REPORT TO THE BOARD OF DIRECTORS – February 2018

This is our second Board meeting together and I feel inspired by all the great people I have met at NYC Health + Hospitals.

We are a large system, so it may take me a while to get to all our facilities, and get there again and again, but I will do so because I deeply believe that the important work of NYC Health + Hospitals happens at the hospitals, skilled-nursing facilities, the clinics, and in the home. The job of Central Office is to provide the necessary support to facilitate care in the best way possible.

Thus far I have had the privilege of visiting Metropolitan, Jacobi, Lincoln, Bellevue, Harlem, Renaissance/Sydenham and just this morning, Gouverneur. I have met with organized labor including those representing our nurses, our doctors, our clerks, our technicians, and a variety of other critical support staff. Everywhere I have found mission-driven people who want to do the best for our patients but are frustrated with bureaucracy, inadequate clinical staffing, antiquated computer systems, and the uncertainty that comes from knowing that we have a large budget gap. The people in our system want to roll up their sleeves, to be heard, to be respected, and to make a difference.

I asked people to please email me directly their thoughts, and have been deluged by great suggestions from the front lines on how we can improve the patient experience, and how we can increase revenue to NYC Health + Hospitals so that we can move from the current budget crisis to a stable economic place. We are showing that we are capable of becoming a more nimble and responsive organization. When it turned out that there was no pediatric Tamiflu in community pharmacies, Dr. Allen and her staff arranged for pediatric dose packets to make sure all our children would be treated. We are currently implementing the ability of patients to receive 90 days of medications for chronic illnesses so that they do not need to return to the clinic for refills. Perhaps the most important attribute of an organization like NYC Health + Hospitals is hope. By demonstrating that we can take on difficult system issues and fix them, we will unleash a great current of energy and wisdom from the frontlines to make the changes happen. I couldn’t be more excited.

On February 9, Congress enacted and the President signed into law a short term spending plan funding the Federal government through March 23 of this year. Of critical significance to NYC Health + Hospitals is the plan’s elimination of two years of reductions to Medicaid disproportionate share (DSH) payments totaling 5 billion dollars for FY 2018 and FY 2019. Had the reductions taken effect, New York State was projected to lose $340 million in 2018, nearly the entirety of which would have been cut from NYC Health + Hospitals. We will continue to work with the Mayor’s office, our congressional delegation, labor partners and community allies to achieve a longer term resolution regarding this critical source of funding for the uninsured.

The spending plan includes a two year extension of Community Health Center funding which benefits our Federally Qualified Health center (FQHC) NYC Health + Hospitals/ Gotham Health. Also included is a four year extension of the Children’s Health Insurance Program (CHIP), coupled with the six years that CHIP was extended in an earlier continuing resolution. CHIP is now extended through Fiscal Year (FY) 2027.

The State legislature continues to debate the provisions of the Governor’s proposed Executive Budget. NYC Health + Hospitals is advocating with our elected officials to protect Health + Hospitals from potential spending cuts and increased funding for safety net hospitals including our own. Even though Congress delayed the DSH cuts for two years, we will still impress upon our legislators the need to address the DSH distribution methodology to avoid bearing the entire burden of DSH cuts in future years.

On Wednesday, March 28, at 1pm, I will be testifying before the New York City Council Committee on Hospitals about NYC Health + Hospitals’ priorities over the next year.

OneCity Health has launched a $5 million Innovation Fund that allows NYC Health + Hospitals and DSRIP community partners to submit applications for potential funding going beyond targeted DSRIP programs to design and implement programs for reducing avoidable hospitalizations, improving community health outcomes, and addressing social determinants of health. OneCity Health expects to fund up to ten awards in total. The awards, which will be announced in late March, are expected to be in the range of $250,000 – $1,000,000 per selected application.

OneCity Health continues to provide technical assistance to partners to help them prepare for a value-based payment environment.

• OneCity Health began a 12-month technical assistance program for community primary care partners. Through individualized coaching, new tools and protocols and sharing of best practices, OneCity Health is assisting community primary care partners to improve capacity, build linkages to other OneCity Health partners to address social support needs, promote team-based care and develop data reporting and monitoring capabilities.
• OneCity Health and its partner, Community Service Society of New York (CSS), continue to provide technical assistance to build community based organization (CBO) partners’ capacity for value-based contracting. Fifty-one partners completed the self-assessments and are now attending a series of Learning Collaboratives on topics such as developing a value proposition and partnering with managed care organizations.

