ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
DECEMBER 20, 2012
HHC LEADERSHIP PRESENTS
HHC THROUGH THE STORM: RISING TO THE OCCASION
Earlier this month, HHC leadership released HHC Through the Storm: Rising to the Occasion, a selection of staff stories that exemplify the commitment and courage of our employees across the system before, during, and after Hurricane Sandy.
Prepared by the Office of Special Projects, Rising to the Occasion features 20 individual and collective profiles of HHC’s men and women who put their personal concerns aside in order to focus on patient care, supported their colleagues through unprecedented circumstances, and braved the elements to protect their facilities during the hurricane.
Rising to the Occasion demonstrates what we, as HHC, accomplished during the hurricane -- it celebrates and recognizes the hard work of employees across the system. I invite you to read the stories of our heroic employees by visiting throughthestorm.nychhc.org.
HURRICANE RECOVERY AND RESTORATION PROCEEDS THROUGHOUT HHC
Recovery and restoration work continues to progress along the same timelines that were previously projected. We still anticipate that inpatient services will be restored at Coney Island Hospital in January and at Bellevue Hospital by February.
Recently limited emergency services became available in the Emergency Department at Bellevue, a significant milestone in Bellevue’s ongoing restoration since Hurricane Sandy disabled much of the equipment needed for the facility to function at full capacity. Bellevue also continues to increase outpatient services, with more than 30 outpatient clinics currently available. At Coney Island Hospital, walk-in urgent care services are available 24 hours a day, 7 days a week, and the hospital continues to regularly add to its roster of restored outpatient services. This week Coney Island Hospital also reopened 32 beds in its psychiatric inpatient unit, the first step toward restoration of full inpatient services. Neither hospital is receiving ambulances, although private ambulance services are on-site 24-hours-a-day to transport patients arriving for urgent care services to other hospitals if needed.
Earlier this week we made an initial submission to FEMA of more than $150 million in project worksheets related to emergent repairs and anticipate, based on statements of the FEMA Administrator Craig Fugate when he visited Bellevue and Coney Island last week, that FEMA will make a substantial advance payment to HHC for the repair work reflected in this first set of worksheets relatively quickly.
HHC RECEIVES $168,000 GRANT FROM AMERICARES
FOR MOBILE CLINIC IN CONEY ISLAND
The nonprofit global health and disaster relief organization AmeriCares has given HHC $168,000 to purchase a mobile clinic that will serve as a temporary location for the Ida G. Israel Community Health Center, which remains closed following Hurricane Sandy. The Ida Israel site, an outpatient health center at 2201 Neptune Avenue affiliated with Coney Island Hospital which served 10,000 patients annually, will not reopen at the same location. The removal of the clinic leaves a substantial hole in the community’s healthcare infrastructure and we are actively searching for a permanent replacement site in the same vicinity. The donation was announced by AmeriCares in a press release today. We anticipate delivery of the van by the end of next week and, following a preparation time of a day or two to install HHC IT infrastructure, the van will be placed into service.
On Friday, December 7, HHC hosted a tour of Bellevue for House Energy and Commerce Subcommittee on Health, Vice Chair Michael Burgess, MD. Dr. Burgess wanted to review the impact of Hurricane Sandy, what preparations had been made in advance, the evacuation process and need for assistance. He told those accompanying him on the trip that he would not have understood the magnitude of the damage and repairs if he had not seen it for himself. He said he was going to recommend to his Congressional Committee that they arrange a field trip for the other members of the Committee to come to NYC for a tour of Bellevue.
A week later, on December 14, both Bellevue and Coney Island hospitals hosted visits from FEMA Administrator Craig Fugate, who saw the severity of the damage and was very impressed with our efforts to restore essential services to our community as quickly as possible. He was encouraging in his assurances that reimbursement funding could include significant mitigation measures that would prevent similar damage in future disaster scenarios.
In Washington, the President's request for a Sandy Emergency Supplemental Appropriations bill for $60.4 billion was introduced in the Senate and debate began this week. At least seven republican votes will be required to reach the 60 votes needed to ensure passage. We will keep you up to date on these developments.
President Obama and House of Representatives Speaker Boehner are negotiating what is being dubbed a "grand bargain" to avoid the so called fiscal cliff on January 1, 2013. As mentioned at prior meetings, there are a number of important tax and fiscal provisions that lapse at the end of the year. They include: 1) the Bush era tax rates; 2) the current Medicare Physician reimbursement rate; 3) unemployment insurance benefits; and 4) the legislatively mandated sequestration of $1.2 trillion over 10 years in spending cuts divided equally between defense and domestic spending, with Medicaid exempt and Medicare held to a 2 percent provider cut.
