Monthly Report May 2013

The Joint Commission conducted its triennial survey of Metropolitan Hospital Center last week and gave high praise to Metropolitan, with surveyors stating they were impressed with how Metropolitan manages to provide such high quality care “while operating with limited resources and challenging patients.” The nurse surveyor stated that Metropolitan consistently demonstrated compliance with the rigorous standards of the Joint Commission, as evidenced by the fact that the survey team had no direct impact findings of non-compliance. They were equally impressed by the staff response and experiences during Hurricane Sandy, led by Meryl Weinberg. The Joint Commission survey team noted that they were particularly pleased to see strong physician engagement and excellent communication and teamwork between medical and nursing leadership and staff.

Congratulations to Executive Director Meryl Weinberg, Senior Vice President Lynda Curtis, Medical Director Richard Stone, Chief Nurse Lillian Diaz, Regulatory Affairs Administrator Patricia Jones and the staff of Metropolitan Hospital Center on raising the bar on survey performance and, most importantly, for a job well done.

Elmhurst Hospital Center will be surveyed by The Joint Commission at some point later this year.

HHC staff once again made major contributions at the 15th Annual Patient Safety Congress sponsored by the National Patient Safety Foundation (NPSF) this month. The theme of this year’s Congress — Patient Safety Solution Evolution – was evident as sessions were carefully crafted by leaders in the field to provide real-world tools, resources, and evidence-based solutions for patient safety issues. HHC’s Assistant Vice President for Patient and Employee Safety, Mei Kong, RN, was cast as a physician in the opening Keynote Plenary Session “Bedside Manners,” a play that highlighted the critical importance of inter-professional education for health care teams, and the causes and patient care consequences of ineffective communication and unprofessional behaviors between healthcare providers. Miriam Klein and Mauvereen Beverley of Kings County Hospital, gave a presentation on reducing readmissions. Nine posters that showcased HHC’s patient safety solutions were presented by staff from Coney Island, Kings County, Harlem, Lincoln and Woodhull hospitals, and this was the largest number of poster presentations accepted from any single organization in the nation.

Thanks to all the staff who participated and to Caroline Jacobs, HHC’s Senior Vice President for Safety and Human Development, who is a member of the NPSF Congress Planning Committee.

Many of the posters are on display today in the hallway of the 5th floor. I hope you will take a few moments to read about some of the notable patient safety solutions developed and employed across our system.

Diagnostic errors are increasingly being viewed as the most common type of medical mistake, accounting for up to 80,000 deaths per year in the United States and an important area of focus on the patient safety front. On April 22nd HHC convened a patient safety forum focused on helping clinicians to understand, identify and minimize opportunities to make diagnostic errors. More than 100 clinical and administrative leaders from across the system gathered at Bellevue Hospital Center where they worked together as teams to discuss real cases where a diagnostic error had occurred and to strategize on ways to prevent a similar error from occurring in their hospitals. Each team was also challenged to develop an action plan to prevent diagnostic errors at their facility. Dr. Carl Ramsay, Vice President, Emergency Medicine Service Line, North Shore/LIJ Health System served as keynote speaker.

Earlier this month, in ceremonies at Coler-Goldwater Specialty Hospital and at Cooper Union, the Fund for the City of New York announced that Stanlee Richards, RN, a director of nursing at Coler-Goldwater, received the Alfred P. Sloan Public Service Award for 2013 — 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. Richards is one of six winners this year, and her recognition marks the fourth consecutive year that an HHC employee has been chosen for this prestigious award.

Since joining HHC more than 40 years ago, Ms. Richards has demonstrated an extraordinary capacity to advocate and care for the most physically fragile and vulnerable patients within HHC. For Coler-Goldwater’s residents, Ms. Richards is a trusted ally and a consummate caregiver. Drawing on her longstanding relationships with patients and insights into their daily lives and medical concerns, Ms. Richards helps shape the hospital’s clinical improvement efforts. She is also an outstanding role model who provides support and counsel for aspiring nurses and annually leads Coler-Goldwater’s team in support of the American Cancer Society Making Strides Against Breast Cancer walk. Nurse Richards also served as a member of the U.S. Army Reserve Command, rising to the rank of Major before retiring in 2007.

