REPORT TO THE BOARD OF DIRECTORS – May 2017

The U.S. House of Representatives voted on May 4th to pass a legislative vehicle for repeal and replacement of the Affordable Care Act (ACA). If the U.S. Senate approves the bill and it is signed into law by the president, hundreds of thousands of New Yorkers will be stripped of their health insurance coverage, and substantial work accomplished over the past several years to make New Yorkers healthier will be set back. The financial cost to NYC Health + Hospitals will be in the tens of millions at a time when our system can least afford to absorb such a blow and continue to carry out our essential mission to deliver high-quality care to all New Yorkers. Enactment would decimate Medicaid–with a particularly devastating impact on New York and other states which expanded their programs under the ACA. House Republicans were able to pass their repeal and replace bill only by including the Faso-Collins amendment which eliminates the local Medicaid share in New York State (for all counties but the five boroughs of New York City) further straining the State’s overall health care resources, to even greater disadvantage for New York City and our system.

The bill will move to the U.S. Senate, where stark differences appear to divide very conservative Senate Republicans from their moderate Republican colleagues. Republicans have hoped to pass health care legislation under budget reconciliation rules allowing for a simple 51 vote majority. But this lower vote threshold for health care legislation disappears if Congress votes on the FFY 2018 budget first. The fact that a lack of consensus on health care threatens to bottle up budget and tax overhaul legislation, may yet incentivize Senate Republicans to pass their own version of ACA repeal and replace legislation, sooner rather than later. Any differences between the Senate and House passed bills will have to be reconciled in a conference committee made up of members from both chambers. Senate deliberations have begun without any indication from the Majority Leader of a timetable, or the likelihood of swift action. NYC Health + Hospitals staff were in Washington, D.C. recently meeting with members of the New York congressional delegation and hospitals associations from across the country to reinforce our message that legislation passed by the House will cause irreparable harm to safety net systems here in New York City and across the country.

President Trump has released his Federal fiscal year (FFY) 2018 budget proposal, a non-binding blueprint that lays out his vision and priorities for the coming fiscal year, and serves as a tool in budget negotiations and other future legislative discussions. The budget proposes converting Medicaid to per capita caps or block grants starting in FFY 2020, similar to the proposal in the American Health Care Act (AHCA), which passed the House of Representatives earlier this month. The Office of Management and Budget (OMB) estimates that this would cut Federal Medicaid spending by $610 billion over 10 years. OMB also estimates that repealing and replacing the Affordable Care Act (ACA), including the Medicaid expansion, would cut Federal spending by $250 billion. NYC Health + Hospitals strongly opposes the budget’s unprecedented cuts to the Medicaid program. If enacted, they would severely harm NYC Health + Hospitals financial viability and our ability to continue carrying out our mission.

On May 9, members of the executive staff and I testified before the City Councils’ Finance, Health, and Mental Health Committees on the FY18 Executive Budget. As you know, Health + Hospitals is facing a $1.1 billion budget gap in FY18, which begins on July 1, and increases to $1.9 billion by FY21. While I remain confident that we have a clear path to closing the FY18 gap, based on the successes of our current revenue enhancement and cost-reduction initiatives, this in no way minimizes the difficulty of the task that lays ahead. We are facing tremendous headwinds out of Washington, with the looming repeal and replacement efforts by the Republicans and the diminishment of enhanced federal support, and our own efforts to adopt industry standard organizational models to streamline our management structure.

Other highlights of the testimony included the transformative work underway through OneCity Health, our DSRIP performing provider system (PPS), an investment of $289 million over five years to implement a new Epic revenue cycle, which will integrate with the Epic patient electronic medical record, and participating in the Mayor’s HealingNYC initiative to stem the tide of the opioid epidemic in New York City.

We continue to hold our yearly, state-mandated public meetings in each borough. These events offer patients and community members an opportunity to express comments and concerns about our operations directly to members of our Board of Directors. Thank you to Board Member Dr. Vincent Calamia, for chairing the May 10th event in Staten Island, as well as to Josephine Bolus, Barbara Lowe, Robert Nolan and Mark Page for being in attendance, and to the staff of NYC Health + Hospitals/ SeaView for hosting the meeting. Last week we held our annual public meeting for Brooklyn at NYC Health + Hospitals/Coney Island. Approximately 40 community members attended. Thank you to Board Members Robert Nolan and Josephine Bolus for attending. Thanks also to General Council Salvatore Russo, Board Secretary Patricia Lockhart and Board Chief of Staff Colicia Hercules for their assistance at these events.

