REPORT TO THE BOARD OF DIRECTORS - May 2021

Mitchell H. Katz, MD
NYC HEALTH + HOSPITALS
PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
May 27, 2021

CORONAVIRUS UPDATE

Vaccination Program – NYC Health + Hospitals continues to provide vaccination services in all 11 hospitals, 7 Gotham Health centers, two Test & Trace sites and Citi Field. Vaccines are available to New Yorkers at all our locations, and we serve walk-ins without an appointment. We also offer the Pfizer vaccine for New Yorkers 12 years and older at 12 locations. As of May 23rd, we have administered nearly 900,000 total doses and more than 480,000 first doses. We continue to do outreach and education to promote vaccine to all our staff and patients 12 years of age and older. We are also offering J&J vaccine to eligible inpatients being discharged from our hospitals and emergency departments. As a thank you to all the Vax Champs, this month we began to distribute gift bags – with t-shirts, hats and PPE – to all our staff and patients who get vaccinated.

NYC Test & Trace Corps – With cases coming down, our NYC Test & Trace Corps team has continued to provide a strong layer of protection for NYC. We are currently reaching 97% of all new cases, and completing interviews with 86% of all new cases. To date, we have reached more than 700,000 cases and more than 600,000 contacts. We have also served more than 20,000 total guests in our Take Care hotel program. To date, NYC Health + Hospitals has completed more than 3.4 million COVID-19 diagnostic tests at all of our sites, including our hospitals, Gotham Health centers and Test & Trace locations.

NYC HEALTH + HOSPITALS LAUNCHES MEDICAL ERACISM PROJECT TO ELIMINATE BIASED, RACE-BASED MEDICAL ASSESSMENTS

This month, NYC Health + Hospitals announced the launch of our “Medical Eracism” initiative to eliminate biased, race-based assessments used for decades in hospitals and clinics across the country to influence medical decisions that have been found to negatively impact the quality of care patients of color receive. We have already eliminated two common diagnostic tests – for kidney disease and vaginal birth after a cesarean delivery (VBAC) – that have embedded race-based calculations for severity of illness and risk, and can lead to implicit biases and errors in diagnosis and treatment. Under the direction of our Office of Quality & Safety and the Equity & Access Council, we will identify additional areas of race-based assessments to recommend for elimination. This initiative builds on our commitment to eliminate implicit bias in health care and provide equitable, quality care to more than one million New Yorkers who choose NYC Health + Hospitals as their medical home.

Race is not a biological determinant, but a social construct. These calculations were based on racialized assumptions about biology that date back to slavery and the belief that somehow the bodies of African descendants where different from others. We are excited to be a national leader in this effort, while we continue to acknowledge that race matters in people’s health and remain cognizant of the impact of racism and social inequities affecting the health of New Yorkers under our care.

NEW CAPITAL FUNDING FROM QUEENS BOROUGH PRESIDENT AND NY STATE ASSEMBLY TO SUPPORT NYC HEALTH + HOSPITALS

NYC Health + Hospitals/Elmhurst received $5.5 million in funding from Queens Borough President Donovan Richards Jr. in FY-22 Capital Funding. The funding will support the renovation of the hospital’s intensive care units and operating suites. The team at Elmhurst proved to be a backbone of the borough of Queens during the horrible COVID-19 pandemic, and the infrastructure improvements supported by this generous allocation will make our community hospital bigger and stronger.

NYC Health + Hospitals/Coney Island this month received $250,000 in capital funding for neurological and cardiac medical equipment. The funding was secured by New York State Assembly Member Mathylde Frontus from the State and Municipal Facilities Program to help purchase an electroencephalogram (EEG) machine and a portable echocardiogram that will allow the hospital’s neurology and cardiology teams to diagnose disorders with more accuracy and speed.

We are very grateful to Borough President Richards and Assembly Member Frontus for their continued support and advocacy that helps us deliver the high-quality, state-of-the-art care our patients need and deserve.

NYC HEALTH + HOSPITALS RECOGNIZES MENTAL HEALTH AWARENESS MONTH BY ADDRESSING STIGMA AMONG HEALTH CARE PROFESSIONALS

Throughout some of the painful moments of the pandemic, many health care staff experienced stress, anxiety, depression, and emotional trauma. Several received support from the NYC Health + Hospitals Helping Healers Heal program. However, others suffered in silence, fearing their call for help would be seen as a weakness. To encourage more open discussion on mental health issues, our health system launched the “Stop Stigma, Start Healing” campaign with discussions and events to support the wellbeing of our staff. The month-long campaign, which took place during National Mental Health Awareness Month this May, was developed by our Helping Healers Heal program team in partnership with our Office of Behavioral Health. We hosted four special events each Friday of the month encouraging staff to participate by sharing their thoughts, experiences, emotions, creativity and bravery.

I participated in an interview that will be part of tomorrow’s event to share how the pandemic impacted my own emotional well-being and strategies I have used to cope. We are better clinicians when we admit that we can be sad, that we can be distressed, that we can be depressed. We are not perfect and we need to go to work and do the best we can and always try to connect to each other.

In addition to this month-long effort, our Helping Healers Heal program continues to work hard to foster a culture of openness with proactive onsite support through wellness events and rounds, and emotional and psychological debriefs across the health system.

