REPORT TO THE BOARD OF DIRECTORS – May 2014

This month The Joint Commission completed its triennial survey of Woodhull Medical and Mental Health Center and the Coler Nursing Facility. Consistent with the positive trends set by the hospitals surveyed thus far this year, both facilities performed extremely well.

At Woodhull, the surveyors complimented the organization for the “great interaction from staff, and an integrated approach to care planning between the medical staff and nursing.” The life safety code surveyor stated “the facility was in excellent condition.” The physician surveyor, who had surveyed Woodhull three years ago, stated “Woodhull has become a high reliability organization, on par with a large medical center in Texas, also a teaching hospital, which dwarfs Woodhull only by its size.” He stated he frequently mentions Woodhull hospital in his mentoring of physician interns. Highlighted best practices included the physician credentialing process, which should be a model for other hospitals, the reporting of critical lab values directly to physicians, and the patient centered medical home model.

At Coler, the surveyor praised the “commitment and dedication of staff who do great work and clearly put the residents first.” The commitment of the organization was evidenced in the observation of care and validated by medical record documentation. The surveyor also complimented the organization on their progress towards being a high reliability organization. Best practices included the Pressure Ulcer Wound Care Program, which the surveyor stated was quite strong, and the program around patient lifts, mattresses and beds, which she recommended be submitted for publication in the Joint Commission’s Leading Practice Library.

Congratulations to the leadership and staff of both organizations for a job well done:

Woodhull Hospital Center – Senior Vice President George Proctor; Medical Director Edward Fishkin, MD; Chief Nurse Executive Angela Edwards, RN; Senior Associate Executive Director, Quality Management, Sharon Neysmith-Crawford; Chief Operating Officer Eve Borzon; and all of the staff of Woodhull Medical and Mental Health Center.

Coler Nursing Facility – Executive Vice President/Acting Senior Vice President Antonio D. Martin; Executive Director, Robert Hughes; Medical Director Yolanda Bruno, MD; Chief Nurse Leah Matias, RN; Associate Executive Director of Quality Management/Regulatory Affairs Steven Catullo; and the staff of Coler Nursing Facility.

Henry J. Carter is the seventh and final facility remaining to be surveyed this year.

I want to update the Board about our application to the New York State Medicaid Waiver. Last week, we submitted the first step in the process — our letter of intent to participate in the Delivery System Reform Incentive Program (DSRIP) — which, as you know, is intended to transform care delivery in NYS and significantly reduce healthcare costs. We expect to build the required partnerships with other healthcare and community providers and form 4 to 6 Performing Provider Systems (PPSs). We are on-track to submit our initial planning application by the June 17th deadline.

By the end of next week, we will also submit the second application to request Interim Access Assurance Funding (IAAF), intended to temporarily support providers under significant financial threat. We expect to receive a significant portion of the $250 million that is allocated to public system providers.

I want to thank the members of our Corporate Steering Committee who are leading this very demanding effort to ensure our success in securing waiver funding and leading healthcare transformation in New York City.

On your agenda today are one-year renewals of Affiliation Agreements with NYU School of Medicine to provide general care and behavioral health services at Bellevue, Gouverneur, Woodhull, Cumberland, Coler and Carter. The proposed agreements are from July 1, 2014 through June 30, 2015 with the same terms currently in place. This extension allows for sufficient time for the parties to conclude negotiations for a new agreement, including development of the next generation of performance indicators. This reflects our corporation’s long-term strategy of continuing to partner with our doctors for better health outcomes for our patients.

HHC patient safety leaders once again made contributions at the 16th Annual Patient Safety Congress sponsored by the National Patient Safety Foundation (NPSF) this month. The theme of this year’s Congress was 1 FOCUS, where patient safety is the center of attention for every session, presenter, and networking opportunity. The Congress has a strong tradition of providing real-world tools, robust resources, and evidence-based solutions for a full spectrum of patient safety issues, with presentations by innovative leaders in the field. The Congress featured educational breakout sessions led by industry experts, thought-provoking keynote sessions with national thought leaders, and engaging and interactive Poster Sessions, as well as a Learning & Simulation Center.

