Bronx Public Meeting

STANLEY BREZENOFF, INTERIM PRESIDENT & CEO
Annual Public Meeting Bronx
Wednesday, April 19, 2017

Remarks by Stanley Brezenoff
Interim President & CEO, NYC Health + Hospitals

Welcome and thank you for coming.

I am Stanley Brezenoff, President and CEO of NYC Health and Hospitals. 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.

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. Our commitment to the patients and communities we serve has never been stronger. In 2016 we provided care for 1,143,572 New Yorkers including, 306,881 patients in the Bronx. We served 1,070,485 patients in our in-patient care facilities, and 117,320 patients in our network of outpatient settings. In 2016 we also we delivered 17,898 babies (not including Melanie Londono, the first baby born to our system in 2017) here in the Bronx, at NYC Health + Hospitals/Lincoln. We continue to serve as the safety net for all other hospitals in the metropolitan area, who depend on us to care for two hundred seventy six thousand, five hundred and eighty four (276,584) uninsured patients each year. Over twenty percent of the patients we saw in the Bronx last year were uninsured.

Today our mission of safeguarding the health of our patients, our fellow New Yorkers, and our city remains unchanged, however, the fiscal and policy environment in which we operate has altered dramatically for the worse. As New Yorkers who have taken an active interest in public health, you are probably aware that NYC Health + Hospitals continues to confront a financial crisis. We are grappling with a large budget gap brought on by higher costs to run our system, and reimbursement policy changes at the federal and state levels that have yielded severe shortfalls associated with being the city’s single largest provider of care to Medicaid and uninsured patients.

We have moved decisively to address this deficit, and I am pleased to be able to inform you that as a result of aggressive action on both the spending and expense side of our operations, we are on track to meet our FY 2017 shortfall of $779 million. Nevertheless, the financial pressure continues to grow. Huge reductions to Disproportionate Share funding — our primary source of federal compensation for serving as the city’s safety net provider– are scheduled to take effect in October of this year, unless Congress takes action to delay them. This challenge, and others, existed before President Trump took office. But the budget and policy uncertainty now emanating from Washington only intensifies the financial stress that NYC Health + Hospitals is under.

A few weeks ago, safety net systems like ours avoided a catastrophic blow with the pulling of the Affordable Care Act (ACA) replacement plan – the American Health Care Act – from a vote by the House of Representatives. Our reprieve may be temporary however. We know that federal budgetary, regulatory, and legislative assaults will continue to pose risks to the ACA, and therefore to us. The prudent course is to treat the failure of Speaker Ryan’s proposal as a short-term victory.

As a reminder, if the ACA were fully repealed, New York State estimates that 2.6 million New Yorkers would lose health insurance coverage, including up to 1.6 million residents of New York City. Based on this estimate, more than 200,000 Health + Hospitals patients would be at risk of losing coverage.

Moving forward, we are prepared to fight for the health care values that New Yorkers believe in, and we will continue to work aggressively and in partnership with the Mayor’s Office, members of our Congressional, Legislative and Council delegations, our colleagues in hospitals nationwide, our union partners, community based organizations, health care advocates and national hospital associations, to attempt to blunt any federal actions designed to undermine safety net care.

All across the country, health care organizations ─ especially safety net systems like ours ─ must respond to significant changes in governmental support, rules and regulations, and consumer expectations. When we talk about the “Transformation” of NYC Health + Hospitals, we mean the urgent need to reinvent public health care delivery in response to those structural changes to the national and local health care landscape. Accomplishing this, especially in the midst of financial crisis, is a massive undertaking. However, as Albert Einstein once said, “In the middle of difficulty lies opportunity.” The necessity that we transform in order to assure long term financial sustainability, offers the chance for us to become a more competitive, more community-based, higher-performing system. We have embarked on a long-term plan to make strategic changes – while we keep focused on meeting our budget gap-closing targets, running a more efficient operation, and providing safe and quality care to the thousands of New Yorkers who rely on our services every single day.

Our Transformation work is driven by the overarching goal to improve care delivery to keep New Yorkers healthy and not just treat them when they are sick. Our ongoing work is guided by principles outlined in the One New York, Health Care for Our Neighborhoods report released by Mayor de Blasio, as well as insights and recommendations made by recognized health care experts and members of the communities we serve.

