John Mastrosimone was having a bad year. He had taken his five-year-old son to many medical appointments, some with pediatricians, some in emergency rooms, and was not happy with the treatment he got there. “It was very difficult as a parent to see how disconnected and uncoordinated the care was. There was a lot of duplication in the process.”
That all changed when he had a crisis while the family was on vacation in Florida and they took him to an urgent care center, a halfway point between a doctor’s office and an emergency room, aimed at patients with non life-threatening conditions. The experience Mastrosimone had in Florida was so good that as a property developer specializing in healthcare facilities, he decided to open his own clinic.
HealthCARE Express opened in July at 4065 Quakerbridge Road in West Windsor. The clinic is open to anyone who walks in from 8 a.m. to 8 p.m., or by appointment. It offers treatment for most non life-threatening conditions, from colds, to minor injuries, to exams and vaccinations. The facility accepts Medicare and most insurance, as well as low-cost cash payments for the uninsured.
Mastrosimone’s HealthCare Express is part of a Texas-based chain that is rapidly expanding around the country, a reflection of the general trend in the urgent care center business.
According to the Urgent Care Association of America (UCAOA), the industry grew by about 300 centers a year between 2008 and 2010. That rate doubled to 600 centers in 2011, although reliable data is hard to come by since there is no national database of urgent care centers, and federal registration is not required. The UCAOA attributes recent industry growth to a confluence of events: difficulty in finding primary care, emergency room overcrowding, and the influx of private equity into urgent care as the business model proves itself.
The Route 1 corridor has seen similar growth in a similar time period. The area has had walk-in clinics for decades, but the first franchised facility didn’t spring up until 2010 when AfterOurs opened an evening clinic at One Washington Boulevard in Robbinsville. A few months later, Doctors Express built a center of its own a half-mile down Route 33 in Hamilton Square.
In Skillman, St. Peter’s University Hospital of New Brunswick has opened an urgent care center in the Village Shopper retail center on Route 206. The urgent care boom has reached West Windsor, where InFocus Urgent Care opened on Princeton-Hightstown Road, as well as Ewing and Lawrence, which each have multiple centers.
PM Pediatrics, at 2421 Route 1 in North Brunswick, is also part of a proliferating chain of urgent care centers. The Lake Success, New York-based company has 13 locations throughout New York and New Jersey. The North Brunswick location opened in 2013 and specializes in late-night service, with the doors opening at 4 p.m. on weekdays and staying open until midnight. The weekend hours are noon to midnight, and the place is open 365 days a year.
Mastrosimone says urgent care centers, while relatively new on the scene in central Jersey, have been popular for years in other parts of the country because of their patient-friendly nature. “From the patient’s perspective, they can get the care they need when they need it,” he says. “It’s more of a consumer-driven retail type of business where there’s an option to get treated without waiting for an appointment. Most people are going to jump at that opportunity.”
Mastrosimone says long waits for appointments have caused some patients to turn to urgent care centers instead of consulting with their family doctor. On the other end of the spectrum are patients with non-life-threatening emergencies who are choosing between an urgent care center and an emergency room, where urgent care centers once again look appealing.
“The E.R. is very expensive to go to, especially if you don’t have insurance,” Mastrosimone says. Still, in New Jersey, urgent care centers have faced a bit of a stigma as more facilities enter the market. Urgent care first gained popularity in the Midwest and South, and practitioners at the new facilities in the Northeast have been forced to educate potential clients about what they are — and are not.
But it hasn’t stopped companies from coming into the state. A Route 130 facility in Hamilton will be Virginia-based Patient First’s first foray into the state, and MedExpress will soon have 17 centers in the state, with one just opening in Cherry Hill and three more on the way.
Mastrosimone is aware of the rapid boom in the business he just entered. “While there are centers popping up all over the place, they are not all created equally,” he says.
“While you have to assume they all provide excellent medical care, what distinguishes one from the other is the environment. What we did is that we took the lessons learned and cues from the hospitality industry. A high level of customer service is critical. Interaction with patients has to be consistent. That’s how our facility works. Informally, we call it the Ritz Carlton Experience because Ritz Carlton is known for having the highest level of customer service possible. It’s about figuring out what patients want and giving it to them consistently and going above and beyond their expectations.”
Customer service and atmosphere is how HealthCARE Express hopes to stand out in an increasingly crowded field. Mastrosimone attributes the rise of the urgent care center to a push from the patient population that doesn’t want to sit in waiting rooms or the sterile environment of hospitals.
Mastrosimone’s facility has doctors, nurses, x-ray technicians, and phlebotomists, for a total of a dozen staffers.
