Manhattan Public Meeting | NYC Health + Hospitals

Manhattan Public Meeting

RAMANATHAN RAJU, M.D., PRESIDENT
Annual Public Meeting Manhattan
Monday, April 11, 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 Manhattan.

Your attendance demonstrates a level of interest and commitment that continues to make NYC Health and Hospitals the strongest public 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—its 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 have a great deal of investment 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 Emergency Department trauma care in the five boroughs,

—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 277,150 residents of Manhattan, 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 2.7%.

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.

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 across Manhattan.

But first, let me say a few words about NYC Health + Hospitals/ Carter —the new and beautiful, long term, acute-care hospital that welcomes us tonight.

We are so proud of the fact that in 2015 Carter received a rating of 5 out of 5 stars from the Federal Government’s Center for Medicare and Medicaid Services.

The “Fight Against Breast Cancer” team at Carter, chaired by Director of Nursing Stanlee Richards, was the top fundraiser in our system citywide. They raised almost $40,000 for the annual campaign, which culminated at the October 2015 Central Park Walk.

And I would like to make special mention of the man who has been called the beating heart of the public hospital system— Henry J. Carter.

This past February the organization Mr. Carter founded, Wheelchair Charities, presented new wheelchairs, specialty mattresses, and communication devices to enhance the lives of patients and residents. We are profoundly grateful for Hank’s continued generosity. And, for his lifelong commitment to improving patients’ lives here at the facility that bears his name.

Looking beyond Carter, we are fundamentally committed to building healthier communities throughout Manhattan 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 especially needed in areas like Central Harlem, East Harlem, the Lower East Side and Chinatown, where the disease burden is especially high.

According to the New York City Department of Health and Mental Hygiene’s 2015 Community Health Profile, the citywide average for hospitalizations due to stroke is 264 per 100,000. But in Central Harlem, this rate balloons to 466 cases, as compared to only 140 cases in Greenwich Village and SoHo.

The Community Health Profile shows that Manhattan-wide rates for obesity and diabetes are lower than the citywide averages of 24% and 10% respectively. But in many places in Manhattan rates spike much higher. 33% of adults in East Harlem were considered obese in 2015, and 13% of adults in East Harlem, and 12% in the Lower East Side and Chinatown had diabetes.

The rate of hospitalizations for children suffering from Asthma in East and Central Harlem is 75 and 69 cases per 100,000 respectively. Much higher than the citywide average of 36 cases per 100,000.

And, at 755 cases per 100,000 the rate of adult psychiatric hospitalization in Manhattan is higher than the citywide rate of 684. East Harlem’s rate is the highest in the city at 2,016 per 100,000.

And while new HIV diagnoses occurred at a rate of 30.4 cases per 100,000 citywide, the rate for Manhattan was considerably higher at 45.6 cases. At 89 cases per 100,000, Central Harlem has the second highest rate of new HIV diagnoses in the city.

In sum, health disparities in many communities of Manhattan are glaringly evident. We believe that these obstacles to good health are not insurmountable. But we need more help to combat the disease burden and the health disparities suffered by residents of these neighborhoods.

We will succeed by strengthening primary care.

That is how, patient by patient, and working in partnership with local providers, CBOs and advocacy groups, we will build healthier communities throughout Manhattan.

Over the past several years the state has embarked on a comprehensive effort to reform the way Medicaid care is delivered in New York. We have secured the opportunity for $1.2 Billion in funding to support care at the community level from what is known as the Delivery System Reform Incentive Program (DSRIP).

Our community partners in Manhattan have been a tremendous help in one of our initial efforts. Partners such as Community Health Network, Community Service Society and the Ryan/Chelsea-Clinton Community Health Center, administered over 500 patient surveys to uninsured and Medicaid patients.

These surveys are a key tool to start discussions with patients about managing their health conditions and helping them identify appropriate primary care and social services. Because, only when we truly know our patients are we are able to provide the most effective care.

As this program evolves, our community partners in Manhattan will help link thousands of patients to high quality care through this effort.

Additionally, teams at Bellevue and Gouverneur were part of the first stage of our palliative care project, through which we successfully engaged hundreds of patients with simple advance care planning.

Moving forward, we will implement more interventions with our community partners aimed at ensuring that our patients’ symptoms and advanced illnesses are appropriately managed in the primary care setting.

Apart from our involvement in Medicaid Reform and the work we do every day to keep New Yorkers safe and healthy, let me highlight a few of the exciting things going on at our different Manhattan facilities over the past year:

We continue to be enormously proud of the critical work being done by our Emergency Management team at Central Office and at NYC Health + Hospitals/Bellevue, which is the hub of metropolitan, regional, and national special pathogens preparedness.

Bellevue has been designated as one of only nine federal Ebola and Special Pathogen Treatment Centers across the country. And it is a co-lead of the National Ebola Training and Education Center.

The unique capacity of our Isolation and Special Pathogens Unit at Bellevue, called “7 West”, enabled us to successfully prevent Ebola from spreading beyond the one confirmed case in October, 2014.

Our secure patient treatment beds and staff training rooms remain New York City’s primary facility for special pathogen containment and care.

