REPORT TO THE BOARD OF DIRECTORS – December 2013

Last week, The Joint Commission conducted its triennial survey of Harlem Hospital Center, several months earlier than anticipated. The four-day survey was conducted by a team of six surveyors comprised of a physician, two nurses, an administrator, a Life Safety Code surveyor and a Behavioral Health surveyor. Harlem received findings in the environment of care. There were no patient care, quality or safety findings.

The surveyors praised both leadership and staff for “the excellent care provided, with limited resources, to a fairly compromised population with unique issues.” They were very impressed with the level of staff and physician engagement, and the team leader commented that “Harlem is a premier HHC facility with clinical and frontline staff who are competent, compassionate, caring, enthusiastic, involved and engaged.”

Congratulations to the leadership of Harlem Hospital, led by Denise Soares, RN, Senior Vice President, Maurice Wright, MD, Medical Director, Ebone Carrington, COO, Yanick Joseph, RN, CNE, Consuelo Dungca and James Acero, Quality Management, Jo-Ann N. Liburd, Central Office Accreditation and Regulatory Services, and all of the staff of Harlem Hospital Center for a job well done. Thanks also to our Board Chairman Dr. Stocker and the Harlem CAB Chairperson Bette White, who participated in the survey Leadership Session.

In 2014, The Joint Commission will conduct unannounced surveys at Bellevue, Coler, Henry J. Carter, North Central Bronx, Queens and Woodhull.

Kings County Hospital Center announced recently that its substance abuse treatment program for opioid users helped drug addicted individuals remain in treatment longer, increasing their chances of recovery. After adopting a series of interventions, including reducing wait times for admission, assigning patient navigators and offering peer support for opioid users, the hospital achieved a 95 percent retention rate for its 30-day treatment program. This high patient retention rate earned Kings County Hospital this year’s Science and Service Award from the federal Substance Abuse and Mental Health Services Administration (SAMHSA).

The federal award for improved retention rates comes when, between 2003 and 2009, there was an increase of about 40 percent in the number of New York City residents reporting misuse of these drugs. In 2011, opioid analgesics were involved in 220 unintentional deaths in New York City, a 65 percent increase from 2005.

To achieve the higher patient retention rates, the hospital adopted the following operational and clinical strategies:

• Created a same-day admission process that reduced admission wait times by over 50 percent and reduced paperwork and administrative tasks, giving staff more time to focus on patients;
  Established a new welcome committee of staff who explain to every patient the roles of each individual in their care team;
• Assigned each patient a “patient navigator” to identify and resolve barriers to the patient remaining in care, such as housing, transportation, or childcare needs;
  Designated an outreach worker to initiate re-engagement efforts following a single missed program visit by any patient;
• Introduced a peer-led orientation on the day of admission for each patient.

The Kings County Hospital opioid dependency treatment program has capacity to treat up to 750 patients at a time who are addicted to opioids like morphine, heroin, codeine, and oxycodone. In 2012, approximately 240 new patients entered the program.

As you know, the HHC adult, pediatric and HIV primary care practices are all currently reapplying for recognition as Patient-Centered Medical Homes (PCMH), and the vast majority have been recognized again. The standards now applied by the National Committee for Quality Assurance (NCQA) are more rigorous than those used when care practices received their first recognitions in 2010, and HHC facilities have all scored very high — well above the minimum requirement for the top Level III recognition that assures the maximum level of enhanced revenue for Medicaid patients — about $18-20 million annually in recent years. There are now 13 facilities that have achieved recognition. Two additional applications will be submitted this month and the final two will be submitted at the beginning of 2014.

MetroPlus enrollments from the New York State Health Exchange continue to increase by about 1,000 applicants each week. As of yesterday, 9,748 applicants have enrolled in our Metroplus Qualified Health Plans on the new health insurance exchange, with coverage scheduled to begin January 1. The MetroPlus plans, which offer some of the lowest costs available on the New York State exchange, continue to attract younger and relatively healthy participants. Of the applicants that have chosen MetroPlus, 72 percent are under the age of 50. More than 700 additional applicants have also signed up for MetroPlus through Medicaid, Child Health Plus and the SHOP plans for employer groups.

