RAMANATHAN RAJU, MD
HHC PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
September 24, 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.
2020 Vision Update: Transforming Our Organizational Structure
Last April we set very ambitious goals and metrics for the year 2020.
- To become the provider of choice for more New Yorkers,
- To bring excellence to patient experience, and
- To gain market share.
Our ultimate goal is to build a financially sustainable health system that continues to fill its essential, historic role in New York City.
Our leadership team has closely reviewed how high performing organizations across the nation are responding to the new demands of the changing healthcare industry. We agree that a new organizational structure will serve as a critical foundation from which to build our future and achieve our 2020 goals.
First, we will reorganize into three functional groups – Inpatient Care, Ambulatory Care and Long Term/Post-Acute Care. We need to respond to today's needs with an organizational structure that is more focused on primary and preventive care, more responsive to the communities we serve, and more committed to keeping New Yorkers healthy.
Second, we are planning to phase-out the outdated internal "network" structure that currently groups together hospitals, long term care facilities, and community health centers under six internal administrative networks. Today these networks simply add avoidable layers of complexity.
The leadership team will complete deliberations by mid-October when we will be prepared to present our vision for this new organizational structure that better supports our goals. We plan to begin putting in place that new structure in January.
I am committed to making these changes as seamlessly as possible, not just for our patients, but also for our dedicated workforce and front line staff. These changes affect the organization only at its most senior levels. The rest of our workforce will continue to provide the same high quality care and support for our caregivers.
Flu Vaccination Campaign Update
In preparation for the upcoming flu season, the Internal Communications Group (ICG) is working on a number of engagement strategies to encourage patients and staff to get vaccinated.
- It’s Not About You -- a series of posters, ad panels, screensavers, and flat screen ads -- themed to call attention to the vulnerability of babies, the elderly, and those with chronic illness, and how their health as well as your own is protected when you vaccinate.
- Flu FAQ for Patients, Our Communities, and Our Staff in all 13 HHC-used languages.
- 10,000 Flu Vax lollipops (“Sweet on Flu Vax at HHC”) and 20,000 Flu Vax temporary tattoos (“Flu Stops Here ↓”).
- Flu Vax Healthy Competition – once vax season is under way, weekly postings of the Employee Vaccination Rates (EVR) by facility will be posted each week in The HHC Insider.
- Why Did You Vax? -- a series of short video interviews in which we ask HHC staff why they did it. These will air on The HHC Insider.
- Flu Stops Here ↓ posters and screen savers featuring HHC staff displaying their flu tattoos.
Over 2,000 New Yorkers die each year from flu-related illness – we propose to lower that number considerably.
OneCity Health Update
OneCity Health has submitted the State Implementation Plan and its first DSRIP quarterly report. OneCity Health received feedback on its quarterly report from the NYS DOH DSRIP Independent Assessor and will make requested adjustments as part of normal course of business.
OneCity Health is working with closely with partners to define interest and participation in each DSRIP project, as well as to identify the mutual obligations in ensuring performance objectives are met.
Our Performing Provider System received a net project valuation to receive up to $1.17 billion and is also eligible for up to $45 million from a separate high-performance fund. As you know, all DSRIP payments are dependent on meeting performance metrics and milestones.
340b Drug Discount Program "MegaGuidance"
In August the federal Health Resources and Services Administration (HRSA) published the Comprehensive 340b “MegaGuidance,” in process since 2007. Despite intense pressure from the pharmaceutical industry there were no major changes proposed to the 340b program. The guidance does include some areas of concern to HHC including the proposed exclusion from the 340b program of pharmaceuticals in bundled Medicaid payments, and of discharge drugs. The 340b Program produces savings of about $40 million a year for HHC and we will continue to keep the Board up to date on it.
CMS Extends Two-Midnight Rule Enforcement Delay
In a positive development, the Centers for Medicare and Medicaid Services (CMS) extended its delay of the Two-Midnight Rule through December 31, 2015. With this extension, auditors would only conduct post-payment patient status reviews on claims for admissions after that date. This extension is in addition to proposed changes to the two midnight rule that CMS included in a rule published earlier this year. The rule allows physicians to exercise judgment in short stays. Physicians would document factors that support their decision such as severity of symptoms etc. Implementation of the existing rule would cost HHC $23-38 million in Medicare revenue each year.
