ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
MARCH 21, 2013
PATIENT SAFETY FORUM AND
2013 PATIENT SAFETY CHAMPIONS AWARD CEREMONY
In celebration of Patient Safety Awareness Week, on March 4, almost 300 staff and leaders from across the enterprise gathered at Lincoln Hospital for our annual Patient Safety Champions Awards Ceremony and Patient Safety Forum. Patient Safety Awareness Week provides an opportunity to recognize the advancements that have been made in the patient safety arena, while acknowledging the challenges that remain -- and re-committing to work on them, every day.
This year’s theme was 7/365: seven days of recognition, 365 days of commitment to safe care. The keynote presentation, "Partnering with Patients: A Bed’s Eye View of Safety" was delivered by Ms. Tiffany Christensen, national patient advocate and author of "Sick Girl Speaks!" Ms. Christensen provided a rare glimpse into the life of a once-terminally ill patient with chronic diseases, who survived both her life-threatening illness and a major medical mistake. In her presentation she described ways to partner with patients and their families to decrease medical errors and improve patient outcomes.
During the awards ceremony, we recognized our 2013 Patient Safety Champions, six individuals and 15 teams who exemplify all that we are striving to achieve in patient safety. This year, the 2013 President’s Choice Award for Patient Safety was given to the Kings County Hospital Center Medical Intensive Care Unit, Patient Safety, Nursing and Infection Control Departments, and the Office of the Medical Director. Through application of multiple risk reduction measures, this team has successfully "Journeyed to Zero" by sustaining 18 months with zero central line bloodstream infections in the MICU.
GOUVERNEUR PERFORMS WELL ON JOINT COMMISSION SURVEY
This week, Gouverneur Healthcare Services Nursing Facility had its triennial survey by The Joint Commission. The survey team, led by Long Term Care surveyor, Ms. Hattie Courtney, RN, remarked on the wonderful way in which staff provide care for Gouverneur's vulnerable and culturally dynamic population. They were particularly impressed with the facility's commitment to patient-centered care and made special mention of its wound care program and hand hygiene practices. The team leader also commented on the remarkable synergistic relationship between medical and nursing leadership and the dedication and commitment of the staff toward their patients.
Gouverneur performed well on their triennial survey, and congratulations go to
Senior Vice President Lynda D. Curtis, Executive Director Mendy Hagler, Medical Director Dr. William Bateman, Chief Nurse Janet Cuaycong, RN, Nursing Home Administrator Robert Sussingham, and the staff of Gouverneur Healthcare Services, for a job well done.
The Budget Control Act’s mandated Sequester will initiate cuts starting April 1st for reimbursements for services that were provided in March. Medicaid and Medicaid Electronic Health Record (EHR) incentive payments are exempt from Sequester cuts but Medicare provider payments, which include Medicare EHR payments, will be cut 2%.
The City’s Office of Management and Budget estimates that the impact on HHC's Medicare reimbursements will be a loss of $18 million per year and a loss of $2.4 million from direct federal grants received by the Corporation.
It is unlikely that the Congress will act to avoid the $85 billion in automatic Sequester cuts between now and September 30th.
On March 6, the House passed the Continuing Resolution (CR) to fund the federal government for the rest of federal fiscal year 2013. The CR will not prevent the Sequester cuts but will give federal agencies more flexibility in implementing the cuts. The CR does not address the Administration’s request for an increase of $949 million for CMS to implement the health insurance marketplaces that are preparing to provide coverage beginning January 1, 2014 and to begin enrollment in October 2013.
On March 12, Senate Appropriations Committee Chair Mikulski introduced a substitute amendment to the House-passed CR, which includes a $71 million increase for the National Institutes of Health and would require the Administration to obligate all FY 2013 funds appropriated for community health centers. However, like the House CR, it retains the $85 billion in Sequester cuts. It is anticipated that the Senate will adopt their version expeditiously and that it will subsequently pass the House long before any threat of a government shutdown when the current CR expires on March 27.