NPSF received 123 poster submissions and only 89 posters were selected to present at the Congress this year. HHC presented seven posters that showcased our patient safety solutions and research. These posters were presented by HHC’s Department of Patient Safety with the Committee of Interns and Residents and HHC facilities, Coney Island, Harlem, Lincoln, Metropolitan, and Woodhull hospitals, and this is one of the largest number of poster presentations accepted from any single organization in the nation. Congratulations to the presenters who demonstrated repeatedly the top priority HHC puts on patient safety.

In August 2013, the federal Centers for Medicare and Medicaid Services (CMS) issued a rule to clarify that patient stays in hospitals for less than two midnights would be considered outpatient care and not inpatient care for purposes of Medicare reimbursement. HHC estimates that this rule could cost HHC $23-38 million in Medicare revenue each year. CMS delayed enforcement until October 1, 2014. With the passage of the Protecting Access to Medicare Act of 2014, Congress further codified this moratorium through March 31, 2015, in order to provide more time to find a solution to these issues. The legislation, however, did not establish a short-stay payment mechanism.

CMS in the FY 2015 IPPS rule called for comments on the two-midnight policy. The Greater New York Hospital Association (GNYHA) is forming a work group on these issues. Comments are due June 30. At a Tuesday, May 20 Ways and Means hearing on the issue, Sean Cavanaugh, Deputy Administrator and Director, Center for Medicare, CMS, testified that they now had time to consider further the short-term stay policy. He raised the issue whether some sort of an outlier should be allowed, whether IME and/or DSH should be part of any short-term stay payment and stated that there needs to be a differentiation between inpatient and outpatient stays.

Mayor de Blasio released the FY2015 Executive Budget Thursday, May 8th. The $73.9 billion spending plan balances the budgets for FY14 and FY15. However, gaps begin at $2.2 billion in FY16 and grow in the out years.

For HHC, the plan:

• Maintains overall City support for HHC;
• Avoids the annual “budget dance” items that the Council traditionally restored were baselined last year and funding continues in this budget. This funding includes $6 million for the Unrestricted Subsidy, $5 million for Child Health Clinics, $2 million for HIV testing and more than $1 million for behavioral health programs; and
• The plan keeps the budgeted increase in HHC Subsidy which goes from $78 million in FY 14 to $81 million in FY 15. In their preliminary budget response released last month, the City Council budgeted an additional $2 million increase for HHC’s Unrestricted Subsidy. Under their proposal, it would go from $6 million to $8 million. The budget and other issues will be discussed at HHC’s Executive Budget hearing, which is scheduled for Tuesday, May 27th at 11:00 am in the Council Chambers.

As part of my board report, starting today and going forward I want to highlight a program that adds value to our patients, our employees and our organization. These projects are chosen from either Corporate or network initiatives. This month I want to highlight our Leadership Academy.

As we strive to create a learning organization and a high functioning workforce, we need to develop training opportunities to perform in the new health care model. Through the development and implementation of our Leadership Academy, we will be creating a variety of on-site workforce development programs to invest in our employees and let them meet current and future workplace challenges and opportunities. The course content of the Leadership Academy aims to develop employees from the entry level supervisor to the mid-level manager in the various core competency areas skilled leaders must possess.

Each development program targets a different level of employee.

• HHC Leadership Development Program for Middle Managers
• New Manager Enhancement Program
• New Supervisor Development Program

The HHC Leadership Development Program for Middle Managers is a partnership between HHC and the Advisory Board Company in which mid-level managers are nominated by executive staff at each HHC facility, and home health services, to participate in a five-session intensive program spanning up to eight months and covering Health Care Management, Problem Solving/Critical Thinking, Instilling Accountability, Facilitating Effective Teamwork, and Impact through Influence. Participants are also required to complete Breakthrough Green Training and Fundamentals of Finance/Budgeting. A News Media Training module is also offered but not required.

