|Bronx Annual Public Meeting
Lincoln Medical and Mental Health Center
October 29, 2007, 6:00pm
Remarks by Alan D. Aviles
President, NYC Health and Hospitals Corporation
Good evening. I am Alan Aviles, President of the New York City Health and Hospitals Corporation (HHC). Thank you all for coming tonight. I look forward to hearing from those who have signed up to speak, but, first, let me also recognize and thank our host Jose R. Sanchez, Executive Director for Lincoln Medical and Mental Health Center and Senior Vice President of the Generations+/Northern Manhattan Health Network.
Before Mr. Levy calls on tonight’s speakers, I would like to provide an overview of some of HHC’s accomplishments over the past year and more specifically, highlight a few of the achievements of our Bronx facilities.
HHC is the largest municipal health care system in the country. We serve 1.3 million New Yorkers, including nearly 400,000 uninsured individuals, and provide a broad array of medical, mental health and substance abuse services through our 11 acute care hospitals, four skilled nursing facilities, six large diagnostic and treatment centers and more than 80 community based clinics. We also provide health services at home for many New Yorkers.
In the Bronx we have three acute care hospitals, Jacobi Medical Center, Lincoln Medical & Mental Health Center and North Central Bronx Hospital, two large neighborhood family health centers, the Morrisania Center and the Segundo Ruiz Belvis Center, and several smaller community-based health centers, all of which provide quality healthcare to residents of the borough.
Across our entire system, we are working to provide safer care that prevents unnecessary harm to our patients, to provide more effective care that better manages chronic disease, and to provide more preventive care that averts disease or that diagnoses disease at an early stage. Our success on these fronts – which has increasingly received both local and national recognition -- speaks to the commitment of our staff at all levels to our mission and to our patients.
In September, HHC became the first healthcare system in the state of New York to voluntarily disclose certain detailed quality and patient safety data to the public. The information we are sharing includes our mortality and hospital-acquired infection rates; how often we follow best clinical practices in treating heart attacks, pneumonia, and
other medical conditions; and how well our nursing homes are doing in providing quality care. This data is available on our public website which is nyc.gov/hhc.
On our website, you can see that our hospitals and nursing homes compare well to state, regional, and national standards on a number of important quality measures. In
the Bronx, our acute care facilities have achieved particularly outstanding performance ratings in providing care for patients who present with heart attack, heart failure or pneumonia.
Apart from showcasing some of our very positive results in rendering high quality care, I am convinced that our commitment to transparency related to quality and patient safety data will help drive further improvements throughout HHC. The information on our website effectively provides a baseline from which the public and we, ourselves, can measure our performance over time. Openly sharing this information may leave us open to criticism in some areas, but it helps to build trust and confidence in our commitment to continually make the care we render as safe, effective, efficient and patient-centered as possible.
Before the end of this year, we will release data to the public on our efforts around prevention and early detection of disease, as well as data on how well we are doing in helping our patients better manage their chronic diseases such as diabetes and asthma.
I have stated publicly that it is our goal to make HHC one of the safest healthcare systems in the nation by the year 2010. In recent years, critical care teams from across our system have taken steps to sharply reduce ventilator-associated pneumonia and central line-associated blood stream infections. Both types of infection increase the risk of death for fragile ICU patients in particular. During the past year the majority of our hospitals went several months in a row without a single case of ventilator-associated pneumonia or a central line infection in their ICUs.
Lincoln’s medical ICU had the second lowest rate of central line blood stream infection in our system and went nine months without a single ICU patient experiencing a hospital-acquired blood stream infection. Lincoln also had one of the lowest rates of ventilator-associated pneumonia among its ICU patients and went six months without a case of hospital-acquired pneumonia in its medical ICU and its surgical ICU.
As important as it is to avert unnecessary physical harm to patients, it is equally important to prevent the unnecessary suffering and anguish that too often accompanies the last weeks and days of life for terminally ill patients in our ICUs. Many patients facing certain and imminent death want high-tech interventions continued to the very end, no matter how invasive or futile, and that is their right. Others, however, would choose differently if given the choice.
