ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
MAY 27, 2010

On May 11, in a press conference at 125 Worth Street, I announced some of the details of a comprehensive HHC Cost Containment and Restructuring Plan and identified the actions that HHC will take in the coming months to close a $1.2 billion budget gap. Deputy Mayor Linda Gibbs and HHC Chair Dr. Michael A. Stocker joined me in the press conference, as did the Senior Vice Presidents of HHC’s seven healthcare networks, all of whom participated in the formulation of our plan.

The four-year restructuring and cost containment plan is expected to generate $300 million in new savings and efficiencies by right-sizing operations, consolidating programs, contracting for targeted support and technical services, and closing a small number of clinics with low patient volume. The $300 million in new savings are on top of $300 million in savings and enhanced revenues expected from actions we have implemented over the past two years to help address a $1.2 billion budget deficit that results from reduced state and federal Medicaid funding, a dramatic rise in the number of uninsured patients and sharply rising pension and healthcare costs. Our total $600 million in cost containment actions were reflected in Mayor Bloomberg’s Executive Budget plan, announced on May 7, which directed substantial additional financial support to HHC to help prevent the need for even deeper reductions and permit a more gradual reduction of the workforce.

The changes I announced, some of which we will begin to implement on July 1, include targeted layoffs, the closure of some clinics, the consolidation of some work areas and functions, and the contracting out of certain functions and services.

Following this announcement, all of our senior leadership has worked to ensure that HHC employees remain informed of the changes being instituted. As we implement this plan, we are committed to keeping our trade unions fully informed and will ensure that implementation actions are undertaken in a manner consistent with our obligations under our collective bargaining agreements. We are also making sure that all other stakeholders -- elected officials, our community advisory board members, community-based organizations, and healthcare advocates -- know and understand the full scope of the changes we are making.

In making these difficult decisions, HHC leadership struggled with the harsh reality that our actions to ensure financial viability of our vital public health safety net system inevitably cause anguish and hardship to those whose jobs and lives are affected by the process.

This month, The Joint Commission conducted unannounced surveys of Jacobi Medical Center, Metropolitan Hospital Center, and Dr. Susan Smith McKinney Nursing and Rehabilitation Center.

Jacobi and Metropolitan Hospitals each had a five-day survey with five surveyors who conducted multiple patient and system tracer activities across each hospital that included inpatient units, ambulatory care clinics, emergency departments, behavioral health settings and a "roof-to-basement" review of the physical plant and environment of care. McKinney had a three-day survey with a Long Term Care Specialist.

I am very pleased to report that each facility performed extremely well on this test of quality and safety. Jacobi received six direct impact findings and Metropolitan, preliminarily, received four direct impact findings; we are awaiting Metropolitan’s final report. It should be noted that Metropolitan’s Behavioral Health Program received no direct or indirect findings and its Life Safety Code survey resulted in no direct impact findings. McKinney received no direct impact findings.

At each facility, the surveyors were impressed with the demonstrated evidence of leadership, teamwork, physician engagement, and facility commitment to quality and safety. The survey teams recognized numerous leading practices at the facilities which we have been invited to share with The Joint Commission.

I commend the Network Senior Vice Presidents and the Executive Directors of the surveyed facilities and their staffs for their exceptional performance.

Elmhurst Hospital Center is the final HHC facility awaiting a Joint Commission survey in 2010.

From May 17th to 19th, various aspects of HHC’s patient safety program were featured at the 2010 National Patient Safety Foundation’s Annual Congress: "Getting Results: Solutions That Work."

Several HHC staff members from facilities and Central Office were selected as faculty and five facilities were invited to present 10 posters at the Congress. Caroline Jacobs, Sr. Vice President for Patient Safety, Accreditation and Regulatory Services, served on the 2010 Congress Planning Committee. Dr. Haru Okuda, Assistant Vice President and Timothy Clapper, RN, Assistant Director, both of HHC’s Institute for Medical Simulation and Advanced Learning, participated in the Congress’ first Learning and Simulation Center where faculty presented interactive, engaging simulations depicting realistic healthcare scenarios in the context of patient safety. Dr. Okuda and Mr. Clapper led sessions on "Reducing the Risk of Central Line Infections and Complications Using Guidelines, Checklists and Simulation."

