ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
JULY 26, 2012

SEA VIEW RECEIVES HIGH PRAISE IN JOINT COMMISSION SURVEY

On July 12th, The Joint Commission completed its triennial accreditation survey of Sea View Hospital Rehabilitation Center and Home. The long term care surveyor praised the processes in place, and was very complimentary of Sea View's leadership, as well as medical, nursing and front line staff. The Leadership Interview Session, which was attended by HHC Board Member Dr. Vincent Calamia, included a discussion on the "Stages of Maturity in Health Care Organizations' Path to High Reliability."

The surveyor was particularly complimentary of two Sea View programs: the "Stop and Watch" program, which trains staff to identify and report changes in a resident's condition; and the Failure Modes Effects Analysis (FMEA) and action plan on reduction of urinary tract infections. The surveyor was impressed with organization's recognition by the Centers for Medicare and Medicaid Services for its stellar performance and #1 ranking on the Nursing Home Value-based Purchasing Demonstration Project on Avoidable Hospitalizations. The CMS ranking is based on staffing, quality measures, avoidable hospitalizations and multiple years of successful regulatory survey results.

Congratulations to Senior Vice President Arthur Wagner, Executive Director Angelo Mascia, Administrator Violet Huie, Medical Director Dr. Maria Pablo, Chief Nurse Carole Morgan and the staff of Sea View for their outstanding survey performance.

The conclusion of Sea View's survey completes The Joint Commission's 2012 multi-facility survey of HHC. In 2013, Elmhurst, Jacobi, Metropolitan, Gouverneur, and Dr. Susan Smith McKinney are scheduled to be surveyed.

PATIENT SAFETY FORUM ON THE UNDERSTANDING
OF HUMAN FACTORS

A Patient Safety Forum entitled "Advancing Patient Safety through the Understanding of Human Factors" was held on at Lincoln Medical and Mental Health Center on July 9th. It was attended by approximately 200 people from across HHC facilities.

The keynote presentation was provided by Kerm Henriksen, Ph.D., Human Factors Advisor for Patient Safety, Center for Quality Improvement and Patient Safety at the Agency for Healthcare Research and Quality (AHRQ). His presentation focused on how patient and provider capabilities can affect the design of interactive healthcare systems to ensure safety, effectiveness, and ease of delivering care.

The second speaker, Aileen Killen, RN, PhD, Director, Patient Safety Program, Memorial Sloan Kettering Cancer Center, spoke on "Human Factors in the Clinical Setting". She shared her experiences when designing an Operating Room, looking at handoffs, and the value of clinical reminders. Her emphasis was to design work areas to fit the people and not getting people to fit design.

The final speaker was David L. Feldman, MD, Chief Medical Officer and Senior Vice-President, Hospitals Insurance Company/FOJP, who presented "Human Factors as a Risk Reduction Strategy: Creating a Culture of Safety in Peri-operative Services and Beyond." The focus of his presentation was on creating reliable teams, by improving communication, mutual support/respect and leadership skills and encouraging implementation of a Just Culture to encourage open/honest reporting of errors.

LEADERSHIP DEVELOPMENT PROGRAM LAUNCHES
ITS FIRST SESSION

On July 10th the first session of the corporate-wide Leadership Development program was held at Draper Hall with 121 middle managers and 32 senior staff, serving as coaches, in attendance. The session was the first of five full day workshops to be conducted by the Advisory Board Company. The session focused on characteristics of different leadership styles, examined a case study of how change was led at Newton-Wellesley Hospital, and guided the participants through a self-assessment to develop a Personal Leadership Profile.

Between workshops, coaches will work with each manager to refine their Leadership Profile, guided by scheduled calls with the Advisory Board instructor. In addition to the program workshops, participants, coaches and executive sponsors will receive access to the Harvard Manage Mentor+, an online resource with additional computer-based learning modules.

The remaining workshops will focus on different aspects of leadership including: instilling accountability; facilitating effective teamwork; critical thinking and problem solving; and impact through influence. The initial session was extremely well received.

A second cohort of up to 125 participants is scheduled to begin a similar leadership development program in Spring 2013.

