STANLEY BREZENOFF, INTERIM PRESIDENT & CEO
Annual Public Meeting Broooklyn
Wednesday, May 17, 2017
Welcome and thank you for coming.
I am Stanley Brezenoff, President and CEO of NYC Health and Hospitals. On behalf of myself, our Board of Directors, our executive staff and workforce, thank you for attending this annual public meeting. We are deeply appreciative of the commitment to public health care that you are demonstrating by being here tonight, and we look forward to hearing your comments and concerns about the current and future state of New York City’s essential public health care delivery system.
Last year a lot of important work was done across NYC Health + Hospitals in order for us to continue delivering on our mission of providing quality, affordable, culturally responsive health care to New Yorkers. As the safety net provider for all New Yorkers, our commitment to the patients and communities we serve has never been stronger. Last year we provided care for nearly 1.2 million people, of which more than 425,000 are uninsured. In 2016, our system experienced 4.5 million outpatient visits, and approximately 1.2 million emergency room visits, which is approximately 30 percent of the City’s emergency department visits. There were 195,000 patient discharges, including 18,000 newborn deliveries.
Today our mission of safeguarding the health of our patients, our fellow New Yorkers, and our city remains unchanged, however, the fiscal and policy environment in which we operate has altered dramatically for the worse. As New Yorkers who have taken an active interest in public health, you are probably aware that NYC Health + Hospitals continues to confront a financial crisis. We are grappling with a large budget gap brought on by higher costs to run our system, and reimbursement policy changes at the federal and state levels that have yielded severe shortfalls associated with our being the city’s single largest provider of care to Medicaid and uninsured patients.
We have moved decisively to address this deficit, and I am pleased to inform you that as a result of aggressive action on both the spending and expense side of our operations, we are on track to meet our FY 2017 shortfall of $779 million. Nevertheless, the financial pressure continues to grow. Huge reductions to Disproportionate Share funding — our primary source of federal compensation for serving as the city’s safety net provider– are scheduled to take effect in October of this year, unless Congress takes action to delay them. This challenge, and others, existed before President Trump took office. But the budget and policy uncertainty now emanating from Washington only intensifies the financial stress that NYC Health + Hospitals is under.
Two weeks ago, safety net systems like ours suffered a potentially catastrophic blow when the U.S. House of Representatives passed a Republican-backed plan to repeal and replace the Affordable Care Act (ACA). The rationale behind this callous piece of legislation has everything to do with political expediency, and nothing to do with making Americans healthier. It would pay for tax cuts for the most fortunate by precipitating enormous cuts in health care for the most vulnerable, and is opposed by experts spanning the health care industry. Although approval by the U.S. Senate and enactment into law is far from certain, we know that federal budgetary, regulatory, and legislative assaults will continue to threaten the ACA. As a result of the House’s action, hundreds of thousands of New Yorkers are a step closer to being stripped of their health insurance coverage. Repealing the Affordable Care Act would cut billions from the Medicaid program resulting in huge setbacks to work that we are doing to make New Yorkers healthier. And the financial cost to NYC Health + Hospitals would be in the tens of millions at a time when we can least afford to absorb such a blow and continue to carry out our essential mission. If the Affordable Care Act is fully repealed, New York State estimates that 2.6 million New Yorkers would lose health insurance coverage, including up to 1.6 million residents of New York City. Based on this estimate, more than 200,000 Health + Hospitals patients would be at risk of losing coverage.
Moving forward, we are prepared to fight for the health care values that New Yorkers believe in, and we will continue to work aggressively and in partnership with the Mayor’s Office, members of our Congressional, Legislative and Council delegations, our colleagues in hospitals nationwide, our union partners, community-based organizations, health care advocates and national hospital associations, to attempt to blunt any federal actions designed to undermine safety net care.
All across the country, health care organizations ─ especially safety net systems like ours ─ must respond to significant changes in governmental support, rules and regulations, and consumer expectations. When we talk about the “Transformation” of NYC Health + Hospitals, we mean the urgent need to reinvent public health care delivery in response to those structural changes to the national and local health care landscape. Accomplishing this, especially in the midst of financial crisis, is a massive undertaking. However, as Albert Einstein once said, “In the middle of difficulty lies opportunity.” The necessity that we transform in order to assure long term financial sustainability, offers the chance for us to become a more competitive, more community-based, higher-performing system. We have embarked on a long-term plan to make strategic changes – while we keep focused on meeting our budget gap-closing targets, running a more efficient operation, and providing safe and quality care to the thousands of New Yorkers who rely on our services every single day.
Our Transformation work is driven by the overarching goal to improve care delivery to keep New Yorkers healthy and not just treat them when they are sick. Our ongoing work is guided by principles outlined in the One New York, Health Care for Our Neighborhoods report released by Mayor de Blasio, as well as insights and recommendations made by recognized health care experts and members of the communities we serve.