For HHC, there are a number of areas under consideration for reductions that would cause a budgetary impact. Prime targets are: 1) reductions in the permissible state provider taxes which would adversely affect HHC if the New York State Medicaid program could not use provider taxes as a source of funding; 2) reductions in Medicare Indirect Medical Education (IME) and Graduate Medical Education (GME) funding, which currently provides HHC with a combined $182 million a year from these programs or about 18 percent of our total Medicare revenue; 3) reductions in the hospital outpatient Medicare reimbursement rates for evaluation and management services, which could mean losses to HHC over 10 years of $187 million.
Any grand bargain may include total dollar figures for cuts in health care with instructions to committees of jurisdiction to decide next year where the cuts will be made. Speaker Boehner, in a notable switch in strategy regarding the fiscal cliff, yesterday introduced a new bill in the house that would find spending cuts and extend the Bush era tax cuts for all Americans except those making over $1 million a year. The legislation includes a number of Medicaid related changes including extending the DSH cuts another year to 2022, lowering the allowable Provider Taxes from 6% to 5.5%, and repeal of the Affordable Care Act's "maintenance of effort" requirement, which specifies that states cannot tighten Medicaid eligibility standards until 2014, as well as significant reductions in food stamps and other safety net programs. This bill is slated to be voted on today in the House but has zero chance of passing the Senate.
ADDITIONAL ENROLLMENT OF PATIENTS
INTO HOME HEALTH PROGRAM APPROVED
The federal Center for Medicare and Medicaid Services (CMS) has approved the second phase of the Health Home program earlier this month, enabling Health Home enrollment activities to commence in the boroughs of Manhattan and Queens. Until a roster of eligible patients is provided by NYSDOH, Phase 2 hospitals will initiate activities by beginning to convert and enroll eligible patients from existing COBRA, CIDP and TCM programs.
Phase 1 hospitals in the Bronx and Brooklyn, have been conducting outreach activities and enrolling patients into the HHC Health Home Program since August 2012. To date, and in light of disruptions caused by Hurricane Sandy, HHC has enrolled only 386 Health Home patients. Some of these patients are among those that have been successfully transitioned from our legacy COBRA, CIDP and TCM case coordination programs and enrolled in the Health Home program. We anticipate that the pace of enrollment will pick up significantly in the months ahead.
BREAKTHROUGH AWARENESS OF ALL HHC STAFF TO BE ENHANCED BY
NEW COMPUTER-BASED TRAINING PROGRAM
This week, HHC announced Breakthrough Awareness training, available to all staff online, through PeopleSoft ELM (Enterprise Learning Management). This 90-minute course introduces staff to basic terms, concepts, skills, and practical applications. This new online program provides an opportunity for staff to initiate this important training at their own convenience and is another option for employees who are not able to participate in in-person Breakthrough Awareness Workshops.
The Breakthrough performance improvement methodology is HHC's chosen method for solving operational problems, eliminating waste from work processes, and making our programs, services and systems even better for patients and staff. Breakthrough tools and practices can be used by everyone, and can be applied to solve both small and large problems. They are being used right now to improve processes and outcomes in our emergency and operating rooms, outpatient services, pharmacies, nursing units, support services, and many other services.
Further information about the training is available on the Breakthrough Intranet site at breakthrough.nychhc.org.
QUEENS HOSPITAL CELEBRATES THE OPENING OF A NEW CPEP
On November 29th, Queens Hospital Center opened an expanded Comprehensive Psychiatric Emergency Program (CPEP), which at 8,500 square feet is almost double the size of the existing CPEP. The new setting allows for a more comprehensive treatment of all psychiatric emergencies, with a focus on guiding patients with acute psychiatric conditions to successful treatment and ultimate re-integration to the community setting.
Regular emergency departments are typically not optimally equipped to deal with psychiatric emergencies. The CPEP is designed to provide the best environment for the evaluation and treatment of psychiatric crises, including suicidal or aggressive behavior, depression, and psychosis. The program offers a discrete space that meets safety standards for psychiatric patients and provides 24 hour-a-day/7 day-a-week staffing by psychiatrists, nurses, social workers and other professionals.
The $9.3 million, 20-month CPEP expansion project was funded through a combination of New York State’s HEAL NY program and capital funds from HHC.
With the opening of the new, larger CPEP, the former 4,500 square foot CPEP unit will be converted to expand the hospital’s medical Emergency Department in a project to begin in 2013.