Our health system was front and center this week during Mayor de Blasio’s concentration on the Bronx, one of an ongoing series of five borough-specific “weeks” devoted to issues and service delivery. Our staff participated in a number of events, including a resource fair in Borough Hall and the Mayor’s town hall meeting. Earlier today First Lady of New York City Chirlane McCray announced the launch of two programs, part of HealingNYC, at NYC Health + Hospitals/Lincoln to combat the opioid epidemic in New York City. The programs are just two components of NYC Health + Hospitals’ work to transform its substance use care models as it addresses New York’s opioid epidemic. The launch of these new programs supports the City’s commitment to increasing access to medication-assisted treatment for addiction for an additional 20,000 New Yorkers and to reduce opioid overdose deaths by 35 percent.

One of the new programs at Lincoln will expand Naloxone distribution throughout the hospital, making the medication more readily accessible to patients and caregivers. Naloxone kits will be distributed broadly by the hospital’s pharmacy, beyond its substance use disorder program, to include the emergency department (ED), ambulatory care, behavioral health, and pain management service areas. 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 ED to screen each patient who presents with non-fatal opioid overdose, opioid intoxication, or a history of harmful opioid use. Peer advocates, who have experience with substance use disorder treatment, will use their personal stories and insights to connect with vulnerable patients at a time when they may be receptive to help, in an effort to connect patients to care and resources.

Last month, The Joint Commission (TJC) conducted their unannounced survey six weeks ahead of the triennial schedule to NYC Health + Hospitals/Woodhull. I am pleased to report that the hospital received full accreditation for the next three years. Over four days, TJC conducted an intensive and rigorous review of clinical practices and operations, including numerous tracers on inpatient units, ambulatory care clinics, and off-site clinics to follow the trajectory of patients’ care. Surveyors reviewed processes around central sterile, medication management, performance improvement, staff competencies, and the environment, including cleanliness. Congratulations to hospital CEO Gregory Calliste, CMO Edward Fishkin, CNO Angela Edwards, and Sharon Neysmith-Crawford of the Quality Management team, and the entire staff of NYC Health + Hospitals/Woodhull, on a successful survey. Thank you as well to Board Member Josephine Bolus, RN, for representing the Board.

Board Member and DOHMH Commissioner Dr. Mary Bassett was guest speaker during the May 4th physician grand rounds at NYC Health + Hospitals/Coney Island, where she kicked off a city wide awareness campaign about the impact that overprescribing has had on opioid addiction, and to discuss the growing body of evidence indicating that prescription opioids have become a gateway to street drugs, especially fentanyl-laced heroin. Dr. Bassett is aiming to meet with 1,000 doctors in Brooklyn by July, following similar efforts in Staten Island and the Bronx, which have led to a drop in opioid prescriptions.

Christopher Mastromano has been appointed Chief Executive Officer of NYC Health + Hospitals/Jacobi. Mr. Mastromano had been serving as interim executive director and he brings years of experience in the nation’s largest public system, where he has served as Chief Operating Officer at both NYC Health + Hospitals/Jacobi and NYC Health + Hospitals/Gouverneur, effectively leading each facility and helping Gouverneur complete a $275 million modernization. Earlier, as Deputy Executive Director for Ambulatory and Emergency Services at NYC Health + Hospitals/Kings County, he oversaw improvements that resulted in over $8 million in savings. He has also served in senior roles at other health care organizations in the New York City area, including Mary Immaculate Hospital in Jamaica and Fidelis Care New York.

David Weinstein was appointed chief executive officer of NYC Health + Hospitals/McKinney, our highly rated post-acute care facility in Brooklyn. Mr. Weinstein had been serving as interim CEO at McKinney since February 2017 overseeing clinicians and staff providing quality short-term rehabilitation and skilled nursing services, in a home-away-from-home setting for patients as they heal, recover, and work towards maintaining their highest quality of life. He has served in a number of senior level management positions in mission driven patient care facilities throughout New York State. His career spans over 30 years, including service as chief operating officer at the Hebrew Home at Riverdale and chief executive officer at Daughters of Sarah Senior Community in Albany, NY.

This month we announced plans to implement new, advanced revenue cycle technology to improve efficiency and ensure that the health system is collecting the maximum amount of revenue for the services it delivers. The new Epic revenue cycle product is projected to help capture an additional 5 percent of adjusted patient revenue—or up to $142 million in revenue, based on FY 2016 patient volume. Among the expected benefits are improved clinical documentation to support billed services, reduced claims denials, and accelerated reimbursements.