OneCity Health launched online NowPow trainings for all NYC Health + Hospitals staff and OneCity Health partners in February. NowPow is a technology platform that allows users to identify social services resources, refer patients, and track engagement.

OneCity Health is continuing its efforts to advance coordinated, accessible behavioral health and primary care services to meet a variety of patient needs by supporting NYC Health + Hospitals and OneCity Health primary care partners in the implementation of Collaborative Care. In February, OneCity Health launched a training series on Collaborative Care, which aims to incorporate behavioral health specialists into primary care teams, in collaboration with the CUNY Graduate School of Public Health and Health Policy.

Earlier today NYC Health + Hospitals hosted a ribbon cutting at NYC Health + Hospitals/Gouverneur to celebrate 60 new skilled nursing facility beds for seniors and clinically complex patients while showcasing our expansion of high-performing post-acute care services and additional community-based short-term rehabilitation services for New Yorkers. With the additional beds, Gouverneur will provide much-needed care in the community, more short-term rehabilitation for patients and generate an anticipated $10 million in new revenue annually for the health system.

The new beds occupy nearly 45,000 square feet of existing space in two new units at 227 Madison Street. Built as part of the facility’s recent $250 million modernization effort, the new units are fully operational and staffed by new providers. The space features a home-like environment, with private bedrooms in single rooms and double-room suites, large, open dining areas, and comfortable community spaces, including fireplaces. The design also includes a private entrance to the nursing facility to enhance the experience of patients and their families. 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.

Gouverneur is designated a “Best Nursing Home” by U.S. News & World Report and has the highest Centers for Medicare and Medicaid Services five-star rating for its high-quality services and home-like environment.

NYC Health + Hospitals/Lincoln recently opened the first hospital-based naloxone kit distribution center, designed to make the drug that reverses opioid overdose available free to the community at large and without a prescription. Last May, Lincoln became the first patient care site in our system to begin distributing naloxone kits to all patients served by the emergency room, behavioral health and chemical dependency departments. The opening of Lincoln’s kit distribution center underscores our commitment to expanding access to this life-saving medication beyond the patient population by establishing public distribution centers at all 11 public hospitals.

Naloxone kits will be available every Tuesday and Thursday from 8:30 am – 4 pm, in conference room 2 at NYC Health + Hospitals/Lincoln (234 East 149th Street, Bronx, NY, 10451). The kits are available to anyone 12 and older, no appointment is necessary. Everyone who receives a kit will also be trained by hospital staff, which takes approximately 3-5 minutes. Training includes how to identify someone who is suffering from an overdose and how to properly administer the naloxone nasal spray.

Earlier this month First Lady of the City of New York Chirlane McCray announced a set of new initiatives designed to break the cycle of incarceration for women in New York City. The City will expand programming to support family connections and resilience, enhance critical behavioral health services and create a network of re-entry services that help women and their families stabilize and prevent future returns to jail.

Building off the strong foundation created by ThriveNYC and the Behavioral Health and Criminal Justice Task Force, NYC Health + Hospitals/Correctional Health Services will expand its work to improve access to high-quality therapeutic services for incarcerated individuals by implementing several evidence-driven strategies that address the unique needs of women in jails, including: connecting dedicated counselors to women at risk of intimate partner violence for safety planning and therapy; creating counseling programs that focus on promoting healthy coping for stress and trauma to address anxiety, depression, chronic pain, and insomnia; and using an intensive treatment model to better manage co-occurring serious medical and mental illness in the women’s infirmary.

NYC Health + Hospitals has announced plans to adopt a 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. The new care management model will target intensive navigational resources to patients with greatest need, regardless of insurance or immigration status. The program will feature dedicated care coordinators from various disciplines who will follow a proactive outreach strategy to steer patients across the spectrum of health care services, as well as work with community partners to address social determinants of health, like housing and access to healthy food.