Ms. Mei Kong, RN, Senior Director, Office of Patient Safety and Dr. Abdul Mondul, Patient Safety Officer, Lincoln Medical and Mental Health Center gave a presentation on "TeamSTEPPS, Just Culture, and Patient Safety." Marian McNamara, RN, MS, Patient Safety Officer, and Carole Morgan, RN, BS, MPA, Director, Nursing Services, Sea View Hospital Rehabilitation Center and Home presented on "Novel Approaches to Improving Medication Management." Lastly, Nandini Gadkar, Senior Assistant Vice President and Reba Williams, MD, Office of Health Care Improvement, described HHC’s rapid response team journey in their presentation entitled "Rapid Response Teams: Do We Need Them?" Ten (10) posters were also presented at the Congress from Coney Island, Lincoln, Harlem, Metropolitan and Sea View hospitals.

HHC's leadership in Patient Safety innovations continues to be recognized by health professionals around the nation.

The ongoing Critical Care Collaborative has released evidence-based corporate-wide clinical guidelines for central line management. The work is a natural extension of the focused efforts undertaken by the corporation over the last four years to reduce rates of infections related to central line (CL) placement. The average rate in HHC ICUs has decreased to 3.4 per thousand CL days in 2009 from 7.6 in 2005.

The HHC central line guidelines have three components: a comprehensive clinical policy, a checklist and a reporting template. These clinical guidelines are to be used as standard of care for the insertion, maintenance and management of patients with central lines treated at HHC facilities.

HHC is committed to reducing central line infections, complications associated with central line placement, such as retained guidewires, and preventing avoidable deaths. To reinforce our commitment to this goal, HHC brought together corporate leaders from the Office of Healthcare Improvement, Critical Care Directors Network and Corporate Central Line Steering Committee to collaboratively develop and implement clinical guidelines for central line management that were evidence-based and reflect best practice. In addition, HHC's Medical Directors, Corporate Nursing, Clinical Affairs, directors of Emergency Medicine, Anesthesiology, Surgery, Interventional Radiology and Infection Control were consulted as content experts and consensus was reached.

The new central line placement and maintenance policy is being used by HHC’s Institute for Medical Simulation and Advanced Learning (IMSAL), to educate junior and senior medical staff across all of HHC. Since October 2009, more than 580 HHC learners have received medical simulation training in central line placement. IMSAL has also launched its skills-based training for the effective clinical management of shoulder dystocia during delivery. Shoulder dystocia is a very serious, unpredictable complication that can occur in an otherwise normal delivery. The medical simulation course prepares the learners to anticipate that it might occur, along with giving them an opportunity to practice with the latest evidenced-based skills that may lead to better outcomes. IMSAL plans to train approximately 430 learners in its Shoulder Dystocia course over the next 12 months, primarily attending physicians, residents and nurses in obstetrics.

One of HHC's medical simulation experts, Timothy Clapper, has been selected by the Editorial Board of the international journal, Clinical Simulation in Nursing, as the winner of the Outstanding Non-Research Article of the Year, for his article, "Beyond Knowles: What Those Conducting Simulation Need to Know About Adult Learning Theory."

HHC is offering training and support for HHC’s primary care sites interested in being recognized by the National Committee for Quality Assurance (NCQA) as a Patient-Centered Medical Home (PCMH). NCQA’s program recognizes physician practices and primary care clinics that can demonstrate standards for the use of systematic, patient-centered, and coordinated care management processes. A PCMH puts patients at the center of the health care system and leads to the improved patient health care that HHC facilities strive to provide. Also, the New York State Medicaid program has adopted the NCQA Patient-Centered Medical Home standards and is offering payment incentives to any provider who has been recognized by NCQA as a Patient-Centered Medical Home.

HHC has put together resources materials, tools, and project management support to help gain recognition and implement the processes needed to operate as Medical Homes. Approximately 30 individual locations throughout HHC will be represented through this application process. Nine of these teams are planning to incorporate HIV/AIDS Services in their PCMH application. A PCMH project web-site was activated the date of the kick-off and contains supporting tools and links that facility teams are using to support and facilitate their application development work. Weekly webinars and Q&A sessions conducted by a PCMH consultant expert review the NCQA standards in detail. Tips learned from these review sessions are distributed to all participants. The teams are planning to submit their applications to NCQA by the end of this year.

