ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
June 21, 2007

Last December the Institute for Healthcare Improvement (IHI) transitioned from its successful "100,000 Lives" campaign to launch a new patient safety campaign to "Protect 5 Million Patients from Harm." The new campaign takes place over a two-year period - December 2006 to 2008 - and specifies implementation of the following six evidence-based interventions to prevent harm to patients who are under hospital care.

• Preventing harm from the use of high-alert medications such as anticoagulants, sedatives, narcotics, and insulin
• Reducing surgical complications by reliably implementing all of the recommendations from SCIP, the Surgical Care Improvement Project
• Preventing pressure ulcers by using an evidence-based practice guidelines
• Reducing Methicillin-Resistant Staphyloccus aureus (MRSA) through scientifically proven infection control practices
• Delivering reliable, evidence-based care for congestive heart failure to avoid readmissions
• Engaging Boards as active partners in accelerating organizational progress toward safe care

During IHI’s Saving 100,000 Lives Campaign, from June 2005 through December 2006, our facilities implemented each of the six interventions recommended for that campaign and reduced inpatient mortality across our system, saving a projected 300 lives during that time period.

Our facilities continue to work on those six interventions and have begun to work on most of the six new interventions that comprise the Protecting 5 Million Lives From Harm campaign, most notably preventing harm from the use of high-alert medications, implementation of the SCIP recommendations, implementation of a standardized protocol to prevent pressure ulcers, and evidence-based care for heart failure.

I will continue to keep you abreast of our patient safety efforts and progress on these specific interventions.

As part of our patient safety efforts, HHC selects one exceptional risk reduction initiative annually to receive an Award of Excellence presented by HHC's Council of Risk Management. This year that award goes to the North Bronx Health Network for its suicide prevention program related to the Assessment and Management of Suicidal Aggressive Behaviors. The program seeks to prevent inpatient suicide and aggressive behavior by the consistent use of two assessment tools - the Broset Violence Checklist and the Suicide Lethality Assessment Tool. Each tool presents a series of questions which prompt the clinician to assess and document risk factors in psychiatric inpatients that might otherwise be missed. This guided assessment helps clinicians to treat at-risk patients as effectively as possible to reduce their risk of suicide. Congratulations to the behavioral health staff at the North Bronx Network for developing this approach to help prevent harm to the patients entrusted to their care.

On May 25th, the Iraq Supplemental Appropriations Bill containing a one-year moratorium on the implementation of a proposed CMS rule detrimental to HHC and other public hospitals was signed by President Bush after passing both Houses of Congress. The rule, if implemented, would reduce supplemental Medicaid funding to HHC by $350 million a year. The moratorium language also bars CMS temporarily from implementing a second rule aimed at drastically reducing Graduate Medical Education (GME) payments within the Medicaid program. If ultimately implemented, this second rule would reduce federal funding to HHC by an additional $200 million yearly and potentially an equal amount that now constitutes the State Medicaid match. The moratorium language in the recent appropriations bill prohibits the implementation of either of these rules until May 25, 2008.

However, both of these rules have been released in final form by CMS and both will go into effect next year, unless other action is taken by Congress to further delay implementation or effectively nullify the regulations. We are working with our trade association allies and other adversely affected safety net provider systems on a legislative strategy to address this threat for the longer term.

The Mayor and the City Council came to agreement last week on the Fiscal Year 2008 Budget that was passed by the Council last Friday. The $59 billion plan included more than $24 million for restorations and enhancements for HHC. This includes funding for the expanded HIV Rapid Testing Program, Child Health Clinics, Mental Health and Substance Abuse Programs, continued support for the TEMIS program along with support for medication provided to uninsured patients through HHC's outpatient pharmacies.

In addition, HHC facilities will also receive more than $13 million in new Capital funding that was appropriated by Council Members and approximately $5 million appropriated by the Borough Presidents for facility specific capital projects. We are grateful to the Mayor, members of his Administration, Speaker Christine Quinn, members of the City Council, and our Borough Presidents for their strong support of HHC, and we acknowledge with appreciation the strong advocacy on behalf of our system and our patients by our Community Advisory Board Members, our union partners, especially DC 37, and the Commission on the Public's Health System.