Extension of 9/11 Zadroga Act Sought
Without Congressional action, the James L. Zadroga 9/11 Health and Compensation Act for injured and ill 9/11 survivors and responders is set to expire in less than a year and a half. HHC’s WTC Environmental Health Program is fully funded until December 31st 2016, but its future will be at risk along with the responder programs if the Zadroga Act is not reauthorized by this current congress. Support for a permanent extension of the Act reached a critical milestone last week when dozens of responders, survivors and their advocates, including staff and patients of our WTC EHC, visited the offices of over half of all congressional members.
Though there is some bipartisan support for a permanent extension of the Act, most Republican members would favor a time-limited extension that is being negotiated in key committees of both the House and the Senate. HHC joins the city of New York in thanking the key legislative leaders, New York Senators Gillibrand and Schumer and Congresspersons Maloney, Nadler and King, for continuing the push for a permanent reauthorization of the bill.
Deviation from HHC Policy Regarding Lease
Pursuant to my authority to deviate from the Corporation's procurement procedures and after consultations with the chair of the Capital Committee and the Acting Board Chair, I executed a First Amendment to Lease with respect to the Corporation’s September 2013 lease of office space at 55 Water Street. By the Amendment, the Corporation rented an additional 35,190 square feet on the 18th Floor of the building. The space will be used to house the staff transferred from the NYC Department of Health and Mental Hygiene that administers Correctional Services for which the Corporation became responsible as of August 9 by virtue of Executive Order No. 11 of 2015 and the Memorandum of Understanding among the Corporation, the City, the Department of Health and Mental Hygiene and the Department of Correction. Due to the very short schedule on which the Corporation is asked to assume management of Correctional Health Services, because the Board had no meeting in August and the need to secure the rental of this space while it was available, there was no time to go through the normal Board approval process. This urgency dictated my use of my authority to deviate from normal procedures. Our occupancy of the new space will governed by the September 2013 lease except the rent will start at $47.50/ft and will increase every five years. The landlord will contribute close to $2.5 Million towards the costs of necessary alterations and the first 10 months of the lease are rent free.
Cumberland Health Center and Satellites Receive Funding for Full FHQC Status
Cumberland Diagnostic & Treatment Center and its six satellite clinics have received notice from the federal Health Resources and Service Administration (HRSA) that it now has full status as a Federally Qualified Health Center– not as a Look-Alike.
All Gotham sites were provided Look-Alike status as a first step to Full status and Cumberland is the first with that designation. Full status comes with a New Access Point (NAP) grant of $541,000 the first year and $650,000 every year going forward. This will improve access to primary care services for those living in public housing and others.
It will also allow HHC and Gotham Health to apply for other Diagnostic & Treatment Centers to achieve full FQHC status. Next on our list is Gouverneur Health.
HHC Executive Director Appointed to New City-Wide Age-Friendly Commission
Earlier this month, Mayor de Blasio announced that Dr. Martha Sullivan, Executive Director of our Long-Term Care facility at Gouverneur is among the new commissioners appointed to the new Age-Friendly NYC Commission. The Commission grew organically from Age-Friendly NYC, launched in 2007 as a partnership among the Mayor's Office, the NYC City Council and the NY Academy of Medicine. Leaders on the current Board have been members of that body, including Dr. Lilliam Barios-Paoli, Dr. Jo Ivey Boufford and Gordon Campbell.
Dr. Sullivan's appointment makes clear HHC's commitment to ensuring that ours continues to grow as a senior-friendly health system.
HHC Hospitals Displays System-Wide Commitment in
This Week's Patient Safety EXPO
The Office of Patient Safety and Employee Safety hosted Patient Safety EXPO 2015 this week at The Corporate Conference Center at Jacobi. Over 230 HHC employees attended this event. Thirty posters were displayed, showcasing successes on patient safety strategies that were evidenced-based, replicable, showed sustainability, and aligned with HHC’s strategic goals and guiding principles. Clinical teams were able to share ideas and best practices.