As I have reported to you previously, we initiated the HHC Connectx program in 2008 to expand our partnership with the community healthcare providers who treat patients in the communities served by our hospitals and to provide support when they wish to refer their patients to HHC facilities for specialty services. In 2009 an additional 545 providers joined HHC Connectx and referred their patients for specialty services at HHC facilities, via fax or online. They included local community practices, and also included major healthcare organizations, such as Downstate Medical Center, Creedmoor Hospital, and many nursing facilities. HHC referral offices processed over 100,000 referrals in 2009 using the computerized referral management system, up from 68,000 referrals in 2008. The online referral system is more efficient and less costly than a manual system, and the rate at which providers have been using it has increased from 33% in 2008 to 52% by the end of the first quarter of 2010. At the same time that referrals processed have increased from 4,300 to 6,000 per month, the time to process and schedule those referrals has decreased from an average of 3.3 days to 1.25 days.

As you know, over the last four years HHC has strived to develop what is commonly referred to as "Just Culture" across the system as a cornerstone of our patient safety agenda. Implementation has been a heavy lift primarily because embedding a Just Culture requires a culture change from one which focuses on the "blame and shame" approach, to one which holds each member of the organization responsible and accountable for making safe behavioral choices that keep their patients and colleagues safe from harm. Our belief is that this fair and just approach will, over time, free staff up to feel both comfortable and compelled to report on mistakes and errors, thereby supporting HHC’s learning culture and ultimately making HHC a safer healthcare system.

Last month, Dr. Richard Daines, Commissioner of the New York State Department of Health invited HHC to begin a conversation with members of his staff, including staff of the Office of Professional Medical Conduct, on how HHC has implemented a Just Culture and the barriers to such implementation. The Department solicited input from HHC on ways to create synergy between their principle role as regulator within the context of an environment where healthcare organizations are striving to improve patient safety by embedding a Just Culture. We were heartened by this initial, very thoughtful, conversation with the State Health Department. We will continue this dialogue next month when representatives of the State Health Department and the Office of Professional Misconduct will meet with HHC facility staff to gain firsthand knowledge on Just Culture implementation strategies, successes and challenges.

A six-month extension of the enhanced Federal Medical Assistance Percentage (FMAP) provisions that were originally part of the American Recovery and Reinvestment Act has been a priority for HHC, and has provided $87 billion to state Medicaid programs across the nation. The initial increase is currently set to expire on December 31, 2010. Both the House and Senate versions of recent jobs legislation under consideration (HR 4213) contain an FMAP extension from January 1, 2011 through June 30, 2011. This provision would be worth an estimated $609 million to New York City and $2 billion to New York State. Another provision in the bill of interest to HHC is a limited extension of the 340B pharmaceutical discount program to cover drugs purchased for uninsured inpatient patients. This provision would have only a minor impact on the corporation, but a full 340B expansion would be worth $25 million in yearly savings. Congressional leaders are currently working to finalize the legislation.

Earlier this week, another major hurdle was overcome in what we hope will be the ultimate approval of the James Zadroga 9/11 Health and Compensation Act. The bill would change 9/11 health funding from an annual appropriation to an entitlement. Late Tuesday night, after the bill was finally approved 33-12 by the House Energy and Commerce committee, Mayor Bloomberg released a statement of gratitude for this important step towards finally making appropriate resources available in the care of those who are ill due to the aftermath of the attacks on 9/11. I join the Mayor in thanking the entire New York delegation in their unwavering commitment to this legislation, especially the bill's sponsors in the House, Carolyn Maloney, Jerrold Nadler and Peter King, and the two New York City members on the Committee, Eliot Engel and Anthony Weiner, both of whom specifically referenced the many Congressional visits made by staff and patients of HHC's World Trade Center Environmental Health Center, which turned the tide in support of the bill for our program.

I also express my gratitude to the Mayor and his team for their continued support, advocacy and guidance during this process to ensure appropriate resources are available for those who need it most, the sickened survivors and those who risked their lives to save others on and after 9/11. One issue that has been raised is whether federal funds can be used for undocumented immigrants. If undocumented immigrants are prohibited from accessing these federal funds, HHC’s WTC Environmental Health Center, which provides treatment to community members, would bear the brunt of the loss in federal funding. So far, no such restriction has been included the bill. There is hope that the bill could be scheduled on the House floor before the Memorial Day recess. It is uncertain when the Senate will take up the bill.

