REPORT TO THE BOARD OF DIRECTORS – February 2014

On February 3, the Office of Patient and Employee Safety continued its collaboration with the Committee of Interns and Residents/SEIU Healthcare and the New York State Nurses Association by hosting a Joint Labor Management Patient Safety Forum. This invitation only conference brought together a representative group of frontline clinical teams and leadership staff from each HHC hospital to discuss how to improve patient safety and quality by examining the root causes of errors. The goals of the one-day conference were to: understand what it means to be truly “patient-centered”; improve patient safety outcomes by understanding the root causes of errors; and improve communication and teamwork within interdisciplinary teams.

The morning began with a presentation on the results of the HHC-CIR/SEIU Resident Patient Safety Survey given by Mei Kong, RN, AVP Patient and Employee Safety and Samrina Kahlon, MD, Patient Safety Officer, Metropolitan Hospital, NY Regional VP CIR/SEIU. The keynote presentation “Improving Patient Safety Outcomes by Understanding the Root Cause of Errors” was delivered by James F. Pelegano, MD, Assistant Professor and Program Director at the Jefferson School of Population Health.

In the afternoon, teams focused on identifying the barriers to reporting errors and to establishing a Just Culture, led by Mei Kong and Say Salamon, MD, PGY-3, Woodhull Hospital, NY Regional VP CIR/SEIU. Ann Bove, RN, Bellevue Hospital Center, Secretary, NYSNA Board of Directors, presented on Communication and Teamwork for Patient Safety; and David Eshak, MD, PGY-3, Jacobi Medical Center, NY Regional VP, CIR/SEIU led a final discussion on barriers to reporting and next steps.

Despite a snowstorm, 200 individuals attended the Forum and approximately 150 others participated via live streaming.

On January 28, the second cohort of HHC facility middle managers and their coaches completed the Corporate Leadership Development program conducted by the Advisory Board Company. The 114 participants and 36 coaches attended five full day sessions, which focused on the Healthcare Management Intensive, Critical Thinking and Problem Solving, Instilling Accountability, Facilitating Effective Teamwork, and Impact through Influence. The coaches also participated in a half-day session on Coaching for Full Potential.

Coaches worked with the managers on over 100 individual and group projects designed to reinforce what was learned in the sessions. In addition to Advisory Board content, participants were required to complete Breakthrough Green training (if they had not already done so), finance training conducted by CFO Marlene Zurack, and Media Relations training held by Senior VP Ana Marengo and Bellevue Associate Executive Director Evelyn Hernandez.

Kudos to Caroline Jacobs for leading this important initiative. To date, 294 managers and senior leader coaches have now participated in this leadership development program. This initiative is part of our investment in developing our workforce and is a central component of our Workforce Development Strategic Plan.

The third cohort is scheduled to begin in May 2014.

Our World Trade Center Environmental Health Center was pleased to recently learn the federal government has added to the list of covered cancer conditions related to 9/11 exposures. When the James Zadroga 9/11 Health and Compensation Act was enacted in 2011 — the federal legislation which created the federal World Trade Center Health Program — no cancers were covered. But in September of 2012 over 50 cancers were appended as WTC-related conditions, and then a year later, in September of 2013, prostate cancer was added. As of last week, now included are malignant neoplasms of the brain, cervix, pancreas and testis. We estimate at least three dozen of our current patients, who were not previously covered for these conditions, now will be. This expanded list of covered cancers will also be likely to encourage additional eligible people to enroll.

HHC was one of 12 healthcare organizations across the United States to receive the Emergency Care Research Institute’s (ECRI) 2014 Healthcare Supply Chain Achievement Award. The winning organizations were chosen out of nearly 3,000 hospitals and health systems who subscribe to the Institute’s supply and capital procurement advisory services. The award honors organizations for excellence in overall procurement spend management and in adopting best practice solutions in their supply chain process. HHC was recognized for its performance in reducing costs, utilization, and readmissions while achieving better healthcare outcomes.

