NYC Health + Hospitals
Annual Public Meeting – Staten Island
Tuesday, October 20, 2020
Report by Dr. Mitchell Katz, President and CEO
I am Mitch Katz, President and CEO of the New York City Health + Hospitals. On behalf of our Board of Directors, and our dedicated workforce, thank you for joining this virtual annual public meeting. We are deeply appreciative of the commitment to public health care that you are demonstrating by connecting with us 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.
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 375,000 were uninsured. In FY19, we provided approximately 5.1 million outpatient visits. There were approximately 152,000 patient discharges, including more than 15,700 newborn deliveries.
RESPONSE TO CORONAVIRUS PANDEMIC
Of course, the most dramatic event of the year was our response to the COVID-19 pandemic. I am so grateful and proud of how well the health care heroes across NYC Health + Hospitals performed, risking their health and their lives to care for an unprecedented surge of critically ill patients. We are tremendously saddened by all the lives lost to this pandemic — particularly the members of our workforce. We’ll always remember their sacrifice. As we continue to respond to this unprecedented global public health crisis, the safety of our staff and patients remains our first priority.
While the health care systems in Wuhan, China and in parts of Italy collapsed, we did not, even though our public hospital infrastructure is aged, our resources are limited compared to some private hospital systems, and the needs of our patients, even in non-COVID times, is great due to the effects of living in poverty, institutional racism, poor nourishment, chronic stress, and higher prevalence of chronic disease. Not only did we meet the challenge of patients coming to us, but we were able to accept transfers from several independent hospital systems that became overwhelmed at a moment in time.
Our transformation work over the past two years and our smart investments — to expand telehealth services, adopt a unified electronic medical record system, hire more nurses, launch a new interfacility ambulance transport system — really served to lay the groundwork for this success.
We began our pandemic planning and response back in January and February to prepare for a surge in patients in respiratory distress, following many of the lessons learned from previous public health and natural disaster scenarios we have experienced like Ebola and Superstorm Sandy. But we could have never predicted what came next. And over a six-week period during March and April, we went from zero patients with COVID-19 to almost 4,000 patients. And from zero to almost 1,000 patients who were intubated.
We were able to triple ICU capacity from a starting point of 320 certified ICU beds, transferred nearly 900 patients across our system to alleviate demand from key facilities experiencing a more dramatic influx of patients, and answered the anxious calls of more than 80,000 New Yorkers who used the COVID-19 hotline we set up in March to connect with clinicians to answer questions on the virus, assess symptoms, and get connected to care.
Within a week of documented community spread of the virus in NYC, we were able to convert all routine face-to-face visits to televisits, or scheduled telephonic visits. We also handled approximately 13,000 patient messages over six weeks during the pandemic through our MyChart patient portal, which allows patients to directly communicate with their care teams.
Supporting the Heroic Workforce
To protect our heroic workforce and to create a safe and supportive environment, we prioritized supplies and equipment, and the practical and emotional needs of our staff.
We provided relief to many front-line clinical staff by adding temporary/supplemental staffing, including 4,000 nurses, 500 providers (doctors, physician assistants, nurse practitioners), 250 environmental health workers (housekeeping) and 200+ other ancillary personnel such as respiratory therapists and pharmacists.
Through persistence, tough negotiating skills and a new centralized ordering system, we were able to support the 600% increase in demand for PPE to deliver safe care and protect our workforce.
We lessened the impact on the elderly and frail in our long-term care facilities by leveraging the shared resources of our integrated system: staff, supplies, clinical leadership, expertise and technology. And we took steps protect our staff and patient inmates in our Correctional Health Services.
Our Behavioral Health and Helping Healers Heal teams across the system teamed up to provide emotional and psychological support to our staff – because we know that none of us will be the same after going through this crisis but leaning on each other will help us heal and come out stronger on the other side of this pandemic.
And we organized a fundraising operation like no other in the recent history of our public health care system. We experienced an outpouring of support for our health care heroes from the local, national and global communities who donated more than $20 million in cash and in-kind donations to lighten the load for our frontline staff with free hotel rooms, three meals a day, free taxi rides, child care, extra scrubs, grab and go groceries, and even Girl Scout cookies.
Thanks to the health care professionals at NYC Health + Hospitals, more than 8,365 New Yorkers with COVID-19 have recovered in our hospitals and have returned home.
