REPORT TO THE BOARD OF DIRECTORS – September 2018

State – The State Department of Health convened its second meeting of the temporary workgroup on indigent care funding in which I am a member. The meeting was held on September 12th in Albany and focused on the transition dollars associated with the indigent care pool. There will be two additional meetings this fall with a report on policy recommendations on disproportionate share hospital (DSH) funding and indigent care funding due to the State Legislature on December 1st. NYC Health + Hospitals needs to be treated fairly and we will work closely with labor and community advocates to ensure that the distribution formula provides DSH funds to hospitals that treat a disproportionately larger share of Medicaid and uninsured patients.

Primary elections for state officials were held last week. Governor Cuomo and the Lieutenant Governor won their respective primaries. There were a number of incumbents defeated in the Democratic primary and, as a result, several of our facilities will have new representatives in Albany: Elmhurst, Jacobi, Kings County, McKinney, Queens, and Woodhull. The General Election is on November 6 and we look forward to working with the members of the State Legislature on the important role of NYC Health + Hospitals in their communities.

Federal – The House and Senate are expected to remain in session for a few additional weeks before the mid-term elections. Congress will need to take action to fund the government before a September 30 deadline. Despite ongoing discussion of funding for a border wall, it appears likely the President will sign a short term continuing resolution to keep the government open without funding for a wall. The federal Centers for Medicare & Medicaid Services (CMS) released its Medicare outpatient prospective payment system proposed rule for FFY 19. The proposal would expand “site neutral” payment policies to off-campus hospital outpatient departments, and cut payments for services known as “evaluation and management” services to more closely match the rate paid to physician offices. Hospital trade groups have strongly opposed the changes in the proposed rule and NYC Health + Hospitals continues to analyze the rules potential impact on our operations and finances. We also continue to monitor the developments related to the 340B program and opioid-related legislation, though it appears unlikely that major legislation will pass or major regulations will be issued prior to the mid-term elections.

• To address the unmet needs of patients and community members, OneCity Health launched its Hospital-Community Partnerships which aim to improve health outcomes. As a part of this effort, new Hub Advisory Workgroups will convene bi-monthly to examine local issues and opportunities to improve performance on priority outcome measures that are tied to DSRIP and value-based payment programs. The Hub Advisory Workgroups will also devise performance improvement strategies inclusive of hospital-community partnerships.
• OneCity Health was asked by the New York State Department of Health to host a Winston Churchill UK Fellow as part of her visit to the United States. Churchill Fellows spend up to two months abroad researching innovative practices on the topic of their choice to explore the practical exploration of practices in other countries. Geraldine Esdaille received the fellowship in partnership with the Mental Health Foundation to focus on community-based approaches, specifically state-funded and community-led interventions for women, particularly black women, who are living with mental illness or managing substance abuse and domestic violence issues.
• In collaboration with NYC Health + Hospitals, Medical & Professional Affairs, OneCity Health applied for the American Hospital Association High-Value Care Collaborative on behalf of NYC Health + Hospitals and was selected. The collaborative brings together national health system leaders in a provider learning network to accelerate adoption of proven high-value care models and innovative pay models. Participation in the collaborative will support NYC Health + Hospitals efforts to implement a system-wide observation services strategy. Implementation of these tactics will support DSRIP goals to reduce avoidable utilization including potentially preventable emergency room visits and inpatient readmissions.
• OneCity Health continues its successful strategies to identify patients in need of a routine visit and to proactively reach out to these members to arrange primary care appointments. Interested patients then receive a call from the NYC Health + Hospitals call center to schedule their primary care appointment. From mid-February through August 2018, over 1,500 primary care appointments have been scheduled.

Earlier this month, we took the difficult, but necessary step to eliminate administrative positions across our facilities as we continue to reduce costs that do not impact direct patient care and allow us to be in a better position to support the front lines of care.

We made it clear that these administrative staff reductions do not reflect on performance by any individual. We know staff separations are difficult. And with the help of our HR team, we were able to offer our colleagues the needed post-employment assistance to ease their transition.
While I hope this represents the last round of administrative staff reductions, we will continue to be diligent about identifying other opportunities to realign our staff resources to support new models of care and our long-term financial health.

I’m very proud of the work we’ve accomplish over the last eight months to advance the top priorities for our health system — to invigorate and expand primary care, improve access to needed specialty care, and bring fiscal solvency to NYC Health + Hospitals. I look forward to celebrating many positive achievements as we work together to build the best public health care system in the country.

Mayor Bill de Blasio marked the opening of a new $28 million NYC Health + Hospitals/Gotham Health community health center on Staten Island, the organization’s first full service ambulatory center in this borough. NYC Health + Hospitals/Gotham Health, Vanderbilt will expand access to primary care for children and adults, mental health counseling and referrals, and opioid treatment. The modern, 18,000-square-foot health center is expected to serve more than 4,500 patients this year—growing to 15,000 patients and 40,000 annual visits by 2020—and help reduce the reliance on overcrowded emergency rooms and prevent avoidable hospitalizations. Located at 165 Vanderbilt Avenue, the new community health center will offer comprehensive primary care by a team of physicians, nurses, social workers, and other health care professionals, with a focus on the medical needs of neighborhood residents.

