REPORT TO THE BOARD OF DIRECTORS – April 2021

Vaccines – The CDC and FDA have made the one-dose Johnson & Johnson/Janssen vaccine available for use again, following an expert panel’s recommendation. During a pause in the vaccine’s use that started on April 13, the Advisory Committee on Immunization Practices investigated a small number of reported U.S. cases of a rare blood clot following vaccine administration. The thorough investigation concluded that the benefits of the vaccine outweigh any potential risks of developing a blood clot.

The vaccine pause and subsequent CDC investigation were a result of the federal safety system that was put in place to track and respond to serious adverse reactions to the COVID-19 vaccine in real-time as they are reported. To-date, the Johnson & Johnson/Janssen vaccine has been administered to about 8 million people in the U.S. The FDA Fact Sheet on the Johnson & Johnson/Janssen (PDF) vaccine has been updated to note the rare blood clot cases. More details here: CDC: Announcement to Lift Pause of Johnson & Johnson/Janssen COVID-19 Vaccine.

Depending on available supply, NYC Health + Hospitals will prioritize the use of J&J vaccine to patients being discharged to long-term care facilities from our hospitals, as well as to other patients being discharged who are 18 years and older.

NYC Health + Hospitals continues to offer vaccinations to all eligible New Yorkers by appointment only, based on available supply. Our hospitals, health centers, Test & Trace vaccine sites have administered more than 700,000 vaccines so far. A select number of city-run sites – all sites run by the city’s Department of Health and our Test & Trace sites — are offering walk-up vaccinations for New Yorkers, along with mental health services. No appointment needed at those sites. Our hospitals are accommodating walk ups as possible but we are focusing on getting all our patients vaccinated via appointments.

NYC Test & Trace – As a City, we continue to do a substantial amount of testing. On a single day last week, we did more than 100,000 tests. In terms of contact tracing, in our last reporting period ending April 24, we reached 97% of all cases Citywide in the prior two weeks. We completed interviews with 85% of all cases. And since June, our hotels program has supported 19,527 unique guests.

NYC Health + Hospitals this week deployed three mobile units across New York City to offer COVID-19 testing and vaccines, as well as other health care services to homeless individuals. The Street Health Outreach and Wellness (SHOW) mobile unit medical teams will be in Midtown, the Upper West Side, and Washington Heights, where they will administer Johnson & Johnson vaccines and ensure homeless New Yorkers have the same, equal chance to get vaccinated. They will also offer critical whole person care, such as wound care, mental health support, naloxone kits, and basic material necessities, like meal packages, hygiene kits, and socks. The mobile units are an extension of the existing services our health System offers homeless populations, understanding primary care looks different for everyone. NYC Health + Hospitals has a long, proven track record of extending necessary health care services and other wraparound services and resources to the City’s homeless population. The COVID-19 pandemic only intensified the need of such crucial resources.

We will be working closely with the city’s Department of Homeless Services, community groups and advocates to conduct the appropriate outreach and ensure street homeless individuals learn about these services. Homeless New Yorkers will be invited in for care and COVID-19 services, no appointments necessary. Each mobile unit can vaccinate up to 150 people a day.

Our first day was a great success: the SHOW team administered about 50 vaccines, 50 COVID-19 tests, distributed 10 Narcan kits, and provided antibiotics and wound dressings to several patients. Our SHOW minibuses will remain in these three neighborhoods indefinitely, from Tuesday to Saturday, 11 a.m. to 7 p.m. And we will consider moving or expanding the program to other neighborhoods and boroughs as needed.

NYC Health + Hospitals is invested in the advancement of each of our 9,000 nursing professionals that keep our system going and provide exceptional care to all New Yorkers. We are pleased to announce that nearly 2,000 NYC Health + Hospitals nurses were selected to participate in the health system’s Nursing Clinical Ladder Program. The program provides nurses career advancement while remaining in the clinical setting, and recognizes and rewards professional development, nursing expertise, and contributions to the nursing profession. It is a great way to support retention of our nursing talent, enhance employee satisfaction, help with recruitment, promote the vision of nursing at NYC Health + Hospitals, and enhance nursing care and patient outcomes. Through the program, nurses are able to engage in a number of initiatives and projects, including leading their own research, engaging in volunteer work, participating in shared governance meetings, and more to help enhance their experience. This is the program’s second year and is open to all staff nurses within the system, regardless of tenue or level.

