ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
May 26, 2011

HHC ANNOUNCES CORPORATE-WIDE TRAINING TO ASSURE CULTURALLY SENSITIVE SERVICES FOR LGBT PATIENTS

Yesterday, I was joined by Deputy Mayor Linda Gibbs and National LGBT Cancer Network Executive Director Liz Margolies to announce the launch of a mandatory employee training program that will help provide safe, welcoming and culturally competent healthcare services to thousands of lesbian, gay, bisexual and transgender (LGBT) individuals who are served by our hospitals and community health centers every year. The new training curriculum is designed to promote staff awareness about sexual and gender identity and increased health risks among LGBT people.

Too often lesbian, gay, bisexual and transgender people delay or avoid healthcare services due to fear of stigma and discrimination from their medical providers and staff in their doctor’s office, local emergency room or hospital. This has contributed not only to people not getting the healthcare they need, but also to health disparities that include an increased risk of suicide and depression among LGBT youth, higher rates of tobacco, drug and alcohol use among LGBT elders, and greater instances of late diagnosis and treatment of breast cancer among lesbian and bisexual women.

Beginning next month, we will adopt a mandatory training program for our entire 38,000-member workforce that is specially designed to promote staff awareness about sexual and gender identity and the increased health risks among LGBT individuals. The new cultural competence training was produced in collaboration with the National LGBT Cancer Network and will reach physicians, nurses, technicians, administrators, and support services staff through new employee orientation, required annual in-service programs, and at employee town hall meetings. The training program features a 10-minute video, entitled "To Treat Me, You Have to Know Who I Am: Welcoming Lesbian, Gay, Bisexual and Transgender Patients into Healthcare," with testimonials from medical providers and LGBT patients.

We want all our staff to understand that their ability to provide culturally competent and patient-centered care to our LGBT patients greatly depends on their ability to show openness, use inclusive language, and welcome and normalize individuals’ disclosures of their sexual orientation and gender identity. We hope that by building this environment of openness and respect, we can also help increase adherence to treatment among LGBT patients.

Estimates suggest that 5 to 10 percent of New Yorkers are lesbian, gay, bisexual or transgendered. HHC cares for approximately 983,000 adolescent and adult patients annually, which means some 49,000 to 98,000 LGBT people are seen at HHC hospitals and community health centers every year.

HHC SUCCESSFULLY REFUTES NYC COMPTROLLER'S AUDIT OF
MAMMOGRAPHY WAIT TIMES

Early this month the New York City Comptroller published an audit of mammography wait times at HHC facilities. We were disappointed that the Comptroller’s report failed to capture the current state of mammography screening wait times at HHC. The auditors spent nearly 18 months reviewing data from fiscal year 2009 and in their press statements chose to ignore the more recent data made available to them which shows the significant improvements HHC has made over the last two years.

HHC released a public statement which clarified the current situation and refuted the Comptroller's conclusion that there are any dangerous delays to patients. There are no delays in cases where a doctor or medical provider has determined that a mammogram is needed immediately. Patients who present with a lump or other negative findings can receive a diagnostic mammogram within 24 to 72 hours. And, at least seven of our hospitals have a zero to one day wait time for a screening mammogram today. That means that the great majority of HHC patients are able to receive mammography within the 14 day target, even some on the same day of request.

The New York Daily News published an editorial soon after release of the Comptroller's audit criticizing the failure to acknowledge current data and noting that "the most serious delays … dated to the fiscal year between July 2008 and July 2009 -- and that more current data show marked improvements at the Health and Hospitals Corp."

JOINT COMMISSION GIVES STRONG EVALUATION TO COLER CAMPUS OF COLER-GOLDWATER

The Joint Commission earlier this month completed its triennial accreditation survey at the Coler Campus of the Coler-Goldwater Specialty Hospital and Nursing Facility. Consistent with the previous Joint Commission surveys conducted this year, the five-member survey team reviewed leadership and governance, national patient safety goals, patient safety, resident care, medication management, infection control, performance improvement, information management and the environment of care.

The survey team was very impressed with the quality and level of care provided to the residents at Coler, as well as the collaboration and cooperation of the clinical team. They also commented on their collective observation of the nurses' strong commitment to the residents and gave them an "A-plus." The physician surveyor commented that he "hoped he never needed their services, but if he was ever sick he would not want to go anywhere else." The two nurse surveyors for the nursing facility component of the survey had no adverse findings.

