ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
February 29, 2012

HHC CELEBRATES PATIENT SAFETY AWARENESS MONTH 

HHC will celebrate Patient Safety Awareness Week, March 4 to 10, with two major events on March 5th.  First, at HHC’s Patient Safety Champion Award ceremony, we will recognize an individual, team, unit or service from each facility who has served as a catalyst to transform the culture of safety in their organization.  As in previous years, the outstanding work done by these Patient Safety Champions will be inspirational to everyone. 

Then, as a further demonstration of HHC excellence in patient safety and teamwork, three teams that prevailed in a series of competitions on patient safety knowledge over the last several weeks will go head to head in the Patient Safety FINAL Jeopardy: Battle of the Networks 2012.  The three winning network teams -- from the Generations Plus Northern Manhattan Network, the Queens Network and the North Bronx Network and Health & Home Care -- will compete to win HHC's Patient Safety Trophy for 2012.

Through these events HHC leaders from throughout our system, as well as Patient Safety Officers and Associates, and frontline staff will come together to celebrate our commitment to our patients and celebrate the progress we have made toward making HHC an even safer place to receive quality health care.

MEDICATION SHORTAGE

The issue of medication shortages has been in the press for well over a year.  Unfortunately it is not getting better and in fact shows signs of getting worse.  Chemotherapy, anti-microbials and anesthetic agents are the most common category of medication in short supply.  The state and federal governments are aware and a recent FDA Bulletin was issued to increase awareness and to announce a new effort to increase chemotherapy availability by permitting importation from Europe.  Every HHC facility is aware and the Pharmacy Directors and Medical Directors are coordinating those efforts. Medical staff are identifying alternative medications where feasible and restrictions are being placed on critical drugs in short supply to ensure optimum utilization. 

HHC HEALTH HOME CERTIFICATION FOR QUEENS AND MANHATTAN
EXPECTED IN MID-MARCH

On February 15th, HHC submitted its application to the New York State Department of Health (DOH) for designation as a Health Home Provider in the boroughs of Queens and Manhattan and we expect to be certified by mid-March.  Last month, DOH certified HHC as a Health Home Provider in the boroughs of the Bronx and Brooklyn.

As I mentioned to you in November, 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 fees to be paid via the Health Home program are to cover the cost of care coordination services and will average about $100 per member per month.  This payment comes in addition to any other reimbursement for the care delivery required by each patient.

We expect that the modest first wave of patients assigned to HHC through the Health Home program -- approximately 500 to 600 patients -- will largely receive services from existing care coordination programs at HHC hospitals.  As we expand the numbers of Health Home patients, we will likewise expand the pool of care coordinators to provide these services. 

FUNDING CUTS TO HHC INCLUDED IN ADOPTED LEGISLATION 

On February 17th, the Senate and the House adopted the Middle Class Tax Relief and Jobs Creation Act of 2012, which President Obama signed into law on February 22.  This law included a 10-month extension of the existing payroll tax reduction and extension of a temporary funding fix to sustain current Medicare reimbursement for physicians.  Without it, physicians across the country would have experienced a 27.4 percent reduction in Medicare reimbursement. 

To offset this spending, the law includes a one year extension, to federal fiscal year (FFY) 2021, of the Medicaid DSH cuts that are included in the Affordable Care Act that otherwise would have expired on September 30, 2020. This one-year extension would result in savings of $4.1 billion for the federal government; however the impact on HHC – if our DSH funding is reduced proportionally - is an estimated $421.8 million cut in funding in FFY 2021.

The law also includes a provision, effective on October 1, 2012, to reduce Medicare reimbursement for hospitals for “bad debts,” which typically include an inability to collect on patient co-pay amounts.  This provision is estimated to save the federal government $6.9 billion from FFY 2012 - 2022.  The cost to HHC will be $200,000 every year starting in FFY 2012, or an estimated total of $1.9 million through FFY 2021.

On a bright note, with leadership from New York Senator Charles Schumer, proposed cuts in Medicare payments to hospital outpatient departments for Evaluation and Management Services were removed from the bill before passage.  These proposed cuts would have resulted in a loss of $186 million to HHC over ten years. 

