Alternatives to the Emergency Room

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Walk-in, specialty care options gaining momentum with city residents

Access to quality healthcare in the city, as in the nation, has long been a pressing issue thanks in part to overburdened emergency rooms and financially-strapped hospitals.

Most recently, Hurricane Sandy wreaked havoc on access to healthcare downtown as it knocked out both NYU Langone Medical Center and Bellevue Hospital, leaving the ER at Beth Israel to operate in overdrive for months as the only option for city residents below 42nd Street.

But, even before Sandy, the healthcare landscape downtown was ailing and in need of an overhaul as St. Vincent's Hospital, a fixture since the early 20th century, closed in 2010 underneath a mountain of debt.

Manhattan-based Continuum Health Partners, which operates Beth Israel Medical Center along with Roosevelt Hospital, St. Luke's and the New York Eye and Ear Infirmary, is betting that strategic partnerships with retail clinics along with expanded primary and specialty care practices will help bolster access to healthcare in the city as well as reduce reliance on emergency rooms for non-emergency ailments.

"We preach access, access, access," said Tom Poole, vice president for Continuum's medical groups, in a phone interview.

Poole detailed Beth Israel Medical Group's expansion of new primary and specialty care practices on E. First Street, West 14th, 23rd Street and 34th Street, which feature a range of internal medicine options and urgent care to treat conditions from the common cold and flu, to STDs, lacerations, sprains and broken bones.

Some practices even offer specialties such as cardiology, pain management, orthopedic surgery and dermatology as well as a variety of laser procedures.

He added that many of the practices operate seven days week, 365 days per year, with hours typically ranging from 8 a.m. - 8 p.m.

According to Poole, many patients visit the specialty care practices off-hours, when their own doctors are unavailable. Plus, he said other patients include local city tourists and working people who commute into the city daily but don't have time to see their own doctors at home.

The two busiest practices, at the 34th and 23rd Street locations, average about 36,000 patient visits per year.

And, in addition to Beth Israel's specialty practices, Continuum has, for the past few years, been in partnership with several Duane Reade Walk-In clinics whereby Duane Reade's on-site physicians are credentialed by Continuum and allowed to admit patients to Continuum-affiliated hospitals.

"In return for credentialing their physicians, the Duane Reade physicians use our radiology and lab services, and send their patients to our ERs when it is of a more serious nature," said Jim Mandler, Continuum's head of public affairs.

Although the clinics are limited in scope and don't provide primary or specialty care, they do offer radiology and lab services via Continuum. Most clinic users get flu shots or seek out help for flu-related symptoms.

Mandler said the Continuum-affiliated Duane Reade clinics were averaging 60,000 visits per year.

Moreover, recent news reports on the "overuse" of emergency room visits seem to favor the growth of competitive urgent care and walk-in clinics in Manhattan and elsewhere.

A report last year from the Empire Center for New York State Policy, a conservative think-tank, chronicled instances of "inappropriate" and "excessive" emergency room use.

"One of the most frequently given reasons-in New York and nationally-for the overutilization of ERs is the lack of access to primary care," the report stated.

A recent Harris Interactive poll on medical retail clinics, such as those hosted by drug chains like CVS and Duane Reade, showed that some of the top uses of the clinics included diagnosis and treatment of cold and flu symptoms, flu shots and filling prescriptions.

In Manhattan, other walk-in and urgent care clinics include Medhattan, CityMD and retail clinics operated out of some CVS locations.

"There are lots of other freestanding and non-hospital affiliated urgent care facilities out there," Poole admitted. "But, where Beth Israel Medical Group differs from them is that our specialty care practices and even our partnership with Duane Reade are backed-up by the deep resources and quality doctors of Beth Israel and Continuum."

Another convenience-based healthcare initiative Beth Israel is experimenting with is a telemedicine/telehealth service called Teledoc. The service offers Continuum's physician services directly to patients, 24 hours a day, seven days a week via phone or online to New York City residents. There is a $30 annual membership and a $38 consultation fee for each doctor interaction.

Dr. Kelly Cassano, medical director for Continuum, said the Teladoc service was being used for about three to five consults per week at the height of the flu season. "The conditions people call about run the gamut but are mostly infections, such as upper respiratory and flu-like symptoms," she reported, during a recent phone interview.

Nicole Palma, a 29-year-old editor for a medical book publisher in Manhattan, reported a very positive recent experience with the service.

"I had the flu for a couple weeks and I wanted to make sure I was caring for the condition properly," Palma said during a phone interview. "I had a nagging cough and couldn't sleep."

Palma was granted a telephone consult at 12: 30 a.m.

"It was fantastic. It was really clear the doctor had read my files." She said she had a good conversation that didn't take too long. "He cared if I got better. I got what I needed."

"Beth Israel medical groups provide a lot of community care," Cassano said. "We're confident we are keeping a good amount of people out of city emergency rooms."

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