REPORT TO THE BOARD OF DIRECTORS – June 2017

Last week at NYC Health + Hospitals/Elmhurst we concluded the last of five annually held, state-mandated, public meetings in each borough of New York City. The full attendance at these meetings demonstrated a public recognition of our system as an essential asset to New York City. Members of the public and health system employees voiced praise and raised concerns about local facilities and about efforts to redesign the system in a way that better meets the needs of the patients and communities we serve. Thank you to all who participated, and to members of the Board who were present at each meeting to hear from attendees.

While we focus on our systemic efforts to redesign care delivery, it’s important not to overlook the excellence occurring, day in, day out within our clinical programs. I’m delighted to report that NYC Health + Hospitals has received national recognition awards for 10 of our hospitals for implementing specific quality improvement measures related to the treatment of patients suffering from heart failure, cardiac arrest, and stroke. The “Get with the Guidelines” (GWTG) 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.

Eight of our hospitals received the highest award for excellence in stroke care, and six received high honors for excellence in heart failure care; three received awards for excelling in both. Two hospitals improved their performance from silver status last year to gold status this year, and seven hospitals earned new recognitions this year. The full list of awards for the public health system is below.

Manhattan

NYC Health + Hospitals/Bellevue

• GWTG-Heart Failure Gold Plus & Target: Heart Failure Honor Roll Award
• GWTG-Stroke Gold Plus & Target: Stroke Elite Plus Honor Roll Award
• GWTG-Resuscitation Gold Award (Adult Patient Population)

NYC Health + Hospitals/Harlem

• GWTG-Stroke Gold Plus Award
• NYC Health + Hospitals/Metropolitan
• GWTG-Stroke Gold Plus Award

Bronx

NYC Health + Hospitals/Jacobi

• GWTG-Stroke Gold Plus & Target: Stroke Elite Honor Roll Award

NYC Health + Hospitals/Lincoln

• GWTG-Heart Failure Bronze & Target: Heart Failure Honor Roll Award
• GWTG-Stroke Gold Plus & Target: Stroke Elite Plus Honor Roll Award

NYC Health + Hospitals/North Central Bronx

• GWTG-Heart Failure Silver Plus & Target: Heart Failure Honor Roll Award

Brooklyn

NYC Health + Hospitals/Coney Island

• GWTG-Stroke Gold Plus Award

NYC Health + Hospitals/Kings County

• GWTG-Heart Failure Silver Award
• GWTG-Stroke Gold Plus & Target: Stroke Elite Honor Roll Award

NYC Health + Hospitals/Woodhull

• GWTG-Heart Failure Gold Plus & Target: Heart Failure Honor Roll Award

Queens

NYC Health + Hospitals/Elmhurst

• GWTG-Stroke Gold Plus & Target: Stroke Elite Plus Honor Roll Award

Earlier this week The New York Times featured our health system’s use of a lifesaving catheter conceived on the battlefields of Iraq. The Times article recounted heroic efforts of doctors and nurses at NYC Health + Hospitals/Bellevue who successfully used a pioneering intervention called the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) (known also as an “Internal Tourniquet”) to save the life of a young woman who was hit in the terrible Times Square vehicular attack on May 18th. The victim, a female high school senior was hemorrhaging internally and at grave risk of cardiac arrest.

Cleared by the Food and Drug Administration in 2015, the REBOA catheter is gradually being adopted by civilian trauma centers around the nation. It involves a slim tube and balloon threaded into an artery in the leg, threaded up to the aorta, and inflated to temporarily stop circulation to the area of the lower body that is hemorrhaging.

NYC Health + Hospitals clinicians Dr. Sheldon Teperman, director of trauma and critical care services at NYC health + Hospitals/ Jacobi, and Dr. Askim G. Rivera a Jacobi-based vascular surgeon pioneered the use of the new catheter in New York City earlier this year to save the life of another trauma victim. Since then, the Jacobi physicians have been teaching the complicated procedure—medical teams need rigorous training to use the catheter successfully, if mishandled it can be dangerous—to NYC Health + Hospitals trauma surgeons and other medical centers across the city.