On Tuesday, March 12, 2013, House Budget Committee Chair Paul Ryan introduced his budget resolution for FY 2014. The Ryan plan would cut more than $4.6 trillion in spending over 10 years; seventy percent of which would be from health programs, much from Medicaid. Approximately $2.7 trillion of the cuts would be from repealing the Patient Protection and Affordable Care Act (PPACA) coverage provisions but retaining the PPACA Medicare and Medicaid cuts.
On Wednesday, March 14, 2013, the Senate Budget Committee Chairwoman Patty Murray introduced her Budget Resolution. The Murray Plan would cut health care programs by $275 billion over 10 years, including $125 billion from Medicare. The Murray plan is half revenue and half spending cuts.
It is likely that the Murray plan will be adopted in the Senate but it is unlikely that the Murray and Ryan Plans will actually form the basis of a compromise in a House-Senate conference because they are so far apart. The conference is not expected to resolve these differences anytime soon. The President is attempting to negotiate a "grand bargain” which would include tax increases, spending cuts and entitlement reforms, including Medicare and Social Security.
The President is expected to release his budget April 8, which is rumored to cut $400 billion from health care programs, none from Medicaid. Congress's budget proposals precede the President's for the first time in recent memory.
STATE BUDGET UPDATE
Last night, Governor Cuomo and the State Legislature reached agreement on the 2013-14 State Budget. Importantly, the Leaders are describing this as a two-year Budget. As you may have read in this morning's papers, the $135 billion budget will include an increase in the minimum wage, a three-year extension of the "Millionaire's Tax," and a new $350 tax rebate for families earning between $40,000 and $300,000. While in many areas, including health care, staff continue to negotiate the details, legislators have already begun to pass less controversial parts of the Budget. The Legislature is expected to complete passage of the budget bills on Sunday, making this the earliest Budget in memory.
The final agreement differs from the proposed Executive Budget in several ways that affect HHC, including:
- Extension of the 2% across-the-board Medicaid cut for two years, expiring March 31, 2015. However, the State Department of Health would have the ability to end the cut sooner and have stated that if Medicaid spending stays on track they will be able to do so;
Eliminates the trend factor increase for health care providers for two years until April 1, 2015;
Reallocates charity care dollars to direct a greater proportion of the funding to hospitals that provide care to the uninsured, underinsured and Medicaid populations in conformance with federal Disproportionate Share Hospital fund methodology changes that were included in the Affordable Care Act. These changes exclude the practice in New York of factoring bad debt into the equation when distributing indigent care to hospitals. The new formula will be phased in over three years with limits on how much hospitals can gain or lose per year. Regardless of these changes, HHC still stands to lose approximately $50 million in state budget cuts this year.
CITY COUNCIL BUDGET HEARING
On March 7, I testified before the City Council on the City's preliminary Budget. Members of the Council expressed concern over the adverse impact that budget cuts would have on HHC and the size of HHC's structural deficit. Specifically, they urged the restoration of funding that the Council provides to HHC each year to support child health clinics, expanded HIV testing, behavioral health programs and for the sexual assault response team program. The Council also asked if we had plans for layoffs given the size of our projected deficit. We responded that we have no plans for layoffs at this time but, if our attempts at securing additional federal and state assistance fail, we may be forced to reconsider our options. HHC will testify again before the Council on the Executive Budget in late May or early June.
US NEWS & WORLD REPORT GIVES TOP RATINGS TO HHC NURSING HOMES
Last week two of HHC’s nursing homes received the highest rating of five stars from U.S. News & World Report in the publication’s new best nursing homes list for 2013. Another received four stars overall.
U.S. News calculates its nursing homes scores using data to evaluate health inspections, nurse staffing, and quality measures. It then issues an overall rating for nursing homes of up to five stars. U.S. News says that the federal Centers for Medicare & Medicaid Services (CMS) has approved its ratings methodology.
