ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
July 26, 2007

As I have reported over the last several months, HHC will begin to publish certain corporate-wide and facility-specific data related to quality and patient safety on our corporate web site early next month. This is the second phase of what we call HHC’s Quality Transparency Initiative.

Health consumers across the country are demanding better and more detailed information from their healthcare providers. Earlier this year, we posted on our web site (www.nyc.gov/hhc) the performance of each of our hospitals on 21 federal quality indicators that reflect how consistently each hospital follows best clinical practices in the treatment of heart attack, heart failure, and pneumonia, and in the prevention of surgical infection. A study published this past month demonstrated that high performance levels on these federal quality indicators correlates with lower hospital mortality rates for patients who present with heart attack, heart failure or pneumonia.

With the launch of the next phase of our Quality Transparency Initiative, we are demonstrating our willingness to step up, voluntarily detail our performance on important patient safety measures, and hold ourselves publicly accountable for doing all we can to keep our patients safe. The information to be posted imminently on our web site includes our system-wide and hospital-specific rates of hospital-acquired infections in our ICUs over the last two years, and our system-wide and hospital-specific mortality data for each of the last four years. As you know, very few hospitals in the country have voluntarily shared this type of data with the communities they serve. We are finalizing the formatting of this data for clear presentation on our web site and I will provide the Board with advance notice and a copy of the related data immediately before we release that data to the public and the press.

Over the last two years, HHC has made several investments in improving healthcare access for low-income Staten Island residents. To expand primary care capacity in the borough, particularly on the North Shore, HHC has provided the financial support, technical assistance and leadership necessary to establish a not-for-profit community health center (the Community Health Center of Richmond) that began operation in July 2006. The community health center currently provides adult and pediatric primary care and will ultimately be a multi-site operation which serves 55,000 borough residents regardless of their ability to pay. HHC has subsidized the operation of this new health center by more than $3 million, including funding the renovations and expansion of space at the health center’s first site.

Another important investment in improving healthcare access on Staten Island has been our initiation of the Staten Island Health Access (SIHA) program. SIHA was originally designed to address the non-acute healthcare needs of low income and uninsured North Shore residents on an interim basis or until the new community health center was in operation. Through SIHA, we have engaged 19 Staten Island-based physicians to serve as primary care doctors for more than 3,100 individuals. As part of this program, we also funded the Staten Island Jewish Community Center (JCC) to assist uninsured individuals in obtaining the public health insurance for which they are eligible. More than 800 individuals have obtained health insurance through the SIHA program. We committed $1.8 million in funding to this program through the end of this month; and another $2.0 million in funding through July 2008. The Board will be asked today to extend our contract with JCC.

HHC has also provided funding to a Staten Island-based provider of services for persons with disabilities, the Institute for Behavioral Research (IBR). We are committed to providing $200,000 to support diagnostic consultation and training services conducted by IBR.

Two months ago, we purchased a community health facility at 155 Vanderbilt Avenue that was sold by the Catholic Medical system as part of its bankruptcy proceedings. Our South Brooklyn/Staten Island Network will provide ambulatory care services in that facility. This purchase represents an additional $1.3 million investment towards strengthening the primary care infrastructure on Staten Island.

Finally, we continue to work with all Staten Island stakeholders to make additional investments, increase service capacity and improve access to non acute hospital care on Staten Island for the borough’s low-income, uninsured and other vulnerable populations. These increased services include the implementation of mobile vans to provide primary and preventive care to hard to reach populations throughout Staten Island. One such effort includes the provision of mobile mammography services through the Women’s Outreach Network. You will hear more about that today, as we will ask your approval of a contract with this organization.