NYC Health + Hospitals/Woodhull expanded its Comprehensive Psychiatric Emergency Program (CPEP) that was open for patients on September 12 and provides a more modern, comfortable space to manage, treat, and follow up with patients presenting with psychiatric emergencies. The new CPEP will more than double the current space from 4,230 square feet to 9,267 square feet, increase the number of extended observation beds from three to six, and accommodate a larger therapist staff. The expansion reflects both a response to the community’s growing need for behavioral health services and the health system’s ongoing transformation, with its focus on increased access to services. This expansion will enable staff to manage the average daily census of 20 people in a safe, therapeutic environment. Located on the fifth floor, the enlarged unit will immediately eliminate the overcrowding of the old unit, providing space to care for patients in psychiatric distress.

NYC Health + Hospitals/Correctional Health Services expanded its Enhanced Pre-Arraignment Screening Unit (EPASU) to Brooklyn Central Booking. First launched at Manhattan Central Booking, the EPASU is designed to increase the scope of services provided during pre-arraignment screening, and will eventually be extended to all four of the City’s central booking facilities. The EPASU program currently conducts health screenings and assessments for medical and behavioral health needs 24 hours a day, 7 days a week for people pending arraignment in Manhattan. The Brooklyn EPASU is projected to screen approximately 35,000 individuals in its first year. The expansion is part of Correctional Health Services’ role in the City’s plan to decrease the jail population and promote health equity in the criminal justice system.

NYC Health + Hospitals/Coney Island opened its new Outpatient Diagnostic Center/Women’s Health, a 7,093-square-foot imaging suite with some of the most advanced imaging technologies, including 3D mammography, Hologic bone densitometry (DEXA)/Osteoporosis scanning, a panorex unit – which moves around the patient’s head to capture jawbone and dental x-rays, and an ultrasound unit that uses high-frequency sound waves to capture images for a range of health care purposes, including ultrasound-guided biopsies.

NYC Health + Hospitals marked the opening of a new neighborhood clinic in Bedford-Stuyvesant, Brooklyn, which has been funded by a $3.1 million capital investment through Mayor Bill de Blasio’s Caring Neighborhoods Initiative. The NYC Health + Hospitals/Gotham Health neighborhood clinic is the latest addition to the public health system’s transformation, expanding access to community-based ambulatory care, especially in underserved neighborhoods. The NYC Health + Hospitals/Gotham Health site is initially offering pediatric care. Additional services will be added, including adult primary care and women’s health services starting in mid-September. Located at 485 Throop Avenue, the neighborhood clinic is expected to serve nearly 3,000 patient visits in the first year, growing to more than 15,000 annual visits over time, as staffing grows to accommodate the anticipated patient demand.

NYC Health + Hospitals/Elmhurst expanded the hours of operation in its Women’s Pavilion—an outpatient prenatal and obstetric care clinic located at 78-20 41st Avenue, adjacent to the hospital’s main building—to better accommodate patients in the community. The pavilion is now open Monday through Thursday from 7:30 a.m. to 7:00 p.m., on Fridays from 7:30 a.m. to 4:00 p.m., and on Saturdays from 8:00 a.m. to 12:00 p.m. The Women’s Pavilion offers a range of women’s health services, including walk-in pregnancy testing, prenatal care, HIV counseling and testing, genetic counseling, high-risk pregnancy services, antepartum fetal testing, and postpartum services. The pavilion also hosts free childbirth, breastfeeding, nutrition, and diabetes education classes through an ongoing health lecture series. The two-story building has spacious reception areas featuring glass facades,18 exam rooms, and on-site phlebotomy and urine labs to facilitate easy access to test results.

NYC Health + Hospitals this week showcased our new medical simulation training to educate doctors, nurses, and other members of the labor and delivery team to demonstrate best practices in the management of maternal hemorrhage, one of the top causes of pregnancy-related deaths for women of color. The simulated high-risk birthing scenario conducted by a team at NYC Health + Hospitals/Harlem is part of the new training program that will be rolled out starting in December to approximately 1,000 labor and delivery staff and other health care professionals who interact with the high-risk patient population, including primary care providers, anesthesiologists, and members of rapid response teams. The simulation training program also includes the opening of new mini-sim labs—one- and two-room satellite simulation training facilities located close to Labor and Delivery units at six of our hospitals—to focus exclusively on maternal care. This new training program is a major component of the city’s four-point plan, announced in July, to reduce severe maternal morbidity and maternal mortality events over the next five years. Thanks to Deputy Mayor Dr. Herminia Palacio for attending the simulation exercise and for the support we’ve received from the City to make this training a reality.

NYC Health + Hospitals Accountable Care Organization (ACO)—a group of doctors and other providers who coordinate care for patients under the Medicare Shared Savings Program (MSSP)— earned more than $2 million from the federal government for reducing costs and meeting high standards of quality care for patients. These results mark the fifth consecutive year that the public health system’s ACO has achieved savings and outstanding quality performance by improving care coordination in the primary care setting and preventing unnecessary emergency department visits, avoidable hospitalizations, and other high-cost care for the more than 10,000 Medicare fee-for-service patients who are served through the program. HHC ACO, Inc., is the only MSSP ACO based in New York State to earn shared savings for five consecutive years and one of only 21 ACOs around the country to have earned that distinction.

