ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
OCTOBER 31, 2013
HHC ACCOMPLISHMENTS ONE YEAR AFTER HURRICANE SANDY
This week New York City observed the one-year anniversary of Hurricane Sandy, the storm which brought so much devastation to our area. We conducted a tour for news media at Bellevue Hospital on Thursday, October 24, where we showed the extensive repairs and discussed future mitigation plans.
As you know, HHC estimates that Hurricane Sandy costs ultimately will exceed $800 million to cover response, repairs, and the work required to mitigate future flood damage. To date, we have paid $198 million for Sandy-related repairs. We have received $61 million in FEMA emergency funds for repair work and another $181 million in Community Development Block Grants from HUD for expenses incurred while facilities were out of service.
We have engaged the engineering firm Arcadis, which has extensive expertise in disaster –related mitigation design, and are actively examining long-term measures to protect facilities in the event of another storm of Sandy’s magnitude or greater. The alternatives being examined include permanent flood walls to protect facility perimeters, and the repositioning and hardening of internal systems such as generators, chillers, boilers, steam, and plumbing and medical gas delivery systems. Raising parts of facilities above flood level, and a new, elevated building at Coney Island Hospital, are also being examined and will be contingent on FEMA funding. We intend to actively seek funding for these essential long-term items under FEMA’s Section 406 Hazard Mitigation Funding.
To better prepare HHC for managing any future large-scale emergency scenario, we have acquired two new communication tools. One is a new communications system that can send alerts to any number of staff members simultaneously through multiple channels. The other is a new web-based incident command system that connects our central office and hospital-based command centers, and can track and prioritize requests for supplies and other resources.
At Bellevue Hospital, large sections of the basement have been restored, new heating, ventilation and air conditioning equipment has been installed, and electrical switchgear that was destroyed has been replaced and moved to the first floor. To prevent or greatly limit future basement flooding, Bellevue has also installed removable flood barriers at its two loading dock entrances facing the East River. The facility also will complete work to raise its domestic water pumps and the fuel pumps for its eight generators out of the basement and to higher elevations. Bellevue is also completing its review of the best way to protect some of its 32 elevators from future flood damage so that at least limited vertical transportation can be maintained.
At Coney Island Hospital, the emergency department and several other first floor areas have been restored, and repairs and restoration elsewhere are soon to be completed. Damaged electrical switchgear has been replaced on a new elevated platform adjacent to the hospital. MRI and CAT scan imaging services are being provided in temporary trailers until permanent imaging locations are rebuilt. The hospital has also acquired temporary barrier systems that can be erected in advance of a storm around its emergency department, main entrances, and generator facility.
Metropolitan Hospital is currently considering ways to elevate electrical equipment and Con Ed feeders in its basement. At Coler, flooded areas have been cleaned, electrical gear has been raised, fire alarm systems have been repaired and emergency generators are positioned on-site.
We will continue to strongly advocate for the FEMA mitigation funding essential to enable our facilities to ride out future severe storms.
ELMHURST WINS PRAISE DURING JOINT COMMISSION SURVEY
Last week The Joint Commission conducted a five day survey of Elmhurst Hospital Center, the final triennial survey for HHC in 2013. Elmhurst underwent a rigorous survey by a team of seven surveyors - two physicians, two nurses, a specialist Ambulatory Care surveyor, Life Safety Code surveyor and a Behavioral Health surveyor.
We are awaiting the final report, but I am pleased to let you know that there were no significant patient care findings. The surveyors commended both leadership and staff for the excellent care they provide to a diverse and underserved population. They were very impressed with the level of staff and physician engagement as well as leadership's demonstrated commitment to becoming a high reliability organization.
The surveyor team highlighted many examples of good or best practices. Of note was the facility's performance improvement program and plan, which was described as one of the best the surveyors have seen, demonstrating evidence of excellent prioritization, effective integration of Breakthrough, and engagement by all levels of staff.
Congratulations to the leadership of Elmhurst Hospital led by Dr. Ann Sullivan, Network Senior Vice President; Chris Constantino, Senior Vice President; Dr. Jasmine Moshipur, Medical Director; Joann Gull, Chief Nurse Executive; the regulatory team led by Joseph Halbach, MD, and Sharon Behar; and the staff of Elmhurst Hospital Center on a job well done.
