free-standing emergency room had opened in an area that lacked a hospital — could be lifesaving.
“They really are as capable as a small hospital, and in many cases more capable, because they carry the weight of their mother ship in its ability to look up and find surgeons and specialists,” he said.
For less acute cases, Dr. Cruzen said, patients would be transferred to “a hospital of their choice.” But there seems to be a hope that, once patients come in the doors at the HealthPlex, they will stay within the North Shore system, which includes 17 hospitals in the city and suburbs.
“If you are part of that small minority that need to be admitted and need specialists’ care, you now have world-class specialists from the North Shore-L.I.J. Health System and Lenox Hill Hospital,” Dr. Licht said.
Nationally, the first free-standing emergency rooms opened in the 1970s, mostly to serve rural areas that lacked access to emergency care. But the number of such emergency rooms has exploded in recent years, to more than 400.
“It used to be that just for-profit hospitals were starting this trend, but now academic medical centers are realizing that it is quite profitable, too,” said Dr. Renee Hsia, an associate professor of emergency medicine at the University of California, San Francisco.
Both Lenox Hill HealthPlex and NYU Langone’s new emergency room will be open 24 hours a day, seven days a week, and will evaluate and provide stabilizing treatment to any patient regardless of ability to pay.
Those are key differences from urgent care centers, which typically require uninsured patients to pay up front, though not all free-standing emergency rooms in the United States treat all comers. Urgent care centers also are not set up to treat acute conditions like heart attack or stroke. But their prices for treating less serious conditions can be up to 85 percent lower than in emergency rooms, according to the website of the insurance company CareFirst BlueCross BlueShield.
As a result, some health care experts expressed concerns that the proliferation of free-standing emergency rooms, at a time when insurers and government policy makers are encouraging patients with minor ailments to avoid emergency rooms, could lead to increased health care costs.
“If you have a facility that needs to be fed, they will figure out how to feed it,” Dr. Robert Berenson, a fellow at the Urban Institute, said. “They will brand it. There will be some people that find that the free-standing emergency department is convenient enough that they’ll go there rather than wait till the next day.”