Please join me in congratulating Ms. Richards for her outstanding accomplishments and for this well-deserved recognition. We have arranged for a congratulatory letter of support to go to Ms. Richards on behalf of the HHC Board of Directors.

HHC honored 28 physicians this month for their leadership and commitment to advancing the mission of our public system and providing the highest quality healthcare to New Yorkers. Our Doctors’ Day Awards were presented at a special ceremony at Baruch College in Manhattan to HHC and community physicians from every borough, varying in background, specialties and years of service and truly representing the diversity of our city and HHC. Together they bring several hundred years of medical experience to bear on the expert care they provide to HHC patients.

Among the Doctors’ Day Award winners is a group of six community physicians who represent HHC’s relationship with doctors who serve outside the public hospital system and work closely with us to manage care to HHC patients. These doctors embrace and advance HHC programs to improve patient safety and the effective treatment of chronic diseases in children and adults, such as asthma and diabetes.

Please join me in congratulating all these physicians for their leadership and their deep commitment to the patients we serve. A full list of the Doctors’ Day winners and their photos are available on our website,www.nychhc.org/hhc.

HHC’s annual May Mother’s Day awareness campaign to promote the benefits of breast cancer prevention, screening and early detection was again a great success. Our facilities hosted more than 95 education and screening events and hundreds of staff, patients and members of the community received information about mammography screening and where at HHC women 40 and older can get this life saving test.

Once again, we asked women to dedicate their mammograms to someone special on pink ribbons, like the ones you were asked to fill out outside, and also by posting a photo of themselves with their dedications on our Facebook and Twitter pages. If you visit our Facebook page, you’ll see a photo gallery of more than 150 women who dedicated their mammograms. We also launched our first contest on Facebook asking for special dedications for a chance to win an iPad mini. That contest is open until tomorrow. All the activity around mammograms in social media generated a record in the number of people who visit, like, friend us and visit our pages.

We received great exposure to the HHC brand through social media reach, which this month averaged 10,000 people per week compared to the previous average of 1,500 people. We also gained an additional 125 fans on Facebook in just a few weeks, which also exceeds our average rate of growth so far.

I want to thank Council Speaker Christine Quinn and Deputy Mayor Linda Gibbs for supporting our campaign by posting very personal and heartfelt dedications, and all our senior leaders who promoted the events in their facilities and who posted mammogram dedications. I also want to thank the Office of Communications and Marketing for organizing the annual campaign.

Over the last eight years, HHC provided nearly 737,000 mammograms and we remain committed to make mammography affordable and accessible to all women regardless of age, income or immigration status.

On April 26, the Centers for Medicare & Medicaid Services (CMS) issued the Medicare Inpatient Prospective Payment System (IPPS) proposed rule for Fiscal Year (FY) 2014. Under the rule, there will be an average payment decrease to hospitals of 0.1% in FY 2014 compared to FY 2013. The proposed rule also includes CMS’ proposal to implement Affordable Care Act (ACA) Medicare disproportionate share hospital (DSH) changes.

As required by the ACA, beginning October 1, 2013, each hospital will receive 25% of their traditional share of Medicare DSH. Part of the remaining 75% will be taken as savings by the federal government, and the rest will be redistributed through a new “uncompensated care payment.” (Based upon the proposed rule, the “cut” to aggregate Medicare DSH in the first year appears to be about 9%.) The portion of the 75% taken as federal savings will increase in future years as the national uninsured rate decreases. HHC expects to see an increase in Medicare DSH payments under this new formula but the amount is uncertain. The most significant issue under the proposed federal rule is the data CMS would use to determine the distributions for these payments. HHC is working with GNYHA and others to suggest that distribution be formulated in such a way that targets more of the funding to safety net hospitals. IPPS rule comments are due June 25.

On May 13, CMS released a proposed rule to implement the Medicaid DSH cuts mandated by ACA. Unlike the Medicare DSH cuts which are sized based upon Congressional Budget Office annual estimates of coverage expansion impact on the number of residual uninsured, the aggregate Medicaid DSH cuts are set in statute, beginning with a 5% cut ($500 million) and ramping up to as much as 50% cut ($5.6 billion) in the out years. The CMS’s proposed formula for calculating the state-by-state distribution of these annual cuts to Medicaid disproportionate share payments is designed, in part, to incentivize states to target DSH payments to those hospitals serving the most low-income patients. CMS intends to use state auditing data to determine the extent to which states are targeting DSH payments to hospitals with high levels of insured or uncompensated care. The ultimate impact to HHC is dependent both upon the extent of the cut to New York’s current Medicaid DSH allocation and how the State elects to implement that cut among the entities that currently receive Medicaid DSH. Comments on the proposed rule are due July 12.

