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4th Annual Retreat for PAGNY Board of Directors Focuses on the Transformation of Healthcare

This year’s Annual Retreat for the PAGNY Board of Directors focused on the transformation of healthcare—both in New York City and across the country. The retreat, held at the Hotel Plaza Athenee in Manhattan on Wednesday, Nov. 16th, featured speakers who addressed City healthcare policies, technological advances in medicine and changes in how hospitals and doctors are paid. Some of the speakers alluded to the possible impact on healthcare by the new federal administration in Washington, but the focus of the retreat was on the internal changes taking place in the industry.

Dr. Herminia Palacio, Deputy Mayor for Health and Human Services, Asks for PAGNY’s Help to Change NYC Healthcare System

Dr. Herminia Palacio, Deputy Mayor of Health and Human Services

Dr. Herminia Palacio, New York City’s Deputy Mayor of Health and Human Services, asked for PAGNY’s support for Mayor Bill de Blasio’s plans to transform New York City Health + Hospitals and the City’s healthcare system, saying, “I am eager for PAGNY’s continued leadership in our transformation efforts.”

“The challenge before us may seem daunting,” she said. “But we know we are up to the task of meeting these challenges. And we are counting on our physicians to meet the challenge of systemic change. PAGNY is on the front lines of this commitment to deliver culturally appropriate and patient-centered care.”

“We depend on you to be community leaders—not only within the four walls of your hospitals—but also to be leaders in your communities and your faith-based communities. The unique commitment of PAGNY physicians is to serve underserved communities. This is a moment of opportunity, not just challenge,” she said.

PAGNY Board members responded warmly and very positively to Dr. Palacio’s presentation, asking numerous questions both during and after her remarks.

Dr. Palacio said the de Blasio administration was thinking strategically about how to better serve the healthcare needs of all populations across the City. She noted that one in six New Yorkers are served by New York City Health + Hospitals—including 400,000 uninsured patients, of which many are undocumented immigrants.

She also noted that there has been a recent 11 percent decrease in the number of patients at City hospitals, yet there has been no reduction in costs. The City hospital system faces a $1.8 billion deficit by 2020, she said, even with the Mayor’s $2 billion addition to its budget in the current fiscal year.

The Deputy Mayor said the City’s mission is to ensure “equality and equity” in healthcare management. That means reducing hospital readmissions and reducing costs, but still keeping patients healthy. “Health + Hospitals remains a leader in care management,” she said. “We must focus on patients as partners in their own care. And we need to rebalance and restructure services to deliver the right care at the right place at the right time.”

To PAGNY Board members, she emphasized four of the 12 strategies unveiled by the Mayor in his One New York healthcare plan developed in consultation with the Blue Ribbon Advisory Panel earlier this year. They are: restructuring the City hospital system to improve efficiency, expanding community-based care, maximizing revenue from MetroPlus (H+H’s insurance plan) and improving operations through the implementation of state-of-the-art technology.

Dr. Palacio also said she was aware of the concerns of possible healthcare changes that could be enacted by the new Trump Administration in Washington.

“There are real and credible threats on the horizon that we don’t have our arms around,” she said. “But let your voices be heard. You can be a voice for the underserved. Physician leadership has considerable clout and is an important voice in Washington.”

Surgeon and Futurist Dr. Rafael Grossmann Calls Technology Essential for Healthcare in the 21st Century

Dr. Rafael Grossmann, Surgeon and Futurist

Dr. Rafael Grossmann, FACS, Surgeon and Healthcare Futurist, told the PAGNY Board that utilizing technology—including telemedicine, virtual reality, holograms and wearable computer devices such as Google Glass—is essential to gain good health outcomes from patients in the 21st century and to train the doctors needed to care for those patients.

Dr. Grossman was invited to address the retreat by Dr. Bijan Safai, President of the PAGNY Board of Directors, who said he has had a lifelong interest in how gadgets work – particularly cameras — and how technology could be applied to medicine. That’s why it was important to invite a speaker who was knowledgeable about how cutting–edge technology was changing the field of medicine.

“It’s not a dream. It’s here now. The only barrier is our imagination,” said Dr. Grossmann, the first surgeon to use high-tech Google Glass eyeglasses during live surgery.

Healthcare in the United States is in trouble, he said, noting that 440,000 Americans die every year from treatable diseases and that there will be a provider deficit of 125,000 by 2025.

“That’s high demand, low supply,” he said. “And doctors spend too much time on their computers or on paperwork—not with their patients.”

Dr. Grossmann said one solution is expanded use of telemedicine. He noted that in 80 percent of doctor visits, patients do not need to be touched. “That means $317 billion is spent every year in unneeded doctor visits,” he said. He predicted that more than 100 million doctor visits could be handled by telemedicine in the near future. “Telemedicine is very intuitive—we now have cameras everywhere,” he said, noting that patients could use their cell phones to be examined remotely.

He added that there are numerous technologies already on the market that use telemedicine to conduct medical tests, including reading brain waves, conducting EEG tests and examining breathing and heart rates.

“You see what the problem is and you can call your doctor or 911—these are really changing how we deal with medicine,” Dr. Grossmann said.

He said he strongly believes that technology can also help train the doctors of tomorrow. Virtual reality (VR) can enable medical students around the world to watch operations in real time. VR can also enable surgeons to conduct test surgeries before they enter the operating room to avoid mistakes.

“Technology is not a substitute but an enhancement for traditional medicine,” Dr. Grossman said. “We are all technical animals and we are all animals of technology.”

Dr. Andrew Brotman, Chief Clinical Officer at NYU Langone Medical Center, Explains Financial Challenges Facing NYC Healthcare Systems

Dr. Andrew W. Brotman, Senior VP and Vice Dean for Clinical Affairs and Strategy and Chief Clinical Officer, NYU Langone Medical Center

Dr. Andrew W. Brotman, Senior Vice President and Vice Dean for Clinical Affairs and Strategy and Chief Clinical Officer at NYU Langone Medical Center, talked to the PAGNY Board members about the many financial challenges facing healthcare systems today.

He said “don’t be surprised” if the changes proposed by the Trump Administration would begin to see patients as “purchasers” of healthcare, as opposed to receivers of medical care.

He told Board members that healthcare reimbursement methods are moving from free-for-service to value-based systems and all healthcare systems will need to adjust. He said the Federal Centers for Medicare & Medicaid Services (CMS) is pushing healthcare systems to adopt alternate payment models. “Everyone is trying to push away from a fee-for-service model,” he said.

He noted that NYU’s medical system, which is primarily focused on ambulatory services, created a “clinically integrated network” in 2006 that allows NYU doctors and affiliated physicians to negotiate with insurers for a “suite of services.” He said

that could be a good model for PAGNY since the size of the two systems—2800 doctors in the NYU network and nearly 3,000 medical professionals in PAGNY—are of a similar size.

Dr. Brotman also said that NYU’s adoption of a “bundled payments” system of reimbursement for Medicare had helped reduce NYU’s costs and even resulted in a $4 million bonus from CMS. For example, he noted that for major joint replacement surgeries under Medicare, NYU has reduced the average length of a hospital stayed from 4.79 days in 2013 to 2.69 days in 2016.

In answer to a question from Dr. Luis Marcos, PAGNY CEO, Dr. Brotman said value-based reimbursement systems could be compatible with Faculty Practice Plans, of which there are four in PAGNY.

“You can do very well, but it’s a different orientation,” he said. “The question is how do you form a system with minimal high cost items and how do you engage your patient population so they stick with you. At the end of the day, we want large patient populations to see you as their provider of care.”