ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
January 25, 2007

FEDERAL GOVERNMENT PROPOSES TO SLASH SUPPLEMENTAL MEDICAID FUNDING

The federal Centers for Medicare and Medicaid Services (CMS) recently published proposed changes that would reduce annual funding to New York State, resulting in an estimated $350 million reduction to the New York City Health and Hospitals Corporation (HHC).  The administration also proposed, in the State of the Union address, to shift additional federal funds away from safety net public hospitals, threatening our mission to extend quality, affordable health care to all New Yorkers regardless of their ability to pay or immigration status.

The proposed defunding would have a potentially devastating impact on the health of the predominately low-income communities served by HHC, and on the public health and safety of all New Yorkers.  These supplemental Medicaid funds help support eleven public hospital emergency departments, including six trauma centers that serve all New Yorkers, and the uniformed services.  These funds also support our extensive primary care network that prioritizes prevention to keep New York City’s communities healthy and provide five million physician visits each year.

At the state level, Governor Spitzer, in his State of the State address, announced his intention of expanding access to healthcare by enrolling all eligible children into existing insurance programs and by streamlining the enrollment process for Medicaid-eligible adults.  The Governor also has stressed the importance of supporting effective chronic disease management for Medicaid patients.  While these stated priorities are positive and heartening, it is anticipated that the Governor will propose an Executive Budget with significant Medicaid funding cuts.  The extent of those cuts and their exact impact on HHC will become clear once the proposed Executive Budget is released on January 31.

MEASURING PATIENT SATISFACTION

The federal Centers for Medicare and Medicaid Services (CMS) will soon require hospitals to conduct patient satisfaction surveys, the results of which will be publicly reported.   The CMS survey tool requires surveyors to elicit responses from a random sample of recently discharged patients about their experience during their hospital stay and their assessments of the quality of their interactions with physicians, nurses and other staff.  The results of these mandated patient surveys are scheduled to be publicly reported by CMS late this year.

As you know, to insure that the surveys are conducted in accordance with CMS’s requirements, the Board recently approved our contract with an approved CMS vendor that will perform the survey and will carry out “dry runs” prior to the official date when survey data will be reported.  The random survey will reach at least 300 adult English or Spanish speaking patients per year from each hospital.  To be counted in the survey results, a patient must have stayed in an acute medical, surgical or maternity bed for more than 48 hours.

HHC facilities have a long tradition of measuring patient satisfaction and using feedback from our patients to drive improvements.  We look forward to working with this standardized tool and survey methodology to further assess our patients’ satisfaction with the hospital services that they receive, and to further our agenda around the consistent delivery of truly patient-centered care.

PATIENT SAFETY CULTURE SURVEYS TO
ESTABLISH BASELINES FOR MEASURING PROGRESS

HHC's ambitious patient safety campaign is entering another phase with the piloting of a patient safety culture survey.  The survey tool, adapted from a similar questionnaire developed by the federal Agency for Healthcare Research and Quality, will measure staff perception about patient safety issues and challenges in our facilities.  Understanding current staff perceptions is an important first step in our efforts to create a fair and just culture that continually fosters patient safety improvements.  We will use the survey to establish internal benchmarks against which to measure the impact of our patient safety campaign on the culture of safety in each of our facilities and across our entire organization. 

Survey results will also help us identify areas of strength and opportunities for improvement, as we move towards HHC's goal of being recognized as one of the safest healthcare systems in the country by the end of this decade.  Employees may complete the anonymous questionnaire through the use of a web-based application soon to be made available throughout our system, or they will be able submit a hard copy version.  The survey is currently being piloted at Bellevue and Queens hospitals, as well as at our McKinney long term nursing facility.  It will be rolled out to all facilities during the early part of this year and will be repeated in 2008. 

COLLABORATION FOR EXPANDED CANCER PREVENTION AND CARE IN QUEENS

As announced at a press event on January 17th, our Queens Cancer Center (located at Queens Hospital Center) has partnered with the Queens Library, the American Cancer Society and Memorial Sloan-Kettering Cancer Center to form the Queens Library HealthLink initiative.  The collective goal is to increase access to cancer screening and care among medically underserved communities in Queens where many cancer rates are two to three times the national average.  The five-year, $2 million federally funded project will use 20 libraries throughout the borough to conduct community health outreach to fight cancer. The libraries will link residents to information and health services available at the Queens Cancer Center and from the American Cancer Society.  The Queens Cancer Center – which combines the cancer-related resources of Queens Hospital and Elmhurst Hospital -- will also make a mobile cancer screening van available at each of the participating community libraries to provide on-site mammograms and cervical cancer screenings.

