REPORT TO THE BOARD OF DIRECTORS – September 2013

Patient Safety has been a cornerstone priority during my tenure as President of HHC, and an area where we have made dramatic improvement over time. I am always reminded of our accomplishments in providing safe care when I attend HHC’s annual Patient Safety Expo. This year’s Expo on September 16 again showed our commitment, as 26 clinical teams reported outstanding successes in safe care.

A panel of judges selected prize winners whose work demonstrated the most impressive results.

• Coler-Goldwater was this year’s Grand Prize winner. It also took First Prize in Long-Term Care, as well as a People’s Choice Award, for reducing the use of unnecessary antipsychotics in the management of dementia-related behaviors.
• Jacobi earned First Prize in Acute Care for reducing the incidence of catheter-related urinary tract infections.
• HHC Health and Home Care won First Prize in Community-based Services, for preventing unnecessary readmissions for discharged patients.
• The President’s Choice Award was given to two hospitals — to Bellevue, for improving identification and early management of severe sepsis, and to Elmhurst for reducing sepsis mortality through its early goal-directed therapy protocol.
• Metropolitan won a second People’s Choice Award, for improving protocols to identify and prevent incidents of violence in behavioral health patients.

I know the Board joins me in congratulating our winners, along with all HHC entrants. Their efforts and hard work make the difference by helping us provide care that is not only of the highest quality, but is as safe as it can possibly be.

An HHC pilot program, called “Treat to Target,” increases the role of registered nurses in the treatment of high blood pressure levels and allows for more frequent and more focused clinic visits. During a year-long pilot, the program helped patients achieve healthier blood pressure levels and reduce their risk of heart attacks and strokes at seven HHC facilities. The pilot resulted in an additional 372 patients with controlled blood pressure at the seven locations, potentially leading to 18 fewer heart attacks and nine fewer strokes in those patients. HHC will now expand the “Treat to Target” program to all hospitals and Diagnostic & Treatment Centers.

Under HHC’s “Treat to Target” program strategy, patients with hypertension have an initial visit with a physician to set and agree upon a goal for desired blood pressure levels and a medication plan to achieve it. Patients then work closely with a nurse, who helps them take control of their illness and is empowered to closely monitor and assist with necessary medication adjustments. The nurse also directs patients to other services that may be helpful in overcoming obstacles to blood pressure management, such as lack of access to healthy food or substance abuse. Patients in the program will typically be in contact with a nurse every 2-3 weeks until the target blood pressure goal is reached.

The nurse-led “Treat to Target” hypertension pilot program led to significant increases in the number of hypertension patients who effectively managed their high blood pressure. Over the next year, as part of its Patient Centered Medical Home transformation, HHC is working to implement a similar approach for patients with multiple chronic illnesses including diabetes, depression, and high cholesterol.

Twelve years after the 9/11 attacks, HHC continues to play a critical role in caring for those who lived or worked in the area. NY1 News did a story on HHC’s WTC Environmental Health Center and interviewed Terry Miles, Executive Director of the Center, who explained that WTC-related ailments can cause a variety of symptoms, including coughing, wheezing, shortness of breath, sinus congestion, digestive problems, depression and anxiety. Another story on Fox 5 News featured the art exhibit “Shifting Clouds” at Bellevue Hospital Center. All the artists represented were patients who lived, volunteered or worked in the area and are now being treated for 9/11-related illnesses. The exhibit celebrated the resilience of patient-artists who have engaged in art therapy at the WTC Environmental Health Center. The art conveyed feelings that may still reflect the aftermath of trauma, but also demonstrated enhanced well-being.

HHC’s WTC Environmental Healthcare Center at Bellevue, Elmhurst and Gouverneur continues to treat thousands of people who were affected by the destruction of the World Trade Center.

Following a recent New York State regulation that addresses vaccination requirements for healthcare personnel, HHC has issued a new Operating Procedure 20-57, Reducing the Prevalence of Influenza. Operating Procedure 20-57 states that all HHC staff, contracted personnel, and volunteers must be vaccinated against the flu or wear a mask for the duration of the flu season and details practices, scope, personnel, and other pertinent information that reinforce HHC’s support for full compliance with the State’s regulation.

As the Board knows, seasonal flu is a serious and potentially life-threatening disease. In New York City, approximately 2,000 people die every year from flu and pneumonia, with the elderly and the very young at higher levels of risk. To protect our employees and patients against the flu and to comply with the State’s regulation, HHC has launched a comprehensive corporate-wide flu vaccination campaign, intended to raise our levels of staff vaccination to more than 90 percent. Although the official start of flu season is a date to be announced by the NYS Health Commissioner, we’re moving forward strongly now, and have sufficient vaccine inventory for all employees and for patient demand. Of course, as in previous years, HHC is providing free flu vaccinations for all staff across the system at numerous locations across the corporation.

