A N D R É W A L L A C E
28 East 1st Street Mount Vernon,NY 10550 July 27, 2020 Hon. Andrew M. Cuomo
Governor of New York State
NY State Capitol Building
Albany, NY 12224 Re: Reimagining Healthcare in Mount Vernon Around Community Care Dear Governor Cuomo: I write on behalf of the residents of Mount Vernon and its surrounding area to respectfully seek your assistance and support for a proposal to transform and revitalize the healthcare and wellness of this under-served urban community. We have been inspired by your calls to “reimagine” what New York and its institutions must look like in a world following the COVID-19 pandemic. Simply put, communities like ours were hit harder by this virus because our access to emergency care, routine care, and preventative care were basically non-existent prior to the pandemic. The virus found a population riddled with undiagnosed or poorly managed underlying health conditions, and it laid waste to our community. With a second wave coming, we cannot delay the process of reimagining healthcare in Mount Vernon and under served urban areas any longer. The other “movement’ defining 2020 is the growing recognition that it is time to stop making Black and Brown communities like Mount Vernon the State’s and the County’s last priority. In one of the wealthiest counties in the country, it is abominable to see the state of healthcare in Mount Vernon. Because it needs the most help is the reason to make it a top priority. Research by Columbia University demonstrates that the impacts of COVID-19 have not been felt equally across racial lines. Black people are getting the disease at a rate twice their respective percentage of the population would otherwise suggest (27.5% of positive cases, 13.4% of the population). Hispanic people are also over represented when it comes to positive cases. Making matters worse minorities are more than twice as likely to suffer from chronic health conditions and comorbidities that make COVID-19 more lethal. Can that system be “reimagined” really? Or, does it need to be fundamentally transformed with resources being prioritized to communities that need them the most, not the least? Profit-before-patient hospital “systems” have failed Mount Vernon for decades. Sound Shore promised a lot then went bankrupt. Despite claims to return Mount Vernon Hospital to a full-service facility, Montefiore has instead run it into the ground. Given the patient and demographic mix, these hospitals are disincentivized to invest in urban hospitals for fear that more patients simply mean more losses,with Medicare and Medicaid reimbursements alone simply not covering the cost of care. Profitable clinics, treatments, and procedures are farmed out to their other hospitals, forcing our residents, many of them chronically ill and elderly, to traverse the county in order to receive basic medical treatment. That must change. What we have learned in 2020 is that a lot must change. The Background People in this city adore this city. Being “born in Mount Vernon” is deemed a badge of honor, one worn with pride.There are some families here with five generations who can lay claim to that honor. But, that cannot happen anymore because Mount Vernon Hospital does not deliver babies, the Pediatrics and OB/GYN center having been long shut down by Montefiore. Gone, too, is the nursing school that gave our young people a path to a medical career. The medical residency program, the chronic wound care and hyperbaric center, committed psychiatric care, and HIV/AIDS treatment center, like the others, gone. In their place remains only a skeleton crew of physicians, a handful of prisoner patients,and waiting ambulances ready to ship anyone who does come in the door to another Montefiore hospital in another city. At last count, Mount Vernon Hospital had a 24-bed capacity – to care for a city of 100,000 residents. Any way you look at it, that’s shameful. So, when Montefiore announced it was going to shut Mount Vernon Hospital down last fall, the outrage was immediate, understandable, and community wide. The city these people revere so much was sold another bill of goods and left with nothing.Again. To add insult to injury, Montefiore was set to receive$41 million in grants from the State of New York to close the hospital and to build an urgent care center to, once again, ship our residents to other cities for treatment. No beds. No baby deliveries. Just come in and get shipped to Yonkers or The Bronx or Nyack or White Plains.That grant would reward incompetence, plain and simple,and must immediately be repurposed to restore adequate medical care to Mount Vernon. At the time, I began to formulate a plan to do things differently at the hospital in Mount Vernon. While I didn’t win the mayoral election that November, I did not give up on the people of this city, our plan, or the goal of having a full-service, full-capacity hospital in Mount Vernon.
The Idea The process of “reimagining” begins first with throwing out bad ideas. Profit-driven medical care in Mount Vernon by regional providers is one of those bad ideas. Forcing elderly patients to travel miles for dialysis and diabetes management is a bad idea. Eliminating profitable procedures that could be performed on patients with commercial insurance (i.e., not Medicaid/Medicare) is a bad idea. Ignoring the needs of the community and failing to recognize the cultural setting in which you operate, those are both bad ideas. When you run a terrible hospital, you lose the trust of the community. They don’t seek out care they need because they don’t trust you to provide it. That’s a bad result, borne of bad ideas. From this came the idea of focusing on “Community Care.” Community Care starts with bringing you into this world in a healthy environment, providing a continuum of care as you grow, and giving you the tools to keep you healthy as an adult. Community Care is focused on addressing wellness as a way of life, not a pipe dream. It demands input from the community, and it requires transparency to the community. Community Care goes beyond the hospital’s balance sheet to consider the community’s balance sheet. Every penny of revenue needs to go back into the hospital, to provide for the changing needs of the community and to prepare for things that no one expected, like COVID-19. Community members need real input into how the hospital is run and how it is supported by donations, grants, and contributions to a charitable foundation that will be set up in conjunction with the not-for-profit hospital. The idea is simple enough. Can it be done? It can be done if you have the vision to imagine it and if you have an experienced team that can execute on that vision. The Team My advisors and I began a search for just such a team in September 2019. What we found was a group of committed professionals at Monument Health Care Partners (“Monument”) with decades of experience in medicine, hospital administration, finance, healthcare reimbursement, and physician recruitment who not only wanted to accept the challenge that Mount Vernon Hospital offers, but also want to become invested in this community by letting the turnaround of the hospital lead a resurgence of the city itself. Even more important, the team that Monument has put together has done this before, turning around a failing 354-bedhospital (United Medical Center) in Ward 8 of Washington, D.C., one of the poorest and most under served communities on the East Coast, transforming it from a loss-generating eyesore into a leading-edge provider of healthcare that rivaled medical facilities in other parts of the District. They established a pediatric emergency department (ED) and revamped the adult ED to the point that, within six years, they were treating 80,000 ED patients annually, allowing parents to once again bring children to their local hospital instead of transporting them across the District, three hours each way. What that did was change the way the community thought about healthcare and, importantly, the hospital that provided it. They led from the front in developing innovative hyperbaric and wound treatment methods, renovated the aging facility, and implemented some of the most efficient reimbursement systems in the District. And, maybe most importantly, they were able to do all of this and turn a profit in an urban hospital, something that’s not supposed to be possible. The Monument team includes:
Frank DeLisi – Frank has been running urban hospitals for over 30 years as an administrator and chief executive. He has a passion for making a difference in the lives of the communities he serves and brings energy and enthusiasm to help build teams within the hospital and among the residents of the community.
