Annual Public Meeting – Queens
Tuesday, May 7, 2019
NYC Health + Hospitals/Elmhurst
Report by Dr. Mitchell Katz, President and CEO
Welcome and thank you for coming.
I am Mitch Katz, President and CEO of the New York City Health + Hospitals and I’m glad to be here with you tonight.
On behalf of our Board of Directors, and our dedicated 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.
This is my second round of annual public meetings and I am delighted to report that it has been an amazing year at Health + Hospitals and we’ve made a lot of progress in meeting my three top priorities: to invigorate and expand primary care, improve access to needed specialty care, and bring fiscal solvency to NYC Health + Hospitals.
By focusing on all three, we are on the path to better address community health needs, improve the patient experience and maximize opportunities for new revenue. With the help of our Board, those of you here today, the Mayor, our organized labor partners, and the incredibly dedicated staff of NYC Health + Hospitals, we have achieved so much in one short year.
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 more than 1 million New Yorkers, of which some 380,000 were uninsured. In FY2018, we provided approximately 5.1 million outpatient visits, which includes nearly 1 million emergency room visits. There were approximately 185,000 patient discharges, including approximately 16,700 newborn deliveries.
We have made great progress executing on the Mayor’s transformation plan and meeting our financial targets to achieve $757 million in revenue-generating initiatives and $430 million in expense-reducing initiatives. Through Q2 of FY 2019, patient care revenue is up $80 million versus this time last year, driven by improved billing and better performance in our value based managed care contracts and we are just $10 million (or .5%) below the ambitious target we set for this year’s budget.
We have seen a 3.8% decline in inpatient utilization, much of that decline comes in our value-based contracts. That means that, as we do a better job keeping patients healthy, they will require fewer hospital visits, and we capture incentives and additional revenue from health plans. We have many important revenue initiatives just getting off the ground and we expect our EPIC electronic health record and financial system – which is coming on-line across all our hospitals this year – to significantly improve our revenue going forward.
On the expense side, we are less than $25 million (or 1%) over our budget due to important investments we have made to improve patient care and to generate revenue in the years ahead. We hired over 340 net new nurses to make sure we deliver the safest and highest quality care possible. We also invested in new staff to improve our ability to bill and collect money from insurance companies. We have offset our investments in new clinical- and revenue- generating staff by reducing the number of temporary workers in our system, eliminating consultants, and making some managerial-level staff reductions. I have made clear to our senior leadership and administrative staff across the system that our number one priority is to invest in patient care and our front-line staff.
A year ago, at my first annual public meeting, I spoke about the concerns around ongoing deficits and how Health + Hospitals would respond to the challenges we face. A year later, despite risks posed by the Trump Administration, Health + Hospitals maintains a balanced five-year financial plan and is well positioned for stability and success.
We are investing in new sites and in our current facilities. By the end of 2021, we will have built three new one-stop-shop community health centers in Jackson Heights in Queens, Tremont in the Bronx, and Bushwick in Brooklyn. We are also investing in needed repairs and improvements, including the $52 million in planned capital investment at NYC Health + Hospitals/Metropolitan. And thanks to the Mayor and the City Council’s generous support, we’re making important improvements to Woodhull, Elmhurst, Kings, Roberto Clemente and many of our other facilities. With funds from FEMA, we are building a brand new, storm resilient hospital campus at NYC Health + Hospitals/Coney Island. And our top-ranked health plan, MetroPlus, opened new community offices and continues to attract more members – with significant growth on Staten Island and the MetroPlus Gold plan for city employees.
Building on the great work of the Mayor’s Get Covered initiative and what MetroPlus have done around the city, we are signing up more New Yorkers for insurance inside of our hospitals. We have increased the number of insurance applications made by our patients by 20% to over 23,000 applications per month. This is great for our patients, who now have the security of knowing their care is covered, and it is great for Health + Hospitals, as we generate an anticipated $40 million in additional revenue this year.
We are getting better at the hard work of billing insurance companies. We have improved at every step of the process – from negotiating better rates with health plans, to more accurately documenting and coding the care we provide, to sending bills more quickly, to collecting the revenue we are owed. Our revenue cycle efforts yielded $150 million in FY 2018. This year, we are on track to achieve over $200 million in revenue – a huge step forward.
We are also improving the patient experience and investing to make sure we better meet our patients’ needs. We have hired more than 40 new primary care providers, streamlined our operations, and reduced our wait-times, patients can now see a primary care provider within one to two weeks. We are investing to make specialty care easier to access at Health + Hospitals. This includes expanding our E-consult system for specialty referrals, hiring new specialists, and adding new clinical services in areas like interventional cardiology, stroke care, and HIV care.
While we are headed in the right direction, we have a lot more work ahead. We need to continue to make the system as great as the people in it, and make it easier to use and more efficient to run. We need to continue to make it easier to get an appointment, to make sure our call center and customer service meets our patients’ needs, and to expand eConsult to all of our specialty clinics.
Great risks remain due to the federal government. The President’s budget would slash Health + Hospitals’ revenue by billions of dollars. Health + Hospitals is already facing potential Medicaid disproportionate hospital share cuts of over $400 million in federal funds the coming year, beginning October 1, 2019, and $600 million in each of the subsequent five years. The President’s budget not only maintains those cuts, but it makes the situation much worse with deeper cuts to Medicare and Medicaid.
Additionally, the Department of Homeland Security’s (DHS) proposed public charge rule could impact 350,000 Health + Hospitals patients and affect the public health system financially. In the fall, we launched an aggressive advocacy campaign opposing this cruel rule, along with other City agencies, and are currently awaiting DHS’s decision. The bottom line is – nothing has changed at Health + Hospitals and our patients should continue to seek care without fear at our facilities.
We are proud to play a key role in the Mayor’s Guaranteed Care Initiative. NYC Care, our new program for New Yorkers ineligible for insurance or unable to afford the options on the exchange, will begin in the Bronx this summer and will roll out to the other New York City boroughs by 2021. MetroPlus, the city’s public option, is developing new partnerships with other city agencies, adopting new outreach and enrollment-assistance strategies, and establishing new and improved member service options to better serve existing members as well as the estimated 300,000 uninsured New Yorkers who are currently eligible for coverage.
Despite the risks, we have accomplished so much together, and I strongly believe we are on track for another great year for Health + Hospitals.
Thanks for allowing me to share this overview of the positive developments and remaining challenges ahead. Now let’s proceed to the main purpose of tonight’s meeting – to hear from you, members of our community. Your input is so important to the future success of this system. We are ready to listen, and would have a formal response to concerns raise which will be presented at a public meeting of the Board and also posted on our website at the end of the meeting series. I will now turn to Andrea Cohen to out the proceeding for tonight’s meeting.