ECRI is an independent, nonprofit organization that researches the best approaches to patient care. It is designated as an Evidence-Based Practice Center by the federal Agency for Healthcare Research and Quality. It is also a Collaborating Center of the World Health Organization.

HHC will once again recognize National Colorectal Cancer Awareness Month in March by educating our patients, staff and the public at large about the benefits of colon cancer prevention, screening and early detection. We will use all communications platforms available to us — from internal email blasts to social media — to remind New Yorkers who are approaching 50 to get a colonoscopy or ask about other effective colon cancer screening tests available. HHC physicians will spread our colon cancer message in op-ed columns in the Epoch Times, Harlem News, Brooklyn Spectator, Queens Courier, El Diario, El Especialito and The Chief Leader. Other campaign elements will include posters, post cards, email messages, our website, a press release, banners, and screen savers. HHC will also collaborate with members of the Citywide Colon Cancer Control Coalition (C5) to create awareness through a dedicated web page and unified social media campaign.

$8 Billion Medicaid Waiver

On February 13, New York State reached an agreement in principle on a federal waiver that will give the state $8 billion in additional federal Medicaid funding over five years, which is lower than the state’s $10 billion request. The federal program is intended to stabilize the healthcare delivery system, focus on primary and preventive care and cut avoidable hospitalizations and emergency department use. Waiver money will flow to hospitals and other healthcare facilities based on performance and outcomes measures of specific projects. HHC plans to apply for funding from the waiver, the terms of which are still being negotiated.

The “Two-Midnight” Rule

In response to advocacy from hospital groups, physicians and others, on Friday, January 31st, the federal Centers for Medicare and Medicaid Services (CMS) announced a six month delay until September 2014 of the enforcement of the “two-midnight” rule.

This rule was promulgated by CMS reportedly to address patients’ concerns with long “observation” stays. While welcome, the recent delay in enforcement by CMS did not alter the underlying policy of arbitrarily using two midnights to determine when an inpatient admission is justified for reimbursement purposes. It also fails to address the provider community’s concern with developing a new payment policy for short inpatient high acuity stays and does not guarantee that the issue will be addressed in the proposed inpatient payment rule this April. The current rule, if implemented, could cost HHC from $23-38 million a year in lost revenue.

During the delay period, contractors will continue to carry out “probe and educate” prepayment reviews on a sample of inpatient claims with dates of admission from October 1, 2013 through March 31, 2014. The probe and educate reviews are intended to determine if hospital inpatient claims comply with the “two-midnight rule.” Those that fail to comply with the new benchmark requirements will be denied. The probe reviews affect acute care hospitals, long-term care hospitals and inpatient psychiatric hospitals.

Despite the delay by CMS of the enforcement of the two-midnight policy until the end of September, HHC and other hospital groups continue to pursue, through both administrative and legislative avenues, the establishment of a rational short-stay payment mechanism under the Medicare inpatient system.

The “Doc Fix”

A bipartisan group from both houses of Congress is currently working on legislation to replace the Sustainable Growth Rate (SGR) formula that has limited physician reimbursement under the Medicare Program since its enactment as part of the Balanced Budget Act (BBA) of 1997. The limitation has been suspended many times since, with the latest expiring on March 31st.

Congress views this year as a very promising window to remedy this problem permanently because the Congressional Budget Office (CBO) has estimated that a permanent fix would cost the federal government $116.5 billion over ten years – about half the estimate in years past – primarily due to lower projections in the growth of Medicare expenditures.

Remarkably, the three relevant congressional committees, House Ways and Means, House Energy and Commerce and the Senate Finance, have come to an agreement on a permanent fix, including new requirements that reward quality and value over volume.

The big risk for HHC and the hospital provider community relates to how the provisions of the bill may be funded. Among the sources being considered to pay for the “doc fix” are many of the hospital reimbursement reductions opposed for the last several years by HHC and others in the hospital advocacy community. These include: Medicaid Disproportionate Share Hospital (DSH) rebasing for additional years (a loss of $495 million to HHC each year when including the local share); Hospital Outpatient Department reimbursement reductions that will greatly impact hospitals serving low income or rural populations where there are few neighborhood physicians (loss of $187 million to HHC over 10 years); and reducing payments for Graduate Medical Education ($215 million loss to HHC over 10 years).

