REPORT TO THE BOARD OF DIRECTORS – March 2014

In late February, The Joint Commission conducted its triennial unannounced survey at Queens Hospital Center, the second HHC facility surveyed by TJC this year. The four-day survey was conducted by a team of seven surveyors: a physician, two nurses, an administrator, a Life Safety Code specialist and two Behavioral Health surveyors. The facility received full accreditation.

With the exception of the team leader, none of the surveyors had surveyed an HHC hospital before and were consistent in their praise of Queens Hospital and HHC. They were impressed with the level of medical staff participation in the survey and the knowledge and enthusiasm of nursing and other staff.

The team leader commented that “staff was engaged in the organization’s efforts to deliver the best care on their path to high reliability.” The nurse surveyor stated that the school-based programs visited were “one of the best embedded integrated programs in a school” that she had seen. The life safety surveyor said “the level of engagement and attention to detail and striving for perfection was remarkable.”

Congratulations to the leadership of Queens Hospital Center — Chris Constantino, Senior Vice President; Julius Wool, Executive Director; Jasmin Moshirpur, MD, Medical Director; Joan Gabriele, RN, Chief Nurse Executive; Jean Fleishman, MD, Quality Management; Kenneth Hart, Regulatory Affairs; and the staff of Queens Hospital Center for a job well done.

The Joint Commission is surveying Bellevue Hospital Center this week, and the results of that survey will be in next month’s report to the Board. Four facilities remain to be surveyed this year: Coler, Henry Carter, North Central Bronx and Woodhull.

In recognition of Patient Safety Awareness Week, on March 5th we hosted our annual Patient Safety Champions Award Ceremony and Forum. The event is our opportunity to acknowledge and celebrate the commitment of HHC staff to increasing safety across the enterprise and to reducing harm to the patients we serve.

This year, awards were given to Champions from each HHC facility and HHC Health and Home Care. Twenty-one facility teams and one individual were recognized. The work of all of the Champions was impressive and well-worthy of recognition. The 2014 President’s Choice Award was presented to the Interdisciplinary Expression of Unmet Needs Team at Sea View Hospital Rehabilitation Center and Home who, over a two year period, achieved a 51 percent reduction in the number of residents receiving antipsychotic medications, thereby improving their quality of life and decreasing risk for harm.

Patient Safety Awareness Week, an annual international patient safety awareness and education campaign for healthcare workers and the communities they serve, is sponsored by the National Patient Safety Foundation (NPSF). This year the NPSF encouraged healthcare organizations to help both patients and staff to “Navigate Your Health…Safely.”

In keeping with that message to staff and patients, the keynote presentation was provided by Doug Bonacum, Vice President for Quality, Safety, and Resource Management at Kaiser Permanente. He focused his remarks on the critically important topic and next horizon of our safety work, “Creating Joy, Meaning, and Safer Health Care — Building a Culture of Worker and Patient Safety.” Doug deepened our understanding of the inextricable link between worker and patient safety, defining worker safety as a pre-condition to patient safety. His presentation and group facilitation was an important step towards our focusing greater attention on identifying and leveraging opportunities to create synergy between the two “safeties” and improving outcomes for both staff and patients. Mr. Bonacum has been an active partner with HHC along our nine-year patient safety journey. He is a nationally renowned speaker who is also a Board member of the National Patient Safety Foundation, and faculty member for the Institute for Healthcare Improvement’s Patient Safety Executive Program.

The patient safety event, held at the Conference Center at Jacobi Medical Center, was attended by over 250 employees, medical staff and administrative leaders from across the enterprise. In addition, over 50 teams participated via live streaming to their facility.

Thank you to Senior Vice President Caroline Jacobs, Mei Kong and their staff for organizing the event and for being relentless HHC patient safety champions throughout my tenure as President.