Over the past year, we have been expanding two successful palliative care programs for terminally ill patients at Coney Island and Bellevue hospitals, and we are creating new ones in our other acute care hospitals, including those here in the Bronx.
As a result, HHC patients and their families who face the end of life will soon have access to expert comprehensive palliative care that includes effective pain control, psychological and emotional comfort and support, advanced care planning and the possibility of home hospice care. In every case, the paramount concern will be to offer patients the opportunity for lucid closure with family and friends.
Lincoln now has a palliative care team that includes three physicians board certified in palliative care and the team has provided palliative care consulting services to more than 200 patients and their families so far this year.
EXPANDING ACCESS TO CARE
Even as we serve those in the community who become ill, suffer injury, or are unable to take care of themselves at home due to disabilities or advanced age, we are very focused on expanding access to preventive and primary care services that keep the Bronx communities healthy and their residents out of the hospital.
Prevention begins with access to comprehensive primary care services. HHC has long set an example of how all people, regardless of their ability to pay or their immigration status, should be served by our nation’s healthcare system. Our financial assistance program, HHC Options, assists eligible patients in obtaining public health insurance and ensures affordable discounted services to uninsured patients who are not eligible for any public insurance program.
Our HHC Options program’s deeply discounted care allows access to affordable healthcare for many uninsured working families with modest incomes. For example, a child in a family of four whose annual family income is between $51,000 and $62,000 can be seen at an HHC clinic or health center for a fee of $15 per visit. Discounted fees apply to families with incomes up to 400% of the federal poverty level – so a family of four is eligible for discounted services if their annual income is less than $81,000.
In FY 2007, HHC Options linked approximately 100,000 uninsured patients to an HHC primary care provider. During the same period, our Medicaid managed care partners, MetroPlus and HealthFirst, enrolled nearly 25,000 uninsured children in Child Health Plus and 314,000 uninsured adults in government-sponsored insurance programs such as Medicaid and Family Health Plus. HHC’s own financial counselors also assisted more than 50,000 New Yorkers in Medicaid enrollment.
Child Health Clinics
Child Health Clinics, now in their 100th year, are another important way that we provide access to healthcare and are an essential component of the City's healthcare safety net for children, regardless of their immigration status or ability to pay.
For the third consecutive year, the New York City Council is providing support to HHC to promote pediatric health initiatives, which has included interior clinic enhancements and community based outreach. The Council is also supporting a highly visible ad campaign, to be launched this month, which highlights the clinics as a much better alternative to a hospital emergency room.
Although our ability to treat ill patients is crucial, preventing people from becoming ill or detecting an illness in its early stage when it is easier to treat are equally important.
Take Care New York
October is the month for our annual Take Care New York campaign, when we provide thousands of New Yorkers with flu vaccinations and health education and screenings for diabetes, hypertension, depression, cancer, HIV infection and other serious diseases.
Although we offer screenings all year, the Take Care New York awareness activities allow us to communicate the importance of early detection and disease prevention and to help increase New Yorkers’ awareness of the importance of primary care to their health and well-being.
I encourage you all to check out the Take Care NY events and other community health events in our Bronx facilities and to take advantage of the screenings offered. While you are at it, get a flu shot, which is especially important if you are over the age of 50 or if you have a chronic disease. A complete list of Take Care NY events is posted at nyc.gov/hhc.
Keeping Infants Healthy
This year we also began wide implementation of an aggressive breastfeeding education and support program to improve infant health for the nearly 22,000 babies born in our hospitals each year. We know breastfeeding can help reduce their risk of common childhood infections, asthma, diabetes and other conditions.
In order to help promote breastfeeding, across all of our public hospitals we now exclude free baby formula samples from gift bags to new mothers, ban formula promotion materials from labor and delivery units and provide the necessary support to encourage the start of breastfeeding in the baby’s first hour of life.
