RAMANATHAN RAJU, MD
HHC PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
JANUARY 29, 2015
Good afternoon. As customary, I will highlight just a few items from the full version of my report to the board. The full version is available to all here and will be posted on our website.
ACTION ON HHC-GOTHAM HEALTH FQHC-LAL APPLICATION
To begin with, I'd like to say how pleased I am to report that HHC's Gotham Health has been approved by the Health Resources & Services Administration (HRSA) for federally qualified health center look-alike designation.
The 39 clinics comprising Gotham Health -- the nucleus of an ambulatory care network -- are now poised to become a valued and vital part of the HHC system, highlighting the prominent role of our health care system's large outpatient care network and supports HHC's ongoing transformation to keep preventive care and wellness as the centerpiece of organizational culture. The additional federal funding will further support our strategic goals to expand access to geographically convenient and culturally-sensitive healthcare services for all New Yorkers and strengthen our ability to keep New Yorkers healthy.
Coming after more than two years of hard work and perseverance, federal approval of our application is truly exciting milestone on the journey we've been making to transform health care delivery in New York City. It demonstrates the distance we've travelled, and marks that we are closer to a final destination in which sick care is a thing of the past, and the provision of healthcare a hallmark of HHC's future.
I appreciate the unwavering support of and partnership with the Gotham Health Board of Directors as we have endeavored to obtain federal designation. In addition, the work of the Diagnostic & Treatment Centers' clinical and administrative staffs to ensure that their sites' operations were compliant with all FQHC requirements has been invaluable over the last two years. And…I especially want to thank Senior Vice President LaRay Brown, and the rest of the team.
SNOW PREPARATION AND RESPONSE
I also want to highlight how deeply proud I was of the way this Corporation reacted to this week's weather emergency. Regardless of the number of inches that ultimately fell within the five boroughs, HHC folks worked tirelessly and selflessly. So many doctors, nurses and staff staying overnight at work, or making their way to work despite transportation shut-downs -- to make sure that the doors to our facilities were open, and ready for whatever might hit New York. This ethos, this redoubled commitment to provide care for New York City in the most threatening of circumstances, represents the ethos of this institution, and made us all terribly proud.
Just to give you a more specific idea of our handling of the emergency---all of our facilities began preparations late last week. Dr. Ross Wilson and Antonio Martin led preparations with senior leadership over the weekend and again on Monday. Supplies such as food, medications, and linens were topped off, and fuel tanks for emergency generators were filled. We rescheduled elective surgeries and clinic appointments. Some patients -- for dialysis, chemotherapy, and methadone supply -- were rescheduled for Monday ahead of the storm. Staff also checked that our home care patients were accounted for and would not be left stranded.
All of our acute care hospitals activated their command centers for the duration of the event and were linked to our main command center here on the fourth floor. Loose objects at our campuses were secured against wind, and snow and ice were cleared from access points. Many of our dedicated staff of stayed overnight at their posts to manage events as they unfolded, as to help assure adequate staffing for the following day.
We prepared for the worst and received the best we could have reasonably hoped for. Our Central Office Emergency Command Center was able to connect in real-time with all of the facilities. Patient care continued all through the storm, staffed by our committed employees. I also wish to acknowledge our organized labor partners and other City agencies that played critical roles. Again, I couldn't be prouder or more grateful for everyone's dedication and professionalism this week.
I also wanted to make you aware that HHC's Performing Provider System (PPS) submitted its final application to participate in the Delivery System Reform Incentive Payment (DSRIP) Program on December 22nd. The application details our approach to meet community needs through our eleven DSRIP projects, as well as our plans to govern our PPS and meet future workforce needs. All PPSs will learn their DSRIP performance awards in late March.
Now that the application has been submitted, our DSRIP team has turned its attention to the complex task of designing and implementing our eleven DSRIP projects across the city, ensuring that our hundreds of partners, including SUNY and scores of community-based organizations, have the capabilities and infrastructure needed to perform according to NYS DOH performance milestones.
