Public Reports and Testimonies

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, our City’s public hospital and health care clinic system. Thank you for being with us tonight. This is the third of our five annual public meetings for 2012. As always, I am eager to hear what HHC’s communities have to say about our performance, especially during what continues to be a very challenging time in health care generally and for HHC specifically.

At the outset, let me recognize HHC’s senior Staten Island executives: Arthur Wagner, Senior Vice President of the South Brooklyn/Staten Island Network and Angelo Mascia, Executive Director of Sea View Hospital Rehabilitation Center and Home, our host this evening. My thanks to both of them and their talented staff for the stellar work they do every day serving Staten Island residents.

I also want to acknowledge the support and guidance of our Board of Directors, under the leadership of Dr. Michael Stocker. And I want to recognize and thank the members of our Sea View Advisory Board and the Auxiliary, who advocate and volunteer their time on behalf of our patients and our public system.

Finally, I want to thank our local elected officials, not only for keeping our feet to the fire in terms of the needs of their constituents, but also for their continued support of HHC and its mission.

Hurricane Sandy

Let me begin by speaking about Hurricane Sandy and its dramatic and wide-ranging effects on HHC and Staten Island. First, let me say that HHC is moved by the resiliency of the people of this borough who continue to sort through the wreckage of the storm. Our Mobile Medical Offices have been out in the community offering vaccines and needed primary care to Staten Island residents. We put in place a strategy to provide primary care in the most flexible way possible to those most in need through our Mobile Medical Office three years ago, and we have used this resource in responding to borough residents’ needs in these most recent weeks. In addition, after the storm had passed and the magnitude of the devastation had become apparent, Sea View staff were able to quickly convert a Coney Island outreach vehicle into a third mobile medical unit and put it into service out in the New Dorp community. And, our Mariner’s Harbor Family Health Center has been busier than ever providing adult and pediatric primary care to Staten Island residents affected by Sandy.

Sea View did not experience damage from Sandy; however, the Stapleton Family Health Center did experience flooding from the storm. The good news is that this health center was re-opened this week and is providing much needed services to the community.

That said, beyond the impact of the storm on any one HHC facility, our employees, just like many other New Yorkers, certainly suffered storm-related effects as many found it difficult to get to work because of transportation disruptions and fuel shortages, and some experienced personal hardships that were storm-related.

Let me say that in the face of this unprecedented event, it was the diligent planning, hard work, bravery and selfless dedication of thousands of HHC staff that protected our patients from harm, and helped relieve their discomfort and anxiety during the storm and in its immediate aftermath. Many staff, often despite concerns for their own families and homes, worked tirelessly over multiple shifts with determined focus on ensuring the wellbeing of our patients.

Before the storm, HHC Central Office Emergency Management and local facility leadership activated Emergency Response Plans, emergency generators were tested and fully fueled; and extra supplies and food were secured. Disaster staffing patterns were set in motion, and preparations were made for staff to sleep over at their facilities. Eight Special Medical Needs Shelters were opened, and staffed round the clock with the help of HHC personnel who worked extended shifts caring for some of the City’s most fragile residents displaced by the storm, including evacuees from Staten Island nursing homes. Sea View helped to staff the Tottenville Special Medical Needs Shelter and provided the medical supplies and equipment that were needed. Sea View staff members also worked extra shifts as New York State Department of Health mandated that staffing of long-term care facilities be increased by 50% for the duration of the emergency.

As you know, two HHC hospitals, Bellevue Hospital in Manhattan and Coney Island Hospital in Brooklyn were severely damaged by the extraordinary storm surge and both had to be evacuated. I was in the emergency command center at Coney Island Hospital on the night of the Storm and witnessed the exemplary performance of the hospital staff who reassured and protected patients as the rising waters flooded the basement and eventually washed through the first floor of the hospital.

Hospital evacuations present a significant risk to patients, even when performed under the most optimal conditions, and this is why a decision to evacuate before a forecasted storm is not made lightly.

It is a testament to the skill and commitment of our staff at both Bellevue and Coney Island, that nearly 1,000 patients, including many critically ill patients, were evacuated safely. All of these patients were transferred without incident into the hands of caregivers at sister HHC facilities and to other non-HHC hospitals, and transfer information was made available to families as quickly as possible.