The new program will also feature enhanced coordinated care strategies from the ActionHealthNYC program that were particularly helpful in reaching uninsured New Yorkers, including providing them legal assistance, enrolling them in health insurance, and making sure they sign up for a city ID card under the IDNYC program. The new care management structure will be implemented in phases starting at NYC Health + Hospitals/Bellevue this month and is expected to be in place across the health system by the end of 2018 when it is expected to serve an estimated 32,000 adult patients who have overlapping medical, behavioral health, and social needs.

NYC Health + Hospitals has announced plans to consolidate under Correctional Health Services (CHS) the management of its four forensic psychiatric evaluation court clinics. The court-ordered forensic psychiatric evaluations largely comprise fitness-to-stand-trial examinations (also known as “730” exams) which, if ordered, must be completed by at least two qualified psychiatrists or psychologists and submitted to the judge before the defendant can proceed with his/her case. As the large majority of these evaluations are conducted for individuals who are incarcerated and awaiting trial, delays in the evaluation process can lead to longer lengths of stay, pending resolution of their cases.

Our consolidation will standardize and modernize the clinics, helping to streamline the forensic psychiatric evaluation process. By centralizing the oversight of these clinics, we’ll not only help streamline the forensic psychiatric evaluation process, but we’ll also tap the great expertise of our Correctional Health Services team who already are uniquely focused on minimizing the health impact of incarceration with the potential to reduce lengths of stay in jail.

First Lady Chirlane McCray, Commissioner Cecile Noel of the Mayor’s Office to Combat Domestic Violence and NYC Health + Hospitals recently announced the expansion of Mental Health Teams at all five NYC Family Justice Centers (FJC). The City has invested $3.3 million to expand the Family Justice Center’s holistic approach to mental health at each site (one per borough) through trauma-informed psychotherapy and psychiatric services. The Mental Health Teams are an expansion of a program first piloted at the Bronx Family Justice Center in 2015 to deliver on-site clinical psychiatric services to survivors; a collaborative effort of ThriveNYC, the Mayor’s Office to Combat Domestic Violence, NYC Health + Hospitals, the Department of Psychiatry at Columbia University Medical Center, and sponsored by the Chapman Perelman Foundation.

The Mental Health Teams will provide onsite clinical psychiatric and psychological assessments for clients within the FJC collaborative framework. Each team will work with clients to develop individualized treatment plans, which may include individual therapy, group therapy, psychoeducation and medication management. Clients will be able to attend workshops where they will learn adaptive techniques for dealing with trauma. As of December 2017, more than 250 survivors of domestic violence have already received mental health services at the City’s five FJCs.

NYC Health + Hospitals recently announced that two more hospitals in the city’s public health care system have earned the prestigious “Baby-Friendly” designation for promoting the highest level of care for infants through breast feeding and 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). We are delighted that NYC Health + Hospitals/Coney Island and NYC Health + Hospitals/Metropolitan received the prestigious designation in recent weeks for providing the optimal level of care to mothers and their babies. Our system now has nine “Baby-Friendly” acute care hospitals. They are among only 14 other hospitals in New York City that have received this designation.

Last week NYC Health + Hospitals/Elmhurst announced the appointment of Georges Sylvestre, MD as the hospital’s new Chief of Maternal Fetal Medicine. Dr. Sylvestre will work alongside a team of obstetricians, neonatologists, nurses, and midwives to provide comprehensive prenatal care specifically adapted to pregnancies complicated by underlying medical conditions. Dr. Sylvestre will see patients at NYC Health + Hospitals/Elmhurst’s Women’s Pavilion, an outpatient clinic dedicated to providing services geared toward the care of pregnant women and the care and treatment of women before and after childbirth. Services include high resolution ultrasound examinations and procedures, such as amniocentesis and genetic screenings, vaccinations, nutritional counseling, and breastfeeding and social services support. We are very pleased to welcome Dr. Sylvestre to our essential health care system.

NYC Health + Hospitals/Lincoln has announced that its Primary Stroke Center has earned The Joint Commission Gold Seal of Approval, making it the first hospital in the South Bronx to receive the organization’s Advanced Primary Stroke Center certification. The hospital also received a Gold Plus Award and the Target Plus Honor Elite Award from the American Heart/American Stroke Association’s “Get with the Guidelines” – stroke program. “Get with the Guidelines” helps hospitals to improve stroke care by promoting consistent adherence to the latest scientific guidelines. It was the third consecutive year the hospital had received the Target award and seventh consecutive year it received the Stroke Gold Plus award.