The HealthLink initiative will build on already strong relationships that the Queens Library has within the diverse neighborhoods it serves.  The program will begin next month.

HHC PROVIDES EXPERT TESTIMONY TO CITY COUNCIL
ON MEDICAL INFORMATION TECHNOLOGY IN PRIMARY CARE

Earlier today, HHC’s Chief Medical Informatics Officer Dr. Louis Capponi gave testimony to the City Council Committees on Health and Technology in Government, about the use of information technology in primary care settings.  Dr. Capponi’s own experience as an active primary care physician makes him uniquely qualified to advise the Council on the important connection between electronic access to patients’ comprehensive health information and providing safe, effective and patient-centered care.  His testimony emphasized that in addition to supporting the development of medical information technology in primary care settings, the Council’s advocacy is also needed for the expansion of primary care capacity in many of New York City’s neighborhoods, where there is a still a shortage.

HHC PIONEERS ELECTRONIC PATIENT RECORDS IN
BEHAVIORAL HEALTH SERVICES

We continue to add to the functionality of our comprehensive electronic patient record system at HHC facilities.  We are presently working on ensuring that our mental health providers can record behavioral health information electronically in the same way that other types of health information are documented.  Because of the complex nature of behavioral health information, including many assessments, treatment plans and progress notes, few healthcare systems have incorporated it into their electronic record.

The Behavioral Health Electronic Record Enterprise (BeHERE) is an electronic clinical documentation solution for all Inpatient, Outpatient, and Emergency Department care settings within mental health and chemical dependency services.   BeHERE has been developed as an integrated component of the Misys EMR system that is currently used throughout general care settings at HHC.   BeHERE is home-grown; it was designed by a multi-disciplinary team drawn from the behavioral health departments of several HHC hospitals as well as personnel from our corporate divisions of Information Technology, Finance and Medical and Professional Affairs.   As with our existing EMR, the BeHERE component will improve information retrieval, reduce duplication, and support billing and regulatory compliance.

The BeHERE system went live at the Coney Island Hospital pilot site in the adult and child mental health outpatient clinics in late 2006.  The inpatient mental health and detoxification units, psychiatric emergency department, chemical dependency services and community-based programs are scheduled to go live in the next six to eight months.  The schedule for roll-out to other facilities is being planned.

WTC HEALTH CENTER TO OPEN AT BELLEVUE

The new WTC Environmental Health Center at Bellevue will officially open next month, making available additional space and resources to treat up to 6,000 patients who are experiencing adverse health symptoms caused by the events of 9/11.  The Center will significantly expand services that HHC has been providing to WTC-impacted patients who are uninsured or otherwise ineligible for financial assistance for medical treatment.  As the mayor announced in September, the city will contribute $16 million over five years to this program expansion.  Bellevue has already enrolled an additional 300 patients into its program over the last several months.  

After its official opening the new Center also will expand its outreach to patients in need and establish further referral connections with other WTC-related community advocacy groups.  Healthcare teams at the Center will continue to collaborate with other health providers in the City to pursue related research and deepen their understanding of the nature and treatment of WTC-related illnesses.

STATE IMPLEMENTS CHARITY CARE STANDARDS

New legislation establishing minimum charity care and financial assistance policies for all hospitals went in effect on January 2007.  HHC, through its HHC Options program, offers a sliding fee scale to patients up to 400% of the federal poverty level, and therefore already exceeds the minimum thresholds in the new law.  Nonetheless, to ensure that our financial assistance policies are communicated as clearly and as broadly as possible, the Literacy Assistance Center is helping us redraft our HHC Options brochure for maximum comprehension at lower literacy levels.  We will then translate the brochure into our ten most common languages and distribute it broadly to our communities. 

LINCOLN AND BELLEVUE FEATURED IN STATEWIDE TRAINING VIDEO
ON PREVENTION OF SURGICAL SITE INFECTION

Staff from Lincoln and Bellevue Hospitals appeared as the primary experts in a training video about the prevention of surgical site infections recently released by the Hospital Association of New York State.  The video, part of a six video series produced by HANYS, was distributed to hospitals across the state to support the adoption of evidence-based best practices championed by the Institute for Healthcare Improvement’s (IHI) 100k Lives Campaign.  Six of the top ten highest performing hospitals in NYC on the CMS quality indicators related to surgical infection prevention are HHC facilities, including Lincoln and Bellevue. 

