In the two years since New York City-based St. Vincent's Hospital closed its doors for the last time, a slew of clinics, pharmacy-based doctor's offices, and other health care delivery models have emerged to serve patients, turning lower Manhattan into a "laboratory for health care reform."
According to the New York Times, St. Vincent's closure led to a "struggle for health care supremacy in some of New York's most distinctive neighborhoods," as a range of health providers have pushed to capture market share:
- Continuum Health Partners is establishing outpatient clinics to create a feeder network to its hospitals in other neighborhoods and establish the foundation for an ACO;
- Continuum also took over St. Vincent's old cancer center and established an HIV-focused clinic;
- NYU Langone Medical Center is expanding its physician practices in the neighborhood;
- North Shore-Long Island Jewish Health System is converting a St. Vincent's facility into a free-standing ED, slated to open in 2014;
- Several urgent care centers have opened, some of which have formed relationships with other Manhattan hospitals;
- Some physicians also have launched practices inside Duane Reade drugstores, which have affiliated with Continuum for credential checks and testing. (The practices in turn refer patients to the hospital system).
Although the immediate struggle may be for market share, the Times notes that the new models may hint at the future of urban medicine.
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Namely, providers are testing the theory that major U.S. cities can survive with fewer hospitals. "Good hospitals are important, but you don't need more than you need," says North Shore CEO Michael Dowling. "In many cases, we've been addicted to inpatient beds. We can't be addicted to them in the future."
And, given the availability of health care through various new settings, "[i]t's been very hard to show that people are dying because St. Vincent's is no longer there," says Charles Carpati, former chief of intensive care at St. Vincent's (Hartocollis, Times, 10/9).