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Mitchell H. Katz, MD
NYC HEALTH + HOSPITALS
PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
September 24, 2020

CORONAVIRUS UPDATE

COVID-19 vaccine trials – Our health system is involved in one vaccine trial and is planning to be involved in another – a phase 3 trial through the COVID-19 Prevention Network formed by the NIH/NIAID. We expect to have several of our hospitals participate and begin their work in early October. Our health system is in a unique position to partake in these trials for ensuring that such vaccines are safe and effective for our diverse populations. We are also involved in several multi-facility COVID-19 industry-sponsored treatment trials.

New COVID-19 Lab – This month the City opened the new Pandemic Response Lab (PRL), a facility dedicated to processing COVID-19 tests within 24-48 hours for NYC Health + Hospitals. Based in the Alexandria Center for Life Science in Manhattan, the lab is now up and running, and will scale up its capacity to process approximately 20,000 tests per day by November. As the need for testing across the country rises, PRL will build on existing capacity as part of the overall NYC testing strategy and provide faster results dedicated to serve the City.

Radiology – During the peak of COVID-19 pandemic, Radiology Services maintained full access for Emergency and In-Patient imaging needs, as well as essential services for Outpatient imaging. Thirty percent of our full time Radiologists were able to conduct readings remotely, which ensured undisrupted Radiology reporting coverage throughout the pandemic. Following ACR/ RSNA best practices, portable X-Ray modalities were used extensively to minimize the risk of infection/ cross-contamination. Many Radiographers worked cross sub-specialties — from Mammography to X-Ray — to ensure sufficient imaging capacity for urgent services. In recent months, Radiologypatient access has been quickly restored back at pre-COVID level, including services such as Diagnostic/ Screening Mammograms. A new Radiology auto-scheduling mechanism has been established in our electronic health record system, which will enable Telehealth providers to schedule exams directly during a virtual patient session. We have also consolidated Radiographer title structure so that imaging capacity can be maintained with improved recruitment and retention outcome.

Emergency Contract Declaration – The emergency Declaration for August and September remains the same as it has been during the pandemic response. It allows the execution of contracts outside of Operating Procedure 100-5. The scope is limited to contracts that are part of our COVID-19 response. Since the end of June, the declaration requires that for every new contract signed per the Emergency Declaration there be a sign off by the SVP General Counsel, the SVP for Procurement and the SVP Chief Financial Officer. During the last two months, the pace of contracting has slowed but is still substantial. Currently, the bulk of the contracts concern Test & Trace Corps and most recently our work to test students and staff in the public schools.

TEST & TRACE CORPS UPDATE

Exceeding Benchmark Goals – Nearly 80 percent of all positive COVID-19 cases are completing the City’s Test & Trace Corps’ intake, surpassing the program’s initial benchmark goals. To date, the program has also potentially prevented up to 15,000 new COVID-19 cases. Nearly three months since the program’s launch, COVID-related visits to emergency departments, case numbers, hospitalizations, deaths, and test positivity are at their lowest since the epidemic began. Contact tracers perform daily calls and conduct in-person visits as necessary. These calls allow tracers to gauge the progress of cases, ensure proper compliance with separation protocol, and connect patients to more supportive services as necessary. Today, 96% of all COVID-19 cases and 93% of contacts reported following isolation and quarantine requirements during their conversation with a contact tracer.

New Test & Trace Hotline – This month we launched a one-stop source for all things Test & Trace Corps. Our new COVID-19 hotline, 1-212-COVID19, can help New Yorkers find a testing location, get test results, connect with tracers, access free hotels to safely separate and much more. The hotline is available from 9 a.m. – 9 p.m. every day.

Priority Testing for School-Based Staff and Students -Testing is being prioritized for all DOE students (3K through 12th Grade), employees, employees of DOE contracted early childhood programs, and affiliated family child care networks, and employees of DOE- and DYCD-contracted Learning Bridges programs at 22 NYC Health + Hospitals testing sites during the 2020-2021 school year. We are also running a Situation Room – a dedicated information line to receive reports of COVID cases in schools and provide support to school administrators.

FINANCE UPDATE

NYC Health + Hospitals closed FY20 with $688M cash-on-hand, beating our initial target of $600M, and closed August 2020 with nearly $500M cash-on-hand. We finalized our three-phased budget strategy for FY21 in August. The final budget includes systemwide initiatives and facility specific business plans tailored to meet the needs of the community. The major themes of systemwide initiatives include continued move to Value Based Payments, implementation of initiatives endorsed by the MRT II, and increasing access to telehealth services in a post-COVID-19 environment. Consistent with our Memorandum of Understanding, the City has transferred nearly $150M to support T2 spending commitments to-date and will continue to provide funds in line with our spending.