HHC’s Chief Medical Informatics Officer, Dr. Louis Capponi, has received Board Certification from the American Board of Preventive Medicine, as part of the first class ever certified in the field of clinical informatics.

Clinical informatics is a relatively new specialty area in medicine and is principally aimed towards healthcare transformation. Specialists in informatics analyze, design, implement, and evaluate information and communication systems. These activities occur at both the individual patient level and at the population level. Clinical informatics combines knowledge from the domains of health systems operations, clinical care, and information and communications technology.

Physicians who are board-certified in clinical informatics collaborate with other healthcare and information technology professionals to promote patient care that is safe, efficient, and effective. Their knowledge of patient care, combined with the understanding of informatics methods and tools, enable them to focus on a variety of changes in healthcare, including the strengthening of the clinician-patient relationship and the improvement of patient outcomes.

Congratulations to Dr. Capponi for demonstrating so ably the leadership that HHC continues to provide in information technology and healthcare reform.

On December 11, the Division of Safety and Human Development, Office of Patient Safety and Employee Safety convened a patient safety forum for network, facility and Central Office leaders on The Future of Healthcare featuring a keynote address by Martin A. Makary, MD, MPH, Chief of the Johns Hopkins Pancreas Islet Transplantation Center and Director of Surgical Quality and Safety. Dr. Makary is the nationally renowned author of the book Unaccountable. In his compelling presentation, Dr. Makary focused on the critical role of both accountability and data transparency in improving quality and safety performance in medical care and healthcare. It is his premise that these two ingredients are essential to reducing performance variability among clinicians and hospitals and in driving improved outcomes.

Following the keynote, Dr. Makary led a workshop for participants where they were asked to work together in teams to identify variability in their current processes that may lead to patient harm and develop “pledges” or specific actions they can take to increase transparency and trust and engage patients.

I highly recommend and am happy to provide interested members of the Board a copy of Dr. Makary’s book Unaccountable.

On December 6, Abdul Mondul, MD, Associate Medical Director, Chief Palliative Care Services and Patient Safety Officer at Lincoln Medical Center; Mei Kong, RN, Assistant Vice President, Patient Safety and Employee Safety; and Harold Hellman, Patient Safety Officer at Dr. Susan Smith McKinney gave a presentation entitled “No Decisions About Me Without Me: Partnering for Safe Care” at the Third Annual Patient Advocate Conference and Workshop in Orlando, Florida. This event was sponsored by The Professional Patient Advocate Institute. The objectives of the session were to: incorporate TeamSTEPPS® into patient and family interactions; provide information that will challenge providers to change their patient/family interactions to a more patient-centered, fully informed partnership model; teach tactics for educating patients and their families about the available treatments, alternatives, and the option to do nothing at all; and provide strategies for presenting information in ways that consumers can relate to and better understand.

Last week, Congressional leaders agreed to a two-year budget agreement. The highlights of the agreement include $85 billion in spending cuts and the replacement of most of the sequester cuts with revenue derived from the imposition of various fees. The bill was passed in both the House and the Senate.

Unfortunately, the sequester-mandated 2 percent reduction in payments made to Medicare providers remains and is extended to 2023. These Medicare 2 percent reductions will cost HHC roughly $18 million a year.

Attached to the Bipartisan Budget Act of 2013 are provisions that would provide three months of relief for doctors who participate in the Medicare program. This temporary three month patch, costing $7 billion, should give Congress enough time to finalize the provisions of a permanent “fix” to the Medicare physician payment during the early part of the next calendar year. Without Congressional intervention, physician’s Medicare payments are slated to be reduced by 20.1 percent on January 1.

