ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
December 15, 2011

WOODHULL OPENS CENTER FOR INTEGRATED HEALTH TO PROVIDE COORDINATION OF SERVICES FOR PATIENTS WITH MENTAL ILLNESS

Late last month Woodhull Hospital opened its new Center for Integrated Health to expand the coordination of patient care by providing both mental and physical health needs to Woodhull’s psychiatry patients in one setting. According to the New York City Health Department, adults with serious mental illness die 15 to 25 years earlier than the general population. Chronic health conditions such as diabetes, hypertension and cardiovascular disease can account for as much as 60 percent of these deaths. These patients are also at higher risk for infectious diseases including Hepatitis B, Hepatitis C and HIV/AIDS. The Woodhull Center is designed to help our patients with all of the issues that can affect their health and quality of life and ensure they receive the best quality care in an efficient and patient-centered environment. The Center was made possible through a generous funding allocation of $250,000 from Brooklyn Borough President Marty Markowitz, which paid for renovation of the space and medical equipment to outfit the practice. The Center is expected to serve 1600 patients annually.

HHC/CUNY GRADUATE HOSPITAL INTERPRETERS TO HELP LIMITED
ENGLISH SPEAKING NEW YORKERS

Ten HHC employees graduated from the HHC/CUNY Healthcare Interpreter program this past Monday at Lincoln Medical and Mental Health Center. This is the third year for this program which trains bilingual and multilingual students to serve as qualified hospital interpreters to help limited English speakers navigate the complex healthcare system. The graduates, who speak Spanish, Polish and French work at HHC facilities across four boroughs -- Harlem Hospital, Lincoln, Jacobi and North Central Bronx hospitals, Coney Island and Elmhurst -- and their job titles range from Assistant Director of Women's and Children's Health to a Public Health Advisor for Family Center Care.

Half of the HHC graduates have also gone on to complete the second level of interpreter courses and must demonstrate a deeper understanding of medical concepts and terminology as well as cultural issues and dialect variation. The graduation received warm media attention and was featured on the front page of Tuesday's edition of El Diario. I know that the Board joins me in congratulating all the graduates of the program. Their advanced interpretation skills will help us address the language and cultural barriers that can negatively affect the access to quality care for patients with limited English language skills.

HARLEM HOSPITAL RECEIVES LEAPFROG AWARD FOR ADVANCES IN QUALITY CARE AND PATIENT SAFETY

Harlem Hospital was honored earlier this month when it received the prestigious Leapfrog Award for its advances in the quality and safety of patient care. The award was based on a review of participating area hospitals conducted by The Leapfrog Group, a coalition of public and private purchasers of employee health coverage dedicated to improving healthcare safety, quality and affordability. The award was given to Harlem Hospital Center for the "Greatest Leaps in Patient Safety and Quality." Leapfrog also benchmarks hospitals against 34 practices that reduce the risk of medical errors and hospital-acquired infections, and improve patient outcomes. This data-driven hospital quality measure is an approach endorsed by the National Quality Foundation.

NY STATE HEALTH FOUNDATION AND HANYS PRESENTATION ON HHC SUCCESSES IN DIABETES CARE

On December 2nd, at a conference co-sponsored by the New York State Health Foundation (NYSAF) and the Healthcare Association of New York State (HANYS) to kick off their Diabetes Campaign, I had an opportunity to report on HHC's progress in its system-wide approach to the treatment of our patients with diabetes. I outlined how HHC has systematically strengthened its chronic disease management capabilities over the last few years, culminating in all of our primary care sites being certified as Level 3 patient-centered medical homes and marked improvements in the blood sugar levels of the large majority of our diabetic patients. I emphasized the role of our electronic diabetes registry and our screening for, and treatment of, depression as key factors in driving steady improvements in the health status of the nearly 60,000 adults with diabetes under our routine care. Our telehealth program, WeCoach program, and on-line Diabetes Wellness Center, as well as our work to bring farmers’ markets onto our hospital campuses and the creation of ethnic-specific cookbooks for our diabetic patients also figured prominently in my presentation as critical approaches to engaging patients in self-management of their chronic illness.

