Brooklyn Public Meeting | NYC Health + Hospitals

Brooklyn Public Meeting

Annual Public Meeting Brooklyn
Wednesday, May 18, 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 for giving us this opportunity to share our plans for a brighter health care future in Brooklyn. Your attendance demonstrates a level of commitment that makes NYC Health and Hospitals the strongest public hospital system in the country.

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 obesity and diabetes
  • or providing the best trauma care in the city

— the mission of our 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 365,000 patients in Brooklyn last year.
We do this by serving as the “safety net” for all other hospitals in New York, who depend on us to care for nearly a half million uninsured patients each year. Over a third of the patients we treated in Brooklyn in 2015 were uninsured. Many of them received care right here at Woodhull.

So it’s not just empty rhetoric when we call the public hospital system “essential”.
New York City simply could not function normally without us. In a moment I’ll discuss some of the initiatives underway to build healthier a healthier Brooklyn.

But first, let me recognize that these are difficult times of transition throughout our system, and here in Brooklyn.

Last week we announced a new leadership team at Coney Island Hospital and other facilities, for whom patient experience will be a top priority.

Anthony Rajkumar, our new CEO at Coney Island is a talented and innovative leader within the public hospital community. His title is upgraded from “Executive Director”, to reflect our commitment to hold hospital chiefs directly accountable for patient satisfaction. He will be a more visible leader, dedicated to increasing workforce engagement, expanding access, and building community collaborations. We welcome Tony and know that his expertise will make a difference.

Joining Tony as Coney Island’s new Chief Operating Officer, is Mei Kong. Mei is a registered nurse with nearly 30 years of clinical and administrative leadership experience in patient care, engagement, and workforce development. She has been a leader in our successful effort to build a robust safety culture across our system. We are glad to have Mei in this new role.

With bright spots like at Coney Island like —

  • Reopening of the new Ida G. Israel neighborhood health center
  • Initiating the planning phase of the new hospital structure
  • and innovative programs for breast cancer survivors like the “Look Good, Feel Better “

— I know that Coney Island Hospital will prevail.

Because of the dedication of its employees, the steadfast support of stakeholders and local elected officials, and the tremendous resiliency of its staff and community supporters, I know Coney Island will once again be the very best hospital in south Brooklyn.

Every patient is precious to us. Last year, we cared for 12,400 men, women, and children at Coney Island and another 41,000 out-patients. At any hospital in the country, including ours, there is room for improvement. We understand that. But we are absolutely dedicated to treating each and every patient, as if they were our own beloved family member or friend. And we will continue to do so.

Let me also say a few words about our host tonight, NYC Health + Hospitals/ Woodhull, which is the inheritor of a tradition of public hospital care that stretches back almost a century. Whether it’s Woodhull’s —

  • extensive women’s health, or pediatric dentistry services
  • or its leadership on asthma prevention
  • or its commitment to being part of the solution on social issues like stable housing, or youth engagement or LGBTQ health equity

— Woodhull epitomizes “compassion-in-action”. And we are glad to be here tonight.

Last month we welcomed Gregory Calliste as Woodhull’s new CEO. With 20 years of hands-on experience in the public system, Gregory has the background and the credibility to motivate and celebrate our workforce, and to put patients first.
We know he will do great things in his new role.

Innovate change is also occurring at Kings County where our Collaborative Care program is ensuring that patients with Depression get appropriate follow up in Adult Medicine Practices. Over 350 patients have participated in the program at Kings County, which has as screening rate of 94%—one of the best citywide.

Teams at Kings County are also doing great work to reduce the amount of time patients spends at an Adult Medicine appointments. And Kings is piloting a 30-day Supported Transition Program to ensure that patients recovering from cardiac, diabetes, or renal treatment really understand and follow their instructions after they leave the hospital.

Initiatives like these are rippling across our system, moving us away from the outdated hospital-centric model, to one that emphasizes better prevention, care-coordination and community based care. But there’s more to be done. True health care also means working aggressively to reduce health disparities that afflict many communities in Brooklyn where differences in the disease burden are starkly evident:

  • For example, 24% of New Yorkers suffer from obesity, which can lead to diabetes and heart disease: But according to the New York City Department of Health and Mental Hygiene Community Health Profile for 2015, the number of Bushwick residents struggling with obesity is 28 %. Rates are even higher, at 31%, for East New York and Coney Island.
  • Diabetes afflicts 10% of the adult New Yorkers. But in East New York 18% of adults, the highest rate in the entire city, suffer from this serious disease.
  • Asthma, is yet another disease that illustrates how certain neighborhoods are cruelly afflicted. The child asthma hospitalization rate in Borough Park, for example, is only 6 children hospitalized per 10,000. But in East New York, the rate is unconscionably higher at 50 kids per 10,000 patients.

