ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
March 22, 2012

JOINT COMMISSION SURVEY EARNS HIGH PRAISE FOR
CONEY ISLAND HOSPITAL 

Last week, The Joint Commission completed its triennial accreditation survey of Coney Island Hospital.  The survey team was very complimentary of Coney Island front line staff and leadership, and impressed by the strong relationship between the medical and nursing staff.  Once again, the survey team leader recognized the commitment of the HHC Board of Directors to quality and safety and praised Mrs. Josephine Bolus for her participation in the Leadership Interview.  The survey team commented that Coney Island does a phenomenal job taking good care of very complex patients.

"Staff care about their patients, and this seems to reflect the mission and vision of the organization and the strong leadership.  In many areas, the organization's processes exceeded the intent of the standards, the lead surveyor said at the close of the survey."  The administrator surveyor noted that if he fell sick, he would come to Coney Island Hospital.  Although the survey included some limited findings for improvement, none were related to patient care, a terrific accomplishment. 

Several Leading Practices were identified by the surveyors including:  the Palliative Care program, the Wound Care program, Code Grey for Crisis Prevention, and the Emergency Management Plan that was used to coordinate the evacuation of patients during Hurricane Irene in 2011. 

I know the Board joins me in congratulating Senior Vice President Arthur Wagner, Medical Director Dr. John Maese, Chief Nurse Terry Mancher and the staff of Coney Island Hospital for a job well done.   

Kings County and Lincoln Hospitals and Sea View Nursing and Rehabilitation Facility remain to be surveyed by The Joint Commission this year. 

NURSE PRACTITIONER AT CONEY ISLAND HOSPITAL RECEIVES
PRESTIGIOUS SLOAN PUBLIC SERVICE AWARD 

Last week, in ceremonies at Coney Island Hospital Center and Cooper Union, the Fund for the City of New York announced that Donna Leno Gordon, a nurse practitioner from Coney Island who led the effort to formalize HHC’s corporate-wide palliative care program, has won the prestigious Alfred P. Sloan Public Service Award for 2012. Since 1973, the Fund for the City of New York has annually presented the Sloan award to outstanding civil servants whose accomplishments and commitment to public service are truly extraordinary; Sloan awardees are selected from among more than 250,000 eligible City employees. Donna is one of six winners this year, and her recognition marks the third consecutive year that an HHC employee has been chosen for the award, considered by many to be the “Nobel Prize” of City government. 

Ms. Leno Gordon’s commitment to improving the lives of some of our most vulnerable patients exemplifies HHC’s mission. In her more than 20 years of service to Coney Island, she has redefined the standards of care across two disciplines. As a champion of palliative care, she has worked to standardize palliative care programs across our system, bringing specialized services to chronically and terminally ill patients citywide. She was a founding member and currently serves as the chair of HHC’s Palliative Care Council. 

She has also dedicated her expertise and resourcefulness to advancing behavioral health services. Under Ms. Leno Gordon’s guidance, Coney Island established a nationally recognized psychiatric crisis prevention program, which employs multi-disciplinary care teams to meet the needs of mentally ill patients. The Sloan award selection committee recognized and saluted Donna for her life-long learning, her tireless and courageous service, her inspiration to other staff, and her commitment to her patients, the Coney Island community, and public service. 

Please join me in congratulating Ms. Gordon for her outstanding accomplishments and on this well-deserved recognition. 

KINGS COUNTY HOSPITAL ACHIEVES NATIONAL RECOGNITION FOR
BREAKTHROUGH PERFORMANCE IMPROVEMENT IN EMERGENCY DEPARTMENT 

Kings County Hospital was recognized nationally for using Breakthrough methodologies to transform its Emergency Department, improve efficiency and patient flow and shorten the time it takes for a patient to see a doctor. A Kings County medical team describes the improvement process in an article published this month in a special issue of the peer-reviewed Journal for Healthcare Quality (JHQ), which recognizes innovative and evidence-based care efforts at a select number of safety net hospitals across the country. 

