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

We are continuing to accelerate our patient safety efforts across multiple fronts. On October 9th, HHC convened the fourth Senior Leadership Forum on Patient Safety. The forum series has been bringing together top HHC administrators and clinical leaders for dialogues that assess our progress and craft specific action steps toward reaching our goal of becoming one of the safest healthcare systems in the nation by the end of the decade. The program faculty included Dr. Allan Frankel, Patient Safety Officer, Partners Healthcare System Inc., whose keynote address was titled "Leadership, Team Practice, Just Culture." More than 140 senior leaders participated in the Forum.

This month we embarked on a 12-month Patient Safety Awareness Campaign designed to engage and educate our employees, patients, and visitors about specific ways that we can work together to improve patient safety.

The campaign, whose theme is HHC & You: Partnering for Safer Care, is designed around four important elements that we believe are critical to the success of our patient safety program. Each has a specific takeaway message.

• Make Safe Choices: Prevent Harm – Reinforces to all employees the importance of making safe behavioral choices in the workplace, to prevent harm to themselves, their patients, and their colleagues. Safe choices include simple yet effective techniques such as checking two patient identifiers before administering a medication.

• Prevent Infections: Good Health is in Your Hands – Emphasizes the importance of effective hand hygiene. Evidence shows that 50% of all infections that occur in healthcare organizations across the nation could be prevented if employees practiced appropriate hand hygiene before and after providing patient care.

• Help us Help You: Partnering for Safety – Reinforces the message that safe patient care requires good teamwork and clear communication between clinicians and their patients.

• Check Meds Every Time: Name, Strength, Dose – Emphasizes the most significant factors that promote medication safety. We cannot overstress the importance of medication safety. The federal Agency for Healthcare Research and Quality has concluded that more than 700,000 people are injured or die in hospitals each year due to an adverse drug event.

We launched the campaign with an update to our internal Patient Safety Gateway Intranet site including an online video message from me to all HHC employees. Network and facility leadership, Patient Safety Officers, and other staff will develop activities to accompany each Campaign component, such as town hall meetings for all employees, information booths in facility lobbies, and distributing campaign materials.

On October 18th, the House of Representatives failed, by a vote of 273 to 156 (including 44 Republicans), to override President George W. Bush's October 3rd veto of the State Children's Health Insurance Program (SCHIP).

The House had originally voted 265-59 on September 25th -- 25 votes short of the two-thirds veto-proof margin -- to approve the legislation. Two days later the Senate voted in favor of the bill by 67-29, a veto-proof majority. Two of the leading Senate architects of the bill were Republican Senators Grassley and Hatch. This created a level of bipartisan support in the Senate that was unfortunately lacking in the House. The legislation would expand coverage from the current 6.6 million children to a total of 10.6 million -- to 300% Federal Poverty Level (FPL) -- and add $35 billion over five years into the program.

While the original authorization of SCHIP expired September 30th, Congress is funding the program at current levels until November 16th via a Continuing Resolution. However, a vote in the House on a revised SCHIP (H.R. 3963) bill is expected today. There are a number of major revisions. The bill clarifies that undocumented children are ineligible (Social Security numbers would need to be checked). It caps eligibility at 300% FPL -- $61,950 for a family of four (although New Jersey, which has the only state program insuring youngsters up to 350% FPL is exempted from this provision). It also re-emphasizes the priority of insuring youngsters under 200% FPL (providing bonus payments only for enrolling such children). It would phase out SCHIP coverage for childless adults within a year and disallow any new state waivers including parents while allowing states to transition covered parents to a separate block grant. The hope is that these changes will generate enough Republican votes to override a Presidential veto. If there are not enough votes to override a veto, the program will be funded through new Continuing Resolutions near current levels while the political battle continues.

It should be noted that the current versions of the bill do not overturn CMS' recent rejection of New York State's proposed eligibility expansion to 400% of federal poverty level. New York, along with seven other states, is suing CMS over new guidelines adopted on August 17th that would make it very difficult for any SCHIP program over 250% of FPL to survive. A key component of these changes would require 95% of eligible children under 200% of FPL to be enrolled in SCHIP or Medicaid before any expansion over 250% is approved or allowed to continue. States would have twelve months to take corrective action. Eighteen states and Washington D.C. either have such programs or have passed legislation to increase eligibility. Since no state currently covers 95% of such children (New York is at 88%) all these programs are in jeopardy unless new legislation is passed. This new requirement was a major basis for the rejection of New York's expansion proposal.

