Bronx Public Meeting

Remarks by Dr. Mitchell Katz
NYC Health + Hospitals President & CEO
Annual Public Meeting – Borough of the Bronx
NYC Health + Hospitals/Lincoln
Wednesday, May 23, 2018

Welcome and thank you for coming.

I am Mitch Katz, President and CEO of NYC Health + Hospitals, and I’m delighted to be here at NYC Health + Hospitals/Lincoln — the team here just concluded a very successful Joint Commission visit and has also been leading the implementation of many of our system’s new and innovative approaches to combat the opioid epidemic. On behalf of myself, our Board of Directors, our executive staff and workforce, thank you for attending this annual public meeting. We are deeply appreciative of the commitment to public health care that you are demonstrating by being here tonight, and we look forward to hearing your comments and concerns about the current and future state of New York City’s essential public health care delivery system.

This is my first annual public hearing in the Bronx and I want to take this opportunity to report on some of the progress made last year, and highlight my vision for the future success that we will achieve together.

I am a Brooklyn boy, a product of the New York City public school system. Growing up my family received their care at Coney Island Hospital and Kings County Hospital, so I know how critical public hospitals are to the well-being of families and their communities.

At heart, I am a primary care doctor. I will begin my New York City medical practice as an outpatient doctor at our community health center on the Lower East Side in June. I will also work as an inpatient doctor at all of our hospitals on a rotating basis, including our hospitals here in the Bronx. I love public hospitals and clinics and the people who work in them and the patients who come to them.

Last year a lot of important work was done across NYC Health + Hospitals in order for us to continue delivering on our mission of providing quality, affordable, culturally responsive health care to New Yorkers. As the safety net provider for all New Yorkers, our commitment to the patients and communities we serve has never been stronger. Last year we provided care for more than 1 million New Yorkers, of which more than 400,000 were uninsured. In FY 2017, we provided approximately 5.3 million outpatient visits and 1.2 million emergency room visits. There were more than 190,000 patient discharges, including 17,323 newborn deliveries.

In the first few months I have been on the job, I can confidently say that NYC Health + Hospitals is filled with mission driven doctors, nurses, social workers, pharmacist and other professionals. The quality of medical and nursing care provided at NYC Health + Hospitals is excellent, and above the community standard. Every day our hospitals save the lives of critically ill patients in our emergency rooms, intensive care units, and hospital units. However, our system suffers from several serious problems related to access if you are not critically ill. And these access problems compound our financial problems because they discourage paying patients from seeking our care. I was charged by the Mayor to take the work on transformation to another level – to turbocharge it – in order to ensure long term stability and quality. I want to work with all of you here to make the “system” as good as the people working in it.

I see we have many of these good people in the room tonight. Similarly, at our meeting at Bellevue in Manhattan last month and more recently in Queens, Staten Island and Brooklyn, many nurses and representatives from NYSNA – the nurse’s union — spoke compellingly about their commitment to their patients and the challenges they are facing. I want to let you know that I hear you, my team hears you and that we are working to address these issues. We have streamlined our hiring process for nurses so that we can identify candidates, hire, and train and have them serving patients as quickly as possible.

To date, NYC Health + Hospitals has been successful in reducing expenses and increasing revenue in order to lessen the risks to meeting our financial targets. For example, through our work to standardize purchases and get the best price we can for products, we have saved more than $106 million over the past two fiscal years. By improving our billing and revenue collection processes, we have garnered more than $107 million in the last fiscal year. Most prominently, we have managed personnel expenses closely over the past three fiscal years for savings estimated at more than $400 million. This is progress but more needs to be done.

Moving forward my three top priorities are: invigorate and expand primary care, improve access to needed specialty care, and bring fiscal solvency to NYC Health + Hospitals. By focusing on all three, we will better address community health needs, improve the patient experience and maximize opportunities for new revenue. I am certain that with the help of our Board, those of you here today, the Mayor, our organized labor partners, and the incredibly dedicated staff of NYC Health + Hospitals, we can achieve these three goals.

