CityMD launches integrated care practice with urgent, primary and specialty doctors under one roof
Dr. Shahida Khan, left, a CityMD physician, and Dr. Karyn Ginsburg, an endocrinologist, at the recent opening of a new clinic in Greenvale where urgent-care patients can access specialists. Credit: Danielle Silverman
CityMD has launched a new medical practice offering the urgent-care chain’s walk-in services plus primary and specialty care under one roof, the latest entry on Long Island’s fast-growing list of super-sized doctors’ offices offering an extensive menu of services.
At the new office in the northern Nassau County hamlet of Greenvale, CityMD urgent-care doctors see walk-in patients. Alongside them, primary and specialty care doctors with the chain’s sister company Summit Health take appointments. The office now has a primary care doctor and an endocrinologist, with more physicians expected to join as the practice grows.
By offering one-stop shopping, such practices aim to make medical care more convenient and better-managed for patients, and more collaborative and less burdensome for doctors. They also have the potential to save money and bring in more revenue for the companies that own them, if patients get more efficient care and remain in-house when they need specialized treatment.
With the 5,600-square-foot Greenvale office, which opened last month with 11 exam rooms, CityMD and Summit Health are venturing further into a crowded and competitive segment of the health-care market, with outside investor-backed companies and major health-care systems vying for patients, while fewer practices are physician-owned.
CityMD opened a new clinic in Greenvale last week. It is one of the urgent care chain’s first locations that combines traditional walk-in services, primary care and specialty care practices under one roof. Credit: Danielle Silverman
The new clinics tend to offer airy waiting rooms, modern furniture and conspicuously branded signs, as well as smartphone apps where patients can make appointments and get test results and referrals. It’s a dramatic change from the days when most doctors ran their own practices out of nondescript offices and assistants scribbled referrals on slips of paper.
Summit Health, formed in the 2019 merger of CityMD and the multispecialty Summit Medical Group, has more than 340 locations in five states, with more than 2,500 providers.
From its start in 2010, “CityMD was built to help people navigate beyond that urgent visit if they needed additional care,” Jeff Alter, CEO of New York City-based Summit Health, a private equity-backed company that includes the CityMD brand, said in an interview. “And then the vision began to grow into, 'well, if we could have our own physicians behind that CityMD encounter, we can connect care and eliminate some of the cost of health care, the duplication of health care.'”
If patients need hospital treatment, Summit Health's providers can direct patients to the hospitals that would provide the most appropriate care for their particular conditions, Alter said.
Outside investments quadrupled
Summit Health is not alone in seeing the value of providing more cost-effective health care. Investments in physician practices by private-equity and venture-capital firms jumped from $15 billion in 2017 to $60 billion by November 2019, a 2020 report by the American Hospital Association found.
That trend has continued during the pandemic, with outside investors acquiring more than 400 physician groups in the 12 months ending in mid-November 2021, up from 200 to 250 a year from 2017 through 2019, the consulting firm PricewaterhouseCoopers reported.
“There's just so much waste in the system,” said Oleg Bestsennyy, a partner with McKinsey & Company. To cut down on fragmented care and duplicated services, he said, practice owners are making hefty investments in electronic medical records and hiring care managers who contact patients to help keep their treatments and medications on track.
Plus, Bestsennyy said, “by creating a brand that people like and enjoy, and are able to receive persistent, high quality of care, you can also grow that group significantly.”
Hospital systems compete
Even as investor-backed practices grow, the largest multispecialty practices on Long Island are operated by the more established health-care systems that also run hospitals and other major facilities, including Long Island-based Northwell Health, Catholic Health and Stony Brook Medicine, as well as systems based in Manhattan.
The leaders of health-care systems maintain patients are best served by practices that have direct links to hospitals, for the times when higher-level care is necessary. “Not only can we help you stay healthy, but you know, in the event something happens, we have history with you, we have the information, we share it, we can move you through those transitions,” said Jeffrey Kraut, executive vice president for strategy and analytics at Northwell.