The EXPO posters were judged by three judges: Kathleen Ciccone, RN, MBA., DrPH., Executive Director, HANYS’ Quality Institute and Co-Director, NYS Partnership for Patients; Patricia Kischak, RN, MBA, Vice President and Chief Nursing Officer, Hospitals Insurance Company (HIC); and Arnold Saperstein, MD, President and CEO, MetroPlus Health Plan.
Four awards were presented:
- Woodhull Medical and Mental Health Center won the First Place award for Hospital Based Service for ‘Optimization of Anticoagulation Management in a Specialty Practice’.
- Henry J. Carter Nursing Facility received the First Prize for Long Term Care for their project titled ‘Establishing a Realistic Hand Hygiene Compliance Rate Using a Secret Observer Program’.
- First Prize for Community Based Service went to HHC Health and Home care for ‘Tele-Care Management: Using Technology to Reduce Hospitalization of Heart Failure Patients’.
- The special President’s Award was presented to Dr. Susan Smith McKinney’s project ‘Pharmacy in Action’.
HHC Staff Diversity Highlighted in Photo Display
On your way into today's meeting you will have seen a photo display which features the broad diversity of our staff. This display has been developed by the HHC CLAS department to highlight the emphasis we place on strong culturally and linguistically appropriate access to healthcare information for all our patients. We're proud to be leaders in providing this critically important access.
HHC Opens New Satellite Simulation Training Center at Elmhurst Hospital
Last week, at HHC Elmhurst Hospital we opened a new state-of-the-art medical simulation training center to help doctors and nurses practice medical emergencies and real life-saving procedures. The new $750,000 simulation center features high fidelity patient mannequins and spaces that can replicate operating rooms, intensive care units, emergency rooms, and pediatric patient exam rooms where staff can be trained to practice complicated cases. It is the first of several planned satellite sites to expand the capacity our Simulation program. More than 2,000 NYC Health + Hospitals employees train at our Sim Center annually.
State Grants Support Bio-Medical Research at HHC Hospitals
Two of our hospitals received research grants from New York State to study obesity, hypertension and cardiac arrest. Over $2 million from the New York State Empire Clinical Research Investigator Program has been earmarked for HHC investigators at Lincoln and Elmhurst hospitals. Researchers at Lincoln will use the state funds to study how to achieve weight loss and blood pressure control among minority patients within various inner-city settings. At Elmhurst, researchers will develop a novel curriculum for hospital medical teams responding to cardiac arrests, with the goal of developing training techniques that will lead to better safety and improved outcomes for patients. We are enormously proud to receive these grants which will allow us to expand our team-based approach and provide additional opportunities for physicians to conduct medical research that will benefit our community.
Coney Island Hospital Physician Wins Third Title
Dr. Terence Brady, the Coney Island Hospital's Associate Chief Medical Officer has received the American College of Physicians's (ACP) “Mastership” designation. Masters are highly accomplished physicians, eminent practice, leadership, or in medical research. Dr. Brady joins two other HHC Coney Island physicians who already hold this designation - Dr. John Maese, Chief Medical Officer and Dr. Paul Gitman of Quality Management. These three physicians are among 785 worldwide to hold this distinction of Masters by the ACP.
For an institution to have three physicians earn this designation is remarkable -- one example of the many skilled and accomplished physicians we have, providing excellent care for our patients and community.
Farewell to Long-Time HHC Leader
With mixed emotions, we bid farewell to William “Bill” Walsh earlier this month. Bill has served Corporation for thirty-one years, the past ten years as Senior Vice President for the North Bronx Healthcare Network. In his next professional chapter, Bill is joining the SUNY Downstate Medical Center as Senior Vice President for Hospital Operations and Managing Director of the University Hospital of Brooklyn.
Always an inspirational leader, Bill has been a tireless champion for patient safety and care quality across the Corporation and a major force in the Corporation’s Breakthrough transformation efforts.
