STANLEY BREZENOFF, INTERIM PRESIDENT & CEO
Annual Public Meeting Manhattan
Wednesday, June 7, 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.
Last month, 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 reductions in health care for the most vulnerable, and is opposed by experts spanning the health care industry. 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. Although the House bill’s 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.
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 Mayor de Blasio, 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 staying focused on meeting budget gap-closing targets, and adopting industry standard organizational models to streamline our management structure.
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 join each of you at NYC Health + Hospitals/Harlem, an icon of this community, and a key asset for public health care delivery in New York City. Countless Harlemites have been born here and have chosen to receive their health care here over the last 120 years. That makes it easy to dwell on Harlem’s famous legacy. Not many hospitals can lay claim to having saved the life of a giant like Dr. King. This one can. However, the important thing to consider about Harlem tonight isn’t its historic past, but instead, its future. Exciting things are happening here:
Harlem is among four NYC Medical Centers selected to be part of National Institute of Health‘s (NIH) Precision Medicine Initiative (PMI) a $46 million dollar, five-year, study to extend personalized medicine to a variety of human diseases. We are gratified that Harlem has been included in research that holds out the promise of transforming our delivery of equitable care to the city’s most vulnerable populations. Our collaboration with Columbia University Medical Center (CUMC), Weill Cornell Medicine and New York-Presbyterian underscores the critical role that NYC Health + Hospitals plays in medical education and cutting-edge research to benefit the communities we serve. Congratulations to CEO Ebone Carrington and Harlem’s entire staff, and thank you for hosting tonight’s public meeting.
From the advanced tertiary care practiced at NYC health + Hospitals/ Bellevue, to the wide array of skilled nursing and rehabilitation services offered at our highly rated post-acute care facilities NYC Health + Hospitals/ Carter and NYC Health + Hospitals/ Coler, to excellent maternity and dental services here at Harlem, to new and innovative behavioral health services offered at patient care locations throughout the borough, we are providing safe care, quality care, and the City’s most culturally responsive care to residents in every corner of Manhattan. In the year since our last public meeting, many positive developments have occurred at our Manhattan sites. I’d like to share just a few of them with you in this report:
NYC Health + Hospitals/Bellevue became another of our large hospitals to earn the prestigious “Baby-Friendly” designation for promoting the highest level of care for infants through breast feeding and promoting bonding between mother and baby. The recognition is awarded to hospitals all over the world by Baby-Friendly USA, part of an initiative of the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). Bellevue also recently earned the 2017 Stand Up for Patient Safety Management Award from the National Patient Safety Foundation (NPSF) for a new program that relies on frequent text messaging between patients and nurses, to make it easier for these patients to manage their insulin levels. 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. And Bellevue remains the city’s bulwark against infectious disease. Recently the Federal government doubled —from 12 million to $24 million– a federal grant for the National Ebola Training and Education Center at Bellevue (and two other sites across the U.S.A.). The supplemental funding will allow us to perform additional site visits, conduct more education and training courses, and further develop a special pathogens research network of regional Ebola treatment centers specially trained and equipped to handle patients with highly infectious diseases.
Many positive developments have come out of NYC Health + Hospitals/ Metropolitan over the past 12 months as well. The facility continues to set the standard citywide as a health care provider of choice for the LGBTQ community. The LGBTQ Health Center established at Metropolitan in 2014 provides comprehensive individual and family-based primary care to lesbian, gay, bisexual, transgender, and queer New Yorkers. Over the past year Metropolitan announced newly expanded health services for transgender patients, including gender-affirming surgeries and increased access to hormone therapy. Metropolitan is one of only a few hospitals in New York City, and the only one within the city’s public health system, offering gender-affirming surgeries. We could not be prouder to lead the way in providing equitable health care for all of our patients, regardless of their gender identities.
I’m also pleased to note that earlier this year Metropolitan received the highest grade of any hospital in Manhattan for patient safety from the Leapfrog Group, a national patient safety watchdog organization. Leapfrog’s Hospital Safety Scores assess hospitals nationwide using 30 evidence-based measures of hospital safety.
Our Manhattan facilities have been active participants in the City’s commitment to protect immigrant New Yorkers. Over the past year NYC Health + Hospitals/Gotham Health, Gouverneur hosted an IDNYC enrollment site, and served as the Manhattan patient care location for ActionHealthNYC, a program designed to serve immigrant New Yorkers that currently do not have access to or qualify for health insurance by offering low- or no-cost coordinated health care to income eligible enrollees.
Finally, we are very proud of our post-acute care and rehabilitative services facilities in Manhattan. Earlier this year NYC Health + Hospitals/Coler received the highest five star rating from the federal Center for Medicare and Medicaid Services (CMS). In the component measures that combine to provide the overall score, NYC Coler maintained its perfect five-star rating in the coveted “Quality” category, which scores information on 11 different physical and clinical measures for nursing home residents, including information about nursing homes’ use of antipsychotic medications with both long-stay and short-stay residents. Despite working under the limitations of an aging physical plant, Coler’s staff continue to excel. We are also very proud that Gouverneur received the highest five star ratings nationally among skilled nursing facilities from both CMS and U.S. News and World Report this year.
Finally, NYC Health + Hospitals/Henry J. Carter continues to receive national notice for the success of its ventilator weening program, with success rates that are consistently higher than the state wide average. Carter also received a five star rating from CMS this year.
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 Manhattan, 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.