Queens Public Meeting | NYC Health + Hospitals

Queens Public Meeting

RAMANATHAN RAJU, M.D., PRESIDENT
Annual Public Meeting Queens
Wednesday, May 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 and neighborhood of the borough of Queens.

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 240,000 patients in Queens 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.

According to the City’s Independent Budget Office, both Elmhurst and Queens Hospitals saw the highest percentage of uninsured adults seeking outpatient care city-wide in 2015. 40 % of the patients we saw in Queens 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 Queens. But first, let me say a few words about our host tonight, NYC Health + Hospitals/ Queens, which has cared for residents of Queens for nearly a century.

We are proud of this state-of-the-art facility, which features:

  • Beautiful new buildings like the ambulatory care pavilion

and which is equipped with the most advanced technology, like:

  • the PET/CT scanner which provides a higher level of accuracy in disease diagnoses, staging and treatment planning
  • and the new Linear Accelerator that is greatly expanding our oncology radiation capabilities

But sophisticated architecture and equipment is not what makes Queens, or Elmhurst, special. It’s our staff that does that. Demographers have called Queens the most diverse place on earth. And this hospital offers a workforce to match that diversity.

I like to think that when a patient enters through our doors, no matter where they come from— Nepal, Ecuador, Ghana, wherever—I can find a person on our staff from that place, who understands that culture, who can communicate in that patient’s language. That’s what makes this place, and this system, special. It’s 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.”

Another thing that makes Queens and Elmhurst special, is that they both became trailblazers within our system last month, as the first City hospitals to launch the best, top-of-the-line Electronic Medical Record available today, called EPIC. The new EMR enables clinicians to access complete, up-to-date patient information at any point of care. It includes a free, user-friendly and secure online tool called MyChart that will empower patients to manage their health information at any time.

The new EMR is integral to our Vision 2020 goals; excellence in patient experience, expanded access, and growth. It is how we will provide better care to all of our patients, in every care setting, across our system.

Implementing the EMR at Queens and Elmhurst was a monumental undertaking. One built on the expertise and dedication of thousands of employees. Hundreds of them at the front lines here at Queens. I particularly want to thank Queens Interim CEO Dona Green and Elmhurst CEO Wayne Zimmerman for the leadership and motivation they showed during this exciting time.

Apart from the EMR, let me briefly highlight a few more exciting things going on at our facilities here:

  • In recent years the Emergency Department at Queens has experienced a significant increase in patient volume. Originally built for 40,000 visits per year, the facility now accommodates 100,000 patients annually as a result of hospital closures in the borough. Plans are underway to expand the Adult Emergency Department here to accommodate the increase in patient volume, reduce wait time and improve the patient experience.
  • We are also embarking on an expansion of the pharmacy at Queens. We are grateful for the announcement of a $1 million capital funding grant from Borough President Melinda Katz. The end result will mean improved efficiency, improved patient access, and decreased wait times.
  • Queens’ vascular and endovascular surgical program has recently expanded its services to the benefit of our patients, who previously had to be transferred elsewhere for advanced surgeries. Now a comprehensive array of services spanning all levels of care is available to patients.
  • At NYC Health + Hospitals/ Elmhurst, design work is proceeding on the expansion and renovation of Emergency Department as well. Construction is scheduled to begin February 2017.I want to thank Council Members Ferreras, Dromm and Borough President Melinda Katz for providing capital funding.
  • And we’ve nearly completed a $28 million comprehensive energy efficiency upgrade at Elmhurst. The project was funded by the New York Power Authority and includes the replacement of new boilers, oil tanks, high-efficiency lighting, and other improvements. Total savings for Elmhurst in electrical and fuel costs are estimated to be $1.5 million annually.
  • Another bright spot at Elmhurst is the ‘A’ rating it has received from The Leapfrog Group—a leading trade organization dedicated to promoting improvements in the safety of health care. The ‘A’ rating means that Elmhurst has patient safety procedures in place that exceeded the standards of other medical institutions.

These improvements mean that we are doing a lot of pro-active work to build healthier communities across Queens, by changing the way we deliver care.

Multiple initiatives are underway across the system to move us from an 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 more aggressively to reduce health disparities that afflict too communities across Queens.

  • For example, 27 percent of adults in Jamaica, and 28 percent of adults in Rockaway are obese, higher than the citywide average of 24 percent according to the New York City Department of Health and Mental Hygiene Community Health Profile for 2015.
  • And while 10 percent of adults citywide have diabetes, 12 percent of adults in Jamaica suffer from the disease, and the rate is 14 percent for people Elmhurst and Corona.
  • The rate for avoidable adult diabetes hospitalization citywide is 312 patients per 100,000, but the number leaps to 430 patients in Jamaica Queens. And to 470 in Rockaway.
  • And, while the avoidable asthma hospitalization rate for adults in wealthier neighborhoods of New York City like Greenwich Village or Soho, is only 46 cases per 100,000. Here in Jamaica, Queens, the number of adults hospitalized for asthma each year is and unconscionable 185 percent higher!
  • Disturbing levels of disparity for Infant Mortality, premature death, and stroke afflict many areas of Queens as well.

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

We are proud to be full partners in the Mayor’s Healthy Neighborhoods Initiative to build capacity in areas of highest need all over the city.

After significant analysis to dig down and determine the community’s health needs in Jackson Heights, for example, we have embarked on a plan to expand the Junction Boulevard neighborhood health center.
Soon, we will be able to provide not just children’s health services, but also adult primary care, women’s health and geriatric services at this site as well. We are excited that moms, dads, or grandparents who bring kids for appointments will be able to see their own doctors at the same time. Renovations are slated to begin in June, with construction scheduled to conclude by early next year. By the end of the first year we hope to serve an additional 5,500 patients with this expansion.

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 DSRIP, 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 DSRIP project here in Queens involves partnering with local organizations including South Asian Council for Social Services, Urban Health Plan, and several others, 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 Queens will help link thousands of patients to high quality care.

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 great achievement with great satisfaction and joy. But an important 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 from coverage. 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 96,000 uninsured patients in Queens alone, last year.

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 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 actively 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?

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 plan, which focuses on growth and efficiency, and on making the patient experience the best that it can be.

And, it includes the Mayor’s Report released a few weeks ago, which focuses on transformation of our workforce and better use of underutilized space on our campuses to meet our patients’ great need for social services and stable housing.

Combined, these strategies comprise a blueprint that we must 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.

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.

Vision 2020, which we launched last year, calls for improvement 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 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 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.

Another prong of our growth strategy is to create more access to our health care. By expanding hours—staying open longer at night and on weekends, we have achieved significant reductions in wait times for pediatric, primary care and behavioral health appointments.

Let me mention one more aspect of our efforts to redesign the care we provide — that is 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

— that can create tremendous barriers to care. That’s why we are concentrating on building partnerships with other social service providers across the spectrum to:

  • make legal services available to our patients right in our hospitals, and to
  • encourage green markets in each of the neighborhoods we serve…

I’m very proud that we are doing more outside the traditional medical realm, to build healthier communities and act as catalysts for positive social change in New York City.

We know our transformation will not be easy and we know it will take time. In the end however, we are convinced that achieving our strategic plan 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 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 change in health care delivery-
— Healthcare Nirvana is what I sometimes like to call it that every resident of every community in Queens deserves.

WE ALWAYS PUT PATIENTS FIRST