Staten Island Public Meeting | NYC Health + Hospitals

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Staten Island Public Meeting

Annual Public Meeting Staten Island
Monday, April 4, 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 for giving me the chance to share our plans for a bright health care future on Staten Island.

Your attendance demonstrates a level of interest and commitment that makes ours the strongest public hospital system in the country. And we offer you our deepest thanks for that.

Let me begin this evening by saying that I believe one of New York City’s proudest traditions, is 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 ferry…
    … 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 safety net, health care provider for more than 1.2 million New Yorkers, including nearly ten thousand Staten Islanders, annually. We are also the safety net for all other hospitals in the metropolitan area who depend on us to care for 1.2 million patients each year, 475,000 of them uninsured.

So it’s not just empty rhetoric when we call the public hospital system “essential”. New York couldn’t operate without us. And, we are providing more care for Staten Islanders than ever before. Between 2013 and 2015 the number of patient health care visits provided to Staten Islanders grew by 7%. In a moment I’ll discuss some of the initiatives we have underway to build a healthier Staten Island.

But first, let me say a few words about NYC Health + Hospitals/ Sea View- – -the award-winning, skilled nursing and long term care facility that hosts us tonight.

We are exceptionally proud that for each year since 2008, Sea View has earned a FIVE STAR rating from the Federal Center for Medicare and Medicaid Services.

And Sea View has maintained its five stars despite sweeping changes to the evaluation process over the past several years.

Its 24-hour medical and nursing care is at the forefront of best practices for improving health outcomes and quality of life for its residents.

Just last month the American Medical Directors Association awarded the 2016 Quality Improvement and Health Outcome Award to Sea View for its work to reduce the use of Antipsychotic medication in the care of patients suffering from dementia.

And earlier this year, the American College of Health Care Administrators (ACHCA) awarded the prestigious Eli Pick Facility Leadership Award to Sea View for its high performance.

By any yardstick, this is an impressive track record. So I’m glad to have this opportunity to thank Angelo Mascia and his leadership team for the great work being done here.

Looking beyond Sea View however, NYC Health + Hospitals is fundamentally committed to building a healthier Staten Island by transforming the way we deliver care in Staten Island.

We are moving from the old model of providing 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 on Staten Island, because the disease burden here is too high:

According to The New York City Department of Health and Mental Hygiene’s 2015 Community Health Profile, Staten Islanders suffer from higher rates of smoking addiction than other New Yorkers.

DOHMH found that hospitalization for diabetes in parts of the borough is 33% higher than for the city overall, as is the rate of adult psychiatric hospitalizations.

The Borough President’s office has identified high levels of heart disease, chronic respiratory disease, obesity and diabetes as significant problems on Staten Island.

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 the residents here. We will only succeed by focusing not on sick care, but instead on primary care. That is how, patient by patient, we will build a healthier Staten Island with our partners.

Our two very active Neighborhood Health Centers spearhead our efforts to offer Staten Islanders more preventive health, more chronic disease management and more specialty care.

The Mariners Harbor Family Health Center and The Stapleton Children’s Health Center. Each provide a full array of primary care services for both adults and children, including:

  • Health screenings for Adults and Children
  • Physicals,
  • Maternity care
  • Well-baby care and
  • Pediatrics
  • Women’s health services
  • And adolescent health services – – –
    – – – Where we are doing a great deal to offer care that meets the needs of today’s young people. Adolescents can ask for a confidential visit when making an appointment. We offer sexual and reproductive care including birth control, treatment for STDs, HIV testing, and pregnancy testing.
  • Our Neighborhood Family Health Centers also provide mental health services for children, adolescents and adults.
  • And we offer the widest array of services aimed at managing chronic diseases including:
  • Heart care,
  • Diabetes care
  • Asthma Care
  • We excel at geriatric specialties entailing the most advanced senior care
  • And we help with smoking cessation and weight management.

At the same time Our MEDICAL MOBILE VANS are offering Staten Islanders clean, comfortable care environments, with the same level of privacy, advanced technology and compassionate care that our patients receive at neighborhood health centers.

Our vans provide:

  • Adult primary care
  • Diagnostic tests
  • Electro-cardiology
  • Family planning
  • Health education
  • HIV counseling and testing
  • Substance abuse screening
  • Women’s health services
  • Cholesterol screening
  • Hypertension (high blood pressure) evaluations
  • Vision tests
  • Dental screening
  • Nutritional counseling
  • HIV education
  • And drug and alcohol treatment referrals.

But care itself isn’t the whole picture.

Knowledge, understanding and cultural responsiveness is just as important to accomplishing our mission of empowering Staten Islanders to live their healthiest lives possible. That’s why we are prioritizing learning as much as we can about the communities we serve.

We are paying close attention to the latest data from community needs assessments like those completed here in Staten Island last year, to better target our care. This enables us to understand the real needs of the patients and communities we serve, and to match our responses to what is needed and to what is most effective.

This is how a collaborative health care system can be developed.

So, if more diabetes treatment is needed in a certain area, then we will work harder to investigate this and to act on it. If more HIV Testing is needed, then we are committed to enhancing that service.

Our transformation involves knowing the communities we serve much better, and acting on that knowledge. Because wellness depends on our health care system being out in the community.

That’s why we place such a priority on partnering with community providers, local advocacy organizations, and especially with our patients.