I’m delighted that The Times has highlighted this example of clinical excellence occurring in our system, even while we labor to meet difficult financial challenges and to transform our delivery model.

As part of HealingNYC, the City’s new comprehensive effort to reduce opioid overdose deaths by 35 percent over the next five years, First Lady of New York City Chirlane McCray and I recently announced the launch of two programs at NYC Health + Hospitals/Lincoln to combat the opioid epidemic in New York City. One of the new programs will expand naloxone distribution throughout the hospital, making naloxone kits more readily accessible to patients and caregivers. The program will help reach more patients with this life-saving medication by increasing the number of kits distributed from just over 100 last year to 800–900 this year. The second initiative, supported with funds from the Department of Health and Mental Hygiene, will use addiction counselors and peer advocates in the hospital’s emergency department to screen each patient who presents with non-fatal opioid overdose, opioid intoxication, or a history of harmful opioid use.

These programs are intended to be models and are expected to be adopted soon system-wide. They are a welcome development in the Bronx, which has some of the highest rates of overdose in New York City. They represent just two components of concentrated, ongoing work to transform our substance use care model into a system of excellence. They demonstrate our commitment reducing opioid overdose deaths by 35 percent over the next five years.

NYC Health + Hospitals has been awarded the America’s Essential Hospitals’ 2017 Gage Award for Innovation and Excellence for OneCity Health work to implement collaborative care for depression in the primary care setting, which has significantly increased psychiatric consultations and treatment for depression in primary care, more than tripling the rate of depression improvement among patients enrolled in the program.

In 2015, we screened about 225,000 adult primary care patients for depression—more than 90 percent of patients who visited a NYC Health + Hospitals site. Nearly 15,000 of those patients—6.7 percent—screened positive. The program’s key clinical outcome metric focused on the depression improvement rate, which increased from 17.7 percent in the second quarter of 2015 to 57.6 percent in the first quarter of 2016. We couldn’t be more proud of this award which helps illuminates the path we are on to becoming a system focusing on prevention and wellness. Congratulations to the entire OneCity Health team.

I am glad to report that late last month, the New York State Department of Health awarded MetroPlus Health Plan the highest “quality measures” score among Medicaid managed care plans statewide. MetroPlus scored highly in categories including; 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.

These results reflect the investment MetroPlus makes in keeping its members healthy, by working closely with members throughout the year to remind them of appointments and to stress the importance of maintaining their medication regimens to improve their health. Happily, our strong scores also mean the receipt of increased incentive premiums from the State to Metro Plus. Congratulations to Dr. Arnold Saperstein, President and CEO and the entire MetroPlus team on this encouraging news.

In honor of Doctors’ Day 2017, NYC Health + Hospitals recognized 25 physicians for excellence and their ongoing commitment to patient care. The annual celebration honors outstanding physicians from across the health system who have distinguished themselves as leaders amongst their peers.

Physicians from the health system’s hospitals and community health centers, as well as its MetroPlus Health Plan, were recognized for their commitment to providing the highest quality health care to New Yorkers. Reflecting a range of specialties and years of service, the award-winning physicians were drawn from NYC Health + Hospitals’ multi-ethnic and multi-cultural workforce, showcasing the health system’s strength in providing culturally competent care to all, without exception. Awardees are as follows:

Brooklyn

NYC HEALTH + HOSPITALS/CONEY ISLAND

Iosif Fradlis, MD
Director, Behavioral Medicine and Integrated Care Department of Behavioral Health