The team also identified a number of processes as best practices which they recommended be shared internally and submitted to The Joint Commission for inclusion in their database of best practices: the Geriatric Depression Screening Tool, Pressure Ulcer Protocol, UTI Bundle and the Resident Education Form.

The Coler Campus of the Coler-Goldwater Specialty Hospital and Nursing Facility will receive full accreditation by The Joint Commission. Congratulations to Network Senior Vice President Lynda D. Curtis, Executive Director Robert Hughes, Medical Director Dr. Yolanda Bruno, Nursing Director Leah Matias and Quality Management/Regulatory Affairs Director Stephen Catullo and their staff for their collective hard work, exemplary performance and commitment to providing quality care to our residents.

North Central Bronx, the Goldwater campus and Woodhull remain to be surveyed this year.

FEDERAL UPDATE

At the request of the President, Vice President Joe Biden, is chairing a bipartisan group seeking budget agreement before August 2, the date by which the $14.3 trillion federal debt ceiling must be increased, according to the Treasury. Senate Minority Leader Mitch McConnell (R-KY) has stated his pre-conditions, which include 2, 5 and 10 year cuts in discretionary and entitlement programs, such as Medicare and Medicaid. Many issues of concern to the hospital industry have been put on the table as part of these budget talks, including cuts in GME and IME, reductions in the use of Provider Taxes, and the Ryan proposals to block grant Medicaid and convert Medicare to premium supports.

The Kaiser Commission released a state-by-state analysis of the Ryan block grant proposal concluding that by 2021 states would receive $241 billion less annually in federal Medicaid money and that nationally between 31 and 44 million people who would have coverage under current law, would not have Medicaid coverage. The study concluded that from 2012 to 2021 NY State would lose $141 billion and that NY hospitals would lose 34% of their Medicaid funds, both federal and state money, in 2021 from repeal of ACA and the Medicaid Block Grant. The Medicaid Block Grant alone would cost NY State hospitals 30% of the current Medicaid reimbursements expected in 2021.

On April 29, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on Medicaid rate-setting by the states. NAPH submitted comments in support of this rule. Under the proposed rule, before cutting Medicaid payment rates to providers, states must demonstrate that beneficiaries will continue to have "sufficient access to care." The rule requires states to report every five years on access to covered benefits and to compare Medicaid payment rates with those of Medicare or private insurers, and with providers’ customary charges.

BUDGET TESTIMONY BEFORE CITY COUNCIL

Earlier this week, I testified on HHC's Fiscal Year 2012 Executive Budget and Financial Plan before the City Council. Many Council members expressed strong support for the Corporation, but they also expressed concerns and reservations about the proposed cuts resulting from our PEG (Program to Eliminate the Gap) reductions and some cost containment initiatives.

HHC has been very fortunate to receive significant funding from the Mayor and the City Council over the past several years. It is my hope that the Council again dedicates expense and capital funding to help support our programs and facilities when the City budget is agreed upon at the end of June.

Members of the public have the opportunity to testify before the Council on the Executive Budget June 6th.

HHC LEADERS NOMINATED TO PUBLIC HEALTH COUNCIL

Several HHC leaders have been nominated to serve on the Public Health and Health Planning Council (PHHPC), a consolidation of the Public Health Council (PHC) and the State Hospital Review and Planning Council that was created in December last year. Pending approval by the State Senate, HHC executives on the council will be Dr. John Palmer, Executive Director of Harlem Hospital, Dr. Ann Sullivan, Senior Vice President of the Queens Health Network, and Dr. Glenn Martin, Director of Medical Informatics at the Queens Health Network.

The PHHPC has a broad array of advisory and decision-making responsibilities with respect to New York State's public health and health care delivery system. It is charged with adopting and amending the Sanitary Code and health care facility, home care agency, and hospice operating regulations. The PHHPC also makes decisions concerning the establishment and transfer of ownership of health care facilities, home care agencies and hospice programs. It makes recommendations to the Commissioner of Health concerning major construction projects, service changes, and equipment acquisitions in health care facilities and home care agencies. HHC is very fortunate to have such significant representation on this important state health council.