Extensive clean up, repair and restoration work is underway at these two hospitals. Coney Island Hospital started offering urgent care services last week and Bellevue Hospital Center also has resumed providing primary care services –both these facilities are making these services available for extended hours 24 hours a day, seven days a week. Coney Island began providing limited emergency department services last week, and Bellevue will do the same starting next week.

We hope to have Coney Island Hospital and its ED operating at nearly full capacity by early January, and Bellevue Hospital and its Level 1 trauma service ED fully functional by early February.

The Coler campus of the Coler-Goldwater Specialty Hospital and Nursing Facility, one of our other long-term care facilities which serves some of the City’s most physically fragile and chronically disabled individuals, lost power and heat after the storm. As a result, 104 medically fragile patients were safely transferred to Goldwater. More than 500 patients remained at Coler. The facility now has power and heat. However, there is significant work to be done to permanently repair damaged electrical and heating systems.

Finally, some of our central office locations sustained damage from the storm. Most notably, more than 1,200 staff members working in key areas such as the Finance Department, Home care, the IT Department, and MetroPlus have been displaced from 160 Water Street. Despite being deployed among several sites across the City, these dedicated employees have kept our core functions operational. We are hoping that the 160 Water Street building management will have the space ready for re-occupancy by the end of February.

Mayor Bloomberg and the City Council have set aside $500 million to help schools and public hospitals to repair extensive damage to buildings. HHC will receive $300 million for structural restorations, new boilers, new mechanical and electrical systems, roof repairs, flood remediation and more. In addition, we have begun the process of applying to FEMA for funds to rebuild facilities and replace equipment. These funds do not cover lost revenue from Bellevue and Coney Island, which amounts to $15 million a week, so it will not completely make up for what we are losing between now and when the two facilities are fully operational.

HHC has faced adversity before, and we have come out of it stronger. We expect the same to be true in this instance, though the physical and financial damage to our facilities is significant, and will strain our budget and make it more difficult to implement the strategic initiatives planned for the coming year. Nonetheless, I have full confidence in our ability to rebuild primarily because of the incredible staff both at our facilities and in our central offices, who work tirelessly to ensure that we sustain our mission in serving all the patients who need us.

The Challenges

Let me turn to the very significant financial challenges HHC faced before the storm – challenges that will continue to intensify.

At the City level, as a result of a forecasted $2.5 billion budget gap for the fiscal year beginning on July 1, 2013, City agencies have been required to submit spending reduction proposals. For HHC, this means a 5.4% reduction to our baseline City funding, or a $4 million cut. This reduction will increase to an 8% reduction, or a $5.1 million cut in Fiscal Year 2014 and beyond.

We also face diminishing state and federal funding. Under the Budget Control Act of 2011, an across the board cut totaling $1.2 trillion over ten years will begin in January 2013—you may have heard this called the “fiscal cliff”. This massive cut will take place unless Congress adopts an alternative approach by the end of December 2012. An across the board 2% cut in Medicare – as currently planned -- would result in HHC losing nearly $10 million in Medicare reimbursement in 2013 and more than $83 million from 2013 to 2021.

Beyond these looming reimbursement cuts, we are increasingly in an environment where we will be expected to deliver better care, with better patient outcomes at lower costs. More and more of our reimbursement will be tied to our ability to accomplish these three things.

Healthcare providers throughout the country are also dealing with these same expectations, however the challenges for HHC are greater because we provide care for so many uninsured patients, yet continue to receive less and less funding for that work.

And under the federal health reform law, upheld by the Supreme Court this June, beginning in 2014 the federal government will make significant reductions in supplemental Medicaid and Medicare funding that supports public hospitals and other safety net institutions. Ultimately, these cuts could reduce HHC’s federal funding by more than $325 million annually. There is very little prospect of Congress re-visiting the wisdom of these looming, devastating cuts.

We continue to grapple with a daunting budget gap, and we are in the third year of a four-year cost containment and restructuring plan projected to yield $600 million in new revenue and cost savings. We remain on target with this plan, and our efforts to date have closed our gap by roughly $400 million. Our workforce has more than 2,700 fewer full-time employees than three years ago. Most of this workforce reduction has not involved direct patient care positions and, to the credit of our dedicated employees, we have maintained virtually the same service capacity across all care settings.

HHC’s senior leadership team is fully committed to keeping our financial plan on track while continuing to provide high quality, safe care to our patients. Let me stress that we are looking at every conceivable way to close our budget gap without adversely affecting our capacity to serve our communities, negatively affecting access to care, or diminishing the stellar gains in safety and quality that we have made. That said, given the looming reductions in federal funding starting next year, it will be considerably harder to achieve these aims.

