REPORT TO THE BOARD OF DIRECTORS - March 2021

Mitchell H. Katz, MD
NYC HEALTH + HOSPITALS
PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
March 25, 2021

ONE YEAR WITH COVID-19

One year ago this month, our health system admitted its first patient with COVID-19. Our heroic front-line care teams faced the unimaginable. We quickly came together as one unified health system to support and keep each other safe, and to save lives in every community across the city. It is nothing short of a miracle that in just one year, there are now multiple vaccines and the end of the suffering is in sight.

While there is much hope ahead thanks to our hard work, we still grieve the friends, relatives and coworkers lost to this pandemic. And over the past few weeks, we have come together with moments of silence at live webinars and memorials all over our System to honor those lost and reflect on the last year.

The COVID-19 pandemic has shown how necessary New York City’s public health system and its employees truly are. We have proven that there is no challenge we cannot overcome when it is about protecting the health of the most vulnerable New Yorkers under our care.

Thanks to our heroic workforce – their sacrifices and readiness to answer a higher calling over the last year — NYC Health + Hospitals has been there for our patients and all New Yorkers at every stage of this: healing, testing, vaccinating and helping patients recover.

Healing – Our hospitals and post-acute care facilities have provided quality, compassionate care to thousands who were gravely ill and saved so many lives. Our emergency departments have managed more than 108,000 COVID-19 patient visits and more than 54,000 hospitalized patients with COVID-19 have been safely discharged. New Yorkers trusted our hospitals and clinics with their care.

Testing, Tracing, Taking Care – We prioritized testing since the early months of the first surge, setting up tents and launching the country’s most successful test and trace operation. In the last year, our hospitals, Gotham Health Centers, Correctional Health Services and NYC Test & Trace Corps testing sites have done more than 3.8 million COVID-19 tests. Our tracing operation has consistently reached more than 90 percent of the cases, more than any other jurisdiction in the country, and have completed more than 500,000 interviews and generated more than 650,000 contacts. And we have helped more than 12,000 guests to safely separate in our free hotels to keep their families and communities safe. Through all these efforts, thousands of New Yorkers experienced for the first time the dedication and passion of the employees in our health system.

Vaccinating – We are so proud to be a significant part of the City’s vaccination efforts, focusing first our employees and our most vulnerable patients, as the state eligibility permitted. Despite the challenges of an unreliable source of vaccine supply, we continue to offer vaccine at every hospital, post-acute care facility and Gotham Health center, and are actively reaching out to our eligible patients to get them in for their vaccine. We also extended hours, added more staff, and created new mass vaccinations sites managed by our NYC Test & Trace Crops, and so far have put vaccine into more than 300,000 arms, and are not letting up.

Recovering – Our ambulatory care teams are serving more than 26,000 patients who had COVID-19 – many of them will face a range of long-term health effects. Our investment to open three new COVID-19 Centers of Excellence in communities hardest hit will ensure access to the specialized care New Yorkers will need to address long-term respiratory, cognitive and cardiac conditions caused by the virus. At these sites, we will be with our patients at every step of their recovery.

We remain aware of how this pandemic worsened the inequities in health care. It created fissures in almost every other part of society too — from education to the economy. These inequities are already having a disproportionate effect on the health of the patients and communities we serve. That is why we must intensify our commitment to health equity, diversity and inclusion in every aspect of our work – from clinical care to language access services.

One year with COVID-19 has shown us the strength of our health System and employees, the incredible humanity we have lost, and the way to move forward but not forget. I am so proud and grateful to our entire health system family for all they have done and continue to do for the thousands of New Yorkers who call NYC Health + Hospitals their health care home.

CONDEMNING ATTACKS AGAINST ASIAN AMERICANS

In recent weeks, we have witnessed a disturbing trend of violent acts of racism and hate committed against Asian Americans and Pacific Islanders across our country and in New York City. My own daughter, who is Vietnamese, asked me last week why people hate Asians. You can imagine how heartbreaking this is.

I know I speak for the entire NYC Health + Hospitals family in condemning these racially motivated attacks that are counter to our values of inclusion, respect and tolerance, and our mission to promote and protect the health, welfare, and safety of the people of the City of New York.

Our dedicated workforce has always recognized that our diversity is our strength. It is a source of pride and strength for all of us. And we work hard every day to bring these values to life in every patient encounter and how we treat each other in our workplaces.

More than ever, we must continue to set an example of love and respect, and reaffirm our commitment to create a safe and welcoming environment for every New Yorker in need of quality, compassionate health care.

EXTERNAL AFFAIRS UPDATE

State – The State legislature is in the midst of its annual budget negotiations. NYC Health + Hospitals has been actively advocating against a series of cuts that would be harmful to our System, most notably an across the board Medicaid cut, a cut to the public Indigent Care Pool, and a capital cut. These cuts were proposed in the Governor’s Executive Budget, and we and many colleagues and advocacy partners have been fighting to eliminate them. Fortunately, both the State Senate and Assembly did reject these cuts. We are grateful to the Assembly and Senate leadership and Health Chairs, our partners at City Hall, our Community Advisory Boards, and many advocacy champions for this initial success. Even more encouragingly, on March 22, the Governor announced that better than expected revenues and additional Federal aid will negate the need for cuts proposed in his budget. NYC Health + Hospitals will continue our advocacy to ensure that these cuts are eliminated. The budget process should be resolved by April 1.