Our cancer prevention, screening and early detection efforts are helping to narrow the gap of ethnic and racial healthcare disparities, and to diagnose significantly more cancers at an earlier stage when treatment is more effective and prognosis much more hopeful. In the past year, we stepped up our screening programs, performing more than 150,000 cervical cancer screenings, more than 90,000 mammograms and nearly 22,000 colonoscopies.
Here at Lincoln Hospital, nearly 80% of female patients over the age of forty received a mammogram last year. Mammograms have been specifically promoted to uninsured women through the Viva Mujer program which also emphasizes screening for cervical cancer. And men are being screened for prostate cancer through the Viva los Hombres program. Lincoln also is now performing over two thousand colonoscopies annually to detect colon cancer early.
Top notch diagnostic equipment and a full array of cancer treatment services are available across our Bronx facilities. And HHC’s smoking cessation clinics and services here in the Bronx and across the city have helped more than 70,000 smokers in the past four years to quit, reducing the risks of lung cancer for those who have successfully done so.
HIV/AIDS is still an epidemic in New York City. It is estimated that 100,000 New Yorkers are diagnosed with HIV or AIDS, and there were roughly 1,500 AIDS-related deaths last year, with 85% of them among African-American and Hispanic New Yorkers. Because an estimated 20,000 New Yorkers are infected by the virus but don’t know it, we are making HIV testing part of routine patient care. This past fiscal year we provided nearly 134,000 HIV tests – more than twice the number tested just two years ago -- and we identified more than 1,600 patients who tested positive. As a result, we have gotten many more individuals into early treatment and have helped to reduce the transmission rate even as we lessen the stigma associated with HIV/AIDS.
An innovative HIV testing program at Jacobi routinely offers HIV rapid tests to patients who visit Jacobi’s emergency department. Mandated risk-reduction education and counseling are provided through an inter-active video program displayed on a laptop computer. Patients complete an anonymous questionnaire, using a computer touch screen, and data is collected wirelessly. This innovative HIV testing program is one of the creative strategies that HHC used to increase HIV testing by more than 125% over the past two years.
CHRONIC DISEASE MANAGEMENT
Chronic disease continues to be a great threat to the health of our communities. For example, asthma and diabetes are epidemics of disproportionate magnitude in New York City. They also especially afflict the African-American and Hispanic communities. In some of our communities more than 8% of adults have asthma while more than 10% of adults have diabetes.
Alarmingly, more than 18% of New York City’s children suffer from asthma, and the disease is the single greatest health-related cause for missed school days. New York City has almost twice the rate of childhood asthma hospitalizations as the rest of the nation, and in some neighborhoods, asthma hospitalization rates for children up to age 14 are nearly four times the national rate.
The good news is that fewer children and adults are being hospitalized for asthma in the Bronx and throughout the city. However, New York City's childhood asthma hospitalization rate remains well above the national rate. In some neighborhoods, asthma hospitalization rates for children up to age 14 are nearly four times the national rate. And the Bronx has the highest number of asthma cases and rates of hospitalizations for children in the city. Rates also continue to be among the high for adults over 35.
All our Bronx facilities are ensuring that primary care physicians prescribe the most effective asthma medications and that they create a customized asthma action plan for each patient and engaging in education and outreach to the community.
This focus on patient engagement in self-management efforts and compliance with evidenced-based best clinical practices is producing positive results, especially for our pediatric patients. Across HHC’s system, asthma-related pediatric emergency visits declined by 24% and hospital admissions dropped by 30% during the past two years.
Diabetes, another chronic disease that reflects deep healthcare disparities, is the leading cause of kidney failure, adult blindness, and lower extremity amputation, and it is a prime contributor to heart disease and stroke. And residents in the areas most affected by diabetes die from their diabetes at seven times the rate of New Yorkers in the least affected neighborhoods. Overall, the percentage of New Yorkers with diabetes has more than doubled over the past ten years, and roughly 8% of all New Yorkers now have the disease.
The Bronx has some of the highest diabetes rates in the nation, and roughly 18% of the residents of the South Bronx have been diagnosed with diabetes. Women in the Southwest Bronx have rates of death from diabetes that are close to twenty times higher than women on the Upper East Side of Manhattan and are five times more likely to have preventable hospitalizations related to diabetes - hospitalizations that could have been avoided by adequate primary and preventive health care.
