ANTONIO D. MARTIN
EXECUTIVE VICE PRESIDENT AND CHIEF OPERATING OFFICER
REPORT TO THE BOARD OF DIRECTORS
APRIL 18, 2013
JOINT COMMISSION SURVEYS AT JACOBI AND McKINNEY
The 2013 Joint Commission surveys of HHC facilities continued with surveys at Dr. Susan Smith McKinney Nursing and Rehabilitation Center and Jacobi Medical Center. Both facilities did very well on their surveys.
At McKinney, The Joint Commission's long term care surveyor was extremely impressed with how the facility was maintained, and the excellent care that staff provided to such a vulnerable population. From discussions with staff and leadership and data collected, she stated it was obvious that the organization was doing a lot of great work, compared to other organizations across the country. She commented on staff longevity with the organization as evidence of their commitment to their patients, and stated that such commitment "said a lot about the leadership of the organization."
Last week, The Joint Commission also completed its triennial survey of Jacobi Medical Center. The Life Safety Code surveyor stated it was the cleanest survey he had ever seen as a Life Safety Code specialist, and he would not hesitate to bring a family member to Jacobi, a sentiment echoed by the Behavioral Health surveyor. At the survey team's Exit, the team leader remarked that Jacobi serves as a "beacon of service to a community that is very challenging."
Along with the members of the Board of Directors, let me congratulate Senior Vice Presidents George Proctor and William Walsh, McKinney Executive Director Michael Tartaglia, Medical Directors Dr. Stephen Kaner and Dr. Joseph Skarzynski, Chief Nurses Jacqueline Horsford and Ellen O'Connor and the staff of Dr. Susan Smith McKinney and Jacobi Medical Center for a job well done.
Elmhurst and Metropolitan Hospitals are the remaining facilities to be surveyed in the 2013 cycle.
On April 10, 2013, the President released his federal fiscal year (FFY) 2014 budget. The budget includes additional cuts to Medicaid and Medicare Disproportionate Share Hospital (DSH) funding and substantial changes in Medicare reimbursement for post-acute care. Specifically the President's budget proposals include:
- A delay in the cut to Medicaid DSH to FFY 2015, however, as a result, reductions will be deeper in subsequent years than were originally proposed and extended through FFY 2023.
- A 10 percent reduction in Indirect Medical Expenses (IME) funding for teaching hospitals starting in FFY 2014. In the first year this reduction would mean an estimated $9.4 million loss in funding for HHC, and total losses through 2022 of $90 million.
- A reduction in Medicare reimbursement for bad debt from 65 percent of bad debts to 25 percent. This would be an estimated loss for HHC of $16 to $17 million from 2014 to 2022.
- A reduction in rate updates for post-acute care by 1.1 percent for skilled nursing facilities, long term care hospitals, inpatient rehabilitation facilities and home health agencies, resulting in an estimated loss to HHC of $19 million between FFY 2014 and FFY 2022.
- Cuts to Medicare reimbursement of inpatient rehabilitation facilities by increasing from 60 percent to 75 percent, the minimum proportion of patients with one of thirteen conditions in order for the facility to receive that level of reimbursement.
- A reduction in payments to inpatient rehabilitation facilities to the same level as payments to skilled nursing facilities for three conditions involving hips and knees, pulmonary, as well as other conditions to be selected by the Secretary of Health and Human Services. National savings of $2 billion over 10 years are projected to result from this proposal. We do not have an HHC impact estimate at this time.
- A reduction in skilled nursing facility (SNF) payments when residents are readmitted to acute care hospitals for conditions that could have been avoided. The SNF payments would be reduced by up to 3 percent for facilities with high rates of care-sensitive, preventable hospital readmissions beginning in FFY 2017. National savings of $2.2 billion are projected between FFY 2017 and FFY 2022. We do not have an HHC impact estimate at this time.
