REPORT TO THE BOARD OF DIRECTORS - December 2020

Mitchell H. Katz, MD
NYC HEALTH + HOSPITALS
PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
December 10, 2020

CORONAVIRUS UPDATE

New COVID-19 Center of Excellence – NYC Health + Hospitals last month opened the first of three Community Health Centers of Excellence designed to meet the unique needs of patients recovering from COVID-19, including specialized services like pulmonary and cardiology care, radiology and diagnostic services, mental health services, and on-site access to medication. The new community health center is located in Tremont, Bronx, and will serve one of the hardest-hit communities. The road to recovery for some COVID-19 survivors will unfortunately be a long one, but NYC Health + Hospitals is investing in these new Centers of Excellence for New Yorkers who need us most and we are committed to helping address any lasting health impacts from this virus. The new health center will also offer comprehensive primary care services to the community, including cancer screenings, dental and vision care, diabetes management, podiatry, pediatrics care, and much more. The other two COVID-19 Centers of Excellence are slated to open in Bushwick, Brooklyn and Jackson Heights, Queens in the next few months.

COVID-19 Vaccine – As the Mayor and Governor announced this week, NYC expects to receive the first shipment of vaccines as early as this weekend. We don’t yet know the exact amount our health system will receive. NYC Health + Hospitals will follow Federal, State and City guidelines regarding who should receive the first doses, which will include nursing home residents and staff, and front-line health care workers who are at high risk of COVID-19. We hope that vaccines for patients at large will be here in early 2021 and we’ll be contacting our patients as soon as we have information about who can get it and when. Our vaccine specialists are in close communication with all public health authorities on the arrival and distribution of the vaccines, and are making preparations to ensure we are ready to offer vaccines to patients and staff as supplies become available.

NYC TEST & TRACE UPDATE

As NYC Health + Hospitals marked one million COVID-19 tests performed, and as we reached a peak of more than 80,000 tests daily, the NYC Test & Trace Corps expanded testing options and enhancements to address testing site wait-times. The additions include more rapid testing sites across the City, where there are in-person contact tracers to do “accelerated” contact tracing. We have also added more mobile units including weatherized vehicles to conduct testing through the winter, test sites at school locations and transit hubs, and real-time updates from testing locations, with more administrative staff and self-test kits offered to help alleviate wait-times. Locations, hours of operation and wait-times are listed on our health system website and the Test & Trace web page.

We continue to have high response rates with our tracing work. NYC Test & Trace Corps continues to reach 90% of all cases across NYC, and completing interview with more than three quarters of New Yorkers reached.

FEDERAL, STATE, CITY UPDATE

Federal – There is a significant amount of activity at the Federal level as we conclude the current Administration and transition to a new Administration and Congress. Federal funding is due to expire on Friday, December 11. The concluding Continuing Resolution includes a delay of the Medicaid DSH cuts that have been pushed back since their creation in the Affordable Care Act. As of today, it seems Congress is likely to authorize a one-week Continuing Resolution, pushing the expiration of government funding and DSH cut delay to December 18. This would allow additional time to negotiate a larger government spending package and a COVID relief package. There continues to be bipartisan support for delaying the DSH cuts, particularly given the ongoing strain of the pandemic.

At this point, there is not a clear direction for a larger COVID package. Though the HOUSE passed the HEROES Act, a $3 trillion package that includes significant support for healthcare, the Senate has not engaged on this bill. Senator McConnell has advanced a much skinnier $500 billion package, which does not include state or local funding or specific support for health care providers. There is also a $908 billion bipartisan package, which includes state and local funding, and which the Democratic leadership have advanced as a minimum package for negotiations. NYC Health + Hospitals continues to advocate for additional support, aid for state and local governments, a technical fix to a previous FMAP enhancement, increased FEMA funding, and regulatory flexibility through Zoom “Hill visits,” partnerships with other City agencies, and coordination with various hospital associations.

Meanwhile, President-elect Biden continues to fill out his Cabinet. Significant healthcare nominations include:

Health and Human Services Secretary*: Xavier Becerra, CA Attorney General
CDC Director: Rochelle Walensky, Chief of Infectious Diseases at Massachusetts General Hospital
Surgeon General*: Vivek Murthy, former Surgeon General in the Obama Administration

We will be sharing priorities with the Biden transition team and look forward to partnering with the new Administration.

State – The NYS Legislature will return to session on January 6, and we expect they will commence deliberations virtually. As a result of the election, a few of our facilities will have new representation in Albany. On January 19, the Governor is expected to release his State Fiscal Year Executive Budget. Given the state budget deficit, (~$14.9B), unfortunately we are expecting additional Medicaid cuts which will be harmful to the System. The federal relief package for state and local funding will affect the severity of these state cuts. We are working with the Legislature, and our community partners to fight against Medicaid cuts and ensuring a stable safety net system for the communities we serve.

City – The City Council recently held two hearings in which H+H participated: an oversight hearing on the COVID-19 vaccine on Friday, December 4; and an oversight hearing on Maternal Mortality and Morbidity in NYC on Monday, December 7. At each hearing, H+H experts partnered with DOHMH and other City colleagues in their responses.

STATE SURVEYS SKILLED NURSING FACILITY

After a 5 day-long survey by the New York State Department of Health, NYC Health + Hospitals/McKinney this month emerged with a perfect, deficiency free survey. This is a huge accomplishment by our dedicated team there, and good news for our residents, especially during the pandemic and the heightened and more in-depth survey process being conducted at long-term care facilities across the State.

FINANCE UPDATE

Through the first quarter of FY21, the health system had a positive net budget variance of $128M, substantially beating the budget. This included patient care receipts coming in $169 million higher than in the same period last year. Additionally, the System continues to implement Value-Based Payment, Managed Care, and Revenue Cycle Strategic Initiatives, generating over $100 million in the first quarter with a full-year line of sight of $370 million.

NYC Health + Hospitals has maintained strong, stable cash balances throughout FY21, ending September with $610 million cash-on-hand and November with approximately $400 million cash-on-hand. Medicaid Managed Care enrollment in MetroPlusHealth 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.

Federal Relief – 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. The COVID-19 cost estimate associated with the first wave and subsequent response continues to be estimated at $1.6 billion. Through October, the System has paid out over $1.2 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.

CONTRACTS, PURCHASE ORDERS AND WORK ORDERS

I approved a Declaration of Emergency dated March 1, 2020, which was subsequently updated and has been reissued through February 28, 2021. Summary reports of emergency procurements were provided at the April 30, 2020 and June 25, 2020 Board meetings. For the time period July through September 2020, the System entered into 9 new emergency agreements, for enhanced laboratory testing and to support the Testing and Tracing initiatives, and paid $26,513,628. The Office of Facilities Development issued an additional 23 work orders, principally to continue facility infrastructure updates supporting critical care units, emergency departments, HVAC systems, as well as the 3 new COVID Centers of Excellence, for a maximum authorized spend of $42,719,441. With these additional emergency agreements and work orders, and payments made during this last quarter for services provided earlier in the year, the System has now authorized a maximum spend for OFD-related work of $266,305,615 and has paid $856,338,119, to vendors for other contracted services, principally supplemental staffing, through September 30, 2020.