REPORT TO THE BOARD OF DIRECTORS – November 2013

This month, Lincoln Medical Center opened its Integrated Wellness Center, an innovative program designed to provide primary care and behavioral health services for adult psychiatric patients under one roof. Using an integrated, collaborative care model, the Center is co-located within Lincoln’s Behavioral Health Clinic, providing easy access to essential services for a vulnerable population in need of a dedicated patient-centered medical home.

The program targets patients who have serious mental illness along with other chronic health conditions such as diabetes or cardiovascular disease. These patients often miss medical appointments and cannot participate in their own care. Sometimes the treatment of their mental illness interferes with their regular primary healthcare. Many of these patients wind up in emergency rooms or being admitted to a hospital unnecessarily. Fifty-five percent of the patients who use Lincoln’s Behavioral Health Clinic have at least one chronic condition (pulmonary, diabetes, cardiovascular disease or HIV) and thirty-one percent suffer from two or more conditions.

This innovative approach to treating mentally ill patients with chronic medical conditions was made possible through a $1.6 million grant over four years from the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services.

Bellevue opened a new, 15-bed inpatient psychiatric unit for adolescents that expands the inpatient capacity by 50 percent and enables the hospital to address the growing need for inpatient mental health services for children and adolescents. The $2.2 million project brings the total number of inpatient beds for children and adolescents to 45. The expansion of the inpatient service was funded through a New York State Health Care Efficiency and Affordability Law (HEAL) grant. The secure unit has been designed to provide an optimal environment for the treatment of psychiatric crises, including depression, suicidal or aggressive behavior, psychosis and serious family conflicts.

In recent years, Bellevue has experienced a steady increase in the number of children and adolescents coming to the emergency room in psychiatric crisis for reasons associated with a number of factors: society’s growing awareness of children’s mental health issues; the crisis of teen suicide; and increased referrals from schools that have implemented psychiatric assessment protocols to prevent school violence.

Also this month, healthcare professionals, elected officials and community leaders cut the ribbon to launch a renovated and greatly expanded psychiatric emergency room at North Central Bronx Hospital (NCBH). The ceremony celebrated the $2.4 million investment made by HHC to provide quality mental health resources for Bronx residents. The new emergency room nearly triples the clinical space used for psychiatric services, from 1430 square feet to 3600 square feet.

Last year alone, NCBH’s original Psychiatric Emergency Room evaluated nearly 3,400 patients. The hospital operates 24 hours a day, seven days a week, providing treatment to all those in need including children, adult and geriatric patients. In the expanded ER, additional examination and intake rooms allow patients to be promptly seen by psychiatrists, nurses, psychologists, social workers and other medical professionals. Once patients are assessed and stabilized, they are either admitted for inpatient services or connected with outpatient resources.

Dr. Michael Zinaman has been appointed Chairman of the HHC North Bronx Healthcare Network’s Obstetrics and Gynecology Department. Dr. Zinaman will oversee inpatient and outpatient women’s health services and labor and delivery services at Jacobi Medical Center and North Central Bronx Hospital beginning in mid-December. With the appointment of the new Chair, HHC will begin to plan the reopening of labor and delivery services at North Central Bronx Hospital (NCBH) in 2014.

The NCBH maternity services were suspended in August after a series of senior physician vacancies proved difficult to fill and led to patient safety concerns related to staffing. As a result, HHC consolidated labor and delivery services from two campuses at NCBH and Jacobi, to one campus at Jacobi to better target resources and ensure optimal staffing while still meeting the community’s need for inpatient obstetrical services. Both campuses have experienced a decrease in the volume of deliveries over recent years and the labor and delivery space at Jacobi was originally sized to accommodate a number of deliveries that is slightly more than Jacobi’s current volume plus the volume from NCBH.

No employees from NCBH lost their jobs as a result of the consolidation and most chose to transfer to Jacobi and follow their patients there. The majority of expectant mothers from NCBH continued to receive their outpatient services at NCBH and since the consolidation more than 250 NCBH moms chose to deliver their babies at Jacobi Medical Center.

Earlier this month, we notified the New York State Department of Health that it is our intention to re-open labor and delivery services at NCBH in 2014 once we have recruited the full complement of obstetricians, midwives, nurses and other staff required to provide coverage for all shifts, seven days a week.

HHC adult, pediatric and HIV primary care practices are all current reapplying for recognition as Patient-Centered Medical Homes (PCMH), and most have received their recertification. The standards now applied by the National Committee for Quality Assurance (NCQA) are more rigorous than those used when care practices received their first certifications in 2010, and HHC facilities have all scored well above the requirement for the top Level III certification that assures the maximum level of enhanced revenue. There are now 10 facilities that have achieved recertification. Two additional applications have been submitted and are under review by NCQA and three applications are under development and will be submitted by the end of the year.

MetroPlus has been informed by the State that nearly 3,200 applicants have enrolled in our Metroplus Qualified Health Plans on the new health insurance exchange, with coverage scheduled to begin January 1. Of the applicants that have chosen MetroPlus, it appears that many are younger members looking for a low cost plan. Seventy-five percent of the applicants are under the age of 50.

