Brooklyn Public Meeting

Remarks by Dr. Mitchell Katz
NYC Health + Hospitals President & CEO
Annual Public Meeting – Borough of Brooklyn
NYC Health + Hospitals/Kings County
Wednesday, May 16, 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/Kings County, one of the oldest public hospitals in our health system, which has been proudly serving this community for more than 180 years. 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 Brooklyn 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 two hospitals here in Brooklyn. 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 and Staten Island, 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.

Our health system has a large footprint here in Brooklyn – with three hospitals, more than a dozen neighborhood based outpatient health centers, and a highly rated post-acute care facility. There has been a lot of positive activity in the last year, including a lot of “firsts”.

NYC Health + Hospitals/Kings County

• Marked the first anniversary of a great partnership with the Ronald McDonald House that created a special room that has provided respite for more than 1,000 family members and caregivers of pediatric patients.
• Opened a new Heart Health Center that will provide comprehensive care after heart failure patients leave the hospital and serve as a medical home base that keeps patients healthy and out of the hospital and emergency rooms.
• Celebrated the opening of a new $100 million housing development project on their campus with 293 units of affordable and supportive housing for low-income residents, many of whom have been or will be connected to needed social services and health services.
• Is likely the first in Brooklyn to use an innovative method of hand surgery that allows patients with carpal tunnel and patients who need reconstructive repair of wounds, or removal of dead tissue, to be awake during the outpatient procedure – a welcome departure from traditional hand surgeries which require general anesthesia and a tourniquet to stem the flow of blood through a vein or artery.
• Added a cutting-edge, minimally invasive surgical technique as part of the award-winning Stroke Center to treat acute ischemic stroke, and marked the first patient to undergo the procedure—mechanical thrombectomy— who was successfully treated.

NYC Health + Hospitals/Coney Island

• Was the first hospital in New York City to receive “Gold” recognition—the highest award of Cribs for Kids®’ National Safe Sleep Hospital Certification Program—for its commitment to best practices and education on infant safe sleep and ensuring that even the littlest New Yorkers are living their healthiest life.
• Received a new $100,000 grant from the Hearst Foundations to study patients living with addiction in southwestern Brooklyn, develop a better understanding of the social and medical complications of addiction, and have the opportunity to play a key role in designing and implementing new policies and practices to combat addiction.
• Opened a brand new radiology suite that promises to become the premier location for convenient, high quality imaging services – from mammography to bone density scanning – to better meet the needs of both our patients and the many community providers in the Coney Island community who need a reliable place to refer their patients.

NYC Health + Hospitals/Woodhull

• Opened North Brooklyn’s first comprehensive Pride Health Center dedicated to providing patient-centered and culturally sensitive health services to lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) patients.
• Was the first hospital in Brooklyn to receive the coveted “Baby-Friendly” designation awarded by Baby-Friendly USA, an initiative of the World Health Organization and the United Nations Children’s Fund (UNICEF), for excellence in promoting infant health, breastfeeding and mother-baby bonding.
• Celebrated the hospital’s recent multiple-birth baby boom — 26 sets of twins and one set of triplets in 2017 — at a special community event and reunion where more than 30 babies and their families attended.
• Was the first in our health system to partner with a community based social service organization to build a supportive housing project on their campus. The hospital marked the ground breaking of a new $28 million, six-story, community residence building with 89 units of supportive and affordable housing – and more than half of these units will be set aside for patients who have behavioral health issues, are eligible for medical discharge, but do not have permanent housing to which to be released.
• Received a $30,000 grant from the Susan G. Komen Foundation to maintain a Patient Navigator Program and ensure the timely and effective linkage of women to breast cancer screening, diagnostic, and treatment services.

Our notable achievements in Brooklyn were not limited to our public hospitals. NYC Health + Hospitals/McKinney, our 320-bed post-acute care and rehabilitation center in East Flatbush:

• Once again received five stars—the highest rating possible—from the federal Centers for Medicare and Medicaid Services for achieving exceptional quality standards. The new rating places NYC Health + Hospitals/McKinney among the top providers of post-acute care in the country. The facility earned the five-star rating for achieving above average performance on 16 different physical and clinical measures for nursing home residents, including for reducing the use of antipsychotic medications among both long-stay and short-stay residents.
• In a true demonstration of the McKinney team’s ability to empower New Yorkers to live their healthiest – and longest lives — the facility recently honored six of its women centenarian residents during a Women’s History Month celebration. The women—ranging in age from a few days shy of 100 to 103—and their families were joined by staff and local elected officials to celebrate 600+ years of life.
• To amplify this resident experience celebration, the facility senior staff and the Community Advisory Board Members held a “wreath laying” ceremony at the gravesite of Dr. Susan Smith McKinney at the Greenwood cemetery in Brooklyn to memorialize the 100th year anniversary of her passing in 1918. She was the first African American female physician in New York State and the third in the nation.

This past year, we made significant investments to support the expansion of primary care in underserved Brooklyn neighborhoods. NYC Health + Hospitals/Gotham Health, our network of community based health centers that specialize in primary and preventive care, completed the renovation and expansion of sites in Bushwick, Crown Heights, Brownsville and Bedford-Stuyvesant.

Thanks to nearly $11 million from the Mayor’s Caring Neighborhoods Initiative funding, our Gotham Health Center in Bushwick increased its service offerings from pediatrics and women’s health and now offers cardiology, podiatry, and optometry, as well as behavioral health. The upgraded facility is expected to record more than three times as many patient visits as before the renovation. The health center in Crown Heights is expanding beyond pediatrics and will be offering family medicine and behavioral health services. Our health center in Brownsville is also expanding beyond pediatrics and will offer family medicine, behavioral health, cardiology, endocrinology, and optometry, and more. And we are soon opening a brand new health center on Throop Avenue in Bedford-Stuyvesant that will offer family medicine and behavioral health services.

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.