ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
March 24, 2011

HHC CELEBRATES PATIENT SAFETY ACHIEVEMENTS AND PATIENT SAFETY CHAMPIONS AT CORPORATE EXPO

To celebrate HHC's Patient Safety progress in 2010, on Wednesday HHC hospitals and health centers participated in one of our finest Patient Safety EXPOs, sharing their top patient safety initiatives with their HHC colleagues in a spirited competition for prizes. First Prize for hospital-based care was awarded to Metropolitan Hospital for its pediatric program to improve immunization compliance. First Prize for nursing homes went to Gouverneur Skilled Nursing Facility for its program to improve outcomes for residents receiving anticoagulation therapy. The top prize for diagnostic and treatment centers was given to Gouverneur Healthcare Services for its program to enhance patient safety by using trained volunteers to improve patients' health literacy and communication skills.

The Grand Prize went to the North Bronx Healthcare Network for their successful work to reduce adverse outcomes in labor and delivery through consistent and safe administration of the high-alert medication oxytocin, which significantly reduced the number of adverse incidents and delivery complications from shoulder dystocia and Erb's palsy. And the ever-popular People's Choice Award was delivered to Metropolitan Hospital for their creation of a "Quiet Zone" for safe medication administration, an initiative conceived when a study of hospital staff found that distractions was one of the top causes of medication administration errors.

At the EXPO, each facility also named a Patient Safety Champion -- the individual or team who best represents HHC's ongoing commitment to patient safety and shows, through their ideas and actions, how to achieve that goal. The 2011 Patient Safety Champions include staff from every function that makes a hospital run -- hospital police, housekeeping staff, medical administrators and laborers, as well as doctors, nurses, and entire multi-disciplinary teams who have made their mark on the front lines of patient safety. By every measure, we are making HHC a high-performing, reliable organization and we rely on the commitment of our entire staff to do that. This year's Patient Safety Champions are outstanding examples of the deep experience, determination and commitment of our workforce that continues to make HHC's accomplishments possible.

JOINT COMMISSION SURVEY KUDOS FOR QUEENS HOSPITAL CENTER

Last week, The Joint Commission conducted its triennial accreditation survey of Queens Hospital Center. The five member survey team covered all aspects of Joint Commission standards related to leadership and governance, patient safety, patient care, medication management, infection control, performance improvement, information management the environment of care, and the national patient safety goals.

The surveyors were impressed with the level of communication between leadership and staff and the demonstrated evidence of participation and collaboration of the medical staff in patient care, quality, safety and the survey process. Several programs were cited as best practices including the Radiation Therapy program, the Diabetic Management Program, and the Healthy Living program in Behavioral Health.

Queens Hospital Center will receive full accreditation by The Joint Commission. We applaud Network Senior Vice President Dr. Ann Sullivan, Executive Director Julius Wool, Medical Director Dr. Jasmin Moshirpur, Chief Nurse Joan Gabrielle, Deputy Medical Director of Quality Dr. Jean Fleischman and Regulatory Affairs Director Anne Fraser for their hard work and that of all of their staff for their exemplary performance on this external evaluation, and validation of the quality and safety of care provided to our patients.

Bellevue, Coler, Goldwater, Harlem, North Central Bronx and Woodhull remain to be surveyed this year.

ALL HHC ACUTE CARE AND DIAGNOSTIC & TREATMENT FACILITIES RECEIVE TOP LEVEL CERTIFICATIONS AS PATIENT-CENTERED MEDICAL HOMES

By the end of 2010, all of our acute care facilities and diagnostic and treatment centers, 17 separate sites in all, submitted applications to the National Committee for Quality Assurance to receive designation as Patient-Centered Medical Homes (PCMH). NCQA has completed their review of these applications and awarded each the highest, Level 3, PCMH Recognition.

HHC is also preparing applications for 22 community health centers and extension clinics. Sixteen of these applications have already been submitted and NCQA has completed their review of six of these community sites, awarding each Level 3 Recognition. As of March 21, we are waiting for NCQA to complete their review of 10 community sites and HHC is completing the last six remaining applications for submission to NCQA.

To date, NCQA has recognized 532 physicians comprising 86 percent of our primary care providers who are linked and practicing in Level 3 PCMH sites. If all of our primary care sites ultimately receive Level 3 NCQA Recognition status, HHC will ultimately qualify for at least $15 million annually in enhanced Medicaid reimbursement rate increases.