NYC HEALTH + HOSPITALS/GOTHAM HEALTH, CUMBERLAND

Alla Shigol, MD
Primary Care Physician – Pediatrician

NYC HEALTH + HOSPITALS/GOTHAM HEALTH, EAST NEW YORK

Marie-Pierre Castermans, MD
Associate Medical Director, Family Health Services

NYC HEALTH + HOSPITALS/KINGS COUNTY

Renuka Ananthamoorthy, MD
Chief of Behavioral Health Sciences

NYC HEALTH + HOSPITALS/MCKINNEY

Ray Ivanovs, DPM
Director, Podiatric Medicine

NYC HEALTH + HOSPITALS/WOODHULL

Anastasia Asanov, MD
Ambulatory Director of Medicine

Queens

NYC HEALTH + HOSPITALS/ELMHURST

Konstantinos Margetis, MD, PhD
Associate Director of Neurosurgery

NYC HEALTH + HOSPITALS/QUEENS

Liana Leung, MD, MPH, FACP
Associate Director, Department of Ambulatory Care and
Associate Director, Internal Medicine Program

The Bronx

NYC HEALTH + HOSPITALS/GOTHAM HEALTH, BELVIS

Marie M. Alizi-Greene, OD
Optometrist

NYC HEALTH + HOSPITALS/JACOBI

Nermica Sarcevic, MD
Director, Inpatient Psychiatry

NYC HEALTH + HOSPITALS/LINCOLN

Moiz Mansur Kasubhai, MD, MRCP
Associate Chair of Medicine and Chief Hospitalist

NYC HEALTH + HOSPITALS/GOTHAM HEALTH, MORRISANIA

Swarupa Rani Gaddipati, MD
Primary Care Physician

NYC HEALTH + HOSPITALS/NORTH CENTRAL BRONX

Haseen Sharma-Cooper, MD
Director, Department of Psychiatry

NYC HEALTH + HOSPITALS/SIMULATION CENTER

Suzanne Bentley, MD, MPH, FACEP
Medical Director, Elmhurst Satellite Simulation Center

MetroPlus Health Plan

Glendon Henry, MD
Associate Medical Director, Utilization Management

Manhattan

NYC HEALTH + HOSPITALS/BELLEVUE

Elena Wachtel, MD, MPH
Medical Director, Neonatal ICU

NYC HEALTH + HOSPITALS/CARTER

Michael Schuster, MD
Attending Physician

NYC HEALTH + HOSPITALS/COLER

Ponnusamy Shanmugham, MD
Attending Physician

NYC HEALTH + HOSPITALS/GOTHAM HEALTH, GOUVERNEUR

Gloria Rubin, MD
Primary Care Physician, Judson Health Center

NYC HEALTH + HOSPITALS/GOUVERNEUR

Alexander Kolessa, MD
Attending Physician

NYC HEALTH + HOSPITALS/HARLEM

Matthews K. Hurley, MD
Former Attending Emergency Room Physician

NYC HEALTH + HOSPITALS/METROPOLITAN

Jason S. Mack, MD, FAAP
Director, Pediatrics Ambulatory Care

NYC HEALTH + HOSPITALS/GOTHAM HEALTH, SYDENHAM

Arthur R. Dove, MD
Attending Physician

Staten Island

NYC HEALTH + HOSPITALS/SEA VIEW

Rufina Santos-Binlayo, MD
Attending Physician

NYC Health + Hospitals/Correctional Health Services

NYC HEALTH + HOSPITALS/CORRECTIONAL HEALTH

Svetlana Kalimulina, MD
Attending Physician

On Sunday June 25, NYC Health + Hospitals will have a significant presence at New York City’s 47th annual LGBTQ Pride March and celebration. We are proud to serve our LGBTQ patients as their partner in preventive health, wellness, and gender affirming care offered in safe, supportive and welcoming environments. The Pride March offers an opportunity to make more New Yorkers aware that 22 patient care locations in our essential public health care system have received the designation “Leader in LGBTQ Healthcare Equality” from the Human Rights Campaign Foundation for 2017. The 22 patient care locations are found in all five boroughs—including in Brooklyn, where no other provider was so recognized. We wish all members of the NYC Health + Hospitals LGBTQ community a happy and healthy Pride celebration.

