REPORT TO THE BOARD OF DIRECTORS – July 2023

Mitchell H. Katz, MD
NYC HEALTH + HOSPITALS
PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
July 27, 2023

RESPONDING TO THE HUMANITARIAN CRISIS – SERVICES FOR ASYLUM SEEKERS

NYC Health + Hospitals remains steadfast in its commitment to helping asylum seekers find a better life, and our Humanitarian Emergency Response and Relief Centers (HERRCs) are a cornerstone of the city’s response to this unprecedented crisis. To meet the demands of housing the burgeoning asylum seeker shelter population, this month our health system assumed administration of another humanitarian center at the Crown Plaza Hotel near JFK Airport. In addition, we will soon open a HERRC tent facility outside the grounds of the Creedmoor Psychiatric Center in Queens with room to accommodate 750 to 1,000 adults.

To date, humanitarian centers have provided a place to stay and compassionate, comprehensive support for 16,000 people currently in our care. These facilities provide asylum seekers and their children a one-stop concentration of services, including medical care, nutrition, language access, mental health support, school enrollment, social programs, technology, and reunification resources. HERRC staff have administered over 26,000 vaccinations to asylum seekers and enrolled over 13,000 people in health insurance.

Our 13 humanitarian centers are a model of success and a pillar of the city’s network of over 192 shelters and respite sites. The city’s shelter system currently has over 56,000 people in its care, and has provided services to over 93,000 asylum seekers since last spring.

NYC HEALTH + HOSPITALS STATEMENT ON ANTI-RACISM AND NONDISCRIMINATION

Structural racism is an increasingly recognized national problem. NYC Health + Hospitals acknowledges that structural racism is a major barrier to equitable health care, which is an NYC Health + Hospitals core value.

In addition, NYC Health + Hospitals recognizes that structural racism – the way in which society fosters racial discrimination through systems of housing, education, employment, criminal justice, and other institutionalized practices – has been a significant factor in creating health care disparities seen in the United States, as evidenced among indigenous peoples and populations of color. These disparities include higher death rates, shorter life spans, and poorer outcomes in the face of chronic diseases.

Therefore, NYC Health + Hospitals reaffirms its mission of identifying opportunities to reduce racism’s impact in clinical care, education and training, professionalism, staff development, staff engagement and in provider and staff recruitment. Additionally, NYC Health + Hospitals commits to actively promoting social justice, challenging discrimination, and continuously monitoring diversity and inclusion efforts.

NYC Health + Hospitals aims to contribute to a health care landscape and workforce environment free of discrimination or bias on the basis of race, color, national origin, alienage or citizenship status; religion/creed; gender identity, disability; age, pregnancy; criminal record, marital status; genetic information; sexual orientation; veteran/military status; status as a victim or witness of domestic violence; weight, height, and/or any other protected class covered by federal, state and/or local anti-discrimination laws. Join us as we continue on a path towards our destination of equity.

NYC HEALTH + HOSPITALS AMONG AMERICA’S MOST SOCIALLY RESPONSIBLE HEALTH CARE PROVIDERS

I am pleased to report that the health system and all our hospitals performed very well on the national index of most socially responsible hospitals in America. The Lown Hospitals Index for Social Responsibility, published by the nonprofit think tank, reviews 3,600 hospitals across the country and it’s the only annual ranking to fully integrate racial inclusivity, community investment, and pay equity with traditional outcomes measures. Medicare Advantage claims have been included for the first time, further distinguishing the Lown Index from other platforms in terms of scope and validity.

As a health system we ranked at the top of all the categories nationwide:

#2 for Health Equity – for strong performance across metrics of community benefit, pay equity, and inclusivity
#3 for Pay Equity – the difference in compensation of hospital executives compared to health care workers with advanced degrees
#5 for Community Benefit – financial assistance spending, service of Medicaid patients, and investing in community health needs

Our individual hospitals also earned high rankings at the national and state level:

Jacobi Hospital ranked #1 in the country for avoiding overuse of test and medical procedures that offer little or no clinical benefit
Metropolitan Hospital ranked at the top as America’s most inclusive hospital, a category that measures the extent to which patients being served are demographically similar to those in the surrounding community. The hospital is also #1 in NY State for Health Equity, Inclusivity, and Racial Inclusivity.
Bellevue Hospital is #1 in NY State for Community Benefit and top 10 in the nation in the same category. It is in the top 5 in NYS for Health Equity.

