NUMC needs an overhaul

The alarms are blaring.

Nassau University Medical Center is in deep, imminent danger. Patients, employees, retirees and taxpayers are all at risk. And there's no quick, simple treatment to shock NUMC, or the public benefit corporation that runs it, back into rhythm.

Nassau Health Care Corp., the public benefit corporation that oversees the 530-bed public mission hospital that many Nassau residents depend on for emergency care and other medical needs, is for all intents and purposes insolvent. Within weeks, it won't have enough money to pay its staff. It already owes more than $300 million in employee health insurance payments.

This is just the latest chapter in NUMC's long, troubled saga. But the hole in which it sits now is deeper than ever, and the distressing situation is growing worse daily.

NuHealth, as the public authority is known, has a dangerously low $19 million in cash, according to a consultant's report late last month. It could be in the red by April.

This issue affects everyone in Nassau. Thousands of patients, the jobs of nearly 4,000 employees, and the benefits of thousands of retirees are directly impacted. But while the state has stepped up, the county has attempted to distance itself, even though its taxpayers are ultimately on the hook for NUMC's bonds and for assuring that the health needs of county residents are met. Passing the buck is both impossible and irresponsible.

WEB OF PROBLEMS

NUMC's failures are due to a complex web of difficulties. Some are beyond its control, such as the changing delivery system of health care, the intricacies of federal reimbursements, and the tribulations of Medicare and Medicaid. The extent of some concerns about NUMC's management, especially on spending and vendors, remains unknown since the hospital hasn't filed required documents with the state for years, though officials say they now are planning to do so.

But many of NUMC's troubles are directly caused by a lack of smart and solid governance by its board of directors and by a lack of smart and solid management by those within the hospital's leadership. It's time to clean house.

NUMC hasn't had the specialized guidance it requires since Arthur Gianelli, who served as chief executive between 2006 and 2014, was ousted by former Nassau County Executive Ed Mangano for not hiring Mangano's cronies. The hospital's board and leadership are stacked with patronage appointments whose decisions on union contracts, hiring and vendors are subject to political influence.

Its financial troubles aren't new, either. Before COVID-19, NuHealth faced similar concerns. But an influx of pandemic relief, combined with additional federal and state money, masked the hospital's troubles and kept it afloat for years. NuHealth officials seemed to think that money would keep coming forever. One such pot, the Delivery System Reform Incentive Program, was always meant to be temporary — but NUMC leaders recently asked the state for $125 million, absurdly arguing the state should restore or replace federal funding.

Gov. Kathy Hochul has wisely prioritized NUMC. A damning letter sent to NUMC Friday from the state health commissioner disputes NUMC's claims of being shortchanged and seeks significant reforms. It's a good start. The state is working with the Nassau Interim Finance Authority, which has a key role because NUMC's debt is guaranteed by the county.

STRINGS ON MONEY

Clearly, NUMC needs cash. And the state must help. But financial assistance must not be unconditional. The strongest of strings must be attached. 

That starts with the state utilizing its ability, by law, to appoint a “temporary operator” when a facility is “experiencing serious financial instability that is jeopardizing existing or continued access to essential services within the community.” That's clearly the case here. Such an operator would present and implement a plan and work with the state.

Longtime general counsel Megan Ryan is now also serving as interim chief executive. Bringing in a new CEO, while necessary, will do little if the existing board of directors, another font of politics and patronage, isn't replaced, including NuHealth chairman Matthew Bruderman. In a statement to the editorial board, Bruderman blamed the state for cutting funding, and NIFA and its consultants for creating “a false narrative in an effort to secretly rob the jobs and healthcare from the poverty level minority citizens of Long Island.” 

Clearly, Bruderman can't steer this ship away from the shoals.

Also critical: The state should foster partnerships between NUMC and other health care systems. Shared services and other assistance would be enormously helpful.

Once NUMC's immediate crisis is stabilized, consider the longer-term future of the hospital, the A. Holly Patterson nursing home, and the extensive land around each. Rethink the delivery of health care, the size and scope of existing facilities, and what areas of care should stay — and which should go. Keeping certain aspects of NUMC, such as its behavioral health and substance abuse departments, while shedding others, is the only way forward. 

Nassau County and New York State need a healthy and re-imagined NUMC. And NUMC needs the county and the state. The only way the hospital can move forward is if the NUMC of the future is nothing like the NUMC of the past.