HHC hospitals played a key role in treating victims of the East Harlem explosion and building collapses earlier this month. Harlem Hospital Center received 13 patients from the disaster and Metropolitan Hospital Center received 19. A press briefing was held that day at Harlem Hospital for staff from both hospitals to provide the media with updates on the victims and steps taken to help them. Kudos to the staff at both hospitals for their outstanding, level-headed and well-organized response to this terrible tragedy.

President Obama’s FY 2015 budget proposal, released March 4, included $402 billion in healthcare cuts over 10 years, including $354 billion in cuts to Medicare providers. If the President’s proposal prevails, the cut in federal dollars to HHC over ten years would be $391 million, specifically:

• $90 million in cuts to Indirect Medical Education funding;
• $17 million in bad debt funding;
• $19 million from changes in post-acute care payments;
• $17.5 million in cuts to inpatient rehabilitation services payments; and
• $247.5 million in Federal DSH funds as a result of the extension of cuts to these supplemental Medicaid funds through FFY 2024.

Last week Governor Cuomo released his Executive Budget for State Fiscal Year (SFY) 2014-15. The $142 billion proposed budget includes an increase of 3.8 percent in Medicaid funding — $604 million. Total Medicaid funding is proposed at $58.2 billion. Although there are numerous budget provisions affecting HHC, staff is still analyzing the details of the proposals. A comprehensive overview of the Executive Budget will be presented at the next meeting of the Board’s Strategic Planning Committee.

The following is a brief summary of some of the key provisions of interest to HHC:

• Extension of the Global Cap on Medicaid spending until March 31, 2016 — one additional year — and associated State Department of Health (SDOH) “superpowers” to make cuts to keep spending within the Cap;
• Restoration of the two percent across-the-board cut to Medicaid provider rates beginning on April 1, 2014;
• Authorization of SDOH to share savings with Medicaid providers if Medicaid spending is below the Global Cap. No less than 50 percent of the savings would be distributed proportionately to all providers and plans and no more than 50 percent to “financially distressed and critically needed providers as identified by the commissioner;”
• Allocation of $1.2 billion over seven years for a new capital program for hospitals, nursing homes, diagnostic and treatment centers and licensed clinics. The program would provide grants to improve financial sustainability and increase efficiency through collaboration. Funding can be used for closures, mergers, restructuring, infrastructure improvements, expanding primary care capacity, promoting integrated delivery systems and providing continued access to essential health services;
• Streamlining of the process for HIV testing by eliminating the requirement for written informed consent, except for patients in correctional facilities;
• Authorization of SDOH to implement an Affordable Care Act insurance option for individuals between 138-200 percent of the federal poverty level. Under this option, the State would implement a Basic Health Plan, which provides public health insurance as an alternative to private insurance that would be purchased through the Health Exchange;
• Allocation of up to a total of $95 million for health information technology, including funding for the operation of the State Health Information Network of New York (SHIN-NY) and the establishment of a statewide electronic medical record and an All-Payer Claims Database for health insurance claims; and
• Allocation of $7 million to establish 11 Regional Health Improvement Collaboratives, which will convene healthcare stakeholders to identify challenges, then recommend and implement solutions.

Last week, the City Council Health Committee heard testimony from HHC on the FY 15 Preliminary Budget and Financial Plan. HHC’s testimony mainly focused on the Corporation’s ongoing efforts to reduce budget gaps, factors that could increase the deficit and areas where new revenue will be seen. The Council focused many of their questions on prior year cost containment and restructuring initiatives, risks to the Financial Plan and how New York State’s tentative Medicaid waiver will affect HHC. New York City Public Advocate Letitia James joined members of the Health Committee at the hearing. Her questions centered on the status of the former Neponsit facility, the proposed dialysis contract with Big Apple Dialysis and what effect the Affordable Care Act would have on the number of uninsured patients served by HHC. A second budget hearing on the FY 15 Executive Budget will be held by the City Council later this year in May.

