ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
OCTOBER 18, 2012 

MEDICATION SAFETY: A PATIENT'S STORY

As part of our continuing collaboration with union partners around patient safety, HHC, together with the Committee of Interns and Residents/ SEIUHealthcare and 1199 SEIU, have launched a patient safety video entitled "Medication Safety: A Patient's Story." The video was developed as one component of a medication safety education and teamwork project funded by grants from the Federal Mediation and Conciliation Service and the Committee on Interns and Residents Patient Care Trust Fund. A major focus of the project was on improving education on appropriate opioid use and effective pain management.

The video features Mrs. Helen Haskell, Founder and President of the advocacy group, Mothers Against Medical Errors. Mrs. Haskell courageously describes the medication error which led to the death of her son, Lewis Blackman, the devastating impact of that error on her and her family, and the lessons healthcare providers can learn from her son's story.

The powerful video can be viewed on our Corporate Patient Safety Gateway intranet site at http://patientsafety.nychhc.org and is now available to the public on YouTube.

HHC URGES PATIENTS, STAFF TO "COMMIT TO BE FIT" DURING TAKE CARE NEW YORK MONTH SCREENING EVENTS

As mentioned in my report last month, HHC's ninth annual Take Care New York (TCNY) public health screening events this year are challenging our patients and staff to curb obesity by eating healthier and creating fitness goals for themselves. To achieve this, our events are offering for the first time a triple assessment that includes measuring Body Mass Index (BMI), blood pressure and cardiovascular fitness. Clinicians administering these tests are offering an exercise prescription tailored to the individual, tips for healthier eating, and a pedometer to encourage participants to be more active. So far, we have conducted 64 screening events across the city, with many more planned throughout the month. Several hundred people having taken the "Commit to be Fit" challenge and many others have been screened for diabetes, HIV, depression and other serious conditions, or have received a flu shot at these events. In an effort to get the word out, our marketing staff have leveraged relationships with a number of local community media outlets and have been able to secure more than $75,000 worth of pro bono print and radio public service announcements to promote our TCNY events.

METROPLUS CERTIFIED FOR MANAGED LONG TERM CARE

MetroPlus received their New York State contract to begin enrollment in a partial capitation Managed Long Term Care Plan, beginning November 1st. Partial Capitation MLTC's are the type of plan into which New York State will be requiring mandatory enrollment for individuals that are receiving Medicaid fee-for-service long term care. New York State has started to send letters to long term care recipients and will begin assigning members to plans beginning November 1st. In order to have a fully comprehensive long term care program, MetroPlus is now completing an application for a Medicaid Advantage Plus license. A MAP-plus plan is comprehensive medical and long term care coverage for dual eligible individuals in a managed care program.

STATE HEALTH DEPARTMENT AWARDS NEW RATES TO HHC FOR CARE COORDINATION OF HEALTH HOME PATIENTS

The NY state health department has increased Health Home per member per month (PMPM) rates by creating a "high-risk" add-on, and adjusting upward the weights for individuals with serious mental illness/serious emotional disturbance (SMI/SED) and two or more chronic conditions. Overall, the average Health Home rate increased by 40.7%, but rates for patients with SMI/SED increased even more significantly. For example, a patient with two chronic conditions and an SMI/SED had an original average rate of $196.49; the new rate for this patient is now $421.47, an increase of 114%. The Office of Ambulatory Care Transformation is now preparing to ramp up our Health Home activities based on these new rates.

PRESENTATION TO CITIZENS BUDGET COMMISSION

Yesterday morning I was the featured speaker at the Citizens Budget Commission breakfast, where I spoke at some length about HHC's progress over the last 10 years and the factors that will affect HHC's future. The CBC is an 80-year-old, non-partisan, nonprofit civic association whose mission is "to achieve constructive change in the finances and services of New York City and New York State government." You will recall that in April of this year, the CBC published a report called "A Troubling Prognosis for HHC's Finances." I was glad to have the opportunity to present a more complete picture of HHC's financial picture, successes and challenges to CBC's trustees and invited guests.

In the presentation I laid out HHC's essential role in New York City's healthcare infrastructure. I discussed our intensifying challenges, including the deep reductions in Medicaid reimbursement and the rising numbers of uninsured patients; and described our successes in cost-containment and increased efficiency. I also focused on how we have strategically positioned our system for healthcare reform through our emphasis on robust primary and preventive care and more effective chronic disease management; our consolidation and restructuring of our affiliation relationships to better partner with a more unified physician leadership around reform-related initiatives; and our building of a stratified care coordination/management infrastructure especially for our patients with more complex conditions.

The authors of the earlier CBC report, Charles Brescher of the CBC, and Matthew Sollars, now press secretary at the Campaign Finance Board, were among the many attendees. The CBC has posted a video of my presentation, as well as the question and answer session, on their website, www.cbcny.org.

