ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
March 27, 2008

March 2-8 was Patient Safety Awareness Week, a national education and awareness-building campaign sponsored by The National Patient Safety Foundation for improving patient safety at the local level. This year's campaign theme Patient Safety: A Road Taken Together emphasized a collective effort for safer health care through partnership among providers, patients, families and communities.

We used the week to remind staff of our commitment to becoming one of the safest healthcare systems in the nation by the end of this decade as well as to introduce the third phase of our year long campaign for patient safety which is "Help Us Help You: Partnering for Safety."

Based on the concept of patient-centered care, the campaign is designed to encourage and empower our patients to speak up when they have a question or concern about their care. At the same time, we are asking our staff to commit to hearing and responding respectfully, promptly, and appropriately to our patients’ concerns. All of these steps help reduce the risk of medical errors and benefit us all.

During the last few weeks, our patients received information about how to become more engaged in their care and our staff was given literature that share tips on how they can help patients achieve this goal.

Last spring, nearly 17,000 HHC staff completed our Patient Safety Culture Survey which identified several areas of strength as well as opportunities for improvement at HHC. During the first two weeks of this month we asked staff to complete the second round of the survey, which was available in both a web-based and hard copy format at all HHC facilities. Our Corporate-wide response rate last year was 44% and this year's goal was an ambitious 70%. I am happy to report that, by March 14th, over 24,000 responses were received. While not quite a 70% response, this greater than 40% increase in survey participation is a testament to the commitment of our entire staff, at every level, to HHC's patient safety goals.

Earlier this month, Queens Hospital Center held the Corporation’s first Breakthrough event to improve the flow of patients through its operating rooms. The Queens team conducted a Rapid Improvement Event (RIE), a key Breakthrough tool used to identify waste, design new processes and effect immediate change. The team reviewed how patients were being processed for ambulatory and other surgeries performed in the operating room, identified waste and redundancy that could be removed to make the process more patient-centric, put the new processes in place, wrote up the new procedures and trained unit staff. As a result, the team was able to achieve a reduction in patient processing time of 1 hour and 20 minutes per patient. These are remarkable initial results which will clearly benefit patients and staff.

As you know, the Board approved our contract with Simpler Consulting in November to facilitate HHC's corporate-wide Breakthrough initiative, a system of principles and tools based in an improvement philosophy known widely as "Lean", that was first developed in the manufacturing industry and was more recently adapted for healthcare. Since then, our pilot facilities and central office divisions have undergone several months of training, learning and preparation. It is very encouraging to see that this first effort at making changes was so successful. Queens is one of three hospitals that have volunteered to lead HHC's efforts to bring the principles of this philosophy and these tools to our improvement work. Through Breakthrough, we will be creating a culture that improves clinical outcomes, brings service closer to the patient, improves patient and staff satisfaction, and reduces waste and long-term costs.

In April, we will embark on similar RIEs at Metropolitan Hospital and Central Office, as well as a second RIE at Queens Hospital Center. The staff at Jacobi Medical Center will complete their pre-RIE training in May. By June, we plan to be holding between four and eight RIEs per month and will begin to see regular outcome data reported from these events. By the end of the calendar year, we expect to have at least seven facilities engaged in Breakthrough training and rapid improvement events with an output of approximately 14 improvement events occurring each month. I have high expectations for this work and look forward to reporting significant benefits and financial savings to the board as we gain momentum.

"House Calls," HHC's telemonitoring program supported by MetroPlus, continues to thrive. The program has now served more than 200 and currently has almost 170 patients with diabetes who have been referred by HHC hospitals and diagnostic and treatment centers. An additional 109 patients have been referred and are now being contacted to arrange their possible participation in the program. The blood sugar levels of the majority of patients supported through this program have improved. The program is now adding telemonitoring of blood pressure in addition to blood sugar levels.

East New York Diagnostic and Treatment Center recently was added as a referral facility for this program. A demonstration of the telehealth monitoring unit was put in place at the facility in response to the initial reluctance of many patients to enroll in the program. After seeing the telehealth equipment in operation, 28 patients have enrolled.

Other large utilizers of "House Calls" are Metropolitan Hospital and Harlem Hospital. Elmhurst Hospital is in the process of organizing their care management department to identify their MetroPlus patients with Hemoglobin A1c results over 7 for referral to the program. We will continue to scale up the program as the year progresses.

Congratulations to Ann Frisch and her staff for their continued success with this important program.