Although we have more work to do on this front, we can take some pride in the fact that we have nearly doubled the percentage of our patients with diabetes who have well controlled blood sugar levels, with about 44 percent of our patients reflecting optimum Hemoglobin A1c levels of less than 7. Further, 72 percent of our diabetic patients reflect at least moderate control with A1c levels below 8, and only 14 percent remain poorly controlled with A1c levels above 9. For a predominately low-income, diverse urban patient population, these health status indicators are well above national benchmarks. The Diabetes Campaign launched by NYSHF and HANYS seeks to support as many healthcare providers as possible in our State in improving the blood sugar, blood pressure and cholesterol levels of their diabetic patients to thresholds that qualify them for the Diabetes Recognition Program of the National Committee for Quality Assurance. Today, all of HHC’s acute care facilities, as well as all of its Diagnostic and Treatment Centers have qualified for such NCQA recognition.

FEDERAL LEGISLATION UPDATE

On Tuesday, the House of Representatives passed the Middle Class Tax Relief and Job Creation Act. All New York Republicans voted for the bill with all the state's Democrats opposed. The legislation included "must-do" end of year provisions including extending the Social Security payroll tax reduction and unemployment insurance as well as preventing the scheduled 27.4 percent reduction in Medicare payments to physicians. However, hospital cuts totaling more than $17 billion over 10 years were included in the bill to help pay for it. The bill would reduce federal funding to HHC by $614 million over the next ten years by cutting Medicaid Disproportionate Share Hospital (DSH) payments, greatly slashing some reimbursements for Medicare Hospital Outpatient Services and limiting payments for Medicare Bad debt. However, the Senate leadership is opposed to the bill and is working on its own version to accomplish an extension of the payroll tax reduction, unemployment benefits and the Medicare physician fix. They may, however, also include extension of tax breaks that are popular with Republicans.

HHC, in conjunction with the various hospital associations, is fighting against the inclusion of the House reductions in any Senate bill. In addition, the administration is opposed to a provision in the House bill which mandates authorization of a controversial pipeline project and has said that it would veto any bill that includes this. In the interim, the Senate leadership will not vote on the Omnibus spending bill for federal fiscal year 2012 until there is an agreement on the "must-do" items. Tomorrow, December 16th, the continuing resolution funding the government expires, so some Congressional action will be necessary.

The House bill includes the following:

Medicaid DSH reductions: The bill would extend the Medicaid DSH cuts originally included in the Accountable Care Act by one year to 2021, costing HHC as much as $421.8 million in that year.

Medicare hospital outpatient reductions: If the House bill is enacted into law, Medicare will reduce what it pays for certain services conducted by the physician, related to evaluation and management during an outpatient visit, by between 71 and 80 percent. The bill would save the federal government $6.8 billion. HHC would lose $187 million from these outpatient cuts over 10 years starting in October 2012.

Medicare bad debt payments: The bad debt provision would reduce Medicare reimbursements for bad debt from 70 percent to 55 percent. This provision would cost HHC $5 million over ten years.

NEW YORK STATE LEGISLATURE ACTS TO INCREASE REVENUES; MEDICAID REDESIGN TEAM WORKGROUPS REPORT

As many of you undoubtedly read last week, the State Legislature returned to Albany for a Special Session called by Governor Cuomo to enact an agreement on a series of initiatives that included changes in the tax code that will generate additional revenue for the State. Those changes are expected to net the State approximately $1.9 billion. This will reduce the projected budget deficit for the upcoming State Fiscal Year (SFY 2012-13) to about $1.6 billion. In addition, Governor Cuomo indicated that he will close the estimated $350 million deficit that opened up in the current fiscal year through spending controls and will not seek additional budget cuts to close that gap.

The Medicaid Redesign Team (MRT) convened in Albany this past Tuesday. At the meeting, the MRT approved the recommendations of four Workgroups. HHC had representatives on each of these groups -- LaRay Brown on Affordable Housing, Dr. Arnold Saperstein on Basic Benefit Review, Marlene Zurack on Payment Reform and Quality Measurement; and Lauren Johnston on Workforce Flexibility and Change of Scope of Practice.

