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REPORT TO THE BOARD OF DIRECTORS – October 2020

REPORT TO THE BOARD OF DIRECTORS – October 2020

Mitchell H. Katz, MD
NYC HEALTH + HOSPITALS
PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
October 29, 2020

CORONAVIRUS UPDATE

Preparing for Possible Second Surge

The NYC Health + Hospitals COVID-19 intelligence team is closely monitoring data across the city and the system looking for signals of potential surges to ensure we can be prepared to respond. We are testing our COVID-19 response plans with citywide exercises, adopting all the best-practices and all the lessons learned, and are well prepared today to take up to 500 COVID-19 cases within our existing staffing, space, and resources. We have created surge plans for up to 2,800 COVID-19 cases within our system utilizing flex space, NYC Health + Hospitals/Roosevelt Island Medical Center, new ICU units at NYC Health + Hospitals/North Central Bronx, cross training of staff, and additional staffing. For reference, our peak number of COVID-19 patients back in March/April was 2,700. Other surge preparations include improved patient level-loading process, improved home monitoring with pulse oximeters, stockpiling PPE and critical equipment, and additional communication and training strategies.

Emergency Declaration

I have signed an emergency declaration extension effective through the end of November which permits the health system to use our emergency contractors and to use emergency authority for contracting if the emergency condition requires it. In this extension of the declaration, we added new process requirements for emergency contracts designed to ensure that even when full procurement procedures cannot be used that there is robust due diligence conducted with respect to pricing and the selection of vendors for emergency needs.

Vaccine Distribution Plans

Mayor de Blasio announced an initial COVID-19 vaccine distribution framework, to be coordinated with the State, to guarantee maximum distribution of a safe, effective, and free vaccine, with an emphasis on communities hardest hit by the pandemic. COVID-19 vaccines may be available in early 2021 through the CDC or the City Health Department. Phase one will focus on health care personnel, frontline workers, and other vulnerable groups. Phase two of the distribution, which could occur as early as 2021, will see more widespread availability for the general public. Our highest priority for initial internal distribution will be Health Care Workers who work in high risk areas or have personal elevated risk, such as age or medical co-morbidities. Both the health system and the facilities will sign the Federal Provider Agreements and will register in the NYC Citywide Immunization Registry (CIR). Our facility pharmacies will receive vaccines directly.

COVID-19 Free Post- Acute Care Facilities

I am very pleased to announce that our Post-Acute Skilled Nursing Facilities, caring for over 1,500 residents each day, are now COVID-free. These have been challenging times for our residents, families and staff, however our system infection control/prevention procedures and program enhancements have successfully limited exposure. All Post-Acute sites continue to test all residents, staff and vendors on a weekly basis, they have designated units to cohort and monitor newly admitted residents and are continuously evaluating their processes to ensure high-quality care and service. In addition, following the Governor’s Executive Order, the 5 SNFs are now allowing in-person visitation and reuniting the residents with their families. Throughout the height of the pandemic, the Post-Acute Service line has remained devoted to the health and safety of our vulnerable, resident population and a few sites have been recently recognized by Newsweek and the US News and World Report as “High-Performing” and “Best Nursing Homes” including NYC Health + Hospitals/Gouverneur, Seaview, Coler and Carter

NYC TEST & TRACE UPDATE

The Test & Trace Corps team has recently opened 32 new testing sites in 3 NYC clusters, with 18 specifically in the red zones, and we’ve been able to do more than 25,000 tests in these clusters. They have also handed out millions of masks, thanks to the great support and coordination with community leaders and community-based organizations. Through all of this effort, we have been able to drive down the percent of people testing positive in the clusters, and last week the Governor announced that the red and orange zones in Queens had shown enough improvement to be updated to lower risk yellow zones.

As the City continues to fight back the COVID-19 clusters in Brooklyn and Queens, and despite having substantial new demands on the contact tracing system with the clusters, the NYC Test & Trace Corps is recording its strongest performance since the start of the program, and surpassing initial benchmark goals in two key critical areas: 91% of positive cases are now being reached citywide, with 78% of those cases completing full intake interviews, and 96% of cases are in quarantine compliance, meaning they are isolating at home or at a hotel with the City monitoring them. Nearly 10,000 confirmed symptomatic contacts have been reached through confirmed cases, which has prevented potentially 25,000 new cases.

