|Manhattan Annual Public Meeting
Harlem Hospital Center
October 30, 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 also want to thank our host Dr. John Palmer, Executive Director of the Harlem Hospital Center, and I want to acknowledge the presence of many of our senior staff from our Manhattan facilities and from central office.
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 Manhattan facilities specifically.
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 Manhattan, we have three acute care hospitals, Bellevue, Harlem and Metropolitan Hospital Centers and two diagnostic and treatment centers – Renaissance Health Care Network Diagnostic and Treatment Center and Gouverneur Healthcare Services. We also have two long-term care facilities Coler-Goldwater Specialty Hospital and Nursing Facility and Gouverneur Healthcare Services. They offer quality healthcare to residents of Manhattan and all New Yorkers by a talented team of healthcare professionals whose expertise is not only recognized in New York City, but across the nation.
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
Manhattan, our acute care facilities have achieved particularly outstanding performance ratings in providing care for patients who present with heart attack, heart failure or pneumonia and in preventing infections in patients who undergo surgery.
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. In 2006, Bellevue’s Medical ICU went all year without a single case of ventilator-associated pneumonia and went nine months without a case of a central line blood stream infection. Harlem has gone seven months without a single case of ventilator-associated pneumonia.
In addition to their work in reducing hospital-acquired infection, each of our facilities has now implemented rapid response teams to bring critical care resources to the bedside of patients outside the ICU when patients show telltale signs that elevate their risk of a cardiac arrest. Again Bellevue has led the way as the first of our facilities to implement rapid response teams hospital-wide during this past year. As a result, the number of out-of-ICU cardiac arrests is down significantly at Bellevue for the year. Several of our other facilities are beginning to see similar results.
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 will be creating new ones in our other acute care hospitals as well. 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.
Earlier this year, Metropolitan Hospital Center created a Department of Pain Medicine and Palliative Care which is led by a physician board-certified in palliative medicine. The inter-disciplinary team at Metropolitian provides palliative care consultation service 24 hours a day, 7 days a week and operates an outpatient palliative care and pain management clinic.
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 Manhattan 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.
The 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 have 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 child health clinics as a much better alternative to a hospital emergency room.
Expansion of Services at the World Trade Healthcare Center
The WTC Environmental Health Center has now expanded from its original site at Bellevue Hospital in Midtown Manhattan to two new locations: Gouverneur Healthcare Services and Elmhurst Hospital Center. Under the direction of Dr. Joan Riebman at Bellevue, the two new sites will treat those experiencing health problems as a result of exposure to dust and smoke from the WTC attack. The expanded WTC Environmental Health Center is a resource for all New Yorkers affected by 9/11 related health conditions, regardless of insurance or immigration status. The Center was established in 2006; though Bellevue has been treating WTC-affected patients since the 9/11 attacks. The expansion will allow the WTC Environmental Health Center to treat up to 20,000 patients over the next five years.
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 many Take Care NY events and other community health events in our Manhattan facilities this month 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. And HHC’s smoking cessation clinics and services here in Manhattan 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.
Studies continue to show that African American men over 50 die from colon cancer at much higher rates than other groups. We were able to get Wesley Autrey, the 51-year-old Harlem resident who became New York City's "Subway Hero" to be HHC’s spokesman during Colon Cancer Awareness Month this past March. He joined us in urging New Yorkers to take charge of their health by getting screened and set an example for others by undergoing his first colonoscopy here at Harlem Hospital.
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 1500 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.
HHC hospitals have been leaders in the AIDS field. This year the HHC Lifetime Service Award in HIV was presented to Dr. Fred Valentine, who has spent his career at Bellevue and NYU, including more than 25 years of research in HIV/AIDS. Dr. Valentine and his colleagues were the first to identify a patient with AIDS-related pneumonia at Bellevue in 1980; it was this case and others that followed that led to the recognition in the United States that a frightening new infectious disease, later to be called AIDS, had emerged.
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 and both especially afflict our African-American and Hispanic communities.
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.
All our facilities in Manhattan are fully engaged in treating asthma by following best clinical treatment standards, ensuring that primary care physicians prescribe the most effective asthma medications and create a customized asthma action plan for each patient. Education and outreach to the community also play a major role.
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 is another chronic disease that reflects deep healthcare disparities. Diabetes is the leading cause of kidney failure, adult blindness, and lower extremity amputation, and a prime contributor to heart disease and stroke. Residents in the areas most affected by diabetes, which includes the Harlem community, 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.