NURSES GRADUATE FROM POVERTY TO NURSING CAREERS IN HHC HOSPITALS

Six New Yorkers received Bachelor of Science in Nursing degrees this month and will secure a career in nursing as part of a New York City program for economically disadvantaged students. They are the first group to graduate from the Long Island University-Kings County Hospital nursing program supported with scholarships from the NYC Center for Economic Opportunity (CEO). The nursing school is located in the "T" Building, in a renovated space that was home to the old Kings County Hospital School of Nursing from 1897 to 1977.

The CEO anti-poverty nursing program, a partnership between the university and HHC, was launched by Mayor Michael Bloomberg in 2007 to ease the nursing shortage and offers a Bachelor of Science degree in nursing to individuals earning no more than 130 percent of the federal poverty level. All CEO program graduates will be hired as Registered Nurses at city public hospitals, with a starting salary of $65,897.

Nurses are the backbone of any hospital or skilled nursing home. Having nurses who reflect the diversity of the patients that we serve is especially valuable to a mission-driven system like HHC. Congratulations to these students for their impressive accomplishment.

NYU MEDICAL SCHOOL CONTRACT

On our agenda today, for your review and approval, is a three-year contract renewal of the Affiliation Agreement with New York University School of Medicine (NYUSOM) for the provision of general care and behavioral health care services at Bellevue Hospital Center and Gouverneur Healthcare Services. The proposed agreement will commence on July 1, 2011 and terminate on June 30, 2014, consistent with the general terms and conditions outlined in the Resolution. The proposed contract costs for the agreement total $420 million for the three-year period.

The proposed agreement will compensate NYUSOM based on Relative Value Units (RVUs) or fixed costs for services at Bellevue, and fixed costs for services provided at Gouverneur. This proposed agreement builds on a long-standing clinical and academic relationship that benefits patient care. The parties propose to add financial incentives that are designed to align business goals and improve overall hospital performance. I urge your support for the contract.

CONTRACT FOR THE OUTSOURCING OF LAUNDRY OPERATIONS

Also on our agenda today is a proposed contract with the Consortium, a joint venture of Sodexo Laundry Services, Inc. and Nexera, Inc. for management of HHC's laundry operations, for a term of nine years. The proposed outsourcing of laundry services was identified by the Restructuring Executive Steering Committee as an area to be explored as part of HHC’s efforts to close a structural budget gap of hundreds of millions of dollars, and an RFP was issued in accordance with HHC operating procedures.

Under the proposed arrangement, which is expected to save nearly $72 million over the next nine years, the current Brooklyn Central Laundry operation would be closed. Recognizing that these employees have a narrow skill set that may make it very difficult for them to secure comparable employment, we are prepared to retrain and redeploy the 83 plant employees who are affected and place them into housekeeping jobs throughout HHC hospitals with slightly higher salaries. This redeployment offer, conveyed to the union in late January, is contingent on our ability to accomplish the outsourcing transition by August 1, 2011. Although the redeployment will allow us to reduce current overtime expenses in our housekeeping operations and to set a higher attrition goal for housekeepers going forward, it nonetheless will reduce projected savings substantially over the next two years as it will take at least that long to achieve an equivalent workforce reduction by attrition alone.

The union continues to threaten litigation to challenge the proposed contracting. We do not believe that there is any sound legal basis to block the outsourcing, although prior history suggests that such litigation could delay the final contracting by many months. For this reason, our offer of redeployment is time-limited. I have made it clear to union leadership that efforts to forestall the outsourcing by litigation or other tactics which delay any final action (and forego related savings) beyond August 1, 2011 will eliminate any flexibility on our part to accommodate redeployment. In that event, once any such litigation is resolved in HHC’s favor, we would have no choice but to proceed with actual layoffs. We continue to hope that such an unfortunate result can be avoided.

Despite alarming claims by DC 37, the union who represents these employees, this proposed outsourcing poses absolutely no risk to patients. Indeed, 35% of our laundry operations have been outsourced for more than 10 years at very considerable savings and no operational problems. Moreover, virtually all other hospitals in our city outsource their laundry operations with no adverse consequences.

I urge the Board to approve the resolution to authorize me to negotiate final terms and to execute a final contract with terms consistent with the not-to-exceed contract amount in the resolution.

DEVIATION GRANTED TO PERMIT BULK PURCHASE OF DELL COMPUTERS

I have granted a deviation from our standard procurement procedures to permit, at the end of fiscal year 2011, the bulk purchase of approximately 7,700 PCs for the Networks as part of the Information Technology Refresh Program. This program targets old computers that are either past or approaching their useful life expectancy.

