Dr. Mitchell Katz, President/Chief Executive Officer
NYC HEALTH + HOSPITALS | Page 169
WHAT WE DO
NYC Health + Hospitals (the System),
the largest municipal public health
system in the country, includes 11
acute care hospitals, five post-acute
care (skilled nursing) facilities, and
over 70 patient care locations of
community and school-based health
centers (Gotham Health). The System
provides comprehensive health care
services including preventive and
primary care, behavioral health,
substance abuse, trauma, high-risk
neonatal and obstetric care and
burn care. The Systemâs acute care
hospitals serve as major teaching
hospitals. In addition, the System
includes a managed care plan called
MetroPlus; an Accountable Care
Organization that provides Medicare
beneficiaries with coordinated care
and chronic disease management,
avoiding unnecessary duplication
of services and preventing medical
errors; a Certified Home Health
Agency; a Health Home; and
Correctional Health Services. NYC
Health + Hospitals is New Yorkâs
single largest provider of care to
Medicaid patients, mental health
patients, and the uninsured, serving
more than one million New Yorkers
within the five boroughs. NYC
Health + Hospitals continues to
have an important role in caring for
New Yorkers during the COVID-19
pandemic.
FOCUS ON EQUITY
NYC Health + Hospitalsâ mission is to deliver high quality health care services
to all New Yorkers with compassion, dignity, and respect, regardless of income,
gender identity, or immigration status. By the very nature of the Systemâs mission,
NYC Health + Hospitals provides high quality care to the most vulnerable New
Yorkers within the diverse communities it serves, many of whom are uninsured
or underinsured. People in these communities who would typically lack access to
health care services are the most impacted, by being able to obtain the quality
care that they need and deserve through NYC Health + Hospitals. For instance,
the NYC Care Program ensures all New Yorkers in need of health care services
are being connected with affordable primary, preventive and specialty care. This
access has become even more important, in consideration of the impact COVID-19
has on New Yorkers who are not eligible for or cannot afford health insurance.
NYC Health + Hospitals also continues to expand MetroPlus membership, offering
low to no-cost health insurance options to eligible people living within the five
boroughs of New York City who otherwise would not be eligible for insurance. The
Systemâs Correctional Health Services, in particular, is among the cityâs strongest
advocates for social and racial justice, and is a key partner in the broader efforts to
reform the criminal justice system. Finally, to further address equity, in March 2020,
NYC Health + Hospitalsâ Equity, Diversity and Inclusion Committee of the Board
approved the creation of the Equity and Access Council, an advisory group that
supports the Human Resources Office of Diversity and Inclusion to develop efforts
that promote equity among both staff and patients, and optimize the delivery of
care and health outcomes for diverse patient populations. This Councilâs focus is
to advance racial and social justice to eliminate barriers, promote institutional and
structural equities, identify and reduce health disparities and continuously improve
the health of vulnerable communities.
OUR SERVICES AND GOALS
SERVICE 1 Provide medical, mental health and substance abuse
services to New York City residents regardless of their
ability to pay.
Goal 1a Expand access to care.
Goal 1b Enhance the sustainability of the Health + Hospitals system.
Goal 1c Maximize quality of care and patient satisfaction.
Page 170 | MAYORâS MANAGEMENT REPORT
HOW WE PERFORMED IN FISCAL 2020
SERVICE 1 Provide medical, mental health and substance abuse services to New York City residents
regardless of their ability to pay.
Goal 1a Expand access to care.
Unique primary care visits increased from 417,000 in Fiscal 2018 to
445,672 in Fiscal 2020 (Fiscal 2019 data was not available due to a
system-wide transition to a new electronic medical record and financial
system). This increase was primarily a result of efforts to improve
primary care capacity and continuity through the addition of primary
care physicians to provide health care access at low- or no-cost to New
Yorkers who do not qualify for or cannot afford health insurance.
The number of calendar days to third next available new appointment
for adults increased from 12 in Fiscal 2019 to 13 in Fiscal 2020. This
same measure for pediatrics increased from six in Fiscal 2019 to nine in
Fiscal 2020. NYC Health + Hospitals is able to guarantee a primary care
appointment offered to patients within two weeks, as well as same day
appointments, which are other important access to care measures. NYC
Health + Hospitals always is working to improve access for patients,
including updating scheduling templates that open up slots on a rolling
basis, always ensuring that there are same-day appointments available. The System has also increased the use of telemedicine
to allow patients and their families the ability to seek medical care at home as well as in-clinic.
The number of eConsults completed, or specialty referrals, increased dramatically from 75,999 in Fiscal 2019 to 171,569 in
Fiscal 2020. This is a strong indicator of the continued commitment of NYC Health + Hospitals to expand access to specialty
services. Through eConsults, primary care providers and specialists are able to co-manage patients and communicate about
them, and they also help primary care physicians to efficiently connect patients to specialty care. A total of 221 departments
across the System are using eConsults, representing outpatient subspecialty services, including Urology, Gastroenterology
and other medical, surgical and behavioral health services.
Eligible women receiving mammogram screening decreased from 74 percent in Fiscal 2019 to 63.5 percent in Fiscal 2020.