PRESIDENT OBAMA RELEASES PROPOSED FFY 2013 FEDERAL BUDGET

On February 13th, President Obama released the Administration's proposed federal budget for FFY 2013. Included were reductions to both the Medicaid and Medicare programs, totaling $364 billion over ten years. The specific health care cuts mirror those that the President had submitted to the budget "Super Committee" in the fall of 2011.  The Administration's proposals, if enacted, could result in reductions of $1.5 billion to HHC over 10 years.

There are three Medicaid proposals of primary concern:

• A phase-down of states' use of Medicaid provider taxes from FFY 2015 to FFY 2017, to 3.5 percent starting in FFY 2015.  New York State is currently at 5.5 percent.  This proposal would save the federal government $22 billion; however HHC would lose an estimated $687.5 million over 10 years.

• A reconfiguration of states' FMAP (the federal Medicaid match) by replacing rates for Medicaid and Children's Health Insurance Program with a single lower rate that could save the federal government $18 billion over 10 years. While there are still no legislative details, preliminary estimates are that HHC could lose $277 million over 10 years.

• Extending the ACA-mandated Medicaid DSH cuts two years, to FFY 2022.  This would save the federal government $8 billion; however HHC would lose $421 million each year.  Note that the first year of this extension was included in the Middle Class Tax Relief and Jobs Act of 2012 adopted on February 17th by Congress.    

On the Medicare side, there are several proposals of major concern to HHC:

• The proposal to reduce Indirect Medical Education payments by 10 percent starting in FFY 2014 would save $10 billion nationally and cost HHC $93.8 million over 10 years.

• The proposal to reduce reimbursements for Medicare bad debt from the current 70 percent to 25 percent over three years to save the federal government $36 billion, would cost HHC an estimated $15.3 million over 10 years.

• The Administration proposes several additional changes that would save the federal government an estimated $63 billion and cost HHC $36.7 million over 10 years, including:

• Reducing payments to inpatient rehabilitation facilities (IRFs), long-term care hospitals, skilled nursing facilities (SNFs), and home health agencies by 1.1 percent beginning in FFY 2014 through FFY 2021;

• Beginning in FFY 2013, equalizing payments to IRF with SNF payments for three conditions involving hips and knees, as well as other conditions selected by the Secretary of Health and Human Services; and

• Reinstituting in FFY 2013, the Medicare policy that required at least 75 percent of patients admitted to an IRF to have conditions that meet one or more of 13 designated severity conditions in order for that facility to qualify as an IRF. 

SCIENTIFIC AND TECHNICAL ADVISORY COMMITTEE RECOMMENDS INCLUSION OF CANCER AS AN ELIGIBLE DIAGNOSIS FOR WTC HEALTH FUNDING

On February 16th, the Scientific and Technical Advisory Committee (STAC) of the World Trade Center Health Program recommended that some cancer patients be made eligible for health benefits through the World Trade Center Health Program. Last year, when Congress enacted the program to compensate and treat persons who were sick as a result of the events of 9/11, cancer was not enumerated as a diagnosis that was eligible for treatment and compensation from the program.

While the scientific debate is still in its early stages over whether higher rates of cancer are a direct and proven result of exposure to the 9/11 dust cloud and smoke, members of the STAC agreed that there is solid biological plausibility of a cancer link, given the numerous cancer causing toxins that were present at the site.   They agreed, with near unanimity, that it was reasonable to expand the program now while the definitive research continues.  While it is not yet clear exactly what the committee will conclude, it is anticipated a variety of cancers will be included in the STAC recommendation.

The Committee's recommendation, due by April 2, 2012, is advisory only.  It can be accepted, rejected, or taken in part by the program's administrator, Dr. John Howard, Director of the National Institute for Occupational Safety and Health.  If Dr. Howard decides to go forward to include cancers, his recommendation would be published in the Federal Register for comment. 

We will keep you posted on further developments on this issue of importance to our own WTC Environmental Heath Program and to all New Yorkers.

HHC REACHES OUT WITH 2012 COLON CANCER AWARENESS MESSAGE

In observance of National Colorectal Cancer Awareness Month in March, we will continue our message that Colon Cancer is Preventable, Treatable and Beatable. This week, the New England Journal of Medicine published the results of a 20-year study done in New York City which showed that the death rate from colorectal cancer was cut by 53 percent in those who had a colonoscopy and whose doctors removed pre-cancerous growths, known as adenomatous polyps.

