ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
JUNE 27, 2013
GOUVERNEUR RECEIVES PCMH RECOGNITION FROM NCQA
This month, Gouverneur Health was the first HHC facility to resubmit an application for Patient-Centered Medical Home (PCMH) Recognition under the new rigorous quality standards established by the National Committee for Quality Assurance (NCQA) PCMH Recognition Program, achieving Level III Recognition with a score of 92.25 out of 100 points.
As you remember, PCMH is a collaborative, team-based approach to primary care that promotes the delivery of coordinated, integrated, and continuous care and cultivates long-standing relationships between the providers and their patients. In 2009, the New York State Department of Health aligned itself with the NCQA PCMH Recognition Program to provide enhanced reimbursement for Medicaid managed care and fee-for-service patients based on the level of recognition earned by primary care practices. In 2010, 39 HHC practices submitted applications and achieved Level III recognition, the highest of three levels, resulting in $18-20 million per year in enhanced revenue.
PCMH Recognition is awarded for a 3-year period, and HHC adult, pediatric, and HIV primary care practices are currently in the process of reapplying for recognition under the 2011 standards. NCQA has raised the bar on performance with these new standards which are more difficult to achieve with a required passing score of 85 and demonstrated competencies in care coordination, care management, and quality improvement.
The Office of Ambulatory Care Transformation has facilitated the PCMH application development process at practices across HHC’s 11 acute care hospitals and six diagnostic and treatment centers, and expects that all facilities will submit their applications for PCMH recognition by October 2013.
SEA VIEW GETS STATE'S TOP RANKING FOR NURSING HOMES
Sea View Hospital Rehabilitation Center and Home has received from NYSDOH the highest score in the state in the benchmarks that will be used to determine how to distribute the $50 million in funding in the 2013 Nursing Home Quality Pool, that will be used to enhance nursing homes with high quality of care standards. Sea View's overall score of 84.86 was the highest score in the benchmarks, which are based on evaluations of 14 quality measures including falls, weight loss, depression, and pain in long-term care patients. Sea View excelled in virtually all areas, with its residents being over 90 percent less likely to experience major injury from falls or to have excessive weight loss than patients at similar institutions. In March, Sea View was given the highest five star ranking by U.S. News & World Report in that publication's 2013 list of the nation's best nursing homes.
LINCOLN HOSPITAL RECEIVES NATIONAL RECOGNITION FOR CANCER CARE EXCELLENCE, DIABETES EDUCATION
Lincoln Medical Center was recognized with the 2012 Outstanding Achievement Award by the American College of Surgeons’ Commission on Cancer, becoming one of a select group of 79 healthcare facilities -- 16 percent of more than 500 accredited cancer programs to receive this national honor. Additionally, Lincoln's Diabetes Center of Excellence received four-year re-accreditation by the American Association of Diabetes Educators (AADE).
Lincoln's specialized program provides self-management education that meets and exceeds national standards, offering a culturally competent and patient centered bilingual curriculum focused on Type 2 diabetes, obesity and the prevention of diabetes complications. Congratulations to Lincoln Medical Center staff for these well-deserved recognitions of the outstanding care provided to patients in their community.
On May 10, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for hospital inpatient and long-term care prospective payment systems for fiscal year 2014. HHC submitted comments on June 24 focused on two suggestions.
First, to calculate the allocation of the 75% of Medicare DSH funds that would go into an uncompensated care pool for hospitals, CMS had considered using charity care, bad debt and other data from the hospital cost report worksheet, called the S-10, as the uncompensated care proxy. However, CMS decided that, since the worksheet is relatively new and many hospitals have had difficulties submitting accurate and consistent data, the S-10 should not be used for these purposes at this time.
In lieu of the S-10 data, CMS’s proposed formula would use inpatient days of Medicaid beneficiaries plus inpatient days of Medicare supplemental security income (SSI) beneficiaries as a proxy for the relative amount of uncompensated care each hospital provides.