An innovative HIV testing program in operation at Jacobi's Adult Urgent Care Department will be presented at the 2007 National HIV Prevention Conference, sponsored by the federal Centers for Disease Control (CDC). Jacobi's Director of Adult Urgent Care, Dr. Yvette Calderon, will give an abstract and oral presentation on the project that she leads together with Dr. Jason Leider. The project routinely offers HIV rapid tests to patients who visit Jacobi for Urgent Care, utilizing a pre and post HIV test risk-reduction and counseling education video, which is displayed on a laptop computer. Patients complete an anonymous questionnaire, using a computer touch screen and data is collected wirelessly. The HIV education and counseling given through the program adheres to all aspects of New York State Health Department regulations. Between October 2005 and May 2007, 5,392 patients agreed to be tested and 43 of those were confirmed positive. Eighty-eight percent of the confirmed positives (38 patients) were successfully linked to care. Congratulations to the Jacobi staff for this innovative HIV testing program, one of the creative strategies that HHC used to increase HIV testing by more than 125% over the last two years.

Sea View Hospital's exceptional patient safety improvements are being featured on the web site and in the newsletter published by the national quality improvement organization IPRO. After two years of participation in IPRO's New York State Nursing Home Quality Initiative (NHQI), Sea View has made significant improvements in reducing the use of restraints by 62 percent, improving pain management by 52 percent, preventing pressure ulcer development by 14 percent, and decreasing the number of residents who become depressed or anxious by 20 percent. Congratulations to Executive Director Angelo Mascia and his staff at Sea View for their continued improvements in these important safety and quality measures.

I am pleased to announce the appointment of Joyce Wale, HHC's Senior Assistant Vice President for Behavioral Health, to the Board of Directors for the Institute For Behavioral Health Improvement, a national organization focused on the quality and patient safety issues in Behavioral health services. This organization was formed two years ago with the guidance and assistance of Dr. Donald Berwick and the national leadership of the Institute for Healthcare Improvement. The IBHI Board includes Behavioral Health leaders from some of the nation's largest healthcare systems, such as Kaiser Permanente and Health Partners, as well as insurers and the academic community.

On July 10 an expanded meeting was held for SPIRIT, HHC's Suicide Prevention Workgroup, for over 75 providers from all HHC hospitals and nursing homes to host the return of Sil Lai Abrams, a survivor of a suicide attempt, who first helped HHC launch SPIRIT in November of 2005. Ms. Abrams has been an outspoken national advocate for the importance of educating healthcare staff to recognize patients who may be at risk for suicide and provide appropriate treatment. She is now embarking on a book tour and participating in several national talk shows to promote her recent book "No More Drama: Nine Simple Steps To Transforming A Breakdown Into A Breakthrough". Since its kickoff, HHC's SPIRIT has been repeatedly recognized throughout New York State as a model for suicide prevention.

HHC has now received upgrades of its bond ratings from all three of the nation’s top bond raters. As I reported to you last month, Standard & Poor’s Rating Services raised its rating on HHC’s bonds from A- to A. Since then, Fitch Ratings upgraded HHC’s ratings from a BBB+ to A-, and said HHC’s Rating Outlook was “Positive.” Moody’s Investor Services has also upgraded its rating of HHC from A2/Stable to A1/Stable. The new ratings followed the upgrading of New York City’s bond ratings. The upgrade by the rating agencies are a clear recognition of the essential role played by HHC in the City's healthcare infrastructure, as well as the Corporation's improved financial outlook resulting from the increased City share of supplemental Medicaid payments retained by HHC.

On our agenda today, for your review and approval, is an Affiliation contract renewal with the Trustees of Columbia University in the City of New York for its Health Sciences Division, for the provision of general care and behavioral health services at Harlem Hospital Center and Renaissance Healthcare Network Diagnostic & Treatment Center. The agreement is a three-year contract commencing July 1, 2007 and terminating on June 30, 2010.

The proposed Agreement will continue to compensate Columbia University based on performance and productivity and continues a long, collaborative relationship that benefits patient care. A pay-for-performance model will be implemented to assess improvement in areas of regulatory compliance, satisfaction of Centers for Medicare and Medicaid Services’ (CMS) indicators, and facility-specific quality and efficiency indicators. The total contract cost for the agreement is $182,585,556 for the three-year period.

