Remarks by Alan D. Aviles
President, NYC Health and Hospitals Corporation
Good evening. I am Alan Aviles, President of the New York City Health and Hospitals Corporation (HHC). Thank you all for coming tonight. Now that we are in the month of December it is not too early for me to officially wish you all a happy holiday season and a healthy and flu-free New Year.
I’d like to recognize our Brooklyn leadership team – including our host, Arthur Wagner, the South Brooklyn Network Senior Vice President and Executive Director of Coney Island Hospital; Antonio Martin, the Central Brooklyn Network Senior Vice President and Executive Director of Kings County Hospital Center, Iris Jimenez-Hernandez, the North Brooklyn Network Senior Vice President and Executive Director of Woodhull Hospital, and Peola Small, Executive Director of the Dr. Susan Smith McKinney Nursing & Rehabilitation Center. I thank each of them and their staff for the exceptional work that they do every day on behalf of the patients and communities that we serve. Two of our Brooklyn leaders are relatively new to their roles, although not new to HHC. At Coney Island, Arthur Wagner took the helm less than a year ago and, within weeks, successfully guided the facility through a Joint Commission survey. The survey Team Leader said that she could not recall a survey at a facility of comparable size where there were so few findings of significance. That’s clearly an example of getting off to a very good start. At Kings County, Tony Martin and his leadership team took over at the beginning of the year and have demonstrated extraordinary dedication to fostering powerful, transformative change. That positive change is most dramatically evident in the hospital’s new behavioral health pavilion where hospital staff are engaged in a wholesale reformation of our delivery of psychiatric services. In do so, they are making good on our promise to the Central Brooklyn community that we would, in the wake of Esmin Green’s tragic death last year, develop a model, patient-centered behavioral health program at Kings County. There is more work to do, but much progress already. Before Mr. Levy calls on tonight’s speakers, I will provide a brief overview of the challenges HHC is facing as well as our plans to address them. I will also highlight some of HHC’s accomplishments over the past year, particularly those related to our Brooklyn facilities.
FINANCIAL CHALLENGES/HHC ORGANIZATION-WIDE RESPONSE
Let me begin with our financial challenges. Some in this room may have heard me, and other HHC leaders, discuss the large financial deficits HHC faces in the years ahead. They are the result of a kind of perfect storm that began with the national financial downturn and the enormous -- and still growing -- New York State budget deficits that have resulted in deep cuts in State Medicaid reimbursement to every HHC facility. As Medicaid and other revenue sources are decreasing, our costs -- for prescription medications, medical equipment and supplies, and pensions and other guaranteed employee benefits -- are rising alarmingly.
In addition, the faltering economy led to reductions in City support for HHC, with more on the horizon, while an increasing number of patients with no health insurance are seeking care in our facilities. We served 450,000 uninsured patients in 2008, an eight percent increase from 2007, and that number continues to rise.
And, as if those challenges were not enough, there’s more. HHC receives two kinds of supplemental Medicaid payments to cover shortfalls in fee-for-service and managed care payments, and to cover the costs of treating uninsured patients. For the last few years, these payments have averaged $1.4 billion annually. Starting next year, these annual are being reduced by $500 million.
Unless we take action to address this evolving crisis, by our next fiscal year which begins in July 2010, our projected expenses will exceed our projected revenue by about $1 billion. And this extraordinary budget deficit will only continue to grow. Working with our facility leadership, we have identified various ways to cut costs and to legitimately increase our billing revenue. Some of this work involves operational improvements, greater efficiencies, and the reduction of waste through a process we call Breakthrough. We project that these measures – as well as a hiring freeze implemented in December 2008 – will save us about $200 million this fiscal year and $300 million next year.
It’s an encouraging start, but it’s not enough. We will continue to advocate strongly for more financial assistance from government at all levels to support our mission; however, our expectations must be realistic given the deepening City and State budget deficits.
And, unfortunately, we cannot look to healthcare reform to solve our financial dilemma. While we still hope that Congress will pass legislation that will expand coverage for the uninsured, the pending bills would -- long-term -- dramatically reduce supplemental Medicaid and Medicare funding for HHC and public hospitals across the country. For us, this would mean the loss of hundreds of millions of dollars in federal funds that cover the costs of serving uninsured patients – including undocumented immigrants who will not be covered by federal healthcare reform.
