ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
MAY 24, 2012

LINCOLN HOSPITAL RECEIVES TOP SURVEY RESULTS FROM
JOINT COMMISSION

Last week, The Joint Commission completed its triennial accreditation survey of Lincoln Medical and Mental Health Center. The survey team complimented Lincoln Hospital's front line staff and leadership and was very impressed by the strong commitment and collaboration between the medical and nursing staff teams. The surveyors also commented on the commitment and support of the HHC Board of Directors to quality and safety, and praised HHC Board Member Mrs. Josephine Bolus, who participated in the Leadership Interview.

There were no patient care-related findings or findings for the National Patient Safety Goals, a great accomplishment. In many instances, the survey team stated that the organization's processes exceeded the intent of the standards. Leading practices identified by the survey team included: the Critical Care Collaboratives, the Behavioral Health Assault Reduction Program, the Infant Abduction Program and the Falls Prevention Program.

Congratulations to Senior Vice President Iris Jimenez-Hernandez, Medical Director Dr. Melissa Schori, Chief Nurse Carl Kirton and the staff of Lincoln Medical and Mental Health Center for a job well done.

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

NATIONAL PATIENT SAFETY FOUNDATION ANNUAL CONGRESS

This week, HHC staff members are making major contributions at the 14th Annual Patient Safety Congress sponsored by the National Patient Safety Foundation (NPSF) in Washington, DC. Carefully crafted by leaders in the field to provide real-world tools, resources, and evidence-based solutions for patient safety issues, the NPSF Patient Safety Congress has a singular focus on patient safety. Caroline Jacobs, HHC's Senior Vice President for Safety and Human Development, is a member of the NPSF Congress Planning Committee. HHC's Assistant Vice President for Patient and Employee Safety, Mei Kong, RN, is presenting a breakout session "Switching Chairs: Health Providers as Patients and Advocates" with Patricia Sklonik, a nationally recognized patient safety advocate and founder of Citizens for Patient Safety.

Seventeen posters that showcase HHC's patient safety successes are being presented at the Congress. HHC and the Committee on Interns and Residents/Service Employees International Union (CIR/SEIU) are making a special presentation on labor and management joining forces to improve patient safety. Other HHC facilities presenting posters are Coney Island, Gouverneur, Harlem, Lincoln, Metropolitan, North Bronx Healthcare Network, Sea View and Woodhull.

PATIENT SAFETY FELLOWSHIPS AWARDED

Four HHC doctors are among 20 physicians in the greater New York area who have been selected as fellows in the prestigious Clinical Quality Fellowship Program, which supports the training and professional development of early- and mid-career physicians and nurses to help them lead quality improvement and patient safety efforts in their hospitals.

The 2012-2013 HHC fellows are:

• Douglas Hirshon, DO, R.Ph., a primary care provider and Director of Ambulatory Care at North Central Bronx Hospital
• Brenda Natal, MD, MPH, RN, an emergency medicine physician at Kings County Hospital Center and the first Simulation Fellow at HHC's Institute for Medical Simulation and Advanced Learning
• Amit Singh Tibb, MD, an attending physician on the chest service, medical ICU and pulmonary consult team at Jacobi Medical Center
• Ming Chih Tsai, MD, Director of Obstetrics and Gynecology, Bellevue Hospital Center

A program of the United Hospital Fund and the Greater New York Hospital Association, the Clinical Quality Fellowship is intended to create a lasting infrastructure supporting quality improvement in the greater New York area. Through an intensive 15-month training session, regional leaders in health care quality teach the fellows proven tools and techniques to improve the quality, efficiency, and safety of patient care within their hospitals. Participating fellows then bring their new knowledge, skills, and strategies back to their institutions, where they are prepared to take on leadership roles as agents of change.

PATIENT SAFETY CULTURE SURVEY IS COMPLETED

HHC's fifth corporate-wide Patient Safety Culture survey was concluded in April 2012, using hospital, nursing home and medical office surveys on Patient Safety Culture published by the Agency for Healthcare Research and Quality. The survey tool is an evidence-based instrument designed to assess staff opinions about patient safety issues, medical errors and event reporting in their organization. Staff may complete the survey electronically via their facility intranet site or on paper. All surveys are anonymous.