As part of the offset for this patch, a number of provisions impacting HHC were included. One provision extended the Medicaid Disproportionate Share Hospital (DSH) reductions by one more year to 2023. This could cost HHC a total of $421.8 million that year (assuming the local match is also lost). On the positive side, the national 5 percent mandated Medicaid DSH cuts were delayed for 2014 and 2015; these cuts could have reduced HHC’s funding by about $56.5 million in each of those years. The Medicaid DSH cut slated for 2016, originally 5 percent, now has been doubled to 10 percent, increasing HHC’s proportional estimated cut in 2016 to $113 million.

The hospital industry is pleased over the delay of these initial Medicaid DSH cuts but the long-term dire threat to Medicaid DSH remains.

Another significant offset in the legislation is a change in the criteria defining what constitutes a long-term Care Hospital (LTCHs). The changes mandate that 50 percent of total discharges be patients who were either originally in an Intensive Care Unit for three days before coming to the LTCH or were patients on ventilators. The new criteria could create major problems for HHC’s new Henry J. Carter LTCH in that it is unclear whether or when Carter could comply given the safety net role that Carter plays, with its mostly Medicaid patient base. The new requirement would need to be met by October 1, 2015. We are working with our Congressional delegation to address these issues and will keep you up to date on developments.

This week HHC did a “soft launch” of a new corporate website, designed to be more patient-centered and accessible to all of our audiences. Its features include:

• A more pleasing visual style with larger photos and graphics;
• Reorganized content that is more consumer-friendly;
• A new, more comprehensive map of our facilities that includes our many community-based health centers;
• A feature that allows patients to search by healthcare service;
• New, updated content to emphasize the high quality of our healthcare, the innovation we demonstrate and the leadership we’ve shown in healthcare reform;
• Clear messaging about preventive healthcare and Patient-Centered Medical Homes;
• Clearer descriptions of the many healthcare services we provide; and
• Messaging that we strive to provide one integrated healthcare system.

The new website still has many of the features that are helpful to our patients and stakeholders: it can be translated into many different languages and the text can be enlarged to help those with vision challenges. We will formally announce the new site next month and begin to promote it. You will see a full demo of the new site in a special presentation at our next Board meeting. In the meantime, please visit our new website at nychhc.org/hhc and give us your feedback.

Throughout most of 2013, I asked HHC leadership and others to participate in a dialogue about building a set of Guiding Principles that will help every HHC employee to align their work — wherever they are in the organization — with our mission and our strategic direction. Included in your packet today is a graphic depiction of these guiding principles and a printout briefly describing each of them.

The Guiding Principles, in a sense, attempt to anchor our work going forward around organizational values that are critical to our future success, and to do so in the simplest, most straightforward way. In another sense, the Guiding Principles are aspirational. They reinforce six essential features that should characterize our daily work individually and collectively: a patient-centered approach, a relentless focus on safety, a commitment to excellence, a steady eye on cost savings and resource management, a proficiency with effective teamwork, and a devotion to, and support for, continuous learning for everyone in the organization.

The Guiding Principles graphic is designed to evoke these core principles and to connect them to the goals of the Triple Aim of better health, better care, and better value. Although safety is at the top of the graphic and patients are at the center, a circular shape reinforces the idea that all of the principles are equally important. And as you will see, supporting, defining language – which is still a work in progress — provides additional guidance in a clear and straightforward way.

I will end today’s report by showing a brief video where I introduce the Guiding Principles and begin to relate them to our strategic initiatives and every day work.

Going forward, we will introduce them again and again to reinforce the important role that each of them plays in guiding us toward providing the best care possible to our patients and communities.

Broadcast

Program Integrates Mental Health Care With Medical Care, Dr. Leonel Urcuyo, Chief of Psychiatry, Dr. Michelle Soto, Director, Center for Integrated Health, Woodhull, NY1 News, 12/04/13

Lincoln Hospital Integrated Wellness Center, Dr. Marieliz Alonso, Lincoln Hospital, News 12 Bronx, 12/16/13

Coordinated Procedure Allowed Large Numbers To Be Treated At Once Following Derailment, Dr. George Agriantonis, Elmhurst Hospital, NY1 News, 12/02/13

