ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
November 30, 2011

CDC RECOGNITION TO HHC FOR
ONE-MILLIONTH NEW YORKER TESTED FOR HIV

This year HHC marks three decades of dedicated service to fighting AIDS with a major milestone: one million New Yorkers have been tested for HIV since 2005 when HHC incorporated HIV testing as a routine part of medical care within public hospitals and community health centers for patients 13 years of age and older. To mark the occasion, Dr. Bernard Branson, Associate Director for Laboratory Diagnostics at the CDC will present an award to Mayor Michael R. Bloomberg and HHC at the World AIDS day breakfast tomorrow morning at Gracie Mansion.

HHC has been in the forefront of incorporating HIV screening into routine medical care. HHC began offering routine testing through its HIV Testing and Expansion Initiative in mid-2005, before the CDC issued its recommendation for routine HIV testing in 2006. HHC reaches patients in all 11 public hospitals' emergency rooms, inpatient units and outpatient clinics, as well as six diagnostic and treatment centers, providing testing in settings that include not only general medical services but also specialty services such as dental care. The testing initiative also reaches non-traditional settings like bathhouses, public health fairs and colleges. From its commencement in mid-2005 to September 2011, the testing initiative has diagnosed 10,600 HIV positive individuals, and linked and retained thousands in HIV primary care -- improving their health and the health of the community. More than 90 percent of patients diagnosed positive at HHC facilities are linked to life-saving HIV medical care and treatment within 90 days of being diagnosed.

CONFERENCE AND NETWORK VISITS HIGHLIGHT ACCOMPLISHMENTS OF HHC'S BREAKTHROUGH PERFORMANCE IMPROVEMENT PROGRAM

The third annual Breakthrough Conference on November 16th had nearly 200 participants, including HHC employees and 30 members of the Healthcare Value Leaders Network (HCVLN), a US/Canadian group of other healthcare providers utilizing Lean. HHC joined the network earlier this year. A notable highlight of the conference was the presentation by John Toussaint, MD, of the ThedaCare Center for Healthcare Value, speaking on Leading a Lean Transformation. Dr. Toussaint is a Lean champion who led the successful Lean transformation of the ThedaCare Health System in Wisconsin and whose organization works to introduce Lean thinking into national healthcare policy. Other speakers at the highly successful conference included speakers from Beth Israel Deaconess in Boston, the Cleveland Clinic, Regina Qu'Appelle in Saskatchewan and a panel of Breakthrough leaders from Bellevue, Elmhurst, the North Bronx Network, and Woodhull.

Following the conference, HHC hosted 40 members of the HCVLN for a series of report outs and "Gemba walks," that is, visits to Bellevue, Kings County and Metropolitan hospitals to learn from the Breakthrough work being done at those sites. This three-day Breakthrough intensive ended with a day of report outs from five HHC facilities and a special session for HHC leaders with Dr. Toussaint and John Shook, whose Lean pedigree expands more than three decades and who has written numerous Lean classics.

PATIENT SAFETY CONFERENCE HIGHLIGHTS MEDICATION SAFETY

Earlier today a one-day conference entitled Improving Medication Safety Through Effective Communication & Teamwork, and jointly sponsored by HHC, Committee of Interns and Residents/SEIU Healthcare and 1199 SEIU, was held at the Jacobi conference center. Patient safety experts have long agreed that medication errors are the single most frequent source of preventable error. These errors can be devastating to patients and their families and also pose a tremendous financial burden on hospitals. Effective communication and teamwork among all members of the health care team are critical components of effective and safe patient care, including the safe ordering, dispensing and administration of medications.