In 2014, Bellevue, Coler, Harlem, Henry Carter, NCB, Queens and Woodhull will be surveyed.
HHC FACILITY PROGRESS TOWARD RECERTIFICATION AS PATIENT-CENTERED MEDICAL HOMES
HHC adult, pediatric, and HIV primary care practices are currently in the process of reapplying for recognition as Patient-Center Medical Homes (PCMH) under more rigorous new standards applied by the National Committee for Quality Assurance (NCQA).
PCMH recognition is a collaborative, team-based approach to primary care that promotes the delivery of integrated care and cultivates long-standing relationships between the providers and their patients. In 2010, HHC practices achieved Level III recognition, the highest of three levels, resulting in $18-20 million per year in enhanced revenue for Medicaid patients from the NY State Health Department. HHC facilities are now applying for recertification of the three-year recognition program. Applications must provide written processes and standard work and evidence of implementation in the following areas: 1) enhanced access and continuity; 2) patient population management; 3) planning and managing care; 4) support for self-care and use of community resources; 5) tracking and coordinating care; and 6) measuring and improving performance.
As of this week, seven HHC facilities have received an additional three years of recognition as Patient Centered Medical Homes at Level III. The threshold for Level III Recognition is a score of 85, and HHC applications have each scored well above 90. The facilities that have now achieved re-certification are Coney Island Hospital, Elmhurst Hospital Center, Gouverneur Health, Harlem Hospital Center, Belvis Diagnostic & Treatment Center, Morrisania Diagnostic & Treatment Center, Lincoln Medical Center, and Metropolitan Hospital Center.
An additional three applications have been submitted and are under review by NCQA and three applications continue to be under development and will be submitted by the end of year.
GROWING COMPLIANCE RATES FOR STAFF IN FLU IMMUNIZATION CAMPAIGN
As you know, New York State has released a regulation this year that addresses flu vaccination requirements for healthcare personnel. All healthcare personnel who are not vaccinated for any reason will need to wear a mask for the duration of the flu season, starting when the Commissioner announces the season’s commencement. HHC fully supports the regulation and has launched a strong campaign to encourage our staff to get vaccinated as soon as possible for the coming flu season.
The vaccination rate so far is just under 60 percent for our staff and rising. We will continue to ensure that all personnel understand the new flu policy and are informed about how and where they can get vaccinated or how they can otherwise comply with the new policy.
NCB HOSPITAL HOSTS FRENCH MINISTER; SART PROGRAM CONTINUES TO DRAW INTERNATIONAL ACCOLADES
On October 14, the staff of North Central Bronx Hospital (NCB) welcomed a special guest, French Minister Najat Vallaud Belkacem, the Minister for Women’s Rights for France. She explained that her country is grappling with sexual violence. She came to NCB to learn from the medical team about effective strategies they have developed for caring for patients who have been victims of sexual violence and for preserving evidence. These strategies have become a model for all New York City public hospitals.
It’s not the first time NCB has received this level of international attention. Delegations from both Jordan and Japan have come to observe the hospital’s Sexual Assault Response Team (SART). SART is an interdisciplinary response by specially trained staff and volunteers that commits exclusive resources to a sexual assault victim within minutes of their arrival at the hospital.
Immediately after a patient is admitted to NCB, a volunteer advocate, who has completed 40 hours of specialized training, is called. Volunteers are at the hospital within 30 minutes. The advocate stays with the patient, serving as a counselor and advisor, as the victim undergoes a minimally invasive forensic examination, remaining at the victim’s side throughout their hospital stay. A trained physician conducts the examination, using advanced technology and, with the patient's permission, submits collected evidence to law enforcement agencies. Throughout the process, members of the SART team place great emphasis on the victim’s well-being. NCB also offers twelve weeks of counseling to patients during their recovery, with proper referral services as a final step.
The SART program first began at NCB in 1999. The program has received accolades from physicians and law enforcement alike. NCB and all other HHC acute care hospitals are now recognized as centers of excellence for providing specialty trained sexual assault forensic examiners who are available around the clock.
