Make sweeping change at NUMC

For close to a century, tens of thousands of Long Island residents have depended on Nassau University Medical Center each year to provide them with care, in its emergency department, specialty wings and inpatient floors.

They needed a public hospital in the 1930s, when Nassau County built the 200-bed Meadowbrook Hospital on 75 acres. And they need one now.

But what the size and scope of that hospital should be, what services it should offer, and how to best position it to thrive, remain key questions.

The answers are important, not only to patients and workers, but to the Island as a whole, especially across Nassau County. As Suburban Hospital Alliance president and chief executive Wendy Darwell told the editorial board, “It’s important to everybody in the county, including the other hospitals, that NUMC is successful.”

While the state took over control of the hospital because of mismanagement and patronage, Nassau County’s role greatly matters, too, as county taxpayers are on the hook for about $57 million in NUMC bonds.

Now, nine decades after Meadowbrook Hospital opened, its successor facility is at a critical turning point. In about 10 weeks, officials at NUMC and its public benefit corporation, Nassau Health Care Corp., will issue a report that outlines potential plans for the troubled safety net hospital. The future-looking assessment comes as Long Island’s healthcare landscape is shifting, as patient needs change and as new facilities, like NYU Langone Health’s planned hospital complex in Melville, emerge.

Their findings won’t be final; they’re meant to jump-start a process. Nonetheless, the report must represent a significant step in determining what’s next for the hospital, its nursing home, the A. Holly Patterson Extended Care Facility, and their 114 acres of land in East Meadow and Uniondale. The analysis must not just rehash old ideas, and it must lead to action. This isn’t a time for small tweaks, hesitant leaders or political plays. Sweeping change is required.

INSIDE THE TALL TOWER

That starts with the hospital itself.

The centerpiece of NUMC’s East Meadow campus is a 19-story tower — the tallest building in Nassau County. Inside there are empty floors, wings and beds, and crumbling infrastructure. A right-sized, modern facility is necessary. To determine what care should take place within its walls, hospital officials must determine what departments should stay. In making those difficult decisions, they should consider what other health systems offer and NUMC patients’ needs, especially related to their access to care.

NUMC’s emergency department, for instance, remains a valuable asset, with nearly 60,000 patient visits last year. Residents across Nassau County and beyond rely on the hospital. What’s more, as a Level 1 Trauma Center, NUMC is often the go-to for emergency services after significant incidents. Beyond NUMC’s safety net role, multiple observers agree that Long Island’s other hospital systems would not be able to accommodate its sheer volume of patients, including those who are uninsured.

NUMC also offers numerous specialties, from behavioral health and cardiac to its burn unit and hyperbaric chamber, and it serves as the medical care hub for the county jail. Recently, the hospital had difficulties with its obstetrics and maternity ward, which closed, opened and closed again. Hospital executives and their outside consultants must assess which departments should be maintained, which could be handled through partnerships with other institutions, and which could be eliminated without harming Nassau residents.

Could NUMC’s future include community ambulatory services, filling in gaps of care for those now underserved? Could it have fewer inpatient beds, and do more outpatient work?

NUMC chief executive Tom Stokes is right to emphasize affiliating with other institutions. Whether other hospital systems will easily agree is another question. State officials, who took over NUMC last year, will need to push to make that happen, connecting Nassau’s public hospital with private institutions and other public ones, including Stony Brook University Hospital.

GAME-CHANGER OF AN ASSET

What’s next for A. Holly Patterson is also unclear. It, too, serves patients without alternative options, but it loses tens of millions of dollars annually. All options must be considered, including a sale or partnership. The nursing home also could be part of a broader plan, one that could include transforming the land in Uniondale into a broader campus, perhaps with assisted living facilities or other healthcare or residential communities, complementing the existing rental apartments there.

The real estate piece of the NUMC equation is the game-changer. A public mission hospital — especially one already deep in the hole — requires other revenue sources. Nassau Health Care Corp. owns the land. Working with area developers to reimagine what that land could look like, adding housing and other development and revitalizing both campuses, could benefit the hospital, its patients and the region.

PUBLIC HOSPITAL AND PROCESS, BOTH

None of this will be easy. It will require significant funding streams and massive buy-in at all levels, including union leaders and state and county elected officials. NUMC always has been a political wasps nest but this isn’t a time to play politics. That, however, will be an enormous challenge, especially as Nassau Republicans who control the county have yet to make their NHCC board appointments.

Yet the best way forward starts simply. Engage every stakeholder, from employees and patients to elected officials and healthcare advocates. The more public the process, both before and after the Dec. 1 deadline for the required report, the better. This will be a long and arduous road, and NUMC officials must not wait to make the tough calls.

NUMC’s diagnosis is complex and challenging. The prescription must meet the moment.