REPORT TO THE BOARD OF DIRECTORS – November 2015

Good afternoon. As customary, I will highlight just a few items from the full version of my report to the board. The full version is available to all here and will be posted on our website.

Last week we announced a new brand strategy that unifies our more than 70 patient care locations in the five boroughs and represents our transition to a wellness-focused health care leader — NYC Health + Hospitals. The change is designed to help redefine us as we embark on an aggressive campaign to attract new patients, expand primary care services in underserved communities, increase membership in our low-cost health insurance plan MetroPlus, and grow revenue to preserve our mission.

Our mission to care for all, without exception, has not changed. But our promise to New Yorkers has evolved. Our new brand graphics symbolize a true evolution as we transition from a hospital-centric corporation to a health care delivery system focused on providing an exceptional patient experience and building healthy communities. Our new logo unifies us, but most importantly, it celebrates our diverse workforce and what our staff does every day to empower New Yorkers to live the healthiest life possible.

The new brand standards are not just simply cosmetic changes on an old package. They signify a real transformation that is happening from the inside out in New York City’s essential health care delivery system.

The implementation of the new brand will be a grassroots effort to build employee and community-based brand ambassadors, and will involve a gradual, multi-year process.

We began to introduce the new logo and graphics standards to our 42,000 employees last week with very enthusiastic and spirited brand celebrations at many of our patient care locations. Each celebration featured a cake with our new logo just like the one you saw it on your way into the Board room today. I want to thank Chef Charles Smith of our Cook & Chill Plant in Brooklyn who has baked 48 cakes and 20,000 cupcakes for our staff as we rolled out the brand across the health care system. I thought I’d take just a few moments here to show you some snapshots from the celebrations at our hospitals and health centers.

In a special agreement between our health plan, MetroPlus, and Memorial Sloan-Kettering, 114 New York City residents, who are currently insured with Health Republic Insurance Plan and in active cancer treatment at Memorial Sloan Kettering Cancer Center, will have the opportunity to continue their cancer care without interruption, despite the pending closure of Health Republic at the end of this month. Patients will maintain continuity of care through enrollment in MetroPlus.

We want to make sure no New York City patient is left behind. There’s no scarier time to lose health insurance than when these patients and their families are facing a cancer diagnosis and relying on the exceptional treatment available at Memorial Sloan Kettering. Thanks to Memorial Sloan Kettering for agreeing to work with MetroPlus on this groundbreaking agreement.

A ceremony was held early this month to kick off the construction of a Ronald McDonald Family Room located inside NYC Health + Hospitals/Kings County. Our philanthropic arm, The Fund for HHC, cemented the capital expansion agreement with Ronald McDonald House-NY and will be managing the creation of Family Rooms throughout our system. The Family Room is expected to be completed and open for use in spring 2016.

The Ronald McDonald Family Room will serve as a respite care facility for caregivers of patients in our neonatal intensive care unit and will offer a kitchen, washer and dryer, bathroom, and lounge area to provide an area of relaxation and a place to recharge for the families of children receiving inpatient care.

When a family is faced with the overwhelming stress of a child in the hospital, as care providers we want to do anything we can to improve their experience and bring that family comfort. Having a Ronald McDonald House Family Room available can be an important part of the healing process and provide a positive and calming experience for patients and their families.

Late last month we honored six nurse professionals with “Nursing Excellence” awards for demonstrating dedication and compassion for the field of nursing and for their patients. Awards were given in six categories of excellence: clinical nursing, inpatient; management; education and mentorship; advancing and leading the profession; home, community or ambulatory care; and volunteerism and service. A “Nursing Champion” was also recognized for support of the nursing profession. This year 186 nurses were nominated for the awards, making it the largest pool of nominees to date.

NYC Health + Hospitals nurses work tirelessly each day to meet our patients’ needs and ensure their satisfaction. Nurses advance the quality of care by spearheading innovative efforts to improve patient experience and patient safety, and make our system an excellent source of wellness and healing for all New Yorkers. Congratulations to all 8,000 of our health care system nurses for their continued dedication to improving patient care and keeping patients first in all they do.

We recently received word from the New York State Department of Health that Terry Hamilton, our Assistant Vice President of HIV Services will be given an award by the Health Commissioner for her commitment to reducing new HIV infections and innovations to promote HIV testing and engage HIV patients in care. The award will be presented in Albany on December 1 – World AIDS Day 2015. I know the Board joins me in offering Terry our warmest congratulations.