The Standard & Poor's rating agency upgraded HHC's bond rating on June 5 from A- to A, acknowledging HHC's strong debt service coverage, while noting that it is closely linked to strong support from New York City. The credit rating increase affects about $697 million in outstanding debt.

On June 4th to 8th, The Joint Commission conducted its triennial survey of Jacobi Medical Center. Jacobi had an intensive five-day survey by five surveyors and received full three year accreditation. The surveyors were extremely complimentary of the Jacobi staff, the facility, and the services provided. Congratulations to Network Senior Vice President Bill Walsh and his staff for their strong performance on this industry-wide test of quality and safety.

Elmhurst Hospital Center will be the last HHC hospital surveyed this year by The Joint Commission.

On June 12th, as part of a city-wide initiative spearheaded by the Mayor’s office, we conducted a full-day of intense training for providers from our pediatric emergency on the identification, assessment and treatment of child abuse and neglect. More than 140 doctors, nurses, social workers, and administrators attended this training and more staff from HHC and other New York City hospitals will attend another training session on June 27th.

This specialized training is required for each of our Pediatric Emergency Departments to become certified facilities for Comprehensive Evaluation and Treatment of Child Abuse and Neglect (CETCAN) by September of this year. Such certified facilities will, in effect, have multi-disciplinary Child Abuse Response Teams available 24 hours a day, seven days a week to provide comprehensive assessments of children suspected to be victims of child abuse or neglect. EMS protocols are being established which will require that ambulances transport children who are suspected victims of child abuse or neglect to pediatric EDs certified as CETCANs, assuming that such a facility can be reached within ten minutes.

At the moment, it appears that the majority of certified CETCAN facilities in the City will be in our public hospitals, which is fitting, as many of our facilities already have deep expertise in this critical area.

On June 12th, a day-long workshop was conducted to help our staff develop programs that can improve access to our hospitals and to our services and to provide reliable continuity of care between community and hospital providers. The session was entitled "Building Productive Relationships with Community Providers" and explored ways of building new relationships and strengthening loyalty of existing relationships with community providers by developing systems and communications that are responsive to their needs and which can help improve the coordination of care.

The workshop was attended by more than 130 of our administrative and clinical leaders. Seven community providers attended as panelists and helped to frame the morning discussion on what they need from hospitals in order to improve the care they give their patients. Also attending was a group from Montefiore who presented their model for hospital - community provider relationships. During the workshop, each hospital team wrote its action plan for growing its community provider program in the next year and taking it to the next level of performance. We look forward to seeing strong progress in this area in the months ahead.

On June 6th, 140 practitioners and administrators from rehabilitation service across our system met at a conference to examine best practices and breakthrough developments in stroke rehabilitation care. At the conference, several facilities presented strategies they have used to deliver the most effective stroke rehabilitation services for patients and their families. Presenters from outside our system also discussed some of the newest evidence-based approaches for restoration of motor function following a stroke, including the use of robotic devices that enable patients to restore greater strength to affected limbs than has been accomplished through traditional therapy. HHC rehabilitation practitioners and administrators lauded the conference content and are now exploring on-going collaborative learning opportunities, using audio conference calls or webcasts. Eight HHC hospitals are designated by the State Health Department as Stroke Centers of Excellence, making these facilities preferred stroke management and stroke rehabilitation centers in New York City.

This year’s Urban Health Conference, hosted on June 14th and 15th by HHC’s Generations Plus Northern Manhattan Health Network, drew over 250 participants to hear national health experts discuss the persistent challenges that are shared by all safety net hospitals in our efforts to reduce the disparities in health that continue to plague the communities we serve. At the opening session a distinguished panel of hospital chief executives from across the nation, moderated by Jo Ivy Boufford, President of the New York Academy of Medicine and former HHC President, offered their valuable insights into the role of safety net hospitals in reducing the burden of disease in diverse urban communities. NYS Department of Health Commissioner Richard Daines was the keynote speaker on the second day of the conference and he outlined his evolving thoughts about the policies that the state must pursue to close the healthcare disparity gaps in our communities. Congratulations to José Sánchez and his staff for organizing and hosting yet another successful conference in this series.