HHC FACILITIES RECEIVE PATIENT SAFETY RECOGNITION
FROM LEAPFROG GROUP
HHC hospitals will be receiving two of the three 2013 Leapfrog Awards given by the Northeast Business Group on Health at their annual meeting on November 14th. Jacobi Medical Center will receive this year's award for Outstanding Performance in Patient Safety and Quality. Queens Hospital Center will receive the award for Greatest Leaps in Patient Safety. The awards are given for meeting requirements on Leapfrog patient safety measures as well as significantly improving on many of them. Measures include improved patient outcomes and reduction of the risk of medical errors and hospital-acquired infections. I know the Board joins me in congratulating the winners. These awards are further acknowledgement from the business community that HHC continues to make patient safety and transparency a priority.
TOP PERFORMER REWARD GOES TO NCB FROM JOINT COMMISSION
The Joint Commission Top Performer award for 2012 has gone to North Central Bronx Hospital, the first HHC hospital to receive this recognition. The formal release of the list of 2012 awards took place yesterday, when The Joint Commission published its "Improving America's Hospitals" annual report and announced recognized hospitals to the national and trade media. This year, the top 33 percent of all hospitals accredited by The Joint Commission were recognized, based on accountability performance data for 2012.
CARTER SPECIALTY HOSPITAL TO OPEN IN NOVEMBER
The new Henry J. Carter Specialty Hospital and Nursing Facility will open its doors to patients, residents, and staff next month. Carter, HHC's new facility in Harlem, is designed, equipped, and staffed to provide on-site specialized clinical support around the clock -- a capacity that distinguishes it from other long-term care settings that often require a patient to transfer to another facility when medical needs escalate.
As the Board knows, the move to the new 400,000 square-foot Carter facility will enable HHC to return the Goldwater site to the city for another importance purpose, and to offer state-of-the-art, technologically advanced acute care and skilled nursing services to current Goldwater residents and to the community of Harlem.
Earlier this month, Goldwater held a farewell celebration for the facility, an event attended by a number of HHC supporters and friends. Although Goldwater’s residents and patients will move to a new physical building, the comforts of the facility on Roosevelt Island will follow them to Carter, including art and music therapy, a computer lab, a patient-library, a patient-run radio station, and many other activities and special amenities.
The new facility is named in honor of Henry “Hank” J. Carter, HHC’s greatest benefactor and close friend, marking the first time HHC has named one of its public healthcare facilities for a living individual. Through the organization he founded, Wheelchair Charities, Inc., Mr. Carter has donated more than $25 million to HHC for a variety of equipment and programs for patients and residents at Coler-Goldwater.
MAJOR MODERNIZATION PROJECTS PROCEED
At the same time that we are opening the Carter Hospital, progress continues on the Corporation’s major modernization projects at Harlem Hospital Center, Gouverneur Healthcare Services, and Lincoln Medical and Mental Health Center.
- At Harlem Hospital Center, the Mural Pavilion is largely complete and the critical care units and operating rooms are occupied. The new Emergency Department is in the very final stage of completion. This project includes a special program to promote and foster community employment within targeted areas around the hospital. To date, 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 Emergency Department is complete, the Mural Pavilion will represent a new state-of-the-art pavilion on Lenox Avenue and will serve as the centerpiece of the campus-wide modernization. The Emergency Department is scheduled to be occupied in December 2013.
- At Gouverneur Health, the new clinic areas and renovations on eight floors are completed and occupied. Construction is in progress on five additional floors and scheduled for occupancy by early 2014. The lower floors house expanded ambulatory care services, and the upper floors house the long-term care services. When the upper floors are complete, the nursing home capacity will increase from 210 to 295 beds. The entire project, including the first floor and exterior, is scheduled for completion in February 2014.
- At Lincoln Medical and Mental Health Center, a renovation and expansion of the facility’s Adult Emergency Department, Pediatric Emergency and Trauma Services should be completed by late December 2013.
HHC FACILITIES REACH OUT TO PATIENTS DURING
NATIONAL DEPRESSION SCREENING DAY
Held annually in October during Mental Illness Awareness Week, National Depression Screening day (NDSD) raises awareness and screens people for depression and related mood and anxiety disorders. The Office of Behavioral Health facilitated this screening across 12 sites on October 10th. This event allowed our Departments of Psychiatry to provide vital community outreach by distributing educational material and resources, performing screenings and making referrals to treatment.
The total number of individuals who attended NDSD across all 12 sites was 886. The total number of individuals who completed Depression Screening across all 12 sites was 578. The total number of follow-up appointments scheduled as a result of the screening was 85.