We also want to ensure that all personnel understand the new flu policy and are informed about how and where they can get vaccinated or how they can otherwise comply with the new policy.

To help facilities effectively share information about the new regulation with staff, the Internal Communications Group (ICG) has created a communications toolkit that includes key messages and important communication materials. The campaign slogan is “Rolling Up Our Sleeves: HHC United Against the Flu.” An intranet site, available through the HHC Insider, gives employees up-to-date information about the flu and where and when flu vaccination is available.

A parallel campaign about HHC’s efforts to get patients and all New Yorkers vaccinated is being launched shortly. As stewards of HHC’s commitment to exceptional healthcare, I know that the members of the Board will join staff in rolling up their sleeves and getting vaccinated against the flu.

On October 1, the funding for all non-entitlement federal government programs is scheduled to terminate. The House has passed a Continuing Resolution (CR) that would extend government spending at current levels through approximately December 15, 2013. This CR includes a de-funding of the Accountable Care Act, which would invite a Presidential veto and possibly lead to a government shutdown October 1. The Senate is expected to strip out the ACA defunding and send the CR back to the House.

The debt ceiling is expected to be reached in mid-October. The President has said that any debt ceiling extension should not be used as leverage on other politically contentious issues; however, his political opponents are still apparently looking to this as a vehicle to cut entitlement funding.

Once again, Congress is faced with addressing an imminent drastic cut to physician Medicare fees that has its origins in a formula for physician reimbursement established back in 1997. Twelve times since then, Congress has avoided implementation of these rate cuts by coming up with short term delays in implementation. The cost of a permanent “Doc Fix” also known as the SGR or Sustainable Growth Rate for physician’s Medicare reimbursement has steadily grown over the years and recently has been estimated by the Congressional Budget Office at $130 billion. The SGR expires January 1. A permanent SGR fix would need offsets to cover its negative impact on the federal budget projections, which raises the serious potential of cuts to GME, IME, and Hospital Outpatient reimbursement rates, as well as another extension of the Medicaid DSH cuts. If implemented, these proposed cuts would generate losses to HHC, over a ten-year period, as follows: GME – $215 million, IME – $626 million, HOPD – $187 million, and an additional Medicaid DSH cut in 2023 of $495 million.

The new health insurance marketplaces created by the Affordable Care Act are set to open October 1. Our health plan, MetroPlus, is participating on the new insurance exchange and is well positioned to gain new membership as enrollments take effect in January.

Immigration reform, at least any comprehensive reform, is unlikely to get a House floor vote until next year. The Senate passed their Immigration Reform bill in late June with a 15-year path to citizenship, during which no Medicare or Medicaid benefits would be available to immigrants. The Senate bill does not change the current eligibility criteria for Emergency Medicaid. The House will not pass the Senate bill. The House has cleared five immigration bills through committees that deal with border security, agricultural workers, interior enforcement, E-Verify, and high-skilled visas similar to the H1 visa provisions contained in the Senate-passed bill. Only the border-security bill that came out of the House Homeland Security Committee has had any Democratic support.

October marks the tenth anniversary of our Take Care New York (TCNY) campaign — public education and awareness events at public hospitals and health centers where NYC residents can get preventive health screenings. We will continue our effort to curb obesity by challenging New Yorkers to eat healthier and create measurable fitness goals. Participants will receive a triple assessment that includes measuring Body Mass Index (BMI), blood pressure and cardiovascular fitness. Those who complete the fit test will receive an exercise prescription, tips for healthier eating and a pedometer to encourage them to be more active. We will have “Commit to Be Fit” stations at sixty events offering flu shots and screenings for HIV, blood pressure, cancer, asthma, diabetes and other health conditions that affect children and adults. We are also partnering with Shape Up NYC! to provide a series of exercise classes during October to include aerobics, yoga, Zumba, Latin cardio, calypso cardio and other exercise routines.

This year, to commemorate the tenth anniversary of the campaign, HHC will implement an innovative social media component. We will follow ten of our employees on Facebook as they each go through one of the Take Care New York screenings. We’ll document the screenings with photos and announce the results. I encourage all board members to follow HHC’s Facebook page and Like and Share our social media posts during the campaign.

During the campaign we will also leverage our relationship with local media partners to obtain pro-bono placement of our message with broadcast and print media outlets. We will support the facilities with collateral materials to promote the sixty “Commit to Be Fit” flu shot and screening events.