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 services, including diagnostic screenings, stress tests, cardiac catheterization, pace maker implantation, angioplasty, surgery and other services are available within HHC.
Earlier this year, Harlem Hospital hosted a conference at the New York Academy of Medicine entitled "Closing the Gap in Stroke Disparities." The conference focused on the disproportionate stroke burden among African Americans and Hispanics and explored evidence-based approaches for the treatment and prevention of stroke.
The Harlem Hospital Stroke Center has a multi-year Stroke Initiative to provide screening services and educate the community to recognize stroke symptoms. One of its most successful programs to date has been the Hip Hop Stroke Program, which has been presented to over 1500 elementary school-aged children, to educate them about lifelong healthy habits that prevent stroke and to teach them how to recognize stroke symptoms. Hip Hop Hall of Fame artist Doug E. Fresh is an enthusiastic spokesman for the program. Dr. Olajide Williams, Associate Director of Neurology at Harlem Hospital and Director of the Stroke Center, was instrumental in developing this innovative and effective program with the National Stroke Association.
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 Manhattan have seen consistent decreases in wait times and rates of patients who fail to keep their appointments since we began this work. Metropolitan and Harlem Hospitals have reduced their waiting time in some primary care clinics by 56% and 52% respectively over the last few years and their no show rates by 63% and 45% in the last year alone.
Our diagnostic and treatment centers in Manhattan have also seen consistent decreases in wait times and no show rates since we began this work. Renaissance Health Care has achieved a 60% decrease in wait time and a 74% decrease in no shows in the last year alone. Gouverneur has achieved a 49% reduction in wait times and an 18% reduction in no show rates.
Even as we make these improvements, we also want patients to be able to see their chosen primary care physician consistently because we know that builds 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 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 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 Manhattan, we have active vibrant affiliation partnerships with the Columbia College of Physicians and Surgeons, New York University School of Medicine and New York Medical College that are greatly valued by the patients and the staff at our hospitals.
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 expended just over $27 million for new buildings, equipment, and renovations, including the construction at Bellevue Hospital Center of a new MRI Center and the WTC Environmental Health Center. We also funded a new Pharmaceutical Robotic System at Metropolitan Hospital Center. At Gouverneur Healthcare Services we financed the WTC Environmental Health Center expansion and the acquisition of a new digital X-Ray Unit.
We have invested nearly $28 million in other capital projects that have been or will be completed in fiscal year 2008. This includes new critical care patient monitors, an echo lab system and digital radiology/fluoroscopy system at Harlem Hospital. At Bellevue, we have already purchased two 64-slice CT Scanners and, at Metropolitan, we will begin renovation of the Geriatric Outpatient Clinic and the Geriatric Inpatient Center as well as complete the design and begin the construction of a new Comprehensive Psychiatric Emergency Program (CPEP).
An additional $337.6 million is currently budgeted for capital projects at our Manhattan facilities that are scheduled for completion in FY 2009 or later, including the relocation of the WPA Murals when the new Harlem Hospital Center construction is completed.
AWARDS AND RECOGNITONS
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 Manhattan continue to demonstrate their excellence in information technology. In 2006, the Generations Plus/Northern Manhattan Network, including Harlem and Metropolitan Hospitals, 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.
Metropolitan Hospital Center was honored with the New York State Organ Donation Medal of Honor for this year. This award is only given to 11 hospitals in the region, all of which have maintained more than a 75% consent rate for organ donors in the last 12 months.
Bellevue Hospital was one of ten hospitals chosen by the Robert Wood Johnson Foundation to participate in a national program that seeks to improve healthcare quality offered to patients with limited English proficiency. Bellevue was awarded $60,000 to provide technical assistance and training for quality improvement measures in their language programs.
I also want to salute Dr. Hawthorne Smith, co-Director of Clinical Services at Bellevue/NYU Program for Survivors of Torture, who was named Hero of 2006 by the Robin Hood Foundation. Dr. Smith will receive a $50,000 grant for the program which helps survivors heal from the physical and psychological trauma of torture, as they build new lives.
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. Although I have focused on many positive achievements across our system, we know that we are not perfect. This meeting affords us an opportunity to hear constructive criticism from the public that we serve and we welcome your suggestions on how we might better meet the needs of our communities. I look forward to hearing your comments tonight.