REPORT TO THE BOARD OF DIRECTORS – DECEMBER 2017

Governor Andrew Cuomo has vetoed, for the second time, enhanced safety net legislation passed by the Senate and Assembly earlier this year. Under Senate bill 5661-B, health care systems such as NYC Health + Hospitals, meeting eligibility requirements for serving a disproportionately large share of Medicaid and uninsured patients would be entitled to medical assistance payments from the state. The bill’s language was similar to language included in the state budget providing for $10 million dollars this year and next. In the veto message, the Governor directed the State Health Department to engage stakeholders on the issue of reimbursement.

In Washington the continuing budget resolution (CR) currently funding federal government operations expires on December 22. Congress must take action by that date to avert a government shutdown on the 23^rd. Options include another short term CR, or one of longer duration. It is unclear whether a short term CR may be used to address the future of Disproportionate Share Hospital (DSH) program funding which has been the subject of debate and uncertainly for nearly a decade. A proposal to postpone the FFY 2018 and 2019 DSH cuts already called for by federal statute (The Budget Reconciliation Act of 2011) coupled with an agreement to deepen reductions in FFY 2020 to offset previous delays, seems to be gathering support in Congress.

Another pressing issue that may be addressed in a CR is the reauthorization of the expired Children’s Health Insurance Program (CHIP), which has dramatically reduced the uninsured among American’s children. The possibility of a stand-alone package of health care “extender” legislation containing CHIP reauthorization and other Health Care measures also exits.

As you know, Congress has passed, and President Donald Trump has signed into law an overhaul of federal taxation policy. The law contains a provision eliminating the individual mandate to purchase health insurance, an important component of the Affordable Care Act. The Congressional Budget Office estimates that as many as 13 million people no longer will have health insurance due to this provision. In addition, the tax bill’s elimination of the deduction for state and local taxes, along with the loss of the individual mandate, will certainly add pressure on the New York State budget which currently has a projected deficit of 4.4 billion for FY 2018.

We will continue to work closely with the Mayor’s office, Congressional allies and partner health care associations to assess the long term impact on health insurance exchanges and safety net systems like ours. The law’s elimination of the deduction for state and local taxes, as well as potential losses of billions of dollars in Medicaid under plans that continue to threaten the Affordable Care Act, are among the drivers of a projected New York State budget deficit of 4.4 billion for FY 2018.

New York City Housing Authority and NYC Health + Hospitals announced that the City will offer free blood lead level testing for the nearly 3,000 children ages 6 months to 8 years who live in more than 2,300 NYCHA apartment units painted in 2016 by workers without proper certification. While the risk of significant exposure from this work remains low, out of an abundance of caution, the City is offering free testing to children aged 6 months to 8 years old due to normal behavior that can result in ingestion of lead dust.

The health effects of exposure to lead are best managed early, so concerned parents are encouraged to take advantage of this free testing. If high lead levels are detected, follow-up is available. Residents in affected apartments will receive a letter and phone calls with more information about how to schedule an appointment at NYC Health + Hospital location across the five boroughs.

I’m pleased to report to the Board that the Hip and Knee Center at NYC Health + Hospitals/Elmhurst has earned The Joint Commission’s Gold Seal of Approval for Advanced Certification for Total Hip and Knee Replacement. This national certification recognizes the hospital for providing top-quality care and for meeting rigorous standards of patient care at every stage, including initial consult, procedure, and post-surgical care such as rehabilitation services.

The center was founded with the goal of restoring mobility and quality of life to individuals with hip and knee joints that no longer function properly and cause difficulty in day-to-day activities. Our team of providers includes an orthopedic surgeon, rehabilitation doctor, physician assistant, physical therapist, occupational therapist, social worker, pharmacist, and nurses. Patients’ pre-surgical preparation involves the coordination of rehabilitation by the team at Elmhurst, and includes planning for rehabilitation services at their home following surgery or in the hospital. The center’s providers are committed to offering patients a compassionate continuum of care, with an individualized approach to treatment, leading to quick recovery and improved mobility.