The Sea View Hospital Rehabilitation Center Home in Staten Island and the Coler-Goldwater Specialty Hospital and Nursing Facility on Roosevelt Island both received a five star overall rating. The Dr. Susan Smith McKinney Nursing & Rehabilitation Center in Brooklyn received four stars overall. Sea View and Coler-Goldwater also achieved a five star rating for performance on measures of quality.
These high ratings confirm that New York City’s public nursing homes are among the nation’s best, and that patients in our care receive top flight services and attention. The recognition by U.S. News is a tribute to the dedication and diligence of our HHC staff at these facilities.
ACCESSIBLE AND AFFORDABLE HOUSING FOR HHC PATIENTS
TO BREAK GROUND SOON IN EAST HARLEM
SKA Marin, an "affordable housing" developer, will be breaking ground soon on a unique project to provide fully accessible apartments for low-income, disabled and/or elderly individuals who are currently patients at Coler-Goldwater Specialty Hospital. The apartments are being built on East 99th Street between First and Second Avenues, a parcel of land on the Metropolitan Hospital campus. The apartment building will contain 176 units, with a mix of studios and one bedroom apartments designed for low income disabled non-elderly and elderly persons whose health status allows them to live independently with some support services.
The project represents a unique partnership among the developer, the public hospital system, the New York City Department of Housing Preservation and Development (HPD), Housing Development Corporation (HDC), New York City Housing Authority (NYCHA), New York State Homes and Community Renewal (HCR), Citibank and Raymond James. The project is also the first in New York State to receive Medicaid Redesign Team funding for projects focused on high cost Medicaid populations. The project is estimated to save $10 million a year in state and federal Medicaid expenditures.
This project will open new horizons of independent living for former skilled nursing facility residents through readily accessible healthcare services provided by Metropolitan Hospital. We are pleased that patients with disabilities from Coler-Goldwater who no longer need institutionally based care will have affordable community living options that for a very long time have not been available.
MAJOR HHC CAPITAL PROJECTS UPDATE
The following is an update on our major capital projects at HHC.
At Harlem Hospital Center, the New Patient Pavilion, now called the Mural Pavilion (MP), is complete and the first phase is occupied. This project included a special program to promote and foster community employment in targeted areas around the hospital. To date, more than 221 people have been employed on the project from the community with many more trained and/or referred to other programs in the city. It has been a very successful program and a model for other projects at City College and Columbia University. Once the second phase is complete this summer, the MP will house new diagnostic suites, an emergency department, operating rooms and critical care units that will serve as the centerpiece of the campus-wide modernization. The MP is connected to the Martin Luther King Pavilion and the Ron Brown, Jr., Ambulatory Care Pavilion.
At Gouverneur Health, the new clinic areas and the 13th floor residence are open and occupied. Floors 4 through 7 have received a Temporary Certificate of Occupancy from the NYC Buildings Department. Occupancy of these floors will occur by the end of the month. Construction is in progress on floors 2, 3, 8 and 9, and these floors are scheduled for occupancy by end of this summer. When complete, the lower floors will house expanded ambulatory care services, and the upper floors will house the long-term care services, with an increase of nursing home capacity from 210 to 295 beds.
At Lincoln Medical and Mental Health Center, a multi-phase renovation and expansion of the facility’s Emergency Department is nearing completion. The first phase constructed an annex and relocated outpatient clinics to the first floor of the new building. The second phase relocated functions to the second floor of the recently constructed annex building, and is complete. The third phase, which remodeled and expanded the existing Adult Emergency Department, is complete and occupied. The fourth and final phase, which includes Pediatric Emergency and Trauma Services, is in construction. The Emergency Department has remained fully functional throughout the project. We anticipate final move-in by Fall 2013.
Finally, at the soon-to-be-opened Henry J. Carter Specialty Hospital, construction of the new building is proceeding as planned. The new elevators will be operational shortly permitting removal of the hoist and completion of the exterior walls. Mechanical roughing, wall layout and framing are ongoing working from the upper floors down. At the Long Term Acute Care Hospital building, mechanical roughing is ongoing. New wall framing and repair and fire-stopping of existing walls are progressing from the top floor down and nearing completion. Upgrades of existing mechanical equipment are in progress. Residents will begin to move into the new structure in early November of this year.