Also released was the Independent Budget Office’s (IBO) report on HHC’s Preliminary Budget, which focused on the Corporation’s projected operating deficits through FY 18. The report highlighted the “well documented” causes of the projected budget gap: State & Federal reimbursement cuts, a high Medicaid and uninsured population, declining utilization and high cost of labor fringe benefits. The report also highlighted MetroPlus’s enrollment achievements through New York State of Health and the Affordable Care Act health insurance marketplace for New York. The report concluded by emphasizing MetroPlus’s strategic importance to HHC’s long term financial outlook.

HHC’s annual public meetings for fiscal year 2014 were held in each borough through the end of calendar year 2013. Our Intergovernmental Relations staff will draft individual responses to comments made by the speakers at those meetings by June.

This week, North Central Bronx Hospital announced plans to reopen Labor and Delivery services by late summer 2014 with an experienced team of medical professionals who specialize in obstetrics and gynecology care and reflect HHC’s commitment to restore safe, high quality and comprehensive maternity services for the North Bronx community. Inpatient maternity services were suspended last August due to physician and other staff vacancies that HHC and NCBH leadership believed could put at risk the quality and safety of patient care.

The details of the reopening plan for maternity services include an investment of nearly $4.5 million for restructuring the staff and operations of the Women’s Health Services at NCBH. A new staff model will provide a core team of experienced physicians, physician assistants, specially trained registered nurses and licensed midwives essential to operate a quality community hospital maternity unit. The North Bronx network is committed to maintaining the midwives’ central role on the healthcare provider team. NCBH will continue its work to improve access and productivity of its entire array of ambulatory OB-GYN services including prenatal care, family planning, and gynecological surgical services. Throughout the process, there will be regular community stakeholder updates.

Tomorrow Harlem Hospital will cut the ribbon on new $19 million Adult and Pediatric Emergency rooms, completing the final phase of its recent $325 million modernization project. The new Emergency Department doubles current adult ED space and nearly triples pediatric ED space to expand patient access and privacy and improve patient flow and comfort.

The new Adult Emergency Department, located on the first floor of the Mural Pavilion, has 26 private treatment rooms and four trauma bays, increases the number of treatment chairs for asthma patients from four to eight, and adds eight additional observation bays. The new Pediatric Emergency Department, also located on the first floor of the Mural Pavilion, has two trauma care bays and six treatment room, and increases the treatment chairs for pediatric asthma patients from six to eight.

The recent multi-year modernization project also encompassed primary and specialty care suites, new adult intensive care and burn units, a Bariatric Center of Excellence, surgical clinics, a new women’s imaging department and testing suites. The Mural Pavilion is also home to a gallery of priceless WPA murals by local artists of the 1930s.

As of early this week, nearly 50,000 New Yorkers have chosen MetroPlus Health Plan on the New York State health insurance exchange. March 31 is the deadline for individuals to enroll in health insurance coverage to avoid a penalty for not obtaining insurance in 2014 under the Affordable Care Act (ACA). The deadline is expected to bring in more last-minute shoppers to MetroPlus, and ongoing enrollment continues to be available as well for small businesses and Medicaid and Child Health Plus members.

Gouverneur Health and other HHC facilities are continuing to partner with MetroPlus to provide bilingual health insurance counselors, especially for Spanish- and Chinese-speaking patients. The lack of access to bilingual counselors has been identified as a major barrier for enrolling limited English speaking New Yorkers in health insurance under the ACA. HHC facilities are making available certified, bilingual enrollment counselors to inform and educate the community about the best health insurance options and ways to minimize premiums and out-of-pocket costs.

Later this spring, HHC will release its first Report to the Community in eight years. Titled Better, this comprehensive document highlights the many accomplishments of HHC’s leadership and staff since 2006 that enabled us to make significant progress toward our strategic and organizational goals.

The report captures our improvements in patient safety and quality, the adoption of new care delivery models, and describes how advancements in IT and robust work in Breakthrough are supporting our transformation into a more integrated, efficient and effective healthcare system. The report includes a message from new President and CEO Dr. Ramanathan Raju, in which he briefly lays out his vision for HHC’s future.