It should be noted that funding the SGR patch of December 2013, which cost $7 billion, included an added year of Medicaid DSH reductions to 2023 as well as new criteria governing Long Term Care Hospitals which, as reported last month, will have a negative impact on HHC’s Henry J. Carter facility. We will keep you posted on any developments in this area.

Medicare 2% Provider Reimbursement Cut Extended

On February 12, Congress passed legislation that restored the Military Retiree COLA. In a disturbing pattern, however, Congress chose to pay for this through an extension until 2024 of the 2% Medicare Provider reimbursement reduction, which was originally enacted as part of the sequester. This continuing Medicare sequester cut will cost HHC $18 million a year.

ACA Employer Mandate Rules Issued

On February 10, the Obama Administration issued Treasury rules providing significant transition flexibility for the ACA employer mandate.

The final rule gives employers with 50 to 99 full-time workers an additional year to phase in employer-mandated compliance and it delayed penalties until January 1, 2016, though they will still have reporting requirements in 2015. A crucial condition for receiving the transition relief is that employers must certify that they haven’t laid off employees in order to come under the 100-employee threshold.

Beginning January 1, 2015, employers with more than 100 full-time equivalent employees must comply with the final rules. The final rule also phases in the percentage of full-time workers that the largest employers need to offer coverage to from 70 percent in 2015 to 95 percent in 2016 and beyond.

The employer-shared responsibility rules generally provide that employers may face penalties if they don’t offer full-time employees and their dependents affordable, minimum value healthcare coverage.

Health Exchange Enrollment

Thus far, HHC’s health plan, MetroPlus, has enrolled 18,000 newly insured members through the new Health Exchange, and has gained about 10,000 new Medicaid members though the Exchange as well. Nearly another 10,000 applications are pending and would become active enrollments upon payment of the first month’s premium.

On February 24, at the request of the Health Committee of the City Council, I testified and gave an update on the various initiatives that are part of HHC’s cost containment and restructuring plan. I provided some historical context to explain why we needed to undertake significant cost-containment and restructuring efforts over the last several years, pointing out that our safety-net role has made us especially vulnerable to deep cuts to Medicaid, the cost of serving a rising tide of uninsured patients, and the erosion of federal funding. I outlined our basic fiscal situation and challenges and then reviewed the Road Ahead initiatives and the principles that guided their implementation. I pointed out that, despite our progress, future budget deficits loom and could be made deeper by the pending labor arbitration outcomes and further federal budget cuts.

A number of council members were very interested in our contractual joint venture around the provision of acute and chronic dialysis and I responded to questions related to continuation of quality and access to services. There were also a number of questions about our timing for the re-opening of maternity services at North Central Bronx Hospital. I indicated that we expected to have a formal staffing plan for both inpatient maternity services and the NICU completed next month and that we would be formally asking the State Health Department to extend our time for re-opening the service for several months. We anticipate that it will take until sometime this summer to identify and on-board a full complement of staff for all tours.

More than 8,000 New Yorkers volunteer in HHC hospitals and health centers every year. Several of these generous volunteers have recently been specially recognized.

The United Hospital Fund is recognizing Bellevue Hospital volunteer Anthony (Tony) Austin with its 2014 Hospital Volunteer Achievement Award. Mr. Austin works three to four days per week telephoning patients to remind them of their therapy session appointments, informing waiting patients when the therapist is ready to see them, and escorting them to and from their sessions. Mr. Austin’s accomplishments are all the more remarkable because he has been a paraplegic since 1983 when, as a cab driver, he was shot while driving his cab. He was treated extensively at Bellevue and has now been a volunteer there for more than 10 years.