Helping New Yorkers Return to Care
Many New Yorkers avoided health care during the surge of the pandemic. As soon as we began to see the cases of COVID-19 declining, we prepared to welcome patients back to care who had put off necessary treatment.
We implemented a number of safety protocols, including mandatory temperature and symptom checks, and use of face masks for all patients, visitors and staff. And we put up clear, multi-language signage to remind everyone of social distancing. We also reserved early-morning appointments for elderly patients and those who are immunocompromised.
Our 11 Emergency Departments (EDs) spaces and out-patient care clinics in hospitals and Gotham Health centers were reengineered to maximize distance between patients in waiting rooms and care areas, and we created new spaces for isolation to help protect patients and staff, and increase capacity to offer safe in-person care.
Playing a Key Role in Suppressing Virus and Reopening City
By the end of April, NYC Health + Hospitals was already serving on the front lines of the City’s pandemic suppression and reopening efforts by setting up testing centers in a variety of high need communities. We made COVID-19 testing and antibody testing widely available to staff, patients and members of the community.
In May, we stood up the NYC Test & Trace Corps – the nation’s largest testing and contact tracing initiative to fight COVID-19. Through a partnership with NYC Health + Hospitals, the Department of Health and Mental Hygiene, and with the on the ground outreach support of nearly 40 community-based organizations, the Corps allows the City to immediately isolate and care for those who test positive for the virus and then rapidly track, assess, and quarantine anyone they may have infected.
To-date, NYC has completed more than 3 million COVID-19 tests at more than 30 NYC Heath + Hospitals testing sites and through partners at other locations citywide. I’m pleased to report that the NYC Test & Trace Corps is now reaching more than 90% of new coronavirus cases across the City, and we are right at our evidence-based benchmark of having more than 75% of all new cases completing intake, meaning they are isolating at home or at a hotel with our help.
Nearly three months since the program’s launch, COVID-related visits to emergency departments, case numbers, hospitalizations, deaths, and test positivity rates are at their lowest since the epidemic began. It’s exciting to see that our efforts are working, giving us the reassurance we need to reopen our City safely.
Responding to Emerging Health Care Needs of COVID-19 Survivors
The global public health community anticipates uncovering the long-term impacts of COVID-19 for generations to come. However, NYC Health + Hospitals is moving now to proactively establish care models to begin serving those who have already been impacted by this vicious virus.
Three new NYC Health + Hospitals/Gotham Health sites will open over the next few months in communities that have been hardest-hit by the COVID-19 pandemic and provide the foundation for long-term health recovery. These new health centers in Bushwick, Jackson Heights, and Tremont, will specifically provide pulmonary care, radiologic and diagnostic services, as well as mental health services to help address anxiety, depression, post-traumatic stress disorder, and psychological distress.
To help patients who need long-term care and dialysis, we opened onsite hemodialysis and peritoneal dialysis treatment units for residents affected by kidney disease at five post-acute care facilities. NYC Health + Hospitals/Carter and Coler have already begun on-site treatments. NYC Health + Hospitals/McKinney, Sea View and Gouverneur are planned to launch in Fall.
THE FUTURE BEYOND CORONAVIRUS
The pandemic was not the only challenge our workforce tackled over the last year. We continue to reduce systemic obstacles facing communities of color, the poor and many others who lack access to affordable health care. And we are deeply invested in addressing long-standing racial disparities that have a direct impact on our community’s health.
Closing the Health Care Gap with NYC Care
Our mission to bring affordable, quality healthcare to every New Yorker has never felt more urgent. Through the support of the Mayor and our community partners, we reached the city-wide expansion of NYC Care with the launch of the program in Manhattan and Queens on September 1, and ahead of schedule, making it easier for New Yorkers who need us most to connect to the quality health care we deliver with excellence, cultural competence, and compassion. After all, good health care starts with good primary care, especially during a pandemic and during the post-COVID recovery period.
NYC Care is our health care access program for those who do not quality for health insurance or cannot afford it. Members receive a primary care appointment within two weeks, a membership card, access to language interpretation services, expanded pharmacy hours, access to video visits, and a 24/7 customer assistance line.
We have already enrolled nearly 30,000 members who have had over 85,000 provider visits, 17,000 telehealth visits and more than 30,000 prescriptions filled during new extended pharmacy hours. Nearly 20,000 members have been screened for depression since the program began and have been connected to additional supports and services when appropriate. For information and to enroll, New Yorkers can call 646-NYC-CARE.