LINCOLN HOSPITAL RECEIVES QUEST FOR QUALITY AWARD
AT JULY 19 LEADERSHIP SUMMIT OF AMERICAN
HOSPITAL ASSOCIATION

Lincoln Medical and Mental Health Center received the prestigious Quest for Quality award from the American Hospital Association (AHA) for its leadership and innovation in quality improvement and safety at the organization's annual AHA Health Forum Summit this month in San Francisco. Lincoln won the prize by demonstrating its commitment to providing patient-centered care focused on ground-breaking methods that improve safety and quality. The award is presented annually to honor leadership and innovation based on the Institute of Medicine's (IOM's) six quality aims -- safety, patient-centeredness, effectiveness, efficiency, timeliness and equity. Lincoln is one of four hospitals selected this year from a nation-wide pool of hospitals competing for the prize. Dr. Melissa Schori, Lincoln's Chief Medical Officer, accepted the finalist award.

Lincoln is the second HHC hospital to receive this recognition from the AHA. HHC's Queens Hospital Center was awarded the Quest for Quality Citation of Merit in 2010.

HIV DIRECTOR AT HHC WINS TOP NATIONAL QUALITY AWARD FOR LEADERSHIP IN QUALITY

Terry Hamilton, HHC's Director of HIV Services received the National Quality Center and Health Resources Services Administration (HRSA) HIV/AIDS Bureau Award for Leadership in Quality. This national award recognizes work that Ms. Hamilton has done since 2005 as part of the HHC corporate-wide HIV Quality Improvement Learning Network. That work has also been critical in informing the development of our enterprise Health Home care management program. Under her leadership, quality management has been a primary concern in HIV services, and the quality of care has continued to improve measurably as a result. One example is the average retention rates, which have increased from 79% in 1999 to 91% in 2010.

Terry Hamilton has a 22-year record as a leader in the development of quality improvement models of HIV care. During her tenure at HHC, she has spearheaded several programs, including the 2006 HIV Testing Expansion Initiative focused on making HIV testing part of routine care and decreasing the stigma associated with it. The program has had the three-fold goal of increasing the number of patients who know their HIV status, the proportion of patients who enter care early, and the proportion of patients retained in care. On World AIDS Day 2011, HHC was recognized by the Centers for Disease Control for testing more than 1 million patients. Ms. Hamilton has also led the four-year effort to develop HIV clinical documentation screens within the HHC electronic medical record, providing effective tools for easier monitoring and reporting.

The National Quality Center, which works with agencies funded through the federal Ryan White CARE act, is the premiere quality improvement resource in HIV care. The organization strives to improve the quality of care by recognizing leadership in the development of state-of-the art HIV-related quality improvement services in HIV.

I know the Board joins me in congratulating Terry Hamilton on this outstanding award and the additional prestige that it brings to HHC's extraordinary HIV services.

HHC HOSPITALS CONTINUE TO EXPAND ACCESS TO HEALTHY FOOD WITH MORE FARMERS MARKETS

HHC welcomes back farmers markets at several public hospital campuses this summer, making healthy food available in communities where residents don't always have access to fresh fruits and vegetables at reasonable prices.

Farmers markets are open now through November, with one market at Queens Hospital Center open year-round. Farmers markets are also hosted by Metropolitan, Jacobi, North Central Bronx, Lincoln, Coney Island and Elmhurst hospitals.

HHC is part of a recently formed city-wide anti-obesity task force made up of 10 city agencies. The task force was established to develop strategies and initiatives to help New Yorkers stay healthy and fight the rising obesity epidemic. HHC has for several years had healthy eating and weight loss programs throughout its facilities to help New Yorkers of all ages boost their health and physical fitness.

The farmers markets are hosted in partnership with Harvest Home and Greenmarket. Shoppers can pay for their fresh fruits and leafy greens using EBT cards (food stamps), Health Bucks, Green Checks, Senior Farmers Market Nutrition Program (FMNP) coupons and Women, Infants and Children (WIC) coupons.

ELMHURST OPENS OBSERVATION UNIT TO IMPROVE EMERGENCY CARE, REDUCE INPATIENT ADMISSIONS

This week Elmhurst Hospital opened a new chest pain unit. The 3,550 square foot unit has 13 beds and will be used to observe many of the nearly 5,000 patients each year who come to the emergency department at Elmhurst with chest pain. The new unit is a calm environment where patients can be safely observed for up to 23 hours and receive a complete battery of tests within the ED. While in the unit, these patients will receive prompt evaluation and expedited care at the bedside. When appropriate, medical staff can release patients or refer them for community-based services, if they do not need to be admitted. More observation time and more complete testing of patients before admission will assist in making accurate initial diagnoses and reduce preventable readmissions. The $1 million unit was financed by Council Member Daniel Dromm and the Queens delegation of the New York City Council. Elmhurst is opening the unit as part of a strategy to expand services and reduce wait times for patients who come to the hospital for emergency services.

