ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
November 29, 2007

On November 12, Sea View Hospital Rehabilitation Center and Home became the first long term care facility in five years to receive the Ernest Amory Codman Award from The Joint Commission. The recognition was given to Sea View for excellence in the use of performance measurement to achieve improvements in the quality and safety of health care. Sea View received the award for its initiative to decrease incontinence among its residents.

The award is all the more meaningful because Dr. Ernest Amory Codman, regarded in health care as the “father of outcomes measurement," encouraged the transparency of outcomes to help guide patients in their health care choices. HHC embraces his philosophy and this award re-affirms our commitment to pursuing transparency and our belief that implementing evidence-based best practices at every level of clinical care leads to improved patient outcomes and increased patient safety.

Sea View developed its enhanced toileting program after finding a correlation between rates for falls and incontinence. The new program, implemented from 2003 to 2006, led to decreases in incontinence rates, from 79 percent to 38 percent; pressure ulcers - from 12.4 percent to 8 percent; and patient-falls - from 8.3 percent to 6.1 percent. There was also a reduction in staff injuries, a common occurrence in the physically-demanding practice of helping patients who have limited mobility.

Congratulations to Sea View’s Executive Director, Angelo Mascia, Carole Morgan, Director of Nursing, and the entire Sea View Staff for this well deserved honor.

On Tuesday, November 6, the American Lung Association of the City of New York presented their highest recognition to HHC, the Life and Breath Award, for our outstanding contributions to lung health in New York City. I was proud to accept this prestigious recognition on behalf of HHC staff. As you know, we have made the fight against chronic illnesses such as asthma a cornerstone of our healthcare agenda. We have adopted a very aggressive approach that follows best practices of asthma care and engages asthmatic patients in their own care management. Across our system, asthma-related pediatric emergency visits declined by 24% and hospital admissions dropped by 30% during the past two years.

I want to acknowledge three members of the Board of the Lung Association and HHC’s own – Dr. Irwin Berlin and Dr. Luis Rodriquez of Elmhurst Hospital and Dr. Edward Fishkin of Woodhull Hospital, three of our many innovative and passionate physicians who are using their skills and resources to go beyond the hospital walls and bring our practice of pulmonary medicine deep into our communities.

It was an honor to receive this award from the American Lung Association. But it’s been a greater honor to be part of HHC’s work to expand access to care, improve health outcomes, and save lives through our work in the fight against asthma.

Tomorrow, on the eve of World AIDS Day, HHC will be announcing the extraordinary increase in HIV rapid testing that our hospitals have achieved by expanding testing to more patient care settings and by making HIV tests part of routine medical care for patients age 13 to 64. I will be joined by City Council Speaker Christine Quinn and other elected officials at a press conference tomorrow to announce these results and emphasize the importance of early detection and treatment.

Making HIV testing part of routine care reduces the stigma associated with HIV and allows us to reach more New Yorkers who may have the disease and not know it. HHC facilities are also observing World AIDS day with a variety of events tomorrow, offering rapid HIV tests and educational events throughout the city.

Our month-long Take Care New York health screening campaign this October provided nearly 17,000 health screenings to New Yorkers, a 17% increase over last year's outreach. This year’s campaign featured flu shots along with the screenings. We're still gathering information from some of our facilities, but preliminary numbers show that more than 1,350 people became new HHC patients as a result of the screenings - up 49% from last year. More than 1,200 people were referred to HHC facilities for followup care, an increase of 73% from the 2006 campaign. Approximately 900 New Yorkers applied for health insurance or registered for HHC Options.

The campaign received multi-media coverage in daily and community press across the city including the New York Daily News, and El Especial, and was featured on NY1 News and Bronx News 12. Our doctors were also featured in broadcasts on popular radio stations WBLS and WADO where they encouraged New Yorkers to get screened. Other agencies and health organizations supported the campaign, including the New York City Health Department, the Department for the Aging, the Mayor’s Office of Immigrant Affairs, the American Cancer Society, the American Diabetes Association, the American Heart Association and MetroPlus. A special acknowledgment goes to the Mayor’s Office of Adult Education who helped nearly 800 adult learners get screened at our events. Special thanks to all of our staff throughout the system who helped make this year’s campaign a success.