Dr. Cyril Allen – Dr. Allen is a renowned medical practitioner in Washington, D.C. who served as Chief Medical Officer for United Medical Center during its turnaround. Growing up in Fayetteville, North Carolina and following his pediatrician father around to help deliver babies in homes because his father’s patients were not allowed in area hospitals, Dr. Allen understands the importance of first-class medical care, especially for people who have been deprived of it for too long.
George Lowe – George has extensive experience in financial processes, fundraising, political and municipal outreach, and hospital operations. He has served as an advisor to a number of Mayors of Washington, D.C., including Marion Barry and Adrian Fenty. He has deep political connections in the District, including extensive experience in navigating grant- and Federal funding sources. Mark Monroe – Mark has been a labor relations specialist for nearly three decades who regularly interfaces with healthcare providers and union representatives to ensure that both sides are pulling in the same direction, with a common goal. He has an array of contacts in national labor organizations and a proven track record of bringing them to the table to help solve problems in a healthcare setting.
Aarti Subramanian – Aarti is a multi-talented, hands-on executive with a proven track record of successful financial management, costs restructuring, receivables management, and recruiting, having served in numerous capacities including CFO, Compliance Officer, Interim CEO, and Head of Government Affairs. All-in-all, we feel that the Monument team is well-suited to taking on this challenge and, more importantly, in succeeding. The Plan To be blunt, Montefiore can no longer be trusted to run Mount Vernon Hospital.It has lost the faith of the community it purports to serve and has cost this community dearly, maybe for years to come. New management needs to be put in place while the hospital is transitioned to a non-profit entity with new ownership. In order to do that, an in-depth assessment needs to be conducted by the Monument team and the results reported to both the community and the Department of Health. Montefiore, for their part, will need to assist (or be compelled to assist) in the process and give support to the Monument team as it makes its assessment. From infrastructure to reimbursement to purchasing to personnel, if this step is not done thoroughly, this project will not succeed. It cannot be done in a rush, and it will likely take 4-6 weeks of dedicated time to accomplish, assuming Montefiore is cooperative in the process. While this occurs, the Monument team will also engage negotiations with Montefiore to transition ownership of the hospital to a new non-profit entity. There are and will continue to be opportunities for Montefiore and other regional hospital chains to partner with the new Mount Vernon Hospital. The goal is to provide a better level of care to Mount Vernon, and all avenues to doing that will be explored. Once the assessment process is completed, the Monument team will undertake the management of the hospital and begin implementing the plan to bring it up to the standards that are expected of a 21st century health care facility.
Funding will be critical, even to begin the assessment process. The Monument team has engaged already with the U.S. Housing and Urban Development Department about capital grants to assist in infrastructure renovation and several other available funding sources have been identified, as well. We would respectfully suggest that the $41 million earmarked for Montefiore would be better served in helping to support this venture. A trust can be set up to ensure the money is spent wisely and accountably, in accordance with its purposes, and directed toward priority medical needs in the community, including increasing capacity for potential second-wave COVID-19 impacts this fall and winter.
The Monument team will also liaise directly with the NYS Department of Health as well as the County Department of Health to ensure that the operations are being tailored to meet the needs of the community and in line with the recommendations of the Commission on Health Care Facilities in the 21st Century to create smarter,more agile and technologically forward health care facilities. They would be happy to engage with the task forces established in the wake of the COVID-19 pandemic chaired by Eric Schmidt and Michael Dowling of Northwell Health, as well.
The Result
If successful, we believe that the Community Care model can be extended to other urban medical facilities and form a foundation of wellness for communities that need it the most. Dr. Allen said it best when he said, “Doing this is going to come at a cost. But, that cost will be nothing compared to what it will cost if we don’t do it.”
My team and I sincerely appreciate your thoughtful consideration of this proposal and stand ready to answer your questions, make available the Monument team to discuss any aspect of the proposal in more detail,and to consider any and all thoughts you may have on the proposal.
Respectfully Yours,
Former Mayor of Mount Vernon
Cc:
Ms. Melissa DeRosa (via electronic mail)
U.S. Representative Eliot Engel (via electronic mail)
County Executive George Latimer (via electronic mail)
State Senator Jamaal T. Bailey (via electronic mail)
State Senator Alessandra Biaggi (via electronic mail)
Assembly Member Gary Pretlow (via electronic mail)
County Legislator Lyndon Williams (via electronic mail)
County Legislator David Tubiolo (via electronic mail)
Mayor Shawyn Patterson-Howard (via electronic mail)
City Council of the City of Mount Vernon (via electronic mail)