The HHC Leadership Development Program pairs middle managers with a senior level Coach. Each Coach is trained and is required to participate in each of the five modules with the program participants. In addition to the classwork, with the assistance and guidance of their Coach, participants are required to identify and implement a project using the leadership principles learned during the program. Since its inception in 2012, nearly 240 middle managers and 66 coaches have participated in the program. Of those who have completed the program, 58 participants and coaches earned promotions or assumed significant additional responsibilities within HHC.

The Manager Enhancement Training was created in-house and is geared towards newly hired or promoted managers. The training is comprised of one full day face-to-face session for three consecutive weeks plus distance e-learning. Topics covered are: Manager Roles and Responsibilities, Strategic and Operational Planning, Giving Feedback, Managing Performance, Evaluating Performance, Labor Relations, Just Culture, Handling Workplace Conflicts, Team Management, Managing Change, Communicating Effectively, Critical Thinking, and Emotional Intelligence.

The third component of the Leadership Academy is the Supervisor Development Program. This program was created in-house and is geared towards newly promoted or newly hired supervisors who have at a least one direct report. Each participant is required to attend live classroom sessions taught by subject matter experts as well as complete e-learning modules. Topics covered in this program are: Supervisor Roles and Responsibilities, Giving Feedback, Managing Performance, Evaluating Performance, Labor Relations, Just Culture/Patient Safety, Handling Workplace Conflicts, Team Management, Communicating Effectively, Critical Thinking, and Emotional Intelligence.

Additional Academy course content is under development.

Dr. Lambert King, a stalwart physician leader who inspired us all by his commitment and passion to the cause, passed away on March 13, at home. Dr. King served as Director of the Department of Medicine at Queens Hospital for about nine years. He was widely admired and respected by staff and patients alike, and will be remembered by his many accomplishments, including the establishment of the Hospitalist Program, strengthening the Internal Medicine residency program, and his advocacy and leadership in the field of HIV/AIDS. He will be sorely missed but his legacy lives on. Our condolences go to his wife Sharon B. King and daughter Martha Whitney King.

Kings County Hospital Center is enhancing both its inpatient and outpatient behavioral health services to offer better care to adolescents and young adults in crisis. The hospital has redesigned its inpatient care model, opening the state’s first hospital unit of its kind that is designed for treatment of psychosis for patients ages 16 to 23. Kings County Hospital has also become one of four hospitals to pilot the state-funded outpatient “OnTrackNY” program, designed to help individuals age 16 to 30 who have recently experienced psychosis for the first time in their lives. Early intervention of psychosis is most effective and can improve longer term outcomes.

Age appropriate programming such as hospital-based educational programs, group and individual treatments, regular family meetings, socialization, and adaptive skills development, will be offered. Patients will be cared for by staff with the experience and expertise needed to address the unique developmental needs of adolescents and young adults. The program also encourages a patient’s family or care takers to be involved in all aspects of the adolescent’s progress, including the initial assessment and the establishment of short and long-term treatment goals. By addressing symptoms of psychosis early in young adults, when they first emerge, the program can help these patients remain on track toward a healthy and productive life.

Kings County announced the program at the same time that NYC’s First Lady Chirlane McCray focused her messaging on young people recovering from mental illness and included praise for the Kings County program in her press release.

Today, Health and Human Services Secretary, Kathleen Sebelius, announced that HHC is one of twelve prospective recipients to receive funding under the Centers for Medicare & Medicaid Services’ (CMS) Health Care Innovation Awards Program. HHC will receive a total of $17,916,663, over three years, to expand and enhance its current pilot Emergency Department Care Management model. The HHC Care Management model uses a multi-disciplinary team that will comprehensively assess patients who present in the emergency department for ambulatory-care sensitive conditions (ACSC), create a care plan that would avoid an unnecessary hospitalization, and provide ongoing support after discharge, including medication management, education, and linkages with Home Health and primary care providers. The grant funded program will operate in six HHC facilities including Bellevue, Elmhurst, Jacobi, Kings County, Lincoln and Queens Hospital Center.

