REPORT TO THE BOARD OF DIRECTORS – July 2018

I’d like to start my report by again thanking the members of this Board of Directors for their support and participation in last month’s press conference with the City’s First Lady Chirlane McCray to highlight the situation facing immigrant children who were separated from their families. Our clinicians promptly flagged what they were beginning to see when about 12 of these children began showing up at our Emergency Rooms showing signs of stress and trauma. I’m really proud of the swift and comprehensive response this health system put in place to not only speak out about the serious health impact facing these children, but also to ensure these kids had access to the health care services they needed.

Our Chief Medical Officer Dr. Machelle Allen and our Chief Nursing Executive Kim Mendez visited the day care center to see first-hand what was happening there and establish connections with the staff. Our renowned child and adolescent mental health expert Dr. Jennifer Havens set up on-site child and adolescent psychiatric consultation services to Cayuga Centers, Lutheran Social Services, and Catholic Guardian, which are federally contracted by the Office of Refugee Resettlement to provide care to the separated children. Our VP of Primary Care Dr. Ted Long put in place a process for expedited referrals and a 24-hour hotline. And our SVP of Managed Care Matt Siegler cleared some hurdles for insurance contracts and reimbursement for the services provided.

Our essential public health care system and the entire city government pulled together to ensure the children were being properly cared for while they were here and offered other support, including legal assistance, trauma training for the foster parents, recreational activities and more. Dr. Allen and Dr. Havens joined City agency officials at a second press briefing to outline all the services in place, and also participated at a City Council hearing on the impact of the Trump Administration family separation policy in New York City.
I was so proud of our response and so grateful for the dedicated and compassionate health care professionals of NYC Health + Hospitals who care so deeply for the health and wellness of every child.

I also want to give a special shout out to the NYC Health + Hospitals clinicians and staff who provide health services in city jails. Their work was well documented in a powerful human interest story publish this week in the Daily News that highlighted the life-saving results of our opioid treatment services to individuals incarcerated. The headline said it all: A Bronx woman battling heroin addiction got locked up at Rikers Island — and is convinced it saved her life. Dr. Jonathan Giftos, director of NYC Health + Hospitals/Correctional Health Services’ opioid treatment program discussed their important work and noted the sad reality that still, for too many opioid users, their only access to the proper treatment is in jail. For those of you getting this report electronically, here’s the link to the story: https://www.nydailynews.com/new-york/ny-metro-bronx-woman-heroin-rikers-20180722-story.html

Mayor Bill de Blasio today marked the opening of the new $28 million NYC Health + Hospitals/Gotham Health, Vanderbilt community health center on Staten Island that will expand access to primary care for children and adults, offer mental health counseling and referrals, and opioid treatment. The health center is expected to serve more than 4,500 patients this year—growing to 15,000 patients and 40,000 annual visits by 2020—and help reduce the reliance on overcrowded emergency rooms and prevent avoidable hospitalizations. The center has same- and next-day primary care appointments available for children and adults.

Expanding ambulatory care, especially primary care, is the right way to address community health needs, and it is also a central element of our transformation into a financially stable health care system. We are pleased to offer the residents of Staten Island high-quality care in a beautiful, modern facility. This represents an important extension of our presence on Staten Island, which includes our health plan, MetroPlus, our top-ranked skilled nursing facility, NYC Health + Hospitals/Sea View, and our home care services. Thanks to all the staff who have worked so hard to get the Vanderbilt center on Staten Island up and running.

NYC Health + Hospitals/Queens this week marked the completion of Phase 1 of its Emergency Room Expansion Project to help meet the community’s growing demand for health care services. We are grateful to the support from Queens Borough President Melinda Katz, who allocated $2.5 million for the project. The expansion adds 6,500 square feet to the existing Emergency Department, and will now include three nurse stations, three triage rooms, a resuscitation room, three isolation rooms, seven exam rooms, and 19 cubicles. The long-awaited project, staged in four phases, is essential as more people rely on NYC Health + Hospitals/Queens following the closures in recent years of other hospitals in the borough. The other phases of expansion are expected to be completed next year and will help the ED capacity to nearly double from its current 50,000 visits per year to 97,000 visits per year.

While as a health system we aim to reduce the need for emergency room care by keeping people healthy and managing their chronic conditions through regular visits to a primary care clinician, people will always need emergency care. This expansion will help us better serve those who entrust us with their care at some of life’s most difficult moments, and we are privileged to help them at such times.

I was pleased to join patients, staff, and local elected officials at a community celebration to mark the reopening of the newly renovated NYC Health + Hospitals/Gotham Health, Roberto Clemente Center, on Manhattan’s Lower East Side. The $1 million renovation, funded by the Manhattan Borough President and the NYC Council, reflects our commitment to community-based ambulatory care. We are proud to continue expanding access to essential primary care and behavioral health services in New York City’s underserved neighborhoods. For more than three decades, this community health center has provided care to the Lower East Side community and this renovation provides a strong foundation to continue that mission for generations to come.

First Lady McCray and Deputy Mayor Palacio last week announced New York City’s first comprehensive plan to reduce maternal deaths and life-threatening complications of childbirth among women of color. The five-year plan aims to eliminate disparities in maternal mortality between black and white women – where the widest disparity exists – and reduce by half the number of severe maternal morbidity events in the five boroughs. The City will invest $12.8 million over the next three years to address implicit bias, increase surveillance, enhance maternity care and expand public education. The plan includes support to enhance maternal care at NYC Health + Hospitals facilities by focusing on four specific strategies:

• Simulation training to help obstetrics staff master skills to identify and respond to the two top causes of pregnancy-related deaths for women of color— postpartum hemorrhage and blood clots.
• New maternal care coordinators who will assist an estimated 2,000 high-risk women in the prenatal and postpartum periods to keep appointments, procure prescriptions, and connect women to eligible benefits.
• Co-location of newborn and postpartum appointments to increase the number of women receiving postpartum care from 60 percent to 90 percent. Postpartum care will include contraceptive counselling, breastfeeding support and screening for maternal depression.
• New practices in primary care to identify women who are planning to have a child within six to 12 months. Providers will assess hemorrhage risks and establish a care plan for women seeking to give birth within that timeline.

