NUMC hospital needs an intervention

In the past 20 years, more than 40 hospitals have closed in New York State.

In most cases, those closures were opposed by community leaders and employee unions but did not create hospital bed shortages. Outside once-a-century pandemics, downstate New York has enough beds.

Yet many facilities that have closed, like St. Vincent’s in Manhattan and Parkway Hospital in Queens, are mourned for the loss of proximity to services they provided.

It’s hard to close a hospital, but it’s harder to change one. Self-interest stymies evolution, and new plans and leaders are announced with fanfare that quickly fades into the status quo. Finally, the money runs out and the doors slam shut, unless the hard changes happen.

The Nassau University Medical Center is near the end stages of this process. Absent major changes in the next two to three years, which may still be possible, the county’s only public-mission hospital will run out of cash and likely have to shutter.

That would be disastrous for patients who utilize its emergency room’s well-regarded trauma center and burn unit. It would be disastrous for adults and children who benefit from its top-notch psychiatric and addiction services, and for the patients at its clinics. NUMC also operates the A. Holly Patterson Nursing Home, which serves as many as 200 residents with needs so intense other facilities can’t or won’t admit them. Closure would be particularly disastrous for them.

Action is needed. But the NUMC board, a decades-old partisan battleground, is too consumed with mudslinging madness and too subject to political pressures to move forward.

And it’s unlikely that a plan being pushed in Albany by Nassau Democrats to increase the board from 15 members to 21 and grant state rather than local officials the right to appoint the six new seats will fix the governance problem, if it even passes.

NEW PLAN NEEDED

What’s needed is a commission of experts, with no political or emotional skin in the game, to determine NUMC’s fate — a Berger Commission for NUMC, with the same ability that body had to make a recommendation that is binding unless both the State Assembly and Senate vote it down.

The Berger Commission, formed in 2005 by former Gov. George Pataki, closed nine hospitals and suggested significant changes for 48 more, including NUMC. The Commission said NUMC should narrow its focus to its emergency department, its outpatient clinics, and its psychiatric and addiction services, just as many experts have said in the years since.

The hospital closures the report demanded came. The changes in facilities left open, including NUMC, mostly didn’t.

In the past four years, NUMC’s annual operating deficit has grown steadily, with shortfalls of $25.7 million in 2017, $46.6 million in 2018, $63.97 million in 2019, and $102.3 million in 2020.

The county guarantees about $170 million in bonding for the facility, and taxpayers would be on the hook if the hospital can’t pay its debt.

Hospital officials say that, unless dramatic changes come quickly, they expect NUMC’s annual loss to be about $120 million going forward, or about $650 per day, per bed, in the 500-bed hospital.

The recent largesse from federal COVID-19 spending can only temporarily mask the shortfalls.

FAMILIAR PROBLEMS

The problems are not new ones. NUMC has a poor reputation. It earned 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.

As a stand-alone facility that’s not part of a larger health care system, NUMC gets too little reimbursement from commercial insurers. It also treats too many Medicare, Medicaid and uninsured patients for too little compensation. Its underutilized East Meadow building needs $300 million in repairs.

Its 3,000 union employees give union leaders outsized political heft, even though medical staffing shortages suggest it’s CSEA leaders, not workers, who’d lose out in a NUMC revamp or closure. In the past decade, glimmers of hope cropped up as dynamic NUMC leaders made fresh starts. Those hopes were swamped by politics and patronage. Some of that political pressure comes from union leaders.

NUMC’s problems and possibilities don’t exist in a bubble. The underutilized land that houses it and the separate parcel that A. Holly Patterson occupies are tremendously valuable, but both facilities need hundreds of millions of dollars in fixes. Another struggling government hospital with $600 million in maintenance needs, the Northport VA, also sits on valuable land and is being eyed for eventual closure.

An apolitical NUMC commission might be able to bring these needs and opportunities together. Or it might decide better billing procedures, improved operations, and smart, small cuts are the answer at NUMC. Or that significant pruning, or a full closure, is the best option.

The challenge is finding a path for NUMC that assures affordable, high-quality care for Nassau’s most vulnerable residents, whether some or all of that care comes from an aging 19-story building in East Meadow, or not.

That’s a challenge the NUMC board has proved it can’t meet.