IT solicited Dell and Dell resellers via the New York State Office of General Services (OGS) contract for these purchases. To date, Dell has been the low bidder on the solicitations conducted. Through the volume purchases off the NYS OGS contract, the average price for a standard PC model has been approximately $850 versus the typical price of $1,000/unit. This volume discount has saved HHC over $1 million.

With multiple IT initiatives underway throughout the networks, both clinical and administrative staff members require functioning computer equipment to perform their jobs. These year-end volume purchases of PCs accomplish this.

DISTRIBUTION OF OPEN LETTER TO IMMIGRANT NEW YORKERS

This month, HHC and the Mayor’s Office of Immigrant Affairs redistributed an open letter in 12 languages that delivers a simple message to immigrant New Yorkers: HHC cares about your health, not your immigration status.

We issued this letter in 2006 and again in 2007, when we learned that some New Yorkers were not seeking healthcare services because they feared that their immigration status would be reported. We must continue to remove any worry our patients may have about having their status disclosed so they can focus on what is really important -- keeping their families healthy.

The open letter has received news media attention in El Diario, Bronx News 12, Epoch Times and the Korea Times and we have commitments for placement of the letter from at least half a dozen other news outlets that reach immigrant New York communities.

Reminding patients about our open door policy is one of the many ways HHC remains committed to serving New York’s immigrants, despite our present fiscal challenges. Most children and pregnant women in New York City, regardless of immigration status, are eligible for health insurance. HHC staff helps all uninsured patients apply for insurance programs for which they may be eligible. Our public hospitals also help patients who cannot get insurance by providing reduced, affordable rates under the HHC Options program.

I am very proud of HHC’s long history of caring for everyone regardless of ability to pay or immigration status. I know you all join me in celebrating HHC’s rich history of diversity and renewing HHC’s promise to immigrant New Yorkers.

HHC IN THE NEWS HIGHLIGHTS

• New Mothers on Mother's Day, Coney Island Hospital, News 12 Brooklyn -TV, 05/08/11
• New Mothers on Mother’s Day, Jacobi Hospital, News 12 Bronx –TV, 05/08/11
• Breast Health Awareness at Jacobi Medical Center, News 12 Bronx –TV, 05/12/11
• New Program Attempts To Eliminate Barriers for LGBT, NY1-TV, 05/26/11 (Also covered in the NY Times Blog, Huffington Post, Advocate.com, InstinctMagazine.com, PassportMagazine.com)
• NYCHHC Open Letter to Immigrants, News 12 Bronx-TV, 05/17/11
• Men's Health Awareness, News 12 Brooklyn-TV, 05/24/11
• Hospitals Developing Checklists to Reduce Mistakes, WNYC- Radio, 05/03/11
• New Hospital Program Addresses LGBT Health Woe, DNAinfo.com, 05/24/11
• Hospitals focus on gay, lesbian and transgender health issues to better serve N.Y. community, New York Daily News, 05/25/11
• NYC public hospitals renew commitment to keep patient immigrant status private, AsianJournal.com, 05/20/11 (Also covered in El Diario and Korea Times)
• After School in Brooklyn, West African Girls Share Memories of a Painful Ritual, The New York Times, 04/25/11
• Doctors, West African women who relocated to NYC speak out against forced female circumcision, New York Daily News, 05/06/2011
• Nurses honored during National Nurses Week, Caribbean Life, 05/21/11
• HHC Goes Lean, Crain's Health Pulse, 04/22/11
• For safety's sake, check the checklist, Crain's Health Pulse, 04/29/11
• HHC primary care excellence earns med-home designation, Bronx Times Reporter, 05/02/11
• A week to say thanks to Island's nursing home staffers, Staten Island Advance, 05/09/11
• HHC urges people with 9-11 ills to seek med care, Bronx Times Reporter, 05/10/11
• Heads Up!: Reading as best prescription for Bronx children, Bronx Free Press, May 2011
• Elmhurst Hospital Center Opens Walkway Of Honor, The Queens Gazette, 05/18/11 (Also covered in the Queens Courier)
• City College students donate handmade quilts to moms at Harlem Hospital, New York Daily News, 05/20/11
• Early Detection Saves Lives,The Bronx Free Press, 05/18/11 (Op-ed by Iris R. Jiménez-Hernández)