DEVIATION FROM POLICY TO SUPPORT CANCER SERVICES FOR HHC'S WORLD TRADE CENTER ENVIRONMENTAL HEALTH CENTER

On September 12th, the federal department of Health and Human Services published a final rule in the Federal Register adding certain types of cancer to the list of WTC-Related health conditions, with an effective date of October 12th -- providing just 30 days for HHC's World Trade Center Environmental Health Center to implement this significant change. The change requires allowing patients to have choice of where they get care, either within the HHC system or elsewhere, but the Center will have responsibility to oversee care, including claims authorizations, no matter where that care is rendered.

With the counsel of Finance, Legal and Intergovernmental Relations, it was determined that contracting with HealthSmart, the third party administrator currently providing such oversight for Mt. Sinai Hospital's Responder Program, would be the least costly and most efficacious approach to meet this federally mandated timeline within 30 days. Therefore I granted a deviation from our procurement policy to execute and implement this contract on the grounds of urgency. It should be noted that because the federal government (NIOSH) has mandated the need for these services, HHC will be fully reimbursed for any contract-related expenses, and we can terminate the contract if the funding ends.

NEW COMPUTERIZED SCHEDULING SYSTEM LIVE AT CONEY ISLAND HOSPITAL

The long planned system-wide upgrade of HHC's computerized scheduling system achieved a noteworthy milestone when Coney Island Hospital and its associated remote facilities became the first HHC facility to be successfully migrated from UNITY Scheduling to Soarian Scheduling on September 24th. Over 42,000 appointments were transferred from UNITY to complete the conversion. Approximately 250 Coney Island Hospital staff members are now scheduling appointments in Soarian Scheduling. Soarian's open scheduling design enables Coney Island Hospital to improve patient access by removing many of the scheduling restrictions previously built into UNITY, including the elimination of some of the manual operational practices Coney Island Hospital was previously performing. As other HHC facilities go live with Soarian, each facility will have the ability to view patient appointments across the enterprise, avoiding scheduling conflicts for the patient. Soarian's enterprise design also gives HHC the ability to explore and establish efficient enterprise-wide or regional call centers, which could not be easily accomplished with the previous scheduling system. Conversion to the new scheduling system throughout HHC is expected to be completed by April 2013.

HHC PARTNERS WITH CMS TO HOST MEDICARE 101 WORKSHOPS

From late September through the middle of November, HHC and the Centers for Medicare and Medicaid Services (CMS) are hosting free public workshops at HHC hospitals and large health centers throughout the city to help senior citizens, other beneficiaries and their caregivers apply for Medicare and get the most out of their benefits. The workshops also cover updates brought about by the Affordable Care Act. Health Insurance Specialists from CMS are conducting 13 Medicare learning sessions in Manhattan, the Bronx, Brooklyn and Queens before and during open enrollment from October 15 to December 7. As well as educating our patients and their families, the workshops provide valuable information for HHC employees who give guidance to patients who are or soon will become Medicare beneficiaries.

COMMUNITY ADVISORY BOARDS AT HHC HOSPITALS SUPPORT VOTER REGISTRATION IN THEIR COMMUNITIES

HHC is collaborating with the NYC Campaign Finance Board and American Hospital Association to promote the importance of getting registered and voting in the upcoming election. This collaboration, in which the Community Advisory Boards from every HHC facility took the lead, involved Auxiliary Board members and Departments of Volunteers at the facilities. More than 75 individuals were stationed at tables in public locations throughout the month of September and until October 12th, the last day to register for the upcoming election, helping patients and employees to register. In all there were more than 1,000 forms distributed in various languages and more than 700 registration forms were collected and mailed to the Board of Elections.

OUTSTANDING HHC NURSES RECOGNIZED AT FIRST ANNUAL
EXCELLENCE AWARDS

This Tuesday HHC honored six nurses and a nursing team with its first-ever Nursing Excellence Awards for their leadership, skill and compassion in areas including improving patient outcomes, teamwork and community service. First-time mothers, frail newborns, heart failure patients and people in need in the community all benefitted from the talent and generosity of these exceptional nurse professionals. They come from among more than 8,000 men and women who provide care daily in HHC public hospitals, nursing homes and primary care centers.

Also recognized were three HHC hospitals that have been designated as Nurses Improving Care for Healthsystem Elders (NICHE) facilities, senior-friendly hospitals designed to meet the special needs of hospitalized elder adults. HHC's Harlem Hospital Center, North Central Bronx Hospital and Queens Hospital Center were designated as NICHE hospitals in May. More than 100 nurses and healthcare professionals at these three institutions have already begun to adopt age-sensitive, patient-centered best practices in elder care to help improve the health status of New Yorkers age 65 year and older.

I know that the board joins me in congratulating these outstanding nurses and thanking them for the passion and commitment they bring every day to care for our patients and their families

FITCH AFFIRMS HHC BONDS AT 'A+' OUTLOOK STABLE

Fitch Ratings last week affirmed its 'A+' rating on approximately $1 billion of debt issued by HHC and said the Rating Outlook was stable. This rating by a global leader in finance is another third-party confirmation that our operation is effective and efficient. The rating is linked to HHC's strong support from New York City and HHC's essential role as the primary safety net provider to the City's Medicaid and indigent population. We remain grateful to the City for their ongoing support.

