Second wave surge response — The 11 acute care hospitals continue to perform exceptionally well as COVID-19 cases and hospitalizations increase around the city. The system’s COVID-19 census has increased steadily since early November, with our facilities surpassing 400 COVID-19 positive patients on January 1 and 600 this week. The steady, linear increase (rather than the exponential increase we saw back in the spring) – has made this surge much different and more manageable. About 20-25% of the system’s COVID-19 positive patients have needed care in our ICUs. Overall, the acuity of patients in this surge is lower than in the spring and this, combined with new therapeutics and other interventions, has reduced mortality significantly.
We continue to build upon the System’s successful patient level loading between facilities that we began in the spring, and have transferred nearly 500 patients between our facilities since November. This is in addition to the hundreds of regular transfers of patients requiring complex care to our tertiary care facilities. This steady movement of patients has helped the System manage capacity as facilities convert units to COVID-19 only units or move into the additional surge spaces that are part of our plan.
While we continue to serve large numbers of non-COVID-19 patients, our facilities have reduced in person ambulatory care visits and non-emergent surgeries to manage the surge. We have redeployed staff from ambulatory care, perioperative services, and Central Office to help our hospital teams manage the increasing volume of COVID-19 patients.
The System has also deployed extensive new data and analytics tools to plan for and respond to this surge. In addition to daily huddles with planning and logistics leadership, we have a regular Wednesday morning system-wide incident management briefing to share intelligence and plans for the week ahead. Weekly COVID-19 staff town halls, live webinars, extensive web content, and internal communications have been important to informing and engaging the workforce in this critical surge effort.
COVID-19 Vaccine — NYC Health + Hospitals began administering COVID-19 vaccine across all 11 of our acute-care facilities starting Wednesday, December 16th and quickly expanded vaccination efforts to include 7 NYC Health + Hospitals Gotham Health centers and 2 vaccination sites run by our NYC Test & Trace Corps. We expanded hours of operation to provide overnight appointments at our Gotham Health, Vanderbilt center on Staten Island, and in the mass vaccination sites at the Brooklyn Army Terminal and Bathgate locations. We are now preparing to open another mass vaccination site at CitiField soon.
But, as the Mayor and Governor announced last week, vaccine supplies have been dwindling. As a result, several vaccination centers across the City had to postpone appointments last week, including NYC Health + Hospitals facilities. We had to postpone some appointments for a few days through Tuesday of this week and are contacting those patients to reschedule. Thankfully we did get an additional supply that will allow us to bring back those patients and offer them priority slots for this week and next. But supplies are still limited and we can only plan week to week. We continue to prioritize vaccinations to our workforce and our most vulnerable patients over 65, and continue to offer second doses as scheduled.
We remain hopeful that this will be a temporary situation and that the State and Federal governments will coordinate efforts to allocate additional doses to our public hospitals and health centers so we can continue to vaccinate as many eligible people as possible, particularly the most vulnerable New Yorkers under our care.
NYC Test & Trace – With the help of the NYC Health + Hospitals Test & Trace Corps, New York City has performed more than 100,000 tests in a single day on multiple occasions. Our team of 4,000 contact tracers is reaching 85% of all new cases – more than any other jurisdiction we are familiar with across the country. Despite being in a second wave resurgence of cases, we’re completing interviews with 77% of all new cases, and 98% of cases that complete our intake, report having not left their home since they last spoke with us – some of our best metrics since the program began. In addition, the NYC Test & Trace Corps has opened two 24/7 COVID-19 vaccination sites – at Bathgate in the Bronx and in the Brooklyn Army Terminal.
Through November, the health system had a positive net budget variance of $269M (+5%), with patient care receipts exceeding the budget by $202 million. Remarkably, patient care receipts are $353 million better than last year due to increased patient acuity, higher rates, and the continued success of our revenue improvement initiatives. We closed November with $430 million cash-on-hand but took steps in December and January to strengthen our position and anticipate closing January with approximately $600 million cash-on-hand.
Medicaid Managed Care enrollment in MetroPlus and Healthfirst has increased by nearly 70,000 between January and September. This membership growth is driving a financial benefit of approximately $100 million through the risk pool improvements.
Consistent with our Memorandum of Understanding, the City has transferred approximately $310 million to support Test & Trace Corps spending commitments through November. The MOU has also been updated to include costs associated with vaccine distribution.
NYC Health + Hospitals has received $199 million in FEMA funds as an advance related to our initial submission of $650 million. A subsequent reimbursement package for temporary staffing is pending with FEMA, with a request for expedited approval. However, Senator Schumer and the Biden Administration have agreed that our costs will be covered at a 100% Federal matching rate, eliminating any cost sharing contribution the System would have to make.
The COVID-19 cost estimate associated with the first wave and subsequent response continues to be estimated at $1.6 billion. Through November, the System has paid out $1.4 billion. To-date, the System has received $1.2B in CARES Act Provider Relief Funds. We anticipate receiving an additional $46 million from the General Allocation Provider Relief Fund in the coming weeks.
MetroPlus Health Plan received five-star ratings for their Medicaid and Child Health Plus plans in the State Department of Health’s latest 2020 Plan Performance report, released earlier this month. MetroPlus earned the coveted 5-star rating by its membership in a number of categories and an overall rating of 5 stars, the highest possible score. More stars mean better health care. The health plan’s top ratings included 5 stars in the clinical areas of Cardiovascular Care, Diabetes Care, Child and Adolescent Care, and Adult Care. This is really great news to our more than 600,000 MetroPlus members and reflects an excellent network of providers who put quality and patient satisfaction first.
I approved a Declaration of Emergency dated March 1, 2020, which was subsequently updated and has been reissued through February 28, 2021. For the time period October 1, 2020 through December 31, 2020, the System entered into two new emergency agreements: one agreement for transportation services to move COVID-19 test kits to the testing sites throughout New York City on an as-needed basis, and one agreement for family support and child care services related to COVID-19. In addition, the Office of Facilities Development issued five work orders to continue facility infrastructure updates supporting critical care units and related services as well as for the three new COVID Centers of Excellence. These agreements and work orders have a maximum authorized spend of $22,628,319.