NYC Health + Hospitals/Jacobi this week received the Beryl Institute 2021 Organizational Innovation award for their Summer of Hope Program — an extension of our health system’s Helping Healers Heal program that offers respite and comfort to front line health care staff. The hospital’s Summer of Hope Coalition grew out of the need to support our health care heroes and help the healing process amid the untold challenges they faced through the COVID-19 pandemic. The members of the coalition worked together on the herculean task of ensuring that all the staff had an opportunity to begin to heal in a way that was meaningful to them. They developed a host of ways to spread hope and healing, including standing debriefs, art and music therapy, creative writing, gardening and crafts. Congratulations to the team at Jacobi and to Dr. Eric Wei for his guidance in making the Helping Healers Heal program available to all staff at NYC Health + Hospitals. Here’s a link to the video recognition for the team at Jacobi: https://vimeo.com/user19038396/review/538810866/d2b5f192a5.

The Fan Fox and Leslie R. Samuels foundation has awarded NYC Health + Hospitals a $152,000 grant to support expanding palliative care for older adults in the post-acute safety net setting at NYC Health + Hospitals/McKinney in Brooklyn. The COVID-19 pandemic highlighted the central importance of palliative care across all settings, and especially in the post-acute care setting. This initiative is a natural next step following the lessons learned from the tele-palliative care program that was launched in April of 2020. The grant funding is meant to support expert-level symptom management and skilled communication about goals of care for our post-acute residents and their families. Our goals with this initiative: 1) raise awareness and education about palliative care among staff and the community; 2) reinforce the importance of advanced directives; 3) increase the number of hospice eligible residents that access hospice benefits.

NYC HEALTH + HOSPITALS RECEIVES $305K IN GRANTS TO SUPPORT STAFF WELLNESS

The Aronson Family Foundation awarded NYC Health + Hospitals a $300K grant to support health care heroes and their continued resilience, and the Centerbridge Foundation provided an additional $5K for the same work. Both grants will be used to improve the infrastructure of the health System’s Wellness Rooms, created in response to the COVID-19 pandemic to support employee wellness and address the trauma, anxiety and burnout among the workforce. The rooms provide respite from the daily stressors of the work, and are used for a variety of support services as part of our Helping Healers Heal program, including group debrief sessions, yoga and dance classes. The new grants will be used to improve the design and outfit the Wellness Rooms with added relaxing seating areas, appropriate lighting, floor and wall coverings, and other calming elements for the space. We see this as an opportunity to cater to the growing mental health needs of our employees, as well as a device to reduce stigma surrounding the utilization of support resources. We want our workforce to feel seen, heard, appreciated and valued for all of their work saving the lives of the patient populations that we serve.

The Fourth Annual NYC Health + Hospitals Simulation Symposium was held virtually on April 21, 2021. More than 220 staff participated – from facility CEO’s to frontline health care workers – along with other external participants. The theme of the meeting was Impacting Culture with Conversation and specifically using debriefing to address unconscious bias. The speakers were very interactive and sparked deep conversation on this important topic. Speakers included; Lou Hart, NYC Health + Hospitals Director of Equity, Quality & Safety; Kellie Bryant, Columbia School of Nursing; Jenny Rudolph, Center for Medical Simulation, Boston (Harvard affiliated); Janice Palaganos, MGH and Dimitri Papanagnou, Jefferson University; Michael Meguerdichian MD; Suzi Bentley MD.

NYC Health + Hospitals is working with Federal partners to advance our priorities. In particular, we are advocating to have hospital needs included in the major infrastructure package that continues to develop in DC. Our health system is grateful to our Congressional delegations’ leadership, both in terms of the infrastructure package and in their review of additional funding requests we have made for capital project support. We will continue to build our Federal relationships on the administrative side as President Biden’s team comes into place, seeking support for public and safety net hospitals, person-centered value-based care, and health equity among other priorities.

