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ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
FEBRUARY 26, 2009
OPENING OF BEHAVIOR HEALTH PAVILION MARKS TRANSFORMATION OF KINGS COUNTY BEHAVIORAL HEALTH PROGRAM
Earlier this month, HHC announced the opening of a new $153 million psychiatric center at Kings County Hospital, a long-awaiting facility that will be a backdrop for the comprehensive reforms we have undertaken to improve care and radically change the patient experience for the 12,000 New Yorkers served by the hospital’s behavioral health program every year. I was joined at the opening by newly appointed Kings County Hospital Executive Director Antonio Martin and Dr. Joseph Merlino, the newly appointed Director of Behavioral Health Services.
The seven-story building features 230 private and semi-private inpatient beds, a new psychiatric emergency center with double the space of the current one, and a wide range of outpatient and day treatment programs. The modern, efficient space replaces and consolidates services that were provided in seven older buildings.
For the past year, we have been making improvements to the psychiatric program at Kings County, including adding more staff, improving crisis management training to care for patients in acute distress and expanding space to address the overcrowding.
The new pavilion and the program improvements underway address shortcomings identified by various regulatory agencies over time as well as alleged deficiencies cited in a pending lawsuit filed by mental health advocates. Last month the United States Department of Justice completed a year-long investigation and issued a report with serious criticisms that echoed both the prior regulatory findings and the pending lawsuit allegations. The report highlighted, among other things, past incidents that have placed our patients' safety at risk, including incidents of patient-on-patient violence.
We will continue to work collaboratively with the plaintiffs toward a settlement of the pending lawsuit and with the Department of Justice toward that same end. We appreciate that they have acknowledged progress and have expressed confidence that an amicable resolution of their concerns is possible.
In addition to the new center, the completed first phase of reforms includes:
- The addition of more than 200 new doctors, nurses, psychologists, social workers and other staff.
- A reduction of the average length of stay in the ER from 27 hours to 8 hours or less through better coordination with EMS and other components of the mental health system, adequate staffing ratios, and more efficient triage, assessment and treatment.
- Priority access to 24 crisis beds at Kingsborough Psychiatric Center (KPC), jointly staffed by Kings County and KPC to further reduce overcrowding.
- Reduced reliance on hospital police to manage patients in crisis with deployment of new, non-uniformed and specially trained personnel who have crisis intervention and security skills.
The second phase of the reforms will include the addition of more Peer Counselors to serve as patient navigators and mentors and the creation of a Consumer and Family Advisory Group. A new care coordination model will also be developed to link patients with doctors who can help them manage chronic medical problems that often go untreated among the mentally ill.
PATIENT SAFETY WEEK ACTIVITIES AT HHC
During the week of March 8 to 14, HHC will join with other healthcare organizations across the nation to recognize National Patient Safety Awareness week, sponsored by the National Patient Safety Foundation. HHC will be sponsoring a range of activities during the month of March to both celebrate and advance our patient safety efforts. This year is pivotal for HHC as we continue our journey to becoming one of the safest healthcare systems in the nation by the end of 2010.
On Monday, March 9th, we are sponsoring a Senior Leadership Symposium on Patient Safety at which national patient safety expert Robert Wachter, MD will give the keynote address – “The End of the Beginning: Patient Safety a Decade After the IOM Report on Medical Mistakes.” After Dr. Wachter’s address I will be joined by Mr. Michael Dowling, President and CEO of North Shore-Long Island Jewish Health System and Dr. Richard Davis, Vice President for Innovation and Patient Safety at the John’s Hopkins Medical Center for a CEO Roundtable Discussion on the role of leadership in creating and sustaining a culture of safety.
On Wednesday, March 11th we will recognize our patient safety champions from across our system. These are individuals or teams that have served as change agents for patient safety. Our keynote speaker will be Ms. Sorrell King, founder of The Josie King Foundation. The Foundation is named after Ms. King’s daughter, Josie who died as a result of a medical error at Johns Hopkins Hospital.