CARE PLAN MANAGEMENT SYSTEM IMPLEMENTATION BEGINS

This month, after the Board's approval at the May meeting, a contract between HHC and Microsoft Corporation was executed for the development and implementation of a Care Plan Management System. The contract includes software licenses, a patient health record and support and maintenance. The system will support care coordination services for HHC patients and ensure that HHC meets NYS Health Home certification requirements and Patient-Centered Medical Home (PCMH) standards for collaborative care planning. The system is a web-based, inter-operable tool that aids both patients and their extended care teams in managing and coordinating the medical and non-medical services and resources patients may require. The term of the contract with Microsoft is for five years, and is renewable for two additional one year terms. The software license is perpetual and the annual maintenance and support agreements are auto-renewable. The total cost of the contract over the seven-year period is capped and will not exceed $16,100,000. The contract was successfully developed with the collaboration of the HHC offices of Information Technology, Ambulatory Care Transformation and Legal Affairs.

HHC HOSPITALS APPLY FOR STATE HEALTH DEPARTMENT HOSPITAL-MEDICAL HOME DEMONSTRATION PROJECT

This month HHC submitted applications for the New York State Department of Health Hospital-Medical Home (H-MH) Demonstration Program on behalf of our 11 hospitals. The H-MH Demonstration Program will make up to $250 million available over the next three years to NYS teaching hospitals to support transition of their outpatient training sites to Patient-Centered Medical Homes (PCMHs). If successful, HHC is estimated to receive approximately $28 million of the $102 million to be disbursed in the first year of the demonstration, based on a formula derived from Medicaid volume and number of primary care residents receiving training at our facilities. Award notifications are expected sometime in August and successful applicants will then be required to submit a work-plan describing selected resident training continuity of care enhancements, care integration initiatives, and inpatient safety projects. Continued funding will be dependent upon meeting certain performance milestones, including achieving Level 2 or 3 NCQA PCMH re-certification by December 2013.

HEALTH HOME SOFT LAUNCH IN BRONX AND BROOKLYN

As announced last month, the Health Home "soft launch" was initiated this week in the boroughs of Brooklyn and The Bronx with activities for both patients and staff. Announcement letters describing the new program and its services and providing instructions on how individuals should proceed with enrollment were sent out to the initial cohort of 200 eligible patients. The toll-free "Warm-Line" was activated and is ready to provide information about the Health Home Program to callers. Also, a second phase of training focusing on outreach, patient enrollment and care coordination processes was conducted for approximately 20 staff members from Woodhull, Kings and Lincoln hospitals. Six workers are ready to conduct outreach to the first group of patients eligible for enrollment.

HHC TO ACHIEVE HIGH QUALITY, EXPANDED ACCESSIBLITY
AND SAVINGS THROUGH CONTRACT WITH PROVIDER
FOR DIALYSIS SERVICES

This contract has been structured to ensure that dialysis services continue to be convenient to our patients, meet high quality standards and help us achieve over $150 million in savings over nine years. Additionally, the contract will allow us to expand our capacity to provide these much-needed services by 35% over the next three years. All this will be achieved without any layoff of employees currently involved in this service.

As I have said in the past, HHC continues to stand behind its mission of ensuring access to all the uninsured, including undocumented immigrants, and our contract with the dialysis operator will reflect that. We have more than six years of experience with this dialysis operator at Elmhurst Hospital and the quality of services has been excellent and no patient has ever been turned away.

As the Board knows, HHC continues to struggle with a structural deficit of several hundred million dollars annually. It is very challenging to close that formidable gap without compromising our mission or reducing our capacity to provide essential services. These agreements will contribute significantly to our gap-closing imperative while maintaining high quality dialysis care, and will actually increase access to these services. I urge the Board's support.

NEW EXECUTIVE DIRECTOR APPOINTED FOR KINGS COUNTY HOSPITAL CENTER

After conducting an extensive search, we have appointed Ernest Baptiste as the Executive Director of Kings County Hospital Center, effective August 20th.

Let me take this opportunity to thank Roslyn Weinstein for her crucial leadership as the acting Executive Director of Kings County Hospital since October 2011. Kings County is one of our largest and most complex hospitals, with one of our busiest emergency departments. With Roslyn, we were fortunate to have a senior executive with extensive operational knowledge, financial acumen, a collaborative leadership style and a deep commitment to our mission. With her steady hand as interim Executive Director, Kings County was able to maintain its excellent standard of care and complete a very successful Joint Commission accreditation survey. I know that Roslyn will be equally indispensable in assisting with a smooth transition as Mr. Baptiste takes the reins as Executive Director.