The Border Security, Economic Opportunity, and Immigration Modernization Act is scheduled to be brought to the Senate floor the second week of June for extended debate expected to last several weeks. As proposed, this comprehensive immigration legislation would allow an undocumented immigrant present in the United States to enter a path to citizenship that would include 10 years as a registered provisional immigrant (RPI) before s/he becomes eligible to be a legal permanent resident (LPR) awarded a green card. After converting to LPR and receiving a green card, an individual would need to wait another five years before having access to Medicaid or CHIP. Accordingly, immigrants on the “path to citizenship” would have to wait a total of 15 years be eligible for federal health care coverage. Such immigrants would remain immediately eligible for Emergency Medicaid. In the House, where no comprehensive bill has been introduced, immigration talks are snagged on this issue of whether and when health benefits should be available to undocumented immigrants seeking U.S. citizenship.

As the New York State Legislature enters the final weeks of the 2013 Legislative Session, there is strong advocacy — both for and against — two bills related to nurse staffing that would significantly impact HHC. The first bill would mandate stringent nurse staffing ratios for hospitals and nursing homes – without regard to the number of other clinical team members or relative patient acuity within specific settings. If enacted, the legislation would require thousands of new nurses to be hired. HANYS estimates this would cost hospitals and nursing homes $3 billion statewide. We estimate this would cost HHC nearly $388 million. The supporters of the bill claim that hiring additional nurses would lead to increases in quality. However, the latest peer-reviewed research shows that simply imposing new staffing mandates does not in itself result in improved patient care.

The second bill would create a new Safe Patient Handling Program that mandates specific and inflexible new equipment, technology and staffing requirements for health care facilities. While HHC supports the expressed intent of this legislation, we do not agree that the requirements imposed by this bill would necessarily accomplish these objectives.

In addition to the objections that have been raised by hospitals and nursing homes on the merits of the bills, it is important to point out that neither bill has any funding attached to it that would assist hospitals and nursing homes to meet these rigid requirements. HHC has invested considerable effort and resources over the past several years that have led to significant increases in safety and quality, and we have done so without increasing the number of registered nurses across our system.

We also anticipate efforts in Albany to move problematic legislation on a variety of liability and malpractice issues. HHC will continue to remain vigilant on these and other proposals as the Session draws to a close.

Over the past six months, staff from Information Technology and the Office of Ambulatory Care Transformation have partnered with Microsoft to develop HHC’s Care Plan Management System (CPMS). The system is web-based and designed to keep all members of the patient’s care team, whether at HHC or community-based, informed of the patient’s health goals and the progress made with the tasks and interventions required to help the patient meet their targets. While the CPMS can be used to generate care plans for all HHC patients, this first prototype, developed and released in April, was built to fulfill HHC’s data and functional regulatory requirements as a NYSDOH certified Health Home. Accordingly, this release houses the Health Home patient roster, and includes enrollment, care team assignment, health goal documentation and care plan development, and task assignment and tracking functions.

While available to all members of the care team, the CPMS is the tool of record for care coordinators whose job it is to ensure that patients can access the services they need and overcome social and personal obstacles that may interfere with a patient’s ability to achieve his or her health goals. Deployment of the CPMS in this phase involves hands-on training with care coordinators at each hospital site, followed by an additional 1-2 weeks of coaching both on site and by email.

Care coordinators begin training by creating a care plan in CPMS for each of their patients. Care plans, once complete, can be printed out and provided to patients for their home use or shared with members of the care team during huddles. The CPMS roll-out to all facilities will be completed by the end of July. Training and deployment has already been successfully completed at Kings County, Woodhull and Lincoln hospitals where over 500 care plans have already been established for patients since deployment began.

