REPORT TO THE BOARD OF DIRECTORS – March 2019

City

On March 25th, I testified at a hearing of the City Council’s Committee on Hospitals and discussed NYC Health + Hospitals financial results through Q2 2019 and answered questions on a range of topics, from NYC Care to correctional heath to the systems’ services for LGBTQ New Yorkers. I was pleased to report that our second quarter financial results demonstrate that our investments in patient care and revenue generation are working, and that Health + Hospitals’ balanced five-year financial plan positions us for stability and success. Our FY 2020 budget plan is on track to achieve $757 million from revenue-generating initiatives and $430 million from expense-reducing initiatives thanks to improved billing and better performance on our value-based contracts. On the expense side, we are less than $25 million—or 1%—over budget mostly due to investments to hire 340 nurses and coding staff to help us collect more reimbursements for our services from payers. I also noted the risks that remain, including recent budget proposals by the Trump administration, the Medicaid disproportionate share hospital cuts, and the proposed changes to the Department of Homeland Security’s public-charge rule. The Committee was supportive of Health + Hospitals direction and will continue to be a critical partner in our transformation efforts.

State

The legislature and Governor continue to negotiate the state budget in advance of the April 1 deadline. Both houses of the legislature reversed the governors health care cuts in their one house budget bills. The Governor subsequently indicated he would pursue budget savings in other areas. NYC Health + Hospitals continues to advocate for the community coalitions proposal to reform the distribution of Indigent Care Pool funds to fairly compensate hospitals who truly provide a disproportionate share of care to Medicaid and uninsured patients.

Federal

President Trump’s budget proposal includes significant cuts to Medicare, Medicaid and other critical health care programs. While the budget is not expected to become law, the extreme level of cuts underscores the importance of NYC Health + Hospitals advocacy to prevent cuts to the Medicaid Disproportionate Share Hospitals program and protect other programs critical to our patients. In addition to the draconian budget proposal, on March 25th the Trump administration took the highly unusual step of refusing to defend the constitutionality of the ACA in the Texas v Azar case. While both conservative and liberal legal scholars view this challenge to the ACA as unsound, the Trump Administration’s step is a reminder that NYC Heath + Hospitals and our advocacy partners need to remain vigilant in our defense of the ACA.

OneCity Health PPS launched its Phase IV contracting, following the approval of funding by the OneCity Health Central Services Organization Board and OneCity Health PPS Executive Committee. Two Project Participation Opportunity were issued to Phase IV partners for 1) the Behavioral Health Intensive Care Transitions Intervention/Critical Time Intervention (CTI) and 2) the expansion of the Home-Based Environmental Asthma Program. These programs aim to enhance or expand services that will improve the outcomes of the PPS population and prepare partners for a future value-based payment environment.

I am pleased to announce that NYC Health + Hospitals has received 100% of the incentivized payments — $30 million — for the 7th quarter in a row of the New York State Value Based Payment-Quality Improvement Program (VBP-QIP), which provides incentivized payment opportunities to support safety-net hospitals as they transition to the value-based purchasing contracting model. While we have received the maximum $210 million to date, there are three more quarters to go and our staff are working diligently to continue to show improvement in the six selected quality measures.

I was very pleased to join the staff, community advisory board members and elected officials to mark the construction of the new, state-of-the-art, flood resistant, 11-story tower building and emergency department at NYC Health + Hospitals/Coney Island. This is the hospital where my family got care when I was young, so I am particularly proud to be part of this exciting new beginning. We’re building a stronger, more resilient hospital that will endure future natural disasters and can provide uninterrupted service during severe storms. We are also renewing our commitment to excellence for the thousands of patients and families who rely on this essential health care facility and deserve nothing less than quality, compassionate care, in a new health and wellness campus.

This transformation is part of a major $922 million hospital campus renovation funded by FEMA to demolish, replace and repair flood damaged buildings from Superstorm Sandy. The new hospital building, built on the north side of the hospital’s campus, is expected to open in early 2022; other parts of the campus renovation are expected to be completed spring 2023. Critical patient services will be located above the 500-year Floodplain. This project represents the first completely new building on the campus since 2006 and supports the public health system’s 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.

NYC Health + Hospitals/Woodhull announced plans for an expansion and renovation of the hospital’s emergency department to improve access to services, alleviate overcrowding, reduce wait times and improve the patient experience. The expansion project will be fully funded by a $5 million capital allocation from the New York City Council’s Brooklyn Delegation and is expected to be completed the first quarter of 2020. The Emergency Department (ED) expansion will add 5,000 square feet of space that will include 16 additional exam rooms, a new and improved state of the art nurse’s station, a new isolation room and a “transition hub”, where patients who are being discharged from the ED are linked to a primary care or specialty service follow up visit, can receive consultation regarding their medications, and access care management services.

