Bronx Public Meeting | NYC Health + Hospitals

Bronx Public Meeting

RAMANATHAN RAJU, M.D., PRESIDENT
Annual Public Meeting Bronx
Tuesday, April 19, 2016

Remarks by Ram Raju, MD
President & CEO, NYC Health + Hospitals

Welcome. I am Dr. Ram Raju, President and CEO of NYC Health and Hospitals. Thank you for coming tonight. And thank you for giving us this opportunity to share our plans for a brighter health care future in every community of the Bronx. Your attendance demonstrates a level of interest and commitment that continues to make NYC Health and Hospitals the strongest public hospital system in the country. And we offer you our deepest thanks for that.

Let me begin this evening by mentioning one of New York City’s proudest traditions:
It’s decision almost 300 years ago, that for the good of the entire city, a public hospital would be established to care for anyone who came through its doors. This was compassionate, and it was smart. Smart policy then, and smart policy today. Because in a city where we live side by side: Rich and Poor, Black and White, Asian and Hispanic, Straight and Gay, Documented and Undocumented, all of us are invested in the good health of our neighbors. The health of our co-workers, the health of the people who cook our food in a restaurant, the health of fellow passengers on the subway, all can impact our own health, and the health of our loved ones.
We are quite literally, in this together. So, whether it’s an infectious disease like Ebola, or working to end epidemics like diabetes, obesity or asthma, or providing the best trauma care in the city, the mission of the public hospital system is to safeguard the health of our patients, our fellow New Yorkers, and our city.

We do this by being the health care provider for more than 1.2 million New Yorkers annually, including 305,000 patients in the Bronx, last year.

We do this by providing more outpatient care than ever before. Between 2013 and 2015 the number of outpatient visits we provided citywide grew by 2.6%.

We do this by serving as the “safety net” for all other hospitals in the metropolitan area, who depend on us to care for nearly a half million uninsured patients each year. A full 27% of the patients we saw in the Bronx last year were uninsured. So it’s not just empty rhetoric when we call the public hospital system “essential”. New York City could not operate without us.
In a moment I’ll discuss some of the initiatives we have underway to build healthier communities throughout the Bronx. But first, let me say a few words about NYC Health + Hospitals/ Lincoln, our host tonight, and a great community asset that is really stepping up to meet the health needs of communities in the South Bronx. Lincoln’s commitment was on full display during last summer’s Legionella outbreak. We were so proud of the clinical and support staff who worked around the clock to treat those who had become ill from exposure.

We are also proud of Lincoln for becoming the first hospital in the Bronx to receive the “Baby Friendly” designation from the World Health Organization. This was recognition of the great work being done here to provide young mothers with the skills, knowledge and confidence to breast feed.

Late this summer Lincoln will continue another year of effective partnership with the New York Yankees on a Back-to-School immunization campaign. As a result, young people in the Bronx between the ages 4 and 18 will have an opportunity to receive their required vaccinations and influenza vaccines at no cost.

And I’m happy to report that Lincoln continues to be a busy center for obtaining the ID NYC card—an important new tool for making the city’s health care resources even more easily accessible to families:

So, a lot of terrific work is going on here at Lincoln and beyond. Because the public hospital system is fundamentally committed to building healthier communities throughout the Bronx by transforming the way we deliver care. We are moving from the old model of sick care, to a more modern system that emphasizes prevention, care-coordination and wellness to meet the needs of our patients today, and tomorrow.

These new approaches are particularly needed in neighborhoods of the Bronx like Mott Haven, Melrose, Morrisania and East Tremont, where the disease burden is especially high. For example, according to the New York City Department of Health and Mental Hygiene Community Health Profile for 2015, the avoidable asthma hospitalization rate for adults in the Bronx is 508 cases per 100,000. Unfortunately, that rate is much higher than the citywide average of 249 cases. And while adult asthma hospitalizations in Morris Park are relatively low, at 329 cases per 100,000, the rate balloons to 769 cases in Morrisania, and 786 cases in East Tremont. These unacceptable levels spur us to work even more aggressively to improve outcomes. Our asthma teams are committed to minimizing the damaging effects that this disease has on men, women and children. Programs like Respirar, which helps identify and eliminate asthma triggers in the home, are designed to provide our patients with more effective treatment regimens to manage the disease. Our approach also includes drug therapy, patient education, behavior modification, and ongoing care.

