RAMANATHAN RAJU, MD
HHC PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
APRIL 30, 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.
OneCity Health Update
I will begin my report with a brief update on the extensive work being done by our DSRIP Performing Provider System (PPS), OneCity Health.
The New York State budget approved on April 1 includes $1.4 billion in new DSRIP-related capital funding. Partners can submit a request for either the new $1.4 billion fund or resubmit for the original $1.2 billion fund, but not both. We are seeking additional clarification and information from the state on these two funding pools.
The high-level, standardized clinical templates for each of our DSRIP projects are near completion. Kick-off meetings for each local hub planning team have been scheduled for early May.
During Phase 1 of partner contracting we will finalize and execute the OneCity Health Master Services Agreement. This agreement describes the roles and responsibilities of OneCity Health governance and operational entities as well as the general roles and responsibilities of our partners. We anticipate that the final Master Services Agreement will be sent to partners for review and signature in early May. In Phase 2 of contracting we will define project-specific roles and responsibilities, and we will enter into the discussions and contract negotiations about performance and financial terms.
OneCity Health has developed a tool called the Partner Readiness Assessment Tool, or PRAT, to develop an accurate and comprehensive understanding of our resources. Customized versions of the PRAT, to reflect specific partner services, will be sent to each attested Partner, with responses due back to OneCity Health by mid-May.
Sustainable Growth Rate (SGR) Passed by Congress and Signed into Law
Earlier this month, Congress passed and President Obama signed a repeal of the Medicare Sustainable Growth Rate (SGR). For 20 years, the SGR used a formula to limit physician payments under Medicare. Without legislation, Medicare payments to doctors would have been reduced by 21 percent on March 31st. Congress had delayed the reduction every year, often paying for it through reductions to hospital reimbursement.
Importantly for our corporation, other beneficial language was included in the bill that repealed the SGR. Specifically, the new law postpones the start of Medicaid Disproportionate Share Hospital funding cuts for one year or until 2018. However, it also extends and increases the DSH cuts through 2025. The originally scheduled 2017 DSH reductions to Health and Hospitals Corporation could have amounted to $181 million.
The new law also extends the delay of Medicare's "two-midnight" rule until September 30, 2015. Implementation of this rule would have cost HHC an estimated $23 to $38 million in Medicare revenue each year.
Other provisions of the law include:
- Provision of $7.2 billion in funding for Federally Qualified Health Centers,
- Extension of the Children's Health insurance Program for two years,
- Initiation of a program to shift the current pay for performance programs in fee-for-service Medicare with a new "Merit-based Incentive Payment System" that starts with 4 percent and increases to 9 percent of physician pay that is at performance-risk beginning in 2019.
- Institution of an initiative to provide a 5 percent bonus to physicians who participate in two-sided risk alternative payment models, such as ACO's, in FFY 2019.
Zadroga World Trade Center Health Reauthorization Introduced
Two weeks ago, a bill was introduced to re-authorize the James L. Zadroga Health and Compensation Act of 2010 (Zadroga), which funds HHC's World Trade Center Environmental Health Center. HHC's program, known as the Survivor Program, is designated to care for community residents, area workers, students and passers-by who were affected by the environmental effects of 9/11. This effort is being spearheaded by Senators Gillibrand and Schumer in the Senate and Representatives Maloney, Nadler, King, Velazquez and other members of the New York Delegation in the House. The goal is to pass the bill by the upcoming 14th anniversary of 9/11 or by the end of this calendar year.
It's important to note that HHC's current program is fully funded until December 31, 2016. Future funding depends on reauthorization. Language in the reauthorization bill remains largely the same. The critical differences are that the bill would create a permanent program, with budget-neutral funding sources and the program would be exempt from sequestration.
Mayor de Blasio released a statement of New York City's support of the legislation, including continuation of funding for 10 percent of the total cost.
HHC's World Trade Center program has 8,300 patients enrolled with approximately 100 new enrollees each month. They share conditions such as post-traumatic stress disorders, respiratory diseases, gastrointestinal disorders and cancers. In many cases patients will require care and treatment for the rest of their lives.
On behalf of HHC and the thousands of patients who will need care for their 9/11-related conditions well into the future, HHC thanks Senators Gillibrand, Schumer, Kirk, and Murkowski, as well as Representatives Maloney, Nadler, King and other members of Congress for their leadership on this critical legislation. I also want to thank the City Council, specifically Council Member Margaret Chin, for unanimously approving a resolution on April 16th in support of the reauthorization.
CMS Moves to Resolve HHC ACO Issue
In my report last month, I reported on an unintentionally problematic rule issued by the Centers for Medicare and Medicaid Services (CMS). The rule would have resulted in coding issues for our Accountable Care Organization (ACO) and six of our hospitals -- Bellevue, Woodhull, Kings County, Queens, Jacobi and North Central Bronx -- whereby they would no longer have many of the patients they serve counted toward their ACO.
Recently, we heard positive news from CMS that they are working to resolve this issue, and once fixed, this will be retroactively effective. I want to thank CMS for their efforts to rectify this as well as members of the New York City Congressional Delegation who contacted CMS on our behalf.