The new technology will standardize revenue collection in each of our hospitals and across our dozens of community-based patient care sites. It will integrate seamlessly with the Epic patient electronic medical record system that we began to adopt last year. Benefits will be experienced by both patients and providers. This revenue cycle technology will allow patients to more easily see and understand the costs of their care, and pay bills online. It will create a common platform for all health system providers, who will be able to complete tasks without having to jump from system to system, by presenting a consolidated and complete patient record to improve efficiency. Other functionality and benefits include improved coding and documentation, expedited billing, reduced denials of claims, and accelerated reimbursement.

NYC Health + Hospitals has been proud to partner with the City’s ThriveNYC effort to prioritize maternal depression screening. Together with First Lady of New York City Chirlane McCray, this month we announced the expansion of depression screenings as a routine part of care at pre-natal clinics at 12 NYC Health + Hospital sites, including each of our 11 hospitals and NYC Health + Hospitals/Gotham Health, Governeur. To mark this expansion, the First Lady met with staff and patients of the NYC Health + Hospitals/Woodhull pre-and post-natal depression support group. A number of the patients we serve shared their moving stories about overcoming depression, thanks to the help and support they received from our care team. The support group started last year by psychiatric nurse practitioner and midwife Rebecca Feldman, and the group was recently awarded a Fund for NYC Health + Hospitals Grant (“FIG”) for innovative programming with potential for scaling across the system.

NYC Health + Hospitals/North Central Bronx has been awarded the 2017 Patient Safety Excellence Award from Healthgrades, a leading online resource for information about physicians and hospitals. NYC Health + Hospitals/North Central Bronx is the only hospital in the Bronx, and one of just two hospitals in New York City, to earn this distinction.

The Healthgrades Patient Safety Excellence Award recognizes hospitals’ performance in safeguarding patients from serious, potentially preventable complications during their hospital stay. Award recipients were determined by evaluating the occurrence of observed incidents and expected performance for a number of indicators of how well a hospital prevents injuries, infections, and other serious conditions. Congratulations to Maureen Pode, Chief Executive Officer, and the entire staff at NCB on this notable achievement.

This month NYC Health + Hospitals/Queens and NYC Health + Hospitals/ Metropolitan hosted new IDNYC pop-up enrollment sites. These sites provided a convenient location for community residents to obtain IDNYC, a government-issued identification card available to all New York City residents 14 and older, with proof of identity and residency, regardless of their immigration status, race, gender identity, or sexual orientation. IDNYC cards have proved extremely popular, with more than 1 million people having signed up for the card since its launch in January 2015. We are proud to partner with IDNYC to bring increased services to residents who may already face significant barriers to resources, care and wellness.

MetroPlus Health Plan co-hosted a series of seminars as part of Asian/Pacific American Heritage Month in May, in order to raise awareness among small business owners in Flushing, Queens, and surrounding areas, of low cost health plans available through the State’s health plan marketplace for businesses with 100 or fewer employees. The seminars also provided information about federal tax credits of as much as 50% of employer’s contribution available to qualifying businesses with 25 or fewer employees. With representatives fluent in Mandarin, Cantonese, and Fujianese, MetroPlus recently opened a new site at Skyview Mall in Flushing. The health plan is also opening a new office in the Sunset Park, Brooklyn to further enhance its commitment to bring affordable health care to the Asian community. The seminars were co-hosted by U.S. Representative Grace Meng, New York State Senator Toby Ann Stavisky, Assemblyman Ron Kim, and New York City Councilman Peter Koo, as well as Asian Americans for Equality (AAFE) and the Flushing Chinese-American Business Association (FCBA).

An innovative NYC Health + Hospitals/Bellevue program using text messaging to improve the management of patients’ insulin-dependent diabetes has received the 2017 Stand Up for Patient Safety Management Award from the National Patient Safety Foundation (NPSF). The initiative features a text messaging program called Mobile Insulin Titration Intervention Program (MITI) to help patients with type 2 diabetes. Patients in the program receive a text message each morning requesting their morning fasting blood sugar level, then text back their results. Values are monitored daily by nurses, who call patients once weekly to advise them on an insulin dose.

Bellevue’s Primary Care Diabetes Team developed the program to address a need to make it easier for patients in the NYC Health +Hospitals/Bellevue Adult Primary Care Center to manage their type 2 diabetes. Many patients with insulin-dependent diabetes found it difficult to take time away from work and other responsibilities to visit the clinic to have their insulin dose adjusted. We are proud that NPSF has recognized the value of this work. It anticipates a future in which a similar approach to disease management is expanded to other chronic diseases, such as hypertension and asthma. Congratulations to Andrew B. Wallach, M.D., F.A.C.P., Clinical Director, Ambulatory Care, NYC Health + Hospitals/Bellevue, Natalie Levy, M.D., Director of NYC Health + Hospitals/Bellevue’s Primary Care Diabetes Program, and the rest of the team.