A national search will be undertaken for Bill’s replacement. In the interim, I am naming Chris Fugazy as Acting Executive Director at Jacobi, where he presently serves as Chief Operating Officer and Gregory Calliste as Acting Executive Director at North Central Bronx Hospital, where he presently serves as Chief Operating Officer.
HHC Program & Individuals of the Month:
The WTC Environmental Health Center, Its Staff & Patients
Normally at this point each month, I call your attention to an outstanding Health and Hospital program, and then to an individual playing a key role in the execution of our mission.
Today I’d like to honor our WTC Environmental Health Center, which encapsulates excellence in both.
Our job as public health professionals is not just to provide the best possible care for neediest and most vulnerable amongst us. We must also fiercely advocate for our patients. We must act as a moral compass by insisting on what is right, and objecting to what is wrong.
Normally I don’t comment on politics in this forum. But in this case a pressing issue---the failure of Congress to reauthorize the federal law which funds healthcare for 9/11 survivors---has become intertwined with our job of caring and advocating for our patients.
9/11 demonstrated New York City at its best.
We showed the world heroic resiliency in standing up to the terrorist attack.
Many responders on that day --- firefighters, police officers, EMTs---displayed bravery that will be forever etched on the American psyche.
But another sort of heroism involved everyday people:
They are unsung, unknown, heroes, many of them undocumented, who brought the City back to its feet by returning to the neighborhoods surrounding Ground Zero, to clear the rubble, to remove the debris, to clean the buildings--- all of which was essential to restoring New York. Yet thousands continue to pay a terrible price for their bravery. In many cases, the Zadroga Act is all they’ve got.
Many developed respiratory illnesses, gastrointestinal diseases, and mental health problems. Many are developing and dying of cancers. Many are forced to rely on oxygen tanks.
All these things are heart wrenching.
But what is worse is the fact that many cannot afford to pay for the care that they need.
In many cases, Zadroga offers their only opportunity for treatment.
When people in our own country are dying because they acted with civic responsibility, and the only program available for them to receive the treatment they deserve is due to expire, that state of affairs is unacceptable.
We cannot be complacent about the devastating effects that 9/11 still has on the health of thousands of New Yorkers.
We cannot be silent about the failure of Congress to reauthorize this act.
The President has often stated that we don’t leave anyone behind on the battle field. We should apply the same rule for the home front.
It is our moral responsibility as a nation to reauthorize this law and make it permanent. This should not even be open for discussion.
9/11 survivors deserve our gratitude, and the nation’s assistance. We will be judged by how we respond.
So, today, let’s fight for the healthcare of great Americans who are also 9/11 survivors--- Survivors like Kimberly Flynn, Catherine McVay Hughes, and Maggie Garcia who we are so proud to recognize tonight. Despite personal challenges related to health, family and work, they undoubtedly played a major role in the Survivor program’s inclusion in the Zadroga Act.
And let’s also offer our gratitude and admiration for Dr. Joan Reibman, who did so much to identify the environmental health threat to New Yorkers almost immediately after the towers fell, and who hasn’t stopped---who hasn’t even slowed down--- in the intervening 14 years of fiercely advocating for the healthcare rights of survivors.
HHC In the News Highlights
Ground Zero Survivors Still Battling Health Problems, CBS News, Bellevue: Dr. Joan Reibman, Medical Director, World Trade Center Environmental Health Center
Back-to-school health tips for parents and kids, WCBS News, Dr. Warren Seigel, Chairman of Pediatrics, Coney Island
Back to School Health Tips, News 12 Brooklyn, Coney Island: Dr. Warren Seigel, Chairman of Pediatrics
Mayor and Dr. Raju Visit Bronx Senior Center, FOX, Dr. Ram Raju, President
Pre-med student says thanks to trauma doctor, News12 Bronx, Jacobi: Dr. Sheldon Teperman, Director Trauma Center
Mayor Thanks Lincoln Staff, Provides Update on Legionnaires
Officials Encourage Bronx Residents to Get Municipal ID, News 12 Bronx, Lincoln: Dr. Raju, President
Jacobi Medical Center makes Memorial Quilt for World Aids Day, News 12 Bronx,
Jacobi: Christine Mastin, Caseworker –HIV Services.