I also thank the Commissioner of the New York State Department of Health and staff for their advocacy.
State Budget Adopted
The new State Budget includes some of HHC's priorities. Although staff gave a comprehensive overview at the Strategic Planning meeting, I do want to update you on a few key issues.
First, I am pleased to say that the final budget includes technical modifications to the way the State distributes the Upper Payment Limit (UPL) which were required by the Centers for Medicare and Medicaid Services (CMS). With these changes now in place, we should soon be receiving more than $1 billion in outstanding payments for services provided from 2011 to 2014.
Second, although the methodology for distributing Charity Care funding was extended for three years, the State Health Department cannot make further changes without legislative approval. There are two more State Budget cycles during which we can seek changes to protect our Corporation from absorbing a disproportionate amount of federal Disproportionate Share Hospital (DSH) funding cuts.
And last, we were very disappointed that public hospitals are not eligible for new Vital Access Provider (VAP) funding that is available for struggling voluntary Safety Net hospitals. It appears that the State was concerned that there was not enough funding available in this allocation, but they have committed to work with us to find other ways to assist us.
With the Budget behind them, the Legislature returned from their spring recess last week. Our staff will be busy monitoring legislative activity and advocating on behalf of the Corporation until the Legislative Session ends in mid-June.
Deviations from Operating Procedures
I want to advise the board that I approved two deviations from our standard operating procedures.
Our launch of the Epic EMR system is a major strategic goal of the Corporation and we are committed to implementing it on time. To bring on a nationally reputable leadership team with Epic experience, we entered into a 15-month consulting agreement with Clinovations division of The Advisory Group for $4,008,000 inclusive of all expenses. Clinovations is now on board with us and has started assessing the current state of the Epic rollout and establishing a strict schedule to assure the timely launch of the program.
I also approved a license to the Human Resources Administration (HRA) for space at Lincoln Hospital at no cost for the NYC ID Program. As you know, this is an important program for the City. HRA has paid all costs of adapting the site to the program. Currently, the program is up and running and is serving a steady stream of New Yorkers who are eager to obtain the identification cards being issued by it.
New York City Gives Strong Safe Sleep Message
As part of the City's "Safe Sleep" initiative, a press conference was held at Harlem Hospital. I was pleased to appear there with the Deputy Mayor, and the Commissioners of Health, Administration for Children Services (ACS), and Dept. of Homeless Services (DHS), and several mothers of babies born at Harlem Hospital. As part of the program, our hospitals will expand our already robust safe sleep education beyond the prenatal care and post-partum units, displaying the new safe sleep campaign materials throughout our hospitals to help reach the broader hospital community.
New Chief Medical Officers in
Jacobi, North Central Bronx and Metropolitan Hospitals
Recently, the health and Hospitals Corporation appointed new Chief Medical Officers in several of our facilities.
Dr. John Morley, has been appointed Chief Medical Officer of Jacobi Medical Center and North Central Bronx Hospital. Dr. Morley will oversee all medical staff and medical affairs for these two Bronx public hospitals serving over 150,000 combined patients each year.
Dr. John T. Pellicone was appointed Chief Medical Officer of Metropolitan Hospital Center. He will lead efforts to improve the patient experience, expand access, and continue providing excellent preventive care and chronic disease management to improve community health.
Congratulations to our hospitals for recruiting such outstanding doctors for these leadership positions.
Asthma Care at the Health and Hospitals Corporation
One of the hallmarks of the Health and Hospitals Corporation is that over many years, we’ve done a great job of helping to control asthma in New York City. We embarked on a journey many years ago to battle this disease and we have achieved great results. Because we don’t just treat asthma purely as a medical problem, we also treat is an environmental and social issue.
Our social workers work effectively with care coordination to mitigate environmental factors that trigger attacks. For example, at Lincoln Hospital the Respirar program links medical services with environmental factors. Social workers visit patient homes and work to make sure that asthma-producing conditions are eliminated. This hands-on, socially conscious, patient-centric approach is what differentiates Health and Hospitals Corporation from other providers. We want to thank and congratulate Dr. Diana Weaver and Desire LaTempa, who have been doing phenomenal work on asthma care, and many other HHC clinicians and social workers who work to control this disease and create a healthier New York City.
Barbara Duckett, Volunteer, HHC Bellevue Hospital
It's Volunteer Appreciation month which is a good time to thank the 8,000 volunteers who donate 1,000,000 hours of their time each year.
Think of all the smiles, phone calls, classes, handshakes and connections that means for our patients. We are fortunate to have an outstanding and unique network of committed volunteers that help us to carry out our mission to deliver compassionate, quality care to all New Yorkers.
And none is more devoted than Barbara Duckett.
Barbara emigrated to New York from Jamaica in 1950, when she landed a job in the Radiology Department at Bellevue in 1959. That first job kicked off her amazing 50-year career in administrative positions at Bellevue.