Although the document speaks to the challenges and uncertainties that we face, it also tells the story of the many ways in which HHC is a better healthcare organization — providing better patient care and better population health at a better value. Better, which will be available electronically, will provide a compelling portrait of HHC’s work on my fronts to a wide range of audiences and stakeholders.

Early this month, Oxford University Press released LEAN BEHAVIORAL HEALTH, the Kings County Hospital Story. This book, about the stunning Breakthrough work conducted at Kings County, was co-edited and written by Dr. Joseph Merlino, Joanna Omi and Dr. Jill Bowen, with contributions from almost 20 additional writers from Kings County and Metropolitan hospitals, as well is the corporation’s central office. Writers include many whose names you will recognize — Marlene Zurack, Joyce Wale, Antonio Martin, Roslyn Weinstein, George Proctor and Claire Patterson.

Other HHC contributing writers include Kristen Baumann, Olga Deshchenko, Robert Berding, Renuka Ananthamoorthy, Lora Giacomoni, Regine Bruny-Olawaiye, Richard Freeman, Roumen Nikolov, Akinola Adebisi, Linda Paradiso, Lancelot Deygoo, Todd Hixson and Janine Perazzo.

This book is intended not as a treatise on Lean, but rather as a very personal and reflective look at the work and lessons learned by the many people involved in transforming the way behavioral health services are provided at Kings County Hospital. We believe that many healthcare organizations will benefit from understanding, in great detail, how Kings County made dramatic improvements to the patient experience in the CPEP, significantly calmed inpatient units making them safer for patients and staff, and streamlined outpatient services to remove waste and increase valuable time with providers.

I want to thank the HHC staff who produced this fine work. As we move into a new healthcare environment, this publication is a very effective way to show the world the innovative work taking place at our hospitals. We have provided each of you with a copy of this book.

March is National Social Work Month, a time to honor HHC’s social workers whose professional dedication helps our patients achieve better, healthier lives. Social workers often step into the lives of patients at critical and difficult times. The assistance they provide embodies the essence of the social work profession, grounded in the commitment to the well-being of others, and the caring work that helps resolve complex personal issues. Whether it is supporting a patient and family through a crisis, or connecting them to hospital or community resources, social workers offer a knowledgeable, personalized approach to meeting the often complex needs of those we serve.

This year, the theme of Social Work Month is “All People Matter.” It reaffirms the profession’s core principle that all people deserve and should be treated with dignity and respect. In serving some of the City’s most vulnerable populations, HHC social workers function in multidimensional roles, serving as advocates, collaborators, problem-solvers, and educators. And with every patient or family interaction, their efforts exemplify this theme.

I know the Board joins me in celebrating our social workers and their dedication to the needs of our patients and their families.

As many of you already know, I will be stepping down as President of HHC on March 31st. I can truthfully say that my seventeen-year tenure here, in a variety of roles, has been the most satisfying period of my long professional career. I consider myself very fortunate.

When Mayor Bloomberg asked me to assume the leadership of HHC in 2005, I had already spent four years as General Counsel and another four years on the executive staff of the Queens Health Network. Those positions gave me invaluable insight into the inner workings of our vast, far-flung system. But, even more importantly, having those positions enabled me to observe first-hand the incredible dedication and talent of the HHC workforce.

Tireless thousands of HHC employees have ministered to the complicated healthcare needs of millions of the most vulnerable New Yorkers, without regard to their immigration status or ability to pay. As I reflect on my long tenure here, there are so many indelible images that will stay with me forever. All of us at HHC mirror the extraordinary diversity that makes New York City such a unique and vibrant community. I will never forget the multitude of patients in our care — from the tiniest preemies in our NICUs to our fragile centenarians. But, most of all, I will remember the compassion and empathy that HHC workers bring to caring for them day in and day out.

I am immensely proud to have shared this experience with the staff at HHC and want to express my eternal gratitude for their hard work in service of HHC’s noble mission. These feelings make it difficult to say goodbye. It has been an honor and a privilege to have led this extraordinary organization.