CONTRACT RENEWAL FOR BREAKTHROUGH PERFORMANCE
IMPROVEMENT CONSULTANTS

On your agenda is a resolution to renew the contract with Simpler Consulting for one year for no more than approximately $5.5 million, to provide consulting services in support of our implementation of the Lean performance improvement methodology, known at HHC as Breakthrough. Through the Breakthrough method, HHC has, during the past five years, achieved nearly $251 million in new revenues and more than $20 million in cost savings, for a total financial benefit of $271 million to the corporation.

Approximately 18% of our employees and affiliate staff have participated in Breakthrough trainings and events. It is their ideas and ingenuity that Breakthrough events unleash to help us make our operations more efficient. We remain committed to expanding our staff awareness and participation in the program to create and sustain a culture of continuous improvement throughout HHC, and to continue the streamlining of our operations that is contributing to closing our still challenging budget gap.

We will confirm our continued commitment to this process by exercising our optional renewal of the contract with Simpler and I urge your support.

HHC IN THE NEWS HIGHLIGHTS

Broadcast

Here and Now, Dr. Robert Gore, Kings County Hospital, WABC-TV, 10/14/12 Kings County Hospital's Diabetes Resource Center, WNYE-TV, 9/22/12

Swizz Beatz discusses his role as Global Ambassador for HHC, CBS-TV: The Couch WLNY, 9/26/12

Swizz Beatz Gives Inspirational Speech at Harlem Hospital, Vladtv.com, 9/27/12

The Opening of the new Mural Pavillion, Denise Soares, Harlem Hospital, NY1, 9/27/12

More News

Harlem Hospital celebrates opening of Mural Pavilion, Harlem Hospital, New York Daily News, 9/28/12 (Also covered in NY Amsterdam News, DNA.info.com, Crain's New York Business, and Crain's Health Pulse)

Swizz Beatz Becomes Ambassador for NYC Public Hospitals, Vibe, 10/09/12 (Also covered in NY Amsterdam News, The Versed, Look to the Stars, The Source, Complex Source, HipHop Blog, Express.co.uk, RealTalkNY.com, HipHopNMore.com, HipHopMula,com, and InFlexWeTrust.com)

Honoring the Man Who Helped Save Dr. Martin Luther King Jr.'s Life, Dr. John Cordice, Harlem Hospital, WNYC, 9/27/12

Major construction complete on $325 million Harlem Hospital Pavilion, Modern Healthcare, 10/06/12

NYC's Top Pediatricians & Pediatric Specialist, Dr. Sarla Inamdar, Metropolitan Hospital, Dr. Jennifer Havens, Bellevue Hospital, New York Family Magazine, 10/02/12

Nourishing change - Hospitals stress healthy food in new partnership, Antonio Martin, HHC, Modern Healthcare, 10/06/12

Medicare Workshops, Alan Aviles, HHC, El Diario, 10/11/12

NYC Mayor asks local facilities to push breast-feeding for better health, Judith Daniels, RNC, Associate Director of Nursing, Harlem Hospital, Nursing Spectrum, 9/24/12

Lincoln's program to fit child obesity, promote healthy eating, Dr. Swati Dave-Sharma, Pediatric Endocrinologist, Lincoln Hospital, The Bronx Free Press, 9/26/12

Your health agenda, HHC, Take Care New York, El Diario, 10/1/12

Local Health Agenda, Take Care NY, HHC, El Diario, 10/15/12

HHC Voter Campaign, Crain's Health Pulse, 10/1/12

Bloomy's Latest 'Nanny State' Crackdown will Curb Junk Food in Hospitals, Harlem, Kings County, New York Daily News, 9/24/12

For People Exposed to World Trade Center Site, Lung Function Improves with Time, Dr. Joan Reibman, Bellevue Hospital WTC Environmental Health Center, Science Daily, 10/2/12

Loser of Bid to Overhaul Hospital Logs Files a Claim, Alan Aviles, HHC, The New York Times, 10/9/12

Take Care NY: Commit To Be Fit, Iris Jimenez Hernandez, Lincoln, Morrisania, Belvis, The Bronx Free Press, 10/03/12

Fitch Affirms New York City Health and Hospitals Corp, NY Rev Bonds at 'A+'; Outlook Stable, CNBC.com, 10/10/12 (Also covered in TMCnet.com, Heraldonline.com, and Crain's Health Pulse)

Queens Library Helps Patrons Beat Cancer, Queens Hospital, LibraryJournal.com, 10/11/12

NYDHA inaugural class aims at EHR improvement, HHC, EHRIntelligence.com, 10/15/12 (Also covered in Crain's Health Pulse)