2013 Community Health Needs Assessment and Implementation Strategy BELLEVUE HOSPITAL CENTER 462 First Avenue New York, NY 10016 (212) 562-4141 Prepared by Marcy Pressman and Steve Bohlen. For additional information, call (212) 562-4516. Table of Contents Introduction to Bellevue Hospital Center 3 I. Description of the Community Served by Bellevue Hospital Center 4 II. Process and Methodology 8 III. Health Needs Identified 9 IV. Community Assets Identified 10 V. Priorities 13 VI. Implementation Strategy 13 VII. Approval 16 Introduction to Bellevue Hospital Center Bellevue Hospital Center (BHC) is America’s oldest con- Clinic Visits tinuously operating hospital, established in 1736, and has a Total Emergency Room 124,396 distinguished history of innovative contributions to public Total visits (non-Emergency Room) 524,152 health, medical science and education. A member hospital of Total primary care 121,264 Total psychiatric 47,121 the New York City Health and Hospitals Corporation (HHC), Total physical medicine 18,174 the nation’s largest public hospital system, BHC is affiliated Total methadone and chemical dependency 67,003 with the NYU School of Medicine and offers a wide range of All other clinic visits 270,590 medical, surgical and psychiatric services in both an inpatient and outpatient setting. BHC is also a major referral center for BHC is considered the “flagship” of HHC, a public highly complex cases city-wide and serves as a medical facility benefit corporation whose mission has always been to for dignitaries visiting New York City, including the President provide comprehensive and high quality healthcare to of the U.S. and diplomats from the United Nations. all, regardless of their ability to pay, in an atmosphere of BHC facilities include a 24-story patient care facility hous- dignity and respect. HHC, the largest municipal health- ing more than 800 inpatient beds and six Intensive Care Units; care organization in the country, is a $6.7 billion inte- a world-renowned Emergency Service and Trauma Center; and grated healthcare delivery system that provides medical, a 4-story modern Ambulatory Care Pavilion. mental health and substance abuse services through its The following charts provide a snapshot summary of key 11 acute care hospitals, four skilled nursing facilities, six indicators for Fiscal Year (FY) 2012 (July 2011-June 2012): large diagnostic and treatment centers and more than 70 community based clinics. HHC Health and Home Care SNAPSHOT FY 2012 also provide in-home services in the local communities Staffing it serves. Full-time employees 5,046 HHC is a crucial access point for local communities Budget that have historically been overlooked by private phy- Total operating budget $755M sicians and voluntary hospitals seeking optimal market Beds Total certified/operating beds 912/828 share in an extremely competitive healthcare environ- Total certified/operating Psychiatry beds 339/327 ment. HHC’s commitment to caring for patients regard- Total Chemical Dependency/Detox beds 20 less of their ability to pay, ultimately gives it the highest Key Indicators “market share” of low-income, uninsured patients across Discharges 31,309 this City. Average Length of Stay – Acute care 5.2 Based on 2010 New York State institutional and Average Length of Stay – Psychiatry 16.4 health center cost reports, HHC hospitals provided a Average Length of Stay – Rehabilitation 19.9 far higher proportion of care to self-pay (or uninsured) BELLEVUE HOSPITAL CENTER CHNA | 3 patients than any other single healthcare provider in New EXHIBIT 1: BHC’S SAFETY NET BURDEN York City. In 2010, HHC acute care hospitals were the Utilization by Payer Mix as a Percent of Total NYC Voluntary Nonprofit All HHC source of 37% of all uninsured inpatient discharges, Hospitals Average* Hospitals Bellevue 43% of uninsured ED visits and 67% of uninsured Discharges clinic visits among all New York City hospitals. This Uninsured 3% 4% 8% Medicaid 33% 38% 57% volume of uninsured care translates into approximately Total Safety Net 36% 42% 65% $698 million in uncompensated care annually at HHC. ED Visits BHC’s safety-net burden is illustrated in the following Uninsured 16% 20% 38% Medicaid 39% 41% 36% Exhibit 1. Total Safety Net 55% 61% 74% Clinic Visits Uninsured 11% 19% 31% Medicaid 55% 52% 45% Total Safety Net 66% 71% 76% * Excludes HHC hospitals. Source: 2010 Hospital Institutional Cost Report, and 2010 Health Center Cost Report. Includes all NYC acute, general care hospitals and any wholly