ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
MARCH 25, 2010

As part of HHC's participation in this year's Colon Cancer Awareness Month campaign, HHC's 2009 statistics on colonoscopies were published on the HHC In Focus web site. HHC doctors performed more than 21,000 colonoscopies and removed pre-cancerous polyps in about 20 percent of those cases at the city public hospitals last year. HHC doctors also removed potentially life-threatening cancerous polyps from 338 patients. HHC again partnered with the New York City Department of Health and Mental Hygiene to urge all New Yorkers 50 and older to undergo a potentially life-saving colon cancer screening in HHC hospitals at little or no cost. During March, screenings are also being offered at the private hospitals on Staten Island at Richmond University Medical Center and Staten Island University Hospital, thanks to funding from HHC.

Since we began our annual campaign in 2003, the number of colonoscopies provided by HHC doctors annually has nearly tripled. Our goal is to make this screening test a routine part of healthcare for all New Yorkers over the age of 50. HHC promoted the month-long campaign with multilingual brochures, posters and postcards distributed to dozens of organizations across the city. In addition, HHC physician experts were interviewed by television and newspaper reporters to inform New Yorkers about the importance of timely colonoscopies.

The week of March 7-13 was designated as National Patient Safety Awareness Week and many facilities hosted special events to highlight aspects of their patient safety work and celebrate the notable advances we have made in keeping patients free from harm. In a ceremony held at the Jacobi Training Center, I had the pleasure of presenting the second annual HHC Patient Safety Champion awards to a number of dedicated individuals and teams that exemplify our improvements and best practices in patient care. This year's Patient Safety Champions are impressive advocates for patient safety. They are also an important reminder of something that I have often said: No matter what our jobs are, we can make a difference when it comes to patient safety.

This year, the top award went to the Point-of-Use Medication Labeling and Storage Systems team at Kings County Hospital Center. This team's innovations enabled the facility to strengthen its culture of medication safety through the introduction of a more effective medication management system.

This month we also introduced a multimedia series, entitled Believing, about HHC's Patient Safety initiative. The series will be available on our web site over the next two months and will feature the HHC individuals and teams that have embraced the belief that we can safeguard our patients from preventable harm while in our care. In doing so, they have made a profound difference.

We continue to add enhancements to our electronic health records to support patient safety and other high priority clinical care initiatives. HHC completed its system-wide implementation of a software-based approach to reducing the risk of intubated patients contracting ventilator-associated pneumonia. The ICU Ventilator Bundle Order Set (VBOS) is an enhancement to existing order-management software that hard-wires a series of safety interventions into the ordering process. With VBOS, providers are prompted to follow best practices that minimize the patient's risk of secondary infection and the time spent on a mechanical ventilator. We also launched a new Palliative Care Data-Entry and Reporting System, or PalTrack. This secure web-based system lets Palliative Care providers at all 11 HHC hospitals capture and manage a range of data relating to the breadth and timeliness of Palliative Care, including source and frequency of referrals, Palliative Care interventions and outcomes, and pertinent patient demographic information.

HHC's Flu Taskforce has concluded its work for this season, giving more than 260,000 doses of seasonal flu vaccine and more than 100,000 doses of H1N1 vaccine across the corporation. The employee vaccination rate for seasonal flu increased this year to 63% from last year's rate of 49%. Eleven HHC facilities had rates over 70% and one of our Bronx facilities, Segundo Ruiz Belvis Diagnostic and Treatment Center, had an employee vaccination rate of 100%. A hearty thanks to all our staff who made this important choice to get vaccinations for their health and for the safety of the patients in their care.

Infection rates in the 27 intensive care units of our 11 hospitals continue to fall and have dropped dramatically since system-wide efforts were commenced in 2006. We have achieved an 88% reduction in the rate of ventilator-associated pneumonia (VAP) and a 55% reduction in the rate of central line bloodstream infections among adult patients in intensive care units since 2005.

Central line infections at all HHC hospital ICUs for 2009 were at 3.4 infections per 1,000 patient days, down from 7.6 in 2005, when we began to report statistics for a smaller number of our ICUs. Despite the increase from 3.0 in 2008, 18 of 27 ICUs were able to achieve five months or more without a single central line infection, compared with 14 of 27 in 2008.