In the next phase of development, the CPMS will offer patients access to a patient portal with direct electronic access to their care plan and to their Patient Health Record. In addition, the CPMS patient portal will facilitate patient use of their mobile devices to access their care team and exchange information about their care experience and progress.
The CPMS also includes screens, assessment tools and care plan prompts to support care management functions and transition of care work flow functions. These will be forthcoming in late 2013 once development is completed.

As you know, our Integrated Clinical Information Services (ICIS) is making a transition to a highly-advanced EMR software system that will enhance HHC’s clinical decision support, enable personalized medicine, and improve patient care and safety. The ICIS transition program is currently being introduced to HHC employees both en masse and to smaller leadership groups. The past two weeks have seen the launch of an HHC-wide monthly newsletter, a weekly email blast and a SharePoint site.

At the same time, the project is being introduced via town hall-style meetings and targeted communications. There was an HHC Leadership Team update on April 24 and an Executive Leadership Kick-Off Meeting on April 29-30. The HHC Operations Staff ICIS Kick-Off is planned for May/June, as are the planning meetings for the Workflow Preview Sessions.

Scope decisions are being made in order to choose which specific applications and available functionalities will be utilized by HHC. In addition, clinical engagement continues as lead analysts on the project are reporting at each clinical council meeting. Procurement is also in progress as the applications that are required for integration with Epic are currently being purchased.

While all this is happening, the identification and recruitment of Subject Matter Experts, Super Users and Clinical Champions from every HHC site is on-going. These positions will support the upcoming key milestone of the 222 Workflow Preview Sessions planned for July 2013.

HHC’s workforce is our greatest resource and the health and well-being of our employees are paramount. This year we are elevating our focus on employee wellness and have launched a quarterly newsletter dedicated to sharing good health tips and wellness information with staff across the enterprise. The inaugural issue of “Employee Wellness Focus” featured tips to gradually and safely incorporate walking into a regular fitness program. We also hosted employee wellness events at Kings County, Lincoln and Queens Hospitals and Central Office where over 1,200 employees have had an opportunity to learn about healthy eating strategies, stress management techniques, and simple exercises aimed at improving health and fitness. Staff were encouraged to learn their wellness numbers, such as blood pressure, blood glucose and Body Mass Index (BMI), and what cancer prevention screening tests are right for them. Staff were also invited to participate in a “healthy healing dance”, receive a therapeutic massage, sign up for the HHC “Step Challenge Program” and receive a pedometer to track the number of steps taken each day.

The Employee Wellness events have been coordinated by staff of the Office of Patient Safety and Employee Safety and supported by multiple HHC units including the Queens Hospital Employee Assistance Program, the World Trade Center Environmental Health Center, MetroPlus, HHC Health and Home Care, the Office of Behavioral Health, the Office of Communications and Marketing’s Breast Cancer Awareness Program as well as external partners such as The American Cancer Society and the NYC Parks Department “Shape Up NYC” Program.

On May 22nd HHC received an award from the Department of Citywide Administrative Services (DCAS) for its leadership in energy management. Along with ten other City agencies, HHC was acknowledged for its efforts in reducing citywide greenhouse gas emissions by approving the construction of two energy efficiency projects at Metropolitan and Elmhurst hospitals. These projects will reduce energy use significantly and follow many recommendations that came from comprehensive energy audits funded by DCAS, replacing previous cooling and heating equipment with premium high-efficiency models. Total project costs at Metropolitan and Elmhurst hospitals are $34 million and $28 million, respectively. Both projects are scheduled for completion by June 2015, are estimated to save HHC $3 million annually, and will have total carbon dioxide reductions of more than 20,000 tons.

HHC continues to work on many other energy efficiency projects throughout New York City. We have window replacement projects at both Coney Island Hospital and Coler-Goldwater Specialty Hospital, a green roof in design for East New York Diagnostic & Treatment Center, and an energy efficient boiler project at Coler-Goldwater, as well as a boiler plant replacement project for Coney Island Hospital.

Two HHC hospitals — Lincoln Medical Center and Elmhurst Hospital Center — received the American Heart Association/American Stroke Association Gold Plus Performance Achievement Award for the successful implementation of higher standards of stroke care, aimed at reducing death and disability, and improving the lives of stroke patients. The Award is an advanced level of recognition that allows hospitals to be acknowledged for their compliance with the Get With The Guidelines® nationally accepted standards and quality measures.