THE FUND FOR HHC RECEIVES GRANT TO SUPPORT
HHC EMPLOYEES AFFECTED BY HURRICANE SANDY
Last month, The Fund for HHC received a grant of nearly $38,000 from the Hurricane Sandy Health Care Employee Relief Fund administered by the United Hospital Fund (UHF) to benefit HHC employees affected the storm.
The Relief Fund was established by the Greater New York Hospital Association, Healthcare Association of New York State, Nassau-Suffolk Hospital Council, New Jersey Hospital Association, Northern Metropolitan Hospital Association, and UHF with support from the American Hospital Association. The total donation of more than $600,000 was distributed to 47 hospitals and healthcare organizations in Sandy-affected communities. UHF awarded HHC the maximum allowable grant amount for a single organization.
Including the Employee Relief Fund grant, The Fund for HHC has raised more than $225,000 to help employees, with the final grant allocations to be made by the end of this month. By that time, more than 700 staff members who suffered personal losses and experienced hardships due to the hurricane will have received financial assistance.
CORPORATE LEADERSHIP DEVELOPMENT PROGRAM FOR MIDDLE MANAGERS
On March 12th, the first cohort of 112 middle managers completed the Corporate Leadership Development Program conducted in partnership with The Advisory Board Company Talent Management Division. The Leadership Development Program has been designed to equip participants with the skills, confidence, and motivation to be more effective leaders while tapping into their ideas and energy to drive innovation and change throughout the organization. Over the course of the program, managers were required to attend five full day sessions: a Healthcare Management Intensive; Instilling Accountability; Facilitating Effective Teamwork; Critical Thinking and Problem Solving; and Impact Through Influence.
Thirty-two senior staff served as coaches to the managers and attended each of the five sessions as well as a specialized class on Coaching to Full Potential. Between workshops, the coaches participated on monthly coaching calls with The Advisory Board faculty and worked with the managers on individual or group projects and application activities to reinforce what was learned in the sessions. Participants, coaches, and executive sponsors received access to Harvard Manage Mentor Plus, an online resource with interactive, computer-based training modules designed to help users tackle common business and staff challenges.
A second cohort of up to 125 participants is scheduled to begin the Leadership Development Program on April 30th. I would like to thank Senior Vice President Caroline Jacobs for leading this important effort which is a critical to developing our workforce to meet our enterprise-wide strategic priorities.
JOINT BUSINESS VENTURE WITH NORTHSHORE-LIJ HEALTH SYSTEM
TO PRODUCE TOP QUALITY LABORATORY SERVICES
On your agenda today is a resolution for HHC to enter negotiations for an agreement with North Shore-LIJ Health System (NSLIJ) to create a new jointly controlled central laboratory that will process routine tests for both hospital systems. HHC projects savings under the project to be $80 million over the next five years and then $23 million annually after that. The proposed lab would be located in New York City and would be the largest hospital-controlled lab of its type in the country. The lab, if approved, will begin operations in 2014 and is expected to process about 20 million tests annually for the HHC and NSLIJ systems when fully implemented by 2018.
The proposed new lab will be run by a shared management team and will be staffed by approximately 700 employees. It will also operate a joint standards committee with representatives of NSLIJ and HHC to develop the laboratory quality assurance standards.
HHC currently operates four core labs and 12 rapid response labs, which together perform about 15 million lab tests per year at a current cost of about $233 million annually. Under this agreement, HHC would consolidate its four core lab operations into the new cooperative lab, which would eventually process about half of all HHC lab tests. HHC would continue to maintain 12 rapid response laboratories for tests that require a turnaround of four hours or less. No current staff would be laid off and HHC would eventually relocate approximately 162 lab staff to the new jointly controlled facility.
