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Hospitals Adding Urgency to their ER Operations

April 18, 2014

Long Island Business News
April 17, 2014
Hospitals Adding Urgency to their ER Operations
By: Claude Solnik 

With urgent-care centers proliferating across Long Island, hospitals are rolling out their own quick-treatment centers to compete – and even modifying emergency rooms to better handle minor injuries.

Manhattan-based Mt. Sinai Medical Center has opened an urgent-care center in Brooklyn, one of the highest-profile urgent-care expansions by a major New York hospital. But it’s hardly the only one; Mercy Medical Center in Rockville Centre, part of Catholic Health Services, has created a separate “express care” area located just 75 feet from its emergency room, with a separate pediatric express care area on tap. And the North Shore-Long Island Jewish Health System has opened two urgent-care centers – one in Bethpage and one in the Rego Park section of Queens – with more to come.
“We’re actively evaluating our options for expanding our footprint in that sector,” said North Shore-LIJ spokesman Terry Lynam. “We believe strongly that there’s a meaningful and beneficial role for urgent-care as well as convenient-care clinics.”

While they can be meaningful and beneficial, Dr. Jeffrey Schor – managing member of Lake Success-based PM Pediatrics, which operates 10 regional pediatric urgent-care centers – suggested hospitals might have another reason for expanding their urgent-care services.
“They’re looking at it more as competition,” Schor said. “People are choosing to use urgent-care facilities. Like any other business, hospitals want to get in the game.”

Patients are increasingly choosing the urgent-care center over the ER for things like minor injuries, according to Dr. John D’Angelo, North Shore-LIJ’s senior VP for emergency medicine, but that doesn’t mean ER use is dropping: If not twisted ankles, more patients are choosing the ER for a greater number of ailments.

“We’re noticing that the complexity is increasing,” D’Angelo said. “The number of patients is about the same, but the complexity is higher.”

Insurers, at least, have no trouble with patients parading to urgent-care centers. Aetna has now contracted with 83 urgent-care operators – totaling with 102 sites – in the New York metropolitan area, and even offers lower co-pays at urgent-care centers than ERs.

“We reimburse them less than hospitals for similar care and we encourage our members to use them,” said Aetna spokeswoman Susan Millerick. “They’re convenient and lower-cost options for good quality care.”

Such mindsets are forcing hospitals to rethink their emergency operations, including the occasional addition of a more personal touch. In Mercy Medical Center’s new express care area, “the waiting area’s like a doctor’s office,” noted Dr. Nenad Grlic, director of Mercy’s emergency services.

“It’s comfortable, has a TV and a separate reception area,” Grlic said. “It’s a quicker-paced, more pleasant atmosphere to work. You’re not under the stress of high-acuity patients.”

Mercy is designing its pediatric express care area to be kid-friendly and equipped to handle minor concussions, cuts and other less-acute injuries.

“We’re trying to create a safer, more comfortable environment for younger children,” said Dr. Aaron Glatt, Mercy’s chief administrative officer. “They’ll feel less like an emergency room and more like a pediatrician’s office.”

There are other benefits to placing urgent-care facilities inside or close to hospitals, Glatt added, including having heavier healthcare guns at the ready. “If you recognize the the patient is sicker than you thought, you wheel them 100 feet away,” he said.

But Schor cited specific “drawbacks” for hospitals looking to add urgent-care services to their ER operations. “Anyone who comes into a hospital still needs to be triaged,” he said, while hospitals also have multiple departments with “a lot of competing agendas.”

There’s also a risk that patients will falsely believe that hospital-based urgent-care centers are staffed and equipped to handle everything a traditional ER might handle.

“There is the perception that, because it’s part of a hospital, the services may be greater,” Schor said.
These are among the many reasons why hospitals, relatively speaking, are just getting their toes wet when it comes to urgent care. But even Schor believes the trend toward urgent care at hospitals is just starting to warm up.

“The competition isn’t really there yet,” he said. “But it’s probably going to come.”
 

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