Mastrosimone is no newcomer to the healthcare sector. His family built the building across the street from HealthCARE Express, Capital Commons, which is home to many doctors’ offices, as well as the Lawrence Campus West medical office campus on Federal City Road. Mastrosimone is in fact a second-generation real estate developer. His father, John Simone, founded Simone Realty, which is located in Lawrence Campus West.
The difference between the father and son’s last names goes back to when Mastrosimone’s great-grandfather arrived from Italy. Somehow the family name changed from Mastrosimone to the anglicized “Seamon” at that point. For his generation and the next, it was Seamon. But Simone’s grandfather decided his children would bear the name “Mastrosimone,” which appears on all of the birth certificates of the third generation. John Simone, Mastrosimone’s father, went by “Simone” in order to continue the family business, and his siblings all used different variants of the name, including the playwright William Mastrosimone. Their children, however, all go by “Mastrosimone.”
Simone’s own father got into the business by buying land between Princeton Avenue and Route 1, building an appliance store, a landfill, a bowling alley, and several other businesses, most of which were eventually bulldozed to make way for road construction. Simone was put in charge of managing the bowling alley and other real estate holdings after he graduated from high school, learning the family business by trial and error.
John Mastrosimone went to the Hun School and then majored in accounting at St. Joseph’s University in Philadelphia, Class of 1999. He went right to work in the real estate business after graduation, learning the business in the school of hard knocks — by knocking on doors to find clients for Jerry Fennelly of NAI. “I was always in the real estate business,” he says. In the 1970s and ’80s, the family business had become a niche brokerage by forming partnerships with doctors, and became known for specializing in healthcare. Mastrosimone likewise became a specialist in medical offices. While Mastrosimone has gone into the urgent care business, Simone Realty continues the family business.
One of its largest projects right now is the former Capital Health campus on Bellevue Avenue in Trenton. In 2011, Capital left the sprawling 550,000-square-foot campus to move to its new location in Hopewell near I-95. In 2013 Simone Realty brokered a deal for Global Life Enterprises to turn the vacant hospital into the GLE Health and Wellness Plaza. Owner Priti Pandya-Patel is renovating the facility and leasing space to private healthcare providers.
The elder Simone also had a hand in helping the hospital find its new home — he sits on the foundation’s board. He first proposed a move to Princess Road in Lawrenceville, later switching it to the former Merrill Lynch property in Hopewell.
Simone Realty built Capital Commons, 20,500 square feet at 4056 Quakerbridge Road, from the ground up. The current home of Mastrosimone’s business, 4065 Quakerbridge Road, was a 12,000-square-foot rehab job originally intended to be rented out to physicians. Lawrence Campus West, at 100 Federal City Road, is home to a 31,000-square-foot medical office complex that the Simone firm built on spec starting in 2004.
These properties show the Simone approach to medical development, which is to build or renovate one-story buildings, so as to eliminate the need for elevators, separate HVAC systems and entrances so practices don’t have to share space, and to make sure the offices have plenty of natural light, high ceilings, earth tones, and ample parking.
Simone told U.S. 1 in 2010 that specializing in medical development means building to suit the unique needs of healthcare providers. (See U.S. 1, January 27, 2010.) Some specialists have equipment that requires specialized spaces. Medical space tends to be more expensive because it cannot be easily adapted to other uses or even to other kinds of medical practice.
Mastrosimone has mostly stepped back from the real estate business to run his urgent care center full time. One thing that sets Mastrosimone’s center apart from other urgent care clinics is the owner’s background. Many centers are run by doctors. Mastrosimone looks at his center from the perspective of a patient, and has done so since the beginning.
As a non-physician, Mastrosimone faced a steep learning curve in setting up a medical business. The doctors he hired gave him advice, as did the HealthCARE Express main office in Texas. But much of it he had to figure out for himself.
“The legal aspects, the healthcare regulations, the way partnerships need to be set up, the many rules and regulations, the Codey Law, make it difficult for non-physicians to enter the business.” The Codey Law is a complex state law that prohibits doctors from referring patients to other healthcare services in which they have a financial interest.
Then there were the mundane details, such as what services to offer and what supplies to order that were unfamiliar to Mastrosimone at first. But ultimately, Mastrosimone believes that not being a doctor gives him an advantage, since he focuses more on customer service than most physicians do. “At the end of the day, I get a lot of really good feedback from patients who like the fact that I’m not a doctor,” he says. “They know they’re going to get excellent medical care. It’s encouraging to them that we are trying to tend to all of their needs.” Mastrosimone hopes to expand into a portfolio of urgent care centers in the future. But for now, he is focusing on making HealthCARE Express a success.
“It’s really building a business from the patient’s perspective, not the physician’s perspective,” Mastrosimone says. “We’re building a business, not a practice.”
HealthCARE Express, 4065 Quakerbridge Road, Princeton Junction 08550; 609-297-0546; John Mastrosimone, www.healthcareexpress.us.