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AGENDA
Story Dave Donelson Illustration Robert Pizzo
ISSUE
Q3 2013
DOC IN A BOX
They’re fast and convenient, but are urgent-care centers good for our healthcare system?
Starbucks locations outnumber urgent- care clinics in Westchester at the moment, but that may not be the case for long. The walk-in medical-care facilities are popping up like morels after a spring rain, with 17
in the County at press time and a dozen more in various stages of development. If some providers have their way, it won’t be long before you can get your scraped knee stitched up anywhere, anytime. Who knows? Maybe even at Starbucks...
That’s either good or bad—or both— depending on whom you ask and what their interest is in the business of medi- cine. Andrew Sussman, MD, president of MinuteClinic, which operates two walk-in clinics in Westchester CVS Pharmacy loca- tions, says, “Our healthcare system today needs easy access, low cost, and quality care.” CVS has 650 MinuteClinics nation- wide and plans to have 1,500 by 2017.
“There are a few positives, but a
whole host of negatives,” says Thomas Lee, MD, chairman of the board of St. John’s Riverside Hospital and immediate past president of the Westchester County Medical Society. “You are increasing access and convenience at the price of good care, quality, and outcomes.”
From a different perspective, Scott Hayworth, MD, president and CEO of Mount Kisco Medical Group (MKMG), observes, “For a large, multi-specialty phy- sician group like ours, it just makes sense. It’s an extension of the care we provide.” MKMG, with 300 physicians and 300,000 patients, operates two centers, in Yorktown Heights and Carmel, New York, with one slated to open this fall in Bedford Hills.
Ron Nutovits, MD, chairman of Emergency Medicine at Hudson Valley Hospital Center (HVHC) in Cortlandt Manor, is not a fan of the phenomenon.
“If the urgent-care centers are only going to be picking the paying customer,” he says, “it will contribute to more deficits for hospitals that are already struggling with the new healthcare economy.”
Contributing to (or confusing) the dis- cussion is the variety of service-offerings that fall under the definition of “urgent-care provider.” The designation encompasses retail clinics like those in CVS that provide— at least now—a limited range of services administered by nurse practitioners; doctor- owned clinics sometimes referred to as “doc- in-a-box” offices; and full-service walk-in facilities operated by major group practices
like MKMG and WESTMED Medical Group as part of the spectrum of care they provide. Blurring the lines are fast-track units set
up by six Westchester hospital emergency rooms, including both Hudson Valley and St. John's Riverside Hospital. Basically, all aim to serve the patient who can’t see a personal physician for one reason or another, but who doesn’t require (or wants to avoid) intensive, expensive, emergency-room treatment.
From the consumer’s standpoint, the argument probably doesn’t matter. When you’re sick, you want care—now. As Annette Choolfaian, chair of the Department of Health Policy and Management at the New York Medical College School of Health Science and Practices points out, “These things have popped up and been relatively successful because they fill a need that tradi- tional practices and emergency rooms have not filled in the past.”
As the business of urgent care grows, it’s drawing more and more players. Jason Lupow, MD, is one of five board-certified ER doctors who trained and now work together at Montefiore Hospital in the Bronx. “We all moonlight or work extra shifts for the hospital, so we decided to do something for ourselves,” he explains. “We
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