The Health Innovation Awards application process has been a long road. The process began nearly a year ago and entailed the establishment of a CMMI grant application workgroup. This workgroup was jointly led by LaRay Brown, Senior Vice President for Corporate Planning, Community Health and Intergovernmental Relations and Dr. Ann Sullivan, former Senior Vice President of the Queens Health Network, was comprised of Central Office and HHC facility staff.

This achievement would not be possible without the hard work of the following HHC staff: Anita Lee, Lincoln Medical Center; Ann Frisch, HHC Health & Home Care; Anthony Divittis, Woodhull Medical & Mental Health Center; Christopher Phillipou, Corporate Planning Division; Inna Val, Corporate Finance Division; Kathleen Whyte, Corporate Planning Division; Kiho Park, Elmhurst Hospital; Krista Olson, Corporate Finance Division; Lauren Leverich, MetroPlus Health Plan; Mahendra Patel, Corporate Grants Management Office; Mark Winiarski, Corporate Planning Division; Marlaina Norris, MD, Elmhurst Hospital; Martin Castaneda, Elmhurst Hospital; Meiqian (Kristy) Li, Corporate Grants Management Office; Nancy Jean-Jacques, Corporate Finance Division; Vincent Henry, Elmhurst Hospital; Wendy Saunders, Corporate Planning Division

Former HHC President Alan D. Aviles was the recipient of Greater New York Hospital Association’s first ever Bishop Joseph M. Sullivan Public Service Award. The honor was bestowed on him at GNYHA’s 2014 annual meeting and reception, which was held May 13 at the Javits Center. Alan Aviles was there and received the award following a moving video that paid tribute to his work at HHC, and a subsequent standing ovation from a crowd of over 1,000 people. At the same GNYHA meeting, I was confirmed as a Vice Chair of the 2014-2015 Executive Committee of the GNYHA Board of Governors.

This month the United Hospital Fund presented Distinguished Trustee Awards to 28 trustees from hospitals across the metropolitan area from the Fund’s beneficiary hospitals, New York City’s public healthcare system, other voluntary hospitals, and those participating in the United Hospital Fund/Greater New York Hospital Association’s quality improvement initiatives. Award recipients include prominent leaders in business, health care, academia, and city government. I’m proud to announce one of those recipients is HHC’s own Anna Kril. Anna is a true leader and her commitment to HHC and the community has been immeasurable. Please join me in congratulating her.

HHC received the IPRO Quality Award in recognition of our organization-wide commitment to quality improvement and specifically for our reduction since 2011 of healthcare associated infections. IPRO’s awards are presented annually to New York State healthcare providers that have achieved significant quality-focused goals.

HHC also received an honorable mention in the Larry Gage awards for our work in the reduction of central line-associated blood stream infections. The Gage Awards Program — named after the founder of America’s Essential Hospitals (formerly NAPH) — honors and shares the outstanding work of members. Winners are recognized for successful and creative programs that boost patient care and meet community needs. HHC’s work will be included in the 2014 awards ceremony and published materials.

Agnes Abraham, the Chair of the HHC Council of Community Advisory Boards received a 2014 Marshall England Public Health Award from the Commission on the Public’s Health System. Named for the influential health advocate who died in 2000, the award recognizes “the heroes and sheroes of public health.” Congratulations to Agnes for this well-deserved honor.