The conference focused on the safe use of opioids in the context of effective pain management. Three nationally recognized speakers and innovators in the field presented their best practices and shared their stories. We heard from Helen Haskell, founder and president of the patient safety organization Mothers Against Medical Error; Mary E. Burkhardt, Chief of the Pharmacy Service at Ann Arbor Veterans Affairs Healthcare System; and Lieutenant Colonel Jorge D. Carrillo, Pharm. D, of the United States Army. The afternoon of the conference featured a panel presentation from HHC facility leaders on medication safety and teamwork. The conference was attended by more than 200 HHC staff, including physicians, pharmacists, nurses, IT staff, patient safety officers, senior administrative and clinical management, and labor representatives.

METROPLUS HEALTH PLAN AGAIN RATED NUMBER ONE
FOR QUALITY AND PATIENT SATISFACTION

MetroPlus Health Plan has again been rated number one in New York City based on quality and patient satisfaction indicators measured by the New York State Department of Health (NYSDOH). The ranking was released in the NYSDOH 2011 Consumer’s Guide to Medicaid Managed Care in New York City. It shows MetroPlus as the highest performing plan among New York City’s 10 Medicaid Managed Care plans. MetroPlus has been the number one plan for six out of the last seven years. The ratings are based on measures including plans’ preventive and well-care for adults and children; quality of care provided to members with chronic illnesses; and patient satisfaction with access and service.

In operation for more than 25 years, MetroPlus offers an extensive network of primary care providers and specialists, including all HHC ambulatory care sites and many independent community providers. MetroPlus’ robust case management programs encourage and support members as partners with their providers to promote the best possible health outcomes. Plan employees are drawn from the diverse communities that MetroPlus serves and speak more than seventy languages. This top rating reflects, in large part, the close collaboration between MetroPlus and our HHC facilities to render the best possible care for our patients.

RECOGNITION OF HHC HEALTH AND HOME CARE DURING HOME CARE MONTH

November is National Home Care month and HHC Health and Home Care celebrated in both their offices in Manhattan and Elmhurst. The theme of this year's celebration was There's No Place Like Home. Representatives from the Office of Emergency Management attended the event in the Queens office to address nurses, therapists, managers and administrative staff about the many emergency situations experienced and well-met by home care staff during the 2011. I attended the event in Queens, which serves patients in the Bronx and Queens. Our Executive Vice President Tony Martin attended the event in Manhattan. Our home care staff provide top notch services to our patients and I fully appreciate their hard work and dedication.

FEDERAL UPDATE

Over the last three months, I have been reporting on the work of the bipartisan Congressional Super Committee which was established under provisions of the Budget Control Act and given the task of identifying at least $1.2 trillion in combined cuts and revenue enhancements. The deadline given the Committee for completion of its work was November 23, 2011. As many had predicted, the Committee failed to reach agreement on a package of deficit reduction recommendations. One of the most significant challenges was that Republicans were focused primarily on putting forth cuts in federal spending on certain programs, including cuts to the big three entitlement programs -- Social Security, Medicare and Medicaid -- and would not to agree to any new revenue proposals unless the Bush-era tax cuts were extended; while Democrats, although willing to accept some curbs on entitlement growth, were not prepared to extend the Bush income tax rates, especially on the wealthy.

The rules mandate that sequestration be triggered since the Committee failed to agree on a deficit reduction package. Sequestration entails automatic across-the-board cuts to mandatory and discretionary spending -- half to defense and half to non-defense spending, including up to 2 percent of Medicare payments to providers. These cuts would take effect January 1, 2013. Medicaid, Child Health Insurance and Social Security are exempt from sequestration.

The impact of a 2 percent cut in Medicare payments would mean an estimated $20 million reduction in HHC’s Medicare revenue. Governor Cuomo has announced that across the board the projected sequestration cuts in federal funding would cost New York State $5 billion over 10 years.

A new round of negotiations on Capitol Hill has already ensued regarding whether and how to potentially alter the sequestration outcome. In a statement released on November 21, the Obama administration voiced its opposition to any altering of the sequester mandate and promised to veto any legislation that might seek changes.

