NUMC to expand treatment for heart attacks

For years, Nassau University Medical Center has operated a cardiac catheterization lab capable of diagnosing heart attacks.

What it has not been able to do is treat coronary blockages with the preferred method — a balloon or stent — because it lacked state approvals.

Ambulances have been known not to take patients complaining of chest pain to NUMC, in favor of hospitals authorized to perform the lifesaving procedure known as percutaneous coronary intervention, or PCI.

That's about to change.

Last month, the state Department of Health approved a $4.1 million lab to perform such procedures, contingent on meeting a construction timeline.

For the first time, doctors at NUMC will be able to perform PCIs, a minimally-invasive procedure in which a stent is placed into a patient through a thin tube to unclog plaque in the arteries. Blood flow is then restored to the heart. It is widely known as the most effective and proven treatment for blockages. 

Officials say offering PCIs will help an underserved population of immigrants, the uninsured and minority communities who regularly use the hospital. 

However, some question whether the financially troubled hospital can afford the expansion. The Nassau Interim Finance Authority, a state control board that runs hospital finances, says the public benefit corporation that oversees the hospital will run out of cash by the end of 2023. Hospital officials say they expect to run a deficit of $179.3 million this year.

But Dr. Anthony Boutin, president and chief executive of NuHealth, the public benefit corporation that runs NUMC, said the hospital was moving full speed ahead with the cardiac unit: "We've been waiting for it for a long time."

"Our mission is different than all the other hospitals, in terms of taking care of the underserved, the poor," Boutin told Newsday, adding that state grants will pay for the expense. "When they come here for whatever they come here for, at some point they have to go somewhere else."

Dr. Amgad Makaryus, the hospital's chair of cardiology, said the cardiac unit could help save lives: "If we needed to fix something, we'd have to transfer them to another hospital."

"Before, either they weren't able to come here or they would come here and then there would be a delay in their care," Makaryus said. "And as you can imagine with the surrounding hospitals in our area — it would take at least 20 to 30 minutes, if not more, with Nassau County traffic to actually get them to where they needed to be."

A business case?

Adam Barsky, chairman of NIFA, told Newsday: "We really haven't seen the business case that justifies that kind of expenditure, but we're open to looking at it."

NUMC has been trying to win state approval for years. In February 2020, Boutin lamented to board members that state officials were holding up the project due to "financial instability" at NuHealth.

NuHealth has struggled with consecutive operating losses over the past decade, recording deficits of $135.6 million in 2021 and $102.3 million in 2020.

Nassau County, as the hospital's guarantor, backs $131 million in NuHealth debt.

The new cardiac procedures should bring in about $1.3 million in  net revenues by 2026, hospital projections show. 

Though NUMC treats 80% of patients who are on Medicaid or Medicare, or are uninsured, Boutin said the initiative will also bring in patients near the hospital with private insurance, which reimburses the hospital at higher rates.

Improving health equity

Adding a cardiac lab to an underserved community could result in better health outcomes all around, said Dr. Dipti Itchhaporia, past president of the American College of Cardiology and a member of the organization's Health Equity Task Force.

"What is better care, that is hopefully going to translate into better outcomes," she said.

In emergencies, "It's critical that I restore blood flow as soon as I can," she said. "If I have the ability to do that in my center, you're going to get the best outcome."

"We can't say just because you're in an underserved community, you don't get access that someone with a better ZIP code gets," Itchhaporia told Newsday. 

At a Feb. 9 meeting of the State's Public Health & Health Planning Council, board member Denise Soffal asked state health department staff if the program was necessary given that other hospitals in Nassau County perform PCIs.

Shelly Glock, director of the state health department's Center for Health Care Facility Planning, Licensure and Finance, said to qualify, a hospital must show that it refers at least 36 emergency procedures a year to other hospitals.

NUMC refers more than 50 patients for emergency PCIs annually to other hospitals, justifying the need for one, state officials said.

"That referral out of that number of cases indicates that they are able to meet the 36," Glock said. "So the other programs in the area are there, and this reduces the transfer of those patients who might need that service showing up at the door of NUMC."

St. Francis Hospital in Flower Hill performed 1,257 emergency PCIs in 2021; NYU Langone Hospital in Mineola performed 900; and North Shore University Hospital in Manhasset performed 866; according to the state Department of Health.

NUMC officials expect to conduct 300 PCIs annually by the cardiac unit's third year in operation.

Running out of money

On Jan. 30, Barsky wrote to NuHealth Chairman Matthew Bruderman, asking if the corporation has "devised a plan that ensures continuity of service beyond January 2024? If so, please share it with us."

Bruderman identified the cardiac unit as an opportunity for revenue growth.

The hospital must start construction on the lab by Aug. 15 and has until April 2024 to complete it, according to deadlines set by the state.

State Sen. Kevin Thomas (D-Levittown) said he was "hopeful in treating patients through that lab, NUMC will get recurring revenue that will help the hospital moving forward."

“That hospital is running out of money,” Thomas said, adding he is “worried this isn't going to be enough to help."

By Scott Eidler

scott.eidler@newsday.com@ScottEidler

Scott Eidler covers Nassau County government and politics for Newsday. Scott has worked at Newsday since 2012 and previously covered municipal government and education.