REPORT TO THE BOARD OF DIRECTORS – January 2014

Mayor de Blasio’s nomination of Dr. Raju to serve as the next President of HHC reflects our new Mayor’s keen understanding of the complex challenges that lie ahead if HHC is to navigate the demands of a rapidly changing healthcare landscape while remaining true to its mission of affording access to all New Yorkers. In addition to his intimate knowledge of our system and his highly effective prior leadership roles here, Dr. Raju’s outstanding performance as CEO of the Cook County public system further demonstrates his exceptional talents as a transformational physician executive. The arrival of Dr. Raju will enable HHC to both solidify its recent accomplishments and to forge a bold path forward that simultaneously delivers clinical effectiveness for each patient, improves the health status for our communities, and increases system-wide efficiency.

I have great admiration and respect for Dr. Raju, and I wish him the same deeply rewarding experience that I have had during these last nine years. I know first hand his deep devotion to HHC and I am certain HHC will greatly benefit from his inspired leadership, strategic vision and unwavering commitment to our core mission.

Needless to say, as you consider the resolution presented today ratifying his nomination, I urge your support.

Last week Governor Cuomo released his Executive Budget for State Fiscal Year (SFY) 2014-15. The $142 billion proposed budget continues an annual cap on any increase of the Medicaid budget of just under 4%. (There are no rate increases contemplated in the released budget; the cap relates to addition expense as a result of increased utilization or expanded services.) Total Medicaid funding is proposed at $58.2 billion.

There are numerous budget provisions affecting HHC. Our staff are still analyzing the details of the proposals. We will be continuing to advocate for new state and federal investments to meet the challenges posed by both levels of government for a transformation of our healthcare delivery system in line with the Triple Aim of delivering better care for the patient, better health for entire communities, and greater overall efficiency.

The following is a brief summary of some of the key provisions of interest to HHC. A comprehensive overview of the Executive Budget will be presented at the next meeting of the Strategic Planning Committee.

• Extends the Global Cap on Medicaid spending until March 31, 2016 (one additional year), and associated State Department of Health (SDOH) “superpowers” to make cuts to keep spending within the Cap;
• Restores the 2% across-the-board cut to Medicaid provider rates beginning on April 1, 2014;
• Authorizes SDOH to share savings with Medicaid providers if Medicaid spending is below the Global Cap. No less than 50 percent of the savings would be distributed proportionately to all providers and plans and no more than 50 percent to “financially distressed and critically needed providers as identified by the commissioner;”
• Allocates $1.2 billion over seven years for a new capital program for hospitals, nursing homes, diagnostic and treatment centers and licensed clinics. The program would provide grants to improve financial sustainability and increase efficiency through collaboration. Funding can be used for closures, mergers, restructuring, infrastructure improvements, expanding primary care capacity, promoting integrated delivery systems and providing continued access to essential health services;
• Streamlines the process for HIV testing by eliminating the requirement for written informed consent, except for except for patients in correctional facilities;
• Authorizes SDOH to implement an Affordable Care Act insurance option for individuals between 138% – 200% of the federal poverty level. Under this option, the State would implement a Basic Health Plan, which provides public health insurance as an alternative to private insurance that would be purchased through the Health Exchange;
• Allocates up to $95 million for Health Information Technology (HIT), including funding for the operation of the State Health Information Network of New York (SHIN-NY) and to establish a statewide Electronic Medical Record (EMR) and an All Payer Claims Database for health insurance claims; and
• Allocates $7 million to establish 11 Regional Health Improvement Collaboratives statewide, which will convene healthcare stakeholders to identify challenges, then recommend and implement solutions.

The new Speaker of the City Council is Melissa Mark-Viverito. HHC has worked closely with Council member Mark-Viverito in the past and we look forward to continuing that collaborative relationship. We also look forward to working closely with several new Committee Chairpersons. These include Corey Johnson from Manhattan, who will be heading the Health Committee; Andrew Cohen from the Bronx, who is chairing the Mental Health Committee; David Greenfield from Brooklyn, leading the Land Use Committee; and Julissa Ferreras from Queens, who is chairing the Finance Committee.

Hearings in the matter of two significant labor arbitrations are coming to an end. In 2012, negotiations for both the New York State Nurses Association and 1199/SEIU were declared to be at impasse by the New York City Office of Collective Bargaining. The Staff Nurse agreement, covering approximately 8,000 Registered Nurses, expired January 20, 2010. The three Local 1199/SEIU agreements covering about 2,200 employees in the titles of Licensed Practical Nurse, Pharmacists and Dietitians, and Microbiologists, expired August 5, 2009. Hearings before a panel of arbitrators have been ongoing throughout 2013. The final hearing days for each arbitration are now scheduled and decisions by each of the panels will likely be reached before the end of the fiscal year.

