NUMC has little cash on hand, could run out of money in April, report says

Nassau County's only public hospital remains in financial peril, with 10 days' cash on hand and the risk of running out of money by late April, its state-appointed consultants warned in a report released Thursday.

NuHealth, the public benefit corporation that runs Nassau University Medical Center in East Meadow, has about $19 million in cash on hand — money that is liquid or unrestricted — and could have a negative balance of $4 million by April 27, according to Manhattan-based Alvarez & Marsal. 

The Nassau Interim Finance Authority, a state board that controls hospital and county finances, rehired the firm in September to analyze the health system, which operates NUMC and the A. Holly Patterson Extended Care Facility in Uniondale. The county backs more than $100 million in borrowing and would be on the hook for the debt if the system shut down.

Having just 10 days' cash on hand is dangerous, the consultants noted. The lowest-performing hospitals, those with "junk" bond ratings, have 74 days' cash on hand, according to S&P Global Ratings.

Richard Kessel, NIFA's chairman, said the report shows NuHealth has a "serious financial crisis."

"One day they've got $30 million, the next day they have $20 million, the next day they have $18 million. You can't run a hospital that way wondering each day what's left in the tank," Kessel said.

"They've got very little cash, and if there were some unforeseen event at the hospital, a breakdown of a major system, the hospital will run out of cash," Kessel said.

NuHealth chairman Matthew Bruderman said in a statement the consultant's findings were "generally correct..." But he said they don't take into account recent initiatives that will "allow additional cash flow from what is reported."

Those changes "resulted in collecting and generating more cash flow today than eight months ago," Bruderman said. 

However, he said, the hospital "cannot operate without the funding from the state," which ought to cover a "significant shortfall."

Bruderman and Megan Ryan, NUMC's acting president and CEO, warned in a Feb. 8 letter to Gov. Kathy Hochul and leaders of the State Legislature the system was "less than 90 days away from not being able to meet our obligations." 

"More than 270,000 patients will lose their medical care," they wrote. "Five-hundred elderly men and women will be without skilled nursing care. More than 3,600 families will be without a paycheck. Nassau County's most at risk communities will lose their hospital."

Bruderman and Ryan asked the governor for $125 million in the upcoming budget to keep NUMC afloat, as well as a recurring budget line based on the "demonstrable needs of the hospital."

Aja Worthy-Davis, a spokeswoman for Hochul, said in a statement Thursday: "While we are still reviewing the NIFA report, it is clear that strong actions must be taken to address serious mismanagement at NUMC, and ensure community members can access the healthcare services they deserve. The letter sent by [NuHealth] to the state contains a number of outright falsehoods that reflect an attempt to deflect blame for the failures of its leadership."

Challenges persist

Hospital officials have been predicting NuHealth will run out of cash since 2020, around the time it lost a major funding stream from the Delivery System Reform Incentive Payment program. The program, funded by the federal and state government, provided tens of millions of dollars annually to NuHealth and other hospitals as an incentive for keeping costs low. It had been scheduled to expire that year.

NuHealth has struggled with persistent operating deficits over the past five years, accumulating $561 million in losses over that time, the consultants said. Deficits at the nursing home reflect nearly a quarter of that total.

The consultants don't expect much of a rebound. The report said NuHealth's cash position changes every day and is dependent on the timing and receipt of state and federal aid.

In January 2021, after the federal government awarded NuHealth $120 million in coronavirus relief funds, the system had $200 million in cash on hand.

The figure is expected to dip to below $10 million in late March, the report shows.

"Executing performance improvement is complex in hospital systems," the report said. NuHealth "does not have a record of achieving operating improvements of the magnitude called for in their performance improvement plan."

At the end of last year, the NuHealth board approved a 2024 budget that wasn't balanced and predicted a $97 million deficit.

The report also noted $316 million NuHealth owes the state for employee health insurance premiums. 

In November, the state Civil Service Department wrote then-CEO Anthony Boutin to alert him NuHealth was more than three months late on payments. The board ousted Boutin in January for undisclosed reasons.

Jian Paolucci, the department's deputy commissioner for administration, said the state could terminate employee coverage if the hospital did not make the payments or enter into a payment plan. 

By Scott Eidler

scott.eidler@newsday.com@ScottEidler

Scott Eidler is a deputy editor for the towns department at Newsday. Scott has worked at Newsday since 2012 and previously covered municipal government and education.