REPORT TO THE BOARD OF DIRECTORS – November 2018

City Update

New York City Health + Hospitals Senior Vice President Patricia Yang testified before the City Council this month to provide an update on Correctional Health Services (CHS) at Health + Hospitals. She highlighted our work to increase access to high quality medical services for people while they are in the City’s custody and as they rejoin their communities. Since NYC Health + Hospitals became the direct correctional health care provider in 2016, our team embarked on a five-year, City-funded plan to establish new programs and expand key services, such as creating the Geriatric and Complex Care Services, the first and only jail-based program of its type in the country, and expanding to a total of six specialized housing units for patients with serious mental illness, among other programs.

Matilde Roman, the system’s Chief Diversity and Inclusion Officer, also testified before the Council to share an update on services provided to Health + Hospitals’ transgender and gender nonconforming (TGNC) patients. She noted that there’s “no wrong door” for TGNC patients to access health care in our system. She also highlighted the Pride Centers in our system, where we offer specialized and comprehensive primary care services for LGBTQ New Yorkers – which include general preventive care and mental health services, as well as gender affirming care and surgery, hormone therapy, or referrals to specialists.

State Update

As a result of the November 6 elections, we will have new representation at a number of our facilities come January. We look forward to working with the new members of the State Legislature and the new Senate Majority to advance the important role that NYC Health + Hospitals plays in their communities.

Earlier this month, the State Department of Health convened its final meeting of the Temporary Workgroup on indigent care funding of which I am a member. Our health system and a community coalition presented a proposal that would direct indigent care funding to NYC Health + Hospitals and other safety net hospitals and at-risk hospitals across the state. We presented a balanced proposal which would provide a Medicaid rate increase to hospitals that actually treat more uninsured and Medicaid patients. In addition, concerns were raised about the risk of adverse federal policies, such as federal Disproportionate Share Hospital (DSH) cuts and Public Charge, which would have an impact on the State and our public health system specifically. A final report including policy recommendations will be presented to the Governor and the Legislature in December.

NYC Health + Hospitals this month marked the opening of the public health system’s first ExpressCare Clinic in the Bronx at NYC Health + Hospitals/Lincoln. The new clinic will provide faster access to medical care for patients who face non-life-threatening conditions like colds, flu, sprains, skin rashes, minor cuts and lacerations, and certain types of infections. The urgent care clinic will be open at the busiest hours seven days a week and will ease overcrowding in the hospital’s emergency room. The clinic will also differ from stand-alone urgent care centers by offering a better connection to primary care providers. The emergency-trained physicians at the ExpressCare clinic will help ensure patients receive the appropriate follow-up care by connecting them with primary care doctors in the Health + Hospitals system. OneCity Health worked with our staff teams to design this clinic model and implement the plan to open the new walk-in urgent care service both at Lincoln and at NYC Health + Hospitals/Elmhurst. The ExpressCare model supports the overall mission of DSRIP to reduce avoidable ED utilization by 25% by 2020.

NYC Health + Hospitals expanded access to buprenorphine, a prescription drug to manage opioid addiction, through adult medicine clinics in 18 community and hospital-based ambulatory care centers. The 18 clinics are located across the five boroughs and will integrate the clinical management of buprenorphine into primary care, making availability easier and treatment more holistic. The new access to buprenorphine adds to existing availability through the public health system’s emergency departments, inpatient care, and specialty outpatient clinics and reflects its ongoing transformational efforts to expand community-based care.

Opioid treatment at each clinic is led by a clinician who has undergone special training and licensing to authorize the prescription of buprenorphine. While other medication-assisted treatments are also available, buprenorphine is an important option for patients because it eliminates the need for a daily clinic visit, which is required of most patients receiving methadone. Additional benefits of buprenorphine are its low potential for abuse and negligible risk for overdose.

Our health system sees approximately 20,000 unique patients with opioid use disorder every year, many of whom aren’t ready to enter into a substance treatment program. Empowering primary care providers to play a greater role in connecting patients to care for opioid addiction is a useful strategy since these are the clinicians most likely to have ongoing relationships with these patients. Personally, I completed the x-waiver training so I can best help my patients.

Two NYC Health + Hospitals skilled nursing facilities received the highest rating from U.S. News & World Report and are included in its list of Best Nursing Home Short-Stay Rehabilitation Centers. Congratulations to our teams at NYC Health + Hospitals/Sea View in Staten Island and NYC Health + Hospitals/Gouverneur in Lower Manhattan for receiving the highest ranking among the nearly 16,000 nursing homes U.S. News evaluated across the country for short-stay care. Less than 20 percent of skilled nursing facilities receive this distinction. Our top ranked skilled nursing facilities offer comprehensive, high-quality care and provide services to help New Yorkers needing short-term rehabilitation, home care, ventilator weaning, Adult Day Health Care, long-term acute care hospitalization, traumatic brain injury, and specialty services for other clinically complex conditions. Our teams work to restore health to residents and enable them to return to the community to live their healthiest lives.