Kings County was among four U.S. public hospitals recognized on March 15 by the National Association for Public Hospitals and Health Systems (NAPH) and the National Association for Healthcare Quality in Washington D.C.  The hospitals were singled out for programs that demonstrate that effective quality improvement measures adopted by safety net hospitals can help address healthcare disparities, improve overall patient care and achieve high standards of quality.  All four hospitals published articles in the JHQ describing their programs.

Although the median number of ER patient visits rose 7.3 percent during the period involved, the total time a patient spent in the ER was reduced by 36 minutes. The amount of time it took for a patient to be triaged was cut in half, to a median of 18 minutes, and the amount of time it took to see a doctor was reduced by 30 minutes. 

HHC has been applying the Breakthrough process in New York City public hospitals since 2007, making quality, efficiency and financial improvement an ongoing and permanent process throughout our system. Congratulations to Kings County for the excellent job they've been doing in using Breakthrough tools to increase efficiency, eliminate waste and improve the patient and staff experience. 

KINGS COUNTY HOSPITAL RECEIVES $3.5 MILLION FOR CANCER CARE 

Late last month Kings County Hospital received $3.5 million to purchase a new linear accelerator to provide radiation therapy at the KCHC Cancer Care Center.  The generous grant was from New York City Council Members Mathieu Eugene and Darlene Mealey, on behalf of the City Council Brooklyn delegation. The new machine will be used to accommodate the more than 600 cancer patients who are coming to KCHC for treatment and support services every year. The hospital’s Cancer Care Center, which opened in 2010, provides comprehensive, one-stop shop services including oncology, chemotherapy, surgery, medicine, pharmacy, nutrition, social services and psycho-social support.  The new linear accelerator will provide 200 additional cancer patients with more precise and advanced radiation treatment modalities.  It will be one of two linear accelerators used at the cancer center. 

FEDERAL UPDATE 

On Tuesday, March 20, House Budget Chairman Paul Ryan released his proposed House Budget Resolution for federal fiscal year 2013. Chairman Ryan’s proposed budget would dramatically reshape the Medicare and Medicaid programs. It is likely that his budget will pass the House in the form of a budget resolution.  However, it will not be taken up in the Democratically-controlled Senate. Ryan's budget sets discretionary spending at $1.028 trillion for federal fiscal year 2013, less than the $1.047 trillion cap agreed upon by both parties last year in the Budget Control Act (BCA).  Although this is a difference of only $19 billion, what is significant is that many cuts are shifted from defense to domestic discretionary and entitlement programs. 

As he proposed last year, Chairman Ryan would change Medicaid into a federal block grant program, giving the states more latitude in designing their programs. Medicaid spending would be slashed by $810 billion over ten years, a larger cut than the $771 billion cut in proposals Ryan made last year. The Ryan budget would also repeal the Affordable Care Act, including the Medicaid expansion components.        

Ryan's Medicare proposal is similar to a proposal he championed in December 2011.  However, unlike last year's proposal, which would have ended traditional Medicare by converting the program to a premium support model, this year's version preserves traditional fee for service Medicare as an option within the premium support rubric. Seniors who turn 65 in 2023 would purchase either a private health plan or the traditional fee for service option through a newly created Medicare exchange. Notably, Ryan's plan saves only $205 billion in Medicare spending over the first 10 years because radical change in the program does not occur until federal fiscal year 2023.

On February 29th and March 1st, Senior Vice President LaRay Brown along with HHC staff from Intergovernmental Relations, participated in the National Association of Public Hospitals' (NAPH) semi-annual legislative conference in Washington.  Meetings took place with Congress Members Eliot Engel and Ed Towns and with New York Congressional staff.  Some of these meetings also included representatives from several other New York State public hospitals. The focus of the meetings was the impact of the President's proposed budget, which, as I mentioned in February, could result in reduced Medicare and Medicaid payments to HHC of $1.5 billion over 10 years. In addition, the cut to Disproportionate Share Hospital (DSH) funding was discussed.  The New York  Congressional staff, with Senator Schumer's staff in the lead, has indicated their strong commitment to fighting any additional proposed Medicaid DSH cuts, as well as supporting efforts  to roll back some of the already Affordable Care Act-mandated Medicaid DSH reductions. As noted in past meetings, current law includes a total of $2.278 billion in Medicaid DSH reductions slated for 2014-2021. These cuts were included in the Accountable Care Act and in the recently enacted HR 3630, the Middle Class Tax Relief and Job Creation Act of 2012. 