Frankly, this will mean redirecting scarce resources from an inpatient service line with declining utilization, and focusing those resources instead on building an even more robust primary care network. Though plans are not yet definitive, the ongoing Transformation process reflects our recognition that this is what’s in the best interests of the people we serve: to do a better job in primary care, in prevention, in wellness.
We have been on a journey, alongside the rest of the country, to build an integrated health care delivery system that is responsive to changing demands in the market, and well-positioned to be competitive in the future. The Transformation work engages Health + Hospitals employees at every level — our labor partners, city government agency leaders, elected officials and the broader community – to reinvent our system in a way that expands access, improves quality, and meets the challenges of the 21st century health care landscape.
And while we undergo this transformation, we will reinforce our historic pursuit of clinical excellence as well as New York City’s fundamental commitment to health care as a human right. To that end, we have taken a number of actions over the past several months to reaffirm our commitment to the health care of immigrants, without regard to their legal status.
Late last year, Immigrant Affairs Commissioner Nisha Agarwal and I joined together to issue a reassuring message to New Yorkers who may not be accessing health care services for fear of having their immigration status disclosed. Our open letter to immigrant New Yorkers was issued in 14 languages in order to assure the community that we remain absolutely committed to our mission to serve all New Yorkers, regardless of immigration status. We underscored our dedication to protecting our patients’ right to privacy, and keeping their immigration status completely confidential at a series of forums across the city designed to reassure immigrant communities that they can seek care from us without fear. These forums offered information and resources, and addressed a variety of important health care topics affecting immigrants, such as health care rights, access to care, and privacy concerns regarding immigration status. Our bottom line is this: the primary concern of this system will remain our patient’s health, not their immigration status.
We also held a series of community engagement meetings around the city to help educate interested New Yorkers about changes to the city’s health care landscape, and to learn from them about their own community’s health needs and priorities. These meetings were an outgrowth of the One New York, Health Care for Our Neighborhoods report, and its commitment to vigorous, ongoing, stakeholder engagement around the transformation of public health care in New York City. We were pleased to partner with the New York Immigration Coalition and Community Resource Exchange in holding these events, and ultimately in producing a report titled NYC Health + Hospitals Community Conversations available on our website.
We have also partnered with Mayor de Blasio, the NYC Human Resources Administration, the NYC Department of Health and Mental Hygiene and our own health plan, MetroPlus to launch an ambitious campaign called GetCoveredNYC, which is focused on enrolling more New Yorkers in health insurance and providing them with access to primary and preventive care at NYC Health + Hospitals facilities. The Affordable Care Act has resulted in more Americans and more New Yorkers having health insurance than ever before. The more people we continue to enroll under current federal law, the harder it will become to roll back progress made since the ACA’s implementation. That is why, late last year, the City hosted five enrollment events focused on engaging applicants–especially younger New Yorkers–and assisting them in applying for coverage. From January through March of this year, GetCoveredNYC enrolled 30,000 New Yorkers in health insurance, bringing the initiative closer to the Mayor’s goal of enrolling 50,000 New Yorkers in 2017 who are eligible for health insurance but are not taking advantage of existing enrollment options.
Another example of our commitment to making health care more accessible to all, is our partnership with the Mayor’s Office and the City University of New York, to raise awareness of IDNYC a government-issued identification card that is now available to all City residents age 14 and older, without regard to immigration status. To date IDNYC has over 1,030,000 cardholders. It is the largest municipal identification card program in the nation. It enables residents to access health care at any NYC Health + Hospitals facility, can be presented as proof of identification for interacting with the police, and is also an accepted form of ID for opening a banking account at certain financial institutions.
Tonight we are pleased to welcome each of you to NYC Health + Hospitals/Coney Island. Under the new leadership of Chief Executive Officer Anthony Rajkumar, Chief Operating Officer Mei Kong, Interim Chief Medical Officer Doctor Edward Fishkin, Chief Nursing Officer Patricia Ruiz, and with the hard work of dedicated clinicians and staff, and tremendous support from the community, a revitalized Coney Island is once more becoming the provider of choice for residents of South Brooklyn and Staten Island.
At the end of February, NYC Health+ Hospitals executed a nearly flawless implementation of our new Electronic Medical Record (EMR) system here at Coney Island. It seamlessly connects the hospital’s emergency room, primary and specialty outpatient services, and community based clinics. This state-of-the-art EMR offers sophisticated decision-support tools to Coney island’s 2,000 providers, helping to prevent medication errors, avoid duplicative and unnecessary tests, and keep patients’ preventive health screenings on schedule. It also features “MyChart”, an online portal that puts patients’ medical history at their fingertips, and allows them to manage their health online by using a smartphone, tablet, or laptop to view medical test results, request prescription refills, send messages to the care team, and access appointment information.
NYC Health + Hospitals is undergoing one of the largest EMR implementations in the country–one that will ultimately unify 40,000 users in more than 70 patient care sites. Since we began the first phase of the new EMR implementation 10 months ago, it has also been fully adopted at NYC Health + Hospitals/Queens, NYC Health + Hospitals/Elmhurst, the health system’s home care operations, and 20 community-based health centers in Queens.