Next week all of our facilities will be holding numerous events for National Handwashing Awareness Week to highlight the importance of consistent hand hygiene in meeting our patient safety goals. With your packet today you have received samples of some of the hand sanitizers and educational materials that will be distributed to staff and patients during the week, from the special handwashing stations that Patient Safety Officers will be setting up in our facilities.

Queens Hospital Rehabilitation Department was recognized as one of the top performing units among 827 such facilities nationwide by Uniform Data System for Medical Rehabilitation - UDS - the standard rehabilitation data benchmarking service recognized by the Joint Commission and CMS. Queens Hospital ranked in the 92nd percentile, in effectively improving patient's ability to function, exceeding the expected level of functions on discharge, and enabling more patients to return to the community. Congratulations to Queens Hospital Executive Director Antonio Martin, as well as Rehab Director Dr. William Gibbs and his staff for their outstanding performance.

This month marked the first anniversary of "House Calls," an innovative health program that uses technology and telecommunication to support diabetes patients in achieving more effective self-management of their chronic condition. The program was developed by HHC Health and Home Care and its initial launch was implemented in collaboration with Metropolitan Hospital and MetroPlus Health Plan.

Patient health is monitored at home, where each patient uses a glucometer connected to a modem. Each day, the patient sends his or her blood sugar readings to a telehealth nurse and triage team over a toll-free phone line. The health team is alerted to any values that are outside the range that has been set by the doctor, and these are addressed promptly to help patients maintain their blood sugar value within an acceptable range. Positive reinforcement is another key to success and patients get frequent phone calls and letters praising them for their effective disease management efforts.

Among the more than 100 patients who have participated in the early rollout of the program, 70% have demonstrated a decrease in average monthly blood glucose and 52% had blood glucose within normal limits. The program is now available to serve patients throughout HHC. Congratulations to Ann Frisch and her staff for the auspicious beginnings of this promising program.

Coney Island Hospital has developed a comprehensive falls prevention program entitled STAR - Safe Teamwork Approach to Reduce Falls. The system includes frequent assessment of patients to determine their risk for falls, written guidelines for nurses, staff and volunteers who assist patients, and multilingual brochures for patients and their families to educate them about precautions they can take to prevent dangerous falls. Patients who are at high risk for falls are clearly identified with a purple wrist band with an illustration of a "falling star" to serve as a simple reminder of the special precautions needed to prevent injury. We look forward to hearing more about the results achieved by this creative approach to a patient safety challenge at every facility.

It's a great pleasure to congratulate a number of HHC leaders who have been singled out for their outstanding contributions, by their colleagues in healthcare and the larger community.

LaRay Brown, HHC's Senior Vice President for Corporate Planning, Community Health and Intergovernmental Relations, was honored last month by the New York Association for Ambulatory Care at its 22nd Annual Celebration of Significant Contributions and Commitment to Ambulatory Care. Ms. Brown was acknowledged for her exemplary contributions to the provision of ambulatory care services to the New York Community. The warm and admiring tribute was highlighted by speeches by Network Senior Vice President Lynda Curtis and Corporate CFO Marlene Zurack, who praised her astonishing work ethic, her encyclopedic understanding of the world of healthcare, and her inspiring leadership.

At the sixth annual benefit dinner held recently at the United Nations by the Bellevue/NYU Program for Survivors of Torture, Bellevue's Chief Financial Officer, Aaron Cohen, was honored for his years of support. The Bellevue program, which has garnered an international reputation for excellence, provides comprehensive multidisciplinary care to immigrants, particularly refugees and asylum seekers, who have experienced torture and other human rights abuses in their countries of origin. The award recognized Mr. Cohen's financial leadership support that has proved vital to the program's growth and development.