Although there was no mention of it at the meeting, HHC was informed by one of co-chairs of the Medical Malpractice Reform Workgroup that the group was unable to reach consensus and would not be submitting any recommendations.

The Health Systems Redesign: Brooklyn Workgroup also recently completed its work. Their report did include a general recommendation for HHC -- that Woodhull Hospital, Kings County Hospital and Coney Island Hospital should become more active partners in the Brooklyn delivery system as the restructuring of that system moves forward. Unlike other MRT Workgroups, the Brooklyn Workgroup recommendations were submitted directly to the State Health Commissioner and not brought to the full MRT for their review and adoption.

The MRT will issue a final report by December 31, 2011. The report will include the recommendations adopted this week, along with those adopted at the November 1st MRT meeting -- Behavioral Health Reform; Health Disparities; Managed Long Term Care Implementation and Waiver Redesign; Program Streamlining and State/Local Responsibilities -- so that Governor Cuomo may consider the recommendations for inclusion in his SFY 2012-13 Executive Budget Proposal.

The State Department of Health also released the Monthly Medicaid Global Cap Update at the meeting. Overall Medicaid spending remains on track to stay within the $15.3 billion cap established for 2011-12. As of the end of October, spending was 1.3 percent below the target at $124.7 million. However, enrollment continues to rise, with an increase of 101,500 enrollees -- a 2 percent increase -- since April.

HHC HEARS FROM NEW YORKERS AT ANNUAL PUBLIC MEETINGS

The public meetings that HHC holds annually in each borough began this year in late November. The meetings are an opportunity for us to report on HHC activities in each borough and give members of the public an opportunity to speak about their needs and concerns to members of the Board of Directors and to HHC leadership. Meetings have been held in Queens, Brooklyn and the Bronx, and will be completed in January with meetings in Manhattan and Staten Island.

BELLEVUE HOSPITAL HOLDS CELEBRATION OF ITS 275-YEAR HISTORY

Bellevue Hospital today hosted a reception in honor of its 275th Anniversary. The oldest continuously operating hospital in America, Bellevue traces its roots back to 1736 when a six-bed infirmary opened on the second floor of an almshouse located on the present-day site of City Hall. Throughout its history Bellevue has been a center for medical and mental health innovations and today is a renowned New York City institution.

Some of the key ‘firsts’ include the first maternity ward (1799) and first cesarean section (1867), the first Emergency Pavilion (1876) and ambulance service in the U.S. (1869), the first teaching hospital associated with a medical school (1861) and the first nursing school (1873).

Bellevue is also raising funds for the establishment of a Museum on the Bellevue campus. The museum will trace the narrative of the hospital’s history and display photos and original objects from the Bellevue archive.

Last year, Bellevue provided over a half million clinic visits; 126,000 Emergency room visits; close to 10,000 ambulatory surgeries; and 31,000 inpatient discharges. Almost 30 percent of clinic visits and 38 percent of emergency room visits were to uninsured individuals, including the newly unemployed, the undocumented and new immigrants. When Bellevue began serving New Yorkers, it had just two employees -- a visiting doctor and a visiting surgeon. Today, Bellevue is a major economic force in the community, employing over 4,700 full time employees and an additional 395 clinical affiliates from the NYU School of Medicine.

PRAISE FOR HHC LEADERSHIP IN HIV TESTING AND PREVENTION

As I reported last month, Mayor Bloomberg and I received recognition from the federal Centers for Disease Control (CDC) on December 1st for reaching an important milestone -- the testing of one million New Yorkers for HIV. In your packet today you will see a letter from the Director of AIDS Prevention at the CDC, praising HHC's outstanding commitment to increasing our HIV testing, and noting the Board of Directors' continuous support for this goal. HHC's history has been outstanding in the area of AIDS prevention and its efforts are held as a model of the success of institutional commitment to individual and community welfare.

In further recognition of HHC's leadership in fighting this disease, we published a World AIDS Day special issue of our monthly electronic newsletter HHC TODAY, and included in it an interactive timeline that shows how HHC hospitals have been in the front lines of HIV/AIDS treatment and prevention since the epidemic first emerged. You can see the timeline online at nyc.gov/hhchivtimeline.

