Manhattan Public Meeting

Annual Public Meeting – Manhattan
Wednesday, April 11, 2018
Report by Dr. Mitchell Katz, President and CEO

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 and I want to take this opportunity 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, and so I know how critical public hospitals are to the well-being of families and their communities.

My first time at Bellevue was as a visiting fourth year medical student in 1985. I came here because of Bellevue’s legendary social mission.

,p>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 our hospitals on a rotating basis. 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 FY2017, 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.

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 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 hospital and community-based primary care clinics – including all of our hospitals in Manhattan and NYC Health + Hospitals/Gotham Health, Gouverneur in the Lower East Side — 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 Manhattan patient care facilities. I’d like to share just a few.

Tonight we are pleased to be at NYC Health + Hospitals/Bellevue, the oldest hospital in the country. It has been designated as a Regional II Ebola and Special Pathogens Treatment Center, and it’s home to the WTC Environmental Health Center that provides specialized care to the survivors of the 9/11 attacks. The hospital recently unveiled several of state-of-the-art, 3D breast imaging equipment that provides more detailed, higher-quality images, which will result in increased early detection of breast cancer and greater treatment options for patients. The new equipment is expected to serve more than 10,000 patients a year. The team at Bellevue also continues to demonstrate excellence in Emergency Care, which is not limited to exceptional trauma physicians. More than 180 nurses in its Emergency Department, Surgical Intensive Care Unit, and Perioperative Services received a well-deserved recognition for the outstanding care they provided patients in recent terrorism attacks and mass casualty events in New York City. They cared for patients injured in a Times Square incident, a Lower Manhattan incident, and the bombing at the Port Authority Terminal.

NYC Health + Hospitals/Metropolitan celebrated its designation as “Baby Friendly” hospital and hosted dozens of new mothers and babies who have benefitted from the exceptional maternal care services available that promotes breast-feeding and mother-baby bonding. The hospital also received a prestigious four-year accreditation from the American Association of Diabetes Educators and was designated as a Diabetes Center of Excellence for providing high-quality, evidence-based education to patients with diabetes. The facility continues to set the standard citywide as a health care provider of choice for the LGBTQ community with expanded health services for transgender patients, including gender-affirming surgeries and increased access to hormone therapy.

The American Hospital Association’s Health Forum named NYC Health + Hospitals/Harlem one of the country’s “Most Wired” hospitals for successfully incorporating technology into health care delivery and for helping patients become more actively involved in their own health through the use of technology. The hospital is also a leading partner in the All of Us Research Program, a long-term research endeavor, involving the National Institutes of Health (NIH) and multiple other research centers, which aims to understand how a person’s genetics, environment, and lifestyle can help determine how best to prevent or treat disease. The hospital will play an important role in recruiting a diverse group of volunteers to participate in this national precision medicine project that may help develop new medical treatments that are unique to each person.

We made some new investments and are close to completing renovations to one of our Gotham Health centers in Manhattan – the Roberto Clemente center. This vital site provides culturally appropriate behavioral health services to many residents on the Lower East Side. We would like to thank the New York City Council and Manhattan Borough President for their support of this essential health center.

Our service expansions have not been exclusive for outpatient care but also post-acute care services. We recently opened 60 new beds at NYC Health + Hospitals/Gouverneur. With the addition of these beds, we will now accommodate more clinically complex and short-term rehabilitation patients. The new space is designed to reflect a modern therapeutic environment that is more home-like than what you would normally think of for a skilled nursing facility. The rehabilitation area features state-of-the-art equipment to serve the needs of patients recovering from heart attacks, strokes, traumatic brain injuries, and other debilitating conditions.

We are very proud of our Long-Term Acute Care Hospital at NYC Health + Hospitals/Carter for its continuous success in helping patients who need prolonged mechanical ventilation to be weaned off the ventilator. While having patients return to breathing on their own is a universal goal, the team at Carter have achieved greater success, despite the complexity of its patient population. They credit their success to three unique factors: 24/7 weaning services, a focus on treating comorbidities to reduce the chances of respiratory setbacks, and access to real time information to support clinical decisions thanks to their on-site lab and radiology services.

Lastly, across the river at NYC Health + Hospitals/Coler, nursing staff were selected to present on their successful non-pharmacological approach to managing behavioral and psychological symptoms of dementia at the NICHE (Nurses Improving Care for Health System Elders) Conference in April. The Coler team was able to highlight their success in reducing the use of antipsychotic medications in long-stay nursing home residents by providing person-centered, comprehensive interdisciplinary care. The facility created a “neighborhood” culture on its Memory Care units with integrated services, consistent staff, and a dedicated coordinator to improve meaningful engagement with residents. Interventions include activities such as live music performances, a weekly cooking program, monthly barbeques, and a quiet room for resident relaxation and the Music & Memory Program.