On September 28th, the federal Centers for Medicare and Medicaid Services (CMS) published a proposed rule governing the use of the outpatient upper payment limit (UPL) that would reduce outpatient Medicaid payments to HHC by over $100 million annually. If implemented, the effective result would be the loss of reimbursement for many ancillary outpatient services as well as payments for Graduate Medical Education (GME). Some reductions, including the loss of GME outpatient payments, overlap with cuts that would result if previous CMS issued Medicaid regulations limiting Public Providers to Cost and eliminating GME were implemented. Currently, there is a Congressionally mandated moratorium on the implementation of these two rules which expires May 25th 2008. HHC will be submitting a comment letter to CMS outlining our opposition to the new proposed rule.

We do have some good news regarding World Trade Center Health issues. The entire Senate on October 24 voted to approve language that for the first time would appropriate some funds for the 9/11-related health needs of residents, office workers and students out of a total of $55 million for WTC Health treatment and screening. Also, 54 members of the House of Representatives have signed a letter initiated by Congressman Nadler addressed to the Congressional Appropriators supporting the Senate 9/11 Health language including residents, area workers and students.

Last month we became the first hospital in New York State to publicly report on our web site many of our quality indicators for inpatient and nursing home care, including mortality and hospital-acquired infection rates. This open and honest reporting was very well received by the public and by healthcare policymakers. Next we will move ahead to add to our web site quality data for a variety of disease prevention and management services. Prevention statistics will include mammograms and colonoscopies done, flu immunizations given, and patients enrolled in smoking cessation programs. Chronic disease management figures will include outcome statistics for asthma and diabetes treatment. Our transparent reporting of these numbers underscores our commitment to quality and our willingness to be held accountable for providing the services that will ensure the continuing health of our community.

The Obstetrics Departments at Elmhurst and Queens hospitals have begun learning a new approach to patient care, Crew Resource Management. The system is based on teamwork principles developed by military and commercial flight teams, and has produced positive results in a number of healthcare settings. The goal of the training is to enhance the culture of communication to reduce errors, enhance patient safety, and improve outcomes in Labor and Delivery units. Training is being done with interdisciplinary teams of Obstetric and Anesthesia physicians, midlevel providers and nurses. It is expected that the remaining HHC hospitals will participate in the Crew Resource Training over the next two years.

On November 1, HHC will receive the 2007 Excellence in Technology Award from the NYC Department of Technology and Telecommunications for Best Application Serving an Agency's Business Needs for our Electronic Medication Administration Record (eMAR). This application has been developed as part of our ongoing improvements to high quality patient care, and is an important addition to our patient safety arsenal. The system enables nurses to document medication administration at the point of care, displays advisories such as drug-drug interactions, lets nurses view orders exactly as the doctor writes them, displays drug-allergy interactions and duplicate procedures, and allows the nurse to know instantaneously when a medication order has been reviewed by the pharmacy. Congratulations to HHC's Chief Medical Informatics Officer, Dr. Louis Capponi, who so skillfully led this ambitious two-year effort, during which more than 3,000 nurses were trained across 150 nursing units. Additional thanks go to the entire nursing leadership, for their enthusiastic participation in the development of the system, and to our facility IT staff, for their diligent work to develop the technical solutions that the system required. It was a large team effort, and this award is well-deserved.