Harlem Hospital ranked in the top 5 in NY State for Social Responsibility, Pay Equity, and Racial Inclusivity.
Lincoln Hospital is in the top 5 in NY State for Health Equity, Community Benefit, and Inclusivity.
Queens Hospital is in the top 5 in NY State for Racial Inclusivity
South Brooklyn Health is #1 in NY State for Pay Equity.
All our hospitals earned an ‘A’ grade in at least one category of equity, value and outcomes.

NYC HEALTH + HOSPITALS EXPANDS BEHAVIORAL HEALTH WORKFORCE WITH 50 PEER ACADEMY GRADUATES

NYC Health + Hospitals this month celebrated our Peer Academy graduation where more than 50 New Yorkers with lived experience with mental health or substance use conditions trained to become peer counselors. Peer services are a critical part of the behavioral health care that we provide to our patients. Peer counselors are able to connect with traditionally hard-to-reach patients by sharing their lived experience to help others cope and recover. They are living proof that recovery is possible, and they are highly adept at inspiring hope for those that they serve. We have more than 80 peers on staff across the system, the largest hospital-based peer workforce in the city. In addition to the self-directed hours required for State certification, the program includes six weeks of classroom training and a six-week, full-time, hospital-based internship with rotations in the inpatient mental health unit, emergency department, and mobile crisis teams. Peer Academy staff work with the students to help them find and maintain employment for up to six months after graduation. An increasing number of the students are former NYC Heath + Hospitals patients who were referred by clinicians throughout the system, and are in recovery yet have very limited work histories. There is huge interest in participating in the program, as it is a job that can fill someone’s life with meaning and purpose.

NYC HEALTH + HOSPITALS/CORRECTIONAL HEALTH SERVICES OPENS REENTRY SERVICE CENTER, PROVIDES FREE SMARTPHONES TO VULNERABLE NEW YORKERS LEAVING RIKERS

Our Correctional Health Services (CHS) team this month opened the first-ever reentry service center on Rikers Island. The CHS center will serve as a resource hub for the hundreds of people who are released from Rikers each year, as well as members of the public who are visiting incarcerated loved ones and individuals who work with people in the City’s custody. The center will be staffed by CHS reentry liaisons, who can help connect formerly incarcerated individuals to community-based health and social services and can provide naloxone training and kits and fentanyl test strips to all visitors. The center will be open Monday through Friday, 8 a.m. to midnight. To mark the opening, CHS teamed up with Premier Wireless Business Technology Solutions to provide free smartphones and wireless plans to clinically vulnerable New Yorkers immediately upon their release from jail. The smartphones and service plans will help former CHS patients who have significant medical and mental health needs to remain engaged in health care and to stay connected to loved ones as they return to the community.

NYC HEALTH + HOSPITALS EXPANDS STREET HEALTH OUTREACH & WELLNESS PROGRAM TO SERVE UNSHELTERED QUEENS RESIDENTS

NYC Health + Hospitals/Elmhurst launched a Street Health Outreach and Wellness (SHOW) mobile unit to provide comprehensive healthcare services and social supports for residents of the Queens community who are unsheltered or living on the street. The SHOW program leverages the mobile medical model our health system pioneered during the COVID-19 pandemic and our principles of patient-centered care and harm reduction to serve New Yorkers in need. The SHOW van is staffed by a comprehensive, patient-centered team of mental health and wellness staff, including a registered nurse or nurse practitioner, social worker, addiction counselor and community health worker. Our system wide SHOW program deploys a fleet of eight mobile health units across New York City to meet people historically disconnected from a continuum of care where they are, engage them, and invite them in for care without appointments, cost, or other barriers. Patients are assessed for care needs, and provided services including wound care, substance use treatment referrals, connections to primary care, snacks and hygiene supplies. Since the program’s launch in April 2021, SHOW teams have performed over 216,000 engagements with New Yorkers, providing nearly 90,000 COVID-19 tests, 21,000 medical consultations, 9,000 vaccinations, and 60,000 social work engagements.