The HHC Foundation is launching the very first HHC Physician Campaign soliciting support from HHC alum across the country. The Campaign goal is $100,000 and was kicked off with an initial lead gift of $10,000 given by former HHC President and Alum Dr. Benjamin Chu. The initial appeal is being sent to 10,000 former interns and residents. Funds raised will support the purchase of robotic patient simulators that can be programmed to replicate a wide range of emergent patient conditions, serving as a state-of-the-art tool to train physicians.

Earlier this month, Coler-Goldwater recognized two individuals, Dr. Augusta Alba and Dr. Masayoshi Itoh, for their tremendous service and invaluable contributions to HHC and the patients they have served for 50 years.

In a letter, Mayor Bloomberg wrote: “For decades, Dr. Alba has provided hope and strength to patients in recovery. An accomplished author, this remarkable doctor is also a premier consultant of the care of post polio syndrome and was instrumental in establishing the Goldwater Memorial Hospital National Foundation for Poliomyelitis Regional Respiratory Center, which closed following the disease’s successful eradication in America.”

Of Dr. Itoh, the mayor wrote: “Over the course of his illustrious career, Dr. Itoh has made invaluable contributions to Rehabilitation Medicine. An internationally renowned expert on the prevention of leprosy and the rehabilitation of leprosy patients and their disabilities, he is also a widely published author with over fifty publications to his credit. His passion and commitment have helped countless patients regain strength, hope and health.”

Both Dr. Alba and Dr. Itoh leave a legacy of compassion and service and personify the deep dedication that so many staff bring to HHC’s mission.

It is with gratitude, as well as some regret, that I note the resignation of Dr. Karen Scott-Collins, who came here five years ago to develop HHC's Office of Healthcare Quality Improvement and Innovation. During her tenure, she has led an ambitious program of corporate-wide quality improvement initiatives in chronic disease management and critical care improvements. She has also helped develop corporate strategies for delivering care more effectively to a culturally and linguistically diverse patient population. In August, Dr. Collins will begin a new position, as Vice President of Quality and Patient Safety at New York-Presbyterian Hospital. We are grateful for her significant contributions to HHC and we wish her the very best as she continues her illustrious healthcare career.

• June 27- El Diario interviewed Terry Miles, COO of Bellevue Hospital Center about the “Window of Health”—a joint health program between the hospital and the Mexican Consulate to provide access to health services at the consulate regardless of immigration status, ability to pay or type of health insurance.

• July 2- Metro interviewed Dr. Joan Reibman, Director of Bellevue's WTC Environmental Healthcare Center, about the treatment of 1,300 residents, office and cleanup workers suffering from exposure to WTC dust and fumes. The program will expand to include pediatric services and open new satellite clinics at Gouverneur Healthcare Services and Elmhurst Hospital Center.

• July 9- In a Letter to the Editor of Crain’s New York Business Ann Jackowitz, Executive Director of the HHC Foundation, highlighted how HHC creates culturally sensitive and language appropriate health plans to reduce health disparities among ethnic groups. The Letter responded to two articles, “NY Groups Find Causes Abroad” and “Labs Target Global Plagues” which described the efforts of funders, physicians, researchers and others who are addressing global health issues abroad. Acknowledging the importance of helping vulnerable populations everywhere they exist, Ms. Jackowitz urged that in addition to thinking globally, we must act locally. This message was highlighted by the Foundation’s tagline, “Serving the healthcare needs of a global city”.

• July 11- New York 1 interviewed Dr. Yvette Calderon and Pamela Lombardi of Jacobi Medical Center about its HIV rapid testing computer education project. In the Emergency Department, patients who consent to rapid testing view educational videos and answer an electronic survey on a touch-screen tablet PC while waiting for test results.

• July 15- After the shooting of Police Officer Timoshenko, The New York Times published an interview with Dr. Robert Kurtz, Director of Trauma Surgery at Kings County Hospital Center in a story about the camaraderie and close support between the local police and emergency staff at the hospital.

• July 16- Nursing Spectrum reported on a joint program between HHC and Pace University that offers nursing scholarships to students in exchange for a four-year commitment to work at an HHC facility. This is the first nursing residency program in the City that includes a service commitment to the City’s public hospitals.