Collaboration Councils Update DOCTORS FORWARD Feb/March 2016 - Bellevue Hospital & Gouverneur Health

COMING UP

NYCERS Pension Presentation Thursday, February 25 6:30PM At Doctors Council 50 Broadway 11th Flr Gotham Health Update Suite 1101 New York, NY 10004

Doctors Meet to Discuss Bellevue CEO Replacement (from left to right: Mr. Kevin Collins, Dr. Nate Link, Dr. Ross Wilson, Dr. Andra Fertig, Dr. Peter Catapano, Dr. Caralee Bellevue Hospital Dr. Aycan Turkmen, M.D., Doctors Council 2nd Vice-President, We are off to a strong start in this important work. While Caplan-Shaw, Mr. Sal Russo, Mr. Matt Campese) Community Advisory Board System-wide Collaboration Council (SWCC) Co-Chair and doctor each FBCC will establish their own dialogue reflective of local In early February, on behalf of Doctors Council members, Doctors Peter Catapano, Andra Legislative Breakfast from Coney Island Hospital, and NYC Health + Hospitals Chief conditions and culture, the SWCC has some unified expectations Fertig and Caralee Caplan-Shaw, and Kevin Collins, Doctors Council Executive Director met Friday, February 26 Medical Officer, Dr. Ross Wilson, M.D. convened the third meeting from the FBCC’s which include: with Dr. Ross Wilson, CMO of NYC Health and Hospitals, Salvatore J. Russo, Senior Vice 9:30 - 11:30AM of our SWCC at Gouverneur Health. President and General Counsel, Matthew Campese Senior Director of Labor Relations, and Dr. Nathan Link, CMO of Bellevue to discuss the hiring of a new Bellevue CEO. The meeting At Bellevue Hospital The SWCC is the oversight body that sets the direction for the The establishment of joint leadership of these meetings comes after many Bellevue doctors signed a petition asking that doctors have a voice in H-12, Rose Room Facility-based Collaboration Councils (FBCC), the goal of which the recruitment of a new CEO following Steven Alexander’s retirement after 30 years. is to significantly improve our patients’ experience and our The creation of a safe environment for all discussion and doctors’ engagement. expression of ideas Dr. Catapano reported that the petition received an overwhelming positive response Bellevue Doctors Council because doctors wanted a search process that was inclusive and transparent. He went on Membership Meeting The FBCCs are NOT a place for grievances or other to say that Bellevue doctors would like to see a CEO who shared values similar to that of With excellent attendance at the SWCC meeting, most of the frontline clinicians. Monday, February 29 two hours was spent in small group discussion in which contractual matters 4pm frontline leaders from Doctors Council SEIU and executives from Dr. Fertig highlighted the important role that a new CEO should play in educating and Finance Conference Room Interest based dialogue and consensus decision-making each of our facilities exchanged ideas about how to establish communicating with doctors regarding the multiple challenges facing Health + Hospitals 1 East 2 - 1st Floor successful FBCCs which will have their first meeting this will be expected such as funding shortages, Outcome-based payment reform (DSRIP) and internal re- month. It is through each FBCC that the processes will be organization of service lines. Improvement initiatives will be developed consistent put in place to enable measureable progress in jointly overseen Gouverneur Doctors Council facility based improvement initiatives. with both Vision 2020 and the parties’ joint commitment Dr. Caralee Caplan Shaw stressed that any new CEO should be committed to the joint to increased doctor empowerment and engagement work between Doctors Council members and Health + Hospitals administration in the new Membership Meeting Collaboration Councils which seek to improve doctor engagement, patient experience, and Wednesday, March 2 Dr. Wilson made clear what it will take for success: “Our goal is to System-wide, facility-wide, and departmental data will overall improved quality. In response, Sal Russo said that Dr. Ram Raju and the search 5:15 - 6:15pm improve our patients’ experience. Success will depend on how committee are looking for a CEO that could lead Bellevue’s efforts in: improving the patient the management and the frontline staff in each of our facilities be shared with the FBCCs to guide the discussion Conference Room 2. 114 towards selection of improvement initiatives experience, increasing the level of quality care, growing Bellevue’s market share and jointly establish strategy and processes for effectiveness. enhancing employee engagement. Improved outcomes are dependent on that process.” Follow Us Online Integration of the IHI Model of Improvement and use of Dr. Wilson stated NYC Health + Hospitals had set a target date of announcing a new CEO Front-line staff and management , grouped by facility , worked the IHI Open School on-line courses to assist our efforts. by the end of February. He also stated that besides Doctors Council members, the search www.doctorscouncil.org/ together to develop meaningful agendas for the initial FBCCs committee already had input from nursing, finance, and union representatives. meetings occurring in February, and set all the supporting The next meeting of the SWCC is on logistics for a successful first meeting. Report-outs from February 24th at which time we will look “I am happy that we had a meeting with NYC Health and Hospitals senior leadership. We had a good cross-section of doctors, and our comments were well-received and discussed the groups showed great progress made toward improving forward to reports on the first meetings of without resistance,” Dr. Peter Catapano said. communication, building trust, defining concrete goals and out FBCC’s. setting the groundwork for the FBCCs. Continued on inside Financial Crisis Looming at Health + Hospitals? Doctors Council Bellevue Financial Planning Forum A Success On Wednesday, February 3rd, over improvement for future presentations, forty doctors met in the Saul Farber from more “case studies” of typical Auditorium at Bellevue to listen to a doctors at different stages of their Doctors Council financial planning careers with different priorities, to presentation by Stacey Braun more focused sessions on one or two Associates. topics covered in the overview.