While there has been a lot of focus on improving our fiscal health, the last year has been filled with important achievements that illustrate our continued commitment to quality care and meeting the health needs of the communities we serve. Here are a few of the highlights:

• NYC Health + Hospitals has emerged as a key partner in the City’s fight against the Opioid epidemic. Seventeen of our patient care sites are now State certified Opioid Overdose Prevention Programs that routinely dispense naloxone based on best practices, including overdose prevention training of patients and community members. With the support of the Mayor and First Lady, our system is expanding peer intervention programs, increasing naloxone distribution and training on how to use this lifesaving drug, and connecting more New Yorkers struggling with substance misuse to treatment.
• Last April, and again last month, 22 of our patient care locations – including our Gotham Health community centers and our long term care facilities — received the national designation of “Leader in LGBTQ Healthcare Equality”. We are proud of this recognition, which underscores our health system’s tradition of pioneering diversity and inclusion in the workplace and developing specialized programs to effectively serve the healthcare needs of our city’s diverse LGBTQ community.
• Our Accountable Care Organization (ACO) achieved shared savings for the fourth consecutive year—the only program in the state to achieve such shared savings success based on outstanding quality performance. The ACO saved the Medicare program $3.59 million for 2016 and returned $1.58 million in shared savings to the public health system. Through enhanced care coordination, the health system was able to prevent unnecessary emergency department visits, avoidable hospitalizations, and other high-cost care for the more than 10,000 Medicare fee-for-service patients who are followed through the program.
• We completed renovations at several community based outpatient care sites over the past year to increase access to primary and specialty care in seven underserved communities. Through the Mayor’s Caring Neighborhoods initiative, we are expanding services at these sites, and now include comprehensive primary care and specialties based on community needs, which include behavioral health, cardiology, endocrinology, and after-hours urgent care. The seven sites will be able to serve 42,000 more patients than before the expansion.
• Seven of our hospitals were recognized as U.S. News & World Report Best Hospital for 2017-18 in Heart Failure. Of those, three hospitals also earned Best Hospital for 2017-18 in Chronic Obstructive Pulmonary Disease (COPD) care.
• Ten of our hospitals received national recognition awards from the American Heart Association and the American Stroke Association for excellence in heart and stroke care.
• With the support of First Lady Chirlane McCray, and under the City’s ThriveNYC program, we expanded maternal depression screenings for pregnant women and new mothers, and are making depression screening a routine part of care at pre-natal clinics.
• We also established the integration of in-clinic technology to provide faster point-of-care hemoglobin A1c testing to patients with diabetes. This enables physicians to assess a patient’s average blood sugar level at the time of their appointment and adjust treatment as needed.
• Thirty-two of our hospitals and community-based primary care clinics received Level 3 — highest-level Patient-Centered Medical Home (PCMH) recognition for meeting rigorous national standards and establishing a model to deliver patient-centered, coordinated, and convenient health care services to New Yorkers. Level 3 designation is expected to yield NYC Health + Hospitals approximately $60 million in state reimbursements over fiscal years 2018 and 2019.
• Our Correctional Health Services recently established the 24/7 enhanced pre-arraignment screening unit (EPASU) to better identify and respond to acute medical and mental health issues, expanded Hepatitis C treatment, opened seven satellite clinics to bring our services closer to patients, opened two new specialized housing units for patients with serious mental illness, nearly tripled the number of daily patients on methadone maintenance and buprenorphine, distributed thousands of naloxone kits to members of the public at the Rikers Island visitor’s center, and enhanced mental health services for women in jail.
• Last May, the New York State Department of Health awarded our MetroPlus Health Plan the highest quality measures score among Medicaid managed care plans statewide. The quality scores reflect the investments the plan is making to keep members healthy. MetroPlus scored particularly high in timeliness of prenatal care, administration of flu shots, smoking cessation, asthma medication management, and two key indicators of diabetes management. MetroPlus also received high scores for postpartum care and well child visits.

NYC Health + Hospitals/Lincoln was the first hospital in our system to expand the distribution of naloxone — the drug that reverses opioid overdose — throughout the entire hospital, making naloxone kits more readily accessible beyond its substance use disorder program, to include the emergency department, ambulatory care, behavioral health, and pain management service areas. Lincoln was also the first to use addiction counselors and peer advocates in the hospital’s emergency department to screen each patient who presents with non-fatal opioid overdose, opioid intoxication, or a history of harmful opioid use. And the first to open a hospital-based naloxone kit distribution center to make it available free to the community at large and without a prescription.