Congratulations to Israel Rocha Jr., Chief Executive Officer of NYC Health + Hospitals/Elmhurst, Rohit Hasija, MD, medical director of the Hip and Knee Center at NYC Health + Hospitals/Elmhurst and their teams for this prestigious recognition. The Joint Commission certification is a great reminder to our patients in the area that they needn’t travel outside their own community to receive high-quality, affordable hip and knee replacement surgery.

Earlier this month we were delighted to announce an advance in diabetes care at NYC Health + Hospitals that enhances the treatment we provide, and our patients’ experience of that treatment. At several sites we’ve begun to include in-clinic technology to provide faster point-of-care hemoglobin A1c. Using an in-clinic machine and a small blood sample, physicians can review a patient’s average blood sugar level for the past two to three months, in as little as five minutes.

The addition of point-of-care testing systems in NYC Health + Hospitals clinics enables a physician to assess a patient’s average blood sugar level at the time of the patient’s appointment. A1c testing is especially important for patients who may not have been seen by their doctor recently, and helps physicians make necessary adjustments to a patient’s treatment plan at the time of their appointment. It’s an effective monitoring tool for patients with diabetes, improving care and removing the wait for lab results following an appointment. Preliminary data shows that patients receiving care at our sites with in-clinic A1c testing have, on average, better control rates, compared to patients at our other sites. This makes good sense. When patients know their diabetes numbers, they can better manage their blood sugar, and their risk of complications decreases.

Our ten facilities currently featuring in-clinic A1c testing are:

Bronx
NYC Health + Hospitals/Jacobi
NYC Health + Hospitals/Lincoln
NYC Health + Hospitals/North Central Bronx
NYC Health + Hospitals/Gotham Health, Belvis
NYC Health + Hospitals/Gotham Health, Morrisania

Brooklyn
NYC Health + Hospitals/Coney Island
NYC Health + Hospitals/Gotham Health, East New York

Manhattan
NYC Health + Hospitals/Harlem
NYC Health + Hospitals/Gotham Health, Sydenham

Queens
NYC Health + Hospitals/Elmhurst

In-clinic A1c testing will be introduced to other sites in the coming months.

I am also pleased to draw the Board’s attention to the launch of NYC Health + Hospitals Global Health Institute. Led by infectious disease specialist Joseph R. Masci, MD, the Global Health Institute at NYC Health + Hospitals/Elmhurst will 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. It will optimize existing and new sources of grant funding to conduct clinical research for the advance of new treatments in HIV and tuberculosis management, among other areas. The Institute will generate innovative care protocols to treat global health conditions in response to disease trends experienced globally and reflected locally, by the hospital’s diverse community. And it will be a resource for the local community by partnering with other providers, business owners, and other stakeholders to gain a better understanding of local health concerns and how they can be addressed.

To kick off its launch, the Institute recently hosted a well-attended HIV Global Health Summit, bringing together local experts and representatives from Ethiopia and Russia to discuss the status of HIV/AIDS locally and internationally and to share best practices. To learn more about the Institute at NYC Health + Hospitals/Elmhurst, visit https://www.nychealthandhospitals.org/elmhurst/globalhealthinstitute/

The Centers for Disease Control and Prevention has recognized NYC Health + Hospitals/Jacobi and its Children’s Health Center as an “HPV Vaccine Is Cancer Prevention” Champion. Jacobi is one of just ten health centers nationwide to achieve this distinction, by vaccinating a large portion of their 13-to-15-year-old patient population. While the nationwide vaccination rate among all teens is 43 percent, Jacobi’s vaccination rate for its 13-to-15-year-old population is 70 percent.

The vaccine protects against from most of the cancers caused by human papillomavirus (HPV) infection, from a common virus spread through sexual contact. About 14 million people, including teens, become infected with HPV each year which can cause a variety of cancers in both men and women. In 2013, to control the spread of HPV in the Bronx, a team of Jacobi physicians and nurses led by Dr. Kathleen Porder embarked on an effort to increase vaccination rates in the target age group. Because the vaccination involves a series of shots over time, the vaccination effort is complicated, often requiring documentation checks, including outreach for records in other states, and translation for records of foreign-born patients. Congratulations to Dr. Kathleen Porder and her team for the thousands of hours of detail-focused work they have put into making our vaccination rate a national model.