New Simulation Training Facility Opens at Elmhurst Hospital, NY1 News, HHC, Queens, Elmhurst: Dr. Suzanne Bentley, Clinical Director, Simulation Center; Dr. Peter England, Emergency Medicine
Hospital Study Highlights Benefits of Helmets for Bicyclists, NY1 News, Bellevue: Dr. Spiros Frangos, Chief of Trauma
City Hospital head to reorganize hierarchy, emphasize ambulatory care, Politico Pro, Dr. Ram Raju, HHC President
New York City’s Public Hospital system to change corporate structure: 5 things to know, Becker’s Hospital Review, Dr. Ram Raju, HHC President
100 Most Influential People in Healthcare – 2015, Modern Healthcare, Dr. Ram Raju, HHC President
Barrios-Paoli to Step Down from Post as Deputy Mayor, Politico Pro, HHC: Lilliam Barrios-Paoli
Council to Nominate New Member to HHC Board, Politico, Pro, HHC: Helen Arteaga
NYC System Appoints new CMO at Bronx Hospital, Modern Healthcare, Lincoln: Dr. Balvindar S. Sareen, Chief Medical Officer
HHC Lincoln Medical Center names new CMO, Becker’s Hospital Review, Lincoln: Dr. Balvindar S. Sareen, Chief Medical Officer
New Simulation Center in Queens, Crain’s Health Pulse, HHC, Elmhurst
NYC Health and Hospitals Opens New Simulation Center, Becker’s Hospital Review, HHC, Elmhurst: Dr. Ross Wilson, Corporate Chief Medical Officer
Texting Helps Low-Income Diabetes Patients Mange Insulin Dosing, Capital Public Radio, Bellevue: Dr. Natalie Levy, Head of Bellevue Hospital's Diabetes Program
Tips for Back to School Success, amNewYork, Coney Island: Dr. Warren Seigel, Chair of Pediatrics
City Encourages Immigrants to get their IDNYC Cards, Mott Haven Herald, Lincoln: Dr. Ram Raju, HHC President
HHC’s Accountable Care Organization saves $7.1 million, Politico Pro, HHC: Dr. Ross Wilson, CEO, HHC’s Accountable Care Organization and Corporate Chief Medical Officer
CMS releases ACO results, Crain’s Health Pulse, HHC
Mothers from Harlem Hospital and Other Hospitals Attempt Breastfeeding Record, Harlem Word, Queens; Harlem: Denise C. Soares, Senior Vice President, Generations+/Northern Manhattan Health Network, Executive Director, Harlem Hospital, Queens: Chris Constantino, Executive Director of Queens Hospital Center and Senior Vice President of HHC’S Queens Health Network; Marcy Stein Albert, M.D., Director of Pediatrics; Barbara Holmes, IBCLC, Breastfeeding Coordinator
Children Board Prematurely Reunite with the Doctors & Nurses Who Saved Them, Sheepshead Bites, Coney Island: Vito Buccellato, Chief Operating Officer; Barbara Rosado; Dr. Cherbrale Hickman; Dr. Althea Senior-Morris; Kathleen Marino; Nana Gvasalia
Elmhurst Hospital Center Receives Grant for Cardiac Arrest Training, Times Ledger, Elmhurst: Chris Constantino, Executive Director
Elmhurst Hospital Center in design Phase of expansion for ER, Times Ledger, Elmhurst
Opinion: The Crucial role of New York’s Public Hospital System, El Diario, HHC, MetroPlus
Executive Director of Jacobi leaving after ten years, Bronx Times, Antonio Martin, Executive VP and Corporate COO; William Walsh, SVP, North Bronx Healthcare Network; Chris Fugazy, COO, Jacobi; Gregory Calliste, COO, NCBH
Pam Brier, a Crain’s Hall of Famer, on her career, Crain’s Health Pulse, HHC, Jacobi, Bellevue