NYC Health + Hospitals/Bellevue will embark on a pilot program to help patients transition to a healthy lifestyle that includes a whole-foods, plant-based diet to improve, and in some cases reverse, chronic conditions such as heart disease, diabetes, obesity, high cholesterol, and high blood pressure. The Plant-Based Lifestyle Medicine Program will launch this Fall and serve up to 100 adult patients with chronic disease who wish to reduce their cardiometabolic risk through healthful lifestyle changes, including following a diet that emphasizes legumes, whole grains, fruits, vegetables, nuts, and seeds, and reduces animal products, fried foods, refined grains, and added sugars. The pilot program is a result of Brooklyn Borough President Eric L. Adams’ advocacy around plant-based nutrition. Dr. Michelle McMacken, director of the NYC Health + Hospitals/Bellevue Adult Weight Management Program, will lead the Plant-Based Pilot Program.

U.S. News & World Report named NYC Health + Hospitals/Lincoln a “High Performing” hospital for both heart failure and chronic obstructive pulmonary disease (COPD) and NYC Health + Hospitals/Coney Island a “High Performing” hospital in heart failure. The recognition was published as part of the national magazine’s “Best Hospital” issue for 2018-19.

NYC Health + Hospitals/Kings County has been recognized by the National Safe Sleep Hospital Certification Program with a bronze certification for its commitment to the reduction of infant mortality and to providing the best patient experience and safe sleep outcomes for mothers and families in Central Brooklyn and beyond. The “Safe Sleep” certification is a significant accomplishment for the Women’s Services team worked tirelessly and played a critical role in this achievement.

Bronx Assemblywoman Carmen Arroyo provided $2.4 million for state-of-the-art 3T Magnetic Resonance Imaging (MRI) equipment at NYC Health + Hospitals/Lincoln. The new technology will be installed by 2020 and will help improve both diagnosis and patient experience.

NYC Health + Hospitals is rolling out a new advanced meal delivery system to enhance the patient experience at all our hospitals. The new state-of-the-art food delivery meal carts are equipped with technology that ensures food reaches hospital patients at optimal temperatures and maintains its nutritious elements. The carts feature a refrigerator and a low-temperature convection oven. Hot food maintains its temperature for 50-minutes while in the unit, which allows ample time for delivery from the hospital’s kitchen to patient rooms. In addition to keeping hot foods moist, the convection oven also expands menu options over the old system. NYC Health + Hospitals/Coney Island became the first hospital in our system to adopt the new system. We are already using the meals carts at a number of our long term care facilities and plan to roll them out at all of our hospitals as well.

NYC Health + Hospitals/Queens and The Joy in Childhood Foundation, the charitable foundation supported by Dunkin’ Donuts and Baskin-Robbins, announced the creation of a Starlight Site in the hospital through a $1.5 million partnership with Starlight Children’s Foundation. The new Starlight Site will transform NYC Health + Hospitals/Queens’ pediatric waiting area into an updated, brighter, and happier space for its pediatric patients. The waiting room update will include a private breastfeeding room, a reading nook, and a teen-friendly area with iPads, headphones and other state-of-the-art equipment. The Starlight Site will be open for patients and their families before the end of the year.

Cristina Contreras, MPA, LMSW, was appointed executive director of NYC Health + Hospitals/North Central Bronx. Ms. Contreras has worked in the New York City public health care system for more than 20 years, including the last ten at NYC Health + Hospitals/North Central Bronx, where she has served as deputy executive director and chief operating officer for the past year. She assumed her expanded leadership role effective September 1.

Kim K. Mendez, EdD, ANP, RN will be taking on a major new leadership role to help advance our work in Information Technology and represent the needs and interests of doctors, nurses and other clinicians in our system. As the new System Chief Health Informatics Officer, Kim will partner with CIO Kevin Lynch, who is responsible for all Enterprise IT Services, and will focus on all clinical information systems, applications and EMR. Kim will transfer from her current role as Sr. VP, System Chief Nurse Officer and will begin her new duties on September 30.

Mary Anne Marra, DNP, MSN, RN has been appointed Interim Chief Nurse Officer for NYC Health + Hospitals. Mary Ann currently serves as CNO at NYC Health + Hospitals/North Central Bronx and will transition into her new role on October 1. She has served as nurse leader, quality improvement manager and hospital administrator in acute care, ambulatory care, psychiatric care and long term care operations. I look forward to working with Mary Ann as part of our health system’s senior cabinet team.

Alina Moran was appointment Chief Patient Growth Officer of NYC Health + Hospitals. Alina is taking on this additional responsibility for our organization while remaining CEO of NYC Health + Hospitals/Metropolitan. In her new role as Chief Patient Growth Officer, Alina will collaborate with MetroPlus, HealthFirst, and other health plans to minimize patient leakage and grow patient volume, assist in developing capacity to increase referrals from community physicians, and contribute to our clinical services and business planning processes.