RAMANATHAN RAJU, MD
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
July 21, 2011

MEDICATION SAFETY COUNCIL FORMED AT HHC

HHC recently formed a Corporate-wide Medication Safety Council to help us improve patient safety by reducing any potential for harm that may be caused by the use of medications.

Here at HHC, a medication error is defined as any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of a healthcare provider, patient, or consumer.

We have already made great strides in improving medication safety practices across our healthcare system and the Council will help us continue. The goals of the Council including continuing to improve systems to prevent harm due to medication errors, reducing the likelihood of harm associated with high-alert medications such as insulin and opiates, disseminating best practices, and prioritizing harm prevention strategies.

This Council is chaired by Mei Kong, RN, MSN, Senior Director, Patient Safety; Abdul Mondul, MD, Patient Safety Officer at Lincoln Medical and Mental Health Center; and Carol Ng, RPh, MS, Director of Pharmacy at Metropolitan Hospital Center. Council members include pharmacists, nurses, physicians, clinical information technologists, administrators, patient safety officers and associates, quality managers, and risk managers representing all of the HHC facilities.

HHC ADVOCATES AGAINST ADDITIONAL MEDICAID AND MEDICARE FUNDING CUTS DURING FEDERAL BUDGET DISCUSSIONS

Federal law caps the amount of debt the government is allowed to incur, known as the debt limit. According to the U.S. Treasury Department, the government will run out of the ability to raise money through incurring debt on August 2nd. If Congress and the President fail to raise the debt limit before that time, the federal government will default on its debt. Congressional Republicans have said that they will reject any legislation to raise the debt limit unless it includes substantial spending cuts, and they are also resistant to the inclusion of tax increases. Thus Congress has linked negotiations concerning the federal budget deficit to the imperative of enacting legislation on the debt limit.

Intensive negotiations between Congressional leaders and the President are occurring to strike a deal. To reach the very high targets being proposed for deficit reduction, the negotiators will certainly have to make substantial cuts to entitlement programs, which make up approximately two-thirds of the federal budget. Healthcare cuts could total hundreds of billions over the next ten years. Which proposals will end up in the final deal and the specific impacts of some of the proposals remain highly fluid.

There are proposals that would have the federal government decrease its share of the Medicaid burden by reducing the Federal Medical Assistance Percentages (FMAP) offered to states. States would either have to assume the costs themselves or cut back their Medicaid programs. One specific proposal entails the establishment of a "blended FMAP," in which states would receive the same federal matching rate for all beneficiaries rather than the amalgam of different rates for various beneficiary groups and services. Nation-wide this proposal is estimated to save the federal government $100 billion over ten years; New York State could lose more than $11 billion and New York City could lose $6.5 billion over a ten year period.

Other proposals would reduce or eliminate the use of provider taxes to support the costs states incur on healthcare. The presidentially-appointed Bowles-Simpson Commission recommended phasing down and ultimately eliminating provider taxes beginning in federal fiscal year 2015. This proposal could save the federal government $18 billion by federal fiscal year 2021; however the impact on New York State over ten years could be $11 billion and HHC could lose $110 million a year.

Medicare and Medicaid Graduate Medical Education payments have long been a target for cuts by federal policy makers. New proposals would cut Indirect Medical Education (IME) funding $4.6 billion a year and Graduate Medical Education (GME) by $1.2 billion a year. This could mean a loss of more than $1.2 billion a year to New York State and nearly $95 million a year of cuts to HHC.

On July 19th, a bi-partisan group of six Senators released a budget proposal that would achieve $3.7 trillion in savings over ten years. Embedded in this significant federal deficit reduction proposal are $116 billion in unspecified healthcare cuts.

HHC Intergovernmental Relations staff continues to work with healthcare advocates, labor representatives (CIRR-SEIU, DC-37), the various hospital associations (American Hospital Association, National Association of Public Hospitals and Health Systems, Greater New York Hospital Association and Hospital Association of the State of New York) and the New York State Congressional delegation to oppose proposals that would adversely affect the healthcare safety net and the patients who rely upon our services. Last Tuesday, Dr. Abha Agrawal, Medical Director of Kings County Hospital Center participated in a meeting at the White House with representatives from a national advocacy and interfaith group at which the impact of federal cuts to Medicaid was discussed. Dr. Agrawal, in advocating against further cuts, emphasized that decisions regarding reducing the federal deficit must take into consideration priorities to care for those least able to afford healthcare, particularly children, disabled, elderly and low-income adults. She also discussed the importance of medical education funding in addressing the shortage of primary care doctors in underserved areas in New York State and City. Last Wednesday, Senior Vice President LaRay Brown and our Washington representative, Judy Chesser, presented the negative impact on HHC, our patients and our workforce of the various proposals being discussed by Congress and the Administration at a meeting convened by Congress Member Rangel with the New York State delegation, 1199 leadership, GNYHA and New York hospital executives. As a result of last week’s meeting the New York House Democratic delegation met with Democratic Leader Nancy Pelosi to urge that she stand strong against proposed cuts to Medicaid and Medicare. The delegation stated that it would "find it next to impossible to support a debt ceiling package which included cuts to Graduate Medical Education funding for teaching hospitals and essential Medicaid service."

HHC HOSPITALS RECEIVE FEDERAL FUNDING TO SUPPORT SCHOOL-BASED HEALTH CENTERS

The federal Department of Health and Human Services (HHS) and the federal Department of Education announced last week that they have awarded funding to 278 school-based health center programs across the country, including four HHC hospitals. Nearly $1 million was awarded to Bellevue, Elmhurst, Queens and Woodhull hospitals. Provided by the Affordable Care Act, the awards will help clinics expand and provide more healthcare services at schools nationwide. The announcement noted that school-based health centers are a major component of the nation's healthcare safety net. They not only enable children with acute or chronic illnesses to attend school, but also improve the overall health and wellness of all children through health screenings, health promotion and disease prevention activities.