But the cornerstone of our commitment to expanding access and transforming health care here on Staten Island is the beautiful, 18,370 square foot, state-of-the-art ambulatory care center we are building on Vanderbilt Avenue.

We are currently completing the design process. And we hope to break ground on the foundation this summer, with our target date for opening in autumn of next year.

When completed, the new center will include 24 exam rooms, and will offer full adult and child primary care services including:

  • OB-GYN
  • pediatrics,
  • adult medicine,
  • podiatry,
  • cardiac care
  • ear, nose and throat,
  • ophthalmology,
  • Mammography and ultra sound.

We are convinced that this great new center will have a positive impact on delivery of primary care here.

We anticipate that it will mean up to 48,715 new patient visits annually.

And when we cut the ribbon next September we will be enormously proud to open the newest and largest ambulatory care center on Staten Island, with the widest expanse of services.

We are grateful for the support of the City Council, especially Council Member Debi Rose, and former Council Member Mike McMahon, the legislative delegation and Borough President James Oddo for their help in moving the project forward.

I’d also like to take a moment to applaud efforts to place a healthy Staten Island at the top of the Borough’s policy agenda.

I was delighted to join Borough President Oddo last year at a Walk with a Doctor event in Silver Lake Park. This was a perfect way to get the word out that walking is a great entry for people to begin exercising and thinking about health.

We need more efforts like these to build a healthier Staten Island, because we are more focused than ever before on teaching people how to live healthy.

We are also committed to working closely with the Borough President and the New York City Economic Development Corporation to explore the visionary proposal to build a wellness complex here at Sea View’s campus.

Over the next year we look forward to continuing discussions on whether this outstanding site, with its senior housing and proximity to public transportation, might be the right location for a synergistic health care and social services hub- – –

– – -a Medical Destination Center that could offer the widest range of health care services, from pediatrics to geriatrics.

Meanwhile, our momentum to expand access to health care here is building:

We are moving aggressively to get insurance to our patient population. Because, as soon as people have insurance, they start getting care…

…care without any stigma attached.

Care that will encourage Staten Islanders to better address and monitor their health concerns- – -often for the first time in many years.

We took an important step in January, when the State approved availability of our low cost, high-quality Metro Plus health insurance plan to Staten Island residents.

Now, any Staten Islander can enroll immediately in MetroPlus plans, including the new Essential Plan with premiums as low as zero to twenty dollars per month.

We are very excited about being able to offer Staten Islanders a health insurance option for quality care which is both accessible and affordable in every neighborhood. Just recently we have made agreements with both Staten Island University Hospital (SIUH) and Richmond University Medical Center (RUMC) to bring their medical facilities into our Metro Plus Network.

And we are pleased that in the few weeks it’s been available here, nearly 1,000 Staten Islanders have enrolled in Metro Plus.

Another pillar of our commitment to a healthier Staten Island is our deep involvement in safeguarding the health of its many vulnerable populations.

We believe health care is a civil right, and human right, and if it was up to me, a constitutional right. That’s why our caregivers act as fierce advocates for the health rights of seniors, Latinos, West Africans, members of Staten Island’s LGBT communities, and so many others. We fight for the health rights of immigrants—like myself. We are nurturing strong alliances with community based providers and organizations like the Staten Island Family Health Coalition and Project Hospitality.

And we hope to partner with the local Federally Qualified Health Center, SIUH and RUMC, as well as the Community Health Center of Richmond to meet the needs of patients suffering from chronic health conditions, substance abuse, smoking addiction and alcoholism.

We are also reaching out to partners to address the lack of available mental health services here.

And we recognize that complimenting the services already available on Staten Island, rather than duplicating them, is key to making our dream of a comprehensive primary care network on Staten Island, a reality.

So, there’s really a lot of exciting activity happening at the moment to improve the quality and accessibility of health care to Staten Islanders.

But let me pivot away from our 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 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 by the Act’s provisions, the level of federal funding for health care for the uninsured is to be reduced also.

Unfortunately, political horse-trading involved in getting the ACA through congress, resulted in the final bill excluding undocumented people.

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. Approximately 475,000 uninsured men and women came through our doors in 2014.

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 and extending through 2025. These federal cuts are creating a significant funding gap for Health + Hospitals – 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- – -these folks now have insurance because of ACA. 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 to the national healthcare delivery system 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, finding more efficiencies within our system, and 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, staff, 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, 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 and others are well on their way to meet our goals for 2017.

The second 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.

And as I touched on a moment ago, the centerpiece of our effort to expand access here on Staten Island will be the big health center we will open next year on Vanderbilt Avenue.

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 factors that impact our patients’ health, like

  • secure housing
  • access to transportation and education
  • availability of nutritious food
  • eligibility for government benefits

Problems our patients have in these non-medical areas undermine their health. These non-medical problems create barriers to care.

That’s why we are concentrating on building partnerships with other social service providers across the spectrum:

  • to create more affordable housing
  • to make legal assistance available to our patients right in our hospitals
  • to encourage green markets in the neighborhoods we serve. As catalysts for positive social change, 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, I am convinced that our 2020 vision will result in more access and better, more comprehensive care. By building a stronger, more efficient, more competitive public system, we will be better positioned to accomplish our mission. Better able to meet and exceed patient expectations. Better able to be there for our patients – now and far into the future.

With strong community interest and support like we see here tonight, we will act together…together to bring about the fundamental transformation in health care delivery here- – -Healthcare Nirvana is what I sometimes like to call it- – – that all residents of Staten Island deserve.