Another volunteer was celebrated when former Schools Chancellor Dennis Walcott, a lifelong Queens native, spent the month of January volunteering at Queens Hospital Center (QHC). While volunteering, Mr. Walcott spent time in the Emergency Room, Pediatric Clinic, Adult Ambulatory Care Department, and several other outpatient and inpatient departments and units to observe how medical staff communicate with and engage patients. Mr. Walcott gave an hour-long, insightful presentation at QHC about his volunteer experience.

Yvette Calderon, MD, has been recognized by the New York State Department of Health with the Laubenstein Award for her decades of work in HIV/AIDS prevention efforts. Dr. Calderon, an emergency department physician and chief of Urgent Care at Jacobi Medical Center, has helped lead HHC’s efforts to combat HIV/AIDS through a variety of innovative programs that engage underserved communities and at-risk populations.

In 2003, Dr. Calderon partnered with Dr. Jason M. Leider, medical director of the North Bronx Health Network’s Adult HIV Services, to develop and implement Project B.R.I.E.F. seeking to boost HIV awareness through rapid testing in non-traditional testing environments such as emergency departments. Research shows that this form of non-traditional testing more effectively reaches high-risk populations that have not otherwise been tested for HIV/AIDS. More than 100,000 Bronx residents have been tested due to her work as programs throughout New York City have adapted her work for their HIV testing and care efforts. Rapid testing is now commonly performed at all HHC hospitals and health centers.

I know the board joins me in congratulating Dr. Calderon on receiving this well-deserved recognition.

The Jacobi Medical Center Auxiliary Inc., in partnership with Fellowship Tabernacle Ministries, Inc., Physicians Affiliate Group of NY, and Jacobi Medical Center, have received $300,000 for the Neighborhood Violence Prevention Project, an injury prevention program incorporating a multi-pronged approach to prevent shootings and violence involving young adults in Bronx County. The program was announced by the governor and received news coverage in many media outlets.

The program is named SNUG – “guns” spelled backwards. Jacobi will implement the evidence-based Cure Violence Model, relying on culturally appropriate staff — often former gang members — who respond to shootings and prevent retaliation through focused outreach. Moreover staff members also detect and resolve conflicts that are likely to lead to shootings and prevent retaliation. An extensive schedule of social and recreational programs specifically designed to appeal to an at-risk population will be implemented. Jacobi Medical Center will provide expert medical leadership including pediatric, adolescent and emergency medicine specialists, as well as a hands-on intense social work component.

This week, HHC’s Internal Communications Group (ICG) released the late-winter edition of the HHC Insider, a print publication that features some of the most popular stories that appear on the Insider intranet homepage. This issue’s leading story introduces HHC’s six Guiding Principles and includes a special message from Dr. Ramanathan Raju, HHC’s next President and CEO. In this issue, readers will also find articles about the Patient-Centered Medical Home, The Fund for HHC, the upcoming relocation of some Central Office groups to new offices, and the soon-to-be-launched ICD-10 coding system.

The inaugural print issue of the HHC Insider was published in November 2013. The current issue, which is in the Board’s packets, will be distributed throughout HHC this week. The Insider is produced and published by ICG, which develops and shares useful, relevant, and interesting information with HHC staff across the system. You can read materials produced by ICG by visiting HHC’s intranet, which is updated daily, at intranet.nychhc.org.

After 40 years of unparalleled service to HHC and our patients, Lynda D. Curtis has announced her retirement effective March 2. Ms. Curtis retires as Senior Vice President of the South Manhattan Network with administrative oversight of Bellevue, Metropolitan, Gouverneur, Coler, and the new Carter facility. She was also, until November 2013, Executive Director of Bellevue. Throughout her career, which began in 1974 as a children’s counselor at Sydenham Neighborhood Family Care Center, Lynda Curtis represented the best of HHC — deep compassion, dedication to improving the health status and safety of patients, unflagging energy, profound integrity, and a commitment to promoting opportunity for all staff. Additionally, Ms. Curtis ably represented HHC in various local and national healthcare forums, where she was widely regarded as the best of the best.

