Nassau University Medical Center's financial problems are so dire that the facility’s other shortcomings get short shrift.
Yes, NUMC has nearly $1 billion in unfunded liabilities, a number growing by $100 million annually. Yes, it has for years failed to pay New York State fully for employee health insurance. Yes, the huge East Meadow facility is deteriorating, and hundreds of its 550 beds are empty. And yes, auditors say it may not be able to continue as a going concern because the money may soon run out.
But it’s also a hospital with a disturbing "D" rating from Leapfrog, a nonprofit that rates hospitals and ranks NUMC as among the most dangerous in the nation for post-surgical recovery. Patients at hospitals with "D" and "F" ratings are 92% more likely to die than at better-ranked facilities.
The Center for Medicaid and Medicare Services names it one of the 200 hospitals, out of 4,000, earning only one star for operations, and one of only 85 to get the lowest possible customer satisfaction rating.
It’s also a hospital battered by leadership turnovers that crush continuity, and a politicized board largely in thrall to the CSEA union and its 3,000 NUMC employees.
Perhaps most importantly, it’s a public-mission hospital in a county where only 4% of residents are uninsured and four other hospital systems, each better-regarded and managed than NUMC, offer care.
Thursday night, yet another new board chairman, nursing home operator Edward Farbenblum, took the reins. He replaced Bob Detor, who resigned after 18 months, citing frustration with the board’s unwillingness to make substantive changes and anger over the handling of a personnel matter.
MORE STAFF THAN PATIENTS
NUMC does some things well, starting with its 120-bed behavioral health and addiction program. Psychological care and addiction treatment are in short supply, poorly compensated, and crucial, and the patients who come to a public-mission hospital for that treatment need help desperately. Its emergency room is a key treatment access point for poor people. And many of its outpatient clinics do good work.
But numerous departments have far too little patient volume, from the neonatal intensive care unit to obstetrics to oncology, surgery, gynecology and pediatrics. And only 2% of NUMC inpatient stays are patients with no insurance. What’s worse, more than 50% of NUMC’s inpatient stays last only one or two days, a red flag to Medicaid, Medicare and commercial insurers that the admissions may have been unnecessary, creating a reason to deny payment.
MONEY RUNNING DRY
Federal and state funding for COVID-19 masks the financial problems. Detor and other insiders say that in 12 to 18 months, without significant changes, NUMC could shutter. They worry, rightfully, that the loss of the behavioral and addiction services, the emergency room and the outpatient clinics, where 20%-30% of patients are uninsured, will leave needs unmet. And they fret that employees who would likely be snatched up during the current medical labor shortage could face a different jobs market later.
Barring big improvements, like going under the state umbrella as part of Stony Brook University Hospital or finding another partner who can secure fair insurance compensation rates, NUMC will go broke, with or without bankruptcy protection.
Erie and Westchester have county public-mission hospitals that fare better than NUMC. The Westchester Medical Center University Hospital, with campuses in Valhalla and Poughkeepsie, has the only all-specialty children's hospital in its region, a leading kidney and liver transplant program, and a large biomedical research site. And the Erie County Medical Center, unlike NUMC, is highly regarded by the public and highly rated by the industry for outcomes and satisfaction.
SUPPORTERS PUSH GROWTH
The CSEA and some Nassau officials argue for growing and improving NUMC rather than shrinking it. Most experts say that ship has sailed. But Farbenblum, picked by County Executive Laura Curran as she seeks reelection and cultivates union support, told the board Thursday that he wants to bring in consultants and turnaround specialists and make moves toward growth like getting state approval for a catheter lab, a pet CSEA ask.
Farbenblum says the hospital and its mission are critical, but sees that a partnership with state-overseen Stony Brook might be a path forward. Yet he rejects the idea that NUMC must downsize dramatically.
If NUMC doesn’t shrink down to doing only what it does well, it will close. That would leave the employees on the street, and the patients who need mental help, emergency care or free outpatient services out of luck.
This is the worst hospital in an area full of very good ones, where most residents have insurance and most patients have better options. Drastic action is needed.
The state should intervene, seriously consider dissolving the board and allow another hospital system to take it over. That will allow NUMC to escape the crush of local politics, and offer only the services that Nassau residents need and other hospitals cannot provide.
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Editorials are written by members of the editorial board, a group of opinion journalists whose views on the issues of the day reflect the longstanding values of Newsday.