Queens Public Meeting

Remarks by Dr. Mitchell Katz
NYC Health + Hospitals President & CEO
Annual Public Meeting – Borough of Queens
NYC Health + Hospitals/Queens
Hospital Auditorium – Main floor
Wednesday, April 18, 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 with you. 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 borough of Queens 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, NYC Health + Hospitals/Gouverneur, as soon as the privileging process is complete. I will also work as an inpatient doctor at all our hospitals on a rotating basis, including our two hospitals here in Queens. 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 19,000 patient discharges, including 17,323 newborn deliveries.

In the first few months I’ve 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 week, 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’s 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’s 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 this 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, including here in Queens. 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 hospital and community-based primary care clinics – including our hospitals in Queens — 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.

In addition to these system wide achievements, there have been many other positive developments at our patient care facilities in Queens. I’d like to share just a few.

Our two Queens hospitals NYC Health + Hospitals/Queens and NYC Health + Hospitals/Elmhurst were the first in our public health system to have installed the state-of-the-art Epic electronic medical record system, which has given our patients in Queens’s access to their personal health records through MyChart. Empowering patients to better manage their health on-line—for example, by ordering prescription refills—the MyChart system has grown in popularity over the past year, with 19,000 Queens’s patients now using it.

Both hospitals are very engaged with their community, and recently partnered with the Queens Library to provide health and wellness events throughout the borough, increase access to health information, with the ultimate goal of improving health literacy.

Tonight we are pleased to be at NYC Health + Hospitals/Queens, the first hospital in the borough to receive the World Health Organization’s designation as a “Baby-Friendly” hospital—the result of an intensive three-year collaborative process to support new mothers in breastfeeding newborns. The hospital kicked off this year with a successful caesarian delivery of triplets – a trio of baby girls who were initially treated in the NICU for mild respiratory distress but recovered fully under the expert guidance of the hospital’s Labor & Delivery team.

The hospital recently partnered with IDNYC to host a pop-up enrollment site to provide a convenient location for community residents to obtain this municipal ID card available to eligible New Yorkers regardless of their immigration status, race, gender identity, or sexual orientation. The team here also added Saturday hours for patients who need phlebotomy services, giving patients who need to have blood drawn for various tests and procedures the additional scheduling options. The extended weekend hours also lightened weekday patient flow to reduce wait time.

And in recognition of the high standards of care, the Queens Hospital team received a well-deserved award from the Northeast Business Group on Health distinguishing their commitment to providing high-quality, safe care for patients.

Our other hospital in the borough, NYC Health + Hospitals/Elmhursta Level 1 trauma center, has one of the busiest emergency departments in the country. It will soon undergo a much-needed expansion, with a second story and an additional 10,000 square feet. The new emergency department will feature a stroke center with an advanced medical imaging unit, additional surgical beds, an Observation Unit, a psychiatric Emergency Room, additional isolation rooms, and centralized radiology services.

The Elmhurst team recently launch the hospital’s Global Health Institute to support and advance groundbreaking research, grow existing relationships with community and global partners, host educational events for the community, and help improve clinical and patient experiences. As you know, Elmhurst serves the most ethnically and linguistically diverse community in the United States, which makes the addition of the Global Health Institute a natural fit for our hospital.

In the last year, Elmhurst was the first hospital in Queens to receive “Gold” recognition — the highest award of Cribs for Kids®’ National Safe Sleep Hospital Certification Program — for its commitment to promote infant safety and help reduce sleep-related infant deaths in the community. The hospital also earned a prestigious national recognition — The Joint Commission’s Gold Seal of Approval for Advanced Certification for Total Hip and Knee Replacement — for meeting rigorous standards of patient care at every stage, including the initial consult, the procedure, and post-surgical care such as rehabilitation services. This seal of approval serves as a reminder that residents of Queens don’t need to travel far to receive high-quality, affordable hip and knee replacement surgery.

Our focus on services in Queens has not been exclusive to our hospital buildings but also to our neighborhood based outpatient locations under the NYC Health + Hospitals/Gotham Health network of community health centers. We recently hosted a ribbon cutting ceremony to mark the opening of a renovated health center in Jackson Heights where we expanded from a pediatrics-only practice and now provide a range of services, including adult primary care, women’s health, and behavioral health. The renovation included upgraded exam rooms, new medical equipment and furniture, and an uplifting décor to create a welcoming environment for patients, as well as staff. The $1.8 million renovation was funded by the Mayor’s Caring Neighborhoods Initiative. The health center is expected to grow to serve 10,000 patients annually.

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. We are ready to listen.