In the last year, the hospital also received recognition for excellence in Stroke Care and for helping patients manage their high blood pressure. The hospital’s Stroke Center received certifications and awards from both The Joint Commission and The American Heart/American Stroke Association for providing exceptional stroke care to the community, and is the first Advanced Certified Primary Stroke Center in the South Bronx. And the care team here helped more than three-quarters of patients with hypertension to get their blood pressure under control— reducing risk for stroke, heart attack, kidney damage, vision loss, erectile dysfunction, and memory loss.

NYC Health + Hospitals/Jacobi and NYC Health + Hospitals/North Central Bronx marked an important milestone this year. They expanded their pediatric dental clinics and integrated the practices with primary care, and together provided dental care to 2,500 children with the help of a special grant from the State Children’s Health Insurance Program (SCHIP) and the Affordable Care Act. They also focused on expanding dental health education through partnerships with the Women’s Infants and Children program, the Illyria Clinic at Jacobi, which is dedicated to serving the Albanian community, and Sapna, a community-based organization serving the South Asian community in the Castle Hill and Parkchester neighborhoods.

NYC Health + Hospitals/North Central Bronx was the first hospital in the Bronx to be designated a Gold Safe Sleep Champion by Cribs for Kids®, a national safe sleep hospital certification program, for their work to keep babies safe in their sleep environment and helping to eliminate sleep-related deaths. The team at North Center Bronx was also awarded the 2017 and the 2018 Patient Safety Excellence Award from Healthgrades, the only hospital in the Bronx, and one of two hospitals in New York City, to earn this distinction. The hospital has also been focused in supporting community access to healthy food and emphasizing nutrition education, and this year hosted a Nutritionist Day Conference that featured the hospital’s expert registered dietitians and nutritionists who provide valuable education to patients and community, encouraging and empowering them to make healthy food choices.

NYC Health + Hospitals/Jacobi this past year had some very notable patient success stories, including the impressive creation of a prosthetic arm and hand using 3D printing for its youngest patient yet – a three year old born without forearms or hands; the particularly high risk pregnancy case and challenging birth of triplets who were almost four months premature and required emergency surgery, but were sent home in good health after time with the expert NICU team; and the dramatic recovery of the man who was almost severed in half by an oncoming train and was literally put together by the talented trauma team. The hospital was also recognized by the CDC as an “HPV Vaccine Is Cancer Prevention Champion.” The recognition is one of just ten given out nationwide to health centers and facilities that have succeeded in vaccinating a large portion of their 13-to-15-year-old patient population. While the nationwide vaccination rate among all teens is 43 percent, NYC Health + Hospitals/Jacobi has been able to vaccinate 70 percent of its 13-to-15-year-old population. The hospital also launched a program focused on oral health for expectant mothers, to support both the women and their babies.

Our notable achievements in the Bronx were not limited to our public hospitals. This past year, we made a significant investment to support the expansion of primary care in the borough. NYC Health + Hospitals/Gotham Health, our network of community based health centers that specialize in primary and preventive care, completed renovations and upgrades to our health center in the East Tremont neighborhood of the Bronx. Funded with $1.2 million through Mayor de Blasio’s Caring Neighborhoods Initiative, the facility renovation reflects NYC Health + Hospitals’ commitment to community-based ambulatory care, one of the chief strategies of the health system’s transformation agenda. The refurbished health center on Arthur Avenue in East Tremont provides services that reflect the needs of the community, including family medicine and behavioral health care. The health center is expected to provide care for more than 7,000 patients annually. The new, modern layout features 13 exam rooms, new medical equipment and furniture, and an uplifting décor to create a welcoming environment for our patients and community.

Thanks for allowing me to share this overview of the challenges and positive developments. Now let’s proceed to the main purpose of tonight’s meeting – to hear from you, members of our community. Your input is so important to the future success of this system. I will now turn the rest of the evening proceedings over to Andrea Cohen, our General Counsel and Moderator.