ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
APRIL 29, 2010

From March 24th to 26th, The Joint Commission conducted its unannounced survey of Gouverneur Nursing Facility. The Gouverneur team performed exceptionally well, receiving a laudatory appraisal from the surveyor and unconditional accreditation. I commend Mendel Hagler, Gouverneur's Executive Director and staff of the nursing facility for their successful survey. Elmhurst Hospital Center, Jacobi Medical Center, Metropolitan Hospital Center, and Dr. Susan Smith McKinney Nursing Facility remain to be surveyed by The Joint Commission this year.

This weekend we completed the 4th annual HHC all-employee Patient Safety Culture Survey. The survey tool is a reliable and valid instrument developed by the Agency for Healthcare Research and Quality that is designed to assess staff opinions about patient safety issues, medical error, and event reporting.

The survey was conducted over a two-week period and was made available to all HHC facility and home health care employees, medical staff, and volunteers in a web-based or hard-copy format. The survey enables staff to anonymously help us to identify areas of strength and opportunities for improvement at HHC. This year, we received over 25,000 survey responses. We will analyze the results during the next month and I will report on our employee feedback in the May meeting.

Dr. Abdul Mondul, Patient Safety Officer and Chief, Palliative Care at Lincoln Hospital and Dr. William Wang, Patient Safety Officer and Surgery Attending at Metropolitan Hospital have been selected to participate in the 2010-2011 Patient Safety Leadership Fellowship Program sponsored by the American Hospital Association and the National Patient Safety Foundation. The Fellowship is a year-long leadership development program that provides leaders of hospitals, health systems and other health care organizations with the skills necessary to shepherd patient safety change initiatives within their organization.

Both Dr. Mondul and Dr. Wang received a full scholarship to the Fellowship Program through HHC's involvement in the Patient Safety Initiative at America's Public Hospitals, a program jointly sponsored by NAPH and NPSF and funded by the Kaiser Family Foundation. One hospital from each of the seven HHC Networks is participating in the Initiative.

Over the course of the next year, each Fellow will be required to complete an Action Learning Project. Dr. Mondul's project will focus on “Integrating Patient Safety and Graduate Medical Education.” Dr. Wang will develop a “Patient Safety Deputy Program” where frontline staff will be “deputized” as change agents to improve patient safety culture in their work area.

This month, HHC is launching the first episode of a four-part multi-media series entitled Believing, focused on our patient safety initiatives and achievements. Believing tells our story through the eyes of a number of the individuals and teams that have been responsible for noteworthy accomplishments and advances in patient safety at all of our facilities. Using narrative, film, photography, and data, the series illustrates the impact of those who believed we could improve, and shows how that belief was translated into action. The series will be available on our web site. The second, third, and fourth episodes will be premiered at the May, June, and July Board meetings.

The closure of St. Vincent's Hospital was publicly announced this month, but Bellevue Hospital, which is the closest HHC hospital in that area of the city, had already been seeing an increase in visits in recent weeks. Over the past 30 days Bellevue saw a 13 percent increase in Emergency Department volume compared to the same time last year. There has also been an increase in psychiatric inpatient activity, with the hospital adult psychiatry census going from 95 percent to 101 percent. Bellevue and Metropolitan Hospitals are both in active discussions with the State Department of Health for support to finance our handling responsibly the inevitable increase in volume that will result from the closure of St. Vincent's.

HHC has asked the State for several million in capital dollars to retrofit beds for in-patient psychiatric care and an additional one-time sum to offset the initial cost of increasing staff. The St. Vincent's closing shows just how important HHC is as the last remaining healthcare safety net system, and how urgent it is to ensure the system remains strong and financially viable. Our mission and our commitment encompass meeting the healthcare needs of New Yorkers left adrift after the closure of a major healthcare facility. But we also need the financial support to deliver on that mission. Now, more than ever, the State Legislature needs to rethink any additional proposed funding cuts to the public hospital system. On April 16, I joined representatives of our labor partners at a press conference at Bellevue Hospital to reiterate this urgent need. As I noted below, the final State budget is not anticipated until sometime in June, at the earliest, so our advocacy efforts must continue.

State legislators returned to Albany earlier this month after the recess to observe Easter & Passover. With their return, discussions on the State Budget resumed. As you may have read, however, little progress has been made between the Assembly, Senate and Governor. On Tuesday, the Governor proposed a new round of cuts to bring his Executive Budget proposal into balance. Under these new proposals, the State would save an additional $620 million. A new trend factor cut is being proposed that would cost HHC an estimated $9.8 million. With this additional proposed cut, the Executive Budget would now reduce funding to HHC by $78.2 million. As I mentioned briefly last month, both the Assembly and Senate put forth their respective one-house budget resolutions before the holiday recess. Both plans included cuts for HHC, but each was less than those in the Governor's proposed budget.