NYC Health + Hospitals announced today that David Weinstein has been appointed chief executive officer of NYC Health + Hospitals/McKinney, a 320-bed post-acute care facility in Brooklyn. Mr. Weinstein had been serving as the facility’s interim CEO since February. Previously, he served in a number of senior level management positions in mission-driven patient care facilities in New York over a career span of over 30 years. Congratulations and welcome to Mr. Weinstein.

I am also pleased to bring your attention to the fact that Dr. Nora V. Bergasa, Chief of Medicine at NYC Health + Hospitals/Metropolitan, has been recognized with the 2017 Heritage Innovation in Healthcare Delivery Award, presented by Heritage Provider Network, the nation’s leading physician-led managed care organization, and Crain’s Custom Studio, a division of Crain’s New York Business. Dr. Bergasa is recognized internationally for her research on pruritus in liver disease. Her knowledge, dedication and skill at creating healing partnerships have led to remarkable levels of patient satisfaction, compliance, and treatment outcomes.

The Heritage Innovation Award recognizes a leader in the development of new modes of diagnosis, treatment, and care who actively improves the delivery of services and improves the quality of health care, improved access, positive impact on patient quality of care, and long-term affordability in New York. Congratulations to Dr. Bergasa for this well-deserved, and prestigious distinction.

Recently social workers, discharge planners, case managers, nursing staff, medical directors, and senior leaders from across NYC Health + Hospitals gathered for a half-day educational session devoted to strengthening the relationship between our post-acute care facilities and our in-patient service line. Informing these discussions is the need to better connect patients to high quality post-acute care services. Doing so will help ensure that they receive the care they need to get better and avoid a return to the hospital. Key takeaways from the conference include:

• Hospitals will soon be required to share information about the quality of post-acute care facilities with patients. We are developing a preferred provider network that includes our five, highly-rated post-acute care facilities, home care services, and other providers in the NYC area.
• A new electronic bedside decision-making tool called CarePort will make it easier for our patients to choose high quality care that is best for their needs by enabling discharge planners to enter specific criteria (such as needed services, insurance coverage, location, and amenities) to generate a patient-friendly list of facilities containing quality information.
• NYC Health + Hospitals/At Home is an integral preferred provider for our health system. NYC Health + Hospitals/At Home, our own certified home health agency, provides more than 86,000 patient visits each year. Services include skilled nursing care, care coordination, rehab, and many others.

Earlier this month triplets born almost four months ago at NYC Health + Hospitals/Jacobi were discharged home in good health, for the first time. Their departure marks the latest progress in a journey of care that included months of carefully coordinated high-risk prenatal care, followed by intensive post-partum care by the hospital’s neonatal medical team.

In the fall of 2016, specialists at NYC Health + Hospitals/Jacobi began treating the expectant mother, Amone Akter in the hospital’s high-risk obstetrical clinic. Her triplets were delivered in December at 25 weeks gestation. Because of the extreme prematurity of the infants, Dr. Beth Nagourney, director of Neonatology, assembled three teams—one for each baby—of neonatologists, pediatricians, neonatal nurse practitioners, and respiratory therapists to coordinate care for the two baby boys (Ruhan and Eshaq) and the baby girl (Israt) at Jacobi’s Level III Neonatal Intensive Care Unit (NICU). One of the babies required emergency surgery at a week old, for an intestinal problem, and another required chest tube placement for a collapsed lung. One of the babies later required surgery to close a fetal blood vessel. Two of the babies required respirators in the NICU for nearly two months until they were strong enough to breathe on their own, while the third triplet remained on a ventilator for close to three months.

At one birth in 6,400, triplets may be the exception, but excellence in Labor and Delivery at NYC Health + Hospitals is the rule. Congratulations to Jacobi’s interdisciplinary team for work well done.