Screening rates decreased primarily due to more patients avoiding health care institutions for routine appointments due to
the COVID-19 pandemic. For example, in February 2020, the rate of mammogram screenings was at 75 percent, and 74.5
percent in March 2020. This level declined consistently to 70.2 percent in April, 66.2 percent in May, and 64.2 percent in
June 2020. Fiscal 2019 monthly rates showed an opposite trend of increase over time, from 68.4 percent in March 2019,
to 74.6 percent in June 2019.
The percentage of HIV patients retained in care decreased from 84 percent in Fiscal 2019 to 81.6 percent in Fiscal 2020. The
decline also is a result of the COVID-19 pandemic, with HIV patients less regularly attending their in-person appointments.
This rate is anticipated to improve as telehealth visits become greater for this group of patients. Similarly, follow-up
appointments kept within 30 days after behavioral health treatment decreased from 60 percent in Fiscal 2019 to 57 percent
in Fiscal 2020. While this metric has improved over the years, this too became challenging due to the COVID-19 pandemic,
with patients not coming to these appointments for fear of going to health care institutions during the surge. To provide
more detail, the March 2019 rate for follow-up appointments kept within 30 days after behavioral health treatment was
at 59.8 percent, while in 2020 it was lower, at 55.7 percent. From April 2020 to June 2020, the rates continued to decline
from 55.1 percent in April to 51.8 percent in June, primarily due to the COVID-19 pandemic. The behavioral health service
is also now leveraging telehealth to maintain continuity in care for these patientsâ treatment.
Both Correctional Health Services measures remained positive. The percentage of patients with a substance use diagnosis
who received jail-based contact slightly decreased from 95 percent in Fiscal 2019 to 94 percent in Fiscal 2020, though
remained well above the 90 percent target. Correctional Health Services continues to offer a broad range of services
for people with substance use disorders, including the nationâs largest opioid treatment program, counseling and reentry planning. The total number of correctional health clinical encounters per 100 average daily population increased
Pediatric medicine Adult medicine
Calendar days to third next available
new appointment
13.1 13.0
4.7
6.0
9.0
12.0
FY 2018 FY 2019 FY 2020
NYC HEALTH + HOSPITALS | Page 171
substantially, from 8,027 in Fiscal 2019 to 15,675 in Fiscal 2020. This increase is due to the migration to a new electronic
medical record and updated workflows, leading to the capture of clinical encounter types such as daily finger sticks and
wound care services that were not able to be captured in the previous medical record. This new electronic health record
captures more granular data and is anticipated to track this information consistently in the future.
NYC Health + Hospitals introduces a new maternal health indicator in this report. The percentage of women enrolled
in care in the first trimester of their pregnancy remained stable from Fiscal 2019 to Fiscal 2020. The American Academy
of Pediatrics and the American College of Obstetricians and Gynecologists recommend that women with uncomplicated
pregnancies be examined at least once in their first trimester for prenatal care.
During the COVID-19 pandemic, telehealth visits, both telephone and video, rapidly increased as an important way to
continue to provide care to patients. Within a week of documented community spread of COVID-19 in New York City,
routine face-to-face visits were converted to telehealth encounters, either telephone or video. In the month prior to the
pandemic, there were 500 billable virtual visits, compared to 40,101 telehealth visits in March, more than doubling in April
to 89,781 visits, 77,618 in May, and 81,738 in June 2020. NYC Health + Hospitalsâ long-term goal is to continue expanding
telehealth services as a viable source of quality care to the patients served in our communities.
Capital commitments ($000,000) $203.5 $202.1 $283.6 $459.4 $531.9 $976.5 $882.8 Up
ÂčActual financial amounts for the current fiscal year are not yet final. ÂČAuthorized Budget Level ÂłExpenditures include all funds âNAâ - Not Available
None
SPENDING AND BUDGET INFORMATION
Where possible, the relationship between an agencyâs goals and its expenditures and planned resources, by budgetary unit
of appropriation (UA), is shown in the âApplicable MMR Goalsâ column. Each relationship is not necessarily exhaustive or
exclusive. Any one goal may be connected to multiple UAs, and any UA may be connected to multiple goals.
Unit of Appropriation
Expenditures
FY192
($000,000)
Modified Budget
FY203
($000,000) Applicable MMR Goals4
001 - Lump Sum Appropriation (OTPS)1 $1,034.6 $1,023.6 All
1
These figures are limited to the City's contribution and planned contribution respectively. 2
Comprehensive Annual Financial Report (CAFR) for the Fiscal Year ended June 30,
Includes all funds. 3
City of New York Adopted Budget for Fiscal 2020, as of June 2020. Includes all funds. 4Refer to goals listed at front of chapter
âNAâ Not Available * None
NOTEWORTHY CHANGES, ADDITIONS OR DELETIONS !
NYC Health + Hospitals has added three measures, with anticipation for continuity of reporting them, given the importance
of each for the communities served by the System. They include the following one replacement and two additions:
âą âPatients enrolled in care during their first trimester of pregnancy (%)â replaces âPrenatal patients retained in care
through delivery (%)â
âą âMyChart (patient portal) activations(%)â
âą âTelehealth visitsâ
Fiscal 2020 data for âpatient care revenue/expensesâ is estimated based on data through March 2020. Full-year Fiscal 2020
data will be available after audit close out, in October 2020.
Fiscal 2020 data for the indicator âPatients receiving a defined set of medical services to treat sepsis within three hours
of presentation (%)â is not available. Data for this measure is reported by the New York State Department of Health and