CITY/STATE/FEDERAL UPDATE

City

I’m pleased to welcome Melanie Hartzog as the new Deputy Mayor of Health and Human Services. We have worked closely with DM Hartzog for years, when she was the OMB Director and in her ascending roles before that. Ms. Hartzog has a great understanding of our health system priorities and our financial position, and we are looking forward to working with her. As Deputy Mayor, Ms. Hartzog will be joining the NYC Health + Hospitals Board of Directors, so you’ll get a chance to know her and her team.

State

NYC Health + Hospitals continues to anticipate and advocate against potential State budget cuts. Though these were preliminarily announced months ago, there has been no activity, presumably as we wait for Election Day. In the meantime, we have continued to enlist our partners in the legislature and community to push back against cuts. We also continue to work with the State for implementation of a number of strategies to strengthen our financial position. Leading up to Election Day, reminder that all 213 seats of the NYS Legislature are up for re-election. Based on primary results, there will be some new Assembly and Senate representation at some of our facilities, and we look forward to forging relationships with these new leaders.

Federal

The Federal Department of Health and Human Services has extended the public health emergency declaration through January 20, 2021. The long-delayed Medicaid DSH cuts are again extended through December 11, and we continue to advocate for a longer delay and ideally elimination of these cuts. We also are working with our legislative partners for additional Federal funding and flexibility in the funds we have been lucky to receive. We are grateful to the New York delegation, particularly our Senators and the House members representing our facilities for their tireless work on our behalf.

FINANCE UPDATE

NYC Health + Hospitals closed FY20 with $688M cash-on-hand, which surpassed our revised target of $600M. We also achieved a positive net budget variance in FY20, exceeding the budget by 2%. The health system closed September 2020 with nearly $650M cash-on-hand, and estimates closing October 2020 with approximately $400M cash-on-hand. We are working with the State to advance certain supplemental Medicaid payments in order to maintain a stable cash balance in the event of a second COVID surge.

The health system continues to see increased Medicaid Managed Care enrollment in MetroPlus and Healthfirst. This should yield a financial benefit to the system as these members will be enrolled in Value Based Payments arrangements. We are monitoring our finalized FY21 three-phased budget against our targets and continue to closely track our systemwide initiatives and facility specific business plans.

Federal Relief

Related to the CARES Act, HHS announced an additional $20B General Distribution of the Provider Relief Fund. We are finalizing our submission to receive funds from this pool and hope our distribution will be received by the end of November. To-date, NYC Health + Hospitals has received nearly $1.2B related to the CARES Act. The system’s FEMA cost estimate remains at an estimated $1.6B based on the increased scope we undertook. We are continuing to expedite submissions to the State and Federal government to receive reimbursement against these costs. To date, we have received $199M in FEMA funds.

CYBER SECURITY AND RANSOMEWARE PREVENTION

NYC Health + Hospitals has a layered defense approach to prevent cybersecurity attacks such as ransomware. The NYC Health + Hospitals Information Security & Risk Management team continuously monitors for cybersecurity threats that can potentially affect the hospital network. Utilizing the layered defense approach and the NIST Cybersecurity Framework, we identify, protect, detect, respond to and recover from a cybersecurity incident. This is an ongoing cyclical process as part of our daily security strategy and foundation driving the processes and technology utilized in our health system.

Threat identification follows a parallel process. It includes an operational risk management plan that identifies risks in the environment with an adequate timeline to remediate those risks. Security awareness and training of our workforce members is also a part of our security identification workflow. Additionally, we conduct security reviews of new applications before they are adopted to identify and minimize the risks. We conduct frequent scans of our network for vulnerabilities and have several automated enterprise solutions in place which detect any anomalies in digital traffic, including firewalls and email filtering and intrusion prevention systems throughout the network to prevent malware from entering and spreading within our hospital network. We also have several endpoint security solutions to detect, respond to and recover from an event as quickly as possible. And finally, as part of the cyclical process, we look at the latest cybersecurity trends and technology to conduct internal reviews of current security measures and recommend enhancements where needed to maintain or improve our risk posture and update our risk management plan.

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