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Sun, 16 Apr 2006

Patients over politics - Newsday Editorial

Patients over politics

To save the troubled Nassau University Medical Center, decision-makers need to get their priorities straight
April 16, 2006

Most Long Islanders are unlikely to become patients at the Nassau University Medical Center unless an auto accident sends them bursting through the emergency room doors on a stretcher. For the uninsured and underinsured, however, the East Meadow facility historically has been their only choice for health care.
Perpetually frail public hospitals, which offer care regardless of a patient’s ability to pay, don’t have rosy prognoses for the future. Not when other types of hospitals are barely surviving on operating margins of slightly more than 1 percent. Nassau’s county hospital has lasted 70 years, but it will be a struggle for it to continue more than another decade absent comprehensive changes to the nation’s health care system. For now, however, the best treatment plan is to keep it alive year to year with the hope that an ultimate cure can be found.
Nassau County seems to be making slow but steady progress toward that short-term goal. That’s why it’s frustrating to watch those who would risk these efforts for their own personal agendas. Putting patients over politics is the only prescription that will work here.
In the coming weeks, the county executive, the legislature and the governor will be involved in the appointment of five new trustees - one-third of the board of the Nassau Health Care Corporation, which runs NUMC and the A. Holly Patterson Nursing Home. Caught up in these board changes will be the future of Daniel Kane, the current CEO, whose considerable skills as a hospital administrator were overshadowed by political missteps and his failure to stop the bleeding at NUMC as quickly as Mineola wanted. Now, Kane, whose contract runs until the end of 2007, has fallen out of favor with the legislature.
Waiting in the wings, meanwhile, is Art Gianelli, who executed the county’s financial turnaround and is now trying to perform the same budgetary magic as NUMC’s executive vice president. Gianelli is seeking to replace Kane, but he’s running into resistance from some board members concerned that he has no experience running a hospital.
NUMC needs steady hands during this personnel transplant. The five new board members must be fresh faces with outstanding professional credentials who are free from conflicts of interest. But if the machinations of the last few weeks are any indication, some legislators are poised to support candidates who will be nothing more than puppets, allowing these legislators to micromanage the institution. That must not happen.

Joined at the hip

The hospital was born with a public mission. In 1930, this nascent first suburb with a population of 303,053, approved a proposition authorizing the spending of $1.75 million for a hospital to treat those with contagious, incurable and chronic diseases. The facility was called Meadowbrook Hospital when it opened five years later. In 1975, a new 19-story tower, still one of the highest buildings in Nassau, was added. A testament to the region’s growth and prosperity, the hospital’s name was proudly changed to the Nassau County Medical Center.
By 1999, Nassau’s fortunes were in reverse. The hospital, after years of being used as a Republican patronage store and piggy bank, was sliding downhill. In a dubious transaction, the county sold the hospital to a newly created public benefit corporation to plug an $82 million budget gap. "University" was substituted for "county" in its name, to highlight its supposed independence - as well as to boost its credibility.
That transaction, however, did little to separate the county’s fortunes from that of the hospital. The sale garnered NUMC huge debt guaranteed by the taxpayers - it’s now at $303 million - and forever created a financial umbilical cord between the two. Unfortunately, what the transaction did do was create a mind-set in the hospital’s management that it was no longer tied to the county’s fiscal fate. The new board has to find a middle ground where it can provide the health care expertise to run the facility while developing a much keener understanding of the financial consequences to the county.
When the hospital’s books tipped into the red this past fall, the county came to the rescue. In a controversial move last month, County Executive Tom Suozzi proposed and the legislature approved using $98 million in proceeds due the county from the nationwide tobacco-litigation settlement for the hospital. The legislature insisted, however, that a strategic plan be developed before any money changes hands.
That plan is likely to recommend that the hospital and the county share resources, such as using the county attorney’s office for legal services, public works for construction projects, and the new data technology center to upgrade NUMC’s medical records. These are examples of the kind of cooperation that needs to be fostered. The hospital’s board should eagerly endorse such measures.
Vital signs are improving
Although the hospital is now using its restricted cash reserves for operating funds, its shortfall was mostly due to delays in state payments. In recent weeks, NUMC was told it would get higher reimbursement rates for its nursing home, with the possibility of an extra $5 million coming in this year. Another $16 million should be headed its way because of an adjustment in the complicated federal-state Medicaid formula.
Those sums have the potential to put the hospital in the black for 2006. But whether any of the checks actually arrive was thrown into doubt last week by Gov. George Pataki’s veto-driven cuts to the state Medicaid budget.
Community outreach
But what good are efforts to save the hospital if the people it serves - 70 percent of patients are black or Latino - are reluctant to use it or don’t even know that some of its services exist? NUMC annually treats 250,000 patients in 81 clinics and another 80,000 in the emergency room. But Legis. Kevan Abrahams (D-Hempstead) claims there are many more residents who don’t use NUMC because of a poor perception of the medical care dispensed there. Abrahams says the hospital needs to creatively and vigorously expand its outreach programs by offering community-based clinics for maternal health, diabetes, hypertension and HIV. The new strategic plan should include initiatives that would bridge this gap.
The county also faces challenges with its A. Holly Patterson Nursing Home in Uniondale. Few people would go there if they could avoid it. Under consideration now is a plan to tear down the underused and decrepit 889-bed home and replace it with a smaller but modern facility. This would be part of a larger plan to sell most of the 64 acres surrounding the nursing home for development as a private continuing-care retirement facilty, which would offer older residents a variety of housing options and different levels of medical services - from wellness classes to skilled nursing. The pot of money from the sale would further strengthen the hospital’s finances.
Life expectancy
NUMC can keep its doors open in the short term by cash infusions, such as those from the tobacco bonds and the contemplated sale of the Patterson property, and with a management team that can bring about fundamental and efficient changes in how the hospital operates. The political overseers need patience and restraint to let this work.
But public hospitals are the most vulnerable institutions in the nation’s troubled health care system. At some point, the county must confront the ultimate uncertainty of NUMC’s life expectancy. That question, however, is being postponed for now.


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