- A bundle-payment approach for at least half of the Medicare payments to post-acute care providers, including long term care hospitals, SNFs and home health providers beginning in FFY 2018. Rates would be based on patient characteristics and other factors to produce a permanent and total cumulative adjustment of -2.85 percent by FFY 2020. Beneficiary coinsurance would equal levels under current law. This proposal is estimated to result in national savings of $8.2 billion between FFY 2018 and FFY 2022. We do not have an HHC impact estimate at this time.
On April 17, 2013 a bipartisan group of eight senators introduced a bill that would allow an estimated 11 million illegal immigrants to achieve citizenship. The bill proposes that a person who has been in the U.S. since December 31, 2011, may apply to become a Registered Provisional Immigrant or RPI. RPIs are not eligible for means-tested public benefits or for subsidies to buy insurance through the health care exchanges. Applicants must pay fines, pay back taxes, learn English, remain employed and pass a criminal background check.
After 10 years as an RPI, the person can apply for a green card and can apply for Lawful Permanent Resident status, which in turn requires a three year wait to become a citizen. This bill states that no RPI can become a Lawful Permanent Resident until certain border security and employee verification systems are in place. Dream Act youth can obtain green cards in five years and citizenship immediately thereafter.
As to the changes for people who are in the US legally or enter legally, the bill does the following:
Upon enactment, the bill raises the cap on temporary H1B visas from 65,000 to 110,000, which can rise by 10,000 annually to 180,000 under certain conditions. The bill requires an employer to demonstrate that they have recruited American workers before an H1B visa is granted. HHC is currently using 630 H-1 visas for workers employed in our facilities and professional affiliates.
The legislation would also create a merit-based program to award visas for legal permanent residents based on a point system. When the merit system takes effect, five years after the bill is passed, at least 120,000 immigrants are expected to receive merit based visas.
Over a decade it is estimated that the balance of visa applications in the immigration system will gradually shift from 75 percent to 50 percent of visas going to family members of immigrants already here. The remaining 50 percent of visas will go through the merit program to foreigners based on job skills. Forty percent of the employment-based visas are to go to certain categories, including those with foreign medical school degrees.
It is important that HHC follows federal immigration reform discussions because a significant number of our patients are undocumented immigrants. Understanding what may or may not become available to undocumented New Yorkers in terms of health care coverage under the different proposals and what may change in terms of visa policies and targets informs our financial, human resources and service planning.
STATE BUDGET UPDATE
The recently enacted State Budget includes many proposals that affect HHC. In total, we are estimating that HHC will lose approximately $63.3 million, with MetroPlus losing an additional $26 million. Importantly, the Budget reflects a two-year spending agreement between the Governor and Legislature. The following are key provisions for HHC:
- Extension of the 2 percent across the board Medicaid cut for two years. However, the State Department of Health would have the ability to end the cut sooner and has stated that if Medicaid spending stays on track it will be able to do so;
- Elimination of the trend factor increase for health care providers for two years;
- Reallocation of charity care dollars to direct a greater proportion of the funding to hospitals that provide care to the uninsured, underinsured and Medicaid populations;
- Elimination of funding for clinical care provided by local public health departments, which will result in a loss of funding to HHC's Children's Health Clinics.
In addition, many of the healthcare policy issues that surfaced during the budget process are likely to reemerge as stand-alone bills during the remainder of the legislative session. These include reforms to the State's Certificate of Need process; creation of new rules governing payment and billing when patients get care from out-of-network providers; authorization for retail clinics operated by chain pharmacies; and pilot programs to allow private, for-profit companies to partner with New York hospitals. We also anticipate robust discussion of legislation to implement staffing ratios in healthcare facilities and to impose new requirements for safe patient handling, as well as legislation on a variety of liability and malpractice issues.
PAYMENTS RECEIVED FOR STORM RECOVERY WORK
HHC is continuing its work with FEMA, the NY State Office of Emergency Management, and our disaster recovery consultant, Base Tactical, to apply for reimbursement for damages caused by Sandy.