Over the last five years, the rates of VAP in our ICUs dropped to 1.3 in 2009 from 10.5 in 2005. Of 27 adult ICUs, 23 went five months or more without a VAP, with 12 of the 23 having no VAP cases for the whole of 2009.

Our results are evidence that we are making dramatic progress against common hospital-acquired infections through increased vigilance, strict adherence to best clinical practices and our relentless focus on optimal hand hygiene. This progress is being sustained. The decline in infection rates represent more than 1,000 infections prevented, many lives saved and savings of millions of dollars in healthcare costs.

The HHC system-wide mortality rate -- which has decreased over the course of the last six years -- has also remained comparatively low at 1.46% for 2009, as compared to the 2008 rate of 1.48%. This rate continues to be better than the most recently published national and regional figures.

With the transparent public reporting of these and other quality and safety measures we are demonstrating our willingness to be held accountable for our performance. The new 2009 rates are published in the “In Focus” section of our website at nyc.gov/hhc.

This past Sunday, the House of Representatives voted 219-112 to approve the Health Care Reform Legislation that had passed the Senate on Christmas Eve, 2009. The President signed the historic legislation (HR 3590) on Tuesday. Also on Sunday, the House passed a companion bill (HR 4872), the pending reconciliation legislation by a vote of 220-211 that incorporated changes to the Senate legislation that will yet have to be approved in the Senate via the budget "reconciliation" process. The benefit of using the reconciliation process is that a filibuster is not permitted and thus only a majority of 51 votes is required for passage, rather than the 60 required to force closure of a filibuster attempt. Senate Majority Leader Reid has assured House Speaker Nancy Pelosi and the House leadership that he has the votes to pass the reconciliation package. The House was reluctant to proceed without this assurance. The Senate started the debate on the reconciliation package this Tuesday evening. A major concession that won over a crucial group of abortion opponents led by Congressman Bart Stupak of Michigan was the issuance of an Executive Order by President Obama further clarifying that no federal funds -- including those used to subsidize health insurance policies sold on the exchange -- could be used for abortion services.

The health reform legislation is projected to provide insurance coverage to 32 million persons -- 95% of legal non-elderly US residents -- by 2019. The reconciliation package unfortunately removed the 340B pharmaceutical discount expansion to inpatient drugs. Undocumented persons do not benefit from either Medicaid expansions or insurance subsidies; the legislative language also prohibits them from purchasing insurance at the unsubsidized full market price through the exchanges.

Other highlights of the pending reconciliation legislation include a national expansion of the Medicaid program to include Americans with incomes of 133% federal poverty level ($29,327 for a family of four). The legislation also provides subsidies for the purchase of policies on health insurance exchanges for persons making up to 400% FPL ($88,200). The State Children's Health Insurance Program (SCHIP) is also preserved with an enhanced federal match (FMAP) of 23%. The health reform bill also would allow young adults up to the age of 26 to stay on their parents' insurance policies. The bill includes consumer protections such as the prohibition of insurance companies from denying coverage to persons with pre-existing conditions; and closes the Medicare Part D "donut hole" by 2020. There is also a provision which mandates that Medicaid primary care rates for physicians -- both managed care and fee for service -- equal Medicare rates in 2013-14.

For HHC, the City and New York State, the reconciliation legislation includes changes that are extremely important -- improvements in the amount of federal matching funds or FMAP for states like New York who have already expanded their Medicaid programs and in the magnitude of reductions to states' Medicaid DSH allocations and hospitals' Medicare DSH payments. New York will receive an enhanced 75% FMAP for all childless adults, with incomes up to100% of federal poverty level (FPL) in 2014, with the FMAP scaling up to 93% in 2019 and back down to 90% starting in 2020. This is a major improvement over the Senate bill. For newly eligible Medicaid categories (in New York this would encompass adults with incomes of 100-133% FPL), the enhanced FMAP will start at 100% in years 2014-16, decrease to 93% by 2019 and settle at 90% starting in 2020. The Medicaid savings to the City in 2014 have been estimated to be $300 million. This figure could increase to more than $600 million in 2019. New York State estimates that it will save $1.3 billion in 2014. The Senate bill would have cost New York State $779 million in 2014, or year one of health reform.