On Friday, March 20th, we are convening a symposium that will feature Paul Schyve, MD, Senior Vice President at The Joint Commission. His keynote address will focus on the critical nexus between cultural competence and health literacy, and the impact they have on patient safety and patient-centered care.
I invite you to participate in any or all of these sessions.
Lastly, one of our most important patient safety measurements focuses on our organizational culture and the extent to which our staff perceive it as just and fair, rather than one of “blame and shame” in the face of a medical error. For two years we have assessed staff perceptions with an annual Patient Safety Culture Survey. This year we will launch the survey during National Patient Safety Awareness Week. We will share the results with you later this spring.
FEDERAL UPDATE
State Children’s Health Insurance Program (SCHIP)
On February 4, 2009, President Barack Obama signed the Children's Health Insurance Program Reauthorization Act of 2009. The new law increases eligibility to 300% of Federal Poverty Level (FPL), thereby expanding the program to an additional 3.9 million children for four and a half years. In addition, a provision to extend Medicaid coverage to legal immigrant pregnant women and children in the country less than five years was included in the final bill. This provision will save New York State $13 million, as the State currently provides SCHIP coverage for such children from state-only funds.
American Recovery and Reinvestment Act 2009
On February 17, the President signed the American Recovery and Reinvestment Act of 2009, the stimulus legislation. While there are numerous health-related provisions in the legislation, I will highlight those that most significantly affect HHC. The bill includes an increase in the federal share of Medicaid that may bring the State and City as much as $12.6 billion and $2.7 billion respectively – official estimates are not yet available. The bill also included a 2.5% increase in New York State's allocation for Disproportionate Share Hospitals DSH funds which is expected to bring approximately $120 million more into New York State, over a two-year period. The Administration released $15 billion, the first installment of the federal medical funding, to states on Wednesday, February 25th.
The legislation includes moratoria, until June 30, 2009, on the onerous Medicaid rules that had become final, including the outpatient rule. The moratoria on the proposed Medicaid rules, including the Limitation on Public Provider Payments and Graduate Medical Education, were extended until July 1, 2009. The Obama Administration is expected to rescind these rules.
The stimulus bill provides for COBRA premiums to be subsidized by 65% for persons who lost their jobs between September 1, 2008 and January 1, 2010 and who make less than $145,000. Transitional Medicaid Assistance will also be extended by 6 months or 12 months at state option.
The legislation provides funding for the federal Health and Human Services Agency (HHS), states, hospitals, physicians, and other healthcare providers to encourage adoption and use of health information technology systems and to promote health information exchange.
The vast majority of the funding -- $17 billion (of $19 billion) -- would establish temporary Medicare and Medicaid payment incentives for hospitals and physicians for several years. To be eligible for the payment incentives, hospitals and physicians must already have in place a "certified electronic health record system" and be a meaningful user of that system. While these criteria are not completely defined in the legislation, and will be established by the Secretary of HHS, they generally mean that entities have a system that can exchange health information and report on quality measures. HHC could receive at least $121 million of these funds. These HIT incentive payments are to begin in 2011 through federal Medicare and Medicaid reimbursement (perhaps sooner for Medicaid) and will be phased-out over a four-year period.
The City is expected to receive $50 million in Community Development Block Grant funds and $230 million in transportation funds. The State will also receive an estimated $750 million in transportation infrastructure funding. HHC will seek to obtain funding support for some of our capital programs from these resources.
2009 Omnibus Appropriations Act
On Tuesday, February 24, 2009, the federal FY 2009 Omnibus Appropriations Act was publicly announced. The bill contains an additional $70 million for 9/11 health programs. These dollars are available for existing programs serving responders, community residents, students and others affected by the attacks of 9/11. Congressional members view this as a step toward passing comprehensive legislation which would provide long-term, ongoing funding for those sickened or injured as a result of the attacks.