In addition, both hospitals were included in the American Heart Association/American Stroke Association’s “Honor Roll” for timely administration of clot-busting, thrombolytic therapy within 60 minutes of patient’s arrival to the hospital. A thrombolytic agent, when administered in a timely manner is the best available treatment for ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, it has been shown to significantly reverse the effects of stroke and reduce permanent disability.

Queens Cancer Center (QCC), part of HHC’s Queens Hospital Center (QHC), has received the highest accreditation award possible by the American College of Surgeons. The “Gold” award to QCC comes after a comprehensive review by a consortium of professional organizations that sets professional standards for cancer research centers and monitors the quality of care that patients receive. The award renews QCC’s full accreditation at the highest level. To be considered for accreditation, cancer centers must comply with stringent criteria and must offer patients a slew of services including diagnostic imaging, radiation oncology, systemic therapy, clinical trial information, psychosocial support, rehabilitation, and nutritional counseling. The American College of Surgeons also looks for several additional elements, including state-of-the-art pretreatment evaluation, staging, treatment, and clinical follow-up for cancer patients in all stages of the disease. It also investigates whether a cancer center has systems in place to consistently educate physicians and evaluate and improve patient outcomes.

I know the Board joins me in congratulating Queens Network Senior Vice President Dr. Ann Sullivan, QHC Executive Director Julius Wool and Queens Cancer Center Director Dr. Margaret Kemeny for achieving this high level of accreditation.

The May 13th edition of The New Yorker includes a very compelling profile of Dr. Joseph Lieber, Associate Director of Medicine at Elmhurst Hospital Center. The piece is written by one of Dr. Lieber’s former medical residents, and highlights not just the work of Dr. Lieber but also some of the unique history of the hospital and the challenges presented by its extraordinarily diverse patient population. The story cites Elmhurst as being an exceptional training site for young doctors to learn about conditions and diseases from around the world, and quotes Mount Sinai’s Dean for Medical Education as saying that Elmhurst is a favorite location for Mount Sinai residents to rotate. But mostly, the story is about Dr. Lieber’s remarkable skill and dedication as a physician, diagnostician, and educator. It is a great tribute to a devoted clinician that HHC and Elmhurst are truly privileged to have on board. A copy of the article is included in your Board package.

In recognition of National Women’s History Month and coincident with its 100th anniversary, El Diario, the oldest Spanish-language newspaper in this country, acknowledged significant contributions of Latinas who have made a positive impact on the lives of others. Awardees included judges, educators, artists, journalists, historians, doctors, economists and public servants. Two HHC leaders, Evelyn Hernandez, Director of Media Relations here in Central Office and Lebby Delgado, Health Information Administrator at Lincoln Medical Center, were among the 40 recipients of the 2013 El Diario Distinguished Women Award. Join me in congratulating both Evelyn and Lebby on this achievement and for their leadership and outstanding contribution to our HHC family.

Coler-Goldwater residents, HHC leaders, star athletes, and donors celebrated the 40th anniversary of Wheelchair Charities, Inc., and its founder Henry J. “Hank” Carter at the New York Hilton Ballroom on May 9. Through Wheelchair Charities, Mr. Carter has donated more than $25 million to HHC for a variety of equipment and programs for residents of Coler-Goldwater. His generous gifts include a computer lab, a rehabilitation gymnasium, assistive and mobility equipment, specially outfitted buses, and thousands of state-of-the-art wheelchairs that enable residents to be more self-sufficient.

The event was attended by Honorable Andrew Young, former U.S. Ambassador to the United Nations and former Member of the U.S. House of Representatives, as well as Larry Miller, President of Nike’s Jordan Brand, who presented Mr. Carter with a check from Nike for $500,000, helping to ensure the successful launch of the next generation of Wheelchair Charities donations to HHC.

During the evening, awards were presented to a number of star athletes who have donated their time and talent to Wheelchair Charities. Among them are WNBA Seattle Storm guard Katie Smith, Baltimore Ravens running back Ray Rice, and WBA Super Middleweight Champion Andre Ward. Also among the honorees were three families recognized for decades and generations of generous support for Wheelchair Charities. They are the Howard White family, the John J. Conefry family, and the Patricia Lanza family.

