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REPORT TO THE BOARD OF DIRECTORS – September 2022

Mitchell H. Katz, MD
NYC HEALTH + HOSPITALS
PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
September 29, 2022

CORONAVIRUS UPDATE

COVID-19 hospitalizations are slowly declining after a small jump earlier this summer. Most cases remain incidental – as most are not admitted for COVID-19 related disease. Given that community transmission is still high in New York City, our health system continues to exercise various heightened screening and infection prevention protocols, and we continue to serve a vital role in the city’s overall response by ensuring access to testing, vaccination and treatment for all New Yorkers.

Updated COVID Booster Vaccine – The new booster is now available at our hospitals and Gotham Health Centers to all NYC Health + Hospitals patients and staff, and at seven vaccine hubs open to the public at large. The new booster is a “bivalent” vaccine, which means it is a new formulation that targets both the original COVID-19 virus as well as Omicron and its subvariants, BA.4 and BA.5. Similar to the way that the annual flu vaccine targets new strains each year, the updated COVID-19 booster should be more protective because it targets the variants of the COVID-19 virus currently circulating in the community. The CDC recommends the booster for everyone over the age of 12 and particularly people 60 and over and those who are immunocompromised, at least 2 months after your primary 2-dose vaccination series or their last booster. We are encouraging everyone – particularly our front-line health care staff and our vulnerable patients – to get the updated COVID-19 booster when eligible. People are still getting sick every day, and especially working in a health care setting, we have to do everything possible to protect our patients and our communities.

Telehealth Services Largest Prescriber of Paxlovid – Our virtual urgent care service, Virtual ExpressCare, has become the largest prescriber of Paxlovid in New York City. Our telehealth team has issued over 20,000 prescriptions for Paxlovid and 6,800 monoclonal antibody infusions to treat COVID-19, potentially preventing over 1,550 hospital visits and over 300 deaths. The NYC Health + Hospitals Virtual ExpressCare program was one of the first in the nation to offer telehealth visits to prescribe Paxlovid, making it easier for New Yorkers to access the medication and protecting the community by keeping COVID-19-positive individuals at home. In addition to COVID-19 services, Virtual ExpressCare provides urgent care for an array of concerns, including minor injuries, fever and flu, upper respiratory infections, anxiety, depression, and substance use issues. The service is available 24/7 in over 200 languages, and patients are connected to a healthcare provider in minutes. In July, Virtual ExpressCare began offering COVID-19 medication prescriptions statewide through the State’s new COVID-19 hotline, 888-TREAT-NY. In its first two months, the service has issued nearly 1,000 prescriptions to residents across the state. Virtual ExpressCare also prescribes Paxlovid via the city’s unique COVID-19 hotline, 212-COVID-19, and offers home delivery to patients in New York City coordinated by the NYC Department of Health and Mental Hygiene. Patients can access Virtual ExpressCare by going to expresscare.nyc or calling 631-EXP-Care (631-397-2273).

NYC Test & Treat Corps – Over the summer, the NYC Test & Trace Corps rebranded as NYC Test & Treat Corps to reflect our priority to provide New Yorkers fast, convenient, reliable testing with direct connections to life-saving COVID-19 treatments.  We expanded the country’s first-ever mobile “Test to Treat” program to over 30 units, and equipped our eight SHOW units that provide care to homeless New Yorkers. Since the mobile program launched, our mobile teams have tested more than 50,000 New Yorkers for COVID-19 and connected 1,500 New Yorkers to treatment with Paxlovid. We also presented Distinguished Service Certificates at a special ceremony at City Hall to half a dozen pharmacy partners who generously stepped up to support the health of their communities and were instrumental in our ability to get treatment to so many, so quickly.

This week, our At-home Test Distribution Program marked a milestone: we distributed 62 million free at-home tests to New Yorkers, approximately seven at-home tests for every City resident. The program’s network of over 1,200 distribution partners — which include City libraries, NYC Parks facilities, cultural institutions and community- and faith-based organizations — have established distribution sites in 88% of New York City zip codes, including all neighborhoods the City’s Taskforce on Racial Inclusion & Equity (TRIE) determined were hardest hit by the pandemic.

