REPORT TO THE BOARD OF DIRECTORS – April 2018

Albany

During our last Board meeting, the Governor and members of the State Legislature were in the process of finalizing the State Budget. There were several important issues that we were working on that were included in the final budget agreement. These include:

• The State agreed to form a workgroup related to Disproportionate Share Hospital funding and Indigent Care Pool funding and provide recommendations by December 2018. Despite the federal two year delay of DSH cuts, the State must revisit the DSH funding formula so NYC Health + Hospitals does not bear the entire brunt of future DSH cuts which will be twice as large.
• Additional funding for Safety Net hospitals was included. The enacted budge appropriates $50 million in safety net funding over 2 years and includes an updated definition of safety net hospital to target more of these dollars to hospitals that see higher numbers of uninsured and low-income patients.
• The State Budget maintained funding for Community Health Centers at $54 million. Our Gotham Health’s community health centers receive approximately $10.3 million from this allocation.
• In addition, a Healthcare Shortfall Fund was established to support delivery of healthcare services, including capital investment, debt retirement or restructuring, housing and other social determinants of health, or transitional operating support to health care providers. We had supported the creation of the shortfall fund to offset potential reductions of Federal DSH funds.

Washington

In relation to health policy issues, Congress has held several hearings over the past few weeks on ways to combat the opioid epidemic. Both House and Senate Committees have been looking at the issue as it relates to: treatment options for persons in public health insurance programs, drug monitoring programs, increased information for prescribers and the effects that opioid distributors have had on the opioid crisis. In the House, there are nearly three dozen bills on the issue. While fewer bills are under consideration in the Senate, the scope is just as broad. Legislators in both houses and on both sides of the aisle have stated that they would like to pass a comprehensive bill, or series of bills, by the end of May.

City

With the release of the City’s Executive Budget, the Council Finance Committee will be scheduling a series of hearings to review the FY19 proposed budget. We expect to testify before the Hospital and Finance Committees in early May.

With a kickoff event in April, NYC Health + Hospitals/Bellevue is the first site to begin to adopt the system-wide care management program designed to improve access to care and health outcomes for thousands of New Yorkers most at risk of frequent, preventable hospitalizations and emergency room visits. OneCity Health is collaborating with the Office of Patient Centered Care, by providing project management support and integration of existing care management programs under DSRIP.

OneCity Health has developed three Workforce Development Initiatives each for Managed Long Term Care and Behavioral Health, earning a payment of $134.6M to NYC Health + Hospitals through the Care Restructuring Enhancement Pilot (CREP) program, which is designed to serve patients in their homes and communities and train/retrain hospital staff to provide services in the community.

OneCity Health launched its Learning Management System (LMS) — a “one-stop-shop” for training-related information and activities that’s available to all partners at no cost.

Two recent health care industry reports showcase work by OneCity Health partners to help transform the delivery system.

• KPMG and the Commonwealth Fund’s report, “Investing in Social Services as a Core Strategy for Healthcare Organizations: Developing the Business Care”, highlights the growing need to address social determinants of health to improve outcomes and lower costs and showcases OneCity Health’s work to evaluate its community-based organization partners and provide technical assistance.
• The Greater New York Hospital Association and New York Academy of Medicine’s study, “Partnerships between NYC Health Care Institutions and Community-Based Organizations” highlights the partnerships that have emerged under DSRIP and highlights OneCity Health collaboration with Little Sisters of the Assumption Family Health Service to reduce hospitalizations and Emergency Department visits for children with persistent, uncontrolled asthma.

We marked Immigrant Heritage Week by reissuing a joint letter with Commissioner Nisha Agarwal of the Mayor’s Office of Immigrant Affairs that sends a clear message to immigrant New Yorkers that we honor and respect them and that we want to be their health care provider of choice. The “open letter” urges New Yorkers to see care without fear, and underscores our promise to protect patients’ right to privacy and keep immigrant status completely confidential. The letter will be distributed to community and immigrant advocacy organizations and is available in the top 14 languages spoken by patients in the health system: English, Spanish, French, Haitian Creole, Russian, Traditional Chinese, Simplified Chinese, Korean, Urdu, Bengali, Polish, Albanian, Hindi, and Arabic. The letter is available on our website.

There’s no question that health care professionals across the country provide great medical care under some of the most demanding circumstances. At NYC Health + Hospitals, our Level 1 trauma teams are among the best in the country. Our mental health experts are the most skilled, compassionate professionals in the field. Yet, sometimes the emotional aftershock of treating victims of terrorist attacks or seeing a child die from the flu can cause deep pain and stress that too often goes unaddressed. After all, doctors and nurses are trained to care for others. But, we want our colleagues to know that when challenges arise, there is help available.

Now the healers can receive peer-to-peer support when they need to heal themselves thanks to a new program we proudly launched this month. We will create a cadre of in-house mental health response teams to provide emotional first aid to peers who are suffering from workplace stress or anxiety and may be at high risk of depression caused by the demanding circumstances of the job and unexpected patient outcomes. The new program is rooted in national research that points to health care providers as “Second Victims” of traumatic events commonly experienced in emergency departments, psychiatric units, and pediatric intensive care units. This new staff wellness initiative follows the model first adopted Dr. Eric Wei, NYC Health + Hospitals chief quality officer, when we served together in the Los Angeles public health system.