We have been notified that at least three HHC facilities have been awarded funds through the Omnibus Bill. Specifically, Harlem Hospital Center will receive $150,000 for the preservation and restoration of historic WPA murals through Ways and Means Committee Chairman Charles Rangel; Lincoln Medical and Mental Health Center will receive $143,000 for the provision of neuro-interventional angiography services for stroke patients through the support of Congressman Jose Serrano; and Representative Elliot Engel has obtained $95,000 for North Central Bronx Hospital to purchase radiology equipment. We appreciate these Members' support.
President Obama's Budget
The President released his budget today, which creates a 10-year $634 billion "reserve fund" to partially pay for an overhaul of the nation's health care system and move toward universal health coverage. The "reserve fund" is funded half by new revenue and half by savings proposals, including and array of changes in Medicare and Medicaid. For example, the budget calls for changes in Medicare rates to align payments with evidence-based treatment regimens that have been proven to be effective and efficient.
STATE UPDATE
Earlier this month, the State Legislature passed a $1.6 billion deficit reduction plan (DRP) that closed the state's FY 2008-09 deficit. We estimate the impact on HHC to be $23.6 million as a result of the cut to the remaining 2008 trend factor - elimination of the public hospital and nursing home workforce recruitment and retention grants and also a delay in the nursing home rebasing effective date. The Legislature did not agree to other proposals in the Executive Budget Proposal which was promulgated in December 2008 such as the across the board cuts to Medicaid rates, trend factor elimination for 2009 and hospital and home care gross receipts taxes to balance the current fiscal year’s budget. These proposals are still on the table as part of the actions to be taken to address the State’s fiscal year 2009-10 budget gap, which is now estimated to be $14 billion.
The debate in Albany now turns to the use of the estimated $24 billion that New York State will receive from the federal stimulus package. While, the funding that will come to the state for education aid, for example, is very prescriptive and cannot be used for other purposes, this is not the case with Medicaid funding, or the FMAP increase. It is estimated that New York State will receive $12.6 billion for 27 months (beginning October 1st, 2008). The Governor’s position is that FMAP money, while “basically” for health care, is not required to be used exclusively for Medicaid spending. The Governor has stated that stimulus funds will not be used to entirely offset cuts to Medicaid spending. He has said that the structural imbalance in health care spending must be addressed.
HHC staff have been advocating continuously with members of the New York City delegation, working with our union colleagues and other healthcare organizations on the budget and will continue to do so until it is adopted. In addition, members of HHC's Community Advisory Boards will be traveling to Albany on March 4th as part of their advocacy efforts.
COMMUNITY OUTREACH CAMPAIGN HIGHLIGHTS IMPORTANCE OF HHC COLON CANCER SCREENING SERVICES
Throughout the month of March, HHC will focus on educating the public about colon cancer and the potentially life-saving colonoscopies that are available at our hospitals. New Yorkers will be offered the procedure at all 11 HHC hospitals, and on Staten Island, by our partners at Richmond University Medical Center and Staten Island University Hospital. The month-long awareness campaign will include on-air radio interviews with HHC experts. Our TV, radio and print media partners have provided HHC with pro-bono placements of our colon cancer message in English and Spanish, generating a value exceeding $229,000 and 21 million impressions. Educational materials featuring New York celebrity spokespersons Ashford & Simpson, Chita Rivera, and subway hero Wesley Autrey will be distributed to community-based organizations citywide. Last year alone, HHC hospitals provided 20,229 colonoscopies, and removed polyps from 3,636 patients. The public hospitals have seen a significant increase in screenings since the corporation began to aggressively promote the procedure in 2003. Since then, nearly 112,000 colonoscopies have been performed, with polyps removed from 17,461 patients. Your board packets today include samples of the flyers that we will be distributing as part of the campaign.
LOS ANGELES HEALTH OFFICIALS MEET WITH TOP HHC LEADERS
On February 9th, HHC senior executive staff had the pleasure of hosting officials from the Los Angeles City public healthcare system who are considering ways to restructure that system to better serve its roughly 700,000 patients. The purpose of the visit was for the LA Healthcare Options Task Force to understand how HHC has managed to dramatically improve system performance and raise the overall quality of care in recent years while carrying out a safety net mission identical to that of the LA system.
