REPORT TO THE BOARD OF DIRECTORS – June 2019

The Mayor and City Council are finalizing an FY 2020 budget. The $92.8 billion budget includes several important provisions for NYC Health + Hospitals. The budget includes $25 million for the NYC Care program in FY20. These funds will be used for hiring new clinical staff, customer services improvements, and an extensive community outreach and marketing campaign. The NYC Care budget will ramp up to $100m in FY 21.

The city budget also includes $26m for the Mental Health Services Corps (MHSC) in FY 2020. Effective January 1, 2020, leadership and operations of this groundbreaking program will transition from the Department of Health and Mental Hygiene and the City University of New York to NYC Health + Hospitals. The program will be run through a collaboration between the Offices of Behavioral Health and Population Health and will place 60 corps members into a variety of Health + Hospitals clinical settings. Health + Hospitals is excited to expand our role in the MHSC to build a diverse, multi-lingual behavioral health workforce and to expand the high quality behavioral health services we provide to New Yorkers.

The final provisions of the FY20 budget are still being negotiated and we will provide the Board a more detailed report on allocations of capital and expense dollars in the coming weeks.

The NY State 2019 legislative session is set to end on June 19th. The end of session focused primarily on rent regulations, removing the non-medical exemptions for vaccinations, and the Green Light NY bill, which will provide the right to a driver’s license regardless of immigration status. Another bill that gained attention relates to expanding the use of the Independent Dispute Resolution (IDR) process between hospitals and insurance companies. The legislation was a major priority of the health insurance industry and was strongly opposed by the hospital industry.

After both sides waged a public campaign, an agreement was made related to when out-of-network emergency hospital charges are submitted to the IDR. The amendment requires insurance companies to pay at least 25% of the charge, before taking the hospital to the IDR. The bill does contains an exemption for safety net hospitals that have at least 60% inpatient discharges that are Medicaid, uninsured, or dual eligible so we do not expect our health system to be affected. NYC Health + Hospitals is actively pushing legislation related to Design Build Authority. This is a construction method where the designers and contractors work together. This method reduces time and costs on projects. Upcoming health system projects would benefit, including the NYC Health + Hospitals/Elmhurst ED expansion and our three new community-based ambulatory care sites. We are monitoring various other proposals but do not expect any other legislation with significant fiscal impact on NYC Health + Hospitals.

NYC Health + Hospitals is partnering with the NYC Fire Department (FDNY) and the Regional Emergency Management Council (REMAC) to explore a new federal demonstration program from the Center for Medicare and Medicaid Services (CMS). The Emergency Triage, Treat, and Transport (ET3) is a voluntary, five-year payment model that provides greater flexibility to emergency management agencies. Under the ET3 model, CMS will pay participating ambulance suppliers to transport patients to either a hospital emergency department or another destination (such as an urgent care center), and/or provide treatment in place with a qualified health care practitioner, in person or by using telehealth. Currently, EMS providers are only paid for ambulance trips that arrive at an emergency department.

The New York City 911 system responds to approximately 1.8 million emergencies each year and about 70% of those result in the patient being transported to the hospital. The Department of Health and Human Services estimates that 15% of patients transported by EMS could be seen at an alternative destination. In other words, implementing an alternative destination program in the city of New York could avoid 189,000 ambulance transports to emergency rooms per year. That’s over 500 each day. Health + Hospitals 11 acute care facilities have some of the busiest emergency departments in the city and are enthusiastic to partner with EMS providers to connect ensure more patients get the care they need in the most appropriate setting.

The NYC Care team is working toward the program launch in the Bronx on August 1. Operational details, such as the enrollment process and call center workflows are being finalized. The NYC Care team is developing a pathway for enrollment that includes partnerships with community-based organizations that employ certified application counselors to streamline the eligibility process for patients. The team is also finalizing the plan to ensure that NYC Care members have 24/7 pharmacy access, through extended pharmacy hours at all our hospital and health center-based pharmacies in the Bronx and a new arrangement with a 24 hour retail pharmacy in the Bronx for emergency prescriptions overnight. We are also on track to recruit and expand primary care teams and will be hiring new providers needed in the Bronx to care for the expected influx of new patients.

We are also working on a robust media and community outreach campaign that embraces cultural diversity and targets the demographic populations we want to reach. We will invest in the advertising and promotion platforms most popularly used by our target community and are developing a list of key stakeholders, including community based organizations and elected officials, to engage with. Dr. Ted Long and our new Executive Director, Marielle Kress, will be presenting at the Bronx Borough President’s Joint Borough Service Cabinet and Borough Board meeting on 6/27/19 and have many other community engagements planned throughout July.

NYC Health + Hospitals/Elmhurst opened a new Medical Primary Care Center designed to support the health system’s focus on expanding primary and preventive care to keep communities healthy and out of the hospital. The new 6,500 square feet outpatient center will bring together a diverse team of clinical experts to offer a wide range of internal medicine, women’s health, mental health and adolescent health services together in one space. The new space features 10 additional exam rooms for a total of 30, modern new furniture in waiting areas, and updated clinical equipment. Last year, the hospital’s primary care practices handled approximate 30, 000 patients. The renovated primary care center will reduce waiting times, increase patient satisfaction and allow clinicians to see an additional 10,000 patients a year. With funding from the state, NYC Health + Hospitals invested approximately $1 million to cover the cost of the renovations and new equipment. Enhancing and building our primary care capacity is key to NYC Health + Hospitals’ effort to reducing emergency room utilization and building long lasting, healthy relationships with our patients. This new Medical Primary Care Center will make our patients feel welcome and at home with their physicians. The clinic represents the future of primary care at NYC Health + Hospitals.