Ernest Baptiste brings with him more than twenty years of experience as a healthcare executive. Mr. Baptiste served during the last four years as the Executive Vice President and Chief Operating Officer of St. Francis Hospital in Wilmington, Delaware. He was also Chief Operating Officer of Duke University Medical Center in Durham North Carolina. Raised in Brooklyn, Mr. Baptiste also has significant local healthcare experience. He was a Vice President at St. Mary's Hospital in Brooklyn, served in various managerial roles at North General Hospital for over twelve years, and worked as a manager at Mount Sinai Hospital and Coney Island Hospital.

I am confident that Mr. Baptiste's extensive hospital administrative experience, his deep understanding of New York City healthcare landscape, and his familiarity and love of Brooklyn afford him a strong foundation for leadership at Kings County Hospital Center.

I know you join me in welcoming him and offering him our full support.

ANNIVERSARY OF MEDICARE AND MEDICAID ENACTMENT

Next Monday, July 30th, marks the 47-year anniversary of President Johnson's enactment of Medicare and Medicaid, health insurance programs created through the Social Security Amendments of 1965. As you know, Medicare was created as a program to cover many healthcare costs for the elderly, a rapidly growing population with increasing healthcare needs and limited income. At the same time, Congress created the Medicaid program to provide coverage for other low-income people, including families with children, the blind and the disabled. Prior to the passage of this law, healthcare services for the indigent were provided primarily through a patchwork of programs sponsored by state and local governments, charities, and community hospitals.

The 1965 creation of Medicare and Medicaid followed many years of legislative debate on the efficacy of a federal program to assist with coverage of healthcare costs. President Lyndon Johnson decided to sign the bill with former President Truman at the Truman Presidential Library in Independence, Missouri, in recognition of Truman's efforts 20 years earlier to establish a national health insurance program.

CITY RESTORES FUNDING FOR HHC PROGRAMS IN NEXT
FISCAL YEAR BUDGET

In the City Budget that was passed at the end of June, the City Council restored more than $14.5 million in Expense funding and appropriated $21 million in Capital funding to HHC. I would like to thank the Council for their generous support and also thank those public health, union and Community Advisory Board advocates who weighed in on HHC's behalf with the Council.

On the Expense side, the Council provided the following funding:

• $6 million - HHC's Unrestricted City Subsidy
• $5 million - Child Health Clinics
• $2 million - Expanded HIV Testing
• $1.46 million - Developmental Evaluation Clinics
• $50,000 - Substance Abuse training funds

On the Capital side, the Council allocated the following:

• $7 million in FY 13 and FY 14 toward the construction of a D&TC at 155 Vanderbilt Avenue on Staten Island;
• $2.5 million for Metropolitan to renovate their Cancer Center and to purchase a new ultrasound system;
• $2.25 million for Coney Island Hospital to purchase new cardiac monitors for the ED, new pneumatic tubes for the ED as well as a new communication system;
• $2.06 million for Kings County to purchase a new MRI;
• $1.275 million to purchase a new CT Scanner and contribute to a new digital radiography unit;
• $1.07 million for Harlem Hospital to renovate their post-partum unit and purchase new ultrasound equipment;
• $850,000 for Bellevue to purchase new OB ultrasound equipment and new cardiac echo machines;
• $750,000 for Queens Hospital to purchase new anesthesia machines and a CT simulator;
• $600,000 for Elmhurst Hospital to make renovations to the adult ED and contribute to a new CT scanner;
• $550,000 for Cumberland D&TC to renovate their pediatric clinic and to purchase a new digital mammography machine;
• $500,000 for Gouverneur to purchase medical equipment;
• $500,000 for new medical equipment at Lincoln;
• $345,000 to renovate the dental suite at Morrisania D&TC; and
• $120,000 to create a pharmacy at Sydenham.