HHC NURSE WINS SLOAN PUBLIC SERVICE AWARD;
FOURTH HHC WINNER IN SIX YEARS

Earlier this month, Elva Rodriguez, an outstanding HHC nurse practitioner in Women’s Health Services at the Segundo Ruiz Belvis Neighborhood Family Health Center in the Bronx, won the prestigious Sloan Public Service Award. The Sloan Awards are presented annually by the Fund for the City of New York to recognize outstanding civil servants whose professionalism, commitment and accomplishments are truly extraordinary.

Ms. Rodriguez has been an OB/GYN certified nurse practitioner for more than 23 years. She provides direct patient care with intelligence and compassion, and has played a key role in improving systems and implementing standards that have raised the bar for healthcare delivery to women. Her dedication and innovative thinking have made a significant difference in the lives of the patients for whom she cares at the Belvis Center.

Ms. Rodriguez is the fourth HHC staff member to win this coveted award in the past six years. Previous awards were won by Theresa Landau, Director of the WIC program at Morrisania D&TC; Joann Gull, RN, Chief Nursing Officer at Elmhurst; and Dr. Julius Berger, Chairman of the Dept. of Dental and Oral Surgery at Kings County Hospital.

This recognition is an inspiration to all of us in public service and is a source of encouragement to continue to strive for excellence in healthcare delivery despite the many challenges before us. I offer my gratitude and congratulations to Ms. Rodriguez for winning this significant recognition for exemplary government service.

FEDERAL LEGISLATIVE ACTIVITY

Early this month, HHC participated in the annual legislative event of the National Association of Public Hospitals and Health Systems. Issues discussed included:

• the continued importance of Disproportionate Share Hospital (DSH) funding to HHC;
• the significance of maintaining Medicaid's status as an entitlement program, rather than having the program converted into block grants for the states;
• the importance of maintaining Graduate Medical Education and Indirect Medical Education Funding; and
• forestalling any changes or weakening of the "Maintenance of Effort" requirements of the Accountable Care Act which mandates that states must maintain Medicaid eligibility for currently covered persons.

With both Congress and the White House focused on the deficit, there have been serious discussions about achieving savings in healthcare, with Medicaid especially vulnerable.

Last week Congress passed a three-week extension of a continuing resolution to fund the federal government. The resolution reduces FY 2011 spending by $6 billion dollars by reducing or terminating 25 federal programs. Without this extension, the federal government would have shut down on March 18th. Negotiations among House Republicans, Senate Democrats and the White House continue to seek a compromise to ensure funding for the remaining seven months of fiscal year 2011. House Republicans are still insisting on massive cuts totaling over $50 billion from last year's levels. Congress also must address many issues related to the upcoming FY 2012 budget. We will keep you posted on these developments.

STATE AND CITY BUDGET UPDATE

State budget negotiations are currently underway as legislative leaders and the Governor work to narrow their differences ahead of next week's budget deadline. As I stated last month, the recommendations of the Medicaid Redesign Team (MRT) were incorporated into the Governor's Executive Budget proposal. As it stands now, HHC could see reductions of approximately $118 million if the proposals remain unchanged. Although this represents a significant loss in funding for HHC, the alternatives could have been worse. The proposed reduction come in the context of the State's having to cut $2.3 billion in Medicaid funding as part of a $10 billion gap closing plan, and the other MRT proposals that were initially being discussed could have led to cuts of more than $200 million. By no means, though, do I want to downplay the size of this reduction. Once the budget is completed, we will have to plan to address this new shortfall in the context of our larger restructuring initiatives already underway. It is expected that three-way negotiations will intensify now through the weekend so a final deal can be struck in time for bills to be printed and voted on before next Thursday.

I would like to note for the Board and for those in attendance today that HHC will be testifying before the City Council Health Committee on the City's Preliminary Budget this coming Monday. I'm sure the Council will have questions for me on the progress that has been made on our cost-containment and restructuring initiatives and on the implications to HHC of the MRT proposals.

HHC RECEIVES CITY REQUEST FOR BUDGET CUTS

The City's Office of Management and Budget recently announced the Fiscal Year 2012 Executive Budget reduction program which calls for a reduction in general City Support of 4 percent. The HHC impact of the 4 percent translates into a reduction of $3.275 million annually. Currently, we are assessing what the detailed impact would mean. Our response to this reduction request is due back to OMB on Friday, March 25.