Under the Assembly plan, HHC would see a reduction of approximately $43 million this year. The Assembly accepted the Governor's proposals to eliminate the 2010 trend factor for hospitals, nursing homes and home care agencies as well as increasing the assessment, or tax, which is imposed upon them. The Assembly rejected the Executive's proposal to penalize hospitals by reducing inpatient funding for “preventable readmissions” and eliminated the nursing home regional pricing proposal. Importantly, the Assembly agreed to a proposal to authorize $276 million in DSH funding for HHC in State Fiscal Year 2011-12 and $417 million in State Fiscal Year 2012-13. They would achieve this by shifting payments to voluntary hospitals that are currently made from the Bad Debt and Charity Care Pool, which takes up room under the State DSH cap, to a new Medicaid payment outside of this pool, thereby freeing up DSH room for HHC.

In the Senate plan, HHC would lose approximately $32 million this year. Similar to the Assembly, the Senate accepted the elimination of the trend factor for hospitals, nursing homes and home care agencies. The Senate rejected the Executive proposal to increase the assessment, or tax, on hospitals, nursing homes and home care agencies. Instead of eliminating the nursing home regional pricing proposal, they agreed to defer its implementation to July 1st, 2011. They also modified the Executive's preventable readmission proposal by carving out patients with psychiatric or substance abuse diagnoses and requested further information from the State Health Department on how these changes would affect hospitals. The Senate resolution was silent on authorizing additional DSH funding to HHC. However, key legislators and Senate staff have given HHC assurances that their intent is to authorize additional DSH funding for HHC, but they have not yet agreed to the methodology that would create the necessary room under the statewide DSH cap.

Unfortunately, for MetroPlus and HHC, both houses agreed to the Executive's proposal to reduce the Medicaid managed care premium by 1.7 percent. This would result in an estimated $15 million cut to MetroPlus.

Until the budget is done, HHC will continue to urge legislators and their key staff to minimize the cuts to HHC while maximizing the DSH funding authorization. As the Board knows, HHC began taking steps last year to reduce expenses in light of a projected budget gap for next fiscal year that exceeds $1 billion and those measures will yield slightly over $200 million in savings this fiscal and a projected $300 million in the coming fiscal year. Because the timing for final resolution of the state budget is so uncertain, HHC will shortly make final decisions on additional cost containment measures that are necessary, and will do so on the assumption the state will make available to us a continuation of the $300 million in DSH funds received last year. If that turns out not to be the case, we will need to make still further cuts and it will be very difficult in that event to preserve the full measure of our mission and the service capacity necessary to meet the needs of our communities. I will, of course, keep the Board apprised on the timing and the content of our proposed budget-related initiatives.

On April 15th, both houses of Congress passed and the president signed into law a bill that includes a clarification to the American Recovery and Reinvestment Act of 2009 (ARRA) provisions on Health Information Technology. The bill states that hospital-based physicians working in ambulatory care settings are eligible for ARRA HIT funding. CMS, in its preliminary rule, had narrowly interpreted the ARRA HIT provisions to exclude all hospital-based doctors from stimulus funding. This change could be worth up to $78 million in additional funding to HHC.

On April 30, 2010, a ribbon-cutting ceremony will be held at Kings County Hospital to mark completion of the renovation of a facility for the Long Island University School of Nursing at Kings County Hospital Center. The Mayor's Center for Economic Opportunity paid for the renovation and provides nursing school scholarships for low-income New York City residents who are not HHC employees. The program, a partnership between HHC and Long Island University School of Nursing, will have 60 BSN graduates each year, beginning in 2011. Those graduates will have guaranteed positions waiting for them within HHC. The nursing school at Kings County re-kindles an old tradition of the public hospital system training many of its own nurses. The program is located on the same site as a former Nursing School that dates back to 1897 and graduated its last class in the late 1970's.

While capital investments in many public works have been affected by the current financial climate, several major modernization projects are continuing to move forward at HHC.

