Michael Dowling, president and chief executive of North Shore-LIJ Healthcare System, speaking at a meeting of the Long Island Real Estate Group, outlined the system's plans to deal with the changing face of healthcare. Those plans, he told 200 real estate industry related professionals at the Old Westbury Country Club, include offering health services directly to employers in the region, opening a nursing school, developing new leaders internally and $5 billion in capital improvements over the next five years. Dowling said, "We're going to start a nursing school in the next couple of years" to ensure against a nursing shortage. And he said, "We want to contract with businesses directly to takeover the healthcare of all the employees in a company. I want to develop [North Shore-LIJ] to be our own insurance company." The Manhasset-based healthcare provider, which operates 15 hospitals in Nassau, Suffolk, Staten Island and Manhattan, recently opened a medical school at Hofstra University in Hempstead and is planning to construct the state's first freestanding emergency room at the former St. Vincent's Hospital in Greenwich Village. North Shore-LIJ has grown through mergers and acquisitions, taking over hospitals in financial distress that might have otherwise gone out of business, he said. "In the healthcare business we have done the merger business better than anyone else." All the acquired hospitals now share administration and clinical leadership and that every thing the system does is measured, he said. "All our facilities follow the same metrics. ... We're focused on making sure we're as efficient as we can be." Dowling said North Shore-LIJ plans to spend $5 billion on capital improvements over the next five years to upgrade facilities that in some cases are 160 years old. He also said the system has programs to develop new leaders to deal with the changes likely to take place in healthcare in the future. Dowling said the future would bring fewer hospital stays and more treatments in non-hospital settings, such as homecare and ambulatory care. He added that hospitals would be paid for how well they do things, not for what they do. "It's all about improved outcomes."