Northwell Health’s contract to help turn around Nassau County’s financially struggling public hospital is in peril.
Less than a year after executives of Northwell, the largest private employer in New York State, signed on to help run Nassau University Medical Center, hospital board members have suspended the Northwell contracts, and county employee unions are warning that Northwell is looking to dismantle the hospital, “for parts.”
Trustees of NuHealth, the public benefit corporation that runs NUMC, announced abruptly at a board meeting on Jan. 16 they were suspending consulting contracts with Northwell, saying the board needed time to review the agreements further. The board members largely were appointed during prior Republican county administrations.
Hours earlier, members of the union representing the 3,000 hospital employees had appeared outside the NuHealth board meeting in East Meadow, and a sign on a union truck flashed, in neon graphics,: "Keep Your Hands Off, Northwell."
In the face of such vehement opposition, Nassau County officials are searching for ways to save the deal. They’ve gotten some help from Gov. Andrew M. Cuomo, who has approved three new NuHealth trustees — though that won’t be enough to take control of the board.
Robert Detor, whom Democratic County Executive Laura Curran appointed as NuHealth board chairman hours before the board's vote on the Northwell contracts, said he hopes to be able to “interpret” the Northwell arrangement for board members and union members, “so that everyone understands what's going on, and that really what they're doing is beneficial toward us.”
“I don't see it as a threat. I see it as another set of eyes looking at the situation …, and then making recommendations to the board," Detor said in an interview. But he continued, "no decisions would ever be made that are strategic decisions without going to the board."
Curran said in an interview: “I think all of that is going to be revisited as the board is reconstituted. The work with Northwell is extremely important, and I know that [Nassau’s financial control board] will want those contracts to continue."
As NuHealth transitions to new leadership, its partnership with Northwell has touched off a contentious debate about the role NUMC should play.
The drama comes as NUMC operates with empty beds, and faces the potential for the Nassau Interim Finance Authority, which controls county finances, to put the hospital under its control.
Earlier this month, NIFA issued a request for proposals to hire a "turnaround specialist" to advise on fixing the health system. The consultant can assess the feasibility of proposed major changes, including disposal of facilities and segments of its operations.
NUMC's mix of patients includes many who are low-income and on Medicaid, or who are uninsured.
The hospital struggles with operating deficits — it had a $46.6 million operating loss in 2018, compared with $25.7 million in 2017. Officials say the budget gap could rise to $82 million in 2020 if $53 million in state federal grants that NuHealth received in 2019 don't come through this year.
The hospital has capacity for 520 beds, but only 350 are filled on an average day, Detor said.
“Do we keep those beds open, or don't we? We have to see," Detor said.
When Northwell came to NuHealth in April 2019, its mission was to assist the health system by developing "a five-year strategic plan" for NUMC and the A. Holly Patterson Extended Care Facility centers.
Michael Dowling, chief executive and president of Northwell, had said Northwell was fulfilling a "social responsibility to assist NuHealth."
NuHealth officials have said the agreement will not cost NUMC any money. Asked Friday for financial details of the arrangement, a state Health Department spokeswoman said a Freedom of Information Law request was necessary.
One of Northwell's key jobs was to provide someone to run NUMC. The job went to Winnie Mack, Northwell's senior vice president of health system operations. However, Mack was prohibited from participating in the development of a strategic plan. Terry Lynam, Northwell spokesman, said the state’s approval of the partnership "explicitly prohibited" Mack from participating in strategic planning, "to avoid any perception of conflict of interest."
Mack departed NUMC after six months. She declined to comment.
Union leaders packed the Jan. 16 board meeting and staged a protest to criticize the partnership with Northwell. Some held signs reading, "Stop Downsizing!"
Jerry Laricchiuta, president of Nassau Civil Service Local 830, said at the meeting, “We cannot have a private vendor commingling anything with this public hospital. We have a different mission than they do."
Laricchiuta said if there are plans to downsize, “I believe that’s a huge mistake — we’ve been here for seven, eight decades.”
He said last week: "They’re stripping us down for parts."