owned or controlled community health centers, including HHC. Discharges exclude normal newborns. ED visits include treat and release, and visits that result in admission. Clinic visits include comprehensive care and primary care visits only. HHC’s uncompensated care costs are $698 million. I. Description of the Community Served by BHC Although BHC is located in the Kips Bay neighbor- 30, 2012, excluding individuals who had only an emergen- hood on the east side of Manhattan, its primary service cy room visit. The primary service area accounts for 50% of area is defined as 27 zip codes that account for 50% of its unique patients and the secondary service area accounts for unique outpatients served from July 1, 2011 through June an additional 25% (Exhibit 2). EXHIBIT 2: BHC PRIMARY SERVICE AREA BY ZIP CODE Priority ZIP CODE Unique Outpatients % Of Total Cumulative % 1 10002 5,055 5.57% 5.57% 2 10009 3,521 3.88% 9.45% 3 10016 2,914 3.21% 12.67% 4 11237 2,380 2.62% 15.29% 5 11368 2,365 2.61% 17.90% 6 11385 2,308 2.54% 20.44% 7 11377 2,181 2.40% 22.85% 8 11206 2,134 2.35% 25.20% 9 11373 2,077 2.29% 27.49% 10 11211 2,035 2.24% 29.73% 11 11221 1,727 1.90% 31.64% 12 11208 1,364 1.50% 33.14% 13 11372 1,339 1.48% 34.62% 14 10029 1,313 1.45% 36.06% 15 11207 1,235 1.36% 37.42% 16 11370 1,233 1.36% 38.78% 17 11220 1,208 1.33% 40.11% 18 10001 1,092 1.20% 41.32% 19 11226 1,072 1.18% 42.50% 20 10011 964 1.06% 43.56% 21 10003 901 0.99% 44.56% 22 10035 882 0.97% 45.53% 23 10036 871 0.96% 46.49% 24 10010 864 0.95% 47.44% 25 11106 862 0.95% 48.39% 26 11222 820 0.90% 49.30% 27 10456 816 0.90% 50.20% Source:Unique outpatients served between July 1, 2011 through June 30, 2012. Excludes individuals who only had an emergency room visit. Siemens Data Warehouse, Run date 10/15/13 BELLEVUE HOSPITAL CENTER CHNA | 4 A map of the Primary Service Area shows that BHC’s patient and Western Queens, with additional patients from Northeast base resides mostly in Southern Manhattan, Northern Brooklyn Manhattan and Southern and Central Brooklyn. (Exhibit 3). EXHIBIT 3: BHC PRIMARY SERVICE AREA MAP As shown in Exhibit 4, there were 1,811,222 residents in population increase from 2000 and an additional 5.8% increase the primary service area in 2010. The area experienced a 3.8% is projected from 2010 to 2018. EXHIBIT 4: BELLEVUE PRIMARY SERVICE AREA POPULATION Population Change 2000 - 2010 Change 2010 – 2018 2000 2010 2018 No. Per. No. Per. PSA 1,744,544 1,811,222 1,916,960 66,678 3.8% 105,738 5.8% Source: Claritas 2013 The primary service area population is slightly younger than of residents under the age of 65 and, conversely, lower percent- New York City as a whole. Exhibit 5 shows a larger percentage ages of primary service area residents in the upper age groups. EXHIBIT 5: 2010 AGE DISTRIBUTION, BELLEVUE PRIMARY SERVICE AREA COMPARED TO NYC Age Group Bellevue PSA % of Total NYC Total % of Total 0-14 314,000 17.3% 1,457,981 17.8% 15 - 17 64,926 3.5% 308,787 3.8% 18-24 219,202 12.1% 868,736 10.6% 25 - 44 620,383 34.2% 2,545,461 31.2% 45-64 407,856 22.5% 1,995,295 24.4% 65 - 84 161,662 8.9% 850,683 10.4% 85+ 23,193 1.3% 141,056 1.7% Total 1,811,222 100.0% 8,167,999 100.0% Source: Claritas 2013 BELLEVUE HOSPITAL CENTER CHNA | 5 BHC’s primary service area’s racial composition is presented service area has increased, a trend that continues through 2018. in Exhibit 6. The primary service area has a large Hispanic popu- The Black population is projected to continue to decline through lation; however it has been trending downward since 2000 and is 2018. The percent of Asians living in the service area has increased projected to continue to do so through 2018 (Exhibit 7). At the and will continue to do so, higher than the rate for New York City same time, the percentage of the White population in the primary as a whole both currently and as projected through 2018. EXHIBIT 6: 2010 - BELLEVUE SERVICE AREA RACE/ETHNIC DISTRIBUTION PSA NYC WHITE 40.0% 44.6% BLACK 21.9% 26.6% ASIAN 15.4% 9.8% OTHER 22.5% 18.9% HISPANIC 38.1% 27.0% Source: Claritas 2013 Source: Claritas 2013. ‘Hispanic’ includes anyone who self-identifies as Hispanic regardless of race. EXHIBIT 7: TRENDS IN RACE/ETHNIC DISTRIBUTION – BELLEVUE PSA & NYC Bellevue PSA NYC 2000 2018 Proj. 2000 2018 White 38.6% 41.1% 44.6% 43.9% Black 23.1% 20.6% 26.6% 24.3% Asian 12.9% 16.9% 9.8% 14.4% Other 25.4% 21.4% 18.9% 17.4% Hispanic 38.4% 37.0% 27.0% 29.0% Source: Claritas 2013 Exhibit 8 illustrates the high rates of poverty in BHC’s service area than in NYC.