The eCommerce automated procurement system has now been brought online throughout HHC. The final implementations occurred at MetroPlus and Health and Home Care on March 5th and the North Bronx network, including Jacobi Medical Center and North Central Bronx Hospital, on March 10th. With the full implementation of eCommerce, HHC has moved closer to paperless procurement. The system can help facilities achieve cost savings by automating and streamlining the procurement process, through the facilitation of bulk "requirement" contracts, and by reducing inventory levels, with "just-in-time" ordering. The system also gives facilities and departments real time information regarding the status of their requisitions and purchase orders.

For the third year in a row, the New York State Department of Health has rated HHC’s own health plan – MetroPlus – as the best Medicaid Managed Care health plan in New York City. The MetroPlus #1 rating, ahead of the other 14 Medicaid Managed Care plans in the city, is for quality and overall patient satisfaction, and is included in the New York City Medicaid Consumer Guide, published by the New York State Department of Health.

I also want to note that MetroPlus enrollments now exceed 300,000 - an impressive achievement. Congratulations to MetroPlus Executive Director Dr. Arnold Saperstein and his staff for reaching this enrollment milestone and for these superlative ratings.

The National Association of Public Hospitals and Health Systems, in conjunction with the American Hospital Association and the Association of American Medical Colleges has initiated a law suit challenging the legality of the final rule from the Centers for Medicare and Medicaid Services (CMS) that would dramatically reduce supplemental Medicaid payments to public providers. Unless there is an extension, the congressionally mandated one-year moratorium on implementation of both this rule and another proposed rule to eliminate Medicaid payments for Graduate Medical Education will expire on May 25, 2008.

The GME-related rule is not yet finalized, but the Public Provider Rule has been finalized, and so legal action was initiated to try to prevent its implementation. The grounds for the law suit include that CMS has overstepped its authority in dictating to states the governmental status of entities within their jurisdiction and that CMS, by issuing the final rule on the very day that the moratorium took affect (May 25th 2007), violated the law as a procedural matter. Implementation of this rule could cost HHC up to $200 million in lost Medicaid revenue annually.

Last month, I delivered testimony before the City Council Health Committee on HHC's Fiscal Year 2009 Preliminary Budget. In my testimony I highlighted the accomplishments we have achieved over the last year, outlined our agenda for this year and reviewed HHC's financial plan. In FY 2009, more than $21 million in funding was not baselined and we have asked the council to restore this funding as they have in the past. This funding in part supports our child health clinics, rapid HIV testing, outpatient pharmacy services, behavioral health programs, and our multi-language telephonic simultaneous interpretation program (known as TEMIS). I will testify again later this spring on the final FY 2009 Executive Budget, after it is released by the mayor in May.

Negotiations on the FY 2008-09 State Budget are proceeding rapidly, with Governor Paterson, legislative leaders, and key staff meeting around the clock. Although the formal April 1st deadline for a budget will be difficult to meet, the parties are striving for a resolution on the budget as soon as possible. However, a consensus has not been reached yet on how to close the State's budget gap estimated to be $4.6 billion. The Assembly and Senate both passed their respective one-house budget resolutions last month outlining their key priorities. I would like to just mention a few of these changes or restorations to the Executive Budget.

The Assembly plan accepted many of the governor's health care proposals to alter the current reimbursement methodologies that would rebase inpatient rates to a 2005 base year and invest most of the savings to increase outpatient rates. In a move that would be beneficial to HHC, the Assembly proposal would restore workforce recruitment and retention funding for hospitals. The Assembly also decided to phase in the proposal to reduce funding for inpatient detox programs over four years instead of one.

The Senate plan rejects the administration's proposal to alter the inpatient and outpatient reimbursement methodologies, arguing that the State Health Department has not fully explained how the proposals would affect individual hospitals. The Senate plan also restores funding for long term care facilities that had been agreed to in 2006, and would occur retroactively, but has not yet been approved by CMS. The Senate resolution additionally restores half of the proposed trend factor reduction for hospitals and nursing homes, and adds $64 million for hospital inpatient services statewide.

• Lincoln Medical and Mental Health Center has been named by the American Diabetes Association (ADA) as a Diabetes Center of Excellence. The designation identifies high quality diabetes self-management education services that meet national standards. Lincoln is joining two other HHC Diabetes Centers of Excellence recognized by the ADA - Kings County and Queens Hospital. Congratulations to José Sánchez and his staff for this recognition.