For the fifth consecutive year, the Fund for the City of New York has selected an HHC employee to receive the prestigious Alfred P. Sloan Public Service Award. This year’s honor went to Janice A. Halloran, Network Senior Associate Director of the Department of Emergency Medicine at the North Bronx Healthcare Network. She also serves as Chair of the network and the borough’s emergency preparedness programs. Considered to be the “Nobel Prize” of City government, the Sloan Award is presented annually to outstanding civil servants whose accomplishments and commitment to public service are truly extraordinary. Ms. Halloran is one of six winners chosen to receive the award out of 250,000 eligible municipal employees.

Ms. Halloran, who has served HHC with distinction for nearly 25 years, embodies and embraces HHC’s Guiding Principles (keep patients first, keep everyone safe, work together, pursue excellence, manage your resources, and keep learning). Her responsibilities include overseeing staff involved in registration, billing, customer service, service recovery, patient flow, patient satisfaction, staff training, and Breakthrough activities. To date, Ms. Halloran has taken part in nearly 30 Breakthrough Rapid Improvement Events (RIEs). Ms. Halloran also recently completed HHC’s Advisory Board Leadership Program. She is highly trained in disaster management and serves as the network’s primary FDNY liaison. As someone who is on-call at all times of day and night, she is known for her exceptional ability to stay gracious, calm, and collected when it comes to quickly responding to and managing emotionally-charged crisis situations.

Ms. Halloran will be formally presented with the 2014 Sloan Public Service Award at a celebratory reception to be held by the Fund for the City of New York on June 4, 2014 at the Cooper Union from 5 PM to 7:30 PM. Board members will find an invitation to the event in their board packets. Additional invitations can be requested from HHC Chief of Staff Randall Mark.

Please join me in congratulating Ms. Halloran for her outstanding accomplishments and for this well-deserved recognition.

The month of May includes many days and weeks dedicated to the national recognitions. April 28 through May 2 marked the observance of Patient Experience Week, a chance to recognize the priority that all the HHC employees place on embedding respect and compassion into every patient encounter, ensuring that our patients have valuable and positive experiences. On the week from May 4 to 10 we also acknowledged Corporate Compliance and Ethics Week, celebrating HHC’s priority to always deliver quality healthcare in an ethical manner. On May 1, we held HHC’s Doctors’ Day award ceremony to honor some of the most innovative physician leaders that are part of the HHC network of providers who treat their patients using proven new models of collaborative care delivery. Finally, National Nurses Week, from May 6 through 12, gave us a good opportunity to thank the 8,000 nurses in our system for their vital role at the forefront of today’s unprecedented transformation of care. We use these observances as an opportunity to recognize our organizational priorities and thank our dedicated workforce.

It’s clear that on any given month, there are many, many outstanding HHC volunteers and employees who so deservingly receive formal recognition for their contribution and commitment to excellence.

That list includes:

• Lincoln’s Dr. Shahnawaz Amdani, who recently won first place for his oral presentation on Pediatric Trainee Night at the New York Academy of Medicine;
• Vitus Farrell of McKinney Nursing Center, who has led his housekeeping department to excellence and was named Employee of the Month;
• and the Queens Hospital Dept. of Psychiatry ACT II Team, who were recently recognized for making a profound difference in the life of a patient under their care.

But, as usual, I will end my report by recognizing one special HHC employee….an employee who represents the many others who do outstanding work each and every day and may not have received a formal acknowledgement for their commitment.

Today I want to bring special attention to a person who does not ask for praise for her work. I’m told that she’s very modest and maybe even a little shy. But she’s very insistent that her patients be well-understood.

I’m speaking of María López-Rosado, an employee of Harlem Hospital who spent countless hours at the bedside of young Oscar Hernandez ……. Who not only survived the horrible blast in Harlem and he embodied what courage really meant.

I first met Maria when she sat next to Oscar’s dad during a press conference to update his son’s progress and thank our extraordinary care givers at Harlem…. who performed a near miracle to mend Oscars wounds. Since that day, I’ve had many more updates on Oscar and am happy to report that his recovery is progressing well, and he looks forward to being discharged in a few weeks.