MONKEYPOX UPDATE

NYC Health + Hospitals continues to be a vital partner in the City’s response to the Monkeypox outbreak – as we support testing, vaccination and treatment. The NYC Department of Health and Mental Hygiene reported 3,500 cases and more than 110,000 vaccinations as of September 20.  Last month, the Centers for Disease Control announced that monkeypox vaccine should be injected intradermally instead of subcutaneously, and NYC Health + Hospitals nurses sprang into action to change their technique and refresh their skills. Subcutaneous injection goes into the fat of the arm, but intradermal injection goes right under the skin, requiring a much smaller dose. The result is four times the total number of doses per vial available for use. The challenge for our highly skilled nursing staff is that intradermal vaccine is not used often and requires a lot of practice and a steady hand. In fact, nurses are generally only familiar with intradermal technique from administering a TB test, which they do not do frequently. Our amazing nursing leadership developed an instant training module for Registered Nurses responsible for giving the vaccine.  The training was a great success and our nurses continue to offer monkeypox vaccine to eligible New Yorkers at four testing sites in our System. We also continue to offer the vaccine at mobile locations and in partnership with a number of community-based organizations.

PROVIDING ESSENTIAL SERVICES TO ASYLUM SEEKERS

Over the last several months, thousands of new asylum seekers have been bused here from Texas, where they had crossed the border to make new lives and found themselves unwelcome. The scope of medical and humanitarian need that unfolded right before our eyes triggered an immediate response from our City government partners. The NYC Health + Hospitals teams and our sister agencies—Mayor’s Office of Immigrant Affairs, Department of Homeless Services, the Department of Health and Mental Hygiene and NYC Office of Emergency Management (NYCOEM) —quickly moved into action.

Within days of the first arrivals, the NYC Health + Hospitals ambulatory care and population health teams set up on-site services at the Port Authority bus terminal and conducted triage to manage everything from hunger and dehydration to much more serious medical conditions and wound care. COVID-19 testing and treatment were administered on the spot. Children received a full physical and the vaccinations required to start school. One young woman was pregnant and so close to delivery when she arrived that she was whisked off to NYC Health + Hospitals/Bellevue where she delivered a healthy baby.  A Navigation Center was set up by the City to provide one-stop social, legal and medical services, and our teams managed mini-clinics there, providing care and access to medications. Our health plan, MetroPlus Health, has also been providing support by enrolling eligible adults into our affordable health plan and hosting resource fairs for the families.

As Mayor Adams announced last week, NYC Health + Hospitals and OEM will be operating the Humanitarian Emergency Response and Relief Centers scheduled to open soon to support the hundreds of asylum seekers who continue arriving in New York City each day. We will work with other City agencies and contracted vendors to coordinate a wide range of services. These humanitarian relief centers will become the first touch point for arriving asylum seekers, helping people by immediately offering shelter, food, medical care, casework services, and a range of settlement options including through connections to family and friends inside and outside of New York City.

The humanitarian relief centers will be expertly designed and built climate-controlled, safe spaces. On arrival, all asylum seekers will be provided with settlement options, as well as immediate health, safety, and legal information. Asylum seekers who do not or cannot find immediate housing will stay at the humanitarian relief centers for approximately 24 to 96.

I am very proud that NYC Health + Hospitals is stepping up to provide this additional support. It is moments like these when you see so clearly who we are and why it is so important that New York City has a robust public hospital system.

NYC HEALTH + HOSPITALS ADOPTS PLANT-BASED MEALS AS PRIMARY OPTION FOR PATIENTS IN PUBIC HOSPITALS

As Mayor Adams announced yesterday, NYC Health + Hospitals is adopting culturally diverse plant-based meals as the primary dinner options at NYC Health + Hospitals/Lincoln, Metropolitan, and Woodhull Hospitals. The dinner program expands on our successful plant-based lunch program that has been running in all 11 hospitals since March of this year and now boasts a 95 percent satisfaction rate. As the mayor said, this transformative program is already changing lives, empowering patients to take control of their own health and further cementing New York City as a leader in preventive medicine.