DON BERWICK, MD LEAVING CMS

Dr. Donald Berwick announced that he would be resigning as the Administrator of the Centers for Medicare and Medicaid Services (CMS) effective December 2, 2011. President Obama first nominated Dr. Berwick in April 2010; however Dr. Berwick never received a Senate confirmation hearing. Instead, the President made a recess appointment installing Dr. Berwick as the head of CMS. In the Spring of 2011, 42 Senate Republicans urged the White House to withdraw the nomination and many vowed to block confirmation. Dr. Berwick’s recess appointment would have expired on December 31, 2011.

The Administration announced that it will nominate Marilyn Tavenner to succeed Dr. Berwick. Ms. Tavenner has served as principal deputy at CMS. She is a former secretary of the Virginia Department of Health and Human Resources, a nurse and former president of the outpatient services group of the for-profit Hospital Corporation of America. She has also served on the board of the American Hospital Association. It is not yet clear whether there will be sufficient Republican support in the Senate for her confirmation.

NEW YORK STATE PROJECTS $3 TO $3.5 BILLION DEFICIT

The State Division of the Budget (DOB) released a grim mid-year financial plan update this month. In the plan, the State has recalculated the projected budget deficit for next year (SFY 2013) to be between $3 billion and $3.5 billion. This is a significant increase over the previous estimate of $2.4 billion deficit. Making matters worse, DOB is now projecting a gap in the current fiscal year (SFY 2012) of $350 million. This gap will have to be closed through a fiscal management plan that DOB will initiate with state agencies and/or by calling the Legislature back into Special Session to identify additional cuts to sufficiently close the gap. While troubling, this news should come as no surprise, given the impact that the global economic downturn has had on governments everywhere. Last month, if you recall, the City announced a new round of cuts in order to meet budget targets for next year.

At this time, we do not yet know how the State will address this year's gap and what those actions would mean for HHC. It is important to note that State Medicaid spending is already subject to a global cap that was put in place by the State earlier this year. The last monthly spending report through August showed Medicaid expenditures to be $172 million below projections. However, Medicaid enrollment continues to increase and expenditures may well trend upwards as the fiscal year progress.

HHC HEALTH HOME CERTIFICATION IS EXPECTED

On November 1st, HHC submitted its application to the New York State Department of Health (DOH) for designation as a Health Home Provider in the boroughs of Brooklyn and the Bronx. Announcement of the certification of Health Homes, as well as identification of patients eligible for Health Home services, is expected from the State by early January of 2012. A second HHC application for Health Home certification for the boroughs of Manhattan and Brooklyn will be submitted on February 1st with announcement of certification and eligible patients expected to arrive by early April.

The Health Home initiative gives us a unique opportunity to further strengthen the quality and efficiency of care delivered to Medicaid patients with chronic medical and/or serious behavioral health conditions. The Health Home initiative aims to improve health outcomes for these patients through focused care coordination, and to decrease costs by reducing the emergency visits and avoidable hospital admissions for this group of patients. The three defining Health Home program components which HHC will focus on are:

• establishing a defined and formal linkage between a patient, primary care provider and care coordinator;
• promoting collaboration and improved communication among all providers on the patient’s care team around a common plan of care; and
• delivering proactive, comprehensive and integrated primary care.

Based on eligibility criteria, HHC estimates that DOH will identify and assign approximately 36,000 patients for our Health Home services in Brooklyn and the Bronx during the first year of operation. Approximately 14,000 or about 40 percent will be new to our system. The remaining patients will most likely be MetroPlus members and fee-for-service HHC patients. A comparable number can be expected to be identified and assigned to HHC after we are certified to provide Health Home services in the boroughs of Manhattan and Queens. We aim to provide care coordination services through our Health Home program to at least 70,000 eligible patients by the end of the program's first year and to roughly 126,000 patients as program fully matures toward the end of 2013.