On May 18, HHC recognized 34 outstanding hospital volunteers in our Annual Volunteer Recognition Ceremony and luncheon at Coler-Goldwater Specialty Hospital and Nursing Facility. These volunteers were chosen from the more than 8,000 men and women who have dedicated nearly one million hours of service to HHC hospitals over the last year. Volunteers are in hospitals, long-term care facilities and diagnostic and treatment centers. They serve as language interpreters, counsel sexual assault victims, feed elderly patients, rock babies, play with children, read to adults and comfort family members. They tend to patients’ spiritual lives by bringing them to chapel and visit those who otherwise would not have any company.

Please join me in saluting our outstanding volunteers, whose special care for our patients is such a vital element of our compassionate patient-centered healthcare system. They are an important part of what makes HHC great.

On May 6, the HHC Foundation presented a check for $125,882 to the Mayor's Fund to Advance New York City, which is managing the City's Haiti Relief Fund. The funds have been received from staff, patients and visitors at HHC's hospitals, long-term care centers and ambulatory care facilities. One hundred percent of the donations received will go to emergency relief organizations who are directly serving victims of the Haiti earthquake this January. HHC employees are donating directly and through payroll deductions, which will continue through the end of this year. Fundraising events like concerts, lunch sales, cook-offs and raffles were also held. And of course many staff traveled as "first responders" to Haiti, using their own time and money to help earthquake victims. For the thousands of HHC patients and staff who have roots in Haiti, there is comfort in the knowledge that their neighbors and colleagues in New York public hospitals are raising funds to support the crucial relief and rebuilding efforts in Haiti.

Several HHC outreach campaigns have received top awards from nationally recognized healthcare marketing organizations. HHC's Palliative Care Brochure and Video won a Bronze award in this year's Healthcare Advertising Awards, sponsored by Healthcare Marketing Report. The Healthcare Advertising Award program is the oldest, largest and most widely respected healthcare advertising awards competition. Over 4,000 entries were received in this year’s competition, making the awards the industry’s largest healthcare advertising awards competition. HHC campaigns were also recognized in the Aster Awards competition, hosted by Marketing Healthcare Today Magazine and Creative Images, Inc. HHC's brochure for the online Diabetes Wellness Center received a Gold award, as among the top 5% of the 3,000 entries in the contest, with HHC's Palliative Care brochure and video also winning a Bronze award.

Terry Hamilton the Director of HIV Services for HHC was honored on Sunday, May 23, 2010 at St. Alyosius Roman Catholic Church in Harlem for her many years of dedicated service to people living with HIV and for her work in New York's public hospital system over the last 10 years.

• Kings County Hospital- Nursing School Opening, News 12 Brooklyn –TV, 04/30/10
• Dr. David Garry discusses Childhood Obesity and Prenatal Care, News 12 Bronx -TV, 05/12/10
• Mother's Day Mammograms, WNYC-TV, 05/17/10
• Volunteer Honored at North Central Bronx, News 12 Bronx–TV, 05/26/10
• Experts say more senior abusing alcohol, WABC LA-TV, 05/05/10
• Carnegie Hall Comes to Jacobi, News 12 Bronx - TV, 05/20/10
• Dr. Rand David talks about Diabetes, WBLS Daily Dose Radio, 04/21/22/23/10
• City Hospitals’ Budget to Cut 500 More Jobs, The Wall Street Journal, 5/11/10 (Also covered by NY1, NY1 Noticias, Univision 41, News 12 Brooklyn, News 12 Bronx, WCBS, The Chief, Brooklyn Daily Eagle, Modern Healthcare, Queens Tribune, Gotham Gazette, Crain’s Health Pulse)
• HHC Infection Rates Continue to Decline, 04/30/10, The Bronx Times, 04/27/10
• HHC Infection Control Improves, Crain's Health Pulse, 05/05/10
• Going Mobile, Modern Healthcare, 05/03/10
• LIU, City Partner To Offer Nursing Degree at Kings County Hospital, Brooklyn Daily Eagle, 04/29/10
• HHC Nursing Program on Track, Crain's Health Pulse, 05/14/10
• Free mammograms in May, Staten Island Advance, 05/10/10