HHC PARTNERS WITH CDC TO INTERVIEW HIV EXPERTS IN NATIONWIDE EVENT ON TWITTER

In an HHC first, Terry Hamilton, Director, HIV, Corporate Planning Services, and Dr. Joseph Masci, Director of Medicine at Elmhurst Hospital Center, will participate in a "TwitterView" -- an interview on Twitter -- this Friday at 2:30 p.m. As part of the CDC's recognition of HHC's leadership in the fight against AIDS, HHC is the featured partner for the month of December on the CDC's National Prevention Information Network (NPIN) website and will participate in the TwitterView. For Twitter users, the CDC's handle is @CDCNPIN and the tweets will be marked with #HIV. Our Communications Department is working with the CDC to ensure a timely and lively discussion over this growing social media platform. Currently, the CDC and HHC have nearly 75,000 followers on Twitter. We hope to learn from this event on Friday and use this important tool to get out information about HHC and the work we do to an even bigger audience. We look forward to recruiting others across our system to join us for future TwitterViews on our Twitter page; our handle by the way is: @HHCnyc.

HONORING THE MEMORY OF DR. MURIEL PETIONI

I note with sadness the passing of Muriel Petioni, M.D., a great friend of many on this Board and at HHC. Dr. Petioni was a pioneer, a role model, a humanitarian, and an inspiration for tens of thousands of young women of color whose idea of becoming a physician took flight because of her. She was also a champion of public health who for more than 50 years touched the life of every Harlem family by at most one degree of separation.

I met Dr. Petioni when she was well into what most would call the “golden years,” but I quickly found that she had the passion and the drive of a newly minted idealist. I was profoundly impressed by her dynamic energy, her keen intelligence, and her ability to say exactly what was on her mind. These qualities were matched by the most extraordinary and justly beloved hallmark of Dr. Petioni’s life, her truly caring spirit that embraced individuals, communities, and, happily for us, Harlem Hospital and its patients.

We are all diminished by her passing. But it is my privilege to tell you that HHC will be honored to follow one of Dr. Petioni’s fondest wishes -- Harlem Hospital’s Geriatric Center of Excellence, which she helped to initiate planning for, will be called the Dr. Muriel Petioni Geriatric Center of Excellence. In this way, she will continue to serve, and we to benefit, from the gifts of her compassion and her leadership.

As the Center progresses, I will ask Denise Soares to keep us all informed.

HHC IN THE NEWS HIGHLIGHTS

• Coney Island Hospital ER Expansion, News 12 Brooklyn-TV, 12/09/11
• Reach Out and Read Event, Queens Hospital, Julius Wool, NY1-TV, 12/02/11
• City Nurses Rally For New Contract, HHC, NY1-TV, 12/06/11
• World AIDS Day, Dr. George Alonso, Elmhurst Hospital, WQBU-Radio, 12/01/2011
• Protecting the health care safety net is top priority for the AHA’s newest board member, Alan Aviles, AHA News, 12/05/11
• Latinos graduate as healthcare interpreters,Latinos se gradúan de intérpretes en la salud, HHC, El Diario, 12/13/11
• Judge devises model for resolving medical malpractice cases more quickly, HHC, The Washington Post, 11/21/11
• Healthcare crisis in Queens dissected, HHC, Queens, Elmhurst, Queens Chronicle, 11/25/11
• NYC recommends antiretroviral therapy for patients living with HIV, HHC, People Daily Online, 12/02/11
• Campaign teaches how to react when someone has been sexually assaulted, North Central Bronx, Nurse.com, 12/05/11
• Woodhull Opens One Stop Shop for Physical and Psych Patients, Woodhull, The Greenpoint Gazette, 11/30/11(Also covered in El Diario and The Brooklyn Daily)
• Muriel Petioni, 97, Prominent Harlem Physician, Dies, Harlem Hospital, The New York Times, 12/10/11 (Also covered in the Amsterdam News and NY Daily News)
• A Conversation with Linda Gibbs Deputy Mayor for Health and Human Services City of NY, HHC, The Business Government, Fall/Winter 2011
• Beauty queen reads to kids in pediatric ward 1, Queens Hospital, The Queens Chronicle, 12/08/11