NYC Health & Hospitals is trying to shore up its outpatient primary-care business and secure payments as part of New York City Mayor Bill de Blasio's plan to curb the safety-net provider's massive projected revenue shortfall.
De Blasio's 2016 report forecast a $1.8 billion deficit by fiscal 2020 for the system—the nation's largest in terms of patients served. He outlined a plan to secure funding and stem the loss of outpatients. From fiscal 2016 to fiscal 2018, NYC Health & Hospitals saw a decline of nearly 30,000 unique primary-care patients—shrinking 6.5% from 446,000 to 417,000. The system has more than 70 community health centers with more than 5 million outpatient visits.
The strategy announced Wednesday will roll out over the next six months and includes a new scheduling system, a push to recruit 75 additional primary-care clinicians, mitigation of the no-show rates, and expansion of the clinicians' communication system to cut specialty care wait times.
The health system's outpatient clinics have no-show rates between 30% to 40%, so NYC Health & Hospitals will reserve 30% to 40% of clinic slots systemwide for appointments made just a week ahead of time. The model was deployed earlier this summer at NYC Health & Hospitals/Bellevue.
To address wait times, the system is expanding the eConsult system so primary-care physicians and specialists can communicate about patients and link the cases that don't require specialists back to primary-care clinicians or let specialists advise those clinicians on treatment or prescriptions.
The system is also offloading paperwork from nurses, physicians and nurse practitioners to administrative staff and splitting off routine care like vaccinations to other staff so doctors and nurses can practice at the highest levels of their licenses. Some medication renewals can be granted over the phone through a call center manned by nurse practitioners.
The system is also training clinicians on billing and coding to increase commercial insurer reimbursements and shrink the likelihood of a carrier rejecting a claim.