Although we understand that a significant number of new Medicaid enrollees have also signed up for MetroPlus under the expanded Medicaid eligibility standards established by the Affordable Care Act, the State will not release those official enrollment numbers to the plans until the middle of December.

Washington has been busy the last few weeks dealing with problems associated with the roll-out of the Affordable Care Act (ACA).

First, the website that functions as the portal to the federal marketplace, which is the gateway for the 36 states that did not set up their own exchanges, has been suffering numerous technical glitches. As a result, the number of persons using the website to sign up for health insurance has been much lower than projected nationally. New York State’s exchange website, which appears to be functioning well, has signed up about 30 percent of all those who have successfully enrolled in exchange insurance plans nationally.

Second, millions of Americans who have had privately purchased health insurance plans have been receiving notification from their healthcare insurers that due to ACA regulations, their plans are being discontinued and canceled. The prime reason is that the plans were substandard under ACA requirements. For example, the plans may not cover all mandated procedures or may have deductibles or out-of- pocket expenses that are too high to qualify under the ACA. This is creating a firestorm on Capitol Hill, with many Democrats joining Republicans in criticizing these cancellations. Many members of Congress have cited the statements made by President Obama and others that “if you like your insurance plan, you could keep it.”

In response, President Obama and the Administration have said that regulations would be promulgated which would allow people to keep their existing plans for up to a year and possibly two. It is important to note that there is an effort by House Republicans to change the ACA to allow these non-complying plans to be offered in perpetuity, which would negate the ACA’s efforts to provide greater consumer protection for those affected, potentially shift the risk profile of the pool of patients available to enroll on the exchange and threaten to ultimately undermine the affordability of premiums on the exchange. It is too early to tell how the President’s attempted “fix” will impact the political or practical dynamics associated with enrollment on the new insurance exchanges.

HHC’s 10th Annual Take Care New York campaign in October successfully advanced our goals of promoting HHC’s various health offerings to the general public, increasing employee wellness, and recognizing staff champions. Almost 6,500 staff and patients attended 60 screening and educational events throughout the month — a 47% increase over last year. More than 4,000 health screening tests were performed on site, which is 49% higher than last year. We also had great pro-bono support from media partners with nineteen local newspapers that provided over $40,000 in free advertising for our events.

I want to thank the 10 HHC staff members from across the corporation who served as “HHC Health Champions” and were featured on our Facebook pages. As Health Champions, they each agreed to go through one health screening and publicly share their experiences with key messages and photos. The TCNY posts on Facebook and Twitter received a record number of engagement, including likes, comments, and retweets.

I also want to thank the Office of Communications and Marketing for leading this campaign and all the facility public affairs and clinical staff who helped to make the 10th Anniversary Take Care New York campaign a success.

Broadcast

Manhattan Hospital Demonstrates New Evacuation Technology, Bellevue Hospital, NY1, 11/15/13

Bellevue Hospital Expands Mental Health Services for Young People in NYC, Dr. Jennifer Havens, Bellevue, WNBC, 11/06/13

North Central Bronx Hospital to Reopen Labor & Delivery Unit, News 12 Bronx, 11/07/13

NYS Nurses Association calls for immediate reopening of maternity ward at North Central Bronx Hospital, News 12 Bronx, 11/18/13

Print

Closed North Central Bronx Hospital Maternity Ward Will Reopen — In About Nine Months!, New York Daily News, 11/07/13

North Central Bronx Opens Psychiatric ER to Ease a Borough’s Anxiety, New York Daily News, 11/07/13

Weight-Loss Patients Show off New Figures on Runway, Bellevue Hospital, DNAinfo.com, 11/09/13

A Healthy Start In Life, Harlem, Jacobi, New York Daily News, 11/06/13

Bellevue Hospital Conducts Emergency Evacuation Drill, CBS New York, 11/15/13

What Happened When NYC’s Bellevue Hospital Found Itself (Literally) Underwater, HealthBeatBlog.com, 11/07/13

When Doctors Share with Their Patients, Op-ed by Dr. Danielle Ofri, Bellevue, The New York Times, 11/14/13

Kings of Kings County, Kings County, East New York Diagnostic & Treatment Center, Dr. Susan Smith McKinney Nursing & Rehabilitation Center, Caribbean Life, 11/15/13

Affording a Healthier Future, HHC, Harlem, Lincoln, Huffington Post, 11/04/13

Coney Island Hospital Employee Receives Nursing Excellent Award, Sheepsheadbites.com, 11/01/13

At A Glance: Rankings if most affordable hospitals in New York state, Coney Island Hospital, Crain’s Health Pulse, 11/05/13

Holiday Brunch date set by Staten Island Inter-Agency Council on Aging, Theresa Rafferty, Associate Hospital Director, Sea View Hospital, Staten Island Advance, 11/17/13

CipherHealth Receives Prestigious PATH Award From New York eHealth Collaborative, President Alan D. Aviles, Digital Journal, 11/15/13