Once fully operational, the new lab is expected to generate savings of at least $23 million annually for HHC, while increasing efficiency, standardizing best practices, and improving quality and depth of services. I urge your support.
SENIOR LEADERSHIP CHANGES
As the Board knows, Iris Jimenez-Hernandez, our Executive Director of Lincoln Medical and Mental Health Center and Network Senior Vice President for our Generations+/Northern Manhattan Network, will be leaving us at the end of the March to become a Senior Vice President in the Health Division at Maximus, a national social service management firm. In her new role, Iris will oversee work in several northeastern states to operationalize health exchanges and other provisions of the Affordable Care Act.
With Iris’s departure, I have asked Denise Soares, the Executive Director at Harlem Hospital Center, to assume the role of Senior Vice President of the Generations+/Northern Manhattan Network. Before her present position, Denise served the North Bronx Healthcare Network for 12 years, as Network Chief Nurse Executive and then as North Central Bronx Hospital’s Chief Operating Officer. She is a leader whose commitment to quality patient care and patient satisfaction is anchored in operational excellence and prudent stewardship. This is demonstrated by Harlem Hospital’s recently earned Leapfrog Award for the Greatest Leaps in Patient Safety and Quality. Additionally, during her tenure at Harlem Hospital, Denise has been a champion of Breakthrough, HHC’s process improvement methodology, with readily apparent positive results.
To fill the void at the helm of Lincoln, I have selected Milton Nunez, the Deputy Executive Director/Chief Financial Officer of the North Brooklyn Health Network to assume the role of Executive Director. Milton has been a senior manager in HHC for 13 years, and most recently assisted PAGNY, our professional affiliate, with the restructuring of its finance operations. Milton’s accomplishments include implementing effective service line consolidations, leading the development of staffing benchmarks for physicians, nurses and other staff, coordinating successful Phase 1 Meaningful Use designation, and leading a collaboration to revamp ambulatory care service delivery to produce lower costs, improved operations, and increased managed care enrollment.
Under the leadership of Denise and Milton, I am confident that the Generations+/Northern Manhattan Network and Lincoln Hospital are in very capable hands. I know that the Board joins me in congratulating them and in offering our support as they assume their new duties.
HHC IN THE NEWS HIGHLIGHTS
Dr. Susan Smith McKinney Nursing & Rehabilitation Center earns 4-star rating from U.S. News, News 12 Brooklyn, 03/13/13
Emergency room struggles after Hurricane Sandy, Coney Island Hospital, WABC, 03/12/13
HHC Aces Ratings, Crain's Health Pulse, 03/01/13
HHC Bonds Get Top Ratings from Moody's, S&P and Fitch, Hospital Newspaper, 03/18/13
The Melody of Memory, Sea View Hospital, Staten Island Advance, 03/11/13
City Hospital Corporation Hit by Sandy Losses, HHC, The Wall Street Journal, 03/08/13
Public hospital MDs push back against pay tied to performance, HHC, The New York World, 03/07/13
Coney Island Hospital Again Receiving Ambulances, Hospital Newspaper, 03/18/13
Nursing Home Innovation: Sea View’s Incontinence Program, Sea View Hospital, Sea View Hospital, Elderbranch.com, 03/15/13
Moving Toward Person - Centered and Recovery - Oriented Services and Systems, Dr. Eric Leventhal, Bellevue Hospital, Mental Health News, Spring 2013
Peer Counseling Effectiveness in Acute Care at Kings County Hospital, Jonathan P. Edwards, LMSW, Janine Perazzo, LMSW, Kings County Hospital, Mental Health News, Spring 2013
Sydenham Health Care Network Center grand opening, Renaissance Health Care Network/Sydenham Health Center, The New York Amsterdam News, March 14-20, 2013
Lincoln Recovery Center, Lincoln Hospital, The Bronx Free Press, 03/06/13
Chinese leader in maternal health visits Gouverneur and Bellevue to learn about natural labor and delivery, World Journal, 03/09/13 (Covered in China Press, SinoVision, DW News)