STANLEY BREZENOFF, INTERIM PRESIDENT & CEO
Annual Public Meeting Queens
Wednesday, June 14, 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/Elmhurst, an asset to the public health and hospital system, and an important focal point of this community. Elmhurst is a major acute care provider comprised of 545 beds, a Level 1 Trauma Center, an Emergency Heart Care Station and a 911-Receiving Hospital. It is a premiere health care facility for key areas such as Surgery, Cardiology, Women’s Health, Pediatrics, Rehabilitation Medicine, and Renal and Mental Health Services. The reputations of Elmhurst and NYC Health + Hospitals/Queens for excellence are drawing patients in today’s difficult health care marketplace, positioning each to compete—and shine—in the future.
We are proud of both hospitals for spearheading our system-wide investment in health care Information technology. A year ago Elmhurst and Queens became the first of our facilities to implement Epic, a new state-of-the-art Electronic Medical Record system (EMR). Our patients deserve 21st century medicine, and the new EMR is helping us provide it, by increasing our ability to offer seamless care and better patient experience in every one of our care settings in Queens.
Strong community support is tremendously important for both Elmhurst and Queens. That support was exemplified last year by $100,000 in state funding arranged by State Senator Toby Ann Stavisky for the purchase of two new shuttle vans to transport patients moving between our hospitals. We are very appreciative of the support of elected officials like Senator Stavisky and others, especially in these challenging times.
A lot of other positive activity is occurring within the public hospital system in the borough, and I’d like to mention just a few highlights:
NYC Health + Hospitals provides the lion’s share of in-patient psychiatric care in New York City. And we have redoubled our commitment to offering best practices and innovative approaches and programming for our behavioral health patients. We were particularly proud last year when Elmhurst’s Methadone Treatment Program achieved the Gold Seal of Approval for Behavioral Health Care Accreditation from The Joint Commission (TJC), the nation’s leading hospital accreditation authority. Our clinicians and mental health professionals here in Queens are deeply committed to helping our patients’ live healthier and safer lives, free from the grip of opioid addiction. Many of these patients’ receive vocational counseling and services, such as evaluation of work skills and capacities, identification of vocational goals and needs, and referrals to schools and training programs. To address the unique needs of the ethnically and linguistically diverse communities served by the hospital, Elmhurst’s staff are fluent in multiple languages, including English, Spanish, Chinese, Greek, and Hindi. Congratulations to CEO Israel Rocha, and the entire staff at Elmhurst, and thanks to each of you for hosting this evening’s meeting.
Earlier this year we were also very pleased that The Joint Commission accredited NYC Health + Hospitals/Queens for the next three years. TJC surveyors reviewed scores of inpatient and outpatient processes and procedures at the main campus and at the off-site clinics, placing a great deal of focus on top challenging issues identified nationwide, including infection control and environment of care. Congratulations to CEO Christopher Roker, CEO, the clinicians and support staff at Queens.
Queens is out front in demonstrating our system’s commitment not just to clinical quality, but to social activism as well, having hosted just last month an IDNYC pop up site.
Another positive development I’d like to mention is our system’s partnership with Northwell Health on a $47.7 million shared, state-of-the-art laboratory here in Queens, designed to enhance quality and patient service while reducing costs for both health systems and their hospitals. The new lab will primarily perform microbiology tests, including molecular diagnostics from local hospitals, clinics and physicians’ offices. It will incorporate the latest technology and advanced robotic testing systems. Our health system currently operates four core labs and seven rapid response labs, which together perform about 15 million lab tests each year. Under the partnership, our health system will consolidate our four core lab operations into the new cooperative lab in Queens, which will eventually process about half of our lab tests. Northwell Health will make the upfront investment to build the facility, with the goal of consolidating and streamlining the operations of the two health systems. Joint savings are expected to be more than $30 million annually. Once completed the centralized Queens lab will be the largest, nonprofit, hospital-operated lab network in the nation, processing over 50 million tests annually.
Finally, I’d like to mention the ongoing commitment of MetroPlus, our system’s health insurance plan, to the people of Queens. We have been opening new health insurance resource centers for New Yorkers to get answers to health insurance program questions and receive assistance to enroll in plans such as Child Health Plus, Medicaid, Qualified Health Plans and the Essential Plan. In Queens, the Flushing Skyview Mall will feature a MetroPlus kiosk to help people find out if they are eligible for no-cost or low-cost health insurance. MetroPlus Health Plan co-hosted a series of seminars as part of Asian/Pacific American Heritage Month in May, in order to raise awareness among small business owners in Flushing, Queens, and surrounding areas, of low cost health plans available through the State’s health plan marketplace for businesses with 100 or fewer employees. MetroPlus representatives fluent in Mandarin, Cantonese, and Fujianese provided information about federal tax credits of as much as 50% of employer’s contribution available to qualifying businesses with 25 or fewer employees.
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 Queens, 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. As with our I.T. initiatives, our DSRIP projects will provide more 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.