Frankly, this will mean redirecting scarce resources from an inpatient service line with declining utilization, and focusing those resources instead on building an even more robust primary care network. Though plans are not yet definitive, there is an ongoing Transformation process that reflects our recognition that this is what’s in the best interests of the people we serve: to do a better job in primary care, in prevention, in wellness.

We have been on a journey, alongside the rest of the country, to build an integrated health care delivery system that is responsive to changing demands in the market, and well-positioned to be competitive in the future. The Transformation work engages Health + Hospital employees at every level — our labor partners, city government agency leaders, elected officials and the broader community – to reinvent our system in a way that expands access, improves quality, and meets the challenges of the 21st century health care landscape.

And while we undergo this transformation, we will reinforce our historic pursuit of clinical excellence as well as New York City’s fundamental commitment to health care as a human right: To that end, we have taken a number of actions over the past several months to reaffirm our commitment to the health care of immigrants, without regard to their legal status.

Late last year, Immigrant Affairs Commissioner Nisha Agarwal and I joined together to issue a reassuring message to New Yorkers who may not be accessing health care services for fear of having their immigration status disclosed. Our open letter to immigrant New Yorkers was issued in 14 languages in order to assure the community that we remain absolutely committed to our mission to serve all New Yorkers, regardless of immigration status. We underscored our dedication to protecting our patients’ right to privacy, and keeping their immigration status completely confidential. Our bottom line is this: the primary concern of this system will remain our patient’s health, not their immigration status.

In November and December we held a series of community engagement meetings around the city to help educate interested New Yorkers about changes to the city’s health care landscape, and to learn from them about their own community’s health needs and priorities. These meetings were an outgrowth of the One New York, Health Care for Our Neighborhoods report, and its commitment to vigorous, ongoing, stakeholder engagement around the transformation of public health care in New York City. We were pleased to partner with the New York Immigration Coalition and Community Resource Exchange in holding these events, and ultimately in producing a report titled NYC Health + Hospitals Community Conversations: that captures the information shared at these meetings. Community Conversations is available at: https://www.nychealthandhospitals.org/wp-content/uploads/2017/03/CRE_Report.pdf

We also recently sponsored a series of forums across the city designed to reassure immigrant communities that they can seek care from us without fear. These forums–one of which was held at Lincoln last week–offered information and resources, and addressed a variety of important health care topics affecting immigrants, such as health care rights, access to care, and privacy concerns regarding immigration status.

We have also partnered with Mayor de Blasio, the NYC Human Resources Administration, the NYC Department of Health and Mental Hygiene and our own health plan, MetroPlus to launch an ambitious campaign called GetCoveredNYC, which is focused on enrolling more New Yorkers in health insurance and providing them with access to primary and preventive care at NYC Health + Hospitals facilities. The Affordable Care Act has resulted in more Americans and more New Yorkers having health insurance than ever before. The more people we continue to enroll under current federal law, the harder it will become to roll back progress made since the ACA’s implementation. That is why, late last year, the City hosted five enrollment events including a launch at NYC Health + Hospitals/ Gotham Health, Gouverneur, focused on engaging applicants–especially younger New Yorkers–and assisting them in applying for coverage. The campaign’s goal is to enroll 50,000 New Yorkers through 2017 who are eligible for health insurance but are not taking advantage of existing enrollment options.

Another example of our commitment to making health care more accessible to all, is our partnership with the Mayor’s Office and the City University of New York, to facilitate the IDNYC program. Just recently right here at NYC Health + Hospitals/Jacobi, 630 Bronx residents were able to obtain a new IDNYC card, which is a government-issued identification card that is available to all City residents age 14 and older, without regard to immigration status. IDNYC is the largest municipal identification card program in the nation. It enables residents to access health care at any NYC Health + Hospitals facility, can be presented as proof of identification for interacting with the police, and is also an accepted form of ID for opening a banking account at certain financial institutions.

In a moment I’ll discuss some of the initiatives we have underway to build healthier communities throughout the Bronx, but first, let me acknowledge our host tonight, NYC Health + Hospitals/ Jacobi — a tremendous community asset. This year our system was particularly proud when Jacobi was designated by the American College of Surgeons (ACS) as a Level I Trauma Center, confirming its readiness to deliver the highest level of care to patients with the most serious injuries. In 2016 Jacobi was also recognized by US News and World Report for high performance in both cardiac care and chronic obstructive pulmonary disease care. Great work is going on here, and we thank Acting CEO Christopher Mastromano and his staff for hosting us this evening.