• Harlem Hospital has been designated as a Multiple Sclerosis Center of Excellence, providing additional treatment opportunities for MS patients in Harlem. Patients whose MS is not responding well to conventional treatments can now go to Harlem for new, more sophisticated treatments otherwise only available at major academic medical centers.

• An abstract submitted by the Woodhull Nursing Department, "The Impact of Nursing in Addressing Health Disparities among Hispanics in a Safety Net Hospital Setting," will be presented at the National Association of Hispanic Nurses annual conference in June. The presenters will be Annabell Garcia, BSN; Lilian Rivera, RN, MS; and Karen Benitas.

• Bellevue Hospital Center will hold a dedication ceremony to name the future $6 million, 20-bed Neonatal ICU in honor of Barbara Gimbel, as approved by the Board of Directors in December 2007. Ms. Gimbel, a former member of the HHC Board and HHC Foundation Board, founded the Children of Bellevue, a non-profit auxillary devoted to improving the care of Bellevue’s pediatric patients, more than fifty years ago and continues to be its strong supporter. Completion of the new NICU is anticipated in 2009.

• For the fifth year, HHC will be a sponsoring organization for the American Lung Association's annual Asthma Walk. The walk will take place on May 31st, and HHC walkers look forward to exceeding last year's impressive outcomes, when we raised more than $69,000 for asthma education, advocacy and research, more the doubling the previous year's results.

• Gouverneur received a $105,000 check from the Entertainment Industry Foundation (EIF) as a beneficiary of their 2007 Revlon Run/Walk New York event and was officially notified that it would be a beneficiary for the 2008 event. Gouverneur has been a beneficiary every year the event has been held in New York, receiving from EIF a total of nearly $770,000 since 1998. Proceeds are used to ensure that uninsured women have access to free or low-cost breast and cervical cancer screening services with appropriate follow-up care if necessary.

• Komen Greater NYC has awarded Elmhurst Hospital Center a 2008 Community Breast Health competitive grant of $60,000 to fund a Breast Health Screening Coordination project at both Elmhurst and Queens Hospitals. This project will make breast health services available to more uninsured and underinsured women throughout Queens County. In 2007, Elmhurst surpassed all providers by providing services for over 6,000 patients who were enrolled in the Queens Breast Health Partnership. These women received breast and cervical cancer screening services at no cost.

• January 31 - Dr. Manuel Lopez, Child and Adolescent Psychiatrist at Woodhull, presented a program about bullying and children on the Hispanic Information Telecommunications Network (HITN-TV). This is one of a series of televised educational programs on HITN-TV in which Dr. Lopez has been a featured speaker.

• February - Six Harlem Hospital doctors were listed in the annual "Best Black Doctors" edition of The Network Journal, a prominent national publication about African American business leaders. Congratulations to Dr. John T. Herbert, anesthesiologist; Dr. Jay Cowan, gastroenterologist; Dr. Velvie A. Pogue, nephrologist; Dr. Alfred R. Ashford, oncologist; Dr. Oville Palmer, otolaryncologist; and Dr. Ferdinand Ofodile, plastic surgeon.

• March 3, 4 - The New York Sun and WNYC radio covered proposed state restrictions on Medicaid reimbursement for bariatric weight-loss surgery, quoting HHC President Alan Aviles, who expressed concerns about subsequent loss of access to important health services for patients in need.

• March 4 - The New York Sun covered President Alan Aviles' Year in Review report to the Board of Directors, featuring HHC 2008 goals to reduce hospital-acquired infections, redesign NICUs, expand monitoring of diabetics, and preventing disease through smoking cessation programs, availability of screening colonoscopies and wider HIV testing.

• March 10 - The New York Sun published an obituary feature article on Dr. Stephen Colvin, who passed away on March 8th. Dr. Colvin was a heart surgeon at NYU Medical Center for 30 years and one-time chief of cardiology at Bellevue. He pioneered minimally invasive cardiac procedures and directed the NYU residency program for 20 years, training more than 100 cardiac surgeons.

• March 12 - The Daily News, newsday.com, and Hoy covered Wesley Autrey's work as spokesperson for HHC's Colon Cancer Awareness Campaign during the month of March.

• March 22 - El Diario published an editorial describing the importance of patient navigators to encourage people to seek preventive healthcare, highlighting the availability of bilingual patient navigators at HHC hospitals, and encouraging Hispanic New Yorkers to get screened for colon cancer.