As part of a growing trend, Westchester Medical Center is currently planning a new $230 million ambulatory-care pavillion, set to open in 2018.
NewYork-Presbyterian/Lawrence Hospital opened its new, state-of-the-art cardiac-catheterization laboratory last year.
The Shift to Outpatient Care
Ironically, as hospital administrators develop plans to increase revenue, keeping people well and out of the hospital is a critical piece of the plan. Why? Hospital overhead is expensive, and studies from the country’s largest health insurers over the last decade have determined that many patients didn’t require all the services and associated expenses of a hospital setting for their ailments. Medicare and Medicaid, the nation’s largest health insurers, began cutting back insurance reimbursements and penalizing hospitals for readmitting patients within 30 days of discharge. Hospital leaders searched for ways to make up the shortfall while still offering quality care. What they realized was that with equipment becoming more portable and many procedures becoming more routine, they had other means to provide treatment. Those who needed a hospital bed in the past could get their doctoring in another setting.
“The advances in medicine have made it possible to shift more and more health services from inpatient to outpatient care,” says Anthony Ferreri, executive vice president and chief affiliation officer of Northwell Health, formerly known as North Shore-LIJ Health System. (Phelps Memorial Hospital Center and Northern Westchester Hospital in Mount Kisco recently joined the Northwell family.) “Hospitals and health systems are opening up urgent-care centers, ambulatory services, and medical office buildings. You can go into a building that’s like a medical mall. As we move into ambulatory settings now, the hospitals are competing more than ever.”
This trend is evident throughout Westchester. Northwell opened urgent-care centers this winter, in partnership with GoHealth Urgent Care, in both Tarrytown and Yorktown Heights, where patients can check wait times online before heading over. This adds to Northwell-GoHealth’s existing location in New Rochelle, where Montefiore Health System operates the 242-bed Montefiore New Rochelle Hospital, as well as an outpatient clinic. White Plains Hospital, a Montefiore Hospital partner since 2015, opened a satellite practice, White Plains Hospital Physician Associates, in New Rochelle in 2013. It has also put down roots farther north, with a medical-and-wellness center in Armonk (White Plains Hospital Medical & Wellness), about a 10-minute drive from Northern Westchester Hospital’s ambulatory-care center in Chappaqua. And Phelps increased its physician presence in Dobbs Ferry and Croton-on-Hudson with new and expanded office spaces. (Even more doctors are taking up residence in the county this spring as ColumbiaDoctors, a NewYork-Presbyterian/Columbia University Medical Center medical practice, moves into a 20,000-square-foot space in Tarrytown.)
It may seem like there’s a lot of redundancy of services in a small geographic space, but the New York State Department of Health doesn’t see it that way. The state agency requires hospitals to substantiate the need for medically related building or services in a community. The CON, or Certificate of Need, process gives the state DOH “oversight in limiting investment in duplicate beds, services and medical equipment which, in turn, limits associated health care costs,” according to its website. As long as the DOH stamps its approval, medical institutions may continue to embed themselves within the same towns and cities.
Providing primary care in a community whose patients they covet is a key way hospitals expect to increase their volume. These new standalone facilities are built for appeal; they don’t carry the doc-in-a-box stigma once associated with retail medical care. A clinic, urgent-care, or wellness center is often the first line to establishing a connection to a hospital brand, particularly among a younger generation of patients who eschew the “single-source, primary-care-physician model favored by older generations,” according to a survey commissioned by PNC Healthcare last year. The survey found that Millennials prefer retail and acute-care clinics nearly twice as
often as baby boomers and seniors.
Beyond the exceptional care these outpatient facilities pledge to everyone, they tend to distinguish themselves through the details. In some cases it’s the availability of late-night or weekend appointments; in others, it’s a variety of specialists or the convenience of getting x-rays, physical therapy, or minor surgery close to home. Northwell’s New Rochelle facility advertises “highly competitive same-day pricing” for patients who may be comparing costs among clinics. Others offer wellness options, such as support groups and nutrition counseling, to draw new patients.