Each year, our health System serves about 3 million meals for lunch and dinner. Patients considered high-risk, those who are prescribed a special diet, or given a referral can meet with one of more than 100 registered dieticians in our health System to learn more about the benefits of a plant-based diet. There are 14 new plant-based options with a selection offered each day. The meals are inspired by the flavors of Latin, Asian, and other cuisines that represent the health System’s diverse patient population. These new recipes have been taste-tested and approved by many of our patients and staff. Thai noodle bowls, meatless sancocho, Spanish vegetable paella with yellow rice, and a Southern black-eyed pea casserole are just some of the new, “chef’s choice” options being offered to patients. Our Food Service Associates work with patients on meal choice and selection from the beginning of their stay until they are discharged, and encourage them to choose healthy meals as part of their healing and recovery plan of care. Non-plant-based options continue to be available and are offered in accordance with a patient’s prescribed diet

We plan to offer plant-based dinner options at all hospitals by this fall, offer plant-based supplements and tube feeds by the end of the year, and introduce the plant-based menu options to post-acute care facilities by January 2023.

 JUST HOME – OUR NEWEST HOUSING INITIATIVE

Just Home is a an innovative housing initiative on the NYC Health + Hospitals/Jacobi campus that will provide the City’s first permanent, supportive housing with wrap-around services for our medically complex, homeless patients after they leave jail. The project reached an important milestone on June 30, when the NYC Department of Housing Preservation & Development (HPD) selected the Fortune Society to serve as the developer, manager, and social service provider. Fortune will provide the intensive, on-site social services and coordinate medical care through Jacobi Hospital.

Our Correctional Health Services team, HPD, and Fortune have engaged local elected officials, community members, and other stakeholders in conversations about the project. As demonstrated by the press announcement we issued last month, the project resonates with key policy makers and progressive advocates working for affordable housing, social justice, and health care equity in New York City. I was pleased to see the New York Daily News publish my op-ed explaining why creating a Just Home for individuals with a history of incarceration and homelessness is a matter of health, housing, social justice and racial equity.  This evening, Jacobi Hospital will host the local community board – 11 – for a public briefing on the initiative. It is our mission at NYC Health + Hospitals to treat these individuals while they are in our care and to provide support that helps them successfully reenter their communities. We know that permanent housing for these individuals can save lives, improve health outcomes, reduce reliance on expensive emergency health care and hospitalization, reduce the likelihood of re-incarceration, and stabilize communities. Working with Fortune and HPD, we can provide some of our most vulnerable patients the opportunity to receive the dignified housing and high-quality health care they deserve.

EARNS MEDICARE SHARED SAVINGS FOR 9TH CONSECUTIVE YEAR

The NYC Health + Hospitals Medicare Shared Savings Program Accountable Care Organization (ACO) will earn $4 million from the federal government for reducing costs and meeting high standards of quality care for patients. Our health System’s ACO is one of 11 nationwide to earn shared savings over nine consecutive years and the only one in New York State with the distinction. The ACO achieves savings by supporting primary care providers and care coordination, which prevents unnecessary emergency department visits, avoidable hospitalizations, and other high-cost care for the more than 8,000 Medicare fee-for-service patients who are served through the program. For 2021, our ACO reduced costs for Medicare patients by $5.45 million and earned $4 million in shared savings. Since the ACO’s inception in 2013, it has saved Medicare over $72.7 million, resulting in earned shared savings and subsequent investment of approximately $39.1 million for NYC Health + Hospitals and our community partners. Value based care is central to our mission, and I am very proud of the providers and team members in our ACO who have helped us achieve this distinction – which is even more impressive considering all the disruptions in care caused by the COVID pandemic.

ALL 11 HOSPITALS IN NYC HEALTH + HOSPITALS SYSTEM EARN PRESTIGIOUS BABY-FRIENDLY ACCREDITATION

There is a reason thousands of New Yorkers choose to deliver their babies at NYC Health + Hospitals every year: our amazing doctors, nurses and other health care professionals are committed to providing exceptional care to new mothers and infants. And this year, that commitment has really paid off. All 11 public hospitals in our health System earned “Baby-Friendly” designation by the Baby Friendly Hospital Initiative, or BFHI. BFHI is an international program that advocates for breastfeeding and requires birth centers to have policies that enhance mother-baby bonding, offer optimal care for infant feeding and ensure a baby’s nutritional needs are adequately met. The program was launched in 1991 by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) to reinforce postpartum best practices and guidance to nursing parents. The process to become a “Baby-Friendly” hospital can be arduous and takes 4 years until the final designation, so this is really cause for celebration and recognition of all the hard work by our dedicated care teams. There is no greater foundation for safeguarding the public health, than making sure babies and new parents get the healthiest start in life possible. We could not be prouder of this designation and what it means to our overall mission. Approximately 20,000 babies are born at NYC Health + Hospitals every year, and we welcome and nurture every single family that needs and wants care during this exciting time of life.