HHC PROGRESS TOWARD MEANINGFUL USE OF ELECTRONIC HEALTH RECORDS TO QUALIFY FOR ENHANCED FEDERAL FUNDING

In order to be eligible to receive American Recovery & Reinvestment Act (ARRA) funding from the federal government, HHC has embarked on an aggressive plan to redesign clinical and financial processes to effectively achieve “meaningful use” of electronic health records. HHC has an opportunity to gain close to $120 million in incentive monies under the hospital program and another $70 million under the Eligible Provider Category.

HHC must demonstrate meaningful use by meeting three criteria: Using certified electronic health record technology, participating in electronic exchange of health information and submitting information on clinical quality measures to the Centers of Medicare and Medicaid Services.

HHC is in the process of migrating its electronic health record platform database and application software to a structure which allows the key functionality required to meet meaningful use. Nine hospitals have already successfully migrated to the new data base platform and the last two are scheduled to be completed by April 2011. Software upgrade installations are scheduled at all facilities through spring 2011 to meet additional criteria. Our core Electronic Health Record Software Vendor, QuadraMed, received federal certification for the Computerized Patient Record use at HHC in December 2010. Our Clinical Information Systems Division continues to work with each of the facilities to review current progress, gaps, and strategies to close them.

HHC will need to demonstrate three months of meaningful use in order to be eligible to begin to receive the incentive payments. HHC is working closely with the Interborough Regional Health Information Exchange to connect its facilities and conduct at least one test of data exchange during this critical time period.

CONFERENCE PREPARES EFFECTIVE CITY-WIDE RESPONSE FOR POSSIBLE TERROR ATTACK

On March 15th and 16th, HHC staff attended a conference entitled Tale of Our Cities 2011 - Planning for an Interdisciplinary Response to Terrorist Use of Explosives. The conference was coordinated by the New York City Department of Health and Mental Hygiene along with the federal Centers for Disease Control and Office of the Assistant Secretary for Preparedness and Response.

The goal of this conference was to bring together the top NYC leaders from key disciplines to save lives and build resilience in response to terrorist explosive events. The conference provided an opportunity to learn from and exchange real-world challenges and solutions based on actual terrorist explosive events in order to effectively coordinate and plan the best response strategy for the city.

Day one included speakers from the London, Madrid, Tel Aviv, Mumbai, and Islamabad. They spoke about the terrorist bombing incidents that occurred in their cities and lessons learned both operational and clinical. On day two, five workgroups were held discussing clinical, operational and security related responses to an explosive event. An invitation-only sixth workgroup was held for leadership. HHC Central Office senior staff attended the leadership workgroup with facility staff attending the other groups. The purpose of the workgroups was to work collectively to identify any gaps specific to NYC readiness and response to a terrorist explosive event and to propose an interdisciplinary plan to address the identified issues.

GRANT-WRITING SEMINAR FOR PRINCIPAL INVESTIGATORS AT HHC FACILITIES

Today, HHC held a webinar for principal investigators at HHC facilities on grant-writing, a specific need identified during a major corporate-wide research conference held at HHC last fall. HHC's Office of Research Administration collaborated with Lincoln Medical and Mental Health Center to hold the conference, which was titled RECORD -- Research Enhancement, Compliance, Orientation & Resource Development. The conference was attended by nearly 200 participants from across the corporation who participated in two days of activities focused on research. The goal of the RECORD initiative is to improve HHC's capacity to conduct clinical research that furthers the science of medicine, particularly in the areas of healthcare disparities and healthcare delivery. Today's grant-writing webinar is the first of several seminars that will be offered, based on needs identified during last year's conference. Dr. Joseph Conigliaro, Director of Practice-Based Research with the NYU-HHC CTSI, led the grant-writing seminar for 40-50 Principal Investigators, all of whom are actively seeking grants to support research at HHC.

FIRST PHASE OF GOUVERNEUR MODERNIZATION NEARS COMPLETION

The $213 million modernization project of Gouverneur Healthcare Services is reaching an important milestone with the anticipated opening this summer of the new Ambulatory Care Pavilion and Atrium that will house part of Gouverneur’s ambulatory care services. Existing services will be expanded in the new Ambulatory Care Pavilion with new modular exam rooms, enlarged waiting areas and a state-of-the-art Women and Children’s Center.

Also opening this summer at the ribbon-cutting will be the first of the new residential floors of Gouverneur's Skilled Nursing and Rehabilitation Center. The modernization project will expand nursing facility capacity from 210 to 295 beds and enable more short term sub-acute care. Residents will be housed in hotel-like private rooms and suites. Each patient floor will have new recreation areas, a country-style kitchen and other amenities for residents.