The decisions of the panels are binding. Should the panels decide in favor of the unions, there will be a significant financial impact for HHC. Both unions are seeking two retroactive 4% wage increases for past years, plus 0.1% funding for salary additions, which is consistent with the settlement that certain other municipal employees received for the comparable contract period. If the unions are awarded these increases, HHC’s Finance Department estimates that the immediate cost for Nurses alone would be $202 million in FY 2014, of which $151 million would cover the retroactive liability. The annual recurring cost of those increases would be $52 million, and the cumulative cost through FY 2017 would be $358 million. For Local 1199, the immediate cost would be $64 million in FY 2014, of which $50 million would cover the retroactive liability. The annual recurring cost of those increases would be $14.5 million, and the cumulative cost through FY 2017 would be $108 million.

We are continuing to work closely with the New York City Office of Labor Relations on these matters and will keep you informed of any further developments.

There are several housing projects nearing completion that will benefit many HHC patients by providing affordable and supportive housing options that did not previously exist.

CAMBA Housing Ventures, Inc. has completed 209 units of transit-oriented, sustainable housing in two buildings on the Kings County Hospital Center campus. CAMBA Gardens is a model for partnership among a public hospital, non-profit developer, service provider and community stakeholders. It’s a unique opportunity to provide revenue for the hospital, reduce costs and provide tenants with access to preventive medicine and improved health outcomes. CAMBA Gardens is expected to be fully occupied by March.

Meanwhile, development of the Metro East 99th Street Housing project is also continuing on the Metropolitan Hospital Center campus, eventually providing fully accessible apartments for low-income, disabled and/or elderly individuals who are currently patients at our Coler long term care facility. The project will open new horizons of independent living for former skilled nursing facility residents and for high risk Medicaid hospital patients who upon discharge would be unstably housed. Project construction completion is anticipated for June 2014 and units are slated for renting between July and September 2014.

HHC has completed the first round of a physician training program designed to help healthcare providers improve communication with their teen and adolescent patients and adopt best practices in caring for teens. The program features a cadre of young patient actors who play the role of teens with complex social and medical needs. To date they have helped coach over 100 HHC care providers to improve their understanding of issues that may hinder adolescent healthcare, providing the feedback physicians need to best treat the hundreds of adolescents who seek primary care at HHC each day.

HHC’s Teen Health Improvement Program developed the Adolescent Standardized Patient Program, which trains young men and women to visit primary care physicians and simulate a typical adolescent-caregiver interaction. Doctors are evaluated on their ability to engage the patient actor and elicit information needed to provide proper care. They are also assessed on whether they provide appropriate counseling and screening, and whether they prescribe and explain a care plan that is suitable for the simulated scenario.

HHC’s Standardized Patient Program worked with physicians in pediatric and adolescent clinics at 15 HHC sites. The trained patient actors presented with common issues affecting teens, including needs for birth control and STI testing and symptoms related to depression. At the conclusion of the scenario, the standardized patients provided immediate feedback to the doctors and completed a written survey on the provider’s performance. Participating physicians then receive an individualized report, and will be directed to training and resources to support his or her knowledge and confidence in addressing topics relevant to adolescent. Feedback from participating providers found that they all thought the experience to be useful, and over 95 percent felt that the Standardized Patient Program could improve primary care provided to adolescents at HHC.

HHC launched its new corporate website last month, designed to be more patient-centered and accessible to our diverse audiences.

Today, I will briefly demonstrate a few features of the new website. The new format is attractive and compelling. It has new tools to help our patients locate our many community-based health centers and describes more fully many of the healthcare services we provide. Robust new content emphasizes preventive care and our primary care medical homes. New sections explain why we are positioned as a healthcare reform leader and feature our many innovations. The website is also an effective portal for our visitors to learn about current HHC news. Most importantly, the new website is a major marketing tool — a front door to our organization as an essential provider of integrated healthcare services. Our website is visited by over one million individuals each year. Bringing them current information about how HHC meets the healthcare needs of New Yorkers insures that we continually attract even more visitors.

We will shortly begin promoting the newly designed website to our patients, staff and the public.

Broadcast

City Hospitals Make Comfort a Priority for Teens, David Stevens, Senior Director, Office of Healthcare Improvement, HHC, Dr. Janet Siegel, Adolescent Services Director, Elmhurst, Dr. Efniki Kyvelos, Elmhurst, NY1, 1/28/14

Doctors Stress Using Common Sense Measures to Keep Body Heated During Cold Temperatures, Dr. Jean-Paul Menoscal, Metropolitan, NY1, 1/7/14

Jacobi Medical Center Sees Influx of Hypothermia, Frostbite Patients, Dr. Bruce Greenstein, Jacobi, News 12 Bronx, 1/28/14

Cityscape: Survivors, Dr. Allen Keller, Director of the Bellevue/NYU Program for Survivors of Torture, WFUV Radio, 1/25/14

