Urgent care centers booming on LI

The doc in the box has come of age.

Urgent care centers are popping up all over Long Island, spurred by patients who want to see a doctor when their regular physicians aren't available and don't want the long waits often associated with the emergency room.

Statewide, there are about 350 urgent care centers, with about 140 to 150 of them on Long Island, according to Margaret Simat, secretary of the Northeast Regional Urgent Care Association, based in Lido Beach.

"That number is rapidly growing," she said. "There really has been an explosion."

For example, ProHEALTH, the huge multipractice group based in Lake Success with more than 300 doctors, has opened 11 urgent care centers in the metro area this year. Three more are to open within the next few weeks, said Bob Russo, director of marketing.

The group plans to open a total of 80 -- about half of them on Long Island -- rolling out two to three new centers every six weeks or so, he said.

North Shore-Long Island Jewish Health System also has gotten into the urgent care business. It has partnered with GoHealth, an urgent care company based in Menlo Park, California, to open 50 urgent care centers in the next four to five years. Two -- one in Massapequa and the other in Forest Hills, Queens -- are to open in November.

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Some detractors

In addition, PM Pediatrics, Syosset-based centers specializing in children's care, has opened four offices this year, bringing to 12 the number of its facilities in New York and New Jersey.

This year, the company said, its four Long Island locations will see twice as many patients as four years ago.

Urgent care centers -- walk-in clinics, often with night or weekend hours, that treat injuries or illnesses that need immediate care but aren't serious enough to require going to the emergency room -- are not without their critics.

Nevertheless, the doctors who run them said they don't try to replace either the emergency room when it's needed or a patient's regular doctor.

"I feel very strongly: We do no primary care -- no immunizations, general physicals or sports physicals," said Dr. Jeffrey Schor, a founder of PM Pediatrics. Schor said his centers, staffed by pediatricians, operate hours that other pediatricians are not likely to be open and send any records to a child's regular doctor.

But others worry that patients will rely more on episodic treatment rather than seeking the continuous care a primary care doctor provides.

Dr. Andrew Kleinman, president of the Medical Society of the State of New York and a plastic surgeon in Westchester, praised Schor's PM Pediatrics for providing good care and making sure pediatricians were aware of visits to his centers. "An urgent care center can see people in a hurry after-hours and provides an alternative to the emergency room," he said.

But, he said, "the real danger is in terms of follow-up. In an urgent care center you don't always have continuity of care."

Reimbursement issues

Richard Murphy, chief executive of South Nassau Communities Hospital in Oceanside, said he feared primary care doctors who perform routine care -- which tends to be reimbursed at lower rates than acute care -- would suffer financially.

"That's the tragedy of that," he said.

And hospitals, which are legally bound to provide a higher level of emergency care and treat all patients regardless of insurance or income in their emergency rooms, argue emergency rooms and their licensed outpatient clinics are held to more stringent building codes and other requirements. That raises their costs, although they also tend to get higher reimbursements. Urgent care centers run by physicians in the state are regulated no differently than a doctor's office.

"If a hospital adds an outpatient or an urgent care center to its state license, which is common, it must get a Certificate of Need," said Wendy Darwell, chief operating officer of the Nassau-Suffolk Hospital Council. "Our position is that there ought to be a level playing field with fairer regulations for hospitals."

In January, the state's Public Health and Health Planning Council recommended regulations specifically for physician-run urgent care centers and so-called retail clinics like those at some CVS stores. The state Department of Health accepted the proposals, which called for defining what services they could perform and how they could label themselves. The proposals were included in the governor's budget but the legislature didn't act on them -- a move state Sen. Kemp Hannon (R-Garden City), chairman of the Senate's health committee, thought was sensible.

"You have to define what the problem is and then you have to define the goal," he said. "Both are lacking. A problem hasn't been identified. An urgent care [center] rests on an individual doctor's license." That, he said, should be sufficient to ensure quality of care.

North Shore-LIJ -- which will not add its new urgent care centers to its state license and therefore won't need state approval -- sees them as one of many ways to attract more patients, who may need a primary care doctor or follow-up care with a specialist.

"It makes sense on a number of different levels," North Shore-LIJ chief operating officer Mark Solazzo said. "Customers are demanding it and it makes sense strategically. We see it as trying to create as many access points as possible."

North Shore-LIJ has taken that access point out of the doctor's office and into the drugstore. Last year, it signed an agreement with CVS MinuteClinics in which its doctors serve as medical directors to the chain's clinics. Staffed by nurse practitioners, these clinics can provide many primary care services, giving shots, treating minor wounds and illnesses, doing physicals, screening for diabetes and other chronic diseases and writing prescriptions. So far, there are six MinuteClinics in New York, two of them on Long Island, with others in the planning stages, the firm said.

It's not just the big players who see urgent care centers as a smart business opportunity.

Neil Kugelman of Woodmere was a software developer until he ran into a high-school friend a year and a half ago who was talking about urgent care centers. "I realized this particular area -- Long Island and metro New York -- is being underserved," he said.

He decided to switch careers and is now chief executive of Urgent-MD, which has opened three centers, two on Long Island. He plans to open two more in Brooklyn before the end of year.

"The majority of patients don't belong in a hospital emergency room, but really sometimes there's no alternative," he said.

Meeting a need

Dr. Jake Deutsch agreed. He said he enjoyed the adrenaline rush of working more than a decade in the emergency department. But, he said, he saw that many people who didn't have life-threatening conditions weren't getting the attention they needed or had to wait hours for it.

He decided to start CURE Urgent Care, with two centers -- one in Manhattan and the other in Huntington -- that aim to provide high-level urgent care that has more of the feel of a spa or hotel than the typical emergency department.

The Huntington facility, which opened last month, is light and spacious with tasteful modern art and snacks. As soon as a patient walks in, he is greeted and asked to fill out a short form. He is quickly whisked into a room by a patient assister, whose job it is to stay with the patient throughout his visit.

On a recent Saturday morning, most patients were in and out in about a half-hour.

One of them was Linda Wright, 68, of Cold Spring Harbor, who had a skin problem on her thumb and arm. She said the urgent care center didn't replace her primary care doctor, although seeing her doctor was more difficult than coming to an urgent care center that didn't require an appointment. "You have to plan ahead," she said of her regular doctor.

Seated on an examination table, she glanced around.

"This is beautiful," she said. "This is not a doc in the box."