Federal Relief – NYC Health + Hospitals has received $199M in FEMA funds as an advance related to our initial submission of $650M. Our revised FEMA cost estimate could reach an estimated $1.6B and will be submitting these revised estimates to FEMA. The change encompasses the increased scope that the system undertook including setting up the field hospitals and higher-than-anticipated contracted staffing commitments for nursing and respiratory therapists due to greater levels of staff absences and higher patient volume.

POST-ACUTE CARE UPDATE

Newsweek Recognition – Congratulations to our Post-Acute Care sites – NYC Health + Hospitals/Sea View, Gouverneur, Coler and Carter — for earning Newsweek’s Top Skilled Nursing Facilities list in America.

New Services – Den dialysis has opened at Coler and Carter Skilled Nursing Facilities. Sea View, Gouverneur and McKinney are in the planning phase to establish onsite den dialysis and telemetry units. These services will improve the quality of life for our residents, eliminate transportation costs to and from dialysis, and will have a positive impact on reducing unnecessary re-hospitalization.

New Bed Capacity – Based on post-acute COVID-19 demands, we opened 21 additional short-term beds at NYC Health + Hospitals/Gouverneur. These patients are expected to return to the community. Today, Gouverneur is now at full census serving 295 residents each day.

HEALTH SYSTEM NEWS

MetroPlusHealth Membership Grows by 10 Percent

Since January through August 2020, MetroPlusHealth Health total membership grew by more than 55,000 members to 568,289 — an increase of 10.8%. Growth was spurred by the pandemic, which not only increased the need for health insurance and the pool of eligible New Yorkers, but also resulted in relaxation of a number of state regulations which made it easier to enroll and stay enrolled in our health plan. Among the regulatory changes implemented that positively impacted our enrollment were: a moratorium on disenrollment from Medicaid plans, an extension of grace periods, and waiving of the member portion of the premium for those with subsidized payments. In addition, MetroPlusHealth’ adoption of online and telephonic enrollment, coupled with a digital and TV marketing strategy to reach consumers where they lived, helped drive consistently robust enrollment throughout the COVID crisis. Growth was strongest in Medicaid, QHP, and the Essential plan.

ACO Achieves Shared Savings for 7th Consecutive Year

On September 15, CMS released 2019 performance results for the Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP). For the seventh consecutive year, the NYC Health + Hospitals ACO earned shared savings—reducing avoidable costs of care while sustaining high quality care for our patients. Since the ACOs inception in 2013, it has saved the Medicare program over $51.5 million, resulting in earned shared savings and subsequent investment of approximately $23.7 million for NYC Health + Hospitals and our community partners. For 2019, the ACO reduced costs for its Medicare patients by $7.8 million, of which it earned $4.62 million in shared savings (this compares to $2.96 million in 2018). The ACO also received a 92.17% overall quality performance score (this compares to 83.39% in 2018). The ACO scored highest in the Preventive Health domain and for the first time we had a significant reduction in Ambulatory Care Sensitive Admissions and All-Cause Readmissions.

Flu Vaccination Campaign Kicks Off Early This Season

With COVID-19 still posing a threat, it is likely that flu viruses and the virus that causes COVID-19 will both be spreading, making it more important than ever that all health care workers get a flu vaccine. We have begun to offer all NYC Health + Hospitals staff free flu vaccinations to protect themselves, their families, our patients and community. This year, we started and employee vaccination effort earlier than usual and will aggressively promote flu shots to both front line providers and others not directly involved in patient care like clerical, housekeeping, laundry, security, maintenance, and billing staff, as well as volunteers. It is imperative that everyone who works in NYC Health + Hospitals is vaccinated against the flu. Getting a flu vaccine this fall will reduce our risk from flu and also help conserve potentially scarce health care resources. We need to be at our healthiest so that we can together take care of our most vulnerable. Of course, we also begun to offer flu vaccinations to all our patients and have created multi-lingual education materials to reinforce the importance of this year’s flu vaccine.

Helping Everyone Count

Our health system staff have been partnering with the city and community groups to help promote two important initiatives – the 2020 census and voter registration.

There are 7 days remaining to fill out the 2020 U.S. Census — critical for making sure our city, our health system, and our communities get the government funding they deserve. The census determines whether New York City gets its fair share of more than $650 billion in federal funds for healthcare, public education, affordable housing, job training programs, senior centers, and infrastructure. And no one stands to benefit more from these government programs and thoughtful representation than many of the patients under our care. It’s no surprise that the undercounted become the underserved. Our efforts to distribute multi-language education material and encourage everyone in the NYC Health + Hospitals family can help ensure everyone gets counted.

The deadline for voter registration is October 9. NYC Health + Hospitals is providing nonpartisan registration assistance in our Emergency Rooms under the leadership of ED residents who are very passionate about getting out the vote and are working in collaboration with the national VotER initiative. Our teams are also sponsoring voter registration and education events, and outreach through our valuable Community Advisory Boards. We are proud of this important community work and will continue to support it in the coming weeks.

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