These statistics may be daunting, but we believe they are not insurmountable. We are proud, for example that Woodhull is a recipient of a New York State-DOH Asthma Regional grant to reduce the burden of the disease in neighborhoods of Brooklyn.

But to reduce and eliminate health disparities citywide, we are going to need more help to continue strengthening primary care.

Earlier this year two of our largest neighborhood health centers, Cumberland and East New York, became part of Gotham Health, a Federally Qualified Health Center that will help us secure better reimbursement rates to support our Ambulatory Care.

And we are proud to be full partners in the Mayor’s Healthy Neighborhoods Initiative to build primary care capacity in areas of highest need all over the city.
We are expanding our Bushwick Communicare Center, which has pediatric care now, but which will soon have an array of specialty care also.

Our existing Women’s Health Center at Bedford-Throop will soon offer a family practice as well. Our pediatric clinic in Brownsville is expanding and will soon offer all levels of primary care, plus a diabetic center of excellence. And at a number of sites in NYCHA developments that currently offer pediatric care, we will soon offer care for all age groups as well.

This is how, patient by patient, neighborhood by neighborhood, and in partnership with local providers, CBOs and advocacy groups, we will build healthier communities everywhere in Brooklyn.

Over the past several years the state has embarked on a comprehensive effort to reform the way Medicaid is delivered in New York. Through an initiative known as DSRIP, we have secured the opportunity for $1.2 Billion in funding.

These dollars allow us to partner with local organizations like Brooklyn Perinatal Network, Ridgewood Bushwick Senior Citizens Council, Make the Road NY and SUNY, to administer Patient Activation Measure surveys to uninsured and Medicaid patients. We recognize that only when we truly know our patients are we are able to provide the most effective care. These surveys help start discussions with patients to better manage their health conditions, and help them identify appropriate primary care and social services.

As this program evolves, our community partners in Brooklyn will help link thousands of patients to high quality care. Additionally, our teams at NYC Health + Hospitals/East New York and NYC Health + Hospitals/Cumberland were part of the first stage of our palliative care project, through which we successfully helped hundreds of patients with simple advance care planning at primary care clinics.

But let me pivot away activity at our facilities, to briefly discuss the state of our health care system citywide, and the nature of the challenges we face. 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.

Although the implementation of the Affordable Care Act has had many positive impacts on the healthcare landscape nationwide and here in New York City, ACA’s exclusion of undocumented people is causing tremendous financial difficulty for public hospitals.
Our situation can be summed up like this: We continue to be the largest provider of uninsured care in New York State, while our federal reimbursement for that care is slashed to the bone.

NYC Health + Hospitals could see reductions of approximately $300 million next year, deepening over time to more than $500 million per year, through 2025. These federal cuts are creating a significant funding gap that we must fill in order to continue carrying out our mission. The question is: What do we do about it?

NYC Health + Hospitals’ strategic plan has evolved over the past decade:

  • It started with the Road Ahead program that focused on cost reduction
  • It includes our Vision 2020, which focuses on growth, efficiency, and particularly on providing excellent patient experience
  • And it continues with the Mayor’s One New York Health + Hospitals Transformation, focusing on realignment of our workforce and better use of underutilized space on our campuses to meet community needs for social services and stable housing

Combined, these strategies are a blueprint that we will undertake so that New Yorkers continue to have access to the healthcare services that they need now – and that they will need in the future. I’m happy to report that we are seeing positive changes already.
Several of our facilities have exceeded state averages for patient satisfaction scores.
Others are well on their way to meet our goals for 2017. And we are seeing real improvement in reducing the time it takes to get a doctor’s appointment:

  • Wait times for non-urgent, new adult primary care appointments have been reduced by 63% to a system wide average of 20 days
  • The wait time for a non-urgent, new pediatric appointments is down to 5 days
  • And for a non-urgent, new Behavioral Health appointment the wait has been reduced from an average of 31 days to 6 days

And, our facilities are open longer later at night now, and on weekends, for the convenience of our patients.

These improvements will help us achieve our goals. But perhaps our greatest asset in our — Himalayan —- effort to provide better access, and more effective, community-based care, is the tremendous diversity of our workforce. I like to think that when a patient enters through our doors, no matter where they come from— Nepal, Ecuador, Ghana, wherever—we can find a person on our staff from that place, who understands that culture, who can communicate in that language. This is what makes our system truly special.

It is what makes me proud to be probably the only chief of a large health care system in the country who can say without exaggeration, “we look like our patients and they look like us”. We know our transformation will not be easy and we know it will take time. In the end however we will build a more accessible, more efficient public health care system;
One that makes us better able to accomplish our mission. One that makes us better able to meet and exceed patient expectations. One that ensures we will be there for our patients —now and far into the future. With strong community interest and support like we see here tonight we will act together to bring about fundamental change in health care delivery—Healthcare Nirvana is what I like to call it —that every resident of every community in Brooklyn deserves.