I have mixed emotions about Lynda’s imminent departure. I am thankful for the professional relationship that we shared at HHC, glad for her opportunity to now enjoy what will undoubtedly be an active and engaged retirement, and sorry to lose a colleague who combined keen intelligence, strategic vision, and inspiring leadership with personal warmth and kindness. In thanking Lynda Curtis for her service, I know that I speak for thousands of HHC staff who have had the pleasure of working for her, with her, or looking to her as an example of what can be achieved in a career well-spent.

Broadcast

Dr. Eric Legome, of Kings County Hospital, says flu season has been less intense due to more vaccinations, Dr. Eric Legome, Kings County, News 12 Brooklyn, 2/3/14

Doctors see increase in patients suffering from Seasonal Affective Disorder this winter, Dr. Michael Adams, Lincoln, News 12 Bronx, 2/4/14

Doctors Warn About Dangers and Accessibility of Synthetic Drugs, Dr. Ronnie Swift, Chief of Psychiatry, Metropolitan, NY1, 2/10/14

Number of Kids Visiting Hospital for Asthma Dropping Fast in Harlem, Metropolitan, NY1, 2/25/14

Death of actor Philip Seymour Hoffman highlights growing heroin problem, Dr. Alla Borik, Lincoln, News 12 Brooklyn, 2/4/14

Anti-Gun Program is a SNUG Fit, Jacobi, NY1, 2/8/14

Best of the Bronx: Jacobi Medical Center’s Dr. Yvette Calderon honored for HIV prevention, News 12 Bronx, Newsday (Video) 2/7/14

Rally to demand reopening of maternity ward at North Central Bronx Hospital in Norwood North Central Bronx, News 12 Bronx, 2/25/14

Print

MetroPlus racks up numbers on exchange, HHC, MetroPlus, Capital New York, 2/20/14

Hospitals’ Dialysis Plan Is Under New Scrutiny, President Alan D. Aviles, HHC, The New York Times, 2/12/14, (Also covered in Crain’s Health Pulse)

De Blasio faces growing public hospitals deficit, President Alan D. Aviles, Crain’s New York Business, 2/24/14 (Also covered in Capital New York)

New Bronx program teaches teens new ways to solve conflicts, Jacobi, New York Daily News, 2/7/14

SNUG comes to the Bronx, Dr. Sheldon Teperman, Dr. Stephen Blumberg, Jacobi, The Bronx Times, 2/14/14 (Also covered in Newsday)

Residents vote to demolish historic Queens Hospital Center T Building but preservationists vow to fight back, Queens, New York Daily News, 2/4/14

On the Record With…Dr. Robert Gore Dr. Robert Gore, Kings County, BET, 2/7/14

How to Stop Heroin Deaths, Dr. Robert S. Hoffman, Bellevue, The New York Times, 2/6/14

The plague of synthetic drugs, Dr. Ronnie Swift, Metropolitan, Manhattan Times, 2/5/14

Psychotherapy May Be Effective Alternative Treatment for Schizophrenia, Study Finds, Dr. Mary Badaracco, Bellevue, Health Day, 2/7/14 (Covered in multiple media outlets, including U.S. News and World Report and Health Medicine Net)

A Weighty Matter for Pediatric Medication Dosing, Dr. Muhammad Waseem, Lincoln, Emergency Medicine News, February 2014

During Black History Month Ceremony, Coney Island Hospital Honors Borough President Eric Adams, Sheepsheadbites, 2/20/14

Sea View Hospital Rehabilitation Center and Home elects new officers, Angelo Mascia, Executive Director, Staten Island Advance, 2/11/14

Lincoln Medical Center Opens Psychiatric In-Patient Unit, Amsterdam News, January 23-29, 2014

Lincoln Announces Mental Health Expansion, Mott Haven Herald, January 10, 2014

What every expectant mother should know (part 2), Dr. Malvina Elmadjian, Lincoln, Bronx Free Press, January 29, 2014

Prevent Cardiovascular Disease: Know Your Risk and Numbers!, Dr. Lekshmi Dharmarajan, Lincoln, Bronx Free Press, 2/19/14