Given these harsh realities, HHC has hired a consulting firm to help us determine how to restructure our large system for greater efficiency and to better position HHC facilities to compete in a post-healthcare reform environment. This restructuring plan may mean that some services available at a number of HHC facilities now will be consolidated to fewer locations and this may inconvenience some patients. However, we will strive to ensure that whatever changes we make are as fair to all our facilities and communities as possible, and that we retain the capacity to provide the full range of healthcare services that our patients need. Finally, we will remain firmly committed to HHC’s mission: to serve all who come to us without regard for their ability to pay or their immigration status.
TRANSPARENCY AND PATIENT SAFETY
Let me now turn to some of our recent accomplishments across our system and here in Brooklyn. In 2007, HHC became the first hospital system in our State to make public system-wide and hospital-specific performance data related to quality of care and patient safety. This past year we have expanded the quality data that we share publicly on our Internet site.
For example, we posted the results of federally-mandated patient satisfaction surveys at each of our hospitals. The results are encouraging, with our average patient satisfaction scores exceeding those of most New York City hospitals. Our Brooklyn facilities did well, with Kings County leading the borough in overall patient satisfaction.
This year we also published data to our Web site that reflects the quality of our maternity and infant care services, an especially important area of focus for us because our hospitals deliver one out of every four babies in New York City – about 24,000 a year. Close to 6,000 of our babies began life in Brooklyn this year. We are proud of the excellent care rendered in our obstetrical units and our extremely low maternal mortality rates, despite handling a disproportionate number of New York City’s high-risk deliveries.
By consistently implementing evidence-based best clinical practices, HHC facilities have also excelled in lowering the number of hospital-acquired infections in our ICUs, operating rooms, and inpatient units. Our facilities have cut the rate of central-line blood stream infections in half since 2005, and the rate of ventilator-associated pneumonia has been reduced by 90% during that same four-year period.
Kings County’s MICU has gone more than two years and Woodhull more than a year without a case of ventilator-associated pneumonia, and Kings County’s SICU went 20 months without a central-line-associated bloodstream infection.
At the Dr. Susan Smith McKinney Nursing and Rehabilitation Center, the incidence of patient falls is approximately 1/3 of the national average, reflecting the staff’s care and concern for keeping patients safe and their diligence at doing so.
Here in Southern Brooklyn, Coney Island Hospital earned national recognition from the Institute of Healthcare Improvement when it was named as one of only eight hospitals in the country to serve as models in the implementation of Surgical Safety Checklists.
This past year the Joint Commission conducted four accreditation surveys of HHC hospitals. In addition to Coney Island’s very successful survey, Kings County had equally impressive results, with the survey team voicing particular praise for the degree of openness and transparency evident among hospital staff.
BEHAVIORAL HEALTH/CHRONIC DISEASE MANAGEMENT
Two other areas where we have made significant strides over the past year are behavioral health and chronic disease management.
HHC facilities provide nearly 40% of hospital-based inpatient mental health services in the city, and we serve a disproportionate number of New Yorkers with serious and persistent mental illness. Those who suffer from serious mental illness have life spans that are, on average, 25 years shorter than the general population, often due to concurrent chronic disease.
The most striking demonstration of HHC’s progress in behavioral health in 2009 occurred at Kings County, where the new $153 million Behavioral Health Pavilion opened in February. Within the Pavilion, staff are successfully implementing a comprehensive plan to radically change for the better the patient experience for the roughly 10,000 behavioral health patients of all ages seen at Kings annually. The vastly improved physical environment, together with new leadership, has helped foster an altered culture of more patient-centered care, anchored in compassion and respect, with an emphasis on sustainable recovery and re-integration into the community.
Among several innovative approaches, Kings County has implemented a Peer Case Manager program, employing former patients as “Ambassadors of Empathy” assigned throughout the facility to provide a special support network to help psychiatric patients with their recovery.
Also this year, thanks to $300,000 from the Fan Fox and Leslie Samuels Foundation, Woodhull Hospital began implementation of Project IMPACT, an evidence-based model to improve treatment of depression in the elderly by integrating geriatric mental health services with primary health care. Woodhull’s Geriatric Wellness Center, which opened in February, is home to the IMPACT team and the source of an array of primary care, behavioral health, and chronic disease resources for the North Brooklyn senior community.
HHC also continues to make progress in other areas of chronic disease management. On May 1, the HHC Cardiovascular Risk Registry became available at all of our hospitals. The registry is an electronic disease-tracking program that greatly improves a doctor’s ability to understand, monitor, and manage cardiovascular disease among patients. Thus far, the registry has identified more than 42,000 patients with high blood pressure and 26,000 patients with high cholesterol whose treatment is being closely monitored and better managed.
