REPORT TO THE BOARD OF DIRECTORS – February 2013

Both Bellevue and Coney Island hospitals have resumed receiving ambulances to their very busy emergency departments.

On February 6, a team from the state Health Department completed its site inspection, and gave Bellevue Hospital permission to re-open fully. Effectively, this means Bellevue is now ready to admit patients, offer full medical, surgical and critical care services, and most importantly, provide all the specialty services and support necessary to fulfill the stringent requirements of Level 1/Trauma designation. Since Bellevue is the only trauma center in Manhattan south of 68th Street, resumption of this service was of critical importance.

Ambulances began arriving at Coney Island Hospital on Wednesday, February 20. The hospital is accepting most types of 911 patients, including heart attack and stroke cases. Trauma care and labor and delivery remain closed. Repairs are ongoing at Coney Island, and its emergency department continues to function at a reduced capacity due to storm damage. However, the hospital’s Tower Building has re-opened along with most of its inpatient beds and imaging and laboratory services, and the hospital has for several weeks been admitting patients from its emergency department and from other HHC facilities. Inpatient adult psychiatric beds, operating rooms, and medical/surgical beds, including intensive care, are all now available. All primary and specialty outpatient clinics are open, and a fleet of mobile medical vans continue to provide primary care services and flu shots in parts of Brooklyn and Staten Island affected by Sandy.

Earlier in the month, Coney Island Hospital also announced the re-opening of its Women, Infants and Children (WIC) food and nutrition program made possible with a $50,000 grant from Public Health Solutions and the Robin Hood Foundation. The two WIC offices run by the hospital have been closed since Hurricane Sandy, affecting 5,000 participants. The grant funding will support a temporary new WIC office, chosen for its easy access to public transportation. The grant will cover the rent of the temporary location, new office furniture, supplies, and clinical equipment, as well as client and community outreach.

Damage at several other HHC sites is extensive and work continues on the restoration of those sites. Continuing updates are provided to HHC staff on the specially established Restoration and Relief intranet site at http://restoration. We remain hopeful that a large portion of the more than $900 million estimated cost of full recovery from Sandy will be covered by FEMA. We are working closely with emergency recovery experts in our planning to restore and protect our facilities going forward, as well to set up the optimal FEMA claims process for this work. So far, FEMA has approved a preliminary submission for $103 million.

The 2013 multi-hospital survey of HHC by The Joint Commission began on Tuesday, February 19th with an Orientation Program for the survey team leader. The Orientation Program provides an opportunity for me and members of my senior staff to present The Joint Commission lead surveyor with an overview of HHC and how we provide oversight and support to the HHC facilities to assure that we meet the intent of TJC standards. This year’s survey team leader, Mr. Siward Hazelton, RN, also briefed the participants on changes to the survey process and new requirements for 2013 and 2014.

The meeting was attended by senior staff from Central Office as well as from the facilities being surveyed in 2013, namely Elmhurst, Gouverneur, Jacobi, McKinney and Metropolitan. I am confident that each facility will perform well on this triennial evaluation of the quality and safety of the care we provide.

The global credit rating agencies Moody’s Investors Service, Standard & Poor’s Ratings Services, and Fitch Ratings have assigned Aa3/A+/A+ ratings, respectively, to $110.5 million of new bonds to be issued next month by HHC. The agencies also said the rating outlook is stable.

Fitch also affirmed HHC’s A+ rating on approximately $1 billion in outstanding debt. HHC expects to issue the new bonds the week of March 18, with proceeds used to pay off a portion of the outstanding debt.

The three agencies said the high ratings are linked to HHC’s strong support from New York City and its essential role as the primary safety net provider to the City’s Medicaid and indigent population. The ratings are confirmation of HHC’s essentiality to the City of New York and our well-developed programmatic initiatives to transform our service delivery to meet the challenges of health care reform.

Citing HHC’s management team as one of the organization’s strengths, Fitch said HHC “has a seasoned management team in place that has produced stable financial performance, completed or is near completing major capital modernization projects at seven of 11 of its acute care hospitals, received federal approval as an accountable care organization, maintained productive relationships with key stakeholders, including NYC officials, and implemented an enterprise-wide process improvement tool that has led to enhanced quality and approximately $487 million in system wide savings.”

The Budget Control Act mandated sequester begins cuts April 1. These cuts will apply to reimbursement for services provided in March. Medicaid and Electronic Health Record incentive payments are exempt from sequester. Medicare provider payments cuts would be limited to 2%. HANYS estimates the Medicare cut to HHC at $9.17 million in the first year and $81 million over 10 years. Many programs, including the Sandy Supplemental, September 11 health, Ryan White, among others, would be cut 6%. Thus, the $60 billion Sandy appropriation would be cut $3.6 million but it is not possible to calculate a specific reduction in any expected HHC reimbursement. This is also true of the WTC Zadroga funding, which is estimated at $27 million for the total national cut and possibly an estimated cut of $2.25 million or less to HHC. It is unpredictable whether or when Congress will act to avoid or end the sequester.