Our PPS will submit applications by the deadline of February 20 for the NYS capital restructuring program, a $1.2B non-Waiver fund intended to support sustainability of DSRIP transformation efforts. HHC is committed to working closely with our partners to ensure that high quality applications are submitted, and that these next steps on our journey together to create true preventive healthcare in New York City is a success.
EXTENSION OF CONTRACT WITH MANATT
In accordance with our rules, I want to inform you that I have authorized extending the contract we previously issued to Manatt Phelps & Phillips for consulting services in connection with the DSRIP project. They've done a phenomenal job assisting HHC with complexity and number of DSRIP requirements, and with the filing of our DSRIP application on December 22. Manatt's services were critical to our ability to file a comprehensive application within a very tight schedule. We will continue to need Manatt's valuable expertise and institutional knowledge of the program as we address the next critical phase in this process by meeting the June 2015 deadline for structuring and operationalizing our PPS.
The extended contract is not to exceed $10 million, the full cost of which will be funded through DSRIP, either through planning grant funds or from the initial DSRIP performance payment. Concurrently, we are bringing on substantial additional staff to bolster our ability to carry out our DSRIP work without Manatt's assistance and part of the Manatt scope is to train our staff and transition to being able to work on their own.
On January 14th, the House of Representatives sent legislation to the Senate which funds the Department of Homeland Security through September 30, 2015. That bill also includes language to eliminate President Obama's immigration policy directives concerning provision of temporary deportation relief and offer of work permits to 4 million illegal immigrants. It is not certain what action the Senate will take.
On January 20th, the President gave his annual State of the Union address. No major health care provisions were mentioned in the address. The President's proposed budget for federal fiscal year 2016 is expected to be released by February 2nd.
EBOLA FUNDING AND RESOURCE ISSUES
Early this month, I visited with Dr. Nicole Lurie, Assistant Secretary for Preparedness and Response at the US Dept. of Health and Human Services (HHS) in Washington to discuss Ebola funding and reimbursement issues. Our Corporation as well as other city agencies incurred significant costs in preparations, treatment, and monitoring activities relative to Ebola. Federal funding has been made available to reimburse these costs, at least in part.
Later in the month, Dr. Lurie and her team visited Bellevue Medical Center seeking from our staff "lessons learned" from the Ebola crisis and treatment of an Ebola-infected patient. Among other issues discussed was the possibility of a federally designated and funded HHC/Bellevue "Biocontainment Patient Care Unit".
These talks will proceed in the near future.
Last Week Governor Cuomo delivered his annual State of the State address and released the Executive Budget for the 2015-16 State Fiscal Year in a combined presentation he called the "2015 Opportunity Agenda." Although the speech did not contain any references to healthcare, the Governor's budget contains many initiatives that could significantly affect HHC.
Our early impression of his proposals is positive and we applaud Governor Cuomo's very thoughtful healthcare investments. His commitment to addressing healthcare disparities is a welcome boost for HHC and the City's efforts to revitalize care delivery in areas such as Central Brooklyn. We will continue to work with his office to manage population health more efficiently, a goal that we are already working toward through the state's Medicaid waiver (DSRIP) process.
The Governor's proposed budget anticipates total spending in the Medicaid program of $62 billion, which represents a 3.6% increase over the previous year. Similar to the proposals he has made the last several years, the Governor proposes to codify a permanent Global Cap on Medicaid spending. He would also impose a "Savings Allocation Plan" if Medicaid spending pierces the Global Cap.
While staff is still analyzing the budget documents, there are several new provisions that are important to HHC, including language:
- Modifying the way the State distributes the Upper Payment Limit (UPL) for HHC. These changes are necessary to implement an agreement with the federal government on a new methodology for UPL payments, including outstanding amounts for 2011-2014. These prior year payments are expected to total more than $1 billion for HHC.