• At Harlem Hospital Center, work is progressing on the New Patient Pavilion that is being built as part of the major modernization of the Harlem Hospital complex. This new state-of-the-art pavilion on Lenox Avenue will house diagnostic suites, an emergency department, operating rooms and critical care units that will serve as the centerpiece of the campus-wide modernization. Harlem is in the third year of a five-year modernization plan that involves demolishing antiquated buildings, renovating 195,000 square feet of space, and building a new patient pavilion. The modernization will connect the Martin Luther King, Jr. Pavilion and the Ronald H. Brown Pavilion, creating one large modern healthcare complex for the Harlem community.
• At Gouverneur Healthcare Services, the modernization project is continuing, with a major renovation of the existing building and construction of a new 108,000-square-foot addition for ambulatory care services. The lower floors of the new building will house expanded ambulatory care services, and the upper floors will house expanded long-term care services. The modernization project is scheduled to be completed by spring 2013.
• At Lincoln Medical and Mental Health Center, the facility's Emergency Department is being renovated and expanded. The remodeled Emergency Department will have the latest state-of-the-art medical technology, and will include a visitor and ambulance drop-off. This is the second phase of a two-phased project, which is expected to conclude in 2012.
• The expansion of the Corporate Data Center, located on the campus of Jacobi Medical Center, enlarges the existing Data Center by 9,200 square feet, and adds an additional 1,200 square feet for the incorporation of a call center. Completion of the expansion is anticipated by June 2010.
• Also on the campus of Jacobi Medical Center, work is progressing on the Institute for Medical Simulation and Advanced Learning Center (IMSAL). This project renovates a 9,200-square-foot space to simulate two dedicated operating room spaces and two emergency room spaces for educational instruction. The program strives to significantly improve the clinical performance and teamwork of health care professionals, as well as process of care throughout the HHC system. Construction is scheduled for completion by fall 2010.

To honor Mother's Day and throughout the month of May, HHC will join forces with the MetroPlus and the American Cancer Society to promote breast cancer awareness. In response to the recent debate about mammograms, our unified message is that women age 40 years or older should get a mammogram every year. Mammograms can detect abnormalities early and reduce the chances of breast cancer. Throughout the month of May, several HHC facilities will provide special public education and screening events where mammograms are accessible to women at little or no cost. Our collaboration with the Cancer Services Program of Staten Island will include breast cancer screenings at Richmond University Medical Center and Staten Island University Hospital.

The campaign will launch in the first week of May. Our partners at MetroPlus have funded a $60,000 advertising schedule that will include WWPR-FM, WKTU-FM, WQHT-FM, WRKS-FM, WPAT-FM and 12 community newspapers, generating almost 7 million media impressions. Through HHC's partnership with the American Cancer Society, public service announcements will appear on Fox 5 TV, MY 9 TV, WBLS-FM, WLIB-AM, three Univision radio stations and the NY Post. Pro-bono media is anticipated to exceed a value of $100,000 and 10 million impressions. HHC's medical experts will also hit the airwaves throughout May to inform New Yorkers about HHC's mammogram message. Mammogram postcards in English and Spanish will be sent to hundreds of community-based organizations. Print advertising will be published in community newspapers in various languages.

On our agenda today, for your review and approval, is an Affiliation contract renewal with Staten Island University Hospital for the provision of general care and behavioral health services at Sea View Hospital Rehabilitation Center and Home. The agreement is a three-year contract commencing July 1, 2010 and terminating on June 30, 2013.

This agreement between the Corporation and SIUH will facilitate the continuity of specialty care for our patients/residents by allowing them to receive timely emergent care, outpatient care and inpatient care from the same providers with minimal disruption, as well as the elimination of travel/transportation expenses.

The proposed Affiliation Agreement, like the prior one, will compensate SIUH based on payments for services provided by the hour. Because of the small size of this contract and since SIUH will only provide services on a part-time basis, additional performance indicators beyond those already being tracked as part of the Corporate quality assurance program are not included. The total contract cost for the agreement is approximately $991,260 for the three-year contract period.

• FDNY Begins Diverting Ambulances from St. Vincent's, NY1-TV, 04/09/10 (Also covered by WCBS, NY Times, Crain's New York Business)
• Alan Aviles discusses National Healthcare Reform, Brain Lehrer Live-TV, 03/24/10 (Also covered by WNYC Radio)
• HHC/Heart Cooling WNYC-TV, 04/13/10
• The 2010 Top 25 Minority Executives in Healthcare, Modern Healthcare, 04/19/10
• 40 Under 40, Crain's New York Business, 03/29/10
• Robles named NYC Health and Hospitals CIO, Modern Healthcare, 03/30/10 (Also covered by Crain's Health Pulse, Government Health IT, Healthcare Informatics, iHealth Beat)
• Cancer Care at Kings County, Crain's Health Pulse, 04/07/10
• Dr. Juan Yamin honored by HHC, Staten Island Advance, 04/19/10
• HHC Breaks Ground on City's Largest Medical Training Center, Nursing Spectrum, 04/05/10
• New York Notable Nurses (Jared Kutzin, RN, HHC), Nursing Spectrum, 03/22/10
• VNSNY initiative slashes preventable hospital readmissions, Crain's Health Pulse, 04/22/10
• Bariatric Surgery May Reduce Risk for Hypertensive Disorders in Pregnancy, MedScape, 04/19/10
• Cooling of cardiac arrests, USA Today, 03/29/10
• NYC Targets Black Women for Breastfeeding, Women's E-news, 03/31/10
• Common Ground, Advance for Nurses, 03/29/10
• Mammography Screening Events, My Fox New York, 04/05/10
• NCBH Hosts Perinatal Confab, Bronx Times Reporter, 04/05/10