The fees to be paid to a Health Home are designed to cover the cost of intensive care coordination services and will average about $100 per member per month. This payment comes in addition to any other reimbursement for care delivery. If 80 percent of the target population are found and engaged in HHC’s Health Home services (which will be challenging based upon the experience of related pilot programs), the initiative could generate an additional $100 million in revenue for HHC and, most importantly, help us to deliver higher quality services and better outcomes for the patients we manage with the most complex conditions.

IMSAL DIRECTOR ANNOUNCED

Next month IMSAL, HHC's Institute for Medical Simulation and Advanced Learning, will be led by a new Director, Katie Walker, RN. Ms. Walker is internationally recognized as a leader in the field of healthcare simulation and has contributed to the field by building new and innovative programs to improve performance and reduce errors in patient care in her native country, Australia. She has also worked in the international arena to spread the use of simulation techniques and strategies as a learning and workforce development platform for improving the delivery of care.

Most recently, Ms. Walker served as Program Manager for Learning Environments, a key program of Health Workforce Australia. There she worked to establish the largest national simulation program in the world, resulting in the addition and integration of 80 new simulation programs throughout Australia. The programs will provide continuous learning opportunities for more than 200,000 healthcare workers and professional staff.

Since 2007 Ms Walker has played a central role in the International Society for Simulation in Healthcare, the largest international healthcare simulation member organization with more than 1,500 international delegates. In May 2011, Ms. Walker co-led the development and establishment of the first Asia-Pacific Meeting on Simulation in Healthcare which was held in Hong Kong (APMSH 2011). This meeting was the first of its kind in the region and was attended by over 500 participants.

HHC is very fortunate to welcome such an internationally distinguished leader to head our medical simulation center.

INCENTIVE PROGRAM TO PROMOTE EMPLOYEE FLU VACCINATIONS

One of the most important things anyone who works in a healthcare setting can do this time of year to protect our patients, our families and our health is to get a flu shot. Yet, not enough of our colleagues at HHC have taken this important patient safety precaution. That's why we are offering free flu shots to employees at convenient locations. In addition, we have launched a flu promotion to increase our overall corporate vaccination rate. All HHC employees who get a flu shot by December 9, 2011 will be automatically entered into a random drawing to win a new Amazon Kindle Fire via the HHC Employee Vaccination Record system. Employees who receive a flu shot outside the workplace may also enter to win the contest by providing proof of vaccination to a Flu Coordinator by December 9, 2011.

As of Monday this week, our current rate of vaccination is only 31 percent and we looking to improve our overall corporate rate substantially during the critical next few weeks.

STAT! EVENTS HIGHLIGHT HHC'S COMMITMENT AND SPIRIT

On October 18, Mayor Michael R. Bloomberg launched STAT! 2011 for NYC’s Public Hospitals with a gala benefit at Bellevue Hospital’s Atrium. For the second year, The Fund for HHC hosted an evening of music and entertainment and presented STAT! Response awards to individuals and organizations whose work embodies HHC’s mission and the spirit of our workforce. Individual honorees included NAPH President, and former HHC President, Dr. Bruce Siegel and musician-activist Kasseem “Swizz Beatz” Dean. Meredith Vieira presented a Response award to the Big Apple Circus Clown Care Unit, of which she is an honorary member.

Between October 23 and 30, five STAT! events were held, one in each borough:

• A family-friendly Broadway production at the Frank Sinatra School for the Performing Arts in Queens
• A concert honoring George Clinton at the Apollo Theater, Manhattan
• An Evening of Old School Hip-Hop at the Paradise Theater, Bronx
• A gospel celebration with Bishop Hezekiah Walker at Berean Baptist Church in Brooklyn
• A Halloween kid’s party at the Snug Harbor Cultural Center, Staten Island

Through STAT! 2011, we again celebrated New York’s public hospital system and raised awareness about the facilities and people who provide vital healthcare services to our city. Of special note was the premiere at the gala and the Paradise Theater events of the gun violence reduction PSA, Guns Down, Life Up, produced by The Fund for HHC and the Office of Special Projects, and featuring classic hip-hop stars.