For the third year in a row, HHC is collaborating with the Centers for Medicare and Medicaid Services (CMS) to hold free public workshops at HHC hospitals and large health centers to help New Yorkers understand and get the most out of health benefits between September 24 and December 4.

The workshops are scheduled to take place during the Medicare open enrollment period, October 1 to December 7, 2013. The workshops will provide Medicare information and materials that are current, accurate and consistent for those who are new to Medicare, those who want a refresher course and prepare coming-of-agers (approaching age 65). Senior citizens are a significant and growing part of our patient population and we are providing this important information to assist them in making informed decisions about their healthcare.

The sessions will also include information on health care reform, the Affordable Care Act and “New York State of Health,” the new health insurance exchange established by New York State to assist consumers in selecting and purchasing health insurance plans. Open enrollment at New York State of Health begins October 1 and runs through March 31, 2014. Many people want to learn more about the Affordable Care Act and the State’s new health insurance exchange, which contains numerous insurance options and offers many New Yorkers subsidies to make coverage affordable. Health insurance specialists from CMS will conduct 13 learning sessions at HHC hospitals and health centers.

On June 5th the second cohort of middle managers and their coaches began the Corporate Leadership Development program conducted by the Advisory Board Company. The 114 participants and 37 coaches have already attended two of the five full day sessions, which are: 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 are working with the managers on over 100 individual and group projects designed to reinforce what was learned in the sessions. The Advisory Board facilitator holds between session calls with coaches to guide progress and help address issues. Participants, coaches, and executive sponsors received access to the Harvard Manage Mentor+, an online resource with additional computer based training modules.

The Supervisory Development Program, a second segment of our Workforce Development Plan, began this month. New supervisors from across the Corporation came together for four full-day sessions spread over a four-week period. The program combines classroom and e-learning modules. The program was developed with input from focus groups and includes sessions on Labor Relations; Team Development; Patient/Employee Safety; Managing Workplace Conflict; Evaluating Performance and Emotional Intelligence.

I would like to thank Caroline Jacobs for leading these important programs. The initiatives are part of our investment in developing our workforce consistent with our Workforce Development Strategic Plan.

With a spectacular mural by famed artist Kenny Scharf, The Fund for HHC is launching The Arts @ Kings, a long-term influx of transformative and therapeutic arts projects at Kings County Hospital Center that will engage the hospital, arts, and local communities in creative and healing efforts.

Scharf’s untitled work completely transforms a seemingly innocuous but important thoroughfare in the Kings Behavioral Health building — the stairwell that connects the adolescent and pediatric psychiatric inpatient units. The artist, a contemporary of Keith Haring and a major star of the early graffiti art movement, conceived and realized the project after a visit arranged by RxArt, a non-profit arts organization that places unique artworks in public hospital settings. The Fund for HHC and RxArt have previously collaborated to bring significant works of art to numerous spaces within HHC, including the commissioned photography of Terry Richardson and Ryan McGinley for the Kings County Pediatric and Adolescent Psychiatric Units. In the coming year, working with RxArt, Kings County Hospital leadership, community organizations, and the burgeoning arts community in Brooklyn, The Fund will support arts installations at Kings that will highlight the transformative relationship between art and healing.

After months of planning and design, Mr. Scharf’s mural was painted entirely during the weekend of September 13-15. Floor-to-ceiling playful and iconic imagery now fills the previously stark and institutional stairwell that is used every day by young patients. The now-vibrant and energetic space is already causing positive buzz in the adolescent and pediatric units, with reviews ranging from “awesome” to “I love it,” and the following commission offer: “When can he paint my room?” Accordingly to the Fund’s Executive Director, Joe Schick, through The Arts @ Kings, The Fund for HHC “hopes to impact medical and behavioral health outcomes with the arts as an inspirational catalyst for positive change.”

Broadcast

Ribbon Cutting Held for State-of-The-Art East Harlem Medical Facility, NY1, 08/21/13

Harlem Hospital Closely Monitors Hypertension Patients, Dr. Matthews Hurley, Harlem Hospital, NY1, 08/06/13

Produce prescriptions helping families fight obesity, Dr. Katherine Szema, Lincoln Hospital, Fox News, 08/01/13

Produce contamination, Dr. Fernando Jara, Lincoln Hospital, News 12 Bronx, 08/02/13

Singer Alicia Keys Promotes HIV Awareness At Harlem Hospital, WCBS Radio, NY1, 08/22/13

