ALAN D. AVILES
JOINT COMMISSION PREPARES FOR 2008 SURVEYS, PRAISES HHC SAFETY AND QUALITY PERFORMANCE RECORD
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
January 31, 2008
The 2008 Joint Commission corporate orientation session was held on January 14th, providing an opportunity for me and my senior leadership team to brief this year’s survey team leader on HHC’s corporate-wide initiatives related to quality, patient safety, and overall performance improvement, as well as HHC’s approach to ensuring compliance with Joint Commission standards. The survey team leader commented that his colleagues who have surveyed our facilities in recent years had praised the outstanding work at our various facilities to meet and exceed the standards set by the Joint Commission.
This year, six HHC facilities will be surveyed: Bellevue, Coler-Goldwater, Harlem, North Central Bronx, Queens and Woodhull. The surveys are conducted on an unannounced basis and may occur at any time between now and the end of December. I will keep you informed of the outcome of each facility survey.
PROFESSIONAL CREDENTIALING PROCESS TO BE
EXPANDED AND STANDARDIZED
HHC has undertaken a two-year initiative to streamline its credentialing process, which has been managed by each individual facility. The current process can be unduly time-consuming and cumbersome for healthcare providers, especially when providers need to be credentialed across multiple facilities. The verification and assessment of professional qualifications for a provider in one facility usually takes 2-3 months to complete, and another 1-2 months any time a provider is credentialed in an additional HHC facility.
When the new Centralized Clinical Credentialing Program is in place, all newly credentialed providers will be credentialed once and that credentialing will be effective throughout the Corporation. When current providers are re-credentialed as part of the standard two-year re-credentialing process, the more than 6,000 providers across our facilities will be credentialed using this same centralized process.
The new credentialing process will reduce the paperwork burden on both facilities and providers, facilitate the deployment of providers across HHC for coverage purposes, and support the efforts of our facilities in building relationships with community physicians who are interested in referring their patients for hospital care.
HHC has already embarked on the initial 5-month assessment phase, to be followed by an 8-month pilot test of the program and the system-wide transition to the new system, which is scheduled for completion at the end of next year.
EMPLOYEE FLU VACCINATION CAMPAIGN UPDATE
As you know, HHC has made flu immunizations for employees an important part of its patient safety campaign.
As of January 30, a total of 19,849 employees -- 49% -- have received the vaccine with several facilities reaching their target of 60% for hospitals and diagnostic and treatment centers and 70% for long term care facilities. 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.
According to the Centers for Disease Control and Prevention only 42 percent of health care workers in the United States are vaccinated against the flu annually. In New York City only 33% of healthcare workers get flu shots. HHC exceeds the national and city average for employee vaccinations, but we still need to persuade more of our colleagues that flu vaccination is as important as handwashing in protecting our patients. Congratulations to those facilities who have reached the goal we set for them. We will share with the Board the final numbers for all facilities at the end of the flu season.
MULTILINGUAL BROCHURES BRING PATIENTS INFORMATION ABOUT HEALTHCARE FINANCIAL ASSISTANCE
Ensuring that all New Yorkers have access to affordable healthcare is a top HHC priority. As part of this effort, a new HHC Options booklet has been developed to help uninsured patients have a better understanding of the eligibility criteria and enrollment process for public health insurance, as well as for HHC’s own financial assistance program for the uninsured, known as HHC Options.
The brochure explains the role that HHC financial counselors play to help patients apply for public insurance programs, and helps those who do not qualify for public health insurance to determine their discounted fee for various health services under the HHC Options program. Fees for outpatient, inpatient, pharmacy and other services are based upon a sliding scale that takes into account household income (up to 400% of the federal poverty level) and family size. Outpatient clinic fees range from $15 to $60 for an adult clinic or emergency room visit and $0 to $18 for pregnant women and children. Prescription drugs or pharmacy co-pays fees range from $2 to $22.
Currently the HHC Options booklet is available in English and Spanish, as well as 11 other languages - Albanian, Arabic, Bengali, Chinese, Creole, French, Hindi, Korean, Polish, Russian, and Urdu. The booklet will be distributed to healthcare advocates, community organizations, and other groups, and is available on the HHC web site in multiple languages.