Dr. Stocker, Dr. Raju and I along with other senior staff gave an overview of our governance, management and strategic agenda at a breakfast meeting. Later that day, the Task Force members met with many members of our senior staff including Marlene Zurack, our Senior Vice President for Finance; Frances Pandolfi, our Chief Information Officer; Dr. Louis Capponi, our Chief Medical Informatics Officer; LaRay Brown, Senior Vice President, Corporate Planning, Community Health and Intergovernmental Relations and Caroline Jacobs, Senior Vice President, Patient Safety. The day closed with a meeting with New York City's Department of Health Commissioner, Dr. Thomas Frieden.
I want to thank everyone involved for giving generously of their time and sharing best practices with our colleagues in Los Angeles.
TOP HHC NURSE LEADERS AWARDED GRANTS FOR DOCTORAL STUDIES
Two outstanding nurse educators and mentors at HHC, Cecil Almendra of Coler-Goldwater Specialty Hospital and Katrina DeVinci of Queens Hospital, recently received scholarships for $12,500 each from the Charles Spear Charitable Trust Foundation, to join the very exclusive group of nurses in the U.S. -- only 1% -- who earn a PhD degree in nursing. They will be among 10 RNs at HHC who have doctoral degrees; another 10 nurses are actively pursuing doctorates while working at HHC facilities. Congratulations to both of these outstanding nurse leaders for this well-deserved recognition.
GRANTS SUPPORT SUCCESSFUL HHC PROGRAMS
- Four HHC Diagnostic and Treatment Centers have been awarded a HEAL 6 grant from the New York State Department of Health to improve their dental services. Renaissance, Cumberland, Belvis and East New York will receive a total grant award of $2.65 million.
- Woodhull, Bellevue, and Queens Hospital Network were awarded a $1.74 million Chronic Illness Demonstration Project grant from the New York State Department of Health. Funding will be used to test the impact of a full service care management model on the effective management of chronic illness across the three acute care facilities.
- Gouverneur Healthcare Services will be a beneficiary of the 2009 New York Revlon Run/Walk. Gouverneur has been a beneficiary for each of the eleven years that the event has been held in New York City, and a total of approximately $850,000 has been awarded Gouverneur for its women’s cancer programs.
LINCOLN WINS TOP AWARD FOR BLOOD DONOR CAMPAIGN
Lincoln Medical and Mental Health Center was ranked #1 among hospitals participating in the New York Blood Center’s 2008 Bronx Blood Donor Campaign, winning the Bronx Borough President’s 2008 Hospital Award, as well as the 2008 Bronx Achievement Award from the Bronx Borough President and the New York Blood Center. Many thousands of patients benefit immeasurably from life-saving blood products. Congratulations to Lincoln Hospital staff for their outstanding support for this important work.
HHC IN THE NEWS HIGHLIGHTS
- Coney Island Hospital’s surgical team using the Surgical Safety Checklist was featured on Good Day New York and Fox 5 News 2/12/09
- IT’s the money: funding to expand HER initiatives nationwide, Modern Healthcare 2/23/09
- HHC Hopes Federal Stimulus Will Offset State Cuts, WNYC Radio 2/1/09
- Stimulus Keeps City Hospitals' High Tech Hopes Alive, WNYC Radio 2/20/09
- HHC a 121M Winner?, Crain’s Health Pulse 2/19/09
- $18 Million for Queens, Crain’s Health Pulse 2/11/09
- Early testing's best male cancer shield, New York Daily News 2/4/09
- A Urologist's Fight Against Prostate Cancer, The Network Journal 2/09
- Elmhurst Hospital Center Opens Lactation Clinic, Queens Gazette 2/18/09
- New Era in Health Care, Caribbean Life 2/11/09
- Other Hospitals see growing wave of displaced patients, Queens Village Times 2/18/09
- Nurses’ Notes to the President, Nursing Spectrum 1/26/09
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Report to the Board of Directors