Woodhull Medical Center’s video project aims to promote school readiness in low-income infants, Dr. Alan Mendelsohn, Bellevue Hospital, News 12 Brooklyn, 08/28/13

Nutrition and Diabetes, Lorena Drago, Lincoln Hospital, BronxNet TV “Dialogo Abierto”, 09/12/13

No Bitter Pill: Doctors Prescribe Fruits And Veggies, Dr. Katherine Szema, Lincoln Hospital, St. Louis Public Radio, 09/13/13

Bronx 9/11 victims remembered at Jacobi Medical Center, News 12 Bronx, 09/11/13

9/11 Art Exhibit at Bellevue Hospital, FOX 5 News, 09/11/13

WTC Healthcare Programs Continue To Treat Those Affected By 9/11 Attacks, Terry Miles, Executive Director, WTC Healthcare Center, Bellevue, NY1, 09/11/13

Hand washing and vaccinations, Telemundo Ch. 47, Dr. Randolph Nunez, Lincoln Hospital 08/25/13

Woman Goes into Labor on LIRR Platform, Gives Birth in Penn Station, Bellevue Hospital, WNBC Ch. 4, 08/08/13 (Also covered by WABC Ch. 7, Univision Ch. 41)

Dr. Oz rushes to help tourist hit by New York taxi, Bellevue Hospital, CNN, 08/20/13 (Also covered in The Wall Street Journal, NY Daily News, USA Today, NY1, The Guardian)

Print

100 Most Influential People in Healthcare – 2013, HHC President Alan D. Aviles, Modern Healthcare, 08/26/13

Alexander Upgraded To Exec Director At Bellevue Hospital, The Chief, 08/30/13 (Also covered in Crain’s Health Pulse)

Bellevue, Gouverneur Changes, Lynda Curtis, Mendel Hagler, Crain’s Health Pulse, 08/21/13

A new health care facility for New Yorkers with disabilities to open in East Harlem, Henry J. Carter Hospital New York Daily News, 08/22/13

It was a great day in Harlem for Hank Carter, Henry J. Carter Hospital, The New York Amsterdam News, September 5-11, 2013 (Also covered in El Diario, Crain’s Health Pulse)

Workshops will explain Medicare, NCB, Jacobi, Lincoln, The Riverdale Press, 09/19/13

Crain’s Symposium, President Alan D. Aviles, Crain’s Health Pulse, 09/12/13

IBM Awarded Contract to Build Analytics Platform for NYC Hospital System, Bert Robles, HHC Modern Healthcare, 09/18/13

$10 Million HHC Contract, Crain’s Health Pulse, 09/19/13

Party Prescription: Murals and Music, Kings County Hospital, The Wall Street Journal, 09/17/13

Hospitals, communities stand strong 12 years after 9/11, HHC WTC Environmental Health Center, America’s Essential Hospitals, 09/11/13

WTC health center serves Staten Island residents, students, volunteers affected by Sept. 11 attacks, HHC WTC Environmental Health Center, Staten Island Advance, 09/10/13

Art therapy helps New Yorkers cope with trauma from 9/11, Bellevue Hospital, NY City Lens, 09/11/13

‘Fragmented’ Cancer Care, Dr. Margaret Kemeny, Director of Queens Cancer Center of Queens Hospital, Modern Healthcare, 09/14/13

Alicia Keys returns to Harlem to advocate HIV/AIDS awareness, Harlem Hospital, New York Amsterdam News, 08/29/13

Levin, Woodhull and Bellevue Announce Hospital-Based Program to Promote School Readiness, The Greenpoint Gazette, 08/30/13 (Also covered in DNAifo.com)

Hurricane Sandy – Sound preparation, vigilant care for patients and staff, HHC, Alan Aviles, Bellevue and Coney Island hospitals, America’s Essential Hospitals, August 26, 2013

Immunization Fair Helps Kids, Lincoln Hospital, Amsterdam News, 09/19/13

Community pharmacies are effective locations for rapid HIV testing, Dr. Yvette Calderon, Adult Urgent Care Director, Jacobi Hospital, Medical Xpress, 08/07/13

Summertime Meet & Greet, Lincoln Hospital, Newsline, August/September 2013

Vaccinations and hygiene basics for a healthier school year, Dr. Randolph Nunez, Lincoln Hospital, The Bronx Free Press, 09/19/13

Diabetes education program at Lincoln Hospital earns re-accreditation, Dr. Lorena Drago, Lincoln Hospital, The Bronx Free Press, 07/14/13

Prescribing Healthy Eating Across New York City, Alan D. Aviles, HHC, Ridgewood Times Newsweekly, August 2013