NYC HEALTH + HOSPITALS RECOGNIZED BY THE AMERICAN HEART ASSOCIATION FOR QUALITY CARE

All 11 public hospitals in our health system were again recognized by the American Heart Association for their commitment to science-based practices and exceptional quality care in heart failure, heart attack, stroke, diabetes, and resuscitation. Every 40 seconds, someone in the U.S. has a stroke or heart attack, and heart disease and stroke are the No. 1 and No. 5 causes of death in the United States, respectively. Studies show patients can recover better when providers consistently follow treatment guidelines. Our hospitals earned these recognitions by meeting specific quality achievement measures for the diagnosis and treatment of heart failure and stroke patients, which includes evaluation of the proper use of medications and aggressive risk-reduction therapies. Before discharge, patients also receive education on managing their heart failure and overall health, and receive other care transition interventions.

NYC HEALTH + HOSPITALS/JACOBI TO EXPAND COMPREHENSIVE ADDICTION TREATMENT CENTER IN THE BRONX

NYC Health + Hospitals/Jacobi was awarded $660,000 by Governor Kathy Hochul, the Office of Addiction Services and Supports (OASAS), and the New York State’s Opioid Settlement Fund to expand the hospital’s Comprehensive Addiction Treatment Center for New Yorkers experiencing substance use disorder. The funds enhance the array of services offered at the center, which include individual and group therapy, medication assisted treatment and support.

NYC HEALTH + HOSPITALS/SOUTH BROOKLYN HEALTH RECEIVES PRESTIGIOUS NURSING AWARD

NYC Health + Hospitals/South Brooklyn Health Emergency Department (ED) nurses are the first in our health system’s history to receive the prestigious Emergency Nurses Association (ENA) Lantern Award. With over 50,000 members worldwide, the ENA’s mission is to advance excellence in emergency nursing, and believes in core values of: collaboration; compassion; diversity and inclusion; excellence; a culture of inquiry, honesty, and integrity; and a spirit of philanthropy. The award recognizes nursing excellence in areas of leadership, practice, education, advocacy and research. Our nurses at South Brooklyn Health are instrumental in providing compassionate and life-saving care while responding to more than 76,000 emergency visits every year.

NYC HEALTH + HOSPITALS/SOUTH BROOKLYN HEALTH MIDWIFERY PROGRAM REACHES MILESTONE WITH 20,000 BIRTHS

NYC Health + Hospitals/South Brooklyn Health reached a significant milestone with its 20,000^th midwifery birth. Baby Girl Ali entered the world on Thursday, July 6 at 4:37 a.m., under the watchful eyes of our certified nurse-midwife — Patrina Royes. The occasion marks the hospital’s commitment to improving maternal and infant health outcomes in South Brooklyn and surrounding communities. Midwives have been part of South Brooklyn Health’s care delivery team since 1982, and remain an integral component in our pursuit of delivering high-quality maternity care, including the elimination of intractable racial disparities in maternal health for Black and Hispanic women. In 2022, South Brooklyn Health had over 1,200 births, with midwives being responsible for nearly one-third of all births.

FINANCE UPDATE

The last Finance Committee meeting of the Board was held on July 10^th where we shared more details about our recent financial highlights. The system closed June with approximately $745 million – 30 days cash-on-hand. Through April, the system has a negative Net Budget Variance of $200 million (-1.4%). Direct Patient Care Receipts (Inpatient and Outpatient) were $3 million lower than the same period in FY22due to lower IP UPL Conversion in FY23 at this point in the fiscal year. Patient care volume in FY23 has returned to pre-COVID levels, and is 8% ahead of FY20 in OP visits. Revenue base remains strong and resilient primarily driven by returning volume and higher average collectability rate over the base. Overall, our strategic Financial Initiatives remain on track generating over $655 million through. April of FY23 with a line of sight that meets our FY23 target of $675.6M. Areas of strongest net performance as of April include value-based payment initiatives and managed care initiatives ($281 million), revenue cycle improvements ($207 million), and growth & service line improvements ($145 million).