The NYS State budget process concluded successfully for NYC Health + Hospitals. Our system is in a far better position than initially feared when the Governor’s original executive budget was proposed. The Governor’s plan had included significant cuts to Medicaid funding and public hospital support, which would have had a roughly $250M negative impact on our system. Thanks to a combination of Federal relief funding, the unusual Albany dynamics, and our unrelenting and strategic advocacy, almost none of these threats were actualized.

Working with an inclusive set of advocacy partners, we were able to avert a threatened 1% across-the-board Medicaid cut and elimination of the Indigent Care Pool supporting public hospitals, and to delay a significant 340B cut for two years. We also limited significant mandates that were proposed for nursing homes and expanded telehealth coverage, we will continue to advocate for the full parity we and many partners are seeking. The final budget also includes new funding for increases in the Essential Plan reimbursements and develops a post-partum insurance program for people whose Medicaid coverage ends with their pregnancy. Unfortunately, the final budget does include a capital rate cut that we and many peers opposed, though it is a relatively minimal financial impact. More specific analyses will follow. And we continue to partner with our champions in the Mayor’s Office and the City Council as the City budget takes shape.

NYC Health + Hospitals closed March with approximately $350M cash-on-hand. The health System has been able to mitigate and eliminate many major external risks over the past month.

The final NY State budget agreement restored all major Medicaid cuts that could have impacted the health system and also includes new financial opportunities as it relates to the Essential Plan, where new monies will be added for a base rate as well as the creation of the a quality pool. The NY City Executive Budget also included good news as it included $349M in new capital funds in addition to the more than $300M included in the preliminary budget.

The State has initiated the transaction to reimburse the remaining $400M of the $511M that was owed. In addition, we are having discussions with HHS regarding the timing of DSH funds related to the DSH eFMAP glitch that was corrected in the American Rescue Plan.

NYC Health + Hospitals and the City’s Office of Management and Budget continue to have discussions with FEMA regional and central office staff on a process and methodology to secure COVID reimbursement. Additional updates will be provided as we make progress.

We remain on track with the FY-22 budget development timeline, which will be presented at the May Finance Committee meeting.

I issued a Declaration of Emergency dated March 1, 2020, which was subsequently updated and reissued through February 28, 2021. There is currently no Declaration of Emergency in effect. The health system has entered into 39 emergency extension agreements with Community Based Organizations (CBOs) at a total cost among the pool not to exceed $15 million. These costs are being reimbursed by the City of New York. In July 2020, 41 CBOs were selected as an outcome of a solicitation to do COVID related outreach in high incidence neighborhoods. Based on the continuing pandemic and the need to continue community outreach in these neighborhoods, the contracts have been extended through June 30, 2021 for 39 of these CBOs. All 39 CBOs were reviewed and are performing satisfactorily prior to extending their agreements.

• Local Businessman Donates $1M to NYC Health + Hospitals/Queens
• NYC Test & Trace Corps Now Connecting Patients at Highest Risk With Life-Saving >Monoclonal Antibody COVID-19 Treatment
• NYC Health + Hospitals EarnsMore Than $1.4M for Green Projects
• NYC Test & Trace Corps Now Offering At-Home Testing for All Contacts of COVID-19 Case
• Philip DeMaiolo Appointed as New Corporate Chef
• Test & Trace Corps Launches AfterCare to Support New Yorkers Living with Long COVID
• NYC Launches New Mobile Vaccination Effort and Expands Walk-In for Seniors
• NYC Health + Hospitals Marks One Year of COVID-19 Pandemic

Walk-Up Vaccinations Available For New Yorkers 75 and Older Plus One Escort at Select Vaccination Sites

• Doctors Council SEIU and NYC Health + Hospitals Commemorate National Doctors’ Day
• 9 New Facilities Participate in Murals Project with Patients, Staff and Community