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 give us the opportunity to connect them to the primary care services they need to stay healthy and out of the ED. I want to thank Council Members Antonio Reynoso, Mark Treyger, and Carlina Rivera and the entire Brooklyn delegation for their support of NYC Health + Hospitals/Woodhull.

MetroPlus Health Plan announced that more Staten Islanders have enrolled in its affordable health insurance coverage, an important step in supporting New York City’s commitment to guarantee health care to all New Yorkers. NYC’s public option health insurance plan reported a jump in membership on Staten Island by nearly 250% in one year. More than 5,200 Staten Islanders chose MetroPlus as their preferred plan of choice by the end of 2018, compared to 1,500 at the end of 2017. The five-star health plan also expanded its provider network to 400 physicians and specialists on Staten Island to offer comprehensive coverage for primary and preventive care, mental health services, and other specialty care that meets the health needs of the community, including the comprehensive outpatient services available at the new NYC Health + Hospitals/Gotham Health, Vanderbilt center that opened last year.

Too many Staten Islanders are still living without health insurance or guaranteed health care. We will continue to step up our efforts to engage more Staten Islanders who are eligible but uninsured to get them connected to the affordable insurance options available through MetroPlus and ensure access to quality care in their community.

For National Patient Safety Awareness Week, more than 200 employees gathered at NYC Health + Hospitals/Jacobi for the annual System-wide Patient Safety Conference, an important event to celebrate our successes and commitment to creating a culture of safety for our patients, coworkers, visitors and the community we serve. The highlight of the conference was the presentation of our Patient Safety Champion Awards. This year, the Presidential Patient Safety Champion Award was given to the NYC Health + Hospitals/Metropolitan’s Infection Prevention and Control Team for focusing on zero harm in hospital acquired infection. NYC Health + Hospitals/Lincoln took 2nd place for achieving zero hospital acquired pressure injuries with sustainable reductions in pressure injuries for over 5 years. NYC Health + Hospitals/Bellevue was awarded 1st place in Patient Safety Performance Improvement for Ventilator Associated Pneumonia in Adult Trauma Patients.

For many, art, music, dance, drama and poetry are ways to escape from the hustle and bustle of everyday life. Here at NYC Health + Hospitals, these forms of creativity hold more clinical importance when incorporated into our patients’ treatment plans. To celebrate National Creative Arts Therapies Week and to highlight the role, our health system held its first annual Creative Arts Therapies Conference last week at NYC Health + Hospitals/Gouverneur. Nearly 170 system-wide health care staff member gathered to celebrate and learn more about the cutting-edge work of our Licensed Creative Arts Therapists. We have more than 100 Licensed Creative Arts Therapists – the largest concentration of any health system in the nation – working to transform the care and wellness of patients and their families. The purpose of Creative Arts Therapies is to help patients improve their self-management and problem-solving skills while providing a means of addressing past traumas, reducing stress and building self-esteem. The goal is also to alleviate patients’ symptoms for both acute and chronic mental and behavioral health challenges.

NYC Health + Hospitals/Bellevue Pediatric Primary Care Clinic received the “HPV Vaccine Is Cancer Prevention Champion Award” for outstanding efforts to protect adolescents from cancers caused by the human papillomavirus (HPV) and achieving high HPV vaccination rates. The national award is a partnership of the Centers for Disease Control and Prevention, the Association of American Cancer Institutes, and the American Cancer Society. Congratulations to the team at Bellevue for their successful efforts to expand access to HPV vaccination among adolescents. As an early adopter of the HPV vaccine, the clinic embraces the strategy of promoting the initiation of HPV vaccination at nine years of age, which is a key factor in achieving high rates of immunization. Thanks to their innovative approaches to educate patients, they have been able to achieve an 86 percent HPV vaccination rate.

Sally Hernandez-Piñero was appointed Chairperson of the Board of Directors of MetroPlus Health Plan, Inc. MetroPlus is the low-cost, five-star quality health insurance plan of choice for more than 500,000 New Yorkers. As the health plan owned by NYC Health + Hospitals, MetroPlus is a vital component of Mayor de Blasio’s Guaranteed Health Care plan to ensure coverage for all New Yorkers. Hernandez-Piñero will fill a 5-year term effective February 28, 2019. She replaces Bernard Rosen, who has served as MetroPlus Board Chairperson since May 2000.

We are fortunate to have Natalia Cineas, DNP, RN, MS, a respected nurse leader and care provider, join our management team as Senior Vice President and Chief Nurse Executive of NYC Health + Hospitals. Our nurses are at the heart of our mission to care for all New Yorkers without exception, and as chief nurse executive, Natalia will help set the standard for care and consistently represent the voices of patients and nurses in all important discussions and decisions. I’m especially pleased to say that Natalia was born at NYC Health + Hospitals/Kings County, and like many of our staff who rely on Health + Hospitals for their family’s care, she will have a unique opportunity to give back to a system that took care of her and her family.