- Extending the current methodology for distributing Charity Care funding for three years through December 31, 2018. The budget continues to gradually phase-in changes to increase the proportion of the funding to hospitals that provide care to the uninsured, underinsured and Medicaid populations.
- Increasing the current $1.2 billion Capital Restructuring Financing Program by an additional $1.4 billion. One half of these new funds or $700 million is to be used to stabilize the health care delivery system in Central and East Brooklyn.
- Providing Medicaid coverage for immigrants newly eligible as a result of President Obama's recent actions on immigration reform.
- Adding an additional $290 million ($580 million if a federal match is obtained) to the Vital Access Provider (VAP) Program to provide adequate budget funding as hospitals and health systems adapt to new DSRIP environment and reduce avoidable hospital admissions.
- Implementing a Basic Health Plan, which will be available for certain low-income, legal immigrants who cannot qualify for Medicaid due to their immigration status. This includes immigrants who are currently covered on "State-only" Medicaid.
- Authorizing Value Based Payment reimbursement methodologies to be used by SDOH and managed care plans, to advance the DSRIP goal for 90% of Medicaid managed care plan payments to providers to be made using value-based purchasing methodologies. It authorizes plans and SDOH to use these methodologies during and post-DSRIP with all providers; and authorizes DOH and Department of Finance to define various levels of risk for contracts.
- Creating an insurance surcharge to pay for the State's Health Insurance Exchange (the New York State of Health).
- Creating a new Ebola health care worker "bill of rights," including job and benefits protection for workers who travel to Africa to care for Ebola patients, and any lost wages if they are placed in quarantine when they return home.
- Authorizing a new Hospital Quality Pool of nearly $100 million (including federal match) to incentivize and facilitate quality improvements in hospitals.
- Including Public Health and Health Planning Council recommendations related to urgent care centers, limited service clinics, office-based surgery and regulatory reforms related to CONs and reduced resident hour audit and other issues.
HHC SHOWCASES SUCCESS WITH HPV IMMUNIZATION
I'd also like to make you aware of Dr. Ross Wilson and Dr. Machelle Allen's testimony on HPV before the City Council Health and Women's Issues Committee, as part of HHC's recognition of National Cervical Cancer Awareness Month,
Their testimony showcased HHC's successful Human Papillomavirus (HPV) immunization rates and cancer screening efforts, which surpass city, state and national rates. In 2013, 77% of our patients age 13 – 17 initiated the HPV vaccination series of 3 shots and 47% completed the series. In 2014, the overall completion rate increased to 52%. The continued improvement in these rates reflects the importance HHC places on this aspect of health care.
Our testimony also highlighted the fact that each year our facilities conduct more than 115,000 cervical cancer screenings. Through these aggressive efforts we aim to diagnose more cancers at earlier stages thus allowing for more effective treatment and a better prognosis. We are grateful to the Council for supporting these efforts, and for allowing us to testify on this important public health issue. We would like to particularly thank Speaker Melissa Mark-Viverito for bringing attention to this important public health issue.
PATIENT SAFETY CONFERENCE HOSTED BY HHC AND LABOR PARTNERS
I am also glad to report on HHC's collaborative effort with our labor partners on patient safety issues. Last month, the Corporate Office of Patient Safety and Employee Safety in collaboration with the Committee of Interns and Residents/SEIU (CIR/SEIU) convened a well-attended annual day long patient safety forum in which over 150 employees and medical staff including medical residents, physicians, nurses, support staff, and leaders from across the our facilities participated. We thank our CIR/SEIU colleagues for continuing to partner with us to improve the safety of our patients and employees.
In recognition of the correlation between employee safety and patient safety, the conference focused on the theme of Working with Disruptive Patient Behaviors While Keeping Safe.