We are currently making claims related to the system-wide damages. The majority of these have been for Emergency Protective Measures for the cleanup and replacement of equipment needed to stabilize and reopen our closed facilities. Now we are turning our attention to the development of Buildings and Equipment claims to make permanent repairs, replace destroyed contents and apply hazard mitigation to our facilities.
We have received about $62 million of the first $139 million in claims submitted and approved.
HHC PROFILE INCLUDED IN UHF REPORT ON
ACCOUNTABLE CARE ORGANIZATIONS
Last week, the United Hospital Fund published a report titled "Moving Toward Accountable Care in New York." It includes a profile of HHC, summarizing our experience, and showing our strong foundation for organizational success as an Accountable Care Organization. The profile outlines the many resources we have invested in developing the Corporation, the growth of our managed care affiliate MetroPlus, and the efforts we've made that have focused on managing the care of sometimes challenging patient populations. All of these assets make it inevitable that HHC reposition itself as a high-quality, fully integrated delivery system that includes ambulatory care, inpatient care, homecare and an allied payer. With HHC's decision to participate in the Medicare Shared Savings Program, we accepted the responsibility and financial risk for improving the quality and reducing the cost of care. As we continue in our progress as an Accountable Care Organization, HHC will continue, through development and partnerships, to provide our patients with all their healthcare needs and to encourage payment arrangements that reward -- and punish -- providers for their performance.
QUEENS HOSPITAL OPENS NEW EXPANDED GERIATRIC CENTER
Queens Hospital Center today celebrated the opening of its newly expanded Geriatrics Center to help meet the growing healthcare needs of elderly residents of the borough, particularly in light of recent hospital closures. The new 4,400 square foot outpatient care center is now nearly double its original size and is staffed by board-certified geriatrics specialists, nurses and social workers to provide quality, comprehensive and senior-friendly primary and specialty services in more comfortable, modern space. This new center also features an activity room, six oversized exam rooms that better accommodate wheelchairs and special equipment, physician consult rooms, and additional space for nurses and social workers.
The Geriatric Center is part of the hospital's Senior Care Program that includes the Diabetes Center of Excellence, ophthalmology and optometry, the Women's Health Center, physical medicine and rehabilitation, behavioral health, cardiology, emergency services, the Queens Cancer Center, an on-site and satellite pharmacy, and geriatric alcohol and chemical dependency services. Last year, the hospital's Senior Care Program generated more than 5,600 outpatient visits. The new $4 million Center was funded through a grant from the NY State Department of Health.
MAY IS FOR MAMMOGRAM AWARENESS AT HHC
Our annual Mother's Day Mammogram Awareness Campaign this year will again feature a series of education events in our hospitals and health centers where the public, our patients and our staff will be invited to learn more about this life-saving cancer screening exam and be urged to schedule a mammogram this year. Breast cancer kills about 1,260 women in New York City every year and still 23 percent of women 40 and older have not had a recent mammogram. Our month-long campaign will include a number of initiatives to create awareness about the benefits of breast cancer prevention, screening and early detection.
HHC will go pink and turn our logo pink for the month -- on our website and on print materials. And we will once again ask women, "Who do you dedicate your mammogram to?" and ask participants to post their dedications on a pink ribbon wall at each event. To add a bit of excitement and increase participation, we will also launch a comprehensive social media campaign, allowing women to make mammogram dedications on Facebook and Twitter. For the first time this year, we'll host a social media contest on Facebook where we will invite our patients and the public at large to submit a special dedication of 150 words or less and enter to win an iPad mini. (HHC employees will not be eligible.)
Other features of the campaign include a collaboration with the American Cancer Society to secure pro-bono media placements to promote the public events, a direct mail piece to all our female patients 40 and older, and a special website page nyc.gov/hhc/mammograms that features compelling dedications from our patients and employees to emphasize the importance of mammograms. We will also continue our year-round effort directed at our staff, where every month we send birthday cards directly to the homes of female employees when they turn 40 to remind them about the benefits of breast cancer prevention, screening and early detection.