HHC facilities are battling diabetes on many fronts and we are committed to doubling the number of our patients system-wide whose diabetes is well-controlled by the end of 2009. This would effectively mean bringing more than 10,000 additional diabetic patients under good control and lessening their risk of life-threatening complications.
Heart disease remains a prime cause of premature death in our city and HHC provides some of the most sophisticated cardiology services in the city. Comprehensive cardiac care including diagnostic screenings, stress tests, cardiac catheterization, pace maker implantation, angioplasty, surgery and other services are available within HHC.
While each of the three hospitals in the Bronx has scored above the city and state averages on federal quality indicators for the treatment of heart attack and heart failure, Lincoln’s performance has been exceptional and earned it a Silver Annual Performance Award from the American Heart Association this past year.
HHC hospitals also have developed unique prevention and early detection programs to reach out to new immigrant communities, including South Asians, who are at greater risk of cardiovascular disease than the general population.
Over the past two years, HHC has acted to help our primary care providers recognize and treat another prevalent chronic disease -- depression. We screened nearly 55,000 patients for depression in our primary care clinics during the past year. With the help of the New York City Department of Health and Mental Hygiene, we have been training primary care providers to treat mild and moderate depression. During the next year we will treat more patients for depression than ever before, and treat many in primary care as we continue to take a more holistic clinical approach in that setting.
PATIENT CENTERED CARE
Last year, speakers expressed concern about patient satisfaction rates among hospitals in New York City and New York State. We believe our increasingly patient centered approach to care and our aggressive initiatives to redesign care delivery for patient convenience are responsive to some of these concerns. A prime example is our continuing work on ambulatory care redesign to keep our average primary care visit time down to our goal of 60 minutes or less and to make appointments more readily available when patients want them.
HHC hospitals in the Bronx have seen consistent decreases in wait times and in rates of patients who fail to keep their appointments since we began this work. For example, Lincoln Hospital has achieved a 46% reduction in wait times over the past several years and Jacobi a 60% decrease. By improving appointment availability, Jacobi and North Central Bronx also have both achieved a 70% decrease in no shows rates in the last year.
Our family health centers in the Bronx have seen consistent decreases in wait times and no show rates since we began this work as well. Morrisania has achieved a 61% decrease in wait time over the past few years and a 26% decrease in no shows in the last year alone. Segundo Ruiz Belvis has achieved a 16% reduction in wait times over the past few years and a 24% reduction in no show rates in the last year.
Our ambulatory redesign efforts are also intended to improve continuity of care. We know that when patients are able to see their chosen primary care physician consistently it helps to build a stronger doctor-patient partnership, fosters earlier detection of health issues, and helps involve patients and families in active and more effective management of chronic diseases.
Several speakers last year were also concerned about our facilities’ ability to recruit and retain nurses, in light of the nation-wide nursing shortage. I want to bring you up to date on the creative recruitment and retention efforts we have been making to face that challenge.
While as many as 1,400 nurses – 20% of the current HHC workforce – are expected to retire within the next five years, we have been able to attract nearly 600 new nurses during the past year. Creative career-ladder programs at HHC bring new talent into the profession as well as offer advancement to seasoned nursing leaders. One such program offers training to non-nursing HHC staff, encouraging them to move into the nursing field. More than 600 HHC employees currently participate in those programs and nearly 90 have already graduated and await their licenses as RNs and LPNs.
Now, with support from the City’s Center for Economic Opportunity, we will provide 300 scholarships to help low-income New Yorkers, as well as eligible HHC employees, attend a four-year program leading to a Bachelor’s of Science degree in Nursing (BSN) from Long Island University. Students will complete two years of undergraduate course work and then two years of classes and clinical practice at the nursing school at Kings County Hospital. The program will guarantee participants’ employment at an HHC facility, will expand the pool of nursing school slots, and will ultimately help us ensure that we can replace those nurses who will retire over the years ahead.