Every incidence of maternal mortality is a tragedy, and we believe many such tragedies can and must be prevented. We are excited to play an active role in this life-saving program.

The City reached a tentative agreement with the Department of Justice and the New York State Nurses Association (NYSNA) this month to settle a longstanding action involving the physically taxing status of certain NYSNA represented nurses employed by the City and NYC Health + Hospitals. The parties have been in negotiations for several years and I am happy to hear that an equitable and mutually agreeable tentative settlement has been reached. I understand that the settlement will provide payments to approximately 1,700 active and retired nurses, which will be based on their age and years of service. I would like to thank Mayor DiBlasio for resolving this longstanding matter and for acknowledging the difficult and physically demanding work that our nurses and midwives perform day in and day out.

State — The State Department of Health convened a temporary workgroup on indigent care funding in which NYC Health + Hospitals is one of the participating members. The first meeting was held on July 11th and meetings will occur throughout the fall with policy recommendations on disproportionate share hospital funding and indigent care funding due December 1st. Health + Hospital will be working closely with labor and community advocates to ensure that we are treated appropriately as the largest safety net provider.

Federal — ACA repeal and/or major cuts to hospital reimbursement is unlikely in the near term. However, we will continue to monitor the federal Centers for Medicare and Medicaid Services efforts to cut the ACA risk- adjustment payments to providers, which was created to help stabilize premiums and spread financial risk across insurers, as well as its cut to the ACA’s navigator funding, which helps organizations assist consumers wade through health insurance options. We are also monitoring Congressional hearings on the 340B program, and opioid-related legislation moving through Congress.

• To help patients schedule and complete an annual visit with a primary care physician, OneCity Health, in collaboration with a vendor and the NYC Health + Hospitals call center, developed a program to conduct proactive, automated outreach phone calls to patients overdue for an annual primary care visit. OneCity Health has helped schedule over 1,250 primary care appointments since April 2017.
• At the conclusion of the 2017-2018 school year, the 100 Schools Project is now in 95 schools across the Bronx, Queens, Brooklyn and Manhattan, an increase of 52 schools since September 2017.
  • Through the program, Behavioral Health Coaches promote wellness and prevent distress in the classroom, meeting the needs of students with emotional, behavioral and substance-abuse issues that can often be a challenge for schools.
  • To scale the benefits of the program, over the summer the 100 Schools Project will expand to colleges. Four community colleges in the CUNY System – Bronx Community College, Guttman Community College, Hostos Community College and LaGuardia Community College – will begin to host workshops for staff, student leaders and families, conduct crisis trainings and mentor students interested in behavioral health careers.

NYC Health + Hospitals/Bellevue unveiled its new Palliative Care Family Meeting Room, also known as the Serenity Room, a project that was a collaboration of hospital staff and graduating medical students who transformed a conference room into a tranquil space for the families of gravely ill patients. The space is designed to provide a tranquil environment for providers to meet with family members of patients to deliver serious news, discuss end-of-life issues, and explore goals of care in gravely ill patients. During a difficult time, the room fosters a feeling of serenity and calm.

The city’s first-ever Safe Sleep Toolkit will be provided to the parents of new babies in all our public hospitals before discharge in an effort to reduce sleep-related injury deaths. The kit, a collaboration between ACS and DOHMH, is part of a larger, citywide public awareness campaign as a way to promote safe sleep practices and prevent future tragedies. The toolkit contains a wearable blanket to keep the baby warm, infant onesie, netting and educational materials about breastfeeding and best practices for infant safe sleep. With our longstanding commitment to promoting safe sleep practices—in both training our staff and educating new parents—we are pleased to play a key role in making available this important new resource. We’ll all sleep easier knowing our newborns are sleeping more safely.

I’m proud to report that, for the first time, all 11 hospitals in our public health care system received national recognition awards for implementing specific quality improvement measures related to the treatment of patients suffering from heart failure, cardiac arrest, and stroke. The awards from the American Heart Association and the American Stroke Association recognize the consistent application of best-practice, research-based standards of care, which reduce recovery time, disability, and mortality rates for stroke patients, and reduce hospital readmissions for heart failure patients. This is a well-deserved recognition of the hard work among our front line providers and further evidence of our ongoing commitment to improving care for our patients.

NYC Health + Hospitals/Harlem launched a month-long social media campaign on Grindr, Instagram, and Facebook to raise awareness among the Harlem community about Pre-Exposure Prophylaxis (PrEP) and direct more New Yorkers to take advantage of the comprehensive HIV/AIDS prevention and treatment programs available at the hospital. PrEP is an HIV prevention method in which people who do not have HIV take a daily pill to reduce their risk of becoming infected. The $20,000 social media campaign uses the tag line “Love Without Fear” and targets Blacks and Latinos who self-identify as men who have sex with men or women who may have an HIV-positive partner, as well as other New Yorkers at risk for contracting HIV. The campaign is part of a larger program funded by the New York State Department of Health’s AIDS Institute to support the operation and administration of the hospital’s PrEP Program. The grant funding is part the State’s commitment to end AIDS as an epidemic by 2020.