In HHC primary care practices that are recognized as Patient-Centered Medical Homes, depression screenings are completed on a regular basis using the PHQ9, a 9-question survey. For patients with chronic illness such as diabetes, asthma or heart failure, depression can be a formidable barrier to the patient engagement that can enable more effective management of chronic disease. By more effectively identifying and treating depression as part of primary care, we address an important, but sometimes neglected, dimension of our patients’ overall health. More recently, across HHC the Collaborative Care Model is used to treat depression. This includes a physician, nurse and care coordinator working with a psychiatrist to advise and coach the team to provide coordinated care within the Primary Care Clinic.
On October 17, the Senate and House passed legislation to fund the Federal government through January 15, which ended the shutdown, and lifted the debt ceiling by allowing the Treasury Department to continue borrowing until February 7.
The two houses also agreed to appoint budget conferees to negotiate a potential agreement on budget parameters by December 13. The House and Senate passed budget resolutions for Federal Fiscal Year 2014, but a conference committee was never formed. There is little common ground in the budget resolutions passed by each house therefore an agreement in the next 6 weeks is unlikely.
While this short-term fix gives Congress some additional time to deal with the debt limit and Federal funding, the debate will return to the forefront in just a few months. Congress may once again target hospital reimbursement rates for cuts, either during deficit reduction talks, or to pay for a Medicare "doc fix" at the end of the year.
If implemented, proposed cuts would generate losses to HHC, over a ten-year period, as follows: Graduate Medical Education - $215 million, Indirect Medical Education - $626 million, Hospital Outpatient Departments - $187 million, and an additional Medicaid Disproportionate Share Hospital cut in 2023 of $495 million. A cap limiting provider tax to 3.5% (New York's rate currently is 5.25%) would result in an estimated loss to HHC of $688 million over ten years.
HHC, the Greater New York Hospital Association, the Hospital Association of New York State and the American Hospital Association continue to urge rejection of any additional hospital cuts. HHC participated in an American Hospital Association advocacy day in Washington on October 29th.
A new regulatory concern was the promulgation by the Centers for Medicare and Medicaid Services (CMS) of the "two midnight rule." The rule states that a patient that does not stay in an inpatient setting for at least two midnights would not be considered an inpatient admission for Medicare purposes. The two-midnight policy, which went into effect on October 1st, deems stays of less than two midnights, with some rare exceptions, inappropriate for inpatient admission reimbursement.
The entire hospital industry is united in opposition to this change. HHC's preliminary estimates show losses of between $23 million and $38 million a year if the rule is not revised. Indeed, revenue from about 16% of HHC's inpatient admissions is jeopardized as a result of this new policy.
NURSING EXCELLENCE AWARDS HONORS HHC NURSES
FOR REMARKABLE SERVICE
Last week, HHC honored six nurses during its second annual Nursing Excellence Awards. The nurses were recognized for providing outstanding service to patients, the community and their colleagues, while demonstrating excellence in leadership, improvement of patient outcomes, education, teamwork and community service.
These nurses have gone beyond their daily routines to be positive leaders and mentors for other nurses, implement programs and processes to improve patient care, and volunteer their personal time to provide medical services to communities in New York City and abroad.
For the first time this year, HHC also presented the Nursing Champion award to a person who has demonstrated outstanding support for HHC nursing. The recipient of this award is someone we all know very well from her work on our Board, Josephine Bolus, RN, MS, CNP, APRN-BC. As a Board member, Mrs. Bolus is instrumental in advocating for patients and nurses. She challenges nurses to be active both professionally and politically, and insists on using quality resources to deliver exceptional patient care. HHC and nursing could not ask for a more dedicated and inspired champion than Mrs. Bolus and she sets a standard that future winners will be challenged to meet.
I would like to extend my congratulations and thanks to all of the winners for the skill, commitment, and compassion we see from them each day. And to the 8,000 nurses at HHC -- men and women who provide care each day to New Yorkers in our public hospitals, long-term care facilities and health centers across the five boroughs -- thank you for your dedication to excellence.
HHC COMMUNITY MOURNS THE PASSING OF
PATIENT ADVOCATE CARRIE THOMAS
Carrie Thomas, a long-time advocate for our patients in the Harlem community, died this month at age 100. For many decades, she was a staunch supporter of Harlem Hospital Center and the Renaissance Diagnostic and Treatment Center. Carrie Thomas has been a constant figure of the Harlem Hospital Auxiliary for decades and was President from 1987-90. She was also a member of the Renaissance Community Advisory Board for decades.
