NUMC board to vote on revamp plan

Nassau University Medical Center's board of directors is expected to vote Tuesday on a proposal to expand outpatient and primary care services and eliminate almost 10 percent of beds in response to a state and federal push to curb costly hospital stays.

If approved, the plan will be submitted to the New York State Department of Health Friday. It also calls for the hospital to forge a closer alliance with the North Shore-LIJ Health System. NUMC officials hope the steps will help win the hospital a $30 million state grant.

NUMC's chief executive, Arthur Gianelli, said he sees the grant as a way to help stabilize the financially struggling East Meadow hospital and improve care for patients, many of whom are poor and lack regular health care. The plan also is a way to get in line with President Barack Obama's health care law, which promotes primary care to keep people out of the hospital and cut costs, he said.

"I look at this as an opportunity for us," Gianelli said. "A lot of people who are admitted to the hospital wouldn't be admitted if they had more robust primary care."

In November, the state health department said it was offering $450 million in grants to financially strapped hospitals statewide to improve their community-based care, eliminate excess hospital beds and reduce over-reliance on more expensive inpatient hospital care.

The NUMC proposal calls for the 530-bed hospital to give up 30 of its 158 medical-surgical beds, 10 of its 20 inpatient detox beds and 10 of its 30 chemical dependency rehabilitation beds.

With the state grant, NUMC would then build an expanded primary care area near the emergency department. That way, Gianelli said, NUMC would be better able to manage patients' overall care to keep them healthier and out of the hospital.

It also would build a comprehensive outpatient substance abuse program that would provide expanded addiction services to replace the inpatient beds.

Dr. Constantine Ioannou, director of NUMC's substance abuse services, said an outpatient program would give the hospital more approaches to treating patients, especially in light of the epidemic of prescription drug abuse.

"Right now, we have a one-size-fits-all system . . . that is incredibly flawed," he said. "This hospital would become the central hub of treatment. Far from getting out of the addiction-treatment business, we're going to be asking for more business."

Gianelli said staff would be retrained to help save jobs, a key issue for Jerry Laricchiuta, Nassau's Civil Service Employee Association president. Laricchiuta said he wanted to ensure that some inpatient detox beds remained open to cope with prescription drug abuse. If the plan keeps such beds and protects jobs, "we can get on board," he said.

The proposal also calls for a closer relationship with North Shore-LIJ. Some NUMC services, such as cardiology and neurosurgery, are already staffed with doctors from North Shore-LIJ.

Under the new initiative, more North Shore-LIJ doctors would work at NUMC and NUMC's doctors would be held to the same quality standard as North Shore-LIJ's.

If the plan is approved, the state would provide NUMC higher reimbursement rates for three years to cover the costs of expanded outpatient services and lower admissions to the hospital.

Seeking to strengthen NUMC's negotiating position with managed-care plans, Gianelli said he is also applying to the state to permit it to obtain assistance from North Shore-LIJ.

Board member Dr. George Miner said he favored the proposal. "If this plan is executed properly I think this will do a significantly better job than the current system," he said.

Michael Dowling, chief executive of North Shore-LIJ Health System, said his interest in more integration with NUMC is to ensure that NUMC remains viable to serve the uninsured and underinsured. "We have a moral obligation," he said.

About NUMC

Number of beds: 530

Number of beds proposed for cuts: 50

Employees: 2,615

Budget:

-- 2011: $558.5 million
-- 2012: $532.5 million

Inpatient revenue sources:

-- Medicaid: 50%
-- Medicare: 25%
-- Commercial insurance: 17%
-- Self-Pay: 5%
-- Workers' compensation and other sources: 3%

Receives from Nassau County:

$13 million annually, which will be eliminated in 2015. A separate $5 million joint county and state contribution will continue.

History:

-- Opened in 1935 as Meadowbrook Hospital, with 582 beds.

-- In 1974, became Nassau County Medical Center, with 725 beds.

-- In 1997, Nassau Health Care Corp., a public benefit corporation created by the state Legislature, was established, removing the hospital from county control.

-- In 2001, the hospital was renamed Nassau University Medical Center.

Sources: Nassau University Medical Center; Nassau-Suffolk Hospital Council