STATE LEGISLATURE CONSIDERING BUDGET FOR COMING FISCAL YEAR 

In Albany, negotiations on the State Budget previously had been proceeding ahead of schedule and it appeared that this would lead to an early budget adoption, but negotiations have slowed down considerably.  Both the Assembly and Senate released their respective one-house budget bills and have been discussing the differences between them and the Governor's Executive Budget.  As you know, we have a presence in Albany and HHC staff have been reaching out to members and key staff over the past several weeks to discuss our issues. We have also engendered the advocacy of our labor partners, CAB members, consumer advocates and others on issues that impact HHC. 

At the moment, we are focused on two key items:  The first is maintaining $75 million in affordable housing funding that was proposed by the Governor.  HHC is slated to receive $7.3 million out of this commitment to develop housing for our patients.  The Legislature is seeking to push between $25 and $50 million of this funding into the out-years.  It is important that the full $75 million commitment remain as proposed by the Governor for State Fiscal Year 2012-2013.  We are also trying to prevent a $29 million cost shift from the State to the City for the payment of a HCRA tax.  Currently, this tax is paid by the State.  And, just to remind the Board, last year's state budget agreement reduced our funding by $174.5 million and over the past 5 years, more than $500 million in funding has been cut on an annualized basis.   

HHC TESTIFIES AT BUDGET HEARINGS BEFORE CITY COUNCIL 

Earlier this week, I testified before the Health Committee at the City Council's Preliminary Budget hearing.  As I normally do in the testimony, I reviewed our precarious financial state, highlighted several major initiatives and briefed them on the status of our major modernization projects.  HHC has been fortunate to receive significant funding from the City and the Council over the past several years.  We hope to fare as well or better this year.  The Council holds another round of hearings on the Executive Budget later in the spring at the end May and into early June.  

HHC USES MULTIPLE CHANNELS TO SPREAD
THE COLON CANCER AWARENESS MESSAGE 

As I mentioned in my report last month, HHC is meeting this year's challenge of National Colorectal Cancer Awareness Month with a variety of messages in print, online and over the air throughout March.  A key focus of our outreach is to engage staff and patients in understanding that a colonoscopy -- starting at age 50 and repeated every ten years -- not only detects the potential for disease, but treats it as well.  Our staff outreach includes many corporate-wide e-mail messages, as well as the placement of brochures and posters printed in English and Spanish in prominent locations in each of our facilities.  We also partnered with the American Cancer Society last week to co-host a "twitter-view" -- an interview on the prominent social network Twitter -- featuring a Q&A with Dr. Jennifer Harley at Metropolitan Hospital.  To raise awareness of the high incidence of colon cancer in the African American community, we arranged for Dr. Joan Culpepper-Morgan from Harlem Hospital to be interviewed by WBLS radio and featured on their popular "Daily Dose" segment repeatedly throughout the month.  We will continue throughout the month to promote colorectal cancer prevention and screening with e-mails, and posts to Facebook, YouTube and Twitter. 

HHC PREPARES TO RECEIVE HEALTH HOME ENROLLEES 

As I mentioned last month, HHC has been preparing to provide care coordination services for Medicaid patients with chronic medical and/or serious behavioral health conditions, as a Health Home certified by the NYS Department of Health (DOH).  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 State DOH has certified HHC as a Health Home in the Bronx and Brooklyn, and we expect to receive certification for Manhattan and Queens in April.  HHC leadership is currently negotiating with New York State to determine the appropriate rate for these services. These rates are directly linked to the acuity of eligible patients assigned to HHC's Health Home. DOH has asked that Health Homes initiate start-up activities by identifying a small group of high acuity need patients for outreach and enrollment. After rates have been negotiated, HHC will begin to provide Health Home services to patients in the Bronx and Brooklyn.  