Queens Health Network leadership was acknowledged by two community organizations last month. Elmhurst Hospital Executive Director Chris Constantino was named "Person of the Year" in the Large Business category by the Queens Chamber of Commerce, who acknowledged his outstanding 26-year hospital career, and praised his numerous accomplishments at Elmhurst. Dr. Ann Sullivan, Senior Vice President of the network was also honored last month, by the Queensboro Council for Social Welfare, who presented her with their annual Claire Shulman Award for outstanding leadership in the Queens community.

As you know, HHC facilities are working this year to meet a new goal of having 60% of all HHC employees and affiliates immunized against the flu. Immunization of healthcare workers is an integral part of our patient safety campaign, since numerous studies have shown that it can prevent flu infection of patients, whose health is often fragile and who can suffer serious consequences from influenza. As of November 15th, 44% of HHC employees had been immunized this year against this serious and preventable illness. This is a strong improvement from the 36% rate achieved by the end of last year's flu season and we look forward to seeing further progress as the flu season continues into the early part of 2008.

As part of its larger patient safety campaign, HHC has been working consistently to implement clinical protocols that prevent hospital-associated infections, including those caused by antibiotic-resistant organisms, such as MRSA, which are of increasing public concern. This week HHC began broad screening for pre-existing MRSA colonization among patients admitted to its ICUs to assess whether this type of surveillance is an effective means of reducing the incidence of infection. We will assess the results of this screening effort after six months to further inform our screening protocols going forward.

I traveled to Washington DC early this month to testify before the House Committee on Oversight and Government Reform on behalf of the National Association of Public Hospitals. HHC and NAPH members are concerned about a number of regulations issued by the Centers for Medicare and Medicaid Services (CMS) over the last several months that would have a severe adverse impact on safety net hospitals and health systems in many parts of the country.

My testimony focused on the Medicaid cost limit regulation, which is subject to a Congressionally-adopted one-year moratorium until May of 2008. By CMS's own reporting, it is estimated that over $5 billion would be cut from the Medicaid program over five years. We project that the impact would be a $200 million cut in annual funding to HHC alone. Other states could see cuts to their public hospitals that could exceed half a billion and more. These cuts, if enacted, would jeopardize vital but unprofitable services provided by HHC and other public hospitals like our trauma centers, neonatal intensive care units and burn units, as well as force a downsizing of our ambulatory care and disaster response capacities.

NAPH members also testified about another proposed CMS rule that would cut funding related to Graduate Medical Education (GME).

We have urged Congress to prevent these rules from taking effect and to reaffirm its role in setting Medicaid policy for the country. We will continue to work with our local elected representatives like Congressman Eliot Engel who is sponsoring a bill -- now with 153 cosponsors -- that would extend the current legislative moratorium on the implementation of the GME and public provider cost limit regulations. We hope to see action before the end of the year.

On October 15, 2007, The Centers for Medicare and Medicaid Services (CMS) approved a request for our subsidiary, MetroPlus Health Plan, to offer managed care coverage to Medicare-eligible New Yorkers in Manhattan, Brooklyn, the Bronx and Queens. MetroPlus Medicare Advantage will be available for those who receive full or partial Medicaid benefits; MetroPlus Medicare Advantage Select, for those eligible for full Medicaid benefits; and MetroPlus Medicare Advantage Partnership in Care, for people with HIV/AIDS, who are eligible for Medicare, with or without Medicaid. Expanding coverage to Medicare beneficiaries is a natural progression of MetroPlus’ mission to promote the health and welfare of all of New York City’s diverse populations. Congratulations to MetroPlus Executive Director Dr. Arnold Saperstein and his staff for achieving this milestone in MetroPlus history.

The NYC Mayor's Office and the City Council are providing $745,000 to the Corporation to conduct community health assessments in underserved NYC neighborhoods and to present findings in time for Fiscal Year 2009 budget discussions in April 2008. Because of the urgency of the funders' deadlines, I have granted a deviation from Operating Procedure 100-5 to allow the Corporation to enter into a contract valued at $450,000 with a consulting firm to conduct this assessment and to work with HHC staff and other stakeholders to develop service expansion recommendations. The firm, Tripp Umbach, was selected through a competitive procurement process and will be subcontracting portions of the study to approximately 10 community-based organizations.