Born without forearms or hands, three-year-old Isaac Cruz’s development was halted in utero because of congenital amniotic bands. These days, however, he is adjusting well to a new prosthetic arm and hand thanks to an innovative use of 3-D printing employed by specialists at NYC Health + Hospitals/Jacobi. Dr. Cesar Colasante, a burn surgery fellow in Jacobi’s Plastic Surgery Department, custom-designed the prosthetic device for Isaac using CAD/CAM software and a 3-D printer. Supervised by Dr. Ralph Liebling, Chief of Plastic and Reconstructive Surgery at NYC Health + Hospitals/Jacobi, and Isaac’s attending physician, and assisted by Andrew Peredo, MD, another burn surgery fellow, Dr. Colasante worked on the designs and construction over nights and weekends, and paid for supplies from his own pocket because reimbursement for 3D-printed prosthetics hasn’t been established.

Once the overall construction was completed, several sessions were required to fit the device and adjust it for Isaac. Now, weeks after receiving the new device, Isaac is getting used to his prosthetic arm, and using it to play with his toy cars. Dr. Colasante guesses Isaac will outgrow the device in six months to a year, and is now at work on a myoelectric prosthetic for Isaac’s other arm that senses muscle contractions and sends a signal to a computer board that drives a motor to close the hand.

There is a direct correlation between healthy eating and the prevention and management of chronic diseases and conditions, such as diabetes, heart disease, and obesity. Making fresh food options available and affordable in neighborhoods that need it most, is the foundation for healthier communities. Which is why I am pleased to report to the Board that we have announced the 2017 schedule of farmers markets hosted at public hospitals and community health centers across the city.

NYC Health + Hospitals has again partnered with Harvest Home Farmer’s Market, GrowNYC, Mott Haven Farmers Market, and Cypress Hills Verde/Cypress Hills Local Development Corporation to host farmers markets or fresh food box programs at patient care locations across the city, with an aim of making fresh fruits and vegetables more accessible for patients, staff, and the community.

2017 Farmers Markets

Brooklyn

NYC Health + Hospitals/Coney Island
Ocean Parkway between Avenue Z & Shore Road
Wednesdays and Fridays: 8:00 a.m. – 4:00 p.m.
June 14 to November 22

NYC Health + Hospitals/Kings County
Clarkson Avenue between E. 37th and E. 38th Streets
Wednesdays: 8:00 a.m. – 6:00 p.m.
June 7 to November 22

NYC Health + Hospitals/East New York
2094 Pitkin Avenue (southeast corner of Pitkin and Pennsylvania)
Tuesdays: 9:00 a.m. – 5:30 p.m.
July 11 to November 21

Bronx

NYC Health + Hospitals/Jacobi
1400 Pelham Parkway
Tuesdays and Fridays: 8:00 a.m. – 4:00 p.m. (except Tuesday July 4)
June 6 – November 24

NYC Health + Hospitals/Lincoln
149th Street between Morris and Park Avenues
Tuesdays and Fridays: 8:00 a.m. – 3:00 p.m.
June 30 to November 21

NYC Health + Hospitals/North Central Bronx
Mosholu Parkway and Jerome Avenue
Wednesdays: 10:00 a.m. – 4:00 p.m.
July 14 to November 22

NYC Health + Hospitals/Gotham Health, Belvis
545 East 142nd Street
Mondays: 10:00 a.m. – 4:00 p.m.
July 10 to November 13

Manhattan

NYC Health + Hospitals/Bellevue*
Fresh Food Box Program Only
Call (212) 562-7311 for more information
462 First Avenue

NYC Health + Hospitals/Gouverneur
Madison Street and Jefferson Street
Thursdays: 8:30 a.m. – 2:00 p.m.
July 8 – November 18

NYC Health + Hospitals/Harlem
512 Lenox Avenue between 135th and 137th Streets
Fridays: 8:00 a.m. to 6:00 p.m.
Open All Year

NYC Health + Hospitals/Metropolitan
East 99th Street at 3rd Avenue
Fridays: 8:00 a.m. to 4:00 p.m.
June 9 to November 17

Queens

NYC Health + Hospitals/Elmhurst
41st street between 80th and 81st Street
Tuesdays: 8:00 a.m. – 4:00 p.m.
June 6 – November 21