City – I testified at the City preliminary budget hearing on March 22. The City budget process will continue over the next few months, as the fiscal year continues until June 30.

Community – We are pleased that the Office of External and Regulatory Affairs has initiated a weekly digest to keep our community stakeholders informed of health System activities and priorities. The Digest already has over 500 subscribers, and we look forward to continue growing its readership and contents.

I understand that there continues to be interest in our previous work to establish temporary emergency hospital beds in unused space of NYC Health + Hospitals/Coler. Please permit me to provide relevant information here. In the spring of 2020, NYC Health + Hospitals developed temporary hospital beds to help accommodate the enormous surge of COVID-19 patients in our system, with State approval. This temporary surge resource was placed within long-unused space in the NYC Health + Hospitals/Coler campus.

The temporary surge location – called the Roosevelt Island Medical Center or RIMC — was situated in distinct portions of Buildings A and C of the Coler complex, in separate wings and floors from those used by Coler. We selected a new leadership team and new staff was brought in to serve the temporary RIMC beds. As volume increased, there were two separate entrances for patients, one for RIMC and one for Coler. Staff did go through one common entrance in order to receive their daily health screenings, and there were common elevators for the two spaces.

At all times, both Coler and the temporary RIMC facility maintained strict infection control policies, and staff removed any PPE before entering into any common spaces. The long-term residents at Coler did not interact with the patients in the temporary hospital space. Patients were required to stay in the rooms or on their units to avoid COVID spread. The RIMC beds were used only as long as needed during the first wave of the pandemic and operations were concluded in July. NYC Health + Hospitals did not subsequently reactivate the RIMC beds during the fall and winter surge.

FINANCE UPDATE

Through December, the health System had a positive net budget variance of $115M (2%), with patient care receipts exceeding the budget by $121.8M (6%). Remarkably, patient care receipts are $397M (21%) better than last year due to increased patient acuity, higher rates, and the continued success of our revenue improvement initiatives. The system closed February with approximately $400 million cash-on-hand (18 days).

Medicaid Managed Care enrollment in MetroPlusHealth and Health First has increased by nearly 76,228 between January and December. Based on Medicaid Managed Care performance as a whole (not just net new membership), we anticipate receipts of $64M through CY20 Q3. Consistent with our Memorandum of Understanding, the City has transferred over $500 million to support T2 spending commitments through December. The MOU also has been updated to include costs associated with vaccine distribution.

Federal Relief – We are pleased to report that the American Rescue Plan Act signed by President Biden fixes the DSH eFMAP glitch, which will offset nearly $800 million in losses in FY21 and FY22. We continue to advocate for expedited FEMA approval of our subsequent reimbursement package and are drafting a formal letter to FEMA in coordination with the City on this request. The COVID-19 cost estimate associated with the first wave and second wave is estimated at $1.9 billion. Through January, the System has paid out $1.5 billion. To-date, the system has received $1.2B in CARES Act Provider Relief Funds and $199M in FEMA reimbursement advances.

THE END OF THE PUBLIC CHARGE RULE

NYC Health + Hospitals was happy to learn last week that the US Department of Justice would stop defending the Trump Administration’s public charge policy in a case that was set to go before the Supreme Court. This means a lower court’s decision is now in effect and the harmful rule can no longer be applied anywhere in the country. At NYC Health + Hospitals, we are celebrating the end of this damaging and cruel policy that caused immigrant families to avoid seeking essential health care services, access to which is more important than ever during the COVID-19 pandemic.

While the rule only applied to a small subset of New Yorkers who are immigrants and officially covered only a small set of public benefits, it instilled fear and confusion throughout immigrant communities and this “chilling effect” could impact immigrant New Yorkers for years to come. Our frontline providers and staff have seen the impact of the public charge rule in action — patients have disenrolled from critical health care and benefits programs for which they are eligible and have avoided seeking essential care. This has likely exacerbated the disproportionate devastation caused by the COVID-19 pandemic among New Yorkers of color in neighborhoods with large immigrant communities.

As we celebrate the end of the public charge rule, we underscore the message we have repeated throughout these past four years amidst a changing immigration policy landscape: NYC Health + Hospitals has always encouraged all New Yorkers to seek care without fear, and has welcomed all patients at NYC Health + Hospitals, no matter their immigration status or ability to pay. That is our commitment. It will never change.

CONTRACTS, PURCHASE ORDERS AND WORK ORDERS

I issued a Declaration of Emergency dated March 1, 2020 related to emergency contracts and procurement, which was subsequently updated and reissued through February 28, 2021. There is currently no Declaration of Emergency for contracting in effect.

The health system has entered into three new emergency agreements not covered in our prior reports. Two of the new agreements are for temporary staffing for the hotels we are managing on behalf of the City, our acute-care facilities, post-acute care facilities, as well as temporary staffing for the expanded vaccination program. One agreement was executed in December 2020 and the other in January 2021.

The third new agreement is for building security services at the COVID-19 testing sites. The Department of Buildings had procured and held this agreement, but our health system manages these COVID-19 testing sites and so we agreed to an assignment of the agreement to us in February 2021. The total spend through February 2021 is $104,000,000.