Reductions in Disproportionate Share Hospital (DSH) funding have been scaled back -- from the Senate's $43 billion total over 10 years to $37 billion. Cuts to states' Medicaid DSH allotments were reduced by $4 billion to $14 billion (years 2014 - 2019). Importantly, most of the Medicaid DSH cuts will take place in 2017 ($1.8 billion), 2018 ($5 billion) and 2019 ($5.6 billion), following the original House approach. There will be a $4 billion cut in 2020. Medicare DSH payments to hospitals will be reduced by $22 billion over ten years. The Senate bill would have reduced Medicare DSH payments by $25 billion.

There is a significant increase of more than $45 billion for 2011-2015 in funding for Community Health Centers; undoubtedly this will serve as a significant boost toward the development of primary care capacity in New York City and State.

We are heartened that HR 4851 (the Continuing Extension Act of 2010), which passed the House last week, includes a provision clarifying that hospital-based physicians are eligible for ARRA health information technology incentive payments. This provision could be worth up to $78 million for HHC. The Senate version also includes this provision. Hospital-based physicians would not have been eligible for incentive payments under the proposed CMS rules.

On another topic, the recent approval by the House Health Subcommittee for the 9/11 Health and Compensation Act was a major milestone to secure continuous federal healthcare funding for responders and survivors of the September 11th attacks. Staff and patients of HHC's WTC Environmental Health Center were instrumental in this outcome by making numerous trips to Washington to educate members of Congress of the ongoing health needs of the men, women and children our clinic serves. Additional support is needed in the House and then the Senate, but with the continued support of Congresspersons Nadler, Maloney and other elected officials -- along with our community advocates -- we are optimistic of full passage of the bill prior to this year's 9th anniversary of 9/11.

Discussions on the State Budget picked up this week with only one week left in the State fiscal year. I was in Albany on Monday for the second time this month to impress upon key legislators and their staffs the message that they need to minimize cuts to HHC and extend authorization to allow HHC to receive at least the additional $300 million in DSH funding that we received this year. While I was in Albany, the Senate released its budget resolution outlining their priorities. In its resolution, the Senate accepted some of the Governor's proposals and rejected others. The Assembly yesterday passed its one-house budget resolution, which partially restores some of the cuts the Governor had proposed. One-house budget resolutions do not have the force of law and are generally meant as a starting point for negotiations among the two houses of the Legislature and the Governor. Both houses of the Legislature are now negotiating to reconcile the differences among their proposals. They aspire to reach agreement and pass a budget before leaving to observe the Easter and Passover holidays.

Turning to the City budget, last Thursday I provided testimony on the impact to HHC of the FY 2011 Preliminary Budget before the City Council Health Committee. In prior years, the Council has been very supportive of HHC by providing $5 million for our child health clinics, $2 million for expanded HIV testing, as well as providing millions of dollars to our facilities for various capital projects. It is our hope that, with strong advocacy by our facilities' Community Advisory Board members (CAB), the unions, health care advocates and consumers of our services, the Council will continue to provide these funds in FY 2011. Over the next two months, the Council will debate the various budget proposals in the Preliminary Budget. A second round of budget hearings will be held on the City's Executive Budget in mid to late May with negotiations concluding and final resolution typically announced in late June.

Dr. Julius R. Berger, professor and chairman at Kings County Hospital's department of dental and oral surgery, was named one of six winners of the 2010 Sloan Award, one of the City's top awards for extraordinary public service. During his 35 years at HHC, Dr. Berger has built a hospital department that was on the verge of closing into one of the premier dental departments and educational programs in the country. His many medical inventions have included a microscope with a focusing foot pedal, a cleft palate prosthetic, and a machine to freeze-dry chemicals. His team now sees 30,000 patients each year. Congratulations to Dr. Berger for this singular honor.