When female patients at Rikers Island need specialty care, they are taken to NYC Health + Hospitals/Elmhurst. Due to security precautions associated with transporting a patient from Rikers to the hospital for specialty care appointments, the trip can take hours and patients must forgo regular programming they receive in jail, such as law library and recreational time. Such obstacles will lead some female patients to refuse an appointment, putting their health in jeopardy.

That’s why NYC Health + Hospitals/Correctional Health Services and NYC Health + Hospitals/Elmhurst are partnering to expand telehealth services for women who are incarcerated. This collaboration is an expansion on the telehealth services available at NYC Health + Hospitals/Bellevue for men on Rikers. With this telehealth program expansion there will be fewer missed appointments, fewer gaps in health care, less disruption in hospital operations, and it will ease the demand on the resources of the Department of Correction. The telehealth service at NYC Health + Hospitals/Elmhurst currently includes rheumatology, oncology, and hematology services, while other specialties, such as infectious disease and gastroenterology, will be added at a later date.

This morning we celebrated the annual “Doctors’ Day” awards presentation to a select group of 25 highly skilled physicians who personify the dedication, compassion, and excellence required to practice in the nation’s largest public health care system. The award winning physicians reflect a range of specialties and years of service, and our multi-ethnic and multi-cultural workforce, showcasing our health system’s strength in providing culturally competent care to all, without exception. I am so grateful to the thousands of physicians who, every day of the year, dedicate their professional lives to ensuring New Yorkers live their heathiest lives. Our physicians are at the heart of this amazing and essential health care system. They are the embodiment of our mission to serve all, no matter who the patients are, where they’re from, what language they speak, or how many dollars they have in their pockets. A complete list of honorees and their bios is available on our website.

We were honored that 22 of our patient care locations, across all five boroughs, for the third year in a row again received the designation “Leader in LGBTQ Healthcare Equality” from the Human Rights Campaign Foundation for 2018. The recognition is given to hospitals, community health centers, and nursing homes across the country that embrace LGBTQ inclusion and patient-centered care, and foster an inclusive work environment for employees. To earn the designation, health care providers are assessed on four Healthcare Equality Index criteria: LGBTQ Patient-Centered Care, LGBTQ Patient Services and Support, Employee Benefits and Policies, and LGBTQ Patient and Community Engagement. You must receive the maximum score in each section earn the designation. While there is more work to do to prevent LGBTQ patients and families from experiencing health disparities, NYC Health + Hospitals is proud to be a leader in the charge.

I want to congratulate the entire team at NYC Health + Hospitals/Coney Island for successfully completing The Joint Commission four-day unannounced survey this month and receiving high praise from surveyors. The team earned one of the highest compliments for being a Learning Organization, which is essential to High Reliability organizations. The hospital also received praise for being ahead of the game with pain management practices, having a well embedded culture of safety and transparency, and for adopting multiple best-practices, including in the area of Behavioral Health. I also want to thank Board Member Josephine Bolus who provided support.

Congratulations to NYC Health + Hospitals/Metropolitan for receiving an “A” from The Leapfrog Group for its efforts in protecting patients from preventable harm, such as medical errors, infections and injuries, and for meeting the highest safety standards in the U.S. The Leapfrog Group is a national patient safety watchdog and the only independent ratings program that focuses solely on how effectively hospitals keep their patients safe. They use 27 measures of publicly available hospital safety data to assign grades to approximately 2,500 U.S. hospitals twice per year. Metropolitan was the only hospital in New York City to receive an A grade.

We partnered with the community nonprofit CAMBA to open CAMBA Gardens Apartments Phase II this week, a $100 million housing development with 293 units of affordable and supportive housing on the campus of NYC Health + Hospitals/Kings County. This follows CAMBA Gardens Apartments Phase I, which opened in October 2013, and together provide a combined 502 affordable and supportive rental housing units for low-income residents, many of whom have been or will be connected to needed social services and health services. The 293 apartments include a mix of studios, one-bedrooms, two-bedrooms, and three-bedrooms, with 110 designated for families and individuals in the community making no more than 60% of the area median income and 182 for formerly homeless families and individuals.

NYC Health + Hospitals/Harlem was recognized for their leadership as good stewards of natural resources. The hospitals’ CEO, Eboné M. Carrington and NYC Department of Environmental Protection (DEP) Commissioner Vincent Sapienza this month announced that the hospital will receive $1.1 million in funding from DEP to further its water conservation efforts. Through water-saving improvements and tracking data, the hospital was able to reduce their water consumption by 35,500 gallons per day over the past two years. This new funding will allow for additional water-efficiency upgrades to be made to toilets, urinals, showerheads, faucets, ice machines, and dishwashers. Upgrades are anticipated to reduce consumption by another 60,000 gallons.

NYC Health + Hospitals/Elmhurst has been verified by the American College of Surgeons as a Level I Trauma Center and commended for the life-saving care they provide each and every day. This is one of the toughest certifications for a hospital to achieve. The three-year verification validates the availability of a comprehensive team of skilled physicians and surgeons who are always ready to serve patients suffering from traumatic injuries caused by motor vehicles crashes, pedestrian and cyclist incidents, falls, gunshot and stabbing wounds, assaults, sports injuries, and many other types of physical trauma. The hospital also received 18 acclamations for the level of care provided, and was recognized for their team-based approach, ability to provide immediate massive blood transfusions, their 24/7 radiology service, and their community outreach and education programs focused on pedestrian injury, falls prevention, and other common injuries seen at the hospital.