Mitchell Katz, MD, the new president and CEO of New York City-based NYC Health + Hospitals, is no stranger to running public healthcare systems.
He spent 13 years as director and health officer of the San Francisco Department of Health. After that, he was director of the Los Angeles County Department of Health Services, one of the nation's largest public safety-net systems.
Now, Dr. Katz has brought his experience to New York City's 11-hospital public healthcare system with approximately 40,000 employees. In his new role, which he began Jan. 8, he faces an array of challenges, including declining reimbursement and a large uninsured and Medicaid patient population.
Becker's Hospital Review recently caught up with Dr. Katz to discuss these challenges, as well as his goals for NYC Health + Hospitals and his leadership style.
Note: Responses have been lightly edited for clarity.
Question: What made you decide to come to NYC?
Dr. Mitchell Katz: I was certainly quite happy in Los Angeles. But the factors for coming to New York were first, I'm a native New Yorker. I grew up in Brooklyn so I feel some allegiance, and I knew the system was having challenges, and I wanted to be able to use the skills I had to help my own hometown. And also, my parents are 95 and 90 and live just outside the New York City area, so for me this was an opportunity to take care of my parents and do the kind of work I love for my hometown.
Q: What have the last two months been like?
MK: It's been great. I would say Health and Hospitals is filled with people who are incredibly mission-driven — doctors and nurses and social workers and pharmacists who really care about our patients. I would say it's overall a system that needs a lot of work and improvement to be as good as the people working in it. We have outdated computer systems, outdated financial systems. It makes it challenging to take care of people in the best possible way. I feel the doctors and nurses are doing an amazing job in spite of the system. What you want is for a system that makes things easier to do an amazing job each day for the patients.
Q: What are your goals for the system?
MK: First would be fiscal stability. This system cannot continue with large [funding] gaps waiting to be filled by New York City. A system needs to be able to run on a reasonable and predictable amount of city subsidy. Health and Hospitals will always require a subsidy because we take care of people who are uninsured. Since by definition if you're uninsured there's no source of reimbursement, it makes sense the city has to contribute funding. What's changed is patients gained insurance through the ACA and other insurance expansions. Health and Hospitals did not make the transition to billing insurance, [and] we are inadequately billing for insured patients. So now with decreases in federal dollars it opened up a huge gap in our funding, and I need to fix that. We have established plans and know how to do that. It's already started. But over the next two to three years, I will be able to have a health system that runs on a predictable and appropriate subsidy level relative to our uninsured patients.
The second goal is to transform from a primarily hospital-focused, emergency department -focused, emergency-focused system to a primary care-focused system. Right now, 85 percent of the hospital admissions for Health and Hospitals come through the emergency department. That is not a mature system. What you want is for people to be seen by their primary care doctors or outpatient specialist and then if they need admission to come via those offices. Of course there will always be a certain number of emergencies, but 85 percent indicates a system with an inadequate outpatient system, and that is a true statement of Health and Hospitals but something we're going to change.
And finally, [the system seeks] a more muscular approach around the social determinants of health, including housing. In Los Angeles, I created more than 4,000 housing units for people who were previously in our hospitals, in our emergency rooms, in our clinics. I think when you're talking about low-income people you have a variety of factors beyond medical care that affect their health. It's impossible I think to maintain an optimum state of health when you're living on the streets or even [in] a shelter system if you're suffering from serious chronic disease.
Q: NYC Health + Hospitals recently added to its executive team. How do the new executives play a role in those goals?
MK: Any organization always has some transition. I think it's good to mix new people who are very enthusiastic with very experienced people who know the organization. The people [hired] reflect the areas that are especially important to me. So a director of managed care because part of how we're going to achieve fiscal stability is to have the appropriate contracts with insurance providers that pay the appropriate rates [and] making sure we get prior authorizations and put the right codes so we can bill. Then I created a vice president of primary care because I want the organization to have a focus around primary care that's part of the second goal of transforming from an inpatient system to an outpatient system. Then we had a vacancy for a CIO position. I was fortunate in being able to convince my CIO from Los Angeles, who's the only CIO I know who's had two successful implementations of EHRs in public systems. And then the fourth was also a vacancy we had for a chief safety officer, and the chief safety officer I chose is someone who's had a lot of success in an important program called the "second victim" program. It focuses on recognizing that when a patient has a bad outcome, the healthcare providers around that person are also hurt, and if you're going to maintain a positive environment to encourage good medical and nursing care you need to address the needs of healers. And that was something in addition to the general areas of safety that he did, so I thought he would be particularly welcomed in the organization.
Q: Do you have your own leadership style?
MK: I think what makes me somewhat different than most of the people who lead large systems is I'm a practicing primary care doctor, and I believe all decisions should be made in favor of patients. To me, every decision is about what is best for our patients. I don't make decisions on the basis of money. I don't make decisions on the basis of protocols or prior precedent. To me, everything has to be about our patients because as a healthcare institution, all we do is care for people — that's our function. And so it seems to me everything needs to be focused on patients. For example, one of the early things I'm doing is decreasing our administrative expenses because I want our money to go to the care of our patients. I am most focused on doctors, nurses, social workers, pharmacists and the people who support them. That would include registration people and IT people, but those people's jobs are to support the frontline clinicians who are interacting with our patients. And those are the things I want us to spend money on. I don't want to spend any more [money] than I have to on rent or consultants or things that are not front and center to the people I take care of.