|Manhattan Annual Public Meeting
Bellevue Hospital Center
Tuesday, December 16, 2008, 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 want to thank our host Lynda Curtis, Senior Vice President, South Manhattan and Executive Director, Bellevue Hospital Center.
Let me start by acknowledging the strong support that HHC enjoys from the Mayor, our elected officials, community boards and patients. Without this support, our system would not have been able to accomplish many of the things I will highlight this evening; and would not be able to successfully overcome the challenges on the horizon.
Finally, I want to thank Charlynn Goins who recently stepped down as HHC Board Chair after four years of extraordinary leadership. We are fortunate to have as the new Chairman of the Board, Dr. Michael A. Stocker, a family practice physician, healthcare policy expert, and retired senior health plan executive, who was appointed by Mayor Bloomberg in September.
Before Mr. Levy calls upon tonight's speakers, I would like to provide an overview of some of HHC's accomplishments over the past year and, more specifically, highlight the achievements of our Manhattan facilities.
First, however, in light of the financial turmoil and uncertainty widely reported in the news media, I want to summarize what we know about the effect the unfolding economic crisis has had on the state and city budgets and the potential impact on HHC.
A special session of the New York State Legislature convened on November 16th produced no agreement on Governor Paterson's proposed state budget reductions. The Governor had proposed a $1.8 billion proposed cut in Medicaid spending that would have cost HHC $168 million - $46 million in the current state fiscal year, which ends on March 31, and $122 million in the coming state fiscal year.
As the Governor announced today in issuing his proposed budget, the state's deficit through the coming fiscal year is now expected to reach $15.4 billion, and to total $51 million over the next three years. The Governor's budget proposals to close that gap include significant cuts that will exact a heavy toll on the funding of HHC's hospitals, health centers, and nursing homes. We are still calculating the full impact of the state budget, but there is no doubt that we may face very serious challenges going forward.
Another area of concern for HHC is the city budget, which is dependent on income tax revenues that will be significantly reduced. HHC has already received a targeted reduction of $2.4 million for the current year; and $4.7 million in reduced funding for next fiscal year, and last week, a further reduction in city funding to HHC -- totaling another $6.5 million in fiscal year 2010 and intended to continue in future years - was announced.
In light of the City and State cuts, I have put in place a series of cost-containment strategies, which include a hiring freeze and other actions that are intended to help us meet the new fiscal realities, and we are committed to take additional actions that may be necessary if conditions worsen. Whatever the future holds, HHC will seek the support of our communities and local elected officials as we advocate for the essential services we must continue to provide.
Given the current financial climate, our work to reduce expenses and improve efficiency is more critical than ever. Over the past few years, HHC has successfully undertaken various initiatives to improve our supply chain management - ensuring that we leverage our size to purchase high-quality products, in a timely way, at the lowest possible cost. We will move ahead with more of these initiatives in the coming year. We will also continue to take a hard look at our day-to-day operations, to develop ways to be more efficient and reduce waste without sacrificing patient care quality.
Now let me turn to some of our accomplishments over the last year, starting with our transparency initiative. Last year, as part of our Quality Transparency Initiative, HHC became the first hospital system in New York to disclose publicly a wide range of quality and patient safety performance measures on our public website. We are committed to sharing meaningful clinical data with the public because that level of public accountability helps to build trust with our communities and to drive performance improvement. Both are essential to remaining competitive during fiscally challenging times.
On our web site, www.nyc.gov/hhc, you can see that our hospitals and nursing homes compare well to state, regional, and national standards on a number of important quality measures. Here are some noteworthy examples relevant to the borough of Manhattan:
- Bellevue, Metropolitan, and Harlem Hospitals
outperformed the majority of hospitals in the New York City metropolitan
area and the majority of hospitals in the nation in complying with best
clinical practices in the treatment and prevention of both heart attack
and heart failure.
- Metropolitan Hospital also outperformed the
majority of hospitals in New York City and the nation in optimizing the
use of antibiotics to prevent surgical infection.
- Gouverneur Healthcare Services surpassed the
majority of nursing homes in New York State and in the nation in its
successful management of its residents’ pain.
- Coler-Goldwater’s record of preventing both falls and pressure ulcers in its nursing home residents is considerably better than averages for all other nursing homes in New York State.
A few words about patient safety -- patient safety is an HHC priority of the highest order. Our goal is to make HHC one of the safest healthcare systems in the nation by the end of the year 2010, and we have made steady progress toward that goal.
This year, we started two important programs to reduce medical errors. The first is the use of surgical safety checklists in our operating rooms to reduce the risks of complications and death in surgery. HHC is the first hospital system in New York City and among the first in the nation to implement such an exacting process for confirming adherence to crucial safety precautions, based on the recommendations of the World Health Organization.
We also implemented the Colors of Safety program in our hospitals and long-term care facilities, which uses standardized color-coded wristbands to quickly communicate patients' high-alert medical conditions and help prevent medication errors, allergic reactions, and falls.
Another major focus has been the aggressive reduction of various types of hospital-acquired infections. Our critical care teams have implemented practices that sharply reduce ventilator-associated pneumonia and central line-associated blood stream infections. Since 2005, we have achieved a 55 percent reduction in the rate of central line bloodstream infections and a 78 percent reduction in the rate of ventilator-associated pneumonia among adult patients in our intensive care units.
In addition to progress in preventing hospital-acquired infections, the 2007 data posted on HHC's web site show that our system-wide mortality rate continued to stay below relevant national benchmarks. Overall, the system-wide mortality rate for HHC hospitals decreased by 11 percent from 2003-2007, resulting in roughly 1,350 fewer patient deaths over that period of time.
SMOKING CESSATION, COLON CANCER SCREENING, AND EXPANDED HIV TESTING
Beyond patient safety, we continue to promote broadly accessible and robust primary