ELMHURST GETS TOP PATIENT SAFETY RANKING
FROM NY STATE FOR ANGIOPLASTY
According to a report issued by the NY State Department of Health, HHC's Elmhurst Hospital leads all Queens hospitals with the best overall safety rating for percutaneous coronary intervention (PCI), a procedure commonly referred to as angioplasty, where a physician inserts a catheter device to clear obstructed or blocked arteries in the heart.
The latest data, which covers patients discharged from 2008 to 2010, shows that Elmhurst Hospital Center treated 1054 PCI patients during that period and for those cases had a risk adjusted mortality rate about half of other Queens hospitals that perform the same procedure. Elmhurst also performed better than most Manhattan hospitals.
Dr. Mazullah Kamran, Director of the Elmhurst Cardiac Catheterization Lab, noted that Elmhurst also specializes in a kind of PCI that results in greater comfort for the patient and fewer complications. Because catheters are inserted through the radial artery in the wrist instead of the femoral artery in the groin, patients experience less bleeding and discomfort at the entry site and have quicker recoveries. Around 80 percent of PCI procedures performed at Elmhurst use the radial artery.
PROCUREMENT SYSTEM AT HHC TO BE CONSOLIDATED TO
LOWER COSTS, IMPROVE EFFICIENCY
Planning is underway for the centralization of HHC's procurement operations. Our goal is to enhance corporate-wide coordination and oversight, while achieving cost savings through greater standardization and economies of scale. I will give a brief presentation on this initiative later in the meeting.
HHC IN THE NEWS HIGHLIGHTS
NICHE Senior-Friendly Nurse Training, Julius Wool, Executive Director; Toni Hilton, RN, Queens Hospital; Susan Domingo, RN; Sonia Nesbeth, RN, Elmhurst Hospital, NYC Media-That's So New York, March 2013
Asthma in the Bronx, Dr. Raghu Loganathan, Lincoln Hospital, News 12 Bronx, 04/05/13
Doctor gives tips on suppressing allergies, Dr. Kiran Shah, Lincoln Hospital, News 12 Bronx, 04/11/13
NY1 Reporter Bowls for Good Cause, Metropolitan Hospital, NY1, 04/11/13
HHC, North Shore in laboratory joint venture, Crain's Health Pulse, 04/03/13
Of Guns & Gangs, Dr. Teperman, Jacobi Hospital; Erik Cliette, Harlem Hospital, New York Daily News, 04/05/13
C. Diff Dangerous in ESRD, Massini Merzkani, MD, Jacobi Medical Center, MedPage Today, 04/05/13
Bellevue Resumes Kids' Book Giveaway After Donation of 7,000 Volumes, DNAinfo.com, 04/11/13
The Rain Is Gone, Here Comes the Sun, Bellevue Hospital, Huffington Post, 4/10/13
HHC Violence Prevention Programs, Kings County Hospital, The Fund for HHC, NAPH Website - Member Innovations, 3/29/2013
The Power of Personalized Music, Margaret Rivers, Coler- Goldwater Hospital, MD News (iPad Exclusive), March/April Edition
HHC Appoints New Executives to Leadership Roles, Denise Soares, Milton Nunez, Lincoln Hospital, Bronx Free Press, 04/10/13
Metropolitan Hospital Community Advisory Board Legislative Forum With Harlem Rep. Rangel, Harlem World, 03/25/13
"When 'Baby Blues' don't go away", Dr. Ray Mercado, Lincoln Hospital, Bronx Free Press, 04/10/13
When food is too little or too much, Dr. Sharma, Lincoln Hospital , Bronx Free Press, 03/27/13
Metropolitan Hospital Auxiliary, amNewYork, 04/10/13