NYC Health + Hospitals’/Sea View palliative care program received two prestigious national awards. One from AMDA: The Foundation for Post-Acute and Long Term Care Medicine; the other from Intalere Healthcare—reflect a continuing tradition of excellence at our skilled nursing facility on Staten Island.

NYC Health + Hospitals/Sea View is the only post-acute facility in the nation to receive AMDA’s award, which recognizes the facility’s Enhanced Interdisciplinary Palliative Care Services program, designed to increase engagement of residents in palliative care, prevent unnecessary hospital readmissions, and foster an alignment of care with family and residents’ wishes. Over a 14-month period, NYC Health + Hospitals/Sea View doubled the number of actively engaged residents receiving palliative care services. The facility was able to maintain a very low percentage of patients requiring transfers from NYC Health + Hospitals/Sea View to acute care services (7.8%)–well below the national benchmark (12.9%). And 98% of residents now have advanced directives in place. The culture of care has changed, too, with staff now embracing palliative care, as well as curative care.

Sea View is one of only three facilities in the nation to receive Intalere Healthcare’s Achievement Award in the “Quality/Patient Care Delivery and/or Patient Satisfaction” category, and the sole recipient in the greater New York City area. Its palliative program was recognized for having created value and greater operational efficiencies through constant innovation and transfer of best practices. Congratulations to CEO Angelo Mascia, Marian McNamara, RN, associate director of nurses, Nenita Premian, RN, assistant director of nurses and the staff at Sea View.

OneCity Health continues its efforts to enhance the care patients receive in primary care, leading to increased referrals and improved outcomes:

Asthma collaborative

In May, as part of its clinical home-based environmental asthma program, OneCity Health hosted its first community health worker (CHW) learning collaborative, where participants learn through role playing exercises and other information sessions. After being assigned pediatric patients from the primary care environment, CHWs complete an asthma assessment, reinforce recommendations from the clinical team, and conduct home visits.

In just one visit to an NYC Health + Hospital/Kings County patient’s home, a CHW saw the heat was broken, smoke from the neighbor seeped in through cracks in the wall, and roaches and mice were present. The child was often in the Emergency Room (ER). To help this patient, the CHW coordinated with the New York City Department of Health & Mental Hygiene – which is OneCity Health’s partner providing professional cleaning and pest management – and the NYC Housing Authority, to clean the apartment and fix the structural issues. The child has not been back to the ER since.
As this example shows, OneCity Health’s asthma initiatives are beginning to improve patient care. To date, our partners have assigned over 600 patients to Community Health Workers (CHWs), and completed nearly 300 home visits. Eleven NYC Health + Hospital facilities and six of our community partners are generating referrals to eight of our partners with CHWs.

Palliative Care

To help identify patients with chronic diseases who may benefit from palliative care in the primary care setting, NYC Health + Hospitals and Community Healthcare Network have begun administering to eligible patients the Integrated Palliative Care Outcomes Survey (IPOS). SUNY Downstate Medical Center will start administering the survey soon as well. Results are shared with the patient’s clinical provider. In addition, 17 NYC Health + Hospital facilities continue to conduct health care proxy interventions for patients in the primary care setting.

Technical Assistance

Our technical assistance vendors continue to assist 54 sites in the OneCity Health network toward achieving Patient Centered Medical Home (PCMH) recognition. In May, Once City Health hosted its third PCMH learning collaborative. Over 50 attendees learned about how care management concepts can be integrated into the primary care environment.

Care Management Programs

• Following expansions to medical units at NYC Health + Hospitals/Metropolitan and Jacobi, six Transition Management Teams (TMTs) are now in place, including medical units at NYC Health + Hospitals/Bellevue and NYC Health + Hospitals/Lincoln, and one psychiatric unit at NYC Health + Hospitals/Kings County. To date, 1,197 referrals have been made to the program, and 662 patients have graduated.
• Through our Health Home At-Risk pilot at six NYC Health + Hospitals sites (Bellevue and five NYC Health + Hospital/ Gotham sites) and four community partner primary care practices (Community Healthcare Network, SUNY Downstate Medical Center, Center for Comprehensive Health Practice and Brightpoint Health) primary care practitioners have made over 300 referrals to care coordinators provided by OneCity Health’s Health Home lead agencies, which are NYC Health + Hospitals, Community Healthcare Network and Community Care Management Partners.