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. This is our second annual public meeting for 2010. We met in the Bronx two weeks ago and meetings have been scheduled in the remaining three boroughs.
First, I want to recognize HHC’s senior executives here in Staten Island: Arthur Wagner, Senior Vice President of the Southern Brooklyn/Staten Island Network and Angelo Mascia, Executive Director of Sea View Hospital Rehabilitation Center & Home and our host this evening. My thanks to Artie, Angelo, and their talented staff for the stellar work they do every day serving Staten Island residents.
Second, I would like to thank the members of Sea View’s Community Advisory Board for their long-standing support and dedication to the residents and staff of this excellent facility.
I also want to acknowledge the support and guidance of our Board of Directors, under the leadership of Dr. Michael Stocker. My special thanks to Board Members – Dr. John Maese and Mrs. Josephine Bolus - who are here tonight.
A year ago, I spoke at this meeting about the financial challenges that HHC faced. Dealing with these financial challenges has made this a very difficult year. Despite these challenging economic times, we at HHC are absolutely committed to providing New Yorkers broad access to quality health care, and rendering that care in a way that reduces disparities and improves the health of our communities. Specifically, on Staten Island, that commitment has been evidenced by our continued investment in primary preventive and specialty care services for this borough’s low income and uninsured residents.
In April 2009, HHC’s Health Connection Mobile Medical Office began providing adult primary care in 5 Staten Island neighborhoods – New Brighton, Tottenville, Midland Beach, West Brighton and Park Hill.
I’m pleased to report that we have received approval from the State Department of Health to provide ophthalmology and podiatry services on a second Mobile Medical Office. We will launch the second mobile medical office in the spring of 2011.
With respect to screening programs and preventive services, we’ve installed digital mammography equipment at Sea View to provide breast cancer screening and diagnosis.
Last month we launched a 24 hour call center to support our primary care operations in the borough. Now, patients can schedule appointments, in English or Spanish, at times which are convenient for them.
This summer, we will begin construction of a new ambulatory care center at 155 Vanderbilt Avenue. This $23.7M facility will be home to comprehensive adult primary care, women’s health services, dental services, a full radiology suite, subspecialty services and an outpatient pharmacy.
As we have done since 2005, we continue to provide operating financial support to the Community Health Center of Richmond.
We are especially proud of the role that Sea View plays in the delivery of health care to the residents of this borough. Sea View has received national recognition for its exceptional programs on numerous occasions, a testament to Sea View’s success in improving the quality of life of nursing home residents. Most recently, the American Medical Directors’ Association (AMDA) Foundation/Evercare recognized Sea View’s highly effective palliative care program. This past year the National Patient Safety Congress recognized Sea View for its Medication Management Optimization Program, which is designed to wean residents off multiple medications.
Over the past few years, HHC’s long term care facilities have begun to redesign the traditional, institutional culture of skilled nursing facilities to one in which the residents, working with the staff, create a more personalized, self-directed environment. Sea View’s efforts have been particularly successful. Residents have more control of their daily schedules, including when they eat their meals, when they bathe and when they go to bed and get up. Families can visit at any time and stay overnight.
Sea View also continues to surpass expectations with respect to flu immunizations. Last year, 73% of the staff was immunized and already this year, they are at 60% and still climbing. These high rates of immunization among staff reflect their high regard for the safety of their vulnerable patients.
The role that HHC plays throughout the City continues to be vital and we must all be vigilant to preserve the mission of our public hospital system. Last year, HHC facilities served approximately 1.3 million adults and children. We admitted about 225,000 patients into our hospitals. We provided outpatient care to another one million patients. We delivered 23,000 babies. We provided one million patient days of skilled nursing facility care, 10% of them here at Sea View. One-third of our patients – more than 450,000 last year – were uninsured.
At this time last year, I told you that HHC faced a extraordinary budget shortfall of $1 billion as a result of the combined effects of rapidly rising costs in such areas as medications, medical equipment and employee pensions; hundreds of millions of dollars in cuts to our Medicaid reimbursement from the state and federal governments; and a dramatic increase in uninsured patients.
Late last year, I shared details of the $300 million cost-containment plan that we had launched earlier in the year. It included a sharp reduction of all discretionary spending, improvements in revenue collection to capture every dollar owed to us from government payors and private insurance companies for the services that we provide, and a commitment to reduce staffing levels through attrition. We have carried out virtually that entire plan successfully and by the end of this year, we will have reduced our budget gap by about $300 million. These measures helped, but still fall short.
This past year, with the help of a consulting firm, our senior leadership completed work on a second plan to further reduce our budget gap without compromising our ability to meet the essential needs of our communities. I won’t go through all the elements of this second cost-containment and restructuring plan; it consists of 39 projects that we will complete over the next four years. To fully implement the plan, we must consolidate some programs, right-size some of our operations, contract for targeted support and technical services, and restructure our largest long term care facility on Roosevelt Island. The entire plan – which, when implemented, will reduce our budget gap by another $300 million – was released this past May and is available for review on our public website.
We have already begun to implement some of these proposals. Layoffs of central office staff, as well as some construction and plant maintenance staff, have already occurred and, last month, we closed five small clinics in the other boroughs. We have also begun the longer term process of changing our relationships with our affiliate partners to reduce the total number of different agreements we have to administer and to standardize terms and conditions so as to strengthen our ability to function as an integrated delivery system.
We regret that these measures are necessary, especially at a time when alternative employment opportunities continue to be scarce. But, these are the tough choices we have to make if we are to remain faithful to our mission, protect our core patient care programs, and avert more drastic reductions or elimination of services.
Even after taking these painful actions, we still fall short of a balanced budget by hundreds of millions of dollars. Fortunately, our goal to stabilize HHC’s finances has been aided greatly by significant additional financial assistance -- in the amount of $350 million -- authorized by the Mayor and the City Council earlier this year. We are grateful for this critical financial support, especially at a time when the City is struggling with a budget deficit of its own and has very limited flexibility. Without this City support, however, we would not have had the ability to target and phase-in the planned reductions and restructuring over a four-year period to minimize disruption to our delivery of care.
The gap closing actions on our part – both those already taken and those planned – will ultimately address only about $600 million of our projected $1.2 billion budget deficit. However, in addition to the $350 million in immediate financial support, the City has included in its financial plan an average of almost $300 million annually over the next several years and, with the help of the State, it appears that these amounts will be matched by federal funds under the supplemental Medicaid program. We are awaiting final federal approval of this additional funding, and with it we will have achieved a more secure fiscal footing for the next several years. We are grateful for this strong support of our safety net mission from all three levels of government.
Staff in the South Brooklyn/Staten Island Network have stepped up this year to meet challenges and maintain a standard of care that rivals that of any healthcare system in our city. I am proud that they so effectively represent our public system’s commitment to our patients and our communities.
But, even as I applaud our work on Staten Island, allow me to again sound this note of concern: the challenges we face are far from over and are likely to increase. For this reason, it is incumbent upon us to work together to advocate vigorously to ensure HHC’s ability to carry out its noble mission now and in the future.
Thank you for your attention and I now will turn the program over to Mr. Russo and I look forward to hearing your comments.