Broadcast

Press Conference Harlem Hospital, Denise Soares, SVP, Dr. Maurice Wright, Chief Medical Officer, Harlem, Dr. Reynold Trowers, Chief of Emergency Medicine, Harlem, Dr. Zafar Sharif, Chief of Psychiatry, Harlem, Dr. Gregory Almond, Chief of Emergency Medicine, Metropolitan, NY1, FOX 5, WCBS, 3/17/14

Counselors Made Available to Help Non-Native Speakers Apply for Health Insurance, Dr. Martha Sullivan, Executive Director, Gouverneur Health, Roger Milliner, Deputy Executive Director, MetroPlus, NY1, 3/18/14 (Also covered in The Epoch Times, NTDTV (New Tang Dynasty TV)

North Central Bronx Hospital to Reopen Labor and Delivery Unit in Summer, President Alan D. Aviles, Dr. William Walsh, SVP, HHC North Bronx Healthcare Network, NY1, 3/17/14

North Central Bronx Hospital Set to Announce Reopening of Labor and Delivery Unit, NCB, NY1, 3/16/14

City Public Hospital System Hopes to Get Federal Funding Headed to State for Hospitals President Alan D. Aviles, NY1, 3/14/14

That’s so NY: Volunteering at City Hospitals, Irene David, Director of Therapeutic Arts, Bellevue, Coney Island, Bellevue, NYC Media, March 2014

Jacobi Medical Center sees rise in bariatric surgeries, Dr. Ajay Chopra and Dr. Jayne Lieb, Jacobi, News 12 Bronx, 3/7/14

Print

The Day the Drills Paid Off, Dr. Maurice Wright, Chief Medical Officer, Harlem, Denise Soares, SVP, Generations + Northern Manhattan Network, The Wall Street Journal, 3/14/14

Harlem Hospital set to open new state-of-the-art emergency department, New York Daily News, 3/3/14

Should City Hospitals’ Dialysis Be Privatized?, President Alan D. Aviles, WNYC, 3/13/14

Tish James warns de Blasio to reject for-profit dialysis deal, President Alan D. Aviles Capital New York , 3/13/14

Healthcare-Agency Deficit Faces Further Expansion, President Alan D. Aviles, The Wall Street Journal, 3/13/14

City hospital head fears short-changing by state, President Alan D. Aviles, Capital New York 3/13/14

IBO: Medicaid waiver could be a loser for city hospitals, President Alan D. Aviles, Capital New York 3/13/14

Obamacare is a ‘Plus’ for insurer, MetroPlus, New York Daily News, 2/26/14

NCBH will Deliver Late on Maternity Ward, Michael Zinaman, Chairman, OBGYN HHC North Bronx Healthcare Network, Dr. Ross Wilson, Chief Medical Officer, Norwood News, 3/17/14

Op-ed: A test that could save your life, Dr. Joshua S. Aron, Elmhurst, Queens Courier, 3/16/14

Harlemites 50 + Urged to Get Colonoscopy, HHC, President Aviles, Joan A. Culpepper-Morgan, MD, Harlem, Harlem World, 3/7/14

Primary Care Practice At Elmhurst Hospital Recertified Highest Level Patient-Centered Medical Home, Queens Gazette, 2/26/14 (Also covered in Town & Village)

Over 32,000 New Yorkers Choose MetroPlus Health Plan On the State-Sponsored Health Insurance Marketplace, MetroPlus, HHC, The Jewish Voice, 3/19/14 (Also covered in Manhattan Times)

Study: Obamacare care improves competition in New York, MetroPlus, Capital New York, 3/17/14

Henry J. Carter Specialty Hospital in Harlem, HHC, Henry J. Carter Specialty Hospital and Nursing Facility, Harlem World, 3/5/14

Lincoln Recognized for Lactation Care, HHC, Bronx Times, 3/7/14

HIV/AIDS: What Every Woman Should Know, Dr. Ray Mercado, Lincoln, Bronx Free Press, 3/12/14