TIER VI PENSION REFORM FOR HHC WORKERS 

On March 16, the Governor signed into law pension reform legislation that puts in place a new Tier VI pension plan for workers hired after April 1, 2012. This legislation also affects current employees who have not joined the pension system under the more generous Tier IV. They must join the pension system by March 31 to be a Tier IV member.  We are conducting aggressive outreach to the approximately 5900 HHC employees who are not pension members to make them aware of the March 31 deadline. 

Savings to HHC from the Tier VI pension plan will ultimately come from an increase in the retirement age from 62 to 63; increased employee contribution rates, ranging from 3% to 6%, based on salary; a lengthening of the vesting period from 5 to 10 years, and changes to the pension calculation formula.  For higher paid employees, the amount earned above the Governor's salary (currently $179,000) will not be eligible for pension calculation under Tier VI. 

HHC IN THE NEWS HIGHLIGHTS 

Broadcast

Training Doctors Perform Virtual Colonoscopies To Perfect Their Skills, Katie Walker, Director of IMSAL, Dr. Meade Barlow, Jacobi Hospital, NY1-TV, 3/12/12 

Lincoln Hospital's Asthma Grant, News 12 Bronx -TV, 3/2/12 

Asthma Grants, Dr. Venkatash Sabhae, Woodhull Hospital, News 12 Brooklyn - TV, 2/29/12 

I Said, “Get Your Hearing Checked!", Dr. Matthew Hanson, Kings County, Brooklyn Independent Television -TV, 3/9/12 

Artists Trade Time and Talent for Treatment, Lincoln Hospital, The Brooklyn Ink -TV, 3/3/12 

Newest New Yorkers Have Unusual Leap Day Birthdays, Elmhurst, NY1-TV, 2/29/12

Leap Year Babies, Dr. Adeola Atilade, Lincoln Hospital, News 12 Bronx-TV, 2/29/12 

Print and Online 

Do Electronic Records Cut Health Costs?, Letter to the editor by Alan D. Aviles, HHC President, The New York Times, 3/12/12 

Sloan Public Service Awards 2012, Coney Island, Donna Leno Gordon, RN Coney Island,The Huffington Post, 3/19/12

(Also covered in The New York Times, NY Daily News, The Chief) 

New York City hospital barters artistic talent for healthcare dollars, Lincoln Hospital, Nursing Spectrum, 3/5/12 

Fondos contra el asma en barrios latinos, Funds to fight asthma in Latino neighborhoods, Lincoln, Woodhull, El Diario, 3/7/12 

Viewpoint: The United Nations of Medicine, Bellevue Hospital, Dr. Lewis R. Goldfrank, Emergency Medicine News, March 2012 

Top ranking for Staten Island's Sea View Hospital Rehabilitation Center, Sea View Hospital, Staten Island Advance, 3/8/12 

Why is Colorectal Cancer in the News?, Dr. Margaret Kemeny, Queens Hospital, The Queens Courier, 3/9/12 

Who Cares About Colon Cancer?, Dr. Jason Gonsky, Home Reporter and Sunset News,  3/12/12 

Balancing Military Service and a Civilian Career Pays Off for These IT Professionals, Corey Cush, HHC, Government Technology, February 28, 2012 

An Early Start on a Healthy Smile, Dr. Rawle F. Philbert, Lincoln Hospital, The Bronx Free Press, 3/7/12 

NYC health leaders: Get a colonoscopy, HHC, The Staten Island Advance, 3/15/12 

Black men last to see doctor but first in the hospital, HHC, Amsterdam News, 3/1/12 

Things Adult Medicine Could Learn From Pediatrics, Bellevue Hospital, The New York Times, 3/12/12