As you are aware, the City's current economic forecast projects significant slowing in key revenue areas. As a result the City Office of Management and Budget has requested reductions of 2.5% for FY 2008 and 5% per year thereafter for city-funded programs. A further directive from OMB has highlighted the need to devise staffing plans that support patient safety and quality, while observing emerging fiscal realities. To meet the OMB directive, I have asked CFO Marlene Zurack to work with all facilities to develop sustainable staffing plans to extend through FY 10.

• On November 2, 2007, a ribbon-cutting ceremony was held for Coney Island Hospital's new 1,100 square-foot Computer Tomography Suite for improved diagnoses and treatment to patients in the Southern Brooklyn Network community.

• On November 27, 2007, Kings County Hospital will rename the Community Advisory Board Conference Room to the "Marjorie Matthews Conference Room," as previously approved by HHC's Board of Directors. Marjorie Matthews provided years of service to the Community Advisory Boards at both Kings County Hospital Center and Woodhull Medical and Mental Health Center. She was a dedicated advocate who ensured access and quality health care for the residents of the City of New York.

• On November 30, 2007, a ribbon-cutting ceremony will be held for Kings County Hospital’s newly renovated Urology and Surgery Clinics located in the Ambulatory Care Pavilion, formerly known as Building "E". The 11,700 square foot space features a light-filled interior which includes reception and waiting areas, examination and consulting rooms, treatment areas, offices and support functions.

• October 23- El Especial, the community paper targeted to the Hispanic community, wrote about HHC’s Take Care New York campaign to provide low cost, no cost screenings and flu shots for all New Yorkers in the month of October.

• November 5- WABC’s Eyewitness News went to Elmhurst Hospital to interview Dr. Huajun Huang and Elmhurst dietician Bernadette Dilig about the work they do with diabetic patients of different ethnic backgrounds to help them control their blood sugar levels through diet control, using examples from their own culture’s typical dishes. The television broadcast featured Dr. Huang showing pictures of different food portions to a patient on a computer in the exam room and Ms. Dilig teaching a patient how to measure her food.

• October 30- The New York Times wrote an article about NYU/Bellevue Hospital’s program for Survivors of Torture. The article quoted Bellevue doctor, Allen S. Keller, founder of the program and several victims of torture from around the world receiving treatment at Bellevue. Over the years, the program has treated more than 2,000 men, women and children from about 80 countries.

• November 2- WNYC Radio reported on Alan Aviles’ testimony before Congress on behalf of the National Association of Public Hospitals and Health Systems in Washington, DC. Aviles presented the House Committee on Oversight and Government Reform with information on the potential devastating effects that the proposed regulations by CMS could have on the safety net hospitals. Aviles also asked for bipartisan support against the proposed federal cuts.

• November 20- The Daily News reported on the number of people with diabetes in The Bronx. The News’ story says that there are about 50,000 diabetics in The Bronx, many who are undiagnosed. The article quoted Dr. Charles Nordin, chairman of medicine at Jacobi Medical Center; Dr. Nordin said that anxiety about the complications of diabetes might be partly responsible for the many undiagnosed cases.

• November 27- In anticipation of World AIDS Day, NY1 News went to Bellevue Hospital to interview some patients who showcased their artwork at the hospital in commemoration of World AIDS Day. Dr Judith Aberg, director of virology at Bellevue Hospital was quoted saying "I think it's really important to constantly keep HIV in everybody's mind, I think one of the things that's happened with HIV is that because we now have remarkable therapies for HIV and we can control the disease, that some people feel like HIV really no longer matters – and it does." Jared Kinnon, one of the featured artists who was diagnosed with HIV at Bellevue hospital said, "A diagnosis of anything chronic hits you like a ton of bricks, you must talk about it. You must express your feelings."