Shrink NUMC to help it survive

One side of the argument over the future of the Nassau University Medical Center is captured in a study commissioned by the Nassau Interim Finance Authority. It concluded NUMC cannot survive without shuttering the hospital's emergency room, slashing payroll from 3,400 workers to about 300 and selling the A. Holly Patterson nursing home.

The other side of the argument is best expressed by a statement from the Long Island Federation of Labor: "We firmly reject any proposal to curtail the operations of these institutions and look forward to working with CSEA and our community partners to map a successful future for these health care providers."

The path forward has to be between these two extremes, with a smaller NUMC evolving into an efficient public-mission hospital that is properly reimbursed for care, focused on services it can provide well, overseen professionally and responsive to community needs.

And that will not be easy.

Nassau County's only public hospital, NUMC provides care to predominantly low-income patients who rely primarily on Medicaid or lack health insurance. Because it is not affiliated with a larger system, it cannot negotiate reimbursement rates comparable to ones given to big systems like Northwell. NUMC, never free from the county's patronage politics, has close to $1 billion in liabilities on the books, including $173 million in debt backed by the county and $800 million in pension and health care obligations. It’s projected to lose $144 million a year without significant changes, and run out of cash within two years.

It could well close.

But there are things NUMC does well, and that the populace of Nassau County needs it to do. NUMC is a stronghold of behavioral care and addiction treatment. The emergency room is well-regarded, and brings in 77% of the hospital’s patients; the study is wrong to recommend it close. Many specialized clinics at the hospital's 530-bed site do good work for hundreds of thousands of patients each year.

Amid the COVID-19 crisis, NUMC was a crucial resource during the first terrifying wave, a reminder of how hospital capacity can suddenly be needed.

County and hospital officials are looking for answers. The best one: Make NUMC a SUNY hospital, like Suffolk’s Stony Brook University Hospital. That would immediately mean better reimbursement rates, funding from the state budget and a stronger oversight structure. The state is not looking for new hospitals, but local officials and union leaders should present a convincing case.

And NUMC must shrink. It must get out of the nursing home business, expected to run losses of $27 million to $35 million a year. The hospital must downsize from 19 floors, 75 acres and 3,400 employees, and stop offering service in specialties where it has few patients.

Nassau County needs a public-mission hospital, but if NUMC becomes simply a CSEA jobs program losing $400,000 per staffed bed annually, it will shutter and that would be a shame.

— The editorial board