This month we marked the launch of new, advanced electronic medical record system at NYC Health + Hospitals/Woodhull and 10 community health centers and neighborhood clinics in Brooklyn. This was the first implementation of the system that integrates both clinical and revenue cycle modules of the customized Epic medical record system, which has been dubbed “H2O,” a creative abbreviation of “Health + Hospitals Online,” following a competitive in-house naming competition. We also retrofitted the already installed electronic medical record systems at three other hospitals—NYC Health + Hospitals/Coney Island, /Elmhurst, and /Queens—and another 15 health centers and neighborhood clinics in Queens and Brooklyn with the new revenue cycle module./

Combined, the four hospitals and 25 community-based ambulatory care sites have approximately 14,000 active users now working with the newly enhanced electronic medical record/revenue cycle system. The new system also makes available the MyChart electronic portal which makes personal health information available to our patients and empowers them to become more actively engage in their health care.

I am so proud of our amazing IT team for pulling this off, and I am equally grateful to all of our clinicians who contributed their time to build a system that would improve our health care delivery and to all of our staff who sat through hours of training so that they can successfully use the new system.

As part of our focus on transforming our ambulatory care operation, this month we announced plans to build three new community-based health care centers that will provide comprehensive, one-stop ambulatory care services for more than 50,000 children and adults. The future sites also reflect our commitment to expand access to primary care in underserved and high-need neighborhoods. I am grateful to the board for approving the three lease agreements that will clear the way for construction of full-service ambulatory care centers in Bushwick, Brooklyn; Jackson Heights, Queens; and Tremont, Bronx. The new health centers will occupy more than 100,000 square feet combined and will cost approximately $82 million to build. They are expected to open by 2021. We’re excited to design and build new health care facilities from the ground up and in convenient locations that will make it easy for families to access the health care they need without having to leave their neighborhoods.

We were pleased to honor six nurse professionals from across the public health care system at our annual Nursing Excellence Awards celebration this month. The awardees are nurse trailblazers who have demonstrated leadership in various capacities. While our nurses work in various specialties and provide care in a wide range of settings, they share a common characteristic: a deep commitment to the New Yorkers who seek our care. Our nurses are at the heart of our mission to care for every New Yorker without exception. They are also at the frontlines of health, delivering the patient-centered, collaborative, community-based care that will help us succeed in the future. I cannot thank them enough for the work they do. You can visit our website to learn more about their leadership and contributions. We also recognized the Hunter-Bellevue School of Nursing – they received the health system’s “Nursing Champion” award for demonstrating support for nurses and the nursing profession.

NYC Health + Hospitals was awarded a $209,000 grant from the Commonwealth Fund to more effectively deliver complex care to high-need patients and to tap the public health system’s expertise and experience in creating and disseminating guidelines for best practices on managing high-risk populations for other safety-net systems. The grant will fund the sharing of best practices within Health + Hospitals and support development of a new guiding document “Complex Care Implementation Guide for Safety-Net Health Systems”—a playbook to help others develop their own programs to improve care coordination for high-need patients. This generous grant will enable us to take what we learn and package it to benefit all safety-net health systems. We expect that this will result in better health outcomes and more coordinated, less fragmented, seamless care for all patients across the board. We are grateful to the Commonwealth Fund for supporting this important work.

We are seeking future physician leaders to apply to the new NYC Health + Hospitals Clinical Leadership Fellowship Program—a one-year opportunity designed for post-residency graduates interested in administrative roles in the nation’s largest public hospital system. During the inaugural program year, fellows will be placed in our Office of Quality and Safety, Population Health, or Ambulatory Care. Successful applicants will receive direct mentorship from leaders within these areas. In addition to their administrative responsibilities, fellows will also provide clinical care outside the scope of their fellowship project and participate in other learning activities, ensuring they can help us provide care to some of the City’s most vulnerable patients.

NYC Health + Hospitals/Metropolitan received an ‘A’ grade for patient safety from The Leapfrog Group, a national patient safety watchdog. Issued twice a year, Leapfrog’s Hospital Safety Grades are assigned to hospitals across the country based on performance in preventing medical errors, infections, and other harms among patients in their care. NYC Health + Hospitals/Metropolitan was awarded an ‘A’ for its efforts in protecting patients from harm and meeting the highest safety standards in the U.S.

NYC Health + Hospitals/North Central Bronx celebrated the opening of two newly designated ambulance bays that are directly adjacent to the emergency room and were created to ensure dedicated parking spaces for ambulances dispatched to NYC Health + Hospitals/North Central Bronx and to expanding access to the hospital’s emergency services. The two new bays doubles ambulance capacity. These spaces were designated specifically to provide FDNY and other ambulance providers increased access to our emergency room. As the FDNY Fire Commissioner said: Every second matters when transporting a patient to the emergency room, and these spaces will provide greater and quicker access to the FDNY as they care for the most critical patients.

The Commission on Cancer, a quality program of the American College of Surgeons, granted three-year accreditation with commendation to the cancer program at NYC Health + Hospitals/Jacobi. To earn voluntary Commission on Cancer accreditation, a cancer program must meet or exceed its quality care standards, be evaluated every three years through a survey process, and maintain levels of excellence in the delivery of comprehensive patient-centered care. Three-year accreditation with silver-level commendation is awarded only to a facility that exceeds standard requirements at the time of its triennial survey.