EXTERNAL AFFAIRS UPDATE

Federal – NYC Health + Hospitals is working with our New York delegation to advance proposed Community Project Requests, otherwise known as earmarks, to support our facilities. The facilities submitted proposed projects to the Congressional representative in their Districts a few weeks ago and are now making submissions to Leader Schumer and Senator Gillibrand, with the support of the Office of External and Regulatory Affairs. There is still a long and competitive road ahead in terms of the Appropriations Committees’ review process, then negotiations between the House and the Senate.

As the Biden Administration and Congress consider infrastructure funding, NYC Health + Hospitals continues to reinforce the importance of including funding for hospitals and health care facilities in any funding package. The COVID-19 pandemic has brought a stark reminder how much we need infrastructure support both to continue battling COVID-19 and for the unknown future. We are grateful to the Representatives that serve our facilities and to our two New York State Senators for their support.

NYC Health + Hospitals is also advocating for the expansion of CMS-funded GME slots, including a proposed bill that would increase the number of new reimbursable Medicare residency slots nationally by 14,000.

State – The NYS Legislature is scheduled to conclude in early June. We continue to advocate for telehealth flexibilities to ensure parity of coverage and reimbursement of telehealth services as compared to in-person services. In addition, we are advocating for legislation that will fix the inequities in the distribution of the Indigent Care Pool funding by addressing the disparity between well-resourced voluntary hospitals and safety net hospitals. The pandemic has shown we need strong and viable safety net providers. We are grateful to our partners in advocacy and our Community Advisory Boards for their ongoing support for this necessary change.

Finally, we are preparing for implementation of the pending staffing bills for hospitals and nursing homes. Earlier this month, the New York State Legislature passed two bills that set staffing-related requirements in hospitals and nursing homes, respectively. These bills have not yet become law, but we expect they will shortly.

The hospital bill was a product of negotiations between health care labor unions and hospital associations, and it requires all hospitals in NYS to create a labor/management clinical staffing committee to establish staffing plans by January 1, 2022. The resulting staffing plan must be adopted and submitted to the State Department of Health (DOH) by July 1, 2022 and implemented by January 1, 2023. Under the bill, hospitals will also be required to publicly post unit-level staffing information on a daily basis and, over time, make quarterly reports on the total hours of nursing care provided by RNs and LPNs. At NYC Health + Hospitals, we are lucky to already have a similar staffing committee structure in place that grew out of to our 2019 collective bargaining agreement and our ongoing partnership with NYSNA, our key nursing union. We know that nurses are at the heart of our mission to deliver high quality, compassionate care for all New Yorkers. They not only offer top quality clinical care but they help patients navigate a complex health care system and support them during some of most trying times in their lives. To address the new requirements in the bill, we will work with NYSNA and other stakeholders to align our committee work and reporting practices as required by the bill, assuming it becomes law.
The nursing home bill mandates specific hours of nursing care per resident. Beginning January 1, 2022, nursing homes will be required to meet a daily average of 3.5 hours of nursing care per resident per day by a certified nurse aide, LPN/RN, or nurse aide. Then beginning January 1, 2023 and thereafter, every nursing home shall maintain daily average staffing hours equal to 3.5 hours of care per resident per day by a certified nurse aide or a RN/LPN. Nursing homes will be required to post nurse staffing information at the facility in a form approved by DOH, and DOH will establish civil penalties for nursing homes that fail to comply. Health + Hospitals is well situated to comply with these requirements. Our internal review shows that we already meet and exceed the expected nursing care hours per patient. In fact, Staffing has been a component of the Nursing Home CMS Star Rating System for many years and the NYC Health + Hospitals Skilled Nursing Facilities have maintained 4 and 5 Stars indicating “Above Average” ratings when compared to State and National levels. We will continue to work at each of our post-acute facilities to ensure that remains the case.

City – I was joined by CFO John Ulberg, and other system leaders, to testify before the City Council about the NYC Health + Hospitals executive budget on May 21, 2021. We received significant stated support from the City Council members and are following up on any questions raised at the hearing. The City is reducing our support by $211M for debt service reimbursement. The final City budget should be concluded ahead of the July 1 start of the new City fiscal year. The Borough Presidents have awarded 14 capital projects across our health system in their executive budgets. Though details are still evolving, we project support of nearly $1M thanks to the generosity of our Borough Presidents. We anticipate additional projects to be awarded by the Mayor’s Office, Borough Presidents and City Council in the adopted budget when it is complete.

NYC Health + Hospitals and the entire City is preparing for our first ranked choice voting primary on June 22 for all City offices. We will be hosting a nonpartisan staff webinar on June 3 to provide education to our workforce on how ranked choice voting works.

FINANCE UPDATE

Through March, NYC Health + Hospitals had a positive net budget variance of $65 million. Direct patient care receipts are $331 million better than the same period last year due to increased patient acuity, higher rates, and the continued success of our revenue improvement initiatives. We closed April with approximately $300 million cash-on-hand and anticipate closing May with $550 million cash-on-hand. Consistent with our Memorandum of Understanding, the City has transferred nearly $750 million to support T2 spending commitments through March.

We continue to advocate for expedited FEMA approval of our subsequent reimbursement packages. The latest COVID-19 cost for our system is estimated at $2 billion. Through March, the system has paid out $1.7 billion. And we have received $1.2B in CARES Act Provider Relief Funds and $266M in FEMA reimbursement advances.

REPORT TO THE BOARD OF DIRECTORS – May 2021