Staten Island Public Meeting | NYC Health + Hospitals

Staten Island Public Meeting

Annual Public Meeting Bronx
Wednesday, May 10, 2017

Remarks by Stanley Brezenoff
Interim President & CEO, NYC Health + Hospitals

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.

Financial Crisis

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.

Changing Policy Environment

Last week, 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.

System Transformation

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.

Commitment to Immigrant Health Care

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.

NYC Health + Hospitals in Staten Island

Tonight we are pleased to welcome each of you to NYC Health + Hospitals/Sea View, and to acknowledge our pride in the recognition this facility consistently receives for excellence in the provision of short term rehab, skilled nursing and post-acute care.

Sea View has earned top ratings in the U.S. News & World Report’s “Best Nursing Homes” report for 2016-2017 which measures quality of care, safety, staffing, and rehabilitation services. Since 2008 it has maintained the highest five star rating from the US Department of Health and Human Services Center for Medicare and Medicaid Services—a result of favorable scores for onsite inspections, hours of care provided to residents, and quality measures for meeting patients’ physical and clinical needs.

Sea View’s clinical work to better align care with the wishes of patients with serious illness or at the end of life, and their families, was recently recognized by AMDA, a leading national organization for the advancement of palliative care medicine. The facility also recently earned the Intalere Healthcare Achievement award for its efforts to create greater value to patients through operational innovation and efficiency.

Sea View’s caring staff clearly makes a difference, within our health system — where it was among the highest scoring of our facilities in the 2016 Press Ganey survey of employee engagement — and sometimes outside it: Just a few months ago Sea View environmental services employee Delroy Lewis, was celebrated on local television news programs for the heroism he displayed in saving three neighbors—two of them young children–from a terrible house fire. We are proud of Delroy for his actions that day, and proud of all our clinicians and staff here in Staten Island, who work so hard to safeguard the health of our patients. So, before proceeding, thank you to NYC Health + Hospitals/ Sea View Chief Executive Officer Angelo Mascia and the entire staff for welcoming us here tonight.

A critical new development in terms of the public health system’s activity in Staten Island occurred in November, when we broke ground on a state-of-the-art ambulatory care facility for Staten Island. When it opens this fall, the 18,000 square foot, $28 million facility on Vanderbilt Avenue will offer primary, out-patient, and urgent care services, and expanded evening and Saturday hours.

The new center reflects our commitment to, and investment in, community-based primary care here on Staten Island, and across the city. It will supplement our two very active neighborhood health centers at Mariner’s Harbor and Stapleton, each of which provide a full array of primary care, chronic disease management and behavioral health services for both adults and children. We anticipate that the new ambulatory care center will provide care for 40,000 additional patient visits annually, by 2020, and that this in turn will reduce the need for costly emergency and inpatient care.

Strengthened primary care here on Staten Island, 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.

DSRIP- OneCity Health

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 here, 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.