The Obama administration issued a final rule on Wednesday, February 20 defining “essential health benefits” that must be offered by most health insurance plans next year. The ACA requires insurers to cover benefits in 10 broad categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

The rule will have a significant effect on the coverage of mental health services. As a result of the rule, the Administration estimated that 32 million people would gain access to coverage of mental health care and 30 million people who already have some mental health coverage will see improvements in benefits.

Through a $1.6 million Substance Abuse and Mental Health Services Administration grant, Bellevue Hospital Center in partnership with the Administration for Children’s Services (ACS) will provide trauma-focused care at two ACS secure juvenile detention facilities — Crossroads in Brownsville, Brooklyn, and Horizon in Mott Haven, The Bronx. Bellevue will establish trauma-informed mental health screening and evidence-based skills groups to reduce trauma-associated problems and will build partnerships in systems associated with juvenile detention to increase trauma responsiveness in those areas.

The grant was announced by Mayor Bloomberg on February 12, as part of a group effort which also includes the Child Study Center and the Atlas Project Administration on Children, Youth and Families, to improve trauma services for children and young people in New York City’s child welfare and juvenile justice systems. The three organizations, which will also work with ACS, the Ulster County Department of Social Services and the New York State Office of Children and Family Services, have received grants totaling $7 million to support programs assisting children in New York City with mental health assessment and treatment, as well as train service providers who care for these children.

The grants are funded by the Substance Abuse and Mental Health Services Administration and the Administration on Children, Youth and Families. Key partners in this collaboration include the New York State Office of Mental Health and Office of Children and Family Services, the National Child Traumatic Stress Network and regional medical centers across the country.

In observance of National Colorectal Cancer Awareness Month this March, HHC will continue our annual tradition of encouraging our staff and patients over 50 to get a life-saving colon cancer screening. As you already know, most cancers are diagnosed in people 50 years or older. A study from the American Cancer Society shows that half of Americans over 50 have not had any type of colorectal cancer screening. If everyone were tested as recommended, thousands of lives could be saved each year. My message to all HHC employees who are 50 or older and have not been screened for colon cancer: it’s time for your colonoscopy.

This year, we are collaborating with the NYC Department of Health and Mental Hygiene and members of the Citywide Colon Cancer Control Coalition to create awareness through a unified social media campaign. Throughout next month, each agency will post a series of important messages, tips and stats about colonoscopy on Twitter and Facebook to help educate thousands of “fans” and “followers” about the benefits of colon cancer prevention, screening and early detection.

This month, after consulting with the Corporation’s Senior Vice President for Legal Affairs and General Counsel, Salvatore J. Russo, I granted a deviation from our procurement Operating Procedure 100-5 due to exceptional and urgent circumstances presented by the expiration of certain information technology services contracts in the next three months if not extended. These contracts have been extended through July 31, 2013 so that Enterprise IT Services (EITS) can complete the competitive selection process in connection with the Health Information Related Services RFP for the Integrated Clinical Information System (ICIS) Project. The total authorized spending authority for all of these contracts is $4.35 million, based upon historical spending for each contract. The RFP process, which will take up to six months to complete, was delayed because of unforeseen circumstances. The longest delay was caused by the need to finalize the award of the ICIS enterprise-wide software system contract to Epic Systems Corporation, since the RFP outlines EITS’s requirement for Epic-certified consulting resources. As you are aware, although the Board of Directors approved the Epic contract award on September 27, 2012, the actual formal award was delayed due to a vendor protest, and was not resolved until late in 2012. Continued support from the consulting firms under contract is integral to the success of our on-going projects and operations.

HHC hospitals have held celebrations of Black History Month throughout the month of February. On February 7th, Elmhurst Hospital Center hosted keynote speaker Esther Armah, a radio host and national best-selling author. Also on the 7th, Lincoln Medical Center celebrated the month through an art show featuring the work of Robert Daniels, whose work with historic themes relates to his African ancestry. On the 14th, the Kings County Hospital Center tribute featured keynote speaker Annette Robertson, NYS Assembly Member and civil rights advocate. Finally, on February 22nd Governor Andrew Cuomo hosted his celebration at Harlem Hospital Center in the Mural Pavilion. The event featured the governor’s traveling art exhibit of important figures in Black History, including Sojourner Truth, Frederick Douglass, Adam Clayton Powell and David Dinkins.

Four HHC staff members have been accepted as 2013-2014 NAPH Fellows. The fellowship program, Leading High Performing Organizations, provides a valuable opportunity to network with colleagues who share similar missions and understand the unique challenges of the safety net. The NAPH Fellows will gain the invaluable knowledge and tools that can help them be even more effective leaders. Participating in this year’s program will be Alina Moran, CFO at Elmhurst; Marie Elivert, Senior Assistant ED at Queens; Lillian Diaz, Deputy ED at Metropolitan; and Frank Piacenti, PharmD, at Lincoln.