Over 23,400 HHC staff responded to the survey, an overall response rate of 61%. By level of care, there was a 57% response rate for the acute care hospitals, 85% for long term care, 84% for the diagnostic and treatment centers, and 62% for home health.

Staff identified several areas of strength including that management supports and provides a work climate that promotes patient safety. Eighty-two percent of hospital staff responded positively that we are actively doing things to improve patient safety. Potential for improvement was identified in the areas of "non-punitive response to error" and "staffing." HHC's results in these two areas are similar to all hospitals in the 2012 AHRQ survey database. Results of the survey will be provided to staff at each facility next week.

The Patient Safety Culture Survey represents an opportunity for staff to express their opinions on patient safety and is a core metric for continuing to assess the progress of safety improvements at HHC facilities and for focusing our patient safety efforts.

FEDERAL UPDATE

On May 10th, the House of Representatives approved The Sequester Replacement Reconciliation Act of 2012. This House bill is meant to replace many of the sequestration cuts scheduled to begin January 2013 as part of the Budget Control Act (BCA) adopted last year. The House would not, however, repeal the 2% Medicare cut that was included in the BCA. The Senate voted down the House-passed budget. However, the House budget bill will likely serve as the starting point in December when negotiations ensue to replace the scheduled sequester cuts that begin in January 2013. One of the features of the House budget bill is the extension of the Disproportionate Share Hospital (DSH) reductions to include federal fiscal year 2022. HHC would lose $421 million in federal fiscal year 2022 from this provision.

On another matter, federal law that requires user fees to be paid to the Food and Drug Administration by pharmaceutical manufacturers and medical device industries expires on October 1, 2012 and Congress is working on a bipartisan legislative effort to ensure the continuation of these fees. The FDA takes in more than $1 billion in fees, which make up more than half of the agency's budget. Of importance to HHC is the fact that this bill to extend the fees is being used as a vehicle to address the shortage of certain pharmaceuticals including sterile injectables used to treat cancer. HHC, like other health providers, is experiencing pharmaceutical shortages.

To date, both the House and Senate committees have reported legislation to extend user fees and the legislation is pending on the Senate floor. Both bills would require drug companies to give the FDA a six-month notification of anticipated shortages and the FDA would be required to provide expedited inspections and reviews for drugs that are in short supply. There is also language in the bills that allows healthcare systems to repackage drugs that have been designated in short supply into smaller doses and to distribute them to their wholly-owned affiliate hospitals.

HHC has been concerned about attempts to use this FDA legislation to exempt certain drugs from the 340B discount drug program for DSH hospitals. Although Senator Orrin Hatch (R-UT) had proposed an amendment to exempt sterile injectables from the 340B program, he did not officially offer his amendment into the bill language now being considered. HHC opposed this amendment. It is unclear whether Senator Hatch will try to offer his amendment when the bill goes to the Senate floor but we are preparing Senator Schumer in case it is offered. HHC saves approximately $130 million annually through the 340B program. We do not have an exact figure on the losses that HHC would sustain if the Hatch amendment were adopted but approximately one-third of our drug purchases are of sterile injectables. On the House side, there have been no attempts to exempt any drugs from the 340B program.

HOUSING DEVELOPMENT FOR LOW-INCOME ELDERLY AND DISABLED

On today's agenda are two resolutions related to the execution of license agreements with MetroHealth Homes Housing Development Fund Corporation (HDFC) for the construction of 176 affordable apartments on the Metropolitan Hospital campus at East 99th Street. These apartments will be specifically designed for current disabled and elderly residents at the Coler-Goldwater skilled nursing facility, who no longer require institutional-based long term care.