The Primary Stroke Center at NYC Health + Hospitals/Lincoln underwent a rigorous onsite review by The Joint Commission in late 2017. Joint Commission experts evaluated compliance with stroke-related standards and requirements, including program management, the delivery of clinical care and performance improvement. Congratulations to Lincoln on this distinction.

NYC Health + Hospitals/Bellevue has presented the Daisy Award for Extraordinary Nurses to 182 nurses in its Emergency Department, Surgical Intensive Care Unit, and Perioperative Services for the outstanding care they provided patients in mobilizing to care for patients in three recent terrorist and mass casualty incidents causing or having the potential to cause severe injury to a high number of people: On May 18, 2017, NYC Health + Hospitals/Bellevue staff cared for 13 patients injured in a Times Square incident, in which police reported that a man drove a vehicle into a crowd of pedestrians. On October 31, 2017, the hospital treated five patients from a Lower Manhattan incident, in which a man drove a vehicle onto a bike path on the West Side; and on December 11, 2017, the hospital received a patient from an event at the Port Authority Terminal, in which police said a man detonated a bomb in a pedestrian tunnel. Law enforcement officials have determined that the October 31 and December 11 events were terrorist attacks. The troubling confluence of events, and the highly professional response to them by nurses from Bellevue’s Emergency Department, Surgical Intensive Care Unit, and Perioperative Services units in responding to them, was the catalyst for departing from customary practice of naming a single nurse honoree for receipt of the Daisy Awards.

Honored were 82 nurses from the Emergency Department, 33 nurses from the Surgical Intensive Care Unit, and 67 nurses from Perioperative Services. The nurses were given certificates from the Daisy Foundation for their work. Their collaboration and expertise, compassion and caring demonstrated why New Yorkers rely on this essential health Care system. We are grateful and honored to have these valuable nurses at NYC Health + Hospitals.

St. George’s University School of Medicine and NYC Health + Hospitals have announced that eight students from the New York metropolitan area will be awarded $1.1 million in CityDoctors scholarships. In return, the awardees are committed to practicing primary care medicine at one of 11 public hospitals in New York City following graduation. Since its inception in 2012, the CityDoctors scholarship program has awarded 99 students with scholarships worth a total of $10.3 million.

The 2018 class of CityDoctors scholarship recipients are a diverse group of women and men, representing Queens, the Bronx, Manhattan, and Staten Island. Recipients hold undergraduate and graduate degrees from a range of prestigious institutions, including Johns Hopkins University, St. John’s University, Boston University, City College of New York, SUNY Albany, Lehman College, the College of Staten Island, and New York City College of Technology.

The Presidential Leadership Scholars Program, a partnership between the presidential centers of George W. Bush, William J. Clinton, George H.W. Bush, and Lyndon B. Johnson, has appointed Robert Gore, MD, NYC Health + Hospitals/Kings County Emergency Department attending physician, to its 2018 class. Dr. Gore was selected by the prestigious leadership training program for developing and implementing the Kings Against Violence Initiative (KAVI), a youth violence prevention program. The Presidential Leadership Scholars Program was designed to cultivate a diverse network of leaders who are capable of addressing our nation’s most pressing challenges. Over the course of six months, the executive-style education series provides mid-career professionals with the opportunity to learn from former presidents, key administration officials, respected scholars, and academics.

In addition to his roles at NYC Health + Hospitals/Kings County, Dr. Gore, a Brooklyn native, serves as an assistant clinical professor of emergency medicine at SUNY Downstate. Founded in 2011, the Kings Against Violence Initiative provides participating youths with academic support, mentoring, and the development of advocacy skills. The program also engages adults to assist in support of participating youths, as well as their families. Dr. Gore continuously seeks new ways to build the program, and his appointment to the Presidential Leadership Scholars Program is expected to provide new ways to build on successes already achieved. Congratulations to Dr. Gore on his acceptance into this elite program, and on the outstanding work he does every day to provide care while cultivating the growth and spirit of youth in New York City.