HHC IN THE NEWS HIGHLIGHTS

Broadcast

Experts Offer Tips for Healthier Ramadan, Dr. Nehad Shabarek, Lincoln, Sonali Upadhyaya, RD, Elmhurst Hospital, NY1, 7/18/12

Elmhurst Hospital Opens New Chest Pain Unit, NY1, 7/23/12

Young girl donates handmade pillows to patients, Jacobi Hospital, News 12 Bronx, 7/23/12

Veda Vasquez struggles toward recovery, Dr. Narajan Sundaresan, Lincoln Hospital, WNBC, 7/13/12

Tips on beating the heat, Dr. Robert Chin, Woodhull, News 12 Brooklyn, 7/6/12

Metropolitan Farmer's Market Opens In East Harlem, NY1, 7/6/12

Hospital Farmer's Market Opens in East Harlem, Metropolitan Hospital, WFUV Radio, 7/6/12

Jacobi's Everlasting Bereavement Garden, Jacobi Hospital, News 12 Bronx, 6/29/12

TV and Print

Supreme Court Upholds Healthcare law

NYC Political Reaction to Health Care Decision Mixed, Alan Aviles, HHC, NY1, 6/28/12 (Also covered by Inside City Hall NY1, CNN, 1010 WINS, WNYC)

New Yorkers divided over 'Obamacare' ruling, Alan Aviles, HHC, Crain's New York Business, 6/29/12

NYC public hospitals see big financial hit from healthcare law, Alan Aviles, HHC, Reuters, 6/29/12

More News

After Affordable Care Act Upheld, Artists Pledge Loyalty to Community Healthcare Programs, Woodhull, Lincoln, New York Observer, 7/6/12

Affordable Care Act: What it means for immigrants, Alan Aviles, HHC, Elmhurst, Queens, The Queens Courier, 7/11/12

Hospital Farmer's Market Opens in East Harlem, Metropolitan Hospital, WNYC, 7/6/12 (Also covered in Crain's Health Pulse)

Best Hospitals in New York, Jacobi, Woodhull, U.S. News & World Report, 7/17/12

Top Spots of Healing: U.S. News rankings for medical centers, Jacobi, Woodhull, New York Daily News, 7/17/12

Metropolitan Hospital Center opens new pediatric inpatient unit, Metropolitan, Nurse.com, 7/2/12

Tales of Pain and Healing, From a Physician Who Knows Both, Dr. Eric Manheimer, Bellevue, 7/13/12 (Also covered in The Wall Street Journal, NY Daily and Huffington Post)

Lincoln Art Exchange: Preventative Healthcare For Artists, Lincoln Hospital, Harlem News, June 28-July 4, 2012

Room emergency: Obese patients weigh on hospital budget, HHC, New York Post, 7/9/12 (Also covered in Sheepshead Bites)

Harvest Home Metropolitan Farmers Market Returns, Metropolitan, Hospital Newspaper, 7/20/12

Calculating different EHR incentive payments, HHC, EHR Intelligence, 7/12/12

Stimulus Dollars Flow to HHC, Crain's Health Pulse, 7/9/12

HIV Testing: It's Best to Know, Dr. Akinola Fisher, Lincoln Hospital , The Bronx Free Press, 7/17/12

Agenda local de salud, Your Local Health Agenda, Elmhurst, Metropolitan and Coney Island, El Diario, 7/16/12

Can't pay that hospital bill? Paint a picture! Dance a jig!, Lincoln Hospital , LA Times/ AP Video, 6/28/12 (Also covered in The Globe and Mail)

Keeping Up with 21st Century Medical Care, Morrisania Diagnostic and Treatment Center, The Bronx Free Press, 6/20/12

Tales of two Bronx students who had to overcome great obstacles to achieve education goals, Jacobi Hospital, New York Daily News, 7/1/12

Harlem Hospital Center celebrates staff, names honorary nurse, Harlem Hospital, Nurse.com, 7/2/12

HHC Goes for ACO Status, Crain's Health Pulse, 7/2/12

HHC Gets $9M State Grant to Upgrade Services in Clinics, The Chief, 7/2/12

At A Glance: Lincoln Logs Quality, Lincoln Hospital, Crain's Health Pulse, 7/23/12

iPods for seniors: viral hit "Alive Inside" still needs your help on Kickstarter, HHC, Venturebeat.com, 7/23/12

Tu agenda: New chest pain unit at Elmhurst Hospital, Elmhurst Hospital, El Diario, 7/25/12

Protecting Your Skin and Eyes from UV Rays, Iris Jimenez-Hernandez, Lincoln, The Bronx Free Press, 7/18/12

NYC may collect extra $950 mln in property tax revenue, HHC, Reuters, 7/24/12

CCNY Radio Station Health Initiative Garners Accolades, Harlem Hospital, The City College of New York, 7/5/12