HHC recommended that a better proxy formula could be devised. We commented that including exempt unit days -- psychiatric and rehabilitation -- in the formula would be more representative of the full scope of uncompensated services. We suggested that a proxy using low income days weighted as a proportion of hospital total days would better identify hospitals likely to be treating many uninsured patients. We also recommended a labor cost adjustment, based on the Medicare wage index, a method consistent with current Medicare payment standards. The estimated increase to HHC if these suggestions were implemented would be $83 million.
The second HHC suggestion is related to the CMS proposal to distribute the DSH pool dollars on a periodic interim basis, rather than on a per discharge rate basis. The result is to effectively exclude managed care discharges from the formula, benefiting Medicare Advantage Plans and disadvantaging providers. Using this method of distributing the DSH funds would result in a loss of about $64 million for HHC. We recommend that CMS instead have the pool payments be made on a per-discharge basis. We are supported in this suggestion by the American Hospital Association, the Greater New York Hospital Association, the Hospital Association of New York State and others.
The New York State Legislature concluded the 2013 Legislative Session last week without passing any of the legislation HHC had been most closely tracking. The legislation creating a new Safe Patient Handling Program that mandates specific and inflexible new equipment, technology and staffing requirements for health care facilities passed in the Assembly but died in the Senate. Neither house passed legislation to enact stringent new nurse staffing mandates, which would have resulted in an additional $388 million in spending each year for HHC. They also chose to defer action on legislation to extend the statute of limitations for filing medical malpractice claims.
Although there was robust discussion on the future of SUNY Downstate Medical Center, ultimately lawmakers did not pass any new legislation or provide any additional funding for the struggling institution. In the last week of the session, Governor Cuomo advanced legislation that sought to implement key elements of the recommendations contained in the SUNY Downstate Sustainability Plan, which was required as part of the recently enacted State Budget. It would have created a new Brooklyn Health Improvement Corporation comprised of Downstate and any voluntary hospitals willing to be co-operated by the Corporation. This Corporation would have been a new vehicle to allow participating voluntary hospitals to receive Delivery System Reform Incentive Payments (DSRIP s) under the State’s pending 1115 Medicaid Waiver. The Senate introduced a revised version of the Governor’s bill, while the Assembly introduced a proposal advanced by organized labor that focuses on monetizing SUNY’s Long Island College Hospital (LICH) and using the proceeds to expand the availability of primary care clinics and preserve as many health care services as possible at both LICH and the University Hospital located across from Kings County Healthcare Center.
Although staff will provide a detailed update at next month’s Strategic Planning Committee meeting, I want to highlight a few of the bills impacting HHC that did pass both houses. The Legislature passed several new hospital mandates, including requirements for new patient screenings for Hepatitis C, maternal depression and congenital heart defects using pulse oximetry on newborns. They also passed legislation imposing new notice requirements for patients admitted into hospital Observation Units. Finally, the Senate and Assembly both passed legislation that would severely limit HHC’s use of Job Order Contracting for capital projects.
At this juncture, it does not appear as though the Legislature will return to Albany prior to beginning of the 2014 Legislative Session in January. However, it is always possible that they will decide to return to address unfinished business such as the Women’s Equity Agenda or Campaign Finance Reform. We will apprise you of any new developments that are likely to result in a special session.
CITY COUNCIL RESTORES FUNDING TO HHC IN BUDGET AGREEMENT
In the City Budget that was passed last night, the City Council restored nearly $14.5 million in expense funding to HHC. I would like to thank the Council for their ongoing and generous support for HHC. I would also thank those public health, union and Community Advisory Board Members who have advocated on HHC's behalf with the Council. On the expense side, the Council provided funding for: $6 million for HHC's Unrestricted City Subsidy; $5 million to support the operation of Child Health Clinics; $2 million for our expanded HIV Testing program and $1.46 million for our Developmental Evaluation Clinics. On the capital side, we have not seen the final list yet, but we expect that the Council will allocate funds to support the purchase of new equipment and renovations at most of our facilities.
