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Leading Health Care Consultant Urges Expansion of Emergency Care & Primary Care Services in Long Beach

Posted: Feb. 16, 2016

A leading health care consultant who studied the medical needs of Long Beach in the wake of Superstorm Sandy has recommended that South Nassau Communities Hospital continue to expand Emergency Services, increase access to primary care physicians and focus on improving behavioral health services and care for the elderly.

Bruce C. Vladeck, Ph.D., the former head of the U.S. Health Care Financing Administration (now the Centers for Medicare & Medicaid) during the Clinton administration and the former President of the United Hospital Fund, found that there is a “significant shortage of physicians, ancillary services and specialty geriatric and behavioral health services” on the barrier island. His recommendations include:

  • A continuing effort to upgrade the types of Emergency Services the newly opened Emergency Department in Long Beach can provide so that it is capable of handling 65-75 percent of all ambulance calls on the barrier island;

  • Expanding laboratory capabilities at the Long Beach Emergency Department and adding ultrasound services there;

  • Adding more observation beds to the Long Beach Emergency Department;

  • Improving South Nassau’s existing Family Practice site so that it would qualify as a Primary Care Medical Home with 24/7 telephone access for patients;

  • Forming a workgroup with Long Beach, State and County agencies to undertake a “more systematic behavioral health services planning for the barrier island.”

The Vladeck study also examined the question of whether Long Beach needs and could financially support a general hospital if one were to be built. Using “relatively optimistic assumptions” about the number of expected inpatient admissions and not including initial “ramp up” costs, the study found a 50-bed hospital would lose an average of $10.8 million a year, totaling $54 million in losses during its first five years of operation. (The financial analysis was conducted by John Lavan of JL Consulting. Lavan is a leading health care financing expert who served as the former Chief Financial Officer of New York-Presbyterian Hospital.)

The estimates were based on a close examination of the 5,543 hospital stays of residents of the barrier island that occurred in 2013. That number of stays would generate an average census of 40 admissions per day, which would require a facility of 50 inpatient hospital beds, the study found.

In addition to the financial losses a 50-bed hospital would generate, the study also questioned whether a hospital that small would have a sufficient volume of cases in certain specialty areas to produce quality patient outcomes.

“A growing body of literature continues to reinforce the general principle that the more a particular physician or hospital sees of a specific condition, the better the outcomes. This relationship is particularly strong for certain surgeries, including cardiac, cancer, GI and prostate,” the study noted. “This relationship is also strong for both routine and high-risk maternity services…which is why hospitals performing fewer than 1500 deliveries a year are gradually closing those services.”

Regulators in New York State also are generally pushing for a reduction in the number of in-patient hospital beds, “especially downstate, including Nassau County,” the study noted.

Vladeck also attempted to address and update the findings of a 2006 Commission on Health Care Facilities in the 21st Century report (also known as the Berger Commission), which recommended at the time that the former Long Beach Medical Center be downsized to a 145 bed facility. Proponents of building a new hospital in Long Beach – post Superstorm Sandy – have repeatedly cited the Berger Commission findings as evidence that the barrier island could support a 145 bed hospital.

As part of his research, Vladeck asked Stephen Berger, the head of the 2006 Commission, if he believed his 2006 study should still be relied upon at this juncture. “It would be a mistake, at this point, to conclude that having access to health services automatically requires a hospital facility,” Berger wrote in response to Vladeck in a letter dated Oct. 30, 2015.

The study also noted that Long Beach is an “extremely well educated” and “well-insured” community that is “solidly middle-class.” As of 2013, 85 percent of the non-elderly adult population had public or private health insurance.

South Nassau commissioned the Vladeck study last August as part of its commitment to Long Beach to determine what medical services are most needed on the barrier island. As part of his study, Vladeck interviewed key leaders from the civic, business & health care communities as well as federal, state and local elected officials. He also reviewed government data on where barrier island residents are receiving hospital care and for what diseases.

South Nassau has briefed more than 60 local community, civic and elected leaders about the results of the study and about its plans for expansion and use of the FEMA funds. That process will continue in the weeks ahead as hospital officials seek additional community input on the Vladeck study and on its proposals for the FEMA funding. The proposed plans still must undergo a series of formal review procedures at the local and state levels.

Some local leaders are expressing support for South Nassau’s plans to improve access to medical care in Long Beach and in Oceanside. Mayor Michael McGinty of Island Park called South Nassau “the finest regional hospital on the Island,” noting it is “at the forefront of service and technology” and its medical staff “is without parallel both in capability and compassion for its patients.” McGinty praised the hospital’s expansion plans. “The administration continues to expand the ability of the Hospital to deliver extraordinary care to its patient population,” he said.

South Nassau took over the former Long Beach Medical Center in October of 2014 after it declared bankruptcy following damage from Superstorm Sandy. The Federal Emergency Management Agency (FEMA) awarded South Nassau $171 million in potential reimbursement funds to help restore medical services to the area. South Nassau has already spent $13 million to open an Urgent Care Center on the site of the former Long Beach Medical Center and upgrade it to a free-standing Emergency Department that started receiving ambulances via the 9-1-1 system as of Aug. 10th. The hospital has said it intends to spend about $40 million on a medical arts pavilion in Long Beach that would be the permanent home of the Long Beach Emergency Department as well as house other services identified by the needs assessment that Vladeck conducted. Under the ‘alternative use’ provision of FEMA legislation, South Nassau intends to spend the remaining FEMA funds to bolster services at its Oceanside campus to benefit Long Beach and other residents in its service area, which stretches from the Rockaways to the Massapequas.

South Nassau’s Oceanside Emergency Department is the only Level II Trauma Center on the South Shore of Nassau County.

Designated a Magnet® hospital by the American Nurses Credentialing Center (ANCC), South Nassau® Communities Hospital is one of the region’s largest hospitals, with 455 beds, more than 900 physicians and 3,000 employees. The hospital is an acute-care, not-for-profit teaching hospital that provides state-of-the-art care in cardiac, oncologic, orthopedic, bariatric, pain management, mental health and emergency services. In addition to its extensive outpatient specialty centers, South Nassau provides emergency and elective angioplasty, and is the only hospital on Long Island with the Novalis Tx™ and Gamma Knife® radiosurgery technologies. South Nassau is a designated Stroke Center by the New York State Department of Health and Comprehensive Community Cancer Center by the American College of Surgeons and is an accredited center of the Metabolic and Bariatric Surgery Association and Quality Improvement Program.

The hospital has been awarded the Joint Commission’s gold seal of approval as a Top Performer on Key Quality Measures, including heart attack, heart failure, pneumonia and surgical care; and disease-specific care for hip and joint replacement, wound care and end-stage renal disease. For more information, visit www.southnassau.org.