FAVORABLE DECISION FOR HHC AND NYC ON APPEAL

Early this month the Appellate Division unanimously reversed and vacated the lower court's order restraining HHC from proceeding with the planned layoffs of various tradespersons, including Carpenters, Electricians, and City Laborers, among others. You will recall that such layoffs were reluctantly planned to have occurred in September as part of our restructuring efforts. The unions involved brought suit to challenge such layoffs and Justice Alice Schlesinger ruled that the layoffs could not safely proceed until the Court was satisfied that they would not unduly impact on patients' and employees' health and safety. This injunction has meant that while this appeal was pending, we were compelled to keep these employees on the payroll. This has, of course, also meant that the cost savings that we had hoped to achieve from these layoffs were not realized.

The decision from the Appellate Division stated that "[n]either the petitioners nor the courts should be permitted to substitute their judgment for the discretionary management of public business by public officials, as neither have lawfully been charged with that responsibility." The Appellate Division also disagreed with the ruling that the Corporation's actions were arbitrary and capricious, stating that "[t]here is nothing in this record which remotely demonstrates that HHC arrived at its decisions in bad faith or without adequate facts or deliberation. In fact, the record demonstrates exactly the opposite." This outcome to our appeal meant that we were free to proceed with the layoffs, and we did so on July 8th. The layoff of employees remains one of the most painful changes required by the cost containment plan. However, these difficult actions are necessary if we are to remain faithful to our mission and prevent the need for more drastic reductions or elimination of services.

AFFILIATION AGREEMENT FOR PROFESSIONAL SERVICES
AT JACOBI AND NCB

On the agenda today, for your review and approval is an 11-month agreement with the Physician Affiliate Group of New York, P.C. (PAGNY) for the provision of general care and behavioral health services at Jacobi Medical Center and North Central Bronx Hospital. The proposed agreement will commence on August 1, 2011 and will terminate on June 30, 2012, consistent with the general terms and conditions outlined in the Resolution. The proposed contract costs for the 11 month period totals $120.4 million. I urge your support.

HHC FACILITIES HOLD SUMMER HEALTH EVENTS

HHC hospitals throughout the city are offering health events and information to their communities throughout the summer months:

• Metropolitan Hospital sponsored its fifth annual Power of Aging Well Health Festival late last month, in collaboration with a raft of partners, include the NYC Dept. for the Aging, the Parks Dept., more than a dozen Hospital programs and over 50 community-based organizations
• Kings County Hospital has launched a new cable television show called "Health Horizons." The show, featuring men's health issues in the first episode, premiered last week.
• Bellevue Hospital is recognizing Annual Breastfeeding week in early August with a day full of activities to encourage mothers to improve infant health through breastfeeding
• Lincoln Medical and Mental Health Center will be holding their fifth annual back to school immunization Health Fair at Yankee Stadium next month.
• In late August, the Bellevue Hospital Bariatric Surgery Center of Excellence will be holding its third annual party to celebrate the thousands of pounds lost by patients who have undergone bariatric surgery at the hospital.

HHC IN THE NEWS HIGHLIGHTS

Colon Cancer Screenings, Dr. Doug Simon, Jacobi, News 12 Bronx –TV, 06/28/11

Wounded taxi driver recuperates at Lincoln Hospital, Telemundo Ch. 47-TV, 07/15/11

Putting together a first-aid kit for the beach, Dr. David Neckritz, Coney Island, WABC-TV, 06/30/11

Court Clears Way for Hospital Corporation Layoffs, News 12 Bronx-TV, 07/08/11

Reach out and Read, Msnbc.com-TV, 07/08/11

HHC President welcomes health law's promise but sees downside for public hospitals, KaiserHealthNews.com, 07/07/11

HANYS Presents Pinnacle Awards to Recognize Quality Excellence, HANYS, 06/28/11

Court Clears Way for Hospital Corporation Layoffs, The New York Times, 07/08/11
(Also covered in The Wall Street Journal, Reuters, The Chief, New York Post, New York Daily News, NewsMax.com, Crain’s Health Pulse, and Becker’s Hospital Review)

Put her in her place, New York Daily News, 07/09/11(Editorial)

Appeals Court Slapdown, New York Post, 07/12/11(Editorial)

Gift of Life: Donating vital organs, The Queens Courier, 06/30/11

HHC hospitals host farmers markets to promote healthy eating, Nursing Spectrum, 07/08/11

Fourth Of July: Make It A Safe And Secure Holiday, The Bronx Free Press, 06/29/11

Improving Immunization Compliance, Advance for Nurses, 06/28/11

Good health is focus of Renaissance Auxiliary's annual public meeting, The New York Amsterdam News, 06/30/11

Cancer survivors' homespun quilts bring hope to QHC, YourNabe.com, 06/30/11

TeamSTEPPS:The Patient Safety Tool That Needs to Be Implemented, Clinical Simulation in Nursing, 2011

Lincoln Hospital lauded, The New York Amsterdam News, 07/01/11

Harlem Hospital celebrates retirement of executive director, The New York Amsterdam News, 07/07/11

Elmhurst Hospital doc leads fight against AIDS, The Long Island City Journal, 07/14/11

Hermon Darby retired after 41 years on the job at Sea View, Staten Island Advance, 07/07/11

Umbilical Blood, DNAinfo.com, 07/15/11

JMC receives accreditation, Bronx Times Reporter, 07/14-07/20/11

North Bronx Healthcare Network initiative recognized, Bronx Times Reporter, 07/14-07/20/11

Sen. Klein brings free asthma screening for kids in Locust Point, Bronx Times Reporter, 07/14-07/20/11