Our awareness campaign will include a Colon Cancer webpage with compelling video messages from employees and patients with a direct appeal to colleagues, friends, family members and others, age 50 or over, to get a colonoscopy.  We will also feature our staff and patients in brochures and posters printed in English and Spanish and placed prominently in our facilities.  Next week, Dr. Jason Gonsky, Director Hematology/Oncology at Kings County Hospital Center, and Dr. Margaret Kemeny, Director, Cancer Center at Queens Hospital Center will each have an article focused on the importance of colon cancer screening published in local newspapers, The Brooklyn Spectator and The Queens Courier.  We also plan to use HHC's presence in the social media channels of Facebook, YouTube and Twitter to extend our colon cancer message during March.

HHC IN THE NEWS HIGHLIGHTS 

Broadcast

• Keeping the Heart Healthy, Dr. Brooks Mirrer, Woodhull Hospital, News 12 Brooklyn -TV, 2/22/12
• Benefits of Breastfeeding, Dianne Velez RN, Lactation Consultant, Metropolitan Hospital, NY1 Noticias -TV, 2/23/12
• Carnegie Hall Performers Bring Act To Queens Hospital, Queens Hospital, NY1-TV, 1/24/12
• Brooklyn Officer Shot In Line Of Duty Heads Home, Dr. Ronald Simon, Bellevue Hospital, NY1-TV, 2/10/12 

Print and Online

• Nurses as Executives, Denise Soares, Harlem Hospital, Advance for Nurses, 1/30/12
• Helping Men Take Better Care of Their Health , Denise Soares, Harlem Hospital, New York Daily News, 2/21/12
• Twenty of the New York Region's Top Urban Health Specialist and Executives, Denise Soares, Harlem; Dr. Jean-Bernard Poulard, Queens Health Network;Tony Martin, HHC,NY Daily News, Urban Health Supplement, 2/21/12
• HHC Imports Expert In Health-Care Simulation For Bronx Institute, HHC, The Chief, 2/17/12 
• In the name of public health, Jan/Feb issue, Antonio Martin, The Network Journal, February 2012
• MetroPlus Health Plan rated No. 1 for quality of care, patient satisfaction, HHC, Nurse.com, 2/20/12
  (Also covered by Insurancenet.com)
• 10 Spine Surgeons Focusing on Trauma, Dr. Sheeraz A. Qureshi, Elmhurst Hospital, Becker's Orthopedic & Spine Review, 2/22/12
• Harlem Hospital Puts ER Patients on the Fast Track, Dr. Maurice Wright, Denise Soares, Harlem Hospital, DNAinfo.com, 2/9/12
• Reading before age 5? Experts say 'yes', Bellevue Hospital, TheGrio.com, 2/21/12
• Offering Paid Sick Time Could Save the City Money, Report Says, HHC,DNAinfo.com, 2/17/12
• Medical Care In Queens Ranks Among Best, Elmhurst Hospital, The Queens Gazette, 1/25/12
• Gouverneur Celebrates Chinese New Year, Gouverneur Hospital, The Lo-Down, 2/1/12
• Hospital Birth Costs: What to Expect, Dr. Aleksandr M. Fuks, Queens Hospital, Dr. Toni Stern, Coney Island Hospital, Learn Vest, 2/6/12
• Bellevue One of the Few, Dr. Jennifer Havens, Dr. Judith Joseph, Bellevue, Our Town, 2/8/12
• W.T.C. Health Registry to complete third survey, HHC WTC Environmental Health Center, Downtown Express, 2/8/12
• Progress made on new building Foundation, HHC Sea View, Staten Island Advance, 2/8/12
• DOH Rolls Out Asthma Grants, HHC, Crain's Health Pulse, 2/23/12
• Art Exchange Program, Fox 5 -TV, 1/25/12
• Lin-Manuel Miranda Partners with 'Lincoln Art Exchange' Program, Broadway World, 1/24/12
  (Also covered in CBS New York, Bronx Times, Metro, Huffington Post, Buffalo Business First)
• Artists to barter talent for health care, The Amsterdam News, 1/26/12
• Lincoln Art Exchange barters health treatment, Lincoln, Bronx Times, 2/14/12
• En Hospital Lincoln los artistas pueden intercambiar seguro médico por su arte, Queens Latino, 1/26/12 
  (Also covered in Atanay.com)