Obesity is another terrible problem…one that can lead to heart disease and other serious conditions. And it is hitting the Bronx disproportionally hard. 24% of New Yorkers are obese. But in the Bronx, that number jumps to 31%. And in Belmont and East Tremont the rate climbs to 35%, the highest rate for obesity in the city.

Diabetes levels are also disproportionately high in the Bronx, where 14 % of the population suffer from the illness compared to 10% citywide. Similar levels of disparity are glaringly evident in the South Bronx for: child Asthma hospitalization rates, infant mortality and premature death rates, and rates for stroke hospitalizations.

These stats may be daunting, but we believe they are not insurmountable. To tackle them however, we are going to need more help… more help to continue our already vigorous commitment to strengthening primary care. Because robust primary care, delivered in partnership with local providers, CBOs and advocacy groups, is how, patient by patient, we will build healthier communities everywhere in the Bronx.

Over the past several years the state has embarked on a comprehensive effort to reform the way Medicaid care is delivered in New York. Through an initiative known as OneCity Health, we have secured the opportunity for $1.2 Billion in funding. These dollars will support care at the community level, because we strongly believe that only when we truly know our patients are we are able to provide the most effective care. One initiative here in the Bronx involves partnering with local organizations like Health People to administer Patient Activation Measure surveys.

These surveys help start discussions with patients about managing their health conditions and help them identify appropriate primary care and social services. As this program evolves, our community partners in the Bronx will help link thousands of patients to high quality care.

Another OneCity Health project in the Bronx involves strengthening palliative care. We are pleased at the progress made at NYC Health + Hospitals/Morrisania, where hundreds of patients were engaged with simple advance care planning.

Apart from these innovations, let me highlight a few of the exciting things going on at our Bronx facilities over the past year: In 2015 NYC Health + Hospitals/Jacobi had 29,500 outpatient visits, 104,000 Emergency Department visits, 21,200 inpatient discharges, and 2,300 babies were delivered.

Our patients accessed Jacobi’s wide array of services including: Level 1 trauma care, a comprehensive breast health center, Regional perinatal and hyperbaric centers and a Burn ICU, just to name a few. Jacobi’s excellence is reflected in the awards and recognition it regularly receives: It is among the Best Regional Hospitals for Diabetes & Endocrinology according to US News & World Report. It received the Stroke Silver Plus Quality Achievement Award from the American Heart Association/American Stroke Association in 2014. And it has been awarded a Centers for Medicare/Medicaid Services Innovation grant for Emergency Department Care Management.

NYC Health + Hospitals/ North Central Bronx offers primary care, geriatric services, women’s health —Including the city’s largest midwife program—pediatrics, asthma programs, among other services. Over the past year NCB received a $2.5 million grant from the federal Health Resources and Services Administration. Combined with a contribution from The Fund, these dollars are supporting expansion of Adult and Pediatric Dental Services at NCB and Jacobi. This will result in adding dental care providers, the opening of new examination rooms, and expanded, evening hours.

I’m also very glad to report that our Women’s Health Service at NCB has now delivered 1500 babies since it reopened, and has been averaging 99 deliveries per month so far this fiscal year. Our Morrisania and Belvis neighborhood health centers remain busy as well, offering residents of Highbridge, Hunts Point and Mott Haven high quality, primary care and diagnostic services. And we are proud of the work that these centers are doing to affect positive social change in the neighborhoods they serve: The Fresh Air Fund, a charity that enables children living in low-income communities to get away from hot, noisy city streets and enjoy free summer sleep-away camp experiences in the country, has set up recruiting stations at both centers. And Belvis is working with the area’s only grocery store, to: meet Shophealthy NYC standards, increase access to locally sourced foods and improve signage about calories.