Although 2017 has been a difficult year for those of us who believe in public health and greater access to care for society’s less fortunate, it has also had its bright points. One of those is the recent multiple-birth baby boom that has been ongoing at NYC Health + Hospitals/Woodhull. Twenty-six sets of twins and one set of triplets were born at the hospital in 2017. More than 30 babies and their families attended a reunion at NYC Health + Hospitals/Woodhull, in celebration of the streak. They were treated to a holiday-themed brunch served by their favorite NYC Health + Hospitals/Woodhull nurses, midwives, and doctors. Each family in attendance received a supply of diapers, a gift certificate to a local grocery store, and other giveaways.

Earlier this year, NYC Health + Hospitals/Woodhull announced its designation as Brooklyn’s first “Baby-Friendly” hospital. Awarded by Baby-Friendly USA, an initiative of the World Health Organization and the United Nations Children’s Fund (UNICEF), the designation recognizes hospitals that encourage and promote breastfeeding and mother-baby-bonding.

NYC Health + Hospitals/Elmhurst has announced the additions of Nnaemeka Anyadike, MD, and Patrick M. Colley, MD, to expand its Endoscopy and Ear, Nose, and Throat Services, respectively. Dr. Anyadike, a gastroenterologist, has been named the hospital’s Director of Endoscopy, and Dr. Colley, an ear, nose, and throat specialist has been named the Regional Director of Otolaryngology for NYC Health + Hospitals/Elmhurst and NYC Health + Hospitals/Queens.

Dr. Anyadike is a graduate of the University of Virginia School of Medicine. He completed his internal medicine residency at Thomas Jefferson University Hospital and completed a gastroenterology fellowship and advanced endoscopy training at Maimonides Medical Center. He specializes in endoscopic procedures to assess conditions affecting the gastrointestinal tract, including the stomach, duodenum, small and large intestines, the pancreas, and the bile duct.

Dr. Colley received his medical degree from Albert Einstein College of Medicine, completed his otolaryngology residency at the New York Eye and Ear Infirmary and a rhinology and skull base fellowship at the University of North Carolina, Chapel Hill. In addition to general otolaryngology, Dr. Colley has extensive training in the treatment of chronic rhinosinusitis, endoscopic sinus surgery, facial trauma, endoscopic orbital surgery, and open and endoscopic approaches to the skull base.

We are delighted to welcome each of these esteemed physicians to NYC Health + Hospitals.

Northeast Business Group on Health, a coalition of health care leaders dedicated to empowering members to achieve the highest value in health care delivery, recently recognized NYC Health + Hospitals/Queens with its “Most Improved Performance Award”, reflecting the hospital’s strong commitment to advancing the quality and safety of the care it provides its clinical services. The award was presented at the Fourth Annual Patient Safety and Quality Improvement Breakfast at the Union League Club in New York City. The event was co-hosted by Leapfrog Group, a national nonprofit watchdog organization focusing on safety, quality, and affordability in health care. For the past several years in the Leapfrog Group’s semi-annual hospital surveys, NYC Health + Hospitals/Queens has garnered impressive scores, including its most recently a “B”, the highest grade of any hospital in New York City.

Earlier this month we held a ribbon-cutting ceremony to celebrate the recent upgrade of 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 refurbished NYC Health + Hospitals/Gotham Health center in East Tremont reflects NYC Health + Hospitals’ commitment to community-based ambulatory care.

The center provides a wide range of services, including family medicine and behavioral health care, and will employ a nutritionist and a social worker to support behavioral health services. Located at 1826 Arthur Avenue in East Tremont, it is expected to provide care for 7,360 patients annually.

The center’s new layout was designed with patient comfort in mind. It includes 13 upgraded exam rooms, new medical equipment and furniture, and an uplifting and welcoming décor. A core tenet of our health system transformation is addressing the challenge of ambulatory care access, one underserved neighborhood at a time. We are proud that now, patients waking up under the weather is East Tremont will have better options than ever before to get quality care right in their own neighborhood.