Lynam said in a statement: "Northwell Health has had a relationship with NUMC since 2005 that has been restructured over the years based on the needs identified by the hospital’s management team and board of directors. Northwell’s efforts have primarily focused on the provision of clinical services and administrative support."
With Detor's appointment, "we have restated Northwell’s commitment to continue to support NUMC in meeting the health needs of the communities it serves," said Lynam.
Tsunis at the Jan. 16 board meeting declined to answer employees who asked for reassurance that downsizing would not occur or their jobs would not be cut.
But Tsunis, who resigned as board chairman Jan. 17, indicated a Northwell takeover had never been an option.
Tsunis recalled a town hall meeting he held for NuHealth employees where an employee asked: "'Are they taking us over?' I said no … They don’t want us."
"We don't want them, either!" said someone in the crowd at the Jan. 16 meeting.
Said Lynam: "Northwell has no desire to assume ownership of NUMC."
Tsunis said NUMC employees must think differently about the problems facing NUMC.
“It’s not a question of overall downsizing, it’s a question of getting rid of things that we don’t need anymore. We have an animal testing lab no one’s been in 30 years. We should keep that?” Tsunis asked.
Union leaders also have expressed concern that the hospital would close its pediatrics unit.
Detor said while no one has made that recommendation, there are "lots of empty beds" in the pediatric wing. He stressed that he has not reviewed the data, and said any decisions about hospital changes will be determined after a detailed analysis.
Detor also has said he's looking for opportunities to offer more outpatient services at the hospital. Nationwide, hospitals are moving to reduce admissions by sending patients for treatment at outpatient or ambulatory care facilities.
Kevin Dahill, president and CEO of the Nassau Suffolk Hospital Council, a Hauppauge-based trade organization that represents 22 hospitals in Nassau and Suffolk, said “the hospital industry in general, is going though a state of transition."
Dahill said hospitals, "were built almost to be hotel-like, and how do you transition some of those facilities to up-to-date, code-compliant outpatient facilities, or how do you situate new facilities in the communities you're serving? So that’s a challenge that all the hospitals are confronting right now."
Curran argued that some NuHealth board members, "may be clinging to outdated models for delivery of health care services."
She continued, "Let’s see what NIFA’s specialist will find and advise, and it’s way too premature to talk about what we’re going to find and what those recommendations are going to be. We need the leadership in place before we talk about anything else.”
NIFA Chairman Adam Barsky said he came away from the Jan. 16 meeting convinced the control board needs to take action.
Noting the NuHealth board's suspension of Northwell agreements and their sudden appointment of interim CEO for NUMC, he said, “there should be some controls to prevent irresponsible actions of a board that potentially could make the hospital’s financial condition worse.”
“If there was ever any debate as to whether NIFA should have oversight over the hospital, Thursday night’s meetings should end any debate," Barsky said.
But the hospital has staunch defenders.
Dorothy Goosby, senior Hempstead Town Councilwoman who represents many constituents who are treated at NUMC, said at the Jan. 16 NuHealth board meeting, "If they didn't have this place to come to in the first place, where would they go?"
Goosby, a Democrat, continued, "We’re the ones in my district that really have the most needs that you serve, and many of them do not have insurance … "
She added, "to have someone come in who has a bad toothache, or someone who has a foot that’s really in bad shape and not be able to come here … I want this hospital to stay."
Hempstead Councilman Dennis Dunne, a Republican, said in an interview:
“I was a [Nassau County] legislator for 22 years, and we held fast to the mission for the facility, being for the underinsured and the uninsured” and also patients with insurance, he said.
“And if that mission is going to be changed, they’re going to have a fight on their hands,” Dunne said.
Nassau County guarantees $188 million in hospital debt and pays about $22 million a year in annual debt service on behalf of the hospital.
- Northwell provides assistance to help develop a “five-year strategic plan” for Nassau University Medical Center and associated facilities.
- Representatives of Northwell’s True North Healthcare Consulting work with NuHealth trustees on strategic planning and make "operational, administrative and financial recommendations to improve performance” at the hospital.
- Northwell officials “identify operational, management and strategic needs, and develop recommendations to improve them.” NuHealth’s board has sole authority to adopt specific strategies.
Sources: Northwell Health; Nassau University Medical Center