First NYC Baby of 2014 Born One Second After Midnight, WABC, 01/01/14

New Year’s Baby, Kings County, News 12 Brooklyn, 1/3/14

New Year’s Baby, Lincoln, News 12 Bronx, 1/2/14

Metropolitan Hospital’s Childrens Holiday Party, Fox 5 News, WPIX, 12/21/13

Holiday Depression An Issue for Many, Dr. Maryann Popiel, Jacobi, News 12 Bronx, 12/23/13

Print

Chief of Chicago Hospitals Will Return to New York, The New York Times, 1/21/14 (Also covered in Crain’s Health Pulse, ND TV, The Chief Leader, Capital New York)

De Blasio Hires Hospitals Chief from Chicago, Crain’s New York Business, 1/21/14

Dr. Ramanathan Raju Leaving Cook County Health, Crain’s Chicago Business, 1/21/14

CEO of Chicago Public Hospitals to Take the Helm of HHC, WNYC, 1/21/14

Staten Island Officials Hopeful After Todt Hill Doctor Ramanathan Raju named to Head HHC, Staten Island Advance, 1/21/14

De Blasio Taps Raju to Lead HHC, Modern Healthcare, 1/21/14

Public Hospitals Use New Law to Expand Base Beyond Poor, President Alan D. Aviles, MetroPlus, The New York Times, 1/16/14

Success of MetroPlus Bolstering H.H.C., President Alan D. Aviles, Capital New York, 1/24/14

On N.Y. Exchange, Handful of Insurers Reap 80% of Signups MetroPlus, Modern Healthcare, 1/14/14

Exchange Market Shares, MetroPlus, Crain’s Health Pulse, 1/15/14

MetroPlus Enrolls Invincibles, President Alan D. Aviles, Crain’s Health Pulse, 1/13/14

NY Awards $56M for Hospitals, Nursing Homes, Woodhull, Associated Press, 1/28/14

State Advances Vital Cash to City Hospital System, Marlene Zurack, HHC, Capital New York, 1/15/14

HHC’s Nurse-Led Pilot Program Aims to Reduce Blood Pressure, Lauren Johnston, RN, Chief Nursing Officer, HHC, Eduvina Hernandez, RN, Gouverneur, ADVANCE for Nurses, 1/9/14

HHC Nurses Achieve Nursing Excellence Awards, Nurse.com, 1/13/14

Hospitals Train Docs, Use Music Therapy to Help Teens, David Stevens, Senior Director, Office of Healthcare Improvement, HHC, Fierce Healthcare, 1/28/14

Telehealth Pilot a Hit with Patients at HHC, Dr. Louis Capponi, Chief Medical Informatics Officer, HHC, Lincoln, Fierce Health IT, 1/24/14

ED Whiteboard Helps HHC Streamline Patient Management, HHC, Louis Capponi, Chief Medical Informatics Officer, FierceHealthIT, 1/27/14

Centralized Blood Bank Creates trail of Data for HHC, Louis Capponi, Chief Medical Informatics Officer, HHC, FierceHealthIT, 1/28/14

Dr. W.V. Cordice Jr., 94, a Surgeon Who Helped Save Dr. King, Dies, President Alan D. Aviles, Harlem, The New York Times, 01/03/14

Surgeon Who Once Saved MLK’s Life Dies in NY at 95, Associated Press, 12/31/13 (Also covered in WNYC, CNN, NY Daily News, The Amsterdam News)

Dalai Lama Names One of New York City’s First Babies of 2014, Elmhurst, Kings County, New York Daily News, 01/01/14 (Also covered in The Queens Courier and Queens Gazette)

First NYC Baby of 2014 Born One Second After Midnight, Elmhurst, Kings County, New York Post, 01/01/14

A Healthy Start in Life, Dr. Priyanka Shekhawat, Harlem, Dr. Camille Rodriguez, Jacobi, New York Daily News, 1/23/14

Sundance Film Highlights Power of Music on Patients with Alzheimer’s, Coler-Goldwater, New York Daily News, 1/15/14

Lots of New Patients, Too Few Doctors, Danielle Ofri, MD, Bellevue, The New York Times, 1/16/14

New Senior Vice President Of Queens Health Network, President Alan D. Aviles, Christopher D. Constantino, Senior Vice President, Western Queens Gazette, 1/15/14 (Also covered in Crain’s Health Pulse)

Who’s News, Vito Buccellato, Chief Operating Officer, Coney Island, Crain’s Health Pulse, 1/17/14

Jacobi Reduces Infections, William Walsh, Senior Vice President, Bronx Times, 14/19/14

What Every Expectant Mother Should Know (Part 1), Dr. Malvina Elmadjian, Lincoln, The Bronx Free Press, 1/22/14

Lincoln Medical Center Opens Psychiatric In-patient Unit, Bronx Times Reporter, January 24-30, 2014

Friends of Harlem Hospital Sixth Annual Holiday Celebration, Harlem News, January 9-15, 2014