HHC joined the New York City Center for Economic Opportunity (CEO) this month to announce the Nurse Career Ladder program for 400 low-income New Yorkers to enter and advance in the nursing profession over the next four years. With $10 million in funding from CEO, the program will provide scholarships to 40 students each year, recruited by the Office of Adult Education, to prepare them for careers as Licensed Practical Nurses at a newly renovated training facility at Coler-Goldwater Specialty Hospital. Another 60 will be selected annually to receive scholarships to train as Registered Nurses at Kings County Hospital. Students will be trained in a new nursing school that will be built, with $7 million of the CEO funding, on the same site as a former Nursing School that opened in 1897 and graduated its last class in the late 1970s. The new nursing school rekindles an old tradition of the public hospital system training many of its own nurses. With so many of HHC's current nursing staff approaching retirement, this program is a sensible method for preparing the next generation of nurses. Many thanks to the Center for Economic Opportunity, the Education Department's Office of Adult and Continuing Education, and Long Island University School of Nursing, who have collaborated with us to develop this program.

Earlier this week, the Mayor announced that a tentative settlement has been reached with the New York State Nurses Association covering 6,500 Registered Nurses who work in HHC hospitals and health centers. The new contract, which covers the period from December 1, 2007, through January 20, 2010, will give nurses wage increases of 2% on January 1, 2008 and 5% on July 1, 2008. Nurses are the backbone of our hospitals and skilled nursing homes and play a vital role in providing quality patient care. We are pleased that the terms of this contract will help make a nursing career in the public hospital system that much more attractive to young men and women in the future.

As I reported last month, HHC is redoubling its efforts this year to immunize as many of our employees as possible against influenza. The flu can be fatal to our most fragile, acutely ill patients, and we've made it clear that flu immunization is an important patient safety issue. We've reached out with posters, email blasts and special incentives to encourage employees to take advantage of the free flu shots that are available to them on every shift during a special two-week "blitz," from October 22nd to November 4th. HHC staff immunization levels have been going up every year, and last year reached 36%. While that is a good showing, we can and must do better, and I have set an overall goal of 60% for the 2007-2008 flu season.

Woodhull and Elmhurst hospitals are among 50 hospitals that have been designated as pilot sites for The Nursing Compass Project, a Business Intelligence Tool designed by the Advisory Board, a Washington, D.C. health research company. The project provides transparent analysis of cost, productivity, clinical quality, and staff management. Nursing-sensitive quality performance metrics will be tracked in the system's Quality Dashboard across time to monitor performance for each unit. The project's goal is to provide better information to the organization and provide tools to quickly translate that information into results. The project is aligned with HHC's strategy to ensure care, quality, and safety through increased transparency.

HHC's strategy to offer more HIV testing throughout our system is reaping very positive results. Because so many of our HIV-positive patients were not learning about their status until the disease had progressed, we have expanded HIV testing, and subsequently connected patients who test positive with a program of effective care. In the latest fiscal year, ending in June, we tested 134,000 patients. At current testing levels, we expect to reach our goal for the current calendar year, which is to provide 150,000 HIV tests to New Yorkers.

For the fifth consecutive year, HHC was a flagship sponsor of the American Cancer Society's March Against Breast Cancer walk. Employees and their friends and families turned out in force to walk and raise funds for breast cancer treatment and research. Final figures are not immediately available, but already it appears that HHC teams have shattered any previous record for number of walkers and dollars raised. I walked in my home borough of Brooklyn this year and was once again moved by the spirit of HHC staff, who contribute their time and enthusiasm so generously to one of the premier events in the fight against a disease that affects so many of our patients.

Harlem Hospital Center is collaborating with the Greater Harlem Chamber of Commerce on a new "Healthy Eating/Healthy Living" initiative, to educate the community about healthier food choices that prevent or reduce the diseases that disproportionately affect Harlem residents.

• A ribbon-cutting ceremony was held on October 18, 2007, to celebrate the new women's imaging center at Metropolitan Hospital Center. The 2,600 square foot imaging center includes two mammography rooms, a breast biopsy room, and an ultrasound room.

• Coney Island Hospital has opened a new GI suite, with 50% more space than the previous space. The suite contains four procedure rooms, four exam rooms, physicians offices, a nurse's lounge and larger patient waiting and recovery areas.

• September 20- WBBR AM-Bloomberg Radio interviewed Alan Aviles about the expansion of the World Trade Center Environmental Health Center to Gouverneur and Elmhurst Hospitals.