Last year, Northwell logged nearly 4.4 million visits to its outpatient facilities, including 115 multispecialty locations on Long Island, and it has another eight such practices in the works, the health system said. Half of Northwell’s revenue now comes from outpatient services. “More and more of health care is delivered outside the walls of the hospital,” Kraut said.
In mall anchor spot
Among the largest new multispecialty practices under development is Stony Brook Medicine’s Advanced Specialty Care at Lake Grove, a 170,000-square-foot colossus expected to open this fall in the former Sears at the Smith Haven Mall.
The system’s existing multispecialty practices, including one in Commack, have “allowed us to develop true multidisciplinary care programs,” said Dr. Margaret McGovern, vice president of health system clinical programs and strategy for Stony Brook Medicine. Patients with complex illnesses such as long COVID, she said, “can see all these providers in a single visit, and then those provider teams can meet together and share information about the care of the patients.”
A rendering of Stony Brook Medicine’s Advanced Specialty Care location planned for the former Sears in Lake Grove. Credit: Innersite, Inc./James Acunto
Mount Sinai Doctors runs an 80,000-square foot facility in Greenlawn that sees about 1,300 patients a day, and Mount Sinai South Nassau hospital is building a 15,400-square foot pavilion in Long Beach. Other new sites are planned as well. The large facilities have staffers who guide patients from one provider to the next, said Ken Long, senior vice president of administration at Mount Sinai South Nassau. “They’re very user-friendly sites,” he said.
Besides, he said, “it's much more cost-effective for health systems to set up a singular, large site than a whole bunch of small sites.”
NYU Langone Health’s multispecialty locations include a 54,000-square-foot facility in Bethpage with 74 exam rooms and six procedure suites that can serve 500 patients a day, as well as a 65,000-square-foot center in Huntington Station and others under development in Garden City, Mineola and Manhasset.
The Manhattan-based system’s outpatient physician network “has grown exponentially” since 2000, from about 200 physicians to 3,300, said Andrew Rubin, NYU Langone’s senior vice president for clinical affairs and ambulatory care.
Not a new concept
Summit Health’s strategy “is not necessarily a new concept,” Rubin said. “It's been our philosophy for many, many years to be able to say, OK, we have an emergency room for people who need an emergency room. We have urgent care for people who need to access us outside of the emergency room. ... And then we have the routine medical practice."
In Rockville Centre, Catholic Health’s Mercy Hospital is building a 16,000-square-foot outpatient center. The system also runs more than 100 outpatient sites, including nine multispecialty practices, seven of which opened in the last five years, with half a dozen more planned from eastern Queens through eastern Long Island, said Dennis J. Verzi, Catholic Health’s executive vice president and chief operating officer.
Catholic Health's system aims to strike a "balance" by offering many small practices throughout the region, along with larger, more centrally located hubs, Verzi said.
Like the 'convenience'
Gary Valentine, 60, an actor who lives in Suffolk County, said he and his wife go to a Catholic Health Integrated Care practice in Lake Success. The practice has 36 exam rooms. “I consider it like the food court of medicine,” Valentine said. “You can get anything you want in one stop. ... The ease of it all and the convenience is really great.”
Dr. Anthony P. Ardito, right, checks patient Gary Valentine at Catholic Health Integrated Care in Lake Success. Credit: Catholic Health/Daryl Thomen
In addition to the sites operated by CityMD and the health-care systems, ProHealth Care, part of UnitedHealth Group’s Optum division, runs dozens of locations on Long Island.
The increased consolidation of physician practices has potential downsides, including reduced competition in some markets and possible expectations that doctors would refer patients to colleagues within their network, even if a different doctor might be more appropriate. But, said Anne Koffel, a partner with McKinsey, “referrals based on familiarity and proximity are nothing new. ... It's something you would experience if you saw your PCP [primary care provider] at a health system as well.”
Easy access to specialists
Some doctors maintain that larger offices can provide better care.
Multispecialty practices “give patients the ability to see their doctors in one place and avoid the hassle of running from doctor to doctor, specialist to specialist,” said Dr. Karyn Ginsburg, Summit Health’s endocrinologist in Greenvale.