• Lincoln Hospital was one of 82 programs nationwide to receive an Outstanding Achievement Award from the Commission on Cancer. The award, which was given to less than 20% of all the programs surveyed, recognizes quality care provided to cancer patients, including outstanding research, community outreach and quality improvement.
• ris Jimenez-Hernandez, Senior Vice President for the North Brooklyn Health Network and Executive Director of Woodhull Hospital, was recognized during Women's History month by the Brooklyn Borough President Marty Markowitz for her outstanding community service, with the Dr. Susan Smith McKinney Humanitarian Award.
• Nursing Spectrum featured Coney Island Hospital's Associate Director of Behavioral Health Nursing, Janet Ferguson, RN, citing the hospital's innovative Code Grey psychiatric crisis prevention team, which was developed as a patient safety initiative to reduce the use of restraints with patients. The Code Grey team was Coney Island's patient safety champion in 2009.

During the 2010 US Census, HHC facilities have participated in New York City's outreach and communication efforts. Promotional videos, in English and Spanish, are being displayed on plasma screens in HHC outpatient pharmacies and waiting rooms, thousands of multi-lingual brochures have been distributed to our patients, and many of our hospitals have provided locations where local residents can get advice on answering the Census questionnaires. MetroPlus has included a Census message in its March membership newsletter, reaching over 200,000 members. The findings of the census are used to determine, among other things, the amount of federal funding that is designated for our area. Historically, many of the patients HHC serves have been undercounted, including many undocumented immigrants. HHC is committed to doing what it can to insure that the population count is accurate.

This week HHC announced the appointment of Norberto (Bert) Robles to the position of Senior Vice President of Information Technology and Corporate Chief Information Officer. He will be responsible for developing a broad strategic vision and business plan for HHC's advanced and complex IT services.

Bert will oversee implementation of information technology to advance health outcomes, and a data center consolidation program that is underway. He will also lead HHC's efforts to meet “meaningful use provider” technology standards to ensure that we are able to access maximum federal stimulus funding and other governmental financial support.

With a distinguished 30-year career in various areas of information services, Robles most recently served as Chief Information Officer for the State University of New York Downstate Medical Center. He also served as a Practice Director for PricewaterhouseCoopers, where he focused on IT strategic planning, process transformation, and deployment.

Bert Robles is a highly effective and innovative leader who will help spread and sustain technology improvement across our complex multi-facility environment. I am pleased to have him join my senior team of advisors and look forward to his contributions to further advance HHC's role as a national leader in health information technology.

• Dr. Sulaiman Azeez on Colon Cancer Awareness Month at Lincoln, News 12 the Bronx-TV, 03/08/10
• Dr. Jamie Ullman on Pedestrian Safety at Elmhurst, WABC- TV, 02/18/10
• Queens Health Network Gets Financial Boost, NY1-TV, 03/08/10
• Harlem Hospital's Medina Clinic doc gives insight into ailments affecting West African community, New York Daily News, 03/15/10
• See one, do one, teach one' obsolete?, Crain's Health Pulse, 02/17/10
• Movin' On Up, Advance for Nurses, 03/01/10
• HHC, New York City, Reports Rise In Uninsured Patients, Advance for Nurses, 03/01/10
• 2010 Sloan Public Service Awards go to six 'outstanding' civil servants, New York Daily News, 03/10/10
• Get colon cancer screening at HHC hospitals, The Queens Courier, 03/10/10
• Coney Island Reduces Restraint Use in Behavioral Health Patients, Nursing Spectrum, 03/08/10
• Addressing Obesity, Crain's Health Pulse, 03/17/10
• Hospital Psychiatrists Dedicated Solely to Inpatient Care Can Reduce Violence, MedScape, 03/02/10
• NYCHHC: Surgical Safety Checklists, NAPH, 03/10/10
• Bellevue Hospital Center- " Finding Effective Ways to Free Up Inpatient Bed Space", NAPH, 03/18/10
• The Kings County Hospital Center in Brooklyn committed to the long term, Haiti Observateur, 02/19/10
• Nurses Turn Focus on Patient Safety into Fulfilling Careers, NurseZone.com, 09/18/10
• Celebrating Its 75th Anniversary, Key Hospital Looks Toward Future, The Queens Tribune, 02/25/10
• Bellevue Hospital Salutes "Pioneering African American Women in Nursing", Harlem News, 03/18/10
• Stop Smoking Programs, Queens Tribune, 02/25/10