NYC Health + Hospitals/Queens
82-68 164th Street
Thursdays: 8:00 a.m. to 5:00 p.m.
July 6 – November 16

South Queens Community Health Center
114-02 Guy R. Brewer Boulevard
Thursdays: 8:00 a.m. to 5:00 p.m.
July 6 – November 16

NYC Health + Hospitals/Bellevue auxiliary Children of Bellevue has partnered with Jerry’s House to bring healing through laughter to children at the hospital. Australian television personality Lochie Graham, co-founder with legendary comedian Jerry Lewis of Jerry’s House, joined children, parents, clowns, and hospital staff Tuesday for the launch of the program at NYC Health + Hospitals/Bellevue.

Jerry’s House will provide the Child Life Specialists at NYC Health + Hospitals/Bellevue with “Healing Through Laughter” toy chests, which are equipped with the tools to bring humor therapy to young patients and their families who are coping with the stress, pain, and fear associated with illness, medical treatment, and hospitalization. The toy chests will be filled with fun play items that are sure to bring smiles to the faces of pediatric patients, including doctor/patient hand-puppets, big buttons that make funny noises when pressed, funny hats, and more. We appreciate the Jerry’s House partnership with Children of Bellevue to enrich our pediatric patients’ experience while they are getting their life-saving treatment in our system.

OneCity Health’s transformation efforts to integrate primary care with behavioral health are ongoing and recently earned state and national recognition. As noted above, through OneCity Health’s Population Health team’s efforts, NYC Health + Hospitals has been awarded a 2017 Gage Award for Innovation and Excellence from America’s Essential Hospitals for implementing Collaborative Care for depression in the primary care setting.

Earlier this month, OneCity Health hosted nearly two dozen people from a variety of our partners and other external organizations for our webinar, “Navigating the Regulatory Options for Co-location of Primary Care and Behavioral Health.”

In collaboration with a vendor, OneCity Health is currently working with 10 pilot sites to implement co-located services for primary care and behavioral health. By integrating the staffing and communication between medical and behavioral health providers, primary care providers can more effectively provide services such as screening and management of depression, linkage to substance and alcohol abuse counseling and treatment, and treatment of medical needs common among patients with severe behavioral health problems. In recognition of this work to date, New York State featured this webinar and accompanying materials in their weekly bulletin to Performing Provider Systems across the state.

We are also continuing with a variety of educational seminars and trainings to ensure our workforce and community partners are able to further implement our primary care and care management initiatives.

• OneCity Health partner 1199 SEIU facilitated an interactive care management training for grant-funded Center for Medicare & Medicaid Innovation (CMMI) staff from NYC Health + Hospitals/Bellevue, Elmhurst, Jacobi, Kings County, Lincoln, and Queens, focused on identifying and addressing patient’s social determinants from the Emergency Department (ED). We plan to apply the findings under this grant regarding patient impact and quality outcomes to OneCity Health’s ED Care Triage initiative, through which we will narrow focus to the highest-needs, highest-utilizing patients instead of all patients with ambulatory care sensitive conditions. Staff will continue to connect patients to primary care, while standardized workflows will help them to better identify providers with capacity, as well as other appropriate outpatient services.
• Over 50 NYC Health + Hospitals Registered Nurses attended OneCity Health’s recent Treat 2 Target Learning Collaborative, which explored the necessary elements related to NYC Health + Hospital’s goal to improve blood pressure control for hypertension patients to 72 percent across the system. Attendees learned the role of nurses in helping to improve health, reduce strokes and save lives through the Treat 2 Target program.
• To begin to address the social determinants of health our patients face, OnceCity Health hosted its first event in collaboration with LegalHealth to train staff from NYC Health + Hospitals facilities and other OneCity Health partners to learn how to make appropriate referrals to legal and immigrant health-related services. A second training session is scheduled for later in June. Nearly 40 people participated in the first session, where they learned the legal issues their patients and clients face so they can help refer and engage them in legal services.