Children’s Health and Safety During the Holidays, Dr. Randy Nunez, Lincoln Hospital, BronxNet-TV, 12/11/13

Print

How Long Can City Hospitals Stay a ‘Going’ Concern?, Alan D. Aviles, President, LaRay Brown, Senior Vice President, Marlene Zurack, Chief Financial Officer, HHC, Capital New York, 12/03/13

Harlem Specialty Hospital and Nursing Facility Opens, Harlem World, 11/30/13

Former Goldwater Hospital Patients Arrive at $285M East Harlem Facility, Henry J. Carter Specialty Hospital and Nursing Facility, Coler-Goldwater, Margaret Rivers, Associate Executive Director, DNAinfo.com, 12/17/13

New York Yankee Great CC Sabathia Visits Henry J. Carter Specialty Hospital and Nursing Facility, The New York Amsterdam News, November 28-December 4, 2013

As a Specialty Care Hospital Prepares to Close, Patients Wonder What’s Next, Executive Director Robert K. Hughes, Coler-Goldwater Hospital, Henry J. Carter Hospital, The New York Times, 11/21/13 (Also covered in the Cornell Daily Sun)

Hospitals Push Coverage – Insured Patients Are Gold for Centers Hit by Federal Cuts in Charity-Care Funds, Alan D. Aviles, HHC, The Wall Street Journal, 11/20/13

Lincoln Opens Integrated Wellness Center The Bronx Free Press, November 29-December 5, 2013 (Also covered in MD News)

Hospital Achieves 95 Percent 30-Day Retention Rates in Outpatient Opioid Program, Dr. Susan Whitley, Kings County Hospital, Alcoholism and Drug Abuse Weekly, 11/25/13

Sharing & Caring Honors Those Who Help Heal, Dr. Marlon Brewer, Elmhurst Hospital Julius Wool, Executive Director, Queens Hospital, Queens Gazette, 11/20/13

Coney Island Hospital Doles Out 102 Thanksgiving Turkeys To Pediatric Patients In Need, Sheepsheadbites.com,

12/02/13

Elmhurst Hospital Center Provides Thanksgiving Dinners, Queens Gazette, 12/18/13

How Your Doctor Feels About You Could Affect Your Care, Dr. Danielle Ofri, Bellevue, WUWM Milwaukee Public Radio, 12/03/13

Muscle Aches From Statins? Drug Interactions May Play a Role, Dr. James A. Underberg, Director, Lipid Clinic, Bellevue Hospital, The New York Times, 12/04/13

Don’t Let the Winter Blues Get You, Dr. Miklos Losonczy, Lincoln, The Bronx Free Press, November 27-December 3, 2013

VAP Round II, Kings County, Crain’s Health Pulse, 12/04/13

Top Hospitals Named for Transparency, Harlem Hospital, Healthcare IT News, 12/05/13

Famous Famiglia Opens at Roosevelt Ave. Transit Hub After Long Delay, Elmhurst Hospital, DNAinfo.com, 12/09/13

Quality Improvement Fellowships Spread Innovation, Spur Careers , Dr. Amanda Asher, Segundo Ruiz Belvis Diagnostic and Treatment Center , North Central Bronx, HHC, United Hospital Fund Blueprint, Fall/Winter 2013

Cuomo Spars with Obama Administration Over Medicaid Exemption, HHC,The Washington Post, 12/12/13

House Budget Tweak Costs N.Y. Hospitals Millions, HHC, Capital New York, 12/12/13

Safety in Toyland: Choose toys that promote health, education and safety, Milton Nunez, Executive Director, Lincoln, Bronx Free Press, December 11, 2013

Elmhurst Hospital Doctors Say Pedestrian Injuries are Continuing to Rise in Queens, Dr. Jaime Ullman, Elmhurst Hospital, New York Daily News, 12/16/13 (Also covered in AmNY, Newsday, Streetsblog.com)

New York State Hospital Cost Data Expose Big Markups, and Odd Bargains, Kings County Hospital , The New York Times, 12/09/13 (Also covered by Washington Post and WNYC Radio)