The first of the resolutions is for the execution of a license agreement that will enable the HDFC to begin the early stages of construction including remediation work in advance of the project's closing scheduled to take place in September. This resolution would also allow the Corporation to advance funds for the early stages of construction subject to reimbursement upon closing and the execution of a long term lease between the Corporation and the HDFC. The early start is essential if the housing is to be available by December 2013 which is the timetable by which the Corporation must vacate the Goldwater campus.

The second resolution seeks the Board's authorization to execute a long term sublease.

I urge you to support both resolutions, as the development of the East 99th Street parcel is intrinsic to our restructuring initiative concerning Coler-Goldwater and our long term care services.

HHC LEADERS PRAISED IN EL DIARIO RECOGNITION OF
DISTINGUISHED WOMEN

In recognition of National Women's History Month, El Diario recognized the diverse and significant contributions of Latinas who have made a positive impact on the lives of others. I am proud to report that two of our prominent leaders, Iris Jimenez-Hernandez, Senior Vice President of Generations +/ Northern Manhattan, and Elizabeth Guzman, Chief Financial Officer at Metropolitan Hospital, are recipients of the 2012 El Diario Distinguished Women Award. Join me in congratulating both Iris and Liz on this achievement and for their leadership and outstanding contribution to our HHC family.

TeamSTEPPS STAFF RECOGNITION

On April 30th the Office of Patient Safety hosted a workshop at Metropolitan Hospital for 130 HHC TeamSTEPPS Master Trainers who actively provide training in their facility or across the enterprise to promote the effective teamwork that has ultimately contributed so much to the higher quality and safer healthcare we bring to our patients. The objectives of the day were: to discuss what we have accomplished thus far on our TeamSTEPPS journey and where we need to go; develop additional skills on coaching, implementation, and measurement; share facility-specific best practices and successes utilizing TeamSTEPPS; and recognize the exemplary leadership contributions of our Master Trainers.

The morning began with presentations from Caroline M. Jacobs, Senior VP, Safety and Human Development, Mei Kong, RN, AVP, Patient Safety and Abdul Mondul, MD, Patient Safety Officer and Associate Medical Director at Lincoln Hospital. In the afternoon, three HHC facilities reported on how they have embedded TeamSTEPPS into daily clinical practice and shared the outcomes achieved. North Bronx Healthcare Network discussed the reductions in adverse outcomes they achieved in Labor and Delivery. Lincoln Medical and Mental Health Center presented how they decreased both catheter-associated urinary tract infections and the rate of falls on the inpatient units. Metropolitan Hospital Center described their success in reducing physical altercations on the Adolescent Psychiatry Unit. We concluded with a collective expression of appreciation for all 130 master trainers.

HHC JOINS NYC HEALTH DEPARTMENT "LATCH ON NY" INITIATIVE TO SUPPORT BREASTFEEDING MOTHERS

Earlier this month, the New York City Health Department launched "Latch on NYC," a new citywide breastfeeding initiative that urges hospitals across the city to ban infant formula from gift bags and promotional materials in labor and delivery units. As a leader in promoting the benefits of breast milk, HHC hospitals have banned formula give-aways since 2007 and renewed their commitment to support and educate women who breastfeed by signing on to the initiative. The event took place at Harlem Hospital, the city's first official "baby friendly hospital" and Executive Director Denise Soares had the chance to speak about their success with breastfeeding.

EXPERTISE OF HHC'S CHIEF MEDICAL OFFICER FEATURED IN MODERN HEALTHCARE MAGAZINE WEBINAR

This past Tuesday, HHC Corporate Chief Medical Officer, Dr. Ross Wilson, was one of three featured panelists in the one-hour Modern Healthcare Magazine Webcast: Making Medicaid Work. Rich Daly, Washington Reporter for Modern Healthcare Magazine, served as moderator, and the two other panelists were Bill Galinsky, VP of Governmental Finance for Scott & White Healthcare in Temple, Texas; and Beth Kidder, Assistant Deputy Secretary for Medicaid Operations, Florida Agency for Health Care Administration. Dr. Wilson and the other panelists discussed strategies to reduce hospital costs, ways to work with state Medicaid programs to optimize both current reimbursement and enrollment of eligible patients, and the likely changes in payment methodologies ahead as states redesign their Medicaid programs.