María López-Rosado is not the trauma doctor who saved Oscar’s life; she’s not one of the nurses who kept him alive and free of infection; and she’s not the child life therapist who came to Oscar’s room to read and care for him.

María is one of the medical interpreters at Harlem Hospital who made that nightmare for Oscar and Mr. Hernandez just a little easier to bear — by making sure the entire care team could easily understand him and be understood.

María interprets for patients and visitors in all situations, including high risk and high profile cases. She believes that only when patients and providers understand each other clearly, can the patient’s anxieties be minimized. Her care and reliability shows the public what HHC is all about.

Maria is one of thousands of staff who delivers on our commitment to provide culturally and linguistically competent healthcare to New Yorkers every day. It is something we do exceptionally well and something we should be very proud of.

Please join me in thanking María López-Rosado for the outstanding work she does every day for HHC patients.

Broadcast

Brooklyn teen shot in eye speaks out against gun violence at hospital meeting, Kings County Hospital, Dr. Robert Gore, KAVI, NY1, WABC, WCBS, WPIX, News 12 Brooklyn, 5/17/14

Health and Wellness Big Topics at Todt Hill Gathering, Dr. Ram Raju, President, NY1, 4/24/14

Asthma Awareness, Dr. Raghu Loganathan, Lincoln, News 12 Bronx, 5/15/14

Ambulances to Bypass Long Island College Hospital Starting At Midnight, Kings County, WCBS, 5/14/14

Kings County Hospital offers mental health services to residents, Dr. Roumen Nikolov, Kings County, News 12

Brooklyn, 5/12/14

Former Bellevue Hospital Center Psychiatrist Restoring Vandalized Statues, WCBS, 5/3/14

Print

Brooklyn teen shot in eye speaks out against gun violence at hospital meeting, Kings County, New York Daily News, 5/18/14

Weekend Gun Report: May 16-18, 2014, Kings County, The New York Times, 5/19/14

Why New York Worked, Dr. Arnold Saperstein, MetroPlus, Capital New York, 4/29/14

50 Most Influential Physician Executives, Dr. Ram Raju, President, Modern Healthcare, May 2014

Health campaign: Your mammogram can be a lifesaver, HHC’s breast cancer awareness campaign, Ragan’s Health Care Communication News, 5/21/14

The Silence of Doctors Around Alzheimer’s, Dr. Danielle Ofri, Bellevue, The New York Times, 5/8/14

Manhattan Borough Students Lift Patient Spirits Through Artwork at Coney Island Hospital, Terry Mancher, Chief Nursing Officer, Sheepshead Bites, 5/14/14

HHC Signs Five-Year Contact to Use UpToDate Anywhere, Crain’s Health Pulse, 5/6/14

Technology Insights to Help Hospitals Navigate the ‘Perfect Storm’, Bert Robles, Senior VP and Corporate CIO, HHC, Forbes, 4/30/14

HHC Urges Harlem Residents To Get a Mammogram, Harlem World, 5/2/14

Roseanne Cousins At Harlem Hospital Wins National Doctors Day Award, Harlem World, 5/1/14

Queens Impact Awards: His influence on the medical community is felt around the country, Dr. Joseph Lieber, Elmhurst, Times Ledger, 5/12/14

Slow zones to cut speed to 25 mph on Northern, Queens boulevards, Dr. Kaushal Shah, Elmhurst, TimesLedger, 5/9/14

Top Women in Business 2014, Dr. Jasmin Moshirpur, Medical Director, Elmhurst, QueensCourier.com, 5/13/14

Lincoln Medical Center Opens World-Class ED, Dr. Fernando Jara, Lincoln, Bronx Free Press, 5/14/14 (Also covered in Bronx Times Reporter)

Information about colon cancer for men and women, Dr. Elliott J. Goytia, Queens, El Especialito, 4/10/14