Six years ago Barbara retired. She may have come off the payroll, but she certainly didn’t leave Bellevue. Instead, she returns several days a week as a volunteer, where she is inspired by her personal motto "Don’t Say No."
Barbara has logged 5,000 volunteer hours so far, visiting patients who appreciate a volunteer making them feel a little more at home. She also devotes much of her time to service as President of the Bellevue Daycare Center.
Last month she was named as Volunteer of the Year by Bellevue at a city-wide luncheon sponsored by the United Hospital Fund. We are delighted to take this opportunity to recognize Barbara Duckett, and so many other volunteers in our networks. We thank you for all you do, for never saying no when our patients are in need.
HHC In the News Highlights
East Village Building Collaspe, NY1 News, Bellevue, Steven Alexander, Executive Director
Expert Sheds Light on Brain Aneurysms, News 12 Brooklyn, Kings County, Dr. Ali Sadr, Neurosurgeon
SNUG Program Expands to Soundview, News 12 Bronx, Jacobi: Dr. Noe Romo, Medical Director, Stand Up to Violence (SUV); Erika Mendelsohn, Program Director and Social Worker, SUV; Darius Covington, SNUG Member
Gouverneur Health Completes Modernization Project, - NY1 Noticias, Gouverneur: Martha Sullivan, DSW, Executive Director; Dr. Denise Infante, Pediatrician
Effects of Hookah Smoking, NY1 Noticias , Bellevue: Dr. Michael Weitzman, Attending Physician
VIP Talk Sessions Help Boost Brain Development, Bellevue: Dr. Alan Mendelsohn, Pediatrics and Population Health; Adriana Weisleder, Director, Bellevue Project for Early Language Literacy and Education Success
City's New HHC Leader Ready to Usher in New, Kinder Era, NY1, Dr. Ram Raju, President
Carbon Monoxide Safety Tips, WNBC, Bellevue, Dr. Raj Gulati, Chief of Emergency Medicine
NYC Launches "Safe Sleep" Campaign to Reduce Infant Fatalities, WNBC and WABC, Harlem, Metropolitan, Dr. Raju, HHC President, Harlem Hospital: Dr. Mary Marron-Corwin, Chair of Pediatrics
NYPD Officers Help Deliver Baby Boy in Brooklyn Apartment, WNBC, Woodhull
Help Me Howard battles Bellevue over $11k in bills, WPIX. Bellevue
Dangers of synthetic marijuana, News12 Brooklyn, Woodhull: Dr. Robert Chin, Chief of Emergency Department
Jacobi offers monitoring device for patients with cardiac arrhythmia, News12 Bronx, Jacobi: Dr. Michael Grushko
City's public-hospital system sets goals for improvement by 2020, Crain’s New York Business, Dr. Ram Raju, President; MetroPlus
City Hospital head lays out ambitious vision, Capital New York, Dr. Ram Raju, President; MetroPlus
HHC 2020 Vision, Crain’s Health Pulse, Dr. Ram Raju, President; MetroPlus
Paging Doctor de Blasio: New York City’s Health and Hospitals Corp. needs emergency care for the mayor, Daily News, Dr. Ram Raju, President; MetroPlus
Letter to the Editor: BdB, M.D., New York Daily News. Dr. Raju, HHC President
50 Most Influential Physician Executives and Leaders 2015, Modern healthcare, Dr. Ram Raju, President
“Safe Sleep” initiative aims to end New York City infant deaths, New York Daily News, Harlem, Metropolitan
Lincoln Medical Receives “Baby Friendly” Designation, Amsterdam News, HHC, Lincoln, Harlem: Milton Nunez, Executive Director
The Bronx Free Press - Lincoln Baby-Friendly, HHC, Lincoln: Dr. Ronald Bainbridge, Associate Director of Neonatology
Gouverneur Health Completes $257 Million Modernization Project, The Lo-Down, HHC: Dr. Ram Raju, President; Gouverneur: Martha Sullivan, DSW, Executive Director
NYC system appoints CMO for two Bronx hospitals, Modern Healthcare, Jacobi, NCBH:
Dr. John Morley
NYC Health and Hospitals Corporation names Dr. John Morley CMO of 2 hospitals, Becker's Hospital Review, Jacobi, NCBH
Meet the 2015 New York/New Jersey Metro GEM Awards finalists, Nurse.com, Lauren Johnston, HHC Chief Nursing Executive
Op-Ed: Past 50? It’s Time to Get a Colonoscopy – Don’t Put Your Health At Risk,
- Courier Life: Coney Island: Dr. Francis Steinheber, Director of Gastroenterology
- Queens Times Ledger: Elmhurst Hospital: Dr. Joshua Aron, Gastroenterologist
- Bronx Times Reporter: Lincoln: Dr. Sulaiman Azeez, Chief of Gastroenterology
Extended Enrollment Period for Affordable Care Now in Effect, Norwood News, MetroPlus: Seth Diamond, COO
Jacobi offers modern cardiac monitoring device, Bronx Times Reporter, Jacobi: Dr. Michael Grushko, Attending Electrophysiology