OUR NEW DIGITAL FRONT DOOR

I confess that I am not a very digitally savvy person. I cannot work the TV remote without the help of my children, and I still text with one finger. But I do understand the importance of public websites, especially in the COVID era when people need information right away but may be reluctant to go in person. Last year, about 7 million people entered our digital front door and public website, nychealthandhospitals.org. Last month, we launched our redesigned website to give those millions of visitors a faster, more user-friendly experience so they can get the information and services they need to stay healthy. The “mobile-first” redesign is an important undertaking because we know, in our digital world, people rely on their smartphones and personal devices to connect with us. Some of the best features include:

  • A reengineered “Find a Doctor” and location finder helping visitors connect to our amazing providers in primary care and every specialty
  • A “Talk to a Doctor Now” button that links directly to our Virtual ExpressCare team for urgent care
  • Quick links to MyChart Click-to-call for an appointment through our call center
  • New homepages for each of our facilities, showcasing awards and unique services
  • Beautiful new photos of our patients and staff
  • Moving patient stories and video testimonials that will make you proud.
  • And, as always, our web content can be translated into more than 20 languages.

NYC HEALTH + HOSPITALS/ELMHURST MARKS 190th ANNIVERSARY

I was pleased to join CEO Helen Arteaga and the amazing team at NYC Health + Hospitals/Elmhurst as they marked the hospital’s 190th year of service to the community — 190 years never looked so good. Originally located on Roosevelt Island, the hospital was first founded as “City Hospital” in 1832. City Hospital was the first hospital in the country to reduce something known as “puerperal fever”, a disease that affected women right after giving birth, causing severe pain and often disability. Hospital staff also played a key role is treating patients afflicted by the 1918 flu epidemic. As New York City’s population grew after World War II, City Hospital relocated to Elmhurst, Queens. What we now know as NYC Health + Hospitals/Elmhurst was founded in 1957. The hospital today offers a myriad of services ranging from cardiology, urology, orthopedics, hand surgery, and the childbirth preparation technique known as Lamaze. The hospital recently ranked by US News & World Report as a High Performing Hospital in eight areas: congestive heart failure, chronic obstructive pulmonary disease, diabetes, heart attack, kidney failure, orthopedics, pneumonia, and stroke. Even at 190 years, Elmhurst Hospital is not the oldest in our historic health system. Here’s a look at how long all of our hospitals have been serving the people of New York City:

  • Bellevue Hospital: 286 years
  • Elmhurst Hospital: 190 years
  • Lincoln Hospital: 177 years
  • Kings County Hospital: 175 years
  • Coney Island Hospital: 147 years
  • Metropolitan Hospital: 147 years
  • Harlem Hospital: 137 years
  • Queens Hospital: 87 years
  • Jacobi Hospital: 67 years
  • North Central Bronx Hospital: 46 years
  • Woodhull Hospital: 40 year

EXTERNAL AFFAIRS UPDATE

The New York State Department of Health (DOH) finalized its 1115 Waiver amendment entitled NY Health Equity Reform (NYHER). The Amendment addresses health disparities and systemic health care delivery issues that have been highlighted and intensified by the COVID-19 pandemic.  DOH is seeking $13.52 billion over 5 years to implement the Waiver amendment. NYC Health + Hospitals was pleased to see some of our comments included in the final submission, and we commend these efforts to close the equity gap, which is fundamental to our work as the essential safety net provider. We will submit comments to CMS who will be negotiating the final aspects of the Waiver with DOH. We look forward to working with the State on implementing the goals and strategies of the Waiver.

NEWS AROUND THE HEALTH SYSTEM