Wednesday, October 10, 2012

Clinical Innovation in New York City after Closure of St. Vincent Hospital
If I can make it there, I'll make it anywhere,
It's up to you, New York, New York
Theme Song in New York, New York, Martin Scorcese Film (1977)
October 10, 2012  -  The U.S. has a resilient health care society  Witness, if you will, the proliferation of urgent care centers, retail clinics, outpatient diagnostic and surgical centers, and concierge and cash-only practices. 
Now look at New York City, where Greenwich Village inhabitants are doing well  without St. Vincent Hospital, which closed two years ago.
How has the health system there been able to cope?  According to yesterday’s New York Times, the system  has been able to do so by innovating in the outpatient arena.   In “New Style of Health Care Emerges to Fill Hospital’s Void,” reporter Anemona Hartocollis observes,
Without building a hospital, one large chain, Continuum Health Partners, is establishing a beachhead in Chelsea and the Village by connecting with outpatient clinics, trying to dominate the market and create a feeder network for its hospitals in other neighborhoods. It is joining forces not just with traditional clinics but also with newer experiments like doctors working out of drugstores. A competitor, NYU Langone Medical Center, is expanding its physician practices downtown, and like Continuum, it has hired dozens of stranded St. Vincent’s doctors. Several walk-in “urgent care” centers have also rushed into the vacuum left by St. Vincent’s in Lower Manhattan, hoping to show that they are more efficient and consumer-friendly than a hospital-based system, but some have already begun to form relationships with the hospitals.’
The reporter  cites a 2009 RAND study of a Minnesota health plan, where people received care for sore throats, infections, and urinary tract infections in retail clinics with a 30% to 40% reduction in costs than in doctors’ offices and urgicare centers, and 80% lower costs in in ERS.
Executives at Continuum, which runs five hospitals in New York City, “ she reports, “ say they expect their expansion  into the community to form the foundation of an accountable care organization.”
Greenwich Village residents can now choose from a dozen clinics or medical practices that have been opened or expanded by Continuum or are affiliated with it.

Continuum has also taken over the former St. Vincent’s cancer center on 15th Street, and it has established a clinic with a focus on H.I.V. patients on 17th Street, renovating several floors and filling them with colorful pop art. Half of the doctors at the clinic, called the Center for Comprehensive Care, were hired from the old St. Vincent’s H.I.V. program.

Continuum has affiliated with doctors practicing out of 13 Duane Reade drugstores in Manhattan and Brooklyn, and has a contract to expand to 20 within the next year or so, and to 50 within four years.

 “Everything is intensely competitive and everyone is everywhere,” said Dr. Andrew W. Brotman, its senior vice president and vice dean for clinical affairs and strategy.

Word of the new options is trickling out, and some patients say they are not mourning St. Vincent’s.

Dr. Charles Carpati, former chief of intensive care at St. Vincent’s, now at Lenox Hill Hospital, said the community seemed to be coping without the old hospital.

“It’s been very hard to show that people are dying because St. Vincent’s is no longer there,” Dr. Carpati said.

Tweet:  In NYC, retail clinics, urgicare centers, MDs in drug stores, and hospital-outpatient affiliations fill the gap left by St. Vincent loss.



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