Must Also Treat Patients Who Can Pay
H + H Chief: Add Staff to Raise Revenue
· By BOB HENNELLY
Mar 12, 2018 Updated 16 hrs ago
MITCHELL KATZ: 'I need to hire revenue-generators.'
At his first City Council committee appearance, the new head of NYC Health + Hospitals laid out a bold turnaround vision for the municipal system that he conceded remains fiscally “precarious.”
Dr. Mitchell Katz told the Committee on Hospitals Feb. 28 that the only way out of the system’s ever-deepening annual deficits was to actually do new hiring for positions that would generate revenue.
Adding Doctors, Nurses
“I understand that when you have a large deficit, people look at requests for new positions with skepticism. I certainly would in their position,” Dr. Katz said. “But to get Health + Hospitals out of its current crisis, I need to hire revenue-generating positions, including primary-care doctors, nurse practitioners, pharmacists and other specialized professionals. I am happy to present business plans.”
Dr. Katz has won high marks as a public-hospital-system turnaround specialist. In 2011, when he was tapped to run Los Angeles’s public-health system, it had a $250-million budget deficit. Six years later, under Dr. Katz’s leadership the system had a $560-million surplus.
While that city's public system has just four hospitals and New York City’s has 11, the annual budget for both systems is in the $7-to-$8-billion range. NYC H+H’s workforce is 40,000, about 6,000 more than the Los Angeles system. Both systems serve cities with a large undocumented-immigrant population as well as tens of thousands of homeless people.
In his Council testimony, Dr. Katz had nothing but praise for the quality of medical and nursing care provided at Health + Hospitals, which he said was actually “above the community standard.”
Roadblocks to Success
“Every day our hospitals save the lives of critically-ill patients in our emergency rooms, intensive-care units and hospital units,” he said. “However, our system suffers from several serious problems related to access if you are not critically ill. And these access problems compound our financial problems because they discourage paying patients from seeking our care.”
Dr. Katz said he had already identified one key way that NYC H+H was undermining itself by passively conceding market share for privately-insured patients the system was entirely capable of treating.
“Stop sending away paying patients,” he said. “In my nearly two months here, I have learned that in many different parts of our system we discourage or even prohibit the care of insured people. There is a widespread urban myth at Health + Hospitals that insured patients should be referred out so that we can focus on care for the uninsured.
“This results in lost revenue and Health + Hospitals” having to pay outside providers to care for the participants in H+H’s own Metro Plus insurance plan, Dr. Katz pointed out.
He told the Council that the public system needed to continue to embrace its traditional role as “the largest provider of behavioral health in NYC, and one of the largest providers in the country” because mental health is part of the system’s core mission, even though those services are poorly reimbursed.
Offer Services That Pay
“What I do not agree with is the idea that we would not do services such as cardiac angioplasty that are well-reimbursed,” he told the Council. “In the case of angioplasty, not only do we lose money when we need to send our patients elsewhere (we do this common cardiac procedure only at Bellevue right now), but ambulances with patients with chest pain have to bypass our hospitals because we are not providing the right mix of services.”
Dr. Katz, 58, grew up in Brooklyn and went through the New York City public-school system but has spent his medical career on the West Coast, leading the San Francisco public-health system and moving on to run Los Angeles.
Back in January Mayor de Blasio’s pick to run H+H told reporters he was going to continue to practice medicine in the hospitals that he also leads.
“I went to a lot of trouble to become a physician and it was a rather hard road and I love doing it. I have always loved caring for people,” Dr. Katz said. “But in my role as an administrator, people have asked, how could you have time? But the time is so well spent because how best do you understand what is working or not working about your system if you are not working in it?"
He continued, “In Los Angeles when we took over the care of inmates in our jail, the first thing I wanted to do was work there. And I did and I had so much of a better sense after I worked as a doctor in a jail. I didn’t do it every day. I didn’t need to do it every day.”
Work at Every Hospital
Dr. Katz told the Council panel that he had just gotten his New York State medical license and would start his H+H practice as an outpatient doctor at a community-health center on the Lower East Side, NYC Health + Hospitals/Gouverneur. He also committed to doing work as an inpatient doctor at all of the public system’s 11 hospitals on a rotating basis.
Dr. Katz’s first City Council appearance was before the Committee on Hospitals, which City Council Speaker Corey Johnson established when he re-organized the City Council Committee structure after his election as Speaker Jan. 3. Council Member Carlina Rivera chairs the committee. The other members are Council Members Mark Levine, Diana Ayala, Francisco Moya, Antonio Reynoso, and Alan W. Maisel.