New services to open in a future phase of the project will include a Computer Tomography (CT scan) unit, a Dialysis unit and a full-spectrum ambulatory surgery center. The Gouverneur modernization project includes renovation of the existing building and an additional 108,000 square feet of new construction. The project will transform the ambulatory care center into The Center for Community Health and Wellness and the nursing facility into The Residence at Gouverneur Court. This is the first phase of a multiphase implementation which is scheduled for completion in early 2014.

NORTH GENERAL/GOLDWATER NORTH PROJECT FORESTALLS EXPENSES REQUIRED TO INSTALL SPRINKLER SYSTEM ON GOLDWATER CAMPUS

In May 2009, a feasibility study was conducted for the installation of fully code-compliant automatic sprinkler systems for both the Coler and Goldwater campuses, as required by August, 2013 for all nursing homes participating in the Medicare or Medicaid programs. The cost for both campuses was estimated at approximately $70 million, with Goldwater’s portion of the project cost estimated at $39 million. As you know, subsequent discussions with the New York State Department of Health have resulted in the development of the North General/Goldwater North project which, when complete, will result in the transfer of patients out of the current Goldwater facility and into a newly developed facility on the grounds of the former North General hospital. The de-commissioning of the Goldwater campus and its incorporation into the North General project will permit HHC to forgo any sprinkler installation into the Goldwater campus, allowing the estimated $39 million cost to be expended on the North General project. I will be giving you a more detailed update on the North General project at our meeting in May.

2010 YEAR IN REVIEW AVAILABLE IN ONLINE VERSION

Last month, in order to report late-breaking budget developments to the Board, I elected not to present my full annual Year in Review summary. While it was included in the Board package, others may not have had an opportunity to read about our 2010 highlights, issues, and accomplishments. The document recounts not only our ongoing challenge to contain costs and preserve critical safety net services, but also updates our successful Breakthrough efforts and our continuing advances in patient safety and quality. The online version is available now at www.nyc.gov/hhc, by clicking Publications and Reports, then Year in Review.

HHC SALUTES OUTSTANDING PHYSICIANS FOR NATIONAL DOCTORS DAY

In recognition of National Doctors Day this month, HHC will honor 31 doctors for their expertise and dedication to providing the highest quality healthcare and advancing the mission of the public hospital system.

These talented men and women vary in specialties, age, education, and years of service, and represent the ethnic diversity of HHC patients. Among them is a group of seven community physicians who represent HHC’s growing relationship with healthcare providers outside the public hospital system who serve HHC patients throughout the city.

The doctors are committed to providing medical care to all New Yorkers regardless of their ability to pay or immigration status, making them vital to the well-being of our city. HHC will honor the doctors at a breakfast next Wednesday, March 30, at Draper Hall at Metropolitan Hospital.

INTERNATIONAL CLOWN CONVENTION BRINGS LAUGHTER TO HHC PATIENTS

Cyrus Zavieh AKA Cido the Clown, an Elmhurst Hospital employee for 19 years, was instrumental in bringing 40 international Caring Clowns to Elmhurst, Bellevue and Coler-Goldwater to perform for patients, families and staff. The clowns were attending the World Clown Association’s annual convention held in New York City for the first time. They received a Mayoral Proclamation declaring March 13 – 19 “Make ‘em Laugh - New York City Clown Week.” Cido the Clown was born 15 years ago after Cyrus, seeing what patients were going through, wanted to find a way to relieve their pain and suffering. Since then, on Saturdays and Sundays Cido volunteers his time to entertain Elmhurst’s patients.

AWARDS TO HHC FACILITY PROGRAMS AND STAFF

Several of HHC's facilities and staff have received awards for their outstanding service and expertise:

• The "Kids Ride Club," a program founded by Dr. Edward Fishkin, Medical Director at Woodhull Medical Center received the Spirit of Excellence Award, sponsored by Modern Healthcare Magazine and Sodexo Healthcare Services. Dr. Fishkin started the program to introduce the youth of North Brooklyn and other city neighborhoods to the health benefits and enjoyment of cycling.
• Dr. Abha Agrawal, Medical Director at Kings County Hospital, has been selected as a Fulbright Scholarship recipient and will be spending a modest part of her time this year working on a Patient Safety project in India.

DEVIATION GRANTED TO PERMIT CM BUILD CONTRACT AMENDMENTS

As was reported to the Board’s Capital Committee earlier this month, and under the authority granted to me pursuant to our operating procedures, I have approved an amendment to our contracts with four construction management firms to expedite the completion of certain state-funded projects. These four firms were previously procured through a competitive process to perform under requirements contracts and those contracts were approved by this Board.