Early this month, we announced a groundbreaking forum for cross-collaboration between front line doctors and management — Doctors Council SEIU and NYC Health + Hospitals. The forum included a three-day training to launch a new system-wide Collaboration Council. The Collaboration Councils (both system-wide and at each of our facilities) are an innovation in labor-management relations. The goal is to develop a collaborative approach to improving the quality of healthcare.

The Institute for Healthcare Improvement, a leading innovator and driver of results in health and health care improvement worldwide, worked with both management and doctors through the three-day program. Participants also heard from special guests which included Dr. Ben Chu, Kaiser Foundation Hospitals on timely health care industry trends and changes on the horizon.

We are keenly attuned to the culturally diverse needs of patients in the City public health system. Offering excellent patient experience is key to the success of our hospitals, and since our physicians are so reflective of the diverse patients we serve, their input is important to our success. That is why we are pleased to be part of the Collaboration Councils and the effort to jointly work with doctors to improve patient experience.

New Speaker and Two-Year Budget Deal

In Washington, Congressman Paul Ryan was elected Speaker of the House last month, succeeding Speaker John Boehner. Before leaving office, Boehner negotiated a two-year budget deal that was signed by President Obama on November 2nd. The deal suspends the nation’s debt limit through March 2017 and increases federal spending for domestic and defense programs by more than $80 billion over the next two years. The passage of this legislation was key for the new speaker as three important issues — the debt limit, spending levels and a rise in Medicare part B premiums — have now been solved for the next two years.

For hospitals, there were two provisions of the bill that impact Medicare payments. A one-year extension of the existing 2% Sequester cut was added which affects Medicare payments. For NYC Health + Hospitals, the impact of the extension is approximately $12 million. The deal also added a provision that, starting January 2017, new hospital outpatient department clinics (those established after November 2, 2015) will no longer receive the higher Medicare Outpatient Hospital rates, but will instead receive lower physician office rates. This provision will not impact Federally Qualified Health Centers (FQHCs), i.e. Gotham Health, or their expansion.

Two-Midnight Rule Finalized

On October 30th, the final Outpatient Prospective Payment System (OPPS) Rule was published, which included codifications of the Two-Midnight Policy. The rule gives physicians discretion in classifying stays less than two midnights as inpatient, on a case by case basis. This is a major victory for the hospital community. If the original version of the policy had been implemented, it could have resulted in Medicare losses of between $23 million and $38 million a year for NYC Health + Hospitals.

Whether we’ve known the tyranny of smoking ourselves, or been the loved one, or family member, or friend, of someone else who has struggled with nicotine addiction, all of us understand what a difficult mountain this is to climb.

Every year, on the third Thursday of November, smokers across the nation take part in the American Cancer Society Great American Smokeout.

But here at NYC Health + Hospitals, every day is a smokeout. We are always here for our patients who smoke. We employ an array of approaches and techniques to help them quit, and to help them keep from starting again.

We screen patients for tobacco use annually in all of our primary care settings. And for patients who self-identify as smokers, we actively follow up with appropriate medical care, be it counseling, nicotine replacement, or referrals to other resources they may prefer, such as the New York State Smoker’s Quitline. Almost every one of our facilities has their own in-house quit smoking clinic, with coordinators who serve as compassionate and informed resources for our patients.

As a metric-driven organization, we track these efforts closely, with each HHC facility reporting to our Board quarterly on the quality of their tobacco efforts within our primary care patient population.

And through research and clinical practice, our understanding of attitudes about quitting are evolving. Increasingly we recognize that even small barriers to quitting –unfamiliarity with NRT products, having to get a prescription to obtain it at low-cost, having to go to a pharmacy — can make the effort simply too daunting for some patients.

Now we view every primary care visit as a smoking cessation opportunity, and we send our patients who smoke, home with a nicotine replacement starter kit.

We know that nothing can seem as tough as quitting smoking. But we also know that we can help our patients find the strength to succeed in winning their lives back…In living their healthiest lives possible.

So please join me today in recognizing NYC Health + Hospitals’ smoking cessation efforts as our program of the month.

Thank you to Lindsey Gottschalk, for guiding our efforts as Program Director here at Central Office. And thank you for the all the great work being done in our primary care, ambulatory clinics, and quit-smoking clinics for helping our patients win this fight.

Key to NYC Health + Hospitals’ transformation to a patient-centric system is our recognition that healthcare is ineffective if delivered in a silo. To deliver on our promise to empower patients to live their healthiest lives possible, we cannot be disengaged from the array of social determinants that impact our patient’s health.

And no factor has as potentially devastating an impact on the health of our young patients as exposure to violence….especially gun violence, which is the leading cause of death for young men of color, ages 13 to 24.

