NUMC has requested $125 million from the state to cover...

NUMC has requested $125 million from the state to cover operations but infusing cash without a plan would be a misuse of taxpayer dollars. Credit: Newsday/J. Conrad Williams Jr.

Nassau University Medical Center could run out of cash in April, according to a consultant to the Nassau Interim Finance Authority, the state watchdog that controls finances for the hospital and Nassau County.

This is no surprise. It was clear in 2020 there was only 18 to 24 months of cash left. COVID-19 funds extended the runway, but the end was always in sight.

NUMC has requested $125 million from the state to cover operations but infusing cash without a plan would be a misuse of taxpayer dollars and an abandonment of government’s obligation to ensure access to care for the community. The current crisis threatens essential NUMC services like its emergency room, psychiatric beds and outpatient care. For more than 2,500 employees, many who live check to check, an abrupt failure would be devastating.

Many safety net hospitals, like NUMC, are at risk. These hospitals serve a community often uninsured, underinsured, or on Medicaid which has lower reimbursement rates than commercial insurers. Government has tried to cover the costs, but health care has become more sophisticated requiring significant capital investments. At the same time, the marketplace for hospitals has evolved into larger systems; many safety net hospitals, including NUMC, have not kept pace. Nassau County needs the capacity provided by NUMC's emergency room and psychiatric beds, but other Nassau providers clearly have capacity for the remaining services. It is time to broaden the lens of possibilities.

The NYU Langone health system wants to build a larger hospital on the campus of Nassau Community College. Placing a new hospital closer to NUMC would be another nail in NUMC’s coffin. However, NYU’s request could be a leveraged opportunity. NYU cannot execute its plan without the state and Nassau’s agreement, creating the possibility for a collaboration among government, NYU and other Nassau health systems to handle NUMC's closure. There are many permutations. The point is to get started. One option could be:

1. NYU's new hospital accommodates NUMC's emergency room volume.

2. Given Nassau County has excess nursing home beds, convert the A. Holly Paterson nursing home to a psychiatric unit able to handle emergencies, with state and county financing for construction and a state commitment for funding operations.

3. The state assumes the $600 million accrued to cover retired employee benefits and writes off the overdue $300 million premium NUMC owes the state employee health plan.

4. Sell NUMC's East Meadow campus to a developer covering Nassau’s bond debt, addressing the region's housing shortage, and placing 52 acres of prime land on the tax roll.

5. Health systems, county services and contractors desperately needing staff give priority to dislocated NUMC employees.

The solution is not inexpensive. Transitional financing to support essential services will be required. At the current rate, NUMC will add another $1 billion to its debt in 10 years; as the funds evaporate, the dollars to maintain a safe, quality care environment will disappear.

Nassau County has an excess of nursing home and hospital beds. The health care trend is for shorter inpatient stays while increasing capacity to provide care outside a hospital. Continuing to financially support the current structure makes no sense.

Nassau, the state, and local health care systems should convene to develop a plan that ensures continued access to care for the community and employment for staff and that ends the financial debacle. This is an opportunity for government to lead, with support from health systems, for the benefit of all Nassau’s residents.

This guest essay reflects the views of Robert Detor, former chairman of the Nassau University Medical Center.

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