Once again, HHC staff, community members, and elected officials embraced STAT! and the mission of HHC through their attendance, support, and involvement in the events. In addition to the Mayor, all five borough presidents expressed their commitment to HHC through public letters, proclamations, and personal appearances at STAT! events.

HHC IN THE NEWS HIGHLIGHTS

• Safe Haven Program And Elmhurst Hospital Team For New Outreach Program, Elmhurst Hospital, NY1-TV, 11/05/11
• Elmhurst Hospital Panel Addresses Resources For Victims of Sexual Violence, Elmhurst Hospital, NY1-TV, 11/10/11
• Flu Prevention Clinic, Jacobi Medical Center, News 12 Bronx-TV, 10/27/11
• Long Emergency Room Wait Times In NYC Kings County, Lincoln, Elmhurst, Fox 5 NY-TV, 11/03/11
• Take Care NY, Dr. Nora Bergasa, Metropolitan, WADO-AM Radio, 10/21/11
• Cuidate Nueva York - HHC's Take Care New York, Dr. Abdul Mondul, Lincoln, WQBU-FM-Radio, 10/19/1
• For City Hospitals, 'Super Committee' Failure is a Pretty Good Option, HHC, WNYC-Radio, 10/26/11
• NAPH announces impact of NYC public hospital system on local jobs and economy, HHC, Healthcare Finance News, 10/26/1 (Also covered in NY Daily News, Crain’s Health Pulse, The Chief, Modern Healthcare, El Diario, and Nursing Spectrum)
• Gouverneur Healthcare Services nursing home, Modern Healthcare, 10/24/11
• Jacobi Medical Center, "Not On My Watch" Campaign, New York Daily News, 10/25/11
• Marley Marl:'Hip-hop music is the CNN of the streets', The New York Amsterdam News, HHC STAT!, Oct 27-Nov 2, 2011 (Also covered in AM New York, AllHipHop.com, BetNews.com, The Bronx Free Press)
• Bronx Hospital joins campaign against guns, HHC, Lincoln, STAT! 2011, El Diario, 10/26/11
• The Road Ahead, The City Limits Magazine, HHC, Nov-Dec 2011
• Elmhurst Hospital a “Safe Haven”, The Long Island City Journal, 11/09/11
• Harlem Hospital Auxiliary Inc. celebrates 100th anniversary,The New York Amsterdam News, Oct 27-Nov 2, 2011
• Free flu shots to be given at Borough Hall, Arthur Wagner, HHC, Staten Island Advance, 11/01/11
• 75 years of providing health care, Queens Hospital Center, The Queens Courier, 10/27/11
• Infant security devices offer new options to keep babies safe, Susan LaMonica, RN, Jacobi Medical Center, Nurse.com, 10/24/11
• Depression: A Treatable Condition,Iris R. Jiménez-Hernández, The Bronx Free Press, 11/02/11
• Groundbreaking Held for Affordable Green Development in Flatbush, Kings County, Brooklyn Daily Eagle, 11/07/11
• Season for Sniffles , Dr. Bijal Dave, Mariners Harbor Family Health Center, Staten Island Advance, 11/14/11
• Often at Center of Mayhem, Emergency Rooms Tend to Be Gunfire-Free Zones, HHC, The New York Times, 11/14/11
• For the Uninsured, Emergency Room Is Main Source of Healthcare, HHC,TheBrooklynInk.com,11/16/11
• Borough Health Care Needs A Fix: Forum, Queens Tribune, 11/17/11
• Emergency Rule Passes, HHC, Crain’s Health Pulse, 11/18/11
• Queens Hospital fills hospital closings gap, Queens Hospital, Times Ledger, 11/23/11(Also covered in Queens Chronicle)
• Bank of Tokyo-Mitsubushi UFJ Distributes Thanksgiving Turkeys At Metropolitan Hospital Center In Harlem, Metropolitan Hospital, Harlem World Blog, 11/22/11