Plus, she said, “I could literally walk down the hall to a colleague in another specialty, and ask them questions … while the patient is still in the building,” she said. “It allows me to care for my patients better.”
It’s a model that some patients favor, too. Luis Proano, 69, a school bus driver, said he came to the new Greenvale office for his mandatory annual physical exam because it was convenient to his employer’s Port Washington headquarters.
Dr. Shahida Khan, a CityMD physician performs a physical for patient Luis Proano, 69, of Glendale, Queens, at the new clinic in Greenvale. Credit: Danielle Silverman
“It’s really better” than going to a smaller office, he said. If more care is needed, he said, “you can go to the specialist.”
For many doctors, solo practices have simply grown too costly and the burdens of keeping up with technology and other demands are too great.
Pamela Clark, 64, said when she learned her internist, Dr. Mark Fierstein, was closing his family-run office and moving to a larger practice, she was a little nervous about whether she’d still be able to get onto his schedule.
“I love my doctor. … it was never an option to look for anyone else,” said Clark, a retired corrections officer who works as a security guard.
Pamela Clark, who underwent knee surgery last year, talks to her primary care physician Dr. Mark Fierstein, at an NYU Langone Health multidisciplinary facility in New Hyde Park. Credit: Johnny Milano/JOHNNY MILANO
Fierstein now practices at NYU Langone Ambulatory Care, located in 107,000 square feet spread across three buildings in Lake Success. The internist is “very popular,” Clark said. But, she said, moving to the larger practice “never took away from the time and attention he's given me. ... I don't feel like I got lost as far as the attention that I was used to getting when he was in private practice.”
Plus, she said, she now sees a knee surgeon and gets physical therapy at the same complex.
A family practice moves on
Fierstein and his brother Dr. David Fierstein had seen patients since 1986 and 1990, respectively, in the medical practice founded by their father, the late Dr. Joseph Fierstein. Their late mother Jean and their sister, Carol Rabin, helped run the practice. Rabin now works at NYU Langone alongside her brothers.
Some patients, Mark Fierstein said, “miss the family … they would see my father and my brother and my mother and my sister and that obviously, you know, will never happen here. We miss that, too. That was a pretty special time.”
But with declining insurance reimbursements, rising costs and increasing administrative burdens, he said, “it was becoming harder and harder to meet expenses and continue to offer the kind of patient care that we needed to or wanted to, and demanded of ourselves.”
Fierstein said he’s happy at NYU Langone, and he feels comfortable referring patients to physicians both in and out of the system. Recently, a longtime friend and patient needed back surgery, so Fierstein used the system’s internal-messaging service to contact a surgeon.
“The guy answered me back in 40 seconds,” Fierstein said. “He saw my friend today, and he's operating on him tomorrow. Those kinds of resources, you just don't have available to you in private practice.”
Plus, he said, “when the pandemic hit, NYU took care of everything, we didn't have to worry about protective equipment, we didn't have to worry about getting vaccinated. ... We literally went home one day, and the next day, we were doing video visits from home on our computers. In private practice, it could have taken us weeks to get up and running with video visits. So our patients never missed a beat through the whole of the pandemic.”
Docs follow big-box trend
As their expenses rise and they face more administrative work and, in some cases, lower payments from insurers, a growing number of doctors are joining large practices run by investment companies, insurers or health-care systems rather than practicing solo.
In fact, 2020 was the first year that fewer than half of doctors worked in wholly physician-owned practices – 49%, a drop of 11 percentage points since 2012, an American Medical Association survey found.
Over that eight-year period, the number of large practices – with 50 or more doctors – jumped by 5 percentage points, to 17%. At the same time, the smallest practices – up to four doctors – declined by more than 6 percentage points, to 33.6%, the survey found.
That trend appeared to continue during the pandemic, with 48,400 physicians leaving independent practice to become employees of hospitals or other corporations over the two years ending in January 2021, a study by the Texas-based not-for-profit group Physicians Advocacy Institute and the consulting firm Avalere Health shows.
Maura McDermott covers health care and other business news on Long Island.