I dwell on this litany of financial challenges because the magnitude of the present threats to our mission as a consequence of sharply rising expenses and deep cuts in revenues is unprecedented.

It is important that all stakeholders understand what we are up against, and why we have resorted to measures such as targeted layoffs, the closure of some small community clinics, and the outsourcing of certain services when such outsourcing lowers our expenses. And it is important that our patients, the communities we serve, and all of our partners understand the severity of our fiscal dilemma and the advocacy required to preserve HHC’s mission and continue to meet community needs.

Unlike some public hospitals across the country, our willingness to make tough and, at times, painful decisions has enabled us to avoid closing any major HHC facilities and allowed us to remain faithful to our core mission of serving all New Yorkers without regard to insurance or immigration status. However, the unrelenting financial pressure we are experiencing represents a grave threat to our mission and to our long-term ability to maintain sufficient service capacity to meet the needs of our patients across the City. And more tough decisions surely lie ahead.

Our Work on Staten Island

Even as we struggle to make our system more efficient and to manage the formidable financial challenges we face, we have continued to work with a variety of local stakeholders to expand the primary care infrastructure here on Staten Island.

Our Mobile Medical Office provides services in 5 neighborhoods including New Brighton, Tottenville, Midland Beach, West Brighton, and Park Hill. In Fiscal Year 2012 (July 2011 – June 2012), 84% of the adult patients served by the Mobile Medical Office were uninsured. We launched a second Mobile Medical Office this year, and it has been serving patients three days a week, providing ophthalmology and podiatric services, two services especially needed by patients with diabetes, a chronic disease that is as prevalent among Staten Island residents as it is across our entire City.

We also installed digital mammography equipment at Sea View to provide breast cancer screening and diagnostic services to patients referred from our health centers and Mobile Medical Offices. Last year, 221 mammographies were performed, and we expect this number to increase significantly in the coming year.

Primary care services for children and adults are available at our two Family Health Centers, Mariner’s Harbor and Stapleton. In Fiscal Year 2012, a total of 1,384 primary care patients were referred to Coney Island Hospital for specialty care services, and 260 patients were sent to Coney Island Hospital for ambulatory surgery.

And we remain firmly committed to build a $23 million state-of-the-art diagnostic and treatment center at 155 Vanderbilt Avenue. The project will be put out for bid in January 2013. Construction will begin in April 2013 and the facility should be open to serve patients in October 2014. The 21,000 square foot, three-story building will provide adult and pediatric primary care, diagnostic and specialty care, as well as behavioral health services.

On the long-term care front, we are especially proud of Sea View’s accomplishments. In the summer of 2012, Sea View had a successful Joint Commission survey. In addition, Sea View has maintained its five-star rating from the federal Centers for Medicare and Medicaid Services. This is the highest score possible and it is based on three factors: quality indicators, nursing staff levels, and prior state surveys. Sea View has received five stars overall and for each rating category, since this particular rating system was implemented in 2008.

As we have in the past, we will continue to work with faith-based and community-based organizations to support enhanced access to health care and the provision of public health and outreach efforts. Over the past seven years, we have provided technical and financial support to the Community Health Center of Richmond. We look forward to continuing to work with the Health Center’s leadership to ensure that the health center can secure additional state and federal funding to further expand its services.

We are also committed to collaborating with our colleagues at the Richmond University Medical Center, Staten Island University Hospital, and other Staten Island health and behavioral health organizations as they implement strategic plans to improve health care access for Staten Island residents. Most recently, we have been engaged in borough-based planning efforts for the Staten Island Health Home to better coordinate the health care of Medicaid patients with complex physical and behavioral health conditions.

Conclusion

We are advocating strenuously at every level of government to fend off additional cuts that would undermine our ability to continue to meet the needs of our vulnerable patients and communities throughout the City, and in Staten Island in particular.

We appreciate the strong advocacy support that we continue to receive from our partners in labor, our elected officials, our community advisory boards and Auxiliaries, and from the many community-based organizations that care about our mission. Our strong connection to, and support from, the communities we serve continues to be one of our most important assets.

Thank you all for your attention and for being here. I now will turn the program over to tonight’s moderator Mr. Russo. I look forward to hearing your comments.