HIGHLIGHTS OF STATE AND CITY BUDGETS
Governor Eliot Spitzer released his $124 billion 2008-09 Executive Budget proposal last week. The plan seeks to reduce healthcare and Medicaid spending by approximately $1 billion and rebase hospital inpatient reimbursement rates to generate savings that can be used to increase outpatient rates. Nearly half of the $1 billion in state savings would be from reductions to hospitals, long term care facilities and home care providers. While the general policy direction of this budget supports many of HHC's priorities, our preliminary estimates still show a potential loss to HHC of $35 to $40 million. Major healthcare features of the Executive Budget also include:
Updating hospital inpatient reimbursement rates to reflect savings that have been achieved through medical advances since the 1981 base year, and subsequently shifting some of those savings to increase emergency room and outpatient rates. A new Ambulatory Payment Groups (APG) system would also be phased in over four years to provide payment differentials for diagnosis and severity of outpatient services;
Reduction of hospital inpatient detoxification reimbursement rates and conversion to per-diem rates;
Reduction by one-quarter of the trend factor that increases rates to account for increased costs, for hospitals, long term care facilities and home care agencies;
Full funding of the state's proposed Child Health Plus expansion from 250% to 400% of the Federal Poverty Level, using state-only funds because of the federal disapproval of the expansion;
Elimination of the public hospital workforce recruitment and retention grants;
Shifting of $19 million from Professional Education Graduate Medical Education (GME) Pool to the smaller GME Incentive Pool;
Phased-in redistribution of Bad Debt and Charity care funds based on number of patients served, beginning in 2009;
Additional streamlining measures for Medicaid enrollment, using a new State enrollment and renewal portal;
Creation of the Doctors Across NY program that will increase reimbursement rates and provide loan forgiveness for doctors who establish or expand their practice to cover underserved areas in both rural and urban areas; and
Creation of an EPIC Discount Card (25%) for low-income, uninsured patients under age 62.
Over the coming weeks and months, HHC will be working closely with our trade associations, our labor partners, and our community members to support many aspects of the Executive Budget that we feel are aligned with our mission and seek to modify those few proposals that are not.
Moving on to the City Budget, Mayor Bloomberg released his FY 2009 Preliminary Budget last Friday. The $58 billion preliminary budget seeks to control spending and generate $1.5 billion in savings through agency efficiencies and other actions. In anticipation of the worsening financial picture, last year all City agencies were asked to submit a proposal on how they would maintain City services while reducing City Tax Levy spending by 2.5% in the current fiscal year and 5% for the next fiscal year. The budget uses $4.6 billion in unspent funds to partially close the budget gaps for FY 2008 to FY 2010. The City faces an estimated budget shortfall of $4.2 billion in FY 2010, $5.6 billion in FY 2011, and $5.3 billion in 2012.
FUNDING GRANTS FOR HEALTHCARE INITIATIVES
PRESTIGIOUS AWARD GOES TO HHC INJURY PREVENTION LEADER
- The HHC Foundation has been awarded a $200,000 grant award from the Fan Fox and Leslie Samuels Foundation in support of Metropolitan Hospital's Department of Pain Management and Palliative Care. The newly formed Palliative Care Department at Metropolitan is a leader in HHC's drive to support and develop palliative care services for patients and families who face the challenges of life-threatening or terminal illness. These care options stress dignity and comfort in the context of a more holistic approach to a dying patient's medical, psychological and spiritual needs.
- The Dr. Susan Smith McKinney Nursing Facility has received a $50,000 grant from the New York State Health Department to provide partial funding for a technology initiative to prevent pressure ulcers in residents. The new system, which includes the installation of 16 touch screen monitors throughout the facility, will replace paper patient care records with a digital system that flags known risk factors and prompts care planning teams to address vulnerabilities. The technology is scheduled to be fully implemented by January of 2009, and will provide staff with detailed reports on care data collected from all 320 facility residents on a weekly or even daily basis.
The New York Academy of Medicine is honoring Dr. Barbara Barlow, Director of Surgery at Harlem Hospital, with its fifth annual Lewis and Jack Rudin Prize for Medicine and Health. Dr. Barlow started Harlem's nationally-acclaimed Injury Prevention Program in 1988, and is the national Director of the Injury Free Coalition of injury prevention programs in pediatric trauma centers throughout the U.S. She will accept the award on February 19th, after delivering a lecture about her experiences in the establishment of the injury prevention model of pediatric healthcare. The program reduces injury through education, construction of safe play areas, and the development and support of safe supervised activities with strong adult mentors. Major injury admissions for children in Harlem have decreased more than 60% since the program's inception. The program and Dr. Barlow have received awards from more than a dozen national and local organizations, including the American Hospital Association, the U.S. Dept. of Transportation, and the American Academy of Pediatrics. Congratulations to Dr. Barlow for another well-deserved honor.
TOP EMPLOYEES HONORED
On January 25th, I had the pleasure of hosting the annual Employee Recognition and Awards Luncheon to honor the employees who were selected by their facility leadership, including Health and Home Care, MetroPlus, and Central Office, as their respective "Employees of the Year".