The overarching intent is to keep people healthy, which administrators believe will result in fewer hospital stays, bolstering the bottom line. “One of the goals of healthcare reform is prioritizing hospital care for the sickest patients,” explains White Plains Hospital CEO Susan Fox, who notes that her hospital has responded by creating new facilities and additional advanced programs to be able to provide “the right level of care in the right setting.”
“That’s our strategy here,” she adds.
Focusing on the Most Prevalent Diseases
Another strategy for local hospitals is to focus on diseases like cancer, whose prevalence, unfortunately, presents myriad business opportunities. White Plains Hospital recently renovated its Dickstein Cancer Treatment Pavilion and added a new six-story pavilion, which opened in February, doubling its original space for cancer care. Nine miles away, NewYork-Presbyterian/Lawrence Hospital officials have been busy constructing their three-story cancer center scheduled to open later this year. And in April, administrators at Phelps Memorial Hospital began the process of bolstering their cancer program by filing a certificate of need with the state Department of Health for a $7.1 million 27,000 square foot oncology facility. These are business decisions based on the realities of the disease.
“There are 5,500 new cases of cancer diagnosed each year in Westchester,” says Maureen Killackey, MD, clinical director of the NewYork–Presbyterian/Lawrence Hospital Cancer Center. “One out of two men, and one out of three women, will get cancer [nationwide] by age 85. Eighty-five percent can be treated in a community-based comprehensive cancer center.”
White Plains Hospital and NewYork–Presbyterian/Lawrence Hospital both have a substantial stake in assuming people will accept that notion. Each has invested more than $50 million in its respective cancer center. White Plains Hospital added 35,000 square feet of additional space with its new tower, which is connected to the existing center. NewYork-Presbyterian/Lawrence is housing its 40,000-square-foot unit—including new, state-of-the-art operating rooms—on the site of a former garden. Other than the color schemes and square footage, they are, on paper, providing similar services: new infusion suites and a linear accelerator for enhanced radiation oncology capabilities, among others. Each boasts renowned on-staff physicians, clinical trials, cutting-edge equipment, and the ability to teleconference with additional specialists who may be in the Bronx or Manhattan or anywhere in the world. Both units are designed with an eye toward comfort for people undergoing the harsh treatment regimen cancer patients often endure.
Though the Bronxville and White Plains centers are the most recent additions to the arena, nearly every hospital in the county, including the 12-bed St. John’s Riverside Dobbs Ferry Pavilion, have oncology offerings, underscoring how pervasive a disease—and business opportunity—cancer is. While many people have excellent odds of winding up in remission, most cancer diagnoses necessitate years of monitoring. Attracting patients to their cancer centers ensures a long-term relationship between patient and hospital.
It is the same situation with heart disease.
“If you are a true community hospital, you have to treat the most prevalent diseases, and that’s cancer and heart disease,” says Ferreri.
Northern Westchester Hospital recently completed a $36.6 million surgical suite renovation.
The quest to be the cardiac-care provider of choice for Westchester residents has also expanded. White Plains and NewYork-Presbyterian/Lawrence Hospitals have upgraded or added to their cardiac-catheterization capabilities recently. (Among the treatments available in a cardiac-catheterization lab are stents, biopsies, internal pacemaker implantation, and emergency angioplasty for people having heart attacks.) Northern Westchester Hospital has an application on file with the state DOH to establish its first cardiac-catheterization lab. Saint Joseph’s Medical Center recently opened a freestanding cardiac-care facility in Yonkers, and Westchester Medical Center keeps adding to its extensive list of cardiac-care capabilities.
“The things we focus on are the advanced services,” explains Michael Israel, Westchester Medical Center Health Network president and CEO. “We used to be the only hospital that did cardiac cath. Then the technology improved, and it became widely available in many hospitals. Now, we do much more advanced things, like TAVR,” he says, explaining that transcatheter aortic valve replacement at WMC is a new approach to replacing heart valves, one that vastly shortens a patient’s recuperation time and hospital stay.