Carrie's personal history continually showed her commitment to the African American community and to fellow New Yorkers. She was a champion and friend to politicians and artists of the Harlem Renaissance. She worked at the NYC Parks Department as the first African American employee, working directly for Robert Moses. She knew and worked with many leaders during the better part of the twentieth century. More recently, she was an important advocate for “saving” the important WPA murals housed at Harlem Hospital, and for mural restoration. She will be greatly missed. A memorial service will be held at Harlem Hospital center auditorium on Saturday, November 9, at 12 noon.
HHC IN THE NEWS HIGHLIGHTS
HHC Shows Sandy Repairs at Bellevue, HHC President Alan D. Aviles, Bellevue Executive Director Steve Alexander, 10/24/13(Also covered by NY1, WABC, FOX, WCBS)
Sandy One Year Later: Hospitals Addressing Problems From Flooding, HHC President Alan D. Aviles, Bellevue Executive Director Steve Alexander, NY1, 10/26/13
HHC supports breast cancer walk, HHC President Aviles, WABC-TV, 10/20/13
Affordable Care Act Workshops Held at North Central Bronx, News 12 Bronx, 09/24/13
Sian Green's Departure, Bellevue Hospital, WABC, 09/26/13
Lincoln Hospital Awards, News 12 Bronx, 09/26/13
Breast Cancer Awareness Month, Dr. Sydney McCalla, Lincoln Hospital, News 12 Bronx, 10/01/13
Patient Navigator, Harlem Hospital, ABC Nightline, 10/02/13
Touring Daniel Dromm’s Council District, Elmhurst Hospital, NY1, 10/04/13
Breast cancer survivors at Kings County Hospital receive surprise performance from Brooklyn Symphony Orchestra, News 12 Brooklyn, 10/09/13
Miss USA 2012 Gets Flu Shot, Queens Hospital, Fox 5, 10/10/13
Take Care NY, Bellevue Hospital, WABC, 10/10/13
SART Program, North Central Bronx Hospital, NY1, 10/15/13
Touring Mathieu Eugene's Council District, Kings County Hospital, NY1, 10/11/13
Busca concientizar a la comunidad latina acerca del Alzheimer, Lincoln Hospital, NY1 Noticias, 10/15/13
Latino Community Conference, HHC, News 12 Bronx, 10/15/13
NY hospitals shift focus to preparing facilities for future superstorms, HHC President Alan D. Aviles, Modern Healthcare, 10/26/13 (Also covered in The New York Times, Crain’s Health Pulse, Crain’s NY Business, Live Science, CBS News)
Before the Next Storm, Bellevue, Senior Vice President, Information Technology, Corporate Chief Information Officer Bert Robles, Robert Wood Johnson Foundation, 10/29/13
Crain’s Health Care Symposium asks: 'Can Brooklyn be cured?', HHC President Alan D. Aviles, Brooklyn Daily Eagle, 10/24/13
Time for Staten Islanders to 'Commit to be Fit', HHC, Staten Island Advance, 10/07/13
Letter to the Editor: The Long, Long Wait for Mental Health Care, Dr. Ruth Gerson, Dr. Jennifer Havens, Bellevue Hospital, The New York Times, 10/06/13
Big Boost For Sandy-ravaged Water Street, HHC, New York Post, 09/27/13
Feeling Down? Coney Island Hospital To Offer Free Depression Screening & Counseling Tomorrow, Sheepsheadbites, 10/09/13
New York Federal Court Rules Public Hospitals Are Exempt from State Labor Laws, HHC, Health Law Policy Matters, 10/22/13
New York City's Health Care Budget Burden, HHC, The Epoch Times, 10/09/13
Golden offers free flu shots to senior citizens, Coney Island Hospital, Brooklyn Daily Eagle, 10/16/13
Tips to Prevent and Manage Bullying, Dr. Muhammad Wasseem, Lincoln Hospital Emergency Pediatrician, The Bronx Free Press, 09/25/13
Commit to be Fit!, By Milton Nunez, Executive Director, Lincoln Hospital, The Bronx Free Press, 10/09/13
Harlem icon Carrie McHenry Thomas passes, Harlem Hospital, The New York Amsterdam News, October 24-30, 2013