HHC FACILITIES SEE INCREASED DEMAND FOR LANGUAGE SERVICES
Since 2010, HHC’s 11 hospitals and dozens of community health centers have experienced a 22 percent increase in requests for over-the-phone interpreter services for patients with limited English proficiency with 700,000 requests in 2012. The number of minutes spent on over-the-phone interpretations -- a service where an interpreter on the phone relays complex and sensitive medical information between doctor and patient -- increased by 55 percent during the same time period to 6.9 million minutes. To meet this increasing need, HHC will invest approximately $31 million over the next five years for 24 hour-a- day, 7-day-a-week medical interpretation services provided by telephone to patients and doctors.
Phone interpretation is just one of several language services provided by HHC. We also offer the assistance of professional interpreters, trained staff interpreters, health instructions and literature for patients in the 13 most common languages at HHC, and multi-language signage appropriate to the patient population of each hospital and health facility.
HHC’s patient population now speaks more than 190 languages and dialects, and roughly 25 percent of patients have limited English proficiency, making our investments in language services more important than ever. When language barriers are eliminated, we increase patient safety and the healthcare provider and the patient can communicate with confidence.
GNYHA RECOGNIZES OUTSTANDING HURRICANE RESPONSE
On June 4th, the Greater New York Hospital Association held a gala awards ceremony to recognize the outstanding response made during Superstorm Sandy by so many New York City public agencies and most especially to honor New York's hospitals and nursing homes. Recognitions of merit were presented to Commissioners at the New York State Health Department, the NYC Health Department, the Office of Emergency Management and the Fire Department of NY. A compelling documentary film was premiered at the event -- "Taking Care: The Exceptional Story of New York's Health Care Response to Superstorm Sandy." The film interviewed leaders and staff at hospitals and nursing homes throughout the city and featured four HHC employees -- Daniel Collins at Coney Island Hospital, Monsey Nieves-Martinez and Jenny Rosario at Coler-Goldwater, and Dr. Leora Balsam at Bellevue. I know the board joins me in thanking them and the thousands of HHC employees who responded so heroically to ensure our patients' safety during the storm.
HHC BREAKTHROUGH LEADERSHIP AT LEAN CONFERENCE IN ORLANDO
On June 4th, the Lean Enterprise Institute and the ThedaCare Center for Healthcare Value convened a two-day conference of healthcare organizations interested in or deploying the "lean" performance improvement methodology, called "Breakthrough" at HHC. The conference in Orlando, Florida was attended by about 600 participants from the US and Canada, including 13 attendees from HHC. Attendees were leaders, board members, lean experts and staff from more than 150 organizations. I was a featured speaker in a plenary CEO panel with two other distinguished healthcare system leaders. My remarks during this panel session included personal insights about the challenges of leading a large organization through a long-term transformation, the engagement and enthusiasm of staff and the critical role of strong, involved leaders. I also spoke about the strong presence in our environment of labor unions and how the unions have been supportive and participatory in the process. The conference was a good opportunity for our Breakthrough leaders to share some of our best practices and to connect with counterparts who are tackling challenges similar to the ones we face.
HHC CHIEF MEDICAL OFFICER DELIVERS KEYNOTE ADDRESS AT
NYC'S C5 COLON CANCER CONFERENCE
On June 7th, the Citywide Colon Cancer Control Coalition -- C5 -- held its annual meeting, bringing together stakeholders from various sectors to discuss current issues in colon cancer screening and control. This year, the Summit reported on the progress and successes of current initiatives, and discussed the implications of emerging issues and trends in the changing healthcare environment. HHC's Chief Medical Officer, Dr. Ross Wilson, gave the keynote address, "Affordable Care Act -- Implications for Preventive Screenings."
Dr. Wilson also received an award on HHC’s behalf for the significant achievements of our Colonoscopy Screening Program. Over the last five years (2008-2012), more than 106,000 New Yorkers had a colonoscopy at an HHC hospital. During the same period, nearly 22,000 people had colon polyps removed at an HHC hospital before they developed into colon cancer.