HHC CERTIFIED AS A HEALTH HOME IN MANHATTAN

In the past month, the NY State Health Department selected HHC as a Health Home provider in Manhattan, making HHC the only entity so designated in four of the City's boroughs. While negotiations for final care coordination rates between HHC and NYSDOH continue, HHC, like other certified Health Homes, is preparing, as a first step, to help eligible patients transition from previously established care management programs at HHC, such as the Chronic Illness Demonstration Project (CIDF), the COBRA case management program for HIV patients and the ICM intensive care management program for behavioral health patients. Once fully established, HHC's Health Home Program will provide a unified and integrated program of care coordination services for all of its eligible patients.

POSSIBLE IMPASSE IN COLLECTIVE BARGAINING WITH NURSES

On May 10, the New York State Nurses Association filed a petition asking the New York City Board of Collective Bargaining to declare that the City, HHC and the union are at impasse over the terms of a new collective bargaining agreement. The contract covering Registered Nurses expired on January 10, 2010 and although the parties have been at the bargaining table since 2009, they have been unable to reach a new agreement. The terms of the expired contract remain in place until a new contract is bargained.

Should the Board declare an impasse, it will designate a panel of arbitrators to conduct a hearing and determine the terms of the new agreement. The panel's decision is final and binding. I will keep the Board updated on major developments regarding the nurses' contract.

METROPOLITAN HOSPITAL OPENS PEDIATRIC INPATIENT UNIT

On Tuesday, March 15th, Metropolitan Hospital opened its new $3.2 million Pediatric Inpatient Unit, which integrates the highest quality medical care for children with a beautiful, nurturing environment that fosters patient safety and healthy recovery. Alan Muraoka, who plays the proprietor of "Hooper's Store" on "Sesame Street," was MC at the special event.

The new 7,500-square-foot Pediatric Inpatient Unit accommodates 14 patients. Funding for the renovation project was provided by a New York State HEAL grant, the Starlight Children's Foundation, and the Metropolitan Hospital Center Auxiliary.

LINCOLN'S PALLIATIVE CARE PROGRAM RECEIVES JOINT
COMMISSION CERTIFICATION

Lincoln Medical and Mental Health Center has become the only hospital in The Bronx and one of two hospitals in New York City with Palliative Care certification from the Joint Commission. The new advanced certification program is designed to recognize hospital inpatient programs that demonstrate exceptional patient and family-centered care in order to optimize the quality of life for patients with serious illnesses. Lincoln is among the first to seek the certification and now joins a select group of just 13 hospitals across the country with Joint Commission-certified Palliative Care Programs. Palliative Care is a medical specialty that focuses on relieving the pain, anxiety and the distress that comes with a severely debilitating, life-threatening or terminal disease. It empowers patients to make timely, informed decisions about their care under difficult circumstances, and encompasses psychosocial, spiritual and bereavement support to patients and caregivers who face end-of-life situations.

The successful implementation of Lincoln Hospital's palliative care program was spearheaded by Dr. Abdul Mondul, the hospital's Deputy Medical Director. The specialized palliative care team consists of doctors, nurses, social workers, a psychologist and a spiritual counselor. There is also a close collaboration with other disciplines such as nutrition and rehabilitation. A partnership with primary care providers and other treating physicians as well as with community resources is critical to success.

Over the past three years, there has been an exponential increase in the demand for inpatient palliative care consultation. To date, Lincoln's Palliative team has been involved in the care of more than 3000 patients with advanced diseases, 97% of whom are minority patients.

ELMHURST HOSPITAL CELEBRATES 180TH ANNIVERSARY

On Thursday, May 17, 2012, Elmhurst Hospital Center (EHC) held its 180th Anniversary Gala at Terrace on the Park in Flushing. Proceeds from the event benefited EHC's new Women's Healthcare Services Pavilion, a state-of-the-art outpatient facility scheduled to open next spring in 2013.

