Martha’s Vineyard Hospital walk-in clinic nears completion

Hospital CEO Tim Walsh at the front desk of the walk-in clinic. — Photo by Nelson Sigelman

The transformation of the former emergency room at Martha’s Vineyard Hospital (MVH) into a new walk-in clinic is in its final stages. Once completed, the state-of-the-art facility will provide Islanders and visitors with improved access to noncritical health care — and an alternative to walking into the emergency room, or seeking an appointment with a primary-care doctor.

“This is a need in the community that we needed to service,” hospital CEO Tim Walsh told The Times Monday. “It closes a hole in our delivery system that was being filled by others.”

Monday morning, Mr. Walsh took The Times on a tour of the gutted and rebuilt 4,800-square-foot hospital wing that will accommodate the walk-in clinic and separate offices for two new primary-care doctors.

A crew of a dozen tradesmen from Columbia Construction of North Reading were installing a complex labyrinth of wiring, piping, and air exchange ducts, which will eventually be hidden by the new ceiling. Two carpenters were installing a curved desk in the reception area.

“The clinic will be staffed by nurse practitioners and physician’s assistants, similar to the other walk-in clinics on the Island,” Mr. Walsh said. “And there will always be a doctor available.”

Mr Walsh said the clinic is expected to be completed in April, and will be fully functional by summer. Hours of operation have yet to be determined, and will be somewhat dependent on demand.

Mr. Walsh said the one of the few remaining challenges is finding staff parking for the summer months, which will most likely mean offsite parking within walking distance of MVH in order to open up parking spaces in front of the clinic. The last step before the clinic can open will be passing the Department of Public Health final inspection.

The clinic will have five exam rooms, several nursing stations, a lab area, a reception area, and an expansive waiting area. Mr. Walsh said he expects to hire at least one new primary-care doctor before he retires in mid-May.

In a previous interview with The Times, Dr. Jeffrey Zack, chief of emergency medicine, said the walk-in clinic will reduce costs for patients and also ease the demand on emergency services. “All too often patients utilize the ER because they may not have a primary-care doctor,” he said. “Emergency medicine is here for the sickest of the sick, yet over the past 10, 20 years we’ve started to take care of everybody. We do a lot of primary care, especially here on the Island. It isn’t the most cost-effective way to deliver quality care. This [walk-in clinic] fills that need of ‘not too sick but can’t wait for an office visit in a week.’”

Dr. Zack said that the walk-in clinic will also help manage the surge in patients when there’s an outbreak of the flu or a virus. “Historically this overflow would go into the ER, which diverts resources and is a costly way to practice medicine. But up until now, there’s been very little option for folks on the Island,” he said.

Mr. Walsh said that the walk-in clinic will also help the hospital adjust to the new conditions of the Affordable Care Act, also known as Obamacare. “They want to do global payments in the future, so they can say, ‘We’ll give you $25,000 a year for this patient; you figure out the health care,’” he said. “That’s where a walk-in clinic can save money.”

Mr. Walsh said people with more serious symptoms, such as chest or abdominal pains, should still go to the ER. “If you have a sinus infection, you go to the walk-in clinic. But if you have chest pains or belly pain, you should go straight to the ER,” he said.

The walk-in clinic is the latest addition to the expanding continuum at MVH in recent years that includes inpatient care overseen by hospitalists, oncology services, and electronic medical record keeping, under the umbrella of the hospital’s parent organisation, Massachusetts General Hospital (MGH), which also provides the Vineyard hospital with radiology and anesthesiology services.

Mr. Walsh said that Partners HealthCare, which MVH became affiliated with in 2007, is also investing $1.2 billion in Epic, a new software system that will provide caregivers across the Partners HealthCare system with improved access to medical records. He expects MVH to be using Epic by this time next year.

Beset with delays

Originally, the walk-in clinic was due to open at the beginning of last summer, but the renovation was plagued with delays. Problems arose right out of the gate when the beleaguered building revealed more damage than was expected, primarily the result of a notoriously leaky roof.

“It’s been quite a feat,” MVH director of facilities John Murray said about the top-to-bottom renovation. “It was a very challenging building.”

Work was also delayed when a problem arose with an air exchange unit in the main hospital, which required $700,000 worth of repairs.
Permitting hurdles were frequent. A good deal of work had already been done before Mark Barbadoro came aboard as the Oak Bluffs building inspector in 2014. The more exacting standards that come with hospital building codes were not being met, in his opinion. There was also a difference of opinion on whether the walk-in clinic was considered a “hospital,” which would have required enormous changes. Once it was determined that it did not have to fit hospital codes, there were still significant issues to be resolved.

“The initial problem was that in their haste, they gutted the place,” Mr. Barbadoro told The Times in an earlier interview. “I guess they thought they could just knock down 5,000 square feet of the building without consequence, but they really weren’t prepared in terms of having an actual functional plan.” Mr. Barbadoro said as an example, the wiring from the emergency generator was not up to code. “Critical branch wiring has to be fire-rated, and it wasn’t,” he said. “They literally had to dig it all out … I was trying to push them to a higher standard, and caught them off-guard a little bit.”