We are also very proud of the level of excellence being achieved by our many Bronx patient care facilities in a variety of other disciplines. Jacobi, Lincoln and NYC Health + Hospitals/ North Central Bronx have met or exceeded national standards established by the “Get With The Guidelines” program, a quality improvement initiative created by American Heart Association (AHA) and the American Stroke Association (ASA) to improve the care of patients with cardiac diseases and stroke. Jacobi and Lincoln were named Gold Plus awardees for care of stroke patients by the ASA, and North Central Bronx was named a Bronze awardee by the AHA for the care of patients suffering from heart failure. Jacobi, Lincoln and North Central Bronx have also each earned the prestigious “Baby-Friendly” designation for promoting the highest level of care for infants through breast feeding and promoting bonding between mother and baby. The recognition is awarded to hospitals all over the world by Baby-Friendly USA, part of an initiative of the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF).

Of pride to our system are recent awards and designations earned by North Central Bronx. Leapfrog Group, a national, nonprofit organization driving progress in the quality and safety of American health care gave NCB a high score in its 2016 assessment of hospitals nationwide. And Healthgrades, the largest on-line resource for comprehensive information about physicians and hospitals, gave North Central Bronx its 2017 Patient Safety Excellence award. NCB was the only hospital in the Bronx, one of only 2 hospitals in New York City, and one of only 11 hospitals in New York State, to earn this distinction.

Also of note is The Joint Commission’s recent survey of North Central Bronx –the facility remains accredited.

As the provider of the majority of inpatient psychiatric treatment in New York City, NYC Health + Hospitals understands the critical need for greater access to mental health care in New York City. We continue to lead and expand efforts to provide much-needed behavioral health services for New Yorkers at every stage of life, at our many patient care locations. We have integrated universal depression screenings for adults in primary care practices across the city, have successfully led efforts in the Bronx and throughout the other boroughs, to screen all pregnant women and new mothers for maternal depression. We have focused efforts to promote health care services to young people at YouthHealth neighborhood centers. And, we are very proud to be expanding a pilot program established at the Bronx Family Justice Center (FJC) to provide on-site behavioral health services at each of the city’s five FJCs, which are designed to provide a comprehensive range of services to survivors of domestic violence in each borough.

We are also proud of our continued efforts to address negative social determinants of health in the communities we serve, by working to increase access to nutritious foods and fresh and affordable produce. Through our partnerships with Harvest Home Farmer’s Market and GrowNYC we are hosting farmers markets at several patient care locations across the borough.

So, a lot of terrific work is going on here. Work which supports NYC Health + Hospitals’ fundamental commitment to building healthier communities by continuing the process of moving, along with the rest of our system, from the old model of sick care, to a more modern system that emphasizes prevention, care-coordination and wellness. A model that strengthens the primary care networks that are so essential to eliminating the health disparities that burden neighborhoods like Mott Haven, Melrose, Morrisania, East Tremont and others across the Bronx.

We understand that more integrated, more community-based care, delivered in partnership with local providers, community-based organizations and advocacy groups, is central to building healthier communities here in the Bronx. And we are doing something about it, by enthusiastically participating in the state’s Delivery System Reform Incentive Program (DSRIP), through which our OneCity Health performing provider system has secured the opportunity for $1.2 billion in funding to support care at the community level. This work is aligned with recommendations made in the One New York Health Care for Our Neighborhoods report, and in the Blue Ribbon Commission on Health Care for our Neighborhoods issue brief on building clinical partnerships. Our participation in DSRIP will allow us to more efficiently build a broader health care network that meets all patient needs, including highly specialized services —and provides continuity of care, efficiency, and a more seamless patient experience.

This report is meant to offer an abridged overview of positive developments occurring within the public health care delivery system at our patient care locations across the Bronx, as well as an acknowledgment of the difficulties we face. But what tonight is really about is hearing from you. These meetings are mandated in our state charter as a public benefit corporation specifically because your input is so important to the future success of this system. We really aren’t here to talk tonight, we are here to listen. So let’s get started with our first speaker.