With the expansion of NYC Care citywide, we are making the vision of guaranteed health care a reality for all who call our city home, regardless of immigration status or ability to pay. NYC Care will continue to bridge health disparities to make New Yorkers healthier as our communities continue to face the challenges of this pandemic and beyond.
Promoting Racial and Racial Equity, Addressing Disparities
I’m proud to have supported our staff who joined the ‘White Coats for Black Lives’ movement in solidary with thousands of Americans who have taken to the street to protest the repeated injustices. And on June 9, staff all across our health system stood firm against racism and violence at a demonstration and moment of silence to honor the life and memory of George Floyd — a powerful symbol of our unity, our values and our respect for our staff, patients and community.
We are taking additional action to promote racial and social equity by offering unconscious bias training to all employees and by hosting a series of anti-racism dialogue sessions to hold real time, anonymous conversations with employees on the topic of implicit bias and racism. In addition, the NYC Health + Hospitals Board of Directors recently approved the creation of the Equity and Access Council to serve as an advisory group to support our Office of Diversity and Inclusion and help develop strategies and initiatives that promote equity and optimize the delivery of care and health outcomes for diverse populations.
As health care professionals, we are not immune from implicit bias that have a direct impact on patient health outcomes. That’s one of reasons we have targeted investment in our maternal health program. Black patients have a pregnancy-related mortality ratio approximately three times as high as that of their white counterparts. And while NYC Health + Hospitals maternal mortality rates are lower than New York State’s rate, we have invested in training staff on OB life support, and this month we announced the expansion of six new obstetrics simulation training labs featuring specially-designed, high-tech, full-body mannequins-of-color to help our staff practice and master skills to help identify potentially life-threatening conditions during labor and childbirth.
Keeping Focused on Our Mission, Quality and Excellence
Despite the challenges, our health system continues to focus on protecting and preserving our mission to care for all, without exception, and expanding access to care to patient populations most in need. In the last year alone, we:
- opened a new Pride Center to care for LGBTQ Adolescents
- strengthened connections between primary care and mental health services
- expanded ExpressCare urgent care services onsite and through online visits
- enhanced services for patients with substance use disorder
- improved services for patients with hypertension, diabetes and heart disease
- expanded access to care for patients with disabilities
- launched peer-to-peer telehealth support for our MetroPlus Health members
- expanded our Arts in Medicine program to tap the healing power of the arts
- developed population health strategies to better serve homeless individuals
- helped our patients address food and housing insecurities
- launched reentry and transition services to improve continuity and quality of medical care for patients leaving City jails
- began plans to open outposted therapeutic housing for incarcerated individuals with complex medical, mental health, and substance use needs
- advocated against dangerous federal policies that discouraged immigrants from seeking medical care
And we continue to keep focused on our mission — ensuring equitable, quality care delivered with the compassion and respect that our patients, families and communities need and deserve.
- All our 11 acute care facilities were recently recognized by the American Heart Association for their commitment to ensuring heart disease and stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines. Seven of our hospitals made the U.S. News & World Report‘s prestigious “Best Hospitals” issue for 2020-21, receiving “High Performing” ratings across various specialties, including psychiatry, congestive heart failure and chronic obstructive pulmonary disease (COPD).
- Several of our hospitals were recognized for their civic leadership and value of care by Washington Monthly Magazine’s “Best Hospitals for America” — an exciting new national hospital ranking that takes under consideration not only the level of care provided, but how inclusive a health system is in providing care to everyone in a community.
- And many of our post-acute care facilities continued to rank among the best nursing homes in the state and in the country – with top rankings by Newsweek and U.S. News & World Report.
Although our future remains a bit uncertain – we don’t know when we’ll have a COVID-19 vaccine or if we’ll experience a second surge or how much federal support we can receive for pandemic costs— aren’t we lucky to have the NYC Health + Hospitals system to care for those New Yorkers who need us most?
Despite the devastating losses and challenges we’ve faced, we have accomplished so much together, so much to be proud of. I strongly believe NYC Health + Hospitals is a stronger, more responsive public health care delivery system – more ready than ever to protect and preserve our mission and help all New Yorkers live healthier lives.
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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. I will now turn to Andrea Cohen to outline the proceeding for tonight’s meeting.