Here at Coney Island we believe the EMR is already driving a culture of clinical improvement and innovation, and helping us to provide 21st century care to the patients and communities who rely on us here. I’d like to congratulate CEO Anthony Rajkumar and the entire staff at Coney Island for this very complex and successful implementation which represents a crucial step in our transformation to better meet the health needs of the communities we serve system wide.
Our system has a large footprint here in Brooklyn. Last year we served 346,000 patients, nearly 88,000 of whom were uninsured. Our locations include Coney Island, NYC Health + Hospitals/Woodhull, and NYC Health + Hospitals/ Kings County hospitals, our major facilities at NYC Health + Hospitals/ Gotham Health, Cumberland; and NYC Health + Hospitals/ Gotham Health, East New York, NYC Health + Hospitals/McKinney, our highly rated post-acute care facility providing quality short-term rehabilitation and long-term skilled nursing services, and, our 16 other community-based patient care sites across the borough.
One of our proudest moments last year came when we marked the successful transformation of Kings County hospital’s behavioral health services into a high-quality, patient-centered psychiatric program. In January, the Federal District Court agreed to end oversight of the hospital’s behavioral health program by the U.S. Department of Justice (DOJ), which reported that performance has exceeded expectations, and in fact Kings County was now considered a “model” psychiatric program meeting high standards of quality care and treatment for the 11,000 patients it serves annually. This validation marks an important milestone for the hospital. The accolades from DOJ are a testament to the complete cultural transformation that has occurred within Kings County’s psychiatric unit. We congratulate the health care professionals who have worked so hard to achieve this transformation and thank them for their ingenuity and dedication to excellent patient outcomes.
There’s a lot of positive activity happening within our system in Brooklyn, but I wanted to call your attention briefly to a few other instances of innovation:
Recently, our allied health insurance plan, MetroPlus, has opened new customer resource centers – Including one in Sunset Park. These centers are staffed with on-site healthcare specialists able to answer insurance questions in English, Spanish, Chinese, and other languages. The specialists are there to offer community members with enrollment assistance in Child Health Plus, Medicaid, Qualified Health, and Essential Plans.
NYC Health + Hospitals/Woodhull is distinguishing itself by advancing ThriveNYC’s citywide agenda to address issues surrounding behavioral health in general, and maternal depression in particular. Tomorrow, we are delighted that First Lady of the City of New York Chirlane McCray is scheduled to pay a visit to Woodhull to meet with members of its pre and post-natal depression support group. The group was started Woodhull psychiatric nurse practitioner and midwife Rebecca Feldman, and was recently awarded an NYC Health + Hospitals “FIG” grant for innovative programming with potential for scaling across the system.
Strengthened primary care here in Brooklyn, and throughout the city is one of the core strategies of our transformation agenda, and reflects NYC Health + Hospitals’ fundamental commitment to building healthier communities by continuing the process of moving, from the old model of sick care, to a more modern system that emphasizes prevention, care-coordination and wellness. A model that strengthens the primary care networks that are so essential to eliminating the health disparities that burden neighborhoods across New York City.
We understand that more integrated, more community-based care, delivered in partnership with local providers, community-based organizations and advocacy groups, is central to building healthier communities. And we are doing something about it, by enthusiastically participating in the state’s Delivery System Reform Incentive Program (DSRIP), through which our OneCity Health performing provider system has secured the opportunity for $1.2 billion in funding to support care at the community level. This work is aligned with recommendations made in the Blue Ribbon Commission on Health Care for our Neighborhoods issue brief on building clinical partnerships. A major thrust of our DSRIP work involves integrating behavioral health services in our primary care settings throughout the city. As the provider of the majority of inpatient psychiatric treatment in New York City, NYC Health + Hospitals understands the critical need for greater access to mental health care in New York City. We continue to lead and expand efforts to provide much-needed behavioral health services for New Yorkers at every stage of life, at our many patient care locations. We have integrated universal depression screenings for adults in primary care practices across the city, and we are spearheading a citywide effort to screen all pregnant women and new mothers for maternal depression. We are at the forefront of developing innovative approaches to the treatment of the behavioral health and substance use disorder issues that many New Yorkers struggle with each day. And, we are proud to partner with Mayor de Blasio’s HealingNYC initiative to combat the opioid epidemic hitting communities in Brooklyn, and across the city. Our participation in DSRIP will allow us to more efficiently build a broader health care network that meets all patient needs, including highly specialized services —and provides continuity of care, efficiency, and a more seamless patient experience.
This report is meant to offer an abridged overview of positive developments occurring within the public health care delivery system at all our patient care locations as well as an acknowledgment of the difficulties we face. But what tonight is really about is hearing from you. These meetings are mandated in our state charter as a public benefit corporation specifically because your input is so important to the future success of this system. We really aren’t here to talk tonight, we are here to listen. So let’s get started with our first speaker.