NYC Health + Hospitals’ full-service community health center on Staten Island will now offer Saturday and additional evening hours to expand access to primary and preventive health services to the community. The NYC Health + Hospitals/Gotham Health center on Vanderbilt Avenue will open the second Saturday of every month and until 7 pm on Tuesdays. The expansion nears the facility’s one year mark when the new $28 million ambulatory care center began offering affordable primary care for children and adults, mental health counseling and referrals, and opioid treatment to meet local community health needs. The investment in the 18,000-square-foot health center is part of NYC Health + Hospitals’ broader multi-year redesign to build a competitive, sustainable organization that will continue to offer high-quality and accessible health care to the people of New York City. We’re proud to celebrate our first year of service in this new, modern health center and to make it more convenient for Staten Islanders to access the health care they need and deserve, right here in their home borough. We are also excited to see more Staten Islanders choosing our health plan, MetroPlus. We saw membership triple in the last year, thanks to our broad network of providers on the Island and the comprehensive health services we offer in our Gotham Health center on the North Shore.

In recognition of National Pride Month, NYC Health + Hospitals opened two new comprehensive Pride Health Centers dedicated to lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) patients. The new health centers at NYC Health + Hospitals/Bellevue and NYC Health + Hospitals/Gotham Health, Gouverneur in Manhattan will provide culturally responsive health services to LGBTQ New Yorkers and address barriers that contribute to health disparities among LGBTQ youth and adults. The new Pride Health Centers are the public health system’s third and fourth, building on a commitment to the LGBTQ community that has earned NYC Health + Hospitals national recognition as “Leaders in LGBTQ Healthcare Equality.” The opening of our two new Pride Health Centers further demonstrates Health + Hospitals’ commitment to ensure all New Yorkers have access to culturally responsive, high-quality health care. We are proud to continue to break down barriers to health care that marginalized communities face.

The de Blasio Administration, along with NYC Health + Hospitals and Planned Parenthood of New York City (PPNYC), announced a new partnership to increase access to contraception services to nearly 3,000 adolescents in the City. Through this partnership, NYC Health + Hospitals and PPNYC will train clinicians to provide family planning services, contraception counseling and same day access to Long-Acting Reversible Contraception (LARC) to students at six of our school-based health centers. Six NYC Health + Hospitals clinicians will participate in the PPNYC two-week training program that prepares health care providers to work with adolescents. The training curriculum covers sexual and reproductive health care, comprehensive contraceptive counseling and management, and the best practices for intrauterine devices (IUD) insertion and removal. The training will conclude in August to ensure providers are prepared to offer these services before the new school year begins. The training will cost $51,600, and will be funded through the Department of Health and Mental Hygiene. Our health system is committed to helping all those of reproductive age to access an array of health care services that can help them fully exercise their reproductive rights. As one of the largest providers of family planning services in NYC, we are committed to working together with our sister agencies and organizations to meet the growing demand for sensible family planning options at all life stages.

NYC Health + Hospitals announced that all 11 public hospitals will host free opioid overdose and naloxone training and dispensing events by the end of 2019 as part of HealingNYC, a citywide initiative to prevent opioid overdose deaths. The training events will prepare community members and non-clinical hospital staff to recognize an opioid overdose and properly and safely administer naloxone medication to reverse it. Naloxone kits will be distributed free to all participants to empower friends, family and other community members to serve as first responders during a potential overdose. The next scheduled training and education session, in partnership with Brooklyn Borough President Eric L. Adams and the NYC Department of Health and Mental Hygiene, will be hosted by NYC Health + Hospitals/Coney Island on Tuesday, July 16, at 1PM. Opioid use has caused a high burden of death and suffering in the communities we serve. I’m proud of the work NYC Health + Hospitals is doing to educate staff, patients, friends and families to save a life in the event of an opioid overdose. We are grateful for the collaboration with HealingNYC that allows us to expand this education programs to save even more lives.

More than 120 NYC Health + Hospitals nurse leaders gathered earlier this month for the first-ever strategic planning Nursing Leadership Retreat at NYC Health + Hospitals/Gouverneur.
The event, organized by Chief Nurse Executive Natalia Cineas, included Chief Nurse Officers and staff that represented the health system’s more than 8,000 nurses who provide care at our hospitals, post-acute facilities, Correctional Health Services, Gotham Health Centers, and Community Care. The purpose of the first annual event was for nursing leaders to develop a strategic plan for the next five years, as well as to strengthen the connection between system-wide and facility-level goals. It was a pleasure to speak to this impressive group of nurse leaders who are so vital to the success of health system’s transformation.

The Joint Commission (JC) conducted its triennial unannounced survey at NYC Health + Hospitals/Harlem this month. The four-day survey was conducted by a team of surveyors who reviewed a broad range of clinical and administrative practices, as well as safety and staff engagement. I’m pleased to report the hospital received full accreditation from the JC. The surveyors did not have any serious findings and cited the hospital for their commitment to the community and chasing zero harm. Congratulations to CEO Ebone Carrington, CMO Dr. Maurice Wright, CNO Keisha Wisdom, and CQO Pamela Bradley for leading the entire hospital team in a successful survey, showing the high quality and safe patient care they provide to the community every day.