Westchester Medical Center, the largest hospital in the region, differentiates itself by focusing on industry-leading treatments and bringing its services to communities farther north, say hospital leaders. Its joint venture, announced last year, with Bon Secours Charity Health System, added community hospitals, several other medical facilities, and a network of more than 80 physicians to its fold. It also recently announced a new partnership with Kingston-based HealthAlliance that will further expand its reach in the Hudson Valley. Westchester Medical Center now has networks and affiliations in eight counties: Westchester, Rockland, Putnam, Dutchess, Orange, Sullivan, Ulster, and Delaware, as well as a $500 million, 15-year joint venture with Phillips which, among other benefits, enhances its telemedicine capabilities. This new eHealth Program allows ICU staff in Valhalla to monitor vital signs, note status changes and connect with patients and family members through in-room cameras in Poughkeepsie’s MidHudson Regional Hospital’s ICU. The program increases the hospital’s geographic reach and connects their specialists to people many miles away who wouldn’t otherwise have access to those doctors.
While Westchester Medical Center is covering more ground outside the county, Bronx-based Montefiore Health System is asserting itself within county lines. Its acquisition of Mount Vernon Hospital and Sound Shore Medical Center in 2013 added significantly to its Westchester patient base, one of its major objectives.
A 2014 redesign of Greenwich Hospital’s maternity wing helped it welcome a record 2,814 newborns in fiscal year 2015.
“Our vision is to have a million people we are caring for,” notes Montefiore’s Susan Green-Lorenzen, RN, senior vice president, operations. “We want to provide them with the best care in the right location.” This idea of “population health management” is a trend healthcare organizations are employing to ensure the patients in their networks stay well at home. It’s targeted largely toward people with chronic conditions, such as diabetes, COPD, or congestive heart failure, who wind up admitted to hospitals in disproportionate numbers. Studies have shown that patients fare better, and it’s more cost-effective, if they keep their symptoms under control. Frequent monitoring from caseworkers via phone or home visits can be part of that process.
One local hospital, just-over-the-border Greenwich Hospital, is competing by investing in numerous areas. In addition to the millions it has allocated toward a new Stamford outpatient facility, a linear accelerator for radiation oncology, and the latest generation of the da Vinci robot for surgery, Greenwich Hospital has recently redesigned its maternity wing with some special touches, which were rewarded with a record number of new babies.
“Known as the region’s destination hospital for prospective parents, Greenwich Hospital welcomed a record 2,814 newborns in fiscal year 2015,” notes Marc Kosak, Greenwich Hospital’s senior vice president of administration. For patients who want additional luxury after they’ve finished laboring, the hospital has luxurious comfort wear and massage services available for an extra charge.
Standing Out in a Crowded Market
As the large health networks with advanced-care offerings move in, residents have many more places to turn for their procedures than they’ve had in the past. As a result, capturing their attention in a crowded market with overlapping services has gotten more complicated. Traditional advertising methods, like slick brochures in the mail and ads splayed across buses, are not enough. Increasingly important—and effective—are recommendations from physicians.
Hospitals recognize the influence primary-care physicians have on steering patients their way. Courting large physician networks, retaining the doctors who trained on their floors, and using research opportunities as incentives help keep those referrals coming.
“We graduate 10 residents a year,” says Spicer of Saint Joseph’s. “When those 10 graduate, we look to assist them by placing them with some of our physician practices. We look to hire them in hospital-affiliated primary-care practices.”
Besides referrals, doctors have assorted roles in hospital advertising campaigns.
“When we first got the Mako robot for partial knee and complete hip replacements, our surgeons actually went out into the community and met patients face to face at senior centers and churches to talk about it,” says Fran Davis, vice president for nursing at St. John’s Riverside Hospital in Yonkers. St. John’s invests a lot of time in cultivating relationships with the people in the city, she notes; connecting their doctors with residents is one way the hospital secures those ties.
At White Plains Hospital, a lounge in its cancer treatment area and the brand-new lobby of the main building both evoke an upscale hotel-like feel.
If you don’t find them at a community center near you, look for physicians online. You can watch them earnestly explain illnesses or promote procedures within hospital websites or on YouTube. For those hospitals willing to spend the cash, there is also television advertising.
NewYork-Presbyterian Hospital, parent to Lawrence and Hudson Valley Hospitals locally, bought 60 seconds of notoriously expensive airtime on Super Bowl Sunday this year to run a colorful, animated ad explaining its research on immunotherapy in cancer.
