National News

City’s New Public Hospitals Chief Will Focus on Primary Care

Posted January 7, 2018 10:02 p.m. EST

NEW YORK — The incoming president of NYC Health & Hospitals wants to turn the nation’s largest public health care network into an agency that focuses less on hospitalized care and more on primary care, similar to initiatives carried out nationwide.

The new president, Dr. Mitchell H. Katz, who begins his job on Monday, also said he would expand the use of eConsult, an electronic health management system to streamline care and reduce wait times for specialty appointments, evaluate staff allocation and consider decreasing administrative services such as “unnecessary consultant expenses” to increase savings and revenue.

“I’m all about trying to strengthen public hospitals,” Katz, the former director of the Los Angeles County Health Agency, said in a recent phone interview. “Public hospitals are incredibly precious. If you don’t look out for them, they’ll disappear.”

Health & Hospitals, a sprawling system of 11 hospitals, five nursing facilities and more than 70 community-based health care centers and extension clinics, faces many challenges: shrinking state and federal funds, a decline in patient population, a large uninsured and underinsured patient population and a funding gap that is expected to balloon to $1.8 billion by the 2020 fiscal year.

In fact, Mayor Bill de Blasio’s administration warned in a report two years ago that the system was “on the edge of a financial cliff” and proposed restructuring and increased city subsidies.

“This is a deficit operation,” said Stanley Brezenoff, the system’s former interim chief executive. “You’re finding ways to close gaps.”

But more needs to be done to “reinvent and remodel the delivery system of Health & Hospitals,” Brezenoff said. “We have a long way to go.”

Katz, 58, the system’s third leader in four years, believes he is up to the challenge after having stabilized the Los Angeles County Health Agency, the second-largest public health care system in the country.

In Los Angeles, Katz said that he inherited a $250 million budget deficit when he became head of the Department of Health Services in 2011 and that he was leaving it with a $560 million surplus. Katz, a physician who still saw patients while leading the agency — which has a $7.6 billion budget, four hospitals, a network of outpatient clinics, and about 34,000 employees — moved the Department of Health Services away from hospital care and toward outpatient services.

“It’s all about providing primary care,” he said. “When you take care of people over time your own involvement with them is healing, and you don’t have to do as many tests to get to the answer because you know the person,” he said. He was also responsible for putting in place the Affordable Care Act in a county with more than 1 million uninsured residents. Residents who visited county medical facilities were enrolled in health insurance and assigned a primary care physician, said Shana Alex Charles, an assistant professor of health science at California State University and a professor at UCLA’s Center for Health Policy Research.

Charles said she believed Katz could have done more to get additional residents insured, but she said he left the agency on an “overwhelmingly positive note.”

Bob Schoonover, president of one of the largest health care workers’ unions in Southern California, said many of the newly insured patients continued to use the public hospital system, which had made improvements in wait times and patient service as well as to the system’s culture.

Katz came to the Los Angeles County Health Agency four years after the 2007 closing of the Martin Luther King Jr./Drew Medical Center, which was known as “Killer King” after a series of preventable deaths and widespread examples of substandard care.

“The county was feeling a little defeated,” Charles said. Under Katz’s leadership, the hospital was transformed to include a county-run outpatient facility and a new hospital run by a nonprofit board that focuses on services for seriously ill patients.

Public health care advocates called Katz an innovator who thinks outside of the box.

Los Angeles has one of the country’s largest homeless populations, and some of those people were patients in public hospitals. Katz used some of the agency’s funds to create 4,000 housing units for the homeless, which helped drive down hospital expenses, he said. (Similarly, NYC Health & Hospitals built more than 670 affordable and supportive housing units on hospital campuses in East Harlem and in East Flatbush. Three additional projects are pending.)

“He has an unusual combination of overarching vision and attention to detail,” said Sheila Kuehl, chairwoman of the board of supervisors for Los Angeles County. “He called it, ‘Writing a prescription: Housing.'”

Kuehl said he inspired the organization to focus on patient care and satisfaction.

“There was a great deal of faith in him as a leader who understood what the staff needed, the services, and he insisted on remaining a physician, which kept him in touch with what clients needed,” she said.

Before joining the Los Angeles County Health Agency, Katz spent 13 years at the San Francisco Public Health Department, where he created the first publicly funded needle exchange program in the country and Healthy San Francisco, a health insurance program.

Born and raised in Brooklyn, Katz left New York for college at 17. He has two children with his partner, Igael Gurin-Malous, an artist and a spiritual counselor at a substance abuse treatment program.

Being back in New York allows Katz to be closer to his parents, who are in their 90s, he said. He also plans to see patients at Gotham Health on the Lower East Side of Manhattan.

Katz’s experience with public hospitals began in Sheepshead Bay, Brooklyn, where he said his family frequented Coney Island and Kings County hospitals — both public hospitals. He said his grandmother had hip replacement surgery at Coney Island Hospital.

The public hospital system includes premier hospitals like Bellevue Hospital Center in Manhattan, which was selected as the center for treatment of the Ebola virus in 2014.

NYC Health & Hospitals, an organization with a $7 billion budget and about 40,000 employees, has long served the most vulnerable New Yorkers: low-income residents, the uninsured, unauthorized immigrants and the mentally ill. One recent evening, German Perez, 54, said he had “a horrible pain” in his leg and traveled more than an hour from his home in Queens with his wife, daughter and son to the emergency room at Bellevue. Perez, an unauthorized immigrant who works as a construction worker, suffered the injury on the job, he said. He spent about an hour in the emergency room before he was given medication and released.

“They don’t have papers or money,” said Perez’s daughter, Vanessa. “If we’re really sick, we go to Bellevue.”

NYC Health & Hospitals is the largest provider of health care to uninsured New Yorkers and those on Medicaid. Thirty-seven percent of the roughly 1.1 million patients who visited the system during the 2017 fiscal year were uninsured, a percentage that has remained the same for the last three years, according to the mayor’s management report.

The system’s problems are not unique to New York, said Dr. Ramanathan Raju, the former chief executive of the organization, who stepped down in November 2016. He said Katz would have to find ways to attract new patients and maintain current ones to generate additional revenue, improve wait times and fight for policy changes.)

“This is a good job, a very fulfilling job serving the neediest of New Yorkers,” Raju said. “You fight for the health care and you have to learn to get the support. It’s a tightrope that you have to walk.”