STATEWIDE RECOGNITION FOR HHC’S HIV PROGRAM

Last night the New York State Health Foundation  awarded HHC a grant of nearly $74,000 for the further expansion of our HIV testing initiative.  The award was one of only 23 selected from more than 600 applications.  The award will allow HHC to identify those HIV testing practices which are most successful in integrating HIV testing into routine medical care.  HHC and the Foundation plan to use the results of the evaluation to inform and encourage the expansion of HIV testing locally and nationally.

Earlier in the month Jacobi’s Corporate Conference Center was site of the first HHC HIV Research Symposium, partly supported by an unrestricted educational grant from Pfizer, Inc.  The Symposium provided an opportunity to award the HHC Lifetime Service Award in HIV to Dr. Fred Valentine, who has spent his career at Bellevue and NYU, including more than 25 years of research in HIV/AIDS. Dr. Valentine and his colleagues first identified the initial Pneumocytis jiroveci pneumonia (PCP) patient at Bellevue in 1980; it was this case and others that followed that led to the recognition in the United States that a frightening new infectious disease, later to be called AIDS, had emerged. Dr. Valentine’s dedication and expertise are known throughout the world and we are fortunate to count him among our HHC physician leaders.

FUNDING FOR EXPANSION OF SUCCESSFUL HHC PROGRAMS

• Through the efforts of the HHC Foundation, HHC has received a grant of $300,000 from the Ambrose Monell Foundation for an initiative to improve outcomes for fragile neonatal patients. The grant will be used for staff training, analysis, planning and environmental modification of our NICUs to minimize noise and ambient lighting.  The program will also offer training to teach parents of premature babies what they can do to improve their infants’ overall development.  Our hospitals handle a disproportionate number of our City’s high risk pregnancies and approximately 20% of all babies born in HHC hospitals require care in one of our Neonatal Intensive Care Units.
  
• Bellevue Hospital was one of ten hospitals chosen by the Robert Wood Johnson Foundation to participate in a national program that seeks to improve healthcare quality offered to patients with limited English proficiency.  Bellevue will be the recipient of up to $60,000 as well as technical assistance and training to be used for quality improvement measures in their language programs.
  
• Dr. Hawthorne Smith, Psychology Director, and co-Director of Clinical Services at Bellevue/NYU Program for Survivors of Torture, was named Hero of 2006 by the Robin Hood Foundation.  Dr. Smith will receive a $50,000 grant for the program which helps survivors heal from the trauma of torture, as they build new lives.

HHC IN THE NEWS HIGHLIGHTS

• December 18-22- WADO Radio reported on HHC’s LegalHealth program, a service that provides free legal advice and representation on civil legal matters for low-income patients.  New York 1 Noticias also covered the story and Channel 47 interviewed Karina Lipan of Elmhurst Hospital Center.
  
• December 21- WBAI Radio interviewed Dr. Edward Fishkin of Woodhull Medical and Mental Health Center about Artist Access, a financial assistance program where artists can earn credits to pay for their health care by performing or providing their services for the hospital's patients.
  
• January 8- New York Post reporter Carl Campanile reported on the city’s public hospitals plan to launch a hospice-type program for terminally ill patients. 
  
• January 11- Channel 47 interviewed Robert Boyd and Lady Cornejo of Bellevue Hospital Center about how it cares for uninsured patients, regardless of immigration status, through HHC Options, a financial assistance program that helps low and moderate-income patients to receive affordable healthcare.
  
• January 15– New York Post reporter Carl Campanile reported on HHC’s rapid response medical teams, which has led to the number of cardiac arrests falling by more than 50 percent last year. 
  
• January 15-17- New York 1 reporter Ruschell Boone featured Queens Hospital Center’s involvement in Queens Library HealthLink, a federally funded initiative to increase access to cancer screenings and care to the medically underserved in Queens.  The program partners the hospital with the Queens Borough Public Library, the American Cancer Society and Memorial Sloan-Kettering Cancer Center.  New York Daily News also covered the story. 
  
• January 21 – HHC President Alan Aviles participated in a roundtable interview on Tiempo, Channel 7's weekly roundtable discussion show that focuses on the issues related to the Hispanic community.  Aviles shared HHC’s role in offering financial assistance to uninsured and underinsured patients, particularly in light of the new state charity care and financial assistance guidelines that all hospitals must fulfill.