Plugging their own merits may not sway increasingly savvy consumers, however. Sorting through the hyperbole and deciphering numerous accreditations and certifications is difficult. It isn’t clear to the average consumer whether it’s more impressive for a hospital to be a U.S. News & World Report designee or recommended on Healthgrades.
Since 2008, with improvements implemented in 2015, there has been a more impartial avenue to compare hospitals: HCAHPS scores. The Hospital Consumer Assessment of Healthcare Providers and Systems is a standardized survey measuring patient satisfaction on a number of issues. Among the items assessed are how well the hospital staff communicates and how responsive they are to patients’ needs. It also asks for an overall rating of the hospital and whether they would recommend it to family and friends.
Not surprisingly, hospitals are keenly aware of the importance of being competitive when it comes to HCAHPS scores.
“We look at our patient-satisfaction scores daily here,” says Davis. “It’s also something that patients now look for; they are educated consumers. HCAHPS scores play into their decision about what hospital to choose. We are really cognizant of that here.”
What makes those surveys more important than simply the happiness of their patients is that hospitals receiving Medicare or Medicaid money can be either penalized or rewarded a percentage of their reimbursements based on those scores.
At Phelps Memorial Hospital Center’s SurgiCenter, each patient has a private room in the admission and recovery area.
“It’s made everyone very focused on the quality of care,” says Elisabeth Wynn, senior vice president for health, economics, and finance at the Greater New York Hospital Association, of how seriously hospital administrators regard their scores.
Still, no matter what the scores suggest or the ads promote, a strong sentiment persists among many Westchester residents that you need to head south, to New York City, to find the best medical institutions.
Refuting that contention is another battle hospitals here have to face if their plans to win over patients are to be successful. A recent spate of promotions on television, radio, in print, and online emphasized both the great care to be had close to home, as well as the NYC connections that local hospitals have to big names, like NewYork- Presbyterian, Montefiore, or Lenox Hill (a Northwell affiliate).
To paraphrase the film Field of Dreams: If you build it, they will come. Hopefully. Nine of the 12 area hospitals are nearing or have surpassed the century mark, numbering them among the oldest businesses in Westchester. In addition to caring for sick residents and their longstanding histories, these hospitals are vital to the local economy. Thousands are employed within their walls, and hospital entities own large swaths of Westchester real estate. There’s a lot riding on their success, while the continuing evolution of healthcare creates an uncertain future. Thus, the competition shows no sign of abating.
Says Northwell’s Ferreri, “Survival is based on volume, efficiency, quality, and service.”
Your cheat sheet to the frenzy of hospital mergers and affiliations that have occurred over the last few years.
Greenwich Hospital: Joined Yale New Haven Health System in 1998.
Montefiore Mount Vernon Hospital: The former Mount Vernon Hospital was acquired by Montefiore Health System in 2013.
Montefiore New Rochelle Hospital: The former Sound Shore Medical Center was acquired by Montefiore Health System in 2013.
NewYork-Presbyterian/Lawrence Hospital: The former Lawrence Hospital was acquired by NewYork-Presbyterian in 2014 after more than 10 years of affiliation.
NewYork-Presbyterian/Hudson Valley Hospital: The former Hudson Valley Hospital Center was acquired by NewYork-Presbyterian in 2015.
Northern Westchester Hospital: Joined Northwell Health in 2014.
Phelps Memorial Hospital Center: Joined Northwell Health in 2014.
Saint Joseph’s Medical Center: Remains independent with a clinical affiliation to Montefiore Health System.
St. John’s Riverside Hospital: Remains independent with a clinical affiliation to Montefiore Health System.
St. John’s Riverside Dobbs Ferry Pavilion: The former Community Hospital at Dobbs Ferry was acquired by St. John’s in 2002.
Westchester Medical Center: Acquired six hospitals within the past three years, in Poughkeepsie, Suffern, Warwick, Kingston, Margaretville and Port Jervis.
White Plains Hospital: Became a member of the Montefiore Health System in 2015.
Bonnie Dresner is a local freelance journalist, EMS educator, and paramedic. She’s witnessed the evolution of hospital care while bringing patients through the doors of many facilities over the years.