NUMC needs a new way forward to survive

There are many reasons the Nassau University Medical Center is going broke.

Those cited by Nassau County Executive Bruce Blakeman and hospital officials — the end of two funding streams that were always temporary — don’t tell the real story: NUMC has too much land, too big a building, too few patients, too little community trust, too many employees, too many staffed departments doing little business, and too little vision.

The hospital lost $135 million in 2021, and $370 million since 2017. NUMC’s 500 beds each lost a staggering $740 per day in 2021.

Broadly speaking, that’s no surprise. More than 40 hospitals have shuttered in New York since 2000, many focused on assisting the same challenging populations served by NUMC, Nassau’s only public-mission hospital: the uninsured and Medicaid and Medicare recipients. And NUMC, not aligned with a big hospital system that can force fair insurance reimbursements, gets paid too little even for patients with good coverage.

NUMC has seen its government funding reduced over the past two years, but not in unfair or unexpected ways. NUMC’s federal reimbursement for COVID-19 treatment providers sank from $40.9 million in 2020 to $8.9 million in 2021, because the crisis lessened. Another funding stream ended on schedule: New York’s Delivery System Reform Incentive Payment program, or DSRIP, a state-administered $8 billion initiative that paid NUMC an average of $30 million annually over six years to encourage shifts from emergency room and inpatient treatment to ambulatory care, and to incentivize better outcomes.

A legitimate gripe is that New York’s DSRIP program was not renewed, while those of Texas and California were. But many New York hospitals face the same challenge and aren’t floundering like NUMC.

NUMC is among the most dangerous hospitals in the nation for post-surgical recovery, and has a “D” rating overall from Leapfrog, a nonprofit that rates hospitals. Patients at hospitals with “D” or “F” ratings are 92% more likely to die than at better-ranked facilities. 

NUMC's 19-story building needs $300 million in repairs. The county backs about $130 million in NUMC debt. The hospital pays only a small portion of its employee health care costs to the state while the rest accrues as debt. Its future liabilities exceed $1 billion. 

But NUMC offers crucial services. Its emergency room, trauma center, burn unit, and psychiatric and addiction services for children and adults are well-regarded. What’s more, many of NUMC’s A. Holly Patterson nursing home patients have needs so intense that placement elsewhere would be difficult.

NUMC is on a clear path to closure, with the cash set to run out next year. A better way forward is possible, but likely requires either downsizing, becoming a state hospital, or partnering with the Northport VA.

It's the stubborn desire to keep NUMC as is that’s most likely to assure it won’t be anything at all.