How does a health system likes ours make a difference on this issue?

By appreciating that gun violence isn’t only a public safety issue—-It’s a public health issue as well—and it requires a vigorous public health response as part of any solution.

Dr. Robert Gore, an emergency room physician at NYC Health + Hospitals / Kings County, is part of that solution. The inspiring work he is doing with young people at-risk in Brooklyn, is the reason I’m proud to name him today as our Individual of the Month.

I hope all of you read the moving story recently in the New York Times about Dr. Gore’s founding of the Kings Against Violence Initiative (KAVI).

As a young intern, Dr. Gore was struck by the scarcity of role models, in medicine particularly, available to young people of color in many of the communities we serve.

He resolved to do something about that. And he has.

And like other initiatives operating at the facility level across the city with assistance from the Fund for HHC’s Guns Down Life Up program, KAVI has proven very successful in mentoring and counseling youth. It offers alternatives to young people to engage in positive activities like sports, dance and the arts as part of a comprehensive violence prevention strategy. And it engages previously incarcerated individuals who have turned their lives around, in order to interrupt youth violence at or near its source. This is great work, and we need to do more of it.

Please join me in congratulating Dr. Gore for going the extra mile, and making a real, lasting, positive, impact on lives of the young people we serve.

Broadcast

• WPIX 11

How an NYC doctor helped Bronx neighborhood cut shootings nearly in half
Jacobi: Dr. Noe Romo; Erika Mendelsohn

Print

• City’s public hospitals to overhaul its patient-experience strategy, Crain’s New York Business, NYC Health + Hospitals President Dr. Ram Raju; Metroplus
• Bye-bye, HHC, Crain’s Health Pulse, NYC Health +Hospitals President Dr. Ram Raju
• A New Name for NYC Health and Hospitals Corp.: 5 things to know, Becker’s Hospital Review, NYC Health +Hospitals President Dr. Ram Raju
• De Blasio to create new health centers, partially fulfilling campaign pledge, Politico New York, Dr. Ram Raju, HHC President
• City health initiative set for Jackson Heights, Times Ledger, NYC Health +Hospitals
• City Hall reaches deal to continue treatment for NYC cancer Patients who had been set to lose insurance coverage, Daily News, NYC Health + Hospitals; MetroPlus
• Ramanthan Raju | 130 Nonprofit Hospital & Health System CEOs to Know 2015. Becker’s Hospital Review, NYC Health + Hospitals President Dr. Ram Raju
• In Fight to Save Young People, Brooklyn Doctor Treats Violence as a Public Health Issue, The New York Times, Kings County: Dr. Robert Gore; Jacobi; Harlem, Erik Cliette, Senior Director, Guns Down, Life Up Initiative
• Woodhull apartment building will house below-market tenants, mental-health patients. The Brooklyn, Paper, Dr. Ram Raju, NYC Health + Hospitals President; Woodhull
• HHC to approve employment contracts for Riker’s staff, Politico New York, NYC Health + Hospitals, Patsy Yang
• HHC to ink deal to staff city jails, Crain’s Health Pulse
• Doctors get more input at HHC, Crain’s Health Pulse, Dr. Ross Wilson, Corporate Chief Medical Officer
• Ronald McDonald, Politico New York, Kings County
• NYC Health + Hospitals Honors Nurses. Advance for Nurses. Marie Alverio, Coney Island; Susan Gullo, NCB; Eileen Achacoso, Central Office; Robert Smeltz, Bellevue; Tiffany Reid, Harlem; Bindu Rai, Elmhurst
• Harlem Nurse Receives “Nursing Excellence” Award, Harlem World Magazine, Dr. Ram Raju, HHC President; Lauren Johnston, Corporate Chief Nurse Executive
• Master of Doctors, Brooklyn Daily, Coney Island: Dr. Terence Brady, Associate Chief Medical Officer; Dr. John Maese, Chief Medical Officer; Dr. Paul Gitman, Quality Management
• Dr. Craig Spencer Reunites with HHC Bellevue Hospital Medical Team a Year after Recovering from Ebola, Hospital Newspaper, Bellevue
• New York Magazine

Ebola Survivor Dr. Craig Spencer Returns to Visit the Hospital That Saved Him, New York Magazine, Bellevue: Dr. Nate Link, Chief Medical Officer; Dr. Laura Evans, Director of Critical Care

• Jacobi SHARE Breast Cancer support program helps survivor, Bronx Times, Jacobi, North Central Bronx
• Oddo tours Sea View campus, talks ‘Health and Wellness’ plan. Staten Island Advance, Sea View: Angelo Mascia, Executive Director