The presentation, a financial planning The event was held in response to a 101, and resulting questions and survey of Bellevue doctors earlier in “The opportunity to sit discussion, ranged over a number of the year conducted by Doctors Council topics, from planning for children’s that identified receiving unbiased, down and think about college costs to projecting the cost of factual financial planning information considerations for retirement. as as a need that Doctors Council financial planning was could help doctors meet. very helpful.It’s hard to Evaluations completed immediately As has been reported in numerous press accounts, Health rewarding care management, the systems that thrive will after the event were universal in In the same vein, Doctors Council will find time for that.” + Hospitals continues to face major challenges in budget be the ones that can most effectively manage the health of noting the value of this discussion, hold a pension discussion with NYCERS — Dr. James Cho, Internal Medicine and financing. As part of the Mayor’s 2016–17 budget, large populations, providing primary care and other basic and appreciation for the low-key, fact- on February 25 at the Doctors Council Health + Hospitals will receive a $337 million infusion of services in many communities across the City as opposed based presentation by Stacey Braun. office, and will conduct a session on cash from the City to close an expected $1.7 billion budget to waiting for patients to walk through the hospital doors. typical legal issues doctors deal with gap, which comes on top of $700 million already allocated Suggestions were proffered for in April. to Health + Hospitals by the City. “That explains why NYU Langone took over Brooklyn’s Lutheran Medical Center and its network of Federally This news also comes on the heels of a recent state Qualified Health Centers and why Northwell Health comptroller’s report that said the corporation’s deficit is (formerly North Shore-LIJ) partnered with Maimonides expected to double to nearly $2 billion within the next in Brooklyn, and why Mount Sinai recently announced a Doctors Unite — from a recent posting on Doctors Council’s blog, Hippocratic Musings three years. cardiology practice on Staten Island.” In a January 9 New York Times If you talk to them for long enough, less to avoid burnout, which was article, reporter Noam Schreiber talks you get the distinct feeling it is bad for them and worse for patients. In addition, as was reported in a Feb 2 story in Politico NY, The article notes that “De Blasio and Raju can’t be as to the newly organized doctors at not just their jobs that hang in the Mayor DeBlasio has tapped the health care consultants nimble as their counterparts who run private hospitals, PeaceHealth in Oregon. In the article, balance, but the loss of something At which point the administration Manatt Health to work with H+H to “look to see if Health and it would be politically challenging to close one of the Dr. Rajeev Alexander, one of the much less tangible — the ability of responded that money was always + Hospitals, which serves primarily Medicaid patients, can corporation’s 11 hospitals so the administration must find PeaceHealth hospitalists, gets to the doctors everywhere to exercise their the issue, according to several people benefit from state reforms and national trends even as other ways to grow revenues or trim expenses.” heart of the issue on why employed professional judgment.” in the room. (The hospital declined to looming federal cuts threaten to make matters worse.” doctors need an independent voice. comment.)” Manatt had already signed a multi-million dollar contract Health + Hospitals’ strategy? “….to grow his [Raju’s] way Dr Alexander and his colleagues In short, as Dr. Brittany Ellison says, with been H+H for consulting services related to DSRIP out of financial trouble by improving patient service so discuss a central issue—professional “We’re trained to be leaders, but they This cynicism coming from hospital program design and implementation. that more people use his system. judgment and autonomy. treat us like assembly line workers.” management is sad but not Perhaps the biggest surprise for the surprising.Increasingly doctors are The article goes on to describe the essential challenges “Raju wants to see 2 million patients by 2020, up from 1.4 “Dr. Alexander and his colleagues say hospital system where the doctors viewed by hospitals as cogs whose facing H+H, and is worth quoting at length: million in 2015, and to double the number of people enrolled they are in favor of efficiency gains. organized is its refusal to believe only concern is money. We are glad in MetroPlus, the insurance arm of Health + Hospitals. It’s the particular way the hospital that money was not their key issue. the doctors formed a union to protect “The key for [Dr.] Raju is wooing more patients with has interpreted this mandate that According to the Times the doctors their patients and the profession. commercial insurance, which typically pays more than “Raju also wants to promote his clinics and health centers has left them feeling demoralized. “preferred to work less and make Medicaid, and is preferable, from a financial perspective, so he can better manage patients before they need to the uninsured and undocumented immigrants. expensive acute care for which the corporation often does

not receive full reimbursement. Like what you see? “The challenge he faces is that the other health systems Read more on in NYC are, more than ever before, vying for the same “Raju is restructuring his leadership team to better focus doctorscouncil.org patients. As Medicaid and Medicare move toward the system on ambulatory care and long-term care.”