HHC FEATURED PROGRAM:
TREATMENT FOR SURVIVORS OF TORTURE
As a health care system that comprises patients and staff from every corner of the globe -- a great many of them new immigrants fleeing oppression and violence -- we at HHC have seen first-hand the unspeakable effects on the human body and psyche -- of torture. For many, that word conjures up an image of someone experiencing unspeakable physical violence. But the definition of torture that I think is most accurate is much more broad and extends to mental pain and suffering from the horror of war, persecution, fear of harm, or fear from threats of future violence. Our emergency rooms are often the port of entry into the health care system for many men and women who have suffered these atrocities in their home countries torn by civil war and human rights violations.
That is why HHC is so proud to recognize a program that confronts the issues resulting from torture and does a great deal to assist its victims in their difficult recoveries.
I can't think of a program that better exemplifies this institution's commitment to respecting the universal human rights of individuals who have made their way to our facilities in search of care. And I can't think of better examples of individual commitments to the provision of that care that Doctors Allen Keller and Dinali Fernando.
Their team has garnered international reputation for excellence in our clinical, educational, and research activities, and contribute knowledge and testimony to global efforts to end torture.
At Bellevue and Elmhurst, this program offers comprehensive and confidential medical and mental health care, and we connect individuals with the social and legal services they need to rebuild their lives from the physical, mental and social devastation of torture. Our well trained teams work to unveil the bleak and unreal stories behind the requests for care of aches and pains, depression and other conditions that may appear routine if not for our compassionate and culturally competent staff. Together, both programs have served more than 4,300 survivors and their family members.
Help me thank Dr. Keller and Dr. Fernando, and the entire staff teams at Bellevue and Elmhurst, for helping so many patients heal, cope and rebuild their lives. Your efforts exemplify the value of our health system to New Yorkers and you make us very proud.
HHC FEATURED EMPLOYEE:
MIREILLE LEROY, RN, NURSE OF THE YEAR
Finally, I am so pleased to bring to your attention an HHC employee who exemplifies the sort of true, unsung, hero who works quietly, often in obscurity, and without regard for credit or attention in order to devote themselves to the care of others. One such hero is Mirielle Leroy, a nurse who we have been lucky to have as a member of the HHC family for the past 21 years.
Mirielle, a nurse in Lincoln Medical Center's ambulatory surgery department, stands out as someone who not only helps herself, her family and many in her extended community -- she goes many steps further by traveling abroad to help hundreds of persons in need, suffering in countries that have experienced recent crises.
Her service was recently recognized by Haitian American Nurses Association who named her "Nurse of the Year."
Mireille was born and spent the early part of her life in Haiti. Ongoing political turmoil there ultimately caused Mireille and her family to move to the United States where she
continued her education.
Public service is clearly part of Mireille's nature. She has been a member and President of the Haitian-American Parent Association, where she helped recently immigrated parents and children, who needed language help, after-school programing, or a summer camp where they could feel more at home.
Mireille's commitment to public service really took off when she started traveling abroad to bring her nursing skill to parts of the world in crisis. She has been to Haiti four times since the earthquake in 2010, as well as to the Dominican Republic and the Philippines after the recent tragic typhoon there. The needs she has addressed on these trips range widely, from treating injuries to providing immunizations to teaching the people how to protect their food and water supply.
Mireille loves reaching out to people she didn't know before and making their lives better. Her motto, which I find very inspiring, is, "You give your best to somebody you don't know."
Mireille has a daughter Christina, who has followed in her footsteps and has also become a nurse, and an eight-year-old grandson Jayden. She also continues to find time for professional development, and is now enrolled in a Master's program at Grand Canyon University in Nursing Leadership.
We're extremely lucky that Mireille is part of our Corporation's family. She gives and gives and then gives some more. The patients at Lincoln Medical Center are richer for it.
Thank you, Mireille, for giving so much to your community and our patients.