This annual awards luncheon offers an opportunity to recognize employees throughout our system and at every level of the organization for their work ethic, commitment to our mission, innovation, and professional contributions. Those selected have earned the esteem and respect of their colleagues, and my appreciation for embodying HHC’s mission and its commitment to provide exceptional service to our patients, our communities, and the City of New York.
NEW SENIOR VICE PRESIDENT FOR QUALITY
I am pleased to announce that Dr. Anne-Marie Audet recently began to serve as HHC's Senior Vice President for Quality, a newly created corporate officer position with broad responsibility for overseeing and supporting our system-wide quality improvement efforts and reporting directly to our Executive Vice President, Dr. Ramanathan Raju.
Dr. Audet was selected, after a national search, by a committee of HHC medical and administrative senior leaders. She comes to us from the Commonwealth Fund where she was Vice President for Quality Improvement and Efficiency. She combines comprehensive academic, medical and administrative experience with a longstanding national reputation for effectively establishing, evaluating and facilitating quality improvement initiatives across various settings.
Dr. Audet has worked in the field of quality improvement for nearly two decades. At the national level she worked in policy analysis at the American College of Physicians. At the state level, she led the implementation of the Medicare Health Care Quality Improvement Program in Massachusetts while working at the Massachusetts Peer Review Organization.
Dr. Audet currently holds an Assistant Professorship on the faculty of Medicine and Public Health at Cornell University. She previously served on the faculties of Harvard University and Beth Israel Deaconess Medical Center. She also served as director of the Office for Clinical Effectiveness/Process Improvement at Beth Israel Deaconess Medical Center in Boston, where she was responsible for development of quality measurement systems, educational programs, and institution-wide medication safety initiatives.
Dr. Audet earned undergraduate and graduate degrees related to healthcare from McGill University, as well as a master’s degree in health policy and management from Harvard University.
I am delighted to have Dr. Audet join our senior management team as we continue to pursue a very ambitious agenda across many quality improvement fronts.
HHC IN THE NEWS HIGHLIGHTS
- January 2, 2008 – Elmhurst Hospital delivered HHC’s and New York City’s first baby of 2008. Little Isabella Sophia Sears, granddaughter of City Council Member Helen Sears, was born moments after the stroke of midnight. She shares the bragging rights with another baby girl delivered at New York Hospital-Queens. The story was covered by the New York Daily News, Newsday, New York Post, El Diario, and television channels 2, 4, 5, 9, 11.
- January 2 – The New York Times reported on the decrease in overall HIV infection rates among older gay men and noted the sharp increase in men under 30. The article quoted Harlem Hospital’s Chief of Infectious Disease, Dr. Wafaa El-Sadr, who said it is unconscionable that there has not been a decrease in new infections in the past decade in the U.S.
- January 3 – WNBC/Channel 4 - Today in New York reported on the Children of Bellevue, Inc. efforts to raise money for pediatric services by selling neckties designed by the hospital’s pediatric patients. The special line of ties is being sold in Macy’s stores with 7 percent of the proceeds going to support Child Life Services. Several participants were interviewed, with one young woman noting how happy she was to have her design seen and worn by so many people, and for such a good cause.
- January 14 – The New York Times published a Letter to the Editor written by HHC President Alan Aviles in response to an article on the financial troubles of Atlanta’s safety-net hospital, Grady Memorial Hospital. Mr. Aviles’ letter noted the financially precarious footing safety-net providers across the country find themselves in because of the impending federal rule changes that would cut financing to safety-net hospitals by $5 billion over five years.
- January 15 – The New York Times and Newsday reported on Manhattan Borough President Scott M. Stringer’s new “Go Green East Harlem Cookbook” that contains healthy recipes for dishes created by people who live, work or contribute to the East Harlem community. Included in the cook book is a recipe from our own Marion L. Bell, the First Vice Chairwoman of Metropolitan Hospital Center’s Community Advisory Board, for "Sweet Potatolicious" - a healthy dish made with sweet potatoes, pineapple and apple sauce.
- January 22 – The New York Sun reported on New York State’s Medicaid inpatient reimbursement rate adjustments to be phased in over the next three years. The article quoted Marlene Zurack, HHC Sr. Vice President of Finance, who shared that some hospitals may find themselves worse off depending on their specialty medical practice, but noted HHC will be better off overall by $7 million once the rate adjustments are fully implemented.
- January 28 – Crain’s New York Business reported on the shortage of skilled workers in three key industries in New York City, including healthcare. The article noted the steps HHC is taking to both increase staff retention and increase the number of nurses entering the profession. Several Nurse Career Ladder program students and Ms. Denise Soares, Jacobi’s Chief Nurse Executive were interviewed. Ms. Soares noted that retention of experienced staff is as important as recruiting new staff.