Honorees included Dr. Jasmin Moshirpur, Regional Medical Director of the Queens Health Network and Dean at the Mount Sinai School of Medicine, Eileen Auld, New York State Director of Citigroup Community Development, and Patricia Wang, President and CEO of HealthFirst. NY1 News anchor and reporter Cheryl Wills served as the evening's MC.

Elmhurst Hospital evolved from a small facility established on Blackwell's Island (later called Roosevelt Island) in 1832. Originally called Charity Hospital, by 1870, the hospital's name had been changed to City Hospital and the building expanded to include a full-fledged maternity unit that developed safer methods to control puerperal or "childbed" fever and substantially reduce maternal deaths.

Relocating from Roosevelt Island to Queens in 1957, City Hospital was renamed Elmhurst Hospital and in 1964 became affiliated with the Mount Sinai School of Medicine.

SEA VIEW PATIENTS ATTEND HHC ART COLLECTION'S
PHOTOGRAPHY EXHIBIT

A group of patients at HHC's Sea View Hospital and Rehabilitation Center and Home were treated to a private reception at Snug Harbor Cultural Center & Botanical Garden to view New York City: IN FOCUS, Vol.2, HHC Art Collection's traveling photography exhibition, in early May. The exhibit captures the spirit of New York City in a collection of 50 black and white, color, and digital prints. The show comprises works by internationally renowned and emerging photographers, including James VanDerZee, Roxanne Lowit, Dawoud Bey, Anthony Barboza, Arlene Gottfried, and Nancy Siesel. At the Snug Harbor reception, Sea View's staff and patients also enjoyed a performance by keyboardist Barry Olsen. Olsen shared his musical talents as part of Carnegie Hall's Musical Connections, a program that brings live music experiences to people in healthcare settings across New York City.

The exhibit is on display at Snug Harbor through May 31. New York City: IN FOCUS, Vol.2 will then travel to Jacobi Medical Center, where it can be viewed from June 6 to July 12.

AMERICAN CANCER SOCIETY GALA HONORS HHC PHYSICIAN AND
LONG-TIME SUPPORTER

The American Cancer Society (ACS) honored HHC's own Dr. Kathie-Ann Joseph for her outstanding healthcare leadership at its Fourth Annual Pink & Black Tie Gala on May 17th.

Every year, ACS celebrates exceptional leaders who have made a contribution to Brooklyn's healthcare, cultural, and business communities. Dr. Joseph, who grew up and currently lives in Brooklyn, was recognized for her dedication to caring for women with breast disease and at high risk for it. Dr. Joseph is an oncological surgeon who serves as the director of breast services for the South Manhattan Network. She oversees breast surgery at Bellevue Hospital and Woodhull Medical Center, sharing her expertise and compassion with our patients every day.

Dr. Joseph has done extensive research on breast cancer in African-American women and published her findings in the New England Journal of Medicine and other prominent journals. She has served on the President's National Cancer Panel and is the co-founder of Breast Cancer in Women of Color, a free educational conference that brings together more than 300 women every September.

ACS also honored pioneering rap artist and longtime HHC supporter Kangol Kid with its Volunteer of the Year award. Kangol Kid's performance at last year's STAT! event in the Bronx electrified the crowd while raising awareness about important cancer prevention efforts.

I know the Board joins me in congratulating Dr. Joseph and Kangol Kid for these well-deserved recognitions.

"I DEDICATE" MAMMOGRAM CAMPAIGN A SUCCESS

During my April report, I mentioned that HHC was launching an "I Dedicate" breast cancer awareness campaign during May to promote regular mammograms for women over 40 years old. The campaign features dedication walls where hundreds of staff and patients in our facilities have dedicated their mammograms to someone important in their lives, and posted their dedications on pink ribbons. We also asked women to post their mammogram dedications on the HHC Facebook or Twitter pages. Many senior staff across our system posted their dedications – some of which are displayed outside this meeting. We also had a special dedication by Council Speaker Christine Quinn, who supported our awareness campaign by posting a video message on our Facebook and Twitter pages. Speaker Quinn dedicated her mammogram to her mother, Mary Callaghan Quinn, who sadly lost her life to breast cancer.