Earlier this month we reached agreement with the New York State Nurses Association on a new union contract for the next two years which will bring the starting nurses salary at HHC up to $66,000 by July 2008 and will allow us to recruit experienced nurses at a higher starting salary than in the past. This new labor agreement – which will make us very competitive in recruiting new nurses -- was overwhelmingly ratified by our nurses just last week.
Our affiliations with academic centers help ensure that we continue to bring a steady supply of professionals into our public hospital system. These affiliations specifically help us attract the brightest young physicians to public hospitals and community health centers. Here in the Bronx, HHC’s longstanding affiliation partnership with Albert Einstein College of Medicine is greatly valued by patients and staff at Jacobi and North Central Bronx.
REBUILDING OUR INFRASTRUCTURE
We continue to re-build our public system with the largest hospital capital construction and modernization in the city’s history. During the last fiscal year, we spent more than $10 million on the renovation of Jacobi Medical Center’s façade and other repair work, as well as on an electronic Fetal Monitoring System for both Jacobi and North Central Bronx Hospitals. At North Central Bronx we also funded a new digital fluoroscopy unit. And at Lincoln, we acquired a new 64-slice computerized tomography scanner.
We are committed to spending nearly $80 million in new projects at Jacobi, including the completion of the new Ambulatory Care Pavilion, as well as the establishment of a Center for Genetic Diagnosis which is being made possible with the help of New York City Council and Borough President funds. At North Central Bronx, we plan to acquire a new 64-slice computerized tomography scanner and digital mammography unit. And at Lincoln we will be funding a new women’s imaging center.
We also have allocated another $54.8 million for projects that are in the design or pre-construction phase for our Bronx facilities.
Progress continues at Lincoln Medical and Mental Health Center on the new medicine clinic annex scheduled to be completed in May 2008. The annex will have 15,000 square feet of ultra modern renovated space that will include 37 state-of-the-art exam rooms and ambulatory surgery, including an endoscopy suite. The expansion of the emergency department, which is expected to be completed by December 2009, will increase its square footage by nearly 50%. A new expanded psychiatric emergency department is part of this expansion.
AWARDS AND RECOGNITIONS
Although being able to serve our communities well is a reward in itself, our system has received a number of notable awards and recognitions over the past year. For example, we received the 2007 Public Health Community Award for outstanding contributions to outpatient psychiatric services and treatment.
The award, given to us by the Public Health Association of New York City, recognizes HHC’s Mental Health Peer Counseling and Case Management Services, which employs individuals who are at a point in recovery from their own mental illness where they can counsel others and serve as a role model.
HHC’s leading edge work in medical and information technology has received awards from top organizations. On behalf of HHC, I accepted a national Information Technology Achievement Award from Modern Healthcare Magazine and the Healthcare Information and Management Systems Society for our use of advanced clinical information technology to render safe, effective, and efficient health care to HHC’s 1.3 million patients.
The award recognized our leadership in advancing strategic goals related to public health through the use of technology, including reducing medication errors and improving health outcomes for patients with diabetes, asthma and other chronic diseases. HHC is the only public hospital system to achieve this national distinction.
HHC facilities in the Bronx continue to demonstrate their excellence in information technology. This year, Jacobi and North Central Bronx were listed among the 100 “Most Wired” hospitals in the United States by Hospitals and Health Networks, the journal of the American Hospital Association. In 2006, the Generations Plus Northern Manhattan Network, including Lincoln Hospital, won the Nicholas E. Davies technology innovation award for the successful development and use of electronic health records to improve healthcare delivery, including the implementation of electronic medication administration documentation.
The achievements that I have mentioned this evening would not have been possible without the generous guidance and advocacy provided by our Community Advisory Boards, the contributions of our volunteers and auxiliaries, the steadfast support of our elected officials, and, of course, the hard work, commitment and creativity of the men and women who staff our community-based ambulatory care centers, nursing homes, and hospitals in this borough and throughout our city.
Thank you for your attention and your support of our public hospital system. I look forward to hearing your comments tonight.