HHC IN THE NEWS HIGHLIGHTS
Healthcare Stories of the Year, CBS News, 12/25/14, Bellevue
Nurse Heads to Africa, News12 Bronx, 12/31/14 Sara Back, RN, NP, NCBH, Bellevue, Jacobi
It's Not Insurance, but Maybe It's a Start, WNYC, 12/31/14, Elmhurst
First NYC Baby of 2015, ABC News, 1/2/15, Coney Island
Temperatures Reach Single Digits as Arctic Air Mass Moves Through NYC, NY1 News, Dr. Rajesh Verma, Chief of Emergency Medicine, Harlem
Cold Health Tips, News 12 Brooklyn, WoodHull: Dr. Robert Chin, Chief of Emergency Medicine
Cold Weather Tips, Univision, 1/12/15, Woodhull: Dr. Luis Rodriguez, Chief of Pediatrics Medicine
City Mandates Flu Vaccines, News 12 Brooklyn, 1/13/15, Kings County: Dr. Lee Waldman, Pediatrician
Shigella Infection, News 12 Brooklyn, Woodhull, Dr. Sean Studer, Chief of Medicine
Storm Prep: Closer Look, Crain's Health Pulse, Dr. Ross Wilson, HHC Chief Medical Officer
East Coast providers take emergency measures as massive storm nears, Modern Healthcare , 1/27/15, Dr. Ross Wilson, HHC Chief Medical Officer
Cuomo budgets $700 million for health care in central Brooklyn, Brooklyn Daily Eagle, 1/22/15, Kings County
2014 Year in Photos, Newsday, 12/30/14, Dr. Laura Evans, Bellevue
Schumer: Feds Should Reimburse Hospitals For Ebola Preparations, WCBS/Associated Press, 1/8/15, Bellevue
US Ebola Czar: Fight against deadly disease reaching "pivot point", but more domestic cases expected, FoxNews, 12/28/14, Bellevue
The 5 biggest successes and 5 biggest failures of 2014, Healthcare Dive, 12/24/14, Bellevue
HHC Coney Island Hospital has First NYC Baby of 2015, New York Daily News, 1/2/15 Coney Island, Metropolitan
New T-Building housing plan revealed, includes units for homeless patients, 1/16/15, The Queens Courier, Queens
CB8 wants more information on T-Building proposal, Times Ledger, 1/26/15, HHC, Queens
CB 8 sets conditions to endorse T-Building, Queens Chronicle, 1/23/15, Dr. Raju, HHC President
H.P.V. at H.H.C. Capital New York, 1/8/15, HHC
A Health Insurance Expert from MetroPlus Health Plan Answers Common Questions about the Affordable Care Act, Bloomberg Businessweek, 12/19/14, Seth Diamond, Chief Operating Officer, MetroPlus
Quality Questioned in HHC Dialysis Sale, Crain's Health Pulse, 1/28/15, HHC, Dr. Ram Raju
Big Apple Dialysis back on agenda, angering union, Capital New York, 1/28/15, HHC, Elmhurst, Kings County, Lincoln, Metropolitan, Harlem,
Criminal investigations at city hospitals total 238 and some date back at least 10 years, New York Daily News, 1/12/15, Dr. Raju, HHC President, Norman Dion, HHC Inspector General
17 NYC hospitals to be fined for infections, other complications, New York Post, 12/25/14, Kings, Jacobi, Coney Island
Hospitals Score Low, Newsday, 12/23/14, Jacobi, Kings County
Dealing with healthcare construction cost and schedule challenges, Healthcare Facilities Today, 1/26/15, Carter
Bariatric surgeries at Jacobi solve obesity, Bronx Times Reporter, 1/21/15, Jacobi, Bellevue, Harlem: Dr. Ajay Chopra, Medical Director for Bariatric Surgery and Chief of Minimally Invasive Surgery
Bellevue Hospital recognized for stroke care, Town & Village Reporter, 1/7/15, Bellevue: Albert Favate, MD, Medical Director, Stroke Unit
Stein Center knitters make sure Bellevue babies don't get cold feet, 12/25/14,; Rohnie D. Williams, RN
HHC leads in adolescent HPV vaccinations, Town & Village, 1/15/15, HHC