The deviation I approved now permits the expansion of the scope of the construction managers’ contracts to include the administration of several construction projects involving time-sensitive New York State Department of Health (SDOH) HEAL grant funds. As part of actions related to the State’s budget deficit, SDOH recently imposed a deadline under which outstanding HEAL grant funds must be expended by this coming August, or such funds may be recouped by SDOH. We, like many other hospitals across the City, are now under extraordinary pressure to complete capital projects that are partly funded with HEAL dollars or risk losing such critical capital funding. For HHC, approximately $35 million dollars in funding is at stake related to eight projects at Elmhurst, Woodhull, Kings County, Bellevue, Lincoln and Queens. While the State may extend the August deadline, there is no indication at this point of its intent to do so. By engaging the construction managers on an expedited basis to manage these projects, including the time-consuming work to procure the needed construction trades, our Office of Facilities Development will be able to move all eight of these projects on a considerably accelerated basis simultaneously and will strive to meet the August deadline on all of the projects.

WEBSITES LAUNCHED FOR ADDITIONAL HHC HOSPITALS

This month HHC launched websites for two more of its hospitals -- Harlem Hospital Center and Queens Hospital Center. During the past two years, HHC has published nine facility websites, which had more than two million visits in 2010. Nearly 40 percent of HHC's website traffic is from visitors seeking more information about our facilities, and we know that web visitors are hungry for more online information. We continue to work with facility staff to optimize their use of the Internet to reach the communities they serve. By the end of this year, we plan to publish individual websites for all of our remaining eleven hospitals and four nursing homes.

HHC REACHES OUT TO PATIENTS WITH NEW VIDEOS, CELEBRITY SPOKESPERSONS

Increasingly HHC is reaching out to patients with video messages published on our Internet website, www.nyc.gov/hhc. The 2011 Colon Cancer Campaign features compelling testimonials from HHC’s patients and employees via short video messages to encourage others to seek a life-saving preventive colonoscopy once they turn 50, or earlier if so directed by their physician. The videos will be part of the first internal healthcare initiative launched under our Take Care HHC campaign.

HHC's online Diabetes Wellness Center has also been expanded to include Celebrity Corner where celebrities share powerful video messages and personal stories to encourage diabetic patients to take control of their health to reduce the risk of complications. Celebrity Corner currently features two NBA basketball legends. Walt “Clyde” Frazier formerly of the New York Knicks, shared how his family members have been devastated by diabetes complications, and talked about how our diabetes patients could effectively manage their disease. This month, Dominique Wilkins, formerly of the Atlanta Hawks, discusses how he manages his Type 2 diabetes and urges HHC patients to work with their care team to keep their diabetes under control. I end this report with this video, showing his story.

HHC IN THE NEWS HIGHLIGHTS

• Elmhurst Patients Get Lesson In Clowning Around, NY1- TV, 03/16/11
• Artist Access Program at Woodhull Hospital, NYC Media -TV, 03/19/11
• Survivors of Torture Program at Elmhurst Hospital, NY1-TV, 03/16/11
• HHC Nurse Practitioner Wins Sloan Award, NY1-TV, 03/12/11
• For Medicaid Savings, Going Where the Money Is: The Costliest Cases, WNYC-Radio, 03/03/11
• Pediatric/Psychiatric Emergency Department, Dr. Muhammed Waseem, Lincoln, Health Radio, 03/11/11
• Healing the tortured, New York Daily News, 03/20/11
• Celebrating Patient Safety Awareness Week at New York City Health and Hospitals Corporation, NAPH, 03/09/11
• Taking the dark and scary out of Elmhurst Hospital, The Queens Courier, 03/10/11 (Also covered by the Queens Gazette)
• Clowns from around the world cheer up sick kids at Elmhurst Hospital Center New York Daily News, 03/18/11
• Visiting Nurse Service Transforms Bellevue Space Into Hospice, Nurse.com,03/21/11
• HHC Nurse Practitioner Wins Sloan Award, The Bronx Times, 03/17/11
• Lincoln Hospital wins national recognition, The Mott Haven Herald, Spring 2011
• Calling all doctors, The Queens Courier, 03/01/11
• We make sure the Bronx is OK, New York Daily News, 03/17/11
• 100 of the Best Spine Surgeons and Specialists in America, Sheeraz A. Qureshi, MD, Elmhurst, Becker's Orthopedic & Spine Review, 02/24/11
• Richmond County Savings Foundation donates $95,000 to G.R.A.C.E. Foundation, Staten Island Advance, 03/08/11