HHC will honor Mr. Carter later this year with the opening of a new 365-bed skilled nursing facility and long-term care hospital in Harlem, named The Henry J. Carter Specialty Hospital and Nursing Facility.

Please join me in thanking and congratulating Mr. Carter for 40 years of caring and devotion to the well-being of Coler-Goldwater residents and HHC.

Broadcast

Springtime Allergies Can Become Irritating Challenge, Dr. Luis Rodriguez, Woodhull Hospital, NY1, 05/08/13

Teen Pregnancy Rates, Amanda Ascher, MD, Segundo Ruiz Belvis, D&TC, News 12 Bronx en Espanol, 05/08/13

Suicide Prevention for Kids, Lincoln Hospital, News 12 Bronx, 05/01/13

Hospital Emergency Preparedness, Janice Halloran, Jacobi Hospital, News 12 Bronx, 04/18/13

Lincoln Hospital provides health screenings at Dominican consulate, NY1 Noticias, 05/21/13

Half Of Coney Island Hospital ER Remains A Construction Zone Six Months After Sandy WCBS, 04/29/13

High Rate of Diabetes in the Bronx, Natasha Wattel, Dietitian, Jacobi Hospital, News 12 Bronx, 04/25/13

Print

Every Disease on Earth, Dr. Joseph Lieber, Elmhurst Hospital, The New Yorker, 05/13/13

2013 Sloan Pubic Service Awards, Stanlee Richards, Coler- Goldwater Hospital, The New York Times, 05/08/13 (Also covered in WSJ, The Chief, NY Daily News)

Teen documentarians hope their graphic anti-violence film will have lasting impact on victims and perpetrators alike, Harlem Hospital, New York Daily News, 04/24/13

Queens Hospital Center Cuts Ribbon For New Geriatric Center, Queens Gazette, 04/24/13 (Also covered in Times Ledger)

Elmhurst Hospital ranked one of safest hospitals for angioplasty, Times Ledger, 04/26/13

Elmhurst Hospital Center to Receive LIVESTRONG Foundation Grant To Advance Palliative Care In Queens, Queens Gazette, 05/22/13

Healthfirst’s 4th Annual Cinco De Mayo festival at Elmhurst Hospital, Elmhurst Hospital, Queens Ledger, 05/07/13

Healthy living help comes to Staten Island’s Park Lane at Sea View, Sea View Hospital, Staten Island Advance, 05/27/13

Tunes soothe dementia, Alzheimer’s patients at Sea View, Jane Fode, RN; Lauren Pegues, RN, Sea View, Nurse.com, 04/22/13

Frequent Flyers: Treat returning psychiatric patients like valued customers, Kings County Hospital, Nurse.com, 05/28/13

Mixed Grades for Hospitals, Lincoln, Jacobi and NCB, Bronx Times Reporter, 05/24/13
A night of healing in Harlem, Harlem Hospital, The New York Amsterdam News, April 18-24, 2013

Sr. VP of HHC honored, Denise Soares, Harlem Hospital, NY Amsterdam News, May 9- May 15, 2013

NYC Teen Pregnancy Rate Dropped 30 Percent Since 2001; New City-Funded App Aims To Reduce Further, HHC, International Business Times, 05/08/13

City focuses on breast cancer, HHC, Queens Chronicle, 05/09/13

In Sandy’s Wake, Extra Special Appreciation For Coney Island Hospital Nurses, Sheepsheadbites.com, 05/14/13

Coney Island Hospital Doctor Honored For Leadership, Olga Golubovskaya, MD, Coney Island Hospital, SheepsheadBites.com, 05/23/13

Coney Island Hospital, Local Artists’ Group Dedicate New Exhibit Space To Recchia Staffer’s Late Husband, Sheepsheadbites.com, 05/16/13

Early Detection is the Best Protection, Milton Nuñez, Lincoln Hospital, The Bronx Free Press, 05/15/13

Dominicans can get free health care at 4 NYC hospitals, Lincoln Hospital, DominicanToday.com, 05/01/13(Also covered in Almomento.net)

Mental Health: A Priority in New York, HHC, Alan Aviles, El Diario, 05/27/13

Tu agenda local de salud, Your local health agenda, HHC mammogram events, El Diario, 05/20/13 and 05/24/13