With national and state policymakers pushing to divert patients from costly emergency rooms to less expensive office visits and preventive care, hospitals in New York City are expressing their skepticism by expanding their emergency departments.

While some hospitals are simply adding square footage, others are adding a specialized approach to emergency care.

Overall, the smell of fresh paint and the sound of hammering at half a dozen hospitals citywide reflects a confluence of factors: a dearth of routine primary care, a growing number of uninsured patients, and an aging population that is living longer but getting sicker. Paradoxically, the period of expanded emergency departments also comes as some hospitals are being downsized by the Berger Commission, a state panel that recommended that five city hospitals close by June 2008.

“I think that the expansions that we’re talking about are intended to ease those pressures and increase patient treatment and satisfaction,” the president of the Greater New York Hospital Association, Kenneth Raske, said.

In 2005, New Yorkers made 3.6 million emergency room visits, up from 3.4 million visits in 2000, according to the Greater New York Hospital Association. There were 421 emergency room visits for each 1,000 individuals in 2005, up from 439 visits for each 1,000 people in 2000, the group told The New York Sun.

Within the past eighteen months, several hospitals have opened newly renovated emergency departments. In September 2006, doctors at New York Downtown Hospital began seeing patients at the $25 million Lehman Brothers Emergency Center. In February of this year, Lenox Hill Hospital unveiled its $20 million Anne & Isidore Falk Center for Emergency Care. All the projects must be approved with a “certificate of need” by the state health department before construction begins.

“There are a lot of people around the city, not just me, who are really seriously interested in providing the best emergency care and they’re trying to do it now and they’re trying to assess the changing needs and the needs of the future,” said the emergency physician-in-chief at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, Neal Flomenbaum.

This past August, Montefiore Medical Center completed construction of its expanded emergency department on the hospital’s Weiler campus in the Bronx. With an additional 7,000 square feet, the new department is capable of handling 90,000 visits each year, up from 60,000. Hospital officials said the expansion was necessary to meet patient volume: In 2002, the hospital logged 42,000 emergency visits and this year, it is on track to exceed 65,000.

“We’ve completely run out of space,” Montefiore’s vice president of clinical and emergency services, Dr. Peter Semczuk, said. As part of the expansion, Montefiore added 28 patient treatment areas, bringing the total to 50.

“We think the growth is going to continue unabated here,” said Dr. Semczuk, pointing to Montefiore’s status as the only academic medical center in the Bronx.

For some hospitals, expansion plans are directly linked to the Berger Commission.

Blocks away from doomed Cabrini Medical Center in Gramercy Park, for example, construction is underway at Beth Israel Medical Center, where a new auditorium for education in emergency medicine and other disciplines was recently completed near the hospital’s emergency room.

On the West Side of Manhattan, Roosevelt Hospital is set to break ground on a new emergency department this month, a project in the works for several years, but inspired in part by the closure of the nearby St. Vincent’s Midtown hospital. Since St. Vincent’s closed in August, Roosevelt has seen the number of daily emergency visits jump to 193 from an average of 150.

Both expansions are “very high on our agenda,” the president and CEO of Continuum Health Partners, the parent company of Beth Israel, St. Luke’s-Roosevelt, Long Island College Hospital, and the New York Eye & Ear Infirmary, Stanley Brezenoff, said in a recent interview. “It goes back to the nature of the health care delivery system,” he said, referring to the tendency of patients to seek primary care at emergency rooms.

Officials at other hospitals echoed similar sentiments regarding a need to expand.

“Why is that true?” the president and CEO of NewYork-Presbyterian Hospital, Dr. Herbert Pardes, said. “I’m not sure. They closed some other emergency rooms, so there’s less available. The other thing is that medicine can do more, so people will come in more. We keep people alive longer, so as they get older they are more likely to become ill.”

At NewYork-Presbyterian, the emergency department is becoming increasingly specialized, with separate spaces dedicated for adult emergency and urgent care, and pediatric emergency treatment.

“We have people who come in who are in the process of developing a stroke. We want them in very fast,” Dr. Pardes said. “Same with a heart attack.”

NewYork-Presbyterian also incorporates specialized approaches to adolescent psychiatry at its Washington Heights campus. The expansion of the emergency department at the Upper East Side Cornell campus will house a new geriatric emergency program, which the hospital said is the first of its kind nationwide. The program will cater to older patients with features like stretchers that can be put in a sitting position, larger signage printed in black on white, special lighting, and a uniformly-colored floor designed to prevent falls. Geriatricians will also be brought on board, since doctors said geriatric patients often present with complex symptoms. Overall, the new unit will have 15 new treatment areas with doors that seal shut, if necessary, as opposed to curtained-off cubicles.

During a recent tour of the hospital’s emergency department, Dr. Flomenbaum, his voice partially drowned out by a construction crew’s hammering outside, said the doors would better prevent the spread of disease. “A major challenge in emergency medicine is how do you treat patients who are dangerous or potentially dangers to others because of the infections they have,” he said. “I’m trying to put out fires now, and at the same time think about where we’re all going to be 10 to 20 years from now.”