I want to acknowledge Senior Vice President Ana Marengo and her staff for invigorating this year's mammogram campaign with the savvy use of social media. And I will conclude my report by sharing with the Board a brief sample of video messages from our employees and the message from Speaker Quinn.

HHC IN THE NEWS HIGHLIGHTS

Broadcast

National EMS Week, Woodhull, News 12 Brooklyn -TV, 5/21/12

City Launches Breastfeeding Initiative, NY1-TV, 5/9/12

Harlem Hospital Breast Feeding Initiative, WABC-TV, 5/9/12

Diabetes Care, Dr. Gul Bahtiyar, Woodhull Hospital, News 12 Brooklyn –TV, 4/22/12

Queens Hospital Center Honors Volunteers, NY1-TV, 4/25/12

Miss Teen USA Reads to Children at Woodhull Hospital, News 12 Brooklyn -TV, 4/19/12

Print and Online

HHC Launches New "I Dedicate" Breast Cancer Awareness Campaign, Hospital Newspaper, 5/13/12 (Also covered in Staten Island Advance)

HHC "I Dedicate" Breast Cancer Awareness Campaign in Harlem, Harlem World, 5/2/12

Mammograms matter, HHC, The Brooklyn Spectator, 5/10/12 (Also covered in Home Reporter and Sunset News, Staten Island Advance)

HHC 'Likes' Mammograms, Crain's Health Pulse, 5/22/12

Hágase su mamograma, Get a mammogram, HHC, El Diario, 5/23/12

She gets second chance at life, thanks to surgeon, Dr. Jose Toro, Jacobi Hospital, New York Daily News, 5/10/12

Some Hospitals Will Curb Samples of Baby Formula, HHC, The New York Times, 5/10/12

More Bronx Psych Beds, HHC, Lincoln Hospital, Crain's Health Pulse, 5/21/12

Big Bonus for MetroPlus, Crain's Health Pulse, 3/28/12

As New York's Colon Cancer Screening Rates Increase, Russian-Americans Are Left In The Dark, HHC, Bensonhurstbean.com, 4/24/12

Alcoholism: Combating a Ravaging Disease Iris R. Jiménez-Hernández, Lincoln Hospital, The Bronx Free Press, 4/18/12

Can Old Harlem Be a Part of the Changes Sweeping the Neighborhood?, Denise Soares, Harlem Hospital Center, New York Observer, 4/27/12

NYC: Combining Advocacy and Great Food, Bellevue Hospital, Children of Bellevue event, Foodrepublic.com, 4/26/12

Innovative ways to slash ED overuse, Dr. Maria Raven, Bellevue Hospital, American Medical News, 5/1/12 (Also covered in HealthExecNews.com)

Learn to Detect Symptoms, Seek Early Intervention, Dr. Paola Carugno, Pediatrician, Lincoln Hospital, The Bronx Free Press, 4/28/12

ID thieves find gold in medical data, Paul Contino, Chief Technology Officer HHC, CS Magazine, 5/1/12

Medical ID fraud booming, HHC, SC Magazine, 5/4/12

New health center for Staten Island's Tompkinsville neighborhood, HHC, Staten Island Advance, 5/2/12

Simpler Consulting Partners with National Association of Public Hospitals and Health Systems (NAPH), HHC, Kings County, Pharmacy Choice, 5/1/12(Also covered in TMCnet.com and InvestorPoint.com)

Wheelchair Charities is a historical journey of caring and love, Coler-Goldwater, The New York Amsterdam News, May 3- May 9, 2012

Elmhurst Hospital Center Set to Celebrate, New York Daily News, 5/10/12 (Also covered in the Western Queens Gazette)

New Healthcare Pavilion Scheduled For Elmhurst, Elmhurst Hospital, Western Queens Gazette, 5/9/12