EXTERNAL & COMMUNITY AFFAIRS UPDATE

Federal – Both the House and Senate continue to discuss Site Neutral policies that could negatively impact hospitals. Congress is also considering workforce investments and delaying the DSH cuts slated for later this year, but these cannot be paired with cuts to hospitals. Our health system continues to advocate to our Congressional delegation about these important priorities.

State – Few workforce related bills that our health system for have been signed into law, including a bill that modernizes the restricted clinical laboratory license bill to allow individuals holding the license to perform all molecular test, and a bill that expands the use of certain non-patient-specific standing orders that registered nurses can administer. We thank Assemblywoman Nily Rozic for securing $1 million dollars in state funds to upgrade the Hugs Infant Security and Protection System at NYC Health + Hospitals/Queens.

City – The Mayor and City Council agreed on City’s FY24 budget on June 29^th, which is approximately $107B. As part of the budget, our health system received $80.6M in capital awards, which breaks down as follows: $59.6M from City Council, $3.2M from Borough President, $2M in Mayoral Funding for Medical Equipment, and another $15.8M from Borough President.

Community Affairs – We hosted our annual Marjorie Matthews Awards Celebration to recognize members of our Community Advisory Boards and Auxiliaries for their service and important role in our communities. We are coordinating with CMS to host 5 Health Insurance Symposiums in the fall. Workshops will focus on Medicare, Medicaid services, recertification, NYS of Health, HRA, NYC Care – and will be open to staff and community partners. Another workshop – for staff – will focus on Medicare Billing and Reimbursement with the Medicare Administrative Contractor. We will announce more details as they are finalized.

CONTRACTS

Since my last update to you regarding our asylum seeker contracting response, we have had the following additional contract actions:

An extension of the food services contract with LIC Com, LLC (an NYC MBE) through December 11, 2023 for an amount not to exceed $217,050,560.
An extension of the food services contract with Rethink Food NYC Inc. through August 1, 2023 for an amount not to exceed $138,337,296.
An amendment of the medical triage services contract with Rapid Reliable Testing NY, LLC to expand the scope of work to include social and casework services and CDI and ASL translation services, as well as to extend the term of the contract through March, 26, 2024 for an amount not to exceed $310,586,338.
To house single adult male migrant asylum seekers, the rental of 320 West 31st Street for one year from June 7, 2023 to June 6, 2024 for an amount not to exceed $8,213,700.
To house single adult male migrant asylum seekers, the rental of 37-11 35th Avenue, Astoria for one year from May 17, 2023 to May 16, 2024 for an amount not to exceed $1,015,155.
A renewal of our existing lease of the Stewart Hotel to house the families of migrant asylum seekers for three years through June 6, 2026 but the agreement may be terminated on or after December 6, 2024 for a cost not to exceed $158,070,221.
To house the families of migrant asylum seekers, the rental of dorms owned by the American Musical and Dramatic Arts School on 117 West 70th Street and 205/207 West 85th Street, sometimes known as the Stratford, for three years from June 12, 2023 to May 31, 2026 but the agreement may be terminated on or after January 11, 2025 for an amount not to exceed $109,010,880.
To house the families of migrant asylum seekers, the rental of dorms located at 1760 Third Avenue for 11 months from June 27, 2023 to April 30, 2024 for an amount not to exceed $30,190,062.
To house single adult male migrant asylum seekers, the rental of 47 Hall Street, Brooklyn for a period of 18 months commencing upon the completion of certain construction at the property projected to occur September 15, 2023 which would put the expiration of the lease at approximately March 14, 2025 for an amount not to exceed approximately $45,000,000. This project has the potential to include more floor area and to be as long as 7 years but the expansion or extension are required to be coupled with a take over of the project from H+H by DCAS.
To house the families of migrant asylum seekers, the rental of the Crown Plaza at JFK Hotel, for three years provided that the agreement may be terminated after one year for an amount not to exceed $72,659,916.

I would also like to note that all of the services being provided to the HERRC hotels are undergoing an RFP process to ensure we have all of our necessary due diligence and vendor diversity considerations accounted for; and the proposed contract awards resulting from the RFPs will be coming to the Board beginning in September.

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