The C5 members are health professionals, clinicians, researchers, academics, administrators and advocates from various public and private institutions and organizations, dedicated to promoting colorectal cancer screening in New York City. C5 strengthens colon cancer prevention and control efforts by facilitating communication between the health department and relevant stakeholders -- health and social service organizations, academic institutions, governmental agencies and advocacy groups.
AFFILIATION AGREEMENTS FOR MEDICAL SERVICES AT
KINGS COUNTY AND SEA VIEW HOSPITALS
There are two items for your consideration on today's agenda. The first is for approval of the renewal of an Affiliation Agreement with the State University of New York/Health Science Center at Brooklyn (SUNY/HSCB) for the provision of general care and behavioral health services at Kings County Hospital Center (KCHC). The agreement is a three-year contract commencing July 1, 2013 and terminating on June 30, 2016, for a total contract cost of approximately $52.1 million for the three-year contract period. This agreement continues a half-century relationship between both organizations and the provision of high quality patient care to the residents of Central Brooklyn. For example, SUNY/HSCB and KCHC are conducting joint research projects in endocrinology, emergency medicine, oncology and radiation oncology to improve the health outcomes of their patients. Additionally, advanced hepatobiliary surgery has been re-established and has resulted in positive outcomes.
The second item is the renewal of the current affiliation contract with Staten Island University Hospital for the provision of general care and behavioral health services at Sea View Hospital Rehabilitation Center and Home. A three-year agreement is proposed for the provision of services commencing July 1, 2013 and terminating on June 30, 2016, for a total estimated cost of $994,464 over the three-year contract. The proposed agreement will continue to compensate the affiliate for services provided on a part-time basis.
HHC IN THE NEWS HIGHLIGHTS
That's So New York: City Healthcare, Alan D. Aviles, Kings County, Woodhull, Bellevue, Queens, Elmhurst hospitals, NYC Media, 6/24/13
Heat Exhaustion Risks, Dr. Fernando Jara, Lincoln Hospital, News 12 Bronx, 06/25/13
Lincoln Asthma Health Fair, Dr. Riyad Basir, Lincoln Hospital, News 12 Bronx, 05/29/13
Metropolitan Hospital Proudly Shows Disabled Artists' Work, Dr. Bijan Safal, NY1, 06/09/13
NYPD Officer Wounded By Gunfire Outside Harlem Hospital, NY1, 06/10/13
Death toll on the rise: Diabetes killed 237 Staten Islanders in 2011, NYC reports, President Alan D. Aviles, HHC, Dr. John Maese, Coney Island Hospital, Staten Island Advance, 06/18/13
National HIV Testing Day observation serves as a reminder for Staten Islanders, HHC, Staten Island Advance, 06/25/13
Staten Island dentist is honored for service at Sea View, Dr. Howard Silverman, HHC, Staten Island Advance, 06/12/13
Modest decline in sweltering heat looms for New York, Dr. Mike Touger, Jacobi Hospital, NY Daily News, 06/25/13
New beginnings for Coney Island Hospital as first post-Sandy babies are delivered at reopened maternity ward , NY Daily News, 06/14/13 (Also covered in Sheepsheadbites.com and Metro)
Puerto Ricans in Health Services, Boricuas al servicio de la salud, Glenda Guzman, Senior Physician Assistant, Queens and Elmhurst hospitals; Dr. Ray Mercado, Lincoln Hospital; Dr. Denise Infante, Gouverneur Hospital, El Diario, 06/10/13
Parents get hospital rest, Jacobi Hospital, Bronx Times Reporter, 06/18/13
Elmhurst greenmarket opens for third consecutive year, Elmhurst Hospital, Times Ledger, 06/08/13
Elmhurst Hospital To Celebrate Greenmarket Opening, Queens Gazette, 06/05/13
Copperhead snake bites High Tor State Park worker, Jacobi Hospital, The Journal News, 6/1/13
Doctor Feelbad, Dr. Danielle Ofri, Bellevue Hospital, The New York Times, 06/17/13
What's New at Area Hospitals, Lincoln Medical Center, MD News, June 2013