• September 20- The Bronx Times Reporter published a column written by HHC president Alan Aviles about HHC’s decision to post its hospitals’ quality and safety performance data on its website. In the column “How to Understand your Hospital’s Record”, Aviles says that the goal of HHC in Focus is to help patients better understand what public hospitals are doing to deliver more reliable, effective care and to keep patients safe. Mr. Aviles says he feels strongly that this open and honest transparency has the power to accelerate performance improvement.

• September 20- The Times Ledger wrote about the quality and measure data posted on HHC’s website, touting Queens Hospital Center among the best of the city’s public hospitals in most categories.

• September 21- The New York Times wrote about the expansion of the World Trade Center Environmental Health Center to two new clinics at Gouverneur and Elmhurst Hospitals. The announcement got broad coverage from other print and broadcast media including the Daily News, New York Post, The New York Sun, Newsday, Fox 5, CBS 2, NY1 News, Univision, NBC 4, News 12 Brooklyn, WNYC Radio, and 1010 WINS.

• September 22- The New York Times wrote about a new rule by the Federal government that limits coverage of emergency medical care for illegal immigrants in New York State, specifically chemotherapy. The Times article, quoting officials from HHC, says that the City’s public hospitals will continue to provide cancer treatment regardless of the new rule but that they would have to look else where for financial support.

• September 26- In a press conference at Bellevue Hospital with Governor Eliot Spitzer and health officials, HHC President Alan Aviles said that the city’s public hospitals will continue to care for illegal immigrants’ emergency medical care in spite of a federal government rule limiting coverage of chemotherapy for illegal immigrants. President Aviles and Ana Marengo were interviewed by Telemundo, Univision, and NY1-Noticias, about HHC’s position to continue caring for illegal immigrants.

• September 26- The Journal News published an article featuring Dr. Sheldon Teperman of Jacobi Medical Center. The article tells the story of a nine-month pregnant woman who was shot in the abdomen and the doctors’ struggle against the clock to save the baby and the mom.

• October 1- NY1 News featured a story about the Take Care New York campaign and the low cost, no cost screenings offered at HHC locations for the month of October.

• October 3- WADO AM Radio interviewed Dr. José Mejía of Woodhull Hospital about the HHC Child Health Clinic Campaign. Dr. Mejía discussed the services offered at the clinics as well as its locations.

• October 15- Crain’s New York Business wrote about the compatibility problems of different computer networks in hospitals and how hospitals are investing in high-tech systems. Dr. Louis Capponi of HHC said that computer networks that can’t communicate with one another are “like the early days of building railroads, different companies laid different-size tracks, when they met up, they couldn’t connect.”

• October 22- Crain’s New York Business in its Health Care Report section featured a story about the surge of the Baby Boomer generation that will be requiring more health care resources for a longer period of time. Alan Aviles was quoted saying that the increase of utilization “is going to be one of the central challenges of the next couple of decades.” The report says that HHC is one of several organizations ahead of the curve in the creation of its own cadre of elder-care specialists, referring to a program created by HHC to train its primary care physicians in geriatrics.

• October 23- The Daily News reported that the nursing education program will return to Kings County after many decades, thanks in part to funding provided by the Center for Economic Opportunity. Alan Aviles said, “It rekindles an old tradition of the public hospitals system training many of its own nurses.” The article also mentions the LPN Program at Coler-Goldwater, stressing that both initiatives help address the nursing shortage and give low income New Yorkers an opportunity to advance or enroll in nursing careers.

• October 23- Wall Street Journal reporter Theo Francis featured an article about how HHC physicians are helping culturally-diverse diabetic patients modify their diets to better manage the disease. It featured Kings County Hospital’s demonstration kitchen and classes for Caribbean Immigrants. The article illustrated Elmhurst Hospital Doctor Huajun Huang’s idea of posting photographs of proper size portion of typical Indian and Chinese dishes in a website available at every exam room at the hospital.

• October 24- The Daily News in its Voice of the People section, published excerpts of a letter written by HHC President Alan Aviles in response to a previous editorial by the News demanding for disclosure of hospital-acquired infection rates. Aviles said that public hospitals were the first in the state to voluntarily make such data public in an effort to build more trust and push improvement.