Training, planning, and exercises go on long after a “threat de jour” disappears from the headlines. The next time a special pathogen threatens the health and safety of New Yorkers, we will be ready.

NYC Health+ Hospitals/ Coler has been the site of a program called Music and Memory, which involves setting up personalized music playlists, delivered on iPods and other digital devices, to dementia patients. These musical favorites tap deep memories not lost to dementia and can bring participants back to life, enabling them to feel like themselves again, to converse, socialize and stay present. A documentary about this work at Coler called Healing with Harmony: A Music & Memory Story was shown multiple times at Grammy Awards events and at the American Medical Directors Association conference last month.

Moving downtown, we are looking forward to the leading role that NYC Health + Hospitals/Gouverneur will play in ActionHealthNYC, a part of Mayor de Blasio’s comprehensive plan to improve health care access for the city’s immigrant population. ActionHealthNYC will offer low or no-cost coordinated primary and specialty health care to enrollees who are immigrant New Yorkers that currently do not qualify for health insurance. Patients who are referred to this program will have the same services available to them that are available to other patients, including: diagnostic testing, primary care, mental health services, and dental care. We are delighted that Gouverneur has been selected as community based outreach and enrollment center for this important initiative.

At a recent board meeting we recognized a group of employees from NYC Health + Hospitals/Harlem whose quick thinking and heroism mitigated a very dangerous situation when flames engulfed a patient bathroom. As smoke billowed out into the hallways, five Harlem employees attempted to douse the flames. They acted quickly and calmly to move acute behavioral health patients out of harm’s way. The professionalism these employees demonstrated was mirrored throughout the rest of the day by many others at Harlem. The premium we place on emergency planning, training and preparedness paid off. We are all extremely proud of how Harlem’s staff reacted.

Let me share one more bit of good news from Harlem: Last week we announced that Eboné Carrington has been appointed Chief Executive Officer,, where she will be responsible for ensuring quality standards of care, increasing workforce engagement, expanding access, building community collaborations and providing an exceptional patient experience. Ms. Carrington’s family has a combined 80 years of service to the Harlem community. With her appointment that record of service is likely to grow much longer.

I’d also like to share with you some of the innovative work happening at Metropolitan Hospital: As healers, we know that the doctor-patient relationship is the essence of medicine. Patients must feel safe with us, and comfortable confiding in us, in order for us to offer the most effective care. Which is why we are so proud of the work occurring at Metropolitan’s new LGBTQ clinic. Over the past year it has:

  • Served almost 100 patients and doubled our clinical hours of availability;
  • Piloted a registration and intake process that collects data about patients’ sexual orientation and gender identity;
  • Transformed the physical environment of the hospital to include LGBTQ friendly imagery and all-gender restroom signs; and
  • Trained more than 1,500 hospital employees on LGBTQ cultural competency.

The work of the clinic to improve accessibility and comfort level for our LGBTQ patients is a proud example of our commitment to wellness for every community.

Across Manhattan, Hurricane Sandy remediation work continues full-tilt to ensure that our patients are protected and our hospitals are better able to withstand the next great storm. After tough negotiations with the federal government, a comprehensive grant agreement has been reached with FEMA for repair, restoration and hazard mitigation of damage to public hospitals resulting from Sandy.

  • At Bellevue we have moved critical electrical switch gear from the basement to the first floor. We have also installed emergency flood barriers, and we are conducting a Phase 2 Hazard Mitigation study reviewing options and design RFPs for flood wall and mitigation work, new elevators, and for raising infrastructure from the basement.
  • At Metropolitan we have upgraded electrical feeders from Con Ed to the hospital’s switchgear, to ensure uninterrupted service. We are working closely with FEMA to protect the hospital by readying it to withstand the next major storm and flood.
  • At Coler we have moved the main switchgear from the basement to the first floor. Discussions are underway with the Roosevelt Island Operating Corporation on projects associated with new flood walls and mitigation work.

But let me pivot away from our programmatic and capital activity locally, to briefly discuss the state of our healthcare 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. 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. 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 acute, in-patient care to 2,500 uninsured individuals, for a total of 2,754 uninsured in-patient hospital visits in Manhattan during 2015.

Last year we also provided care for 105,838 uninsured out-patients in Manhattan for a total of 375,266 uninsured out-patient visits.

Our situation can be summed up like this: We continue to be a large provider of uninsured care, while our federal reimbursement for this care is slashed to the bone.

We estimate that 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 Obamacare.

That means that they can now pay for care. And THAT means New York City’s voluntary hospital systems are now competing with us for patients who have traditionally been ours.

These structural changes in healthcare 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 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 the hospital.

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 care by the year 2020.

Because we know that when patients have a good experience and are more engaged, and 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, which will result in a bigger patient base and the growth I mentioned earlier. 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 Mayor de Blasio’s Healthy Neighborhoods Initiative to build primary care capacity in areas of highest need all over the city.

Let me mention one more aspect of our plan to grow the public health and hospital 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:

  • create more affordable housing
  • make legal assistance 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 even during times of financial challenge, we are doing more than we’ve ever done before, 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 an efficient, competitive 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…
…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 Manhattan deserves.

WE ALWAYS PUT PATIENTS FIRST