CONTRACT WITH PHYSICIAN AFFILIATE GROUP OF NEW YORK
On today's agenda for your consideration is a three-year agreement with the Physician Affiliate Group of New York, P.C. (PAGNY) for the provision of general care and behavioral health services at six of our hospitals and three of our diagnostic and treatment centers. The facilities included in the agreement are:
- Lincoln Medical and Mental Health Center
- Morrisania Diagnostic and Treatment Center
- Segundo Ruiz Belvis Diagnostic and Treatment Center
- Jacobi Medical Center
- North Central Bronx Hospital
- Harlem Hospital Center
- Renaissance Health Care Network Diagnostic and Treatment Center
- Metropolitan Hospital Center
- Coney Island Hospital
The proposed agreement is effective from July 1, 2012 to June 30, 2015, consistent with the general terms and conditions outlined in the resolution. The costs for the three-year period total $1.276 billion.
The agreement identifies a series of pay-for-performance metrics designed to align business goals and improve overall performance. They link physician behavior to the goals of patient satisfaction, accurate documentation, a fully effectuated patient-centered medical home model, improved quality and greater efficiency.
The agreement also strengthens the Joint Oversight Committee (JOC) process to ensure joint planning and alignment with the local facility and enterprise-wide strategic direction. Each of the JOCs at the PAGNY facilities will work collaboratively to ensure appropriate staffing levels, maximize productivity, lower costs, increase revenue and monitor progress with the performance indicators.
This proposed affiliation agreement, together with those negotiated earlier this year with NYU and Mt. Sinai, represent a significant milestone toward aligning financial incentives for our physicians with performance targets that will generate more revenue, reduce projected losses, improve patient satisfaction or otherwise better position HHC at the leading edge of healthcare reform. This approach reflects the reality that collaboration with our physician leadership and workforce will be more important than ever going forward if we are to preserve HHC’s mission and successfully navigate the challenges inherent in evolving healthcare reform at the federal and state levels. I urge your support for the agreement.
LAUNCH OF TAKING ON THE CHALLENGE
INFORMATIONAL VIDEO SERIES FOR HHC STAFF
On December 10 and 17, I shared the first two installments of my four-video series called Taking on the Challenge with all HHC employees. Produced by the Office of Special Projects, the video series is intended to provide HHC staff with an overview of challenges we have faced in the past and what we have done about them, a look forward at changes that will arise in the healthcare reform era that will affect healthcare delivery at our hospitals, and where I see us headed as we move toward the future.
Keeping staff informed and educated about new policies, programs, and governmental requirements will be key to helping them understand why these developments are important; how they will impact our hospitals, services, and providers; and what we all need to do to flexibly adapt to change. The first and second videos are now available on the HHC intranet and others will be added as they are released in the coming weeks.
HHC IN THE NEWS HIGHLIGHTS
New Psychiatric Wing, Queens Hospital Center, NY1, 12/04/12
NY Medical Team Leads Way For Surgery On Traumatic Eye Injuries, Dr. Douglas Lazzarro, Dr. Wayne Scott, King County, NY1, 12/05/12
Savory Bites & Sweet Sensations Cookbook, Lincoln Hospital, News 12 Bronx, 11/17/12
Bellevue Hospital Cleanup Update, NY1, 12/03/12
How NYC hospitals met challenges in Sandy's wake, Bellevue and Coney Island hospitals, CBS New York, 11/27/12
Healthcare Leaders, HHC President Alan Aviles, Poder Hispanic Magazine, Dec/Jan 2013
With Some Hospitals Closed After Hurricane, E.R.’s at Others Overflow, Coney, Bellevue, The New York Times, 12/04/12 (Also covered in NY Daily News)
Sandy Relief Rolls In, HHC, Crain's Health Pulse, 12/03/12
Lessons Learned From the Storm, HHC, The Huffington Post, 12/03/12
Coney Island Hospital Reopens Urgent Care Center, Sheepsheadbites.com, 12/03/12
(Also covered in Brooklyn Daily Eagle)
HHC's CNE: Communication, preparation key amid disasters such as Sandy, Nurse.com, 12/03/12
Queens Hosp Opens Center, Queens Times Ledger, 12/10/12
Taking A Healthy Bite of the Bronx, Lincoln Hospital, The Bronx Free Press, 12/07/12
Telehealth Program for Medicaid Patients with Type 2 Diabetes Lowers Hemoglobin, HHC, The Journal of Managed Care Medicine, December Issue 2012