Working with our diabetes registry, our clinicians continue to improve the health of more than 50,000 diabetic New Yorkers under care in HHC hospitals. And the number of our diabetic patients with healthy blood sugar, normal blood pressure, and healthy cholesterol levels increased significantly from last year to this year.
Woodhull’s cookbook for diabetic patients – Cooked to Perfection, Cherished Family Recipes That Are Good for You – is an example of our effort to help to support a commitment to healthy eating in a culturally sensitive way. The book compiles recipes favored by the community but deliciously re-imagined with healthier ingredients, lower in fat and salt.
COMMITMENT TO LOCAL COMMUNITIES
HHC facilities are deeply engaged with local communities, and respond to their specific health needs by creating a variety of programs that are effective as well as culturally sensitive.
I was especially pleased this year that, in recognition of this work, HHC received the Builders of New York Award from the New York Immigration Coalition, an umbrella policy and advocacy organization of more than 200 groups in New York State that promotes fairness and opportunity for immigrants and refugees. We were cited for our significant innovations in expanding access to care for immigrants, including our financial assistance policies that provide deeply discounted fees for the uninsured, our comprehensive communications assistance for limited English proficiency patients, and our strictly enforced confidentiality policies that afford new immigrants a sense of security in accessing needed care.
In addition, several specific community initiatives here in Brooklyn are worth mentioning.
Woodhull has been a leader in the fight against childhood asthma, and the hospital’s pediatric asthma program has shown a significant drop in return emergency department visits. Woodhull recently received $900,000 over five years the New York State Department of Health to partner with local schools and the North Brooklyn Asthma Action Alliance to help teach children with asthma how to manage this debilitating disease.
Five years ago, Coney Island was the first HHC hospital to develop a palliative care program to offer patients facing end-of -life an option that focuses on pain relief, psychological and spiritual support, and other comfort care that is often more conducive to achieving meaningful closure with family and friends. With the highest population of fragile elderly patients in the HHC system, it is not surprising that the demand for this dignified alternative continues to grow. Today the palliative care team receives more than 100 referrals a month, and surveys of patients and families reinforce the extraordinary value of this coordinated, compassionate care at a crucial point in patients’ lives.
Turning to capital investments, despite economic challenges, our hospital modernization program continues to create modern, comfortable high-tech therapeutic environments supporting better clinical outcomes.
A total of $251 million in capital projects have been underway at our Brooklyn facilities, $166 million of which were substantially completed this year.
In June Coney Island opened a new angiography suite to provide state-of-the-art interventional radiology procedures for its patients. This program was funded through the City Council.
In September, with the help of funding from the Mayor’s Center for Economic Opportunity, the first class of 29 nurses began a two-year clinical study course at the new LIU School of Nursing at Kings County. Nurses attending this program commit to work at an HHC facility for four years upon graduation.
Before I bring my remarks to a close, let me briefly mention something that’s been on everyone’s mind – the flu. From the beginning of the H1N1 outbreak last spring, HHC has played a critical role in the city’s coordinated emergency response and preparedness efforts, and our Brooklyn hospitals performed particularly well. We took immediate steps to ensure that patients received the care that they needed, despite dramatically increased patient volume in our emergency departments and many of our primary care settings.
We have opened four Fast Track Flu Centers in Brooklyn to help meet public demand for both seasonal and H1N1 flu vaccinations.
We have been fortunate that our communities across the city have not yet experienced high levels of flu activity. But whether the flu season has peaked, as some are suggesting, or will surge again in the months to come, we will continue to monitor the situation closely and will be prepared.
The achievements that I have touched upon would not have been possible without the collaboration and advocacy provided by our Community Advisory Boards and our labor partners; the contributions of our volunteers and auxiliaries; the steadfast support of Mayor Bloomberg and other elected officials; and, of course, the compassion, creativity, and commitment of the men and women who staff our health centers and hospitals in Brooklyn and our other HHC facilities throughout the city.
As noteworthy as our achievements are, I must close by coming back to the significant challenges that lie ahead for HHC. I want to assure you that we will do what is necessary to preserve our ability to carry out our mission, and we will always be open and honest with our communities about whatever changes are necessary.
Thank you for your attention and your commitment to our public hospital system. I will now turn the microphone over to our moderator, Mr. Levy, and I look forward to hearing your comments.