By Sabina Mollot
As of the past three weeks, Bellevue has had a new CEO, William Hicks, who previously served as the hospital’s COO. The appointment came following the retirement of Hick’s predecessor, executive director Steven Alexander and came alongside a number of other new leadership hires throughout NYC Health + Hospitals, Bellevue’s parent organization.
Hicks had been the acting CEO for the past few months, but since announcing the formal transition, he met with a Town & Village reporter in his new office, which doubles as a conference room, to discuss the big health care issues of the day. Those would include dealing with cuts in federal funding, adapting to the health care industry trend of ambulatory care and how the downsizing of another East Side medical mammoth, Mount Sinai Beth Israel, could impact Bellevue.
The recent news about how a hospital with over 800 beds would be shrinking to one housing just 70 has sent shockwaves through the community, and the medical community at Bellevue has been no exception.
But, said Hicks, “We’re doing our best to stay plugged in and we need to be mindful about what the impacts are. How will that affect our ED (emergency department) and our inpatient care? In an area where we may not have a lot of capacity?”
Asked if his hospital, which has 844 beds that are usually around 90 percent occupied, is prepared for an uptick in patients, Hicks said there is a “surge” plan in place.
“We’ve seen in New York City a terrible influx of patients,” said Hicks, noting that the plan was actually made to accommodate New Yorkers in the event of something like a terrible flu season. Should such a thing happen, “We would open up additional space in the hospital,” said Hicks. “What we have in place are short order plans if something was to happen. Not as strong a plan as we would want for the longterm.”
That said, the surge plan might not be needed. Mount Sinai has said its beds at Beth Israel have on average been under 60 percent utilized.
Meanwhile, considering the overall shift in the health care industry to ambulatory care and urgent care centers, Hicks compared the situation to “trying to change a tire on a car while you’re still rolling. You can’t stop.”
He also pointed out that as city-run facility, there are some advantages in the event of any medical emergency. “We have the right people in the right place. What the mayor knows we know too,” Hicks said.
Hicks also weighed in on the subject of Beth Israel in a written statement sent after the interview.
“The changes at Beth Israel Medical Center underscore how vital NYC Health + Hospitals/Bellevue and the entire public hospital system are to the people of New York City,” he said. “Now is the time to strengthen and protect Bellevue and all of NYC Health + Hospitals so we can continue to serve our patients, especially those who are uninsured and have limited options.”
At this time, Bellevue has a staff of over 6,200, a figure that accounts for residents and volunteers. It’s America’s oldest hospital, established in 1736. Its emergency room gets 110,000 visits a year and the hospital 500,000 outpatient visits. It’s also affiliated with the NYU School of Medicine.
It is also a hospital facing an uncertain financial future. The American Healthcare Act, while applauded by Health + Hospital’s administrators, has also meant that federal funding it’s relied on to subsidize its many uninsured patients (roughly one third), who can’t pay, including many undocumented immigrants, has been cut. The funds, known as Disproportionate Share Hospital (DSH) funding, are set to be cut starting in October, 2017.
The public hospital network has estimated that without legislative intervention to stall or prevent this, the budget shortfall will be $1.8 billion by fiscal year 2020. The city has pledged $2 billion in support to be dispersed by that time, but that funding is also tied to the hospitals investing in a number of changes aimed at getting the hospital for financially stable by focusing more on what’s been referred to as preventative care and “community-based” care. The city is also not recommending layoffs. Health + Hospitals has so far not done so though it has shed over 700 positions over the course of six months, according to testimony given to the City Council by Dr. Ram Raju in May. Meanwhile, Raju also stressed that the city’s hospitals would still be expected to meet the demands posed by STDs, diseases like Zika and street drugs like K2.
Within the hospital network, Bellevue is no exception in that it has “a great deal of uncompensated care,” Hicks said, due to people who “because of their insurance or they’re undocumented” or a multitude of other reasons, can’t or won’t seek care elsewhere. On the DSH (pronounced dish) cuts, they have put Bellevue in a position where “we in effect have to compete for every patient that’s out there,” said Hicks, “and we have to do it with the extra burden of patients who are uncompensated for us.”
In a talk to staffers and others at the hospital at an event in February, Dr. Ram Raju, the CEO of Bellevue’s parent organization, the recently renamed Health + Hospitals, said the response to the budget gap would be to improve customer service at member hospitals, a plan that has since been implemented.
“We have to make the experience exceptional so that the patients come back to us,” said Hicks. “We spend a lot of time looking at ways we can make things better, at ways we can be more efficient.”
This includes making sure employees are well trained and supported. “Staff engagement is key to us succeeding,” said Hicks. “Happy employees mean happy customers. We’re trying to do more with what we have, not with less but what we have.”
He gave an example of how instead of making a patient sign up for different services at different departments, “we’re trying to make a one-stop shop. Instead of a patient having to go to one desk to take care of financing and then go to another desk to make an appointment.” Hicks is also focused on reducing wait times for primary care service. “We can’t have weeks of wait time.” He said there have already been some improvements to this though it varied with each department.
Additionally, said Hicks, “We’re looking at all opportunities to use technology, tele-medicine” and expand primary care services. “As we keep patients healthier, we’ll have less emergency department visit and less inpatient visits,” he predicted.
Any expansion in a department would not be likely to mean new hires though but rather “shifts” within the system from one department to another.
Hicks has also done a fair share of shifting himself. A 37-veteran of the health care industry, having begun as x-ray tech at Kings County Hospital at age 20, Hicks said, “I grew up literally in hospitals.”
He’s held a number of positions over the years, mostly at Bellevue, including chief innovation officer and chief tech and he’s also previously, as a student in the x-ray program, worked as a clerk filing nuclear medicine reports. “I’ve seen this place from a lot of levels,” said Hicks, adding that the experience has helped him “make informed decisions and understand the effect of those big decisions.”
Over the years, Bellevue has made a name for itself in terms of specialty care and 40 percent of patients come from the outer boroughs. Behavioral health programs are also a major draw, and Bellevue has one of the only CPEPs (child psychology emergency program) in the country and the only one in the state. The program, said Hicks, is “highly utilized.” The hospital’s famous psychiatric and addiction treatment programs, including two forensic units, serve both children and adults, including prisoners in a unit that’s maintained by the Department of Corrections.
Bellevue, Hicks noted, is an in institution with a lot of firsts over its 280 years in existence. Most recently, it became the first hospital in New York to treat an Ebola patient and has since been recognized as a level 2 Ebola and special pathogens treatment center, a federal designation. So if the New York City area was to be struck with a dangerous pathogen, “we would be involved in the treatment,” Hicks explained. “If we have another disease that’s airborne, and as deadly as Ebola, we could apply a lot of the principles we worked on and we’re in a position to teach.”
In fact, he noted during the interview, a national conference was taking place on the subject of Ebola in another part of the building.
In related news, the building itself has had to do some evolving. As a response to Hurricane Sandy, it’s recently undergone repairs and work to mitigate future disasters. Bellevue, along with other hospitals on the East Side of Manhattan, NYU Langone and the VA, suffered significant damage to its campus from flooding during the 2012 storm. Now many of its systems are higher in the building, fuel that supplies its generators has been upgraded and the elevators are now able to run from the first floor up and then down again, even if the elevator pit gets flooded.