Earlier this week more than 275 people attended HHC's Annual Behavioral Health Conference and Recognition Awards. The title of the conference was Improving Care: The Mind/Body Connection. As the theme suggests, many of the presentations addressed ways to achieve more effective integration of physical and mental health care for our patients. The data presented on the disparity of morbidity and mortality among those with severe mental illness was particularly striking, with several studies reflecting an average life expectancy among the seriously mentally ill falling roughly 25 years short of the life expectancy for the general population. Much of this disparity can be traced to preventable or treatable conditions that are often not diagnosed or adequately treated among the severely mentally ill, and are, at least, partly the byproduct of a highly compartmentalized approach to both behavioral and medical care.

Many of the presentations by our own staff at the conference reflected the excellent work that is being done, both in rendering more effective, evidence-based care to mentally ill or chemically dependent patients and in building a foundation for a more holistic and integrated care delivery model. The presentations on depression screening and treatment in primary care settings and on the piloting of our newly developed electronic medical record module for behavioral health settings reflected the cutting edge work that is on-going at our facilities on this important front.

Every year, HHC employees demonstrate their commitment to our mission not only in their day to day work, but also in their generous support of charitable causes focused on some of the health challenges that we face in our communities across the city. Earlier this month, HHC employees demonstrated that commitment and generosity once again, raising over $69,000 as part of the American Lung Association's annual Asthma Walk on June 2nd and more than doubling the funds raised by HHC last year. The South Manhattan network brought in the lead team at HHC, raising over $22,000. As an added bonus, HHC social worker Frances Bultron of Bellevue was the happy winner of the 2007 Toyota Prius Hybrid Vehicle that was raffled to all contributors in this year's event. Thanks to all the HHC employees and their friends who helped us, for the second year in a row, raise more funds than any other corporate sponsor of the event.

HHC's computerized registry for proactive care of patients with chronic diseases has been hailed as a Project Best Advancing Agency Business Objectives by the New York State Center of Digital Government and Government Technology, a national research and advisory institute on information technology in state and local government. The "2007 Best of New York" award was one of 15 technology awards given to agencies in every branch of government throughout New York State at the government technology state conference on June 14th. As you know, our computerized registry harnesses key information from patient medical records and gives health providers access to data that helps them track key indicators and more successfully manage chronic diseases, producing better outcomes for patients.

On June 6th, HHC received a Public Health Community Award from the Public Health Association of New York City for its Mental Health Peer Counseling and Case Management Services. PHANYC does not often grant this award to mental health programs, and this recognition is an outstanding acknowledgement of the innovative programs being developed for our patients. These services, in which trained recovering patients effectively enhance the treatment of their fellow patients, are provided at Kings County, Woodhull, Coney Island, Queens and Elmhurst hospitals.

Woodhull, the lead agency for the North Brooklyn Asthma Action Alliance (NBAAA) implemented a month-long outreach and educational program during May, funded in part by the New York City Department of Health and Mental Hygiene and the New York State Department of Health. The theme for World Asthma Day this year was Kids With Asthma Can Do Anything. A total of 19 events were held, including The Asthma Mile walk for children with asthma every Monday and Friday, Woodhull’s Attack Back Workshops to educate children and their families on asthma self-management, school health screenings at PS 250 and a local Community Health Fair. The month culminated in a World Asthma Day Conference for parents and their children with asthma.

This is yet another impressive example of Woodhull’s activist approach in engaging with other community-based organizations, as well as its patients and their families, to more effectively address the pressing problem of asthma in North Brooklyn.

HHC has received a $1.8 million grant with four automatic one-year extensions from the New York City Human Resource Administration's HIV/AIDS Service Administration (HASA) to provide general mental health consultation services and Comprehensive Health Assessment Teams (CHAT) at thirteen HASA centers throughout the city, with Gouverneur staffing eight of the centers and Woodhull Hospital the other five. Each CHAT will include social work and psychiatric staff who will assess clients and determine their need for referral for supportive housing.

• May 28- New York magazine profiled two cancer patients for “The Survivor Monologues-Life on the other side of diagnosis”—a special feature about New Yorkers living with cancer. The patients were treated at North Central Bronx Hospital and Bellevue Hospital Center.

• June 13- El Diario guest columnist Jose Sanchez, Senior Vice President of the Generations + Northern Manhattan Health Network, wrote about the Urban Health Conference—a forum which discusses reducing health disparities among racial and ethnic groups.