But let me pivot away from our programmatic and capital activity locally, to briefly discuss the state of our health care system citywide, and the nature of the challenges we face. We in the public health community supported the passage of Obamacare with all our hearts and souls. It has expanded health care coverage to more people than ever before. And as healers, we regard this achievement with satisfaction and joy. But a key premise of the Affordable Care Act is this: As the number of uninsured people is reduced, the level of federal funding for health care for the uninsured will be reduced as well. Unfortunately, political horse-trading involved in getting the ACA through Congress resulted in the final bill excluding the undocumented immigrants of our country. The result is, there are more uninsured people than the ACA anticipated. And many of them are our patients.

Hundreds of thousands of undocumented people are uninsured New Yorkers. And it is the duty of the public hospital system to treat them when they are injured or sick. In 2014 approximately 475,000 uninsured men and women came through our doors. We provided in-patient and outpatient care to 83,300 uninsured patients here in the Bronx last year. Our situation can be summed up like this: We continue to be the largest provider of uninsured care, while our federal reimbursement for this care is slashed to the bone.

We estimate that NYC Health + Hospitals could see reductions of approximately $300 million next year. And the cuts will get deeper over time to more than $500 million per year through 2025. These federal cuts are creating a significant funding gap for us – a gap we must fill in order to provide services to our neediest residents. And that’s not the only challenge we face. Many of our patients who never had insurance before — people who aren’t undocumented but whose lower income levels led them to rely on our hospitals and services — now have insurance because of the Affordable Care Act.

That means that they can now pay for care. And THAT means New York City’s other voluntary hospital systems are now competing with us for patients who have traditionally been ours. These structural changes in health care nationally have meant a perfect financial storm for the public system. The question is: What do we do about it?

A year ago, I set out a vision for NYC Health + Hospitals that will transform, and grow our system by the year 2020. First and foremost, our program for growth hinges on patient experience. Our number one strategic priority is to make the patient experience the best that it can be. That’s how we will grow our patient base, and ultimately how we will close our funding gap. Our vision also involves re-thinking the role of hospitals. It involves expanding our ambulatory care capacity, and finding more efficiencies within our system. It involves developing innovative care management programs that keep patients healthier and out of hospitals.

Our vision calls for transformation at every stage of the care continuum. From admitting to discharge. From parking to wait-times. From better doctor-patient communication to the kindest, most compassionate attitudes on the part of our staff. With the help of hundreds of nurses, physicians, labor and managers, we have committed to a series of 22 specific, measurable actions to bring excellence to patient experience by the year 2020.

Because we know that when patients have a good experience and are more engaged, they have better outcomes. They become loyal partners who continue to come back to us for care. They will tell their friends and family about the great care they received. We have seen a positive sign already. Several of our facilities have exceeded state averages for patient satisfaction. Others are well on their way to meet our goals for 2017.

Another prong of our growth strategy is to create more access to our health care. We are full partners in the Mayor’s Healthy Neighborhoods Initiative to build primary care capacity in areas of highest need all over the city.

And let me mention one more aspect of our plan to grow our system — our commitment to act as social change agents. We are breaking out of our traditional medical silo in order to deliver more effective health care. We are getting involved in social determinants that undermine our patients’ health, such as: insecure housing, lack of availability of nutritious food, difficulty with eligibility for government benefits. These conditions can create tremendous barriers to care.

That’s why we are concentrating on building partnerships with other social service providers across the spectrum. We are applying our resources, talents and unique knowledge of the communities we serve in order to: make legal services available to our patients right in our hospitals, and encourage green markets in the neighborhoods we serve. Among many other initiatives. As catalysts for positive social change, I’m proud that we are doing more outside the traditional medical realm, to build healthier communities.

We know our transformation will not be easy and it will take time. In the end however, we are convinced that our 2020 vision will result in more access, and better, more comprehensive, care. By building a more efficient public system, we will be better able to accomplish our mission. We will be better able to meet and exceed patient expectations. We will be better able to be there for our patients – now and far into the future with strong community interest and support…support like we see here tonight…we will act together to bring about the fundamental transformation in health care delivery — Healthcare Nirvana is what I sometimes like to call it — that every resident of every community in the Bronx deserves.