The city government and Children's Hospital of Philadelphia are planning to join forces to provide health care to South Philadelphia adults and children in a unique arrangement that might also include a new library and recreation center.
The plan, announced by Mayor Nutter during Thursday's budget address, moves two existing clinics - a pediatric practice owned by the hospital and a city health center that mainly serves adults, each of them in need of expansion - into one building that would be constructed by the hospital on city land and outfitted by both.
Officials described multiple synergistic possibilities, from the sharing of some medical equipment, waiting room, and lab, to treating children and adults in the same location. For the low-income population that both practices serve, this makes it more likely that some will be seen at all, a key potential benefit.
"Kids are generally healthier if their parents are healthier," said Donald F. Schwarz, deputy mayor for health and opportunity.
Schwarz said the idea came up in an unrelated conversation in the fall, when hospital officials asked if he knew of any property on South Broad Street to move their clinic, which now operates out of the former St. Agnes Hospital; the 30,000-patient practice is the fastest-growing of Children's 30 regional pediatric practices.
He did: The city's Health Center No. 2, near Morris Street just a few blocks away, was the second-busiest in the Philadelphia Department of Public Health's network of primary-care clinics. The roof leaked water, the original, 50-year-old windows leaked air, there weren't enough examination rooms, and the cost of renovations had been estimated at $7.2 million, just $3 million less than replacement.
And there might be possibilities for the outdated branch library and DiSilvestro playground on the same site.
"The possibility of integrating these three new facilities - health center, library, and rec center - would allow us to provide coordinated services that include much-needed health and wellness programming and literacy training," Nutter said in his prepared remarks to Council. "At the same time we will continue to expand the city's dental care, mammography, prenatal care, and a wide range of other children's and adult health-care services."
Under the conceptual agreement, the hospital will fully fund construction for a building that will house both clinics. The city will charge a nominal fee to lease the land.
The hospital is raising money for the health center building and trying for a library and recreation center as well.
"We are very optimistic that we are going to be able to do the first part of it. We are working to be able to get that same level on the other two pieces," said spokesman George V. Bochanski Jr. "The idea of having all these things located within a city block, all on the mission of helping kids - that really appeals to us."
He said he could not provide cost details Thursday. But both he and Schwarz, who was a pediatrician at Children's Hospital before becoming health commissioner and deputy mayor, said the city would pay nothing.
At the same time, Schwarz said, taxpayers will save on energy costs and patients will get a state-of-the-art facility.
The potential linking of health center, library, and recreation center reflects current thinking that "health is holistic," Schwarz said, "and literacy is a critical value and factor in health."
Fitness clearly is as well. "You could write a prescription for a child [or a parent] to get exercise," he said, and that could then get picked up by a rec person who would say, "You should be in a program."
Sara Rosenbaum, a professor of law at George Washington University School of Public Health, said she did not know of any similar arrangements between a pediatric hospital and a city.
"It is the kind of joint venture that you would like to see replicated all over the country," said Rosenbaum, who specializes in insurance and health-care financing for medically underserved populations.
If a library and rec center are included, she added, "then it is very special. Then it is really health and wellness as well."
Philadelphia's network of eight health centers provide primary-care services to the city's neediest people. About half the 339,000 visits last year were from patients with no insurance at all; most of the rest were covered by Medicaid or Medicare.
The uninsured make up an even higher percentage at Health Center No. 2 in South Philadelphia, where 81 percent of the patients had incomes below the poverty level ($19,090 for a family of three). It also is the most diverse of the city's clinics, with about 48 percent of the 53,563 visits last year from black patients, 32 percent Asian, 12 percent white, and 7 percent Hispanic; there were 137 visits from patients who identified themselves as American Indians.
As of December, adult patients had to wait 78 days for an initial appointment at the center. (Health Center No. 10, in the Northeast, is the most crowded, with a 235-day wait.)