I am sad to announce that Iris R. Jimenez-Hernandez will soon be leaving HHC. For the past six years, she has served HHC first as Senior Vice President of the North Brooklyn Network and Executive Director of Woodhull Medical Center and then as Senior Vice President of the Generations+/North Manhattan Health Network and Executive Director of Lincoln Medical Center. Under her leadership, Harlem Hospital opened its new Mural Pavilion, underscoring the historical role that Harlem Hospital Center has played in the community; the Renaissance Health Care Network relocated its flagship site, Sydenham Health Center, to a modern facility; and Lincoln Medical Center is on track to complete its Emergency Department expansion and renovation later this year. Lincoln also received the prestigious 2012 American Health Association-McKesson Quest for Quality Finalist Award for leadership and innovation in quality improvement and safety.

Prior to her most recent appointments at HHC, Iris spent 15 years at the New York City Human Resources Administration as Executive Deputy Commissioner, overseeing diverse and complex social services programs, including Medicaid, Adult Protective Services, Home Care Services, HIV/AIDS Services and the Food Stamp Program. Just as she excelled in managing those programs for the City, she has done a magnificent job as a leader with HHC. I know the Board joins me in both thanking Ms. Hernandez for her stellar service and in wishing her well in her future endeavors.

Broadcast

Beneficios de la vacuna contra la gripe durante el embarazo (Benefits of the flu vaccine during pregnancy), Telemundo Ch. 47, 01/18/13

Health and Safety Tips in the Snow, Dr. Fernando Jara, Lincoln Hospital, Telemundo Ch. 47
02/08/13

Partnership Aims To Pinpoint Trauma’s impact On City Youth, NY1, 02/12/13
(Also covered by WCBS TV and WCBS Radio)

Ambulances Return To Coney Island Hospital, NY1, 02/22/13

Print

Fitch rates NYC Health and Hospitals Corp 2013A revs ‘A+’ HHC, Reuters, 02/21/13

Bellevue Hospital Fully Returns 99 Days After Evacuation, The New York Times, 02/07/13
(Also covered by NY1, WCBS, Reuters, Modern Healthcare, The Wall Street Journal, WNBC, iTech, Crain’s Health Pulse, Ch 7, Ch 5, Ch 4, Associated Press, Chicago Tribune)

Hospitals Eye Big Changes After Sandy, Bellevue, Coney, Coler-Goldwater,The Wall Street Journal, 02/03/13

Bellevue Hospital Center in Manhattan Getting Federal Funds to Help Recovery, WFUV, 02/01/13

Bellevue Hospital’s Slow Comeback After Superstorm Sandy, WNYC/NPR, 01/30/13

Coney Island Hospital Resumes Some Services, The Wall Street Journal, 02/22/13
(Also covered in Crain’s Health Pulse, Newsday, WABC, Sheepsheadbites.com, Brooklyn Daily, The Washington Post)

Coney Island Hospital Reopens WIC Program After Sandy, Sheepshead Bites, 02/07/13

Performance-Based Bonuses Offered To Physicians by HHC, The Chief, 01/28/13

Medical Pay Model: Hospitals and Doctors Weigh In, Dr. David Stevens, HHC and Dr. Bruce Siegel, NAPH, Letters to Editor, The New York Times, 02/03/13

Dr. Wheelchair keeps things rolling, Mike Acevedo, Coler-Goldwater, HHC, The New York Times, 02/15/13

Managed care helps nurses guide members through rough waters, HHC, Nurse.com, 02/25/13

Managed-Care Market Consolidates as it Grows, MetroPlus, Crain’s Health Pulse, 02/20/13

DOH Wants to Go Metric, Dr. Art Cooper, Harlem Hospital, Crain’s Health Pulse, 02/11/13

Curbside medical check saves man’s life, Coney Island Hospital, Brooklyn Daily, 02/05/13

Road to recovery, Terry Mancher, RN, Coney Island, Bellevue Hospital, HHC, Nurse.com, 01/28/13

theGrio’s 100: Dr. Robert J. Gore, saving lives even before the trauma, Dr. Robert J. Gore, Kings County, theGrio.com, 01/15/13

Harlem Black surgeons saved the Civil Rights, Harlem Hospital, Caribbean Life, Jan 25-31, 2013

Matters of the Heart, Dr. Lekshmi Dharmarajan, Lincoln, The Bronx Free Press, 01/30/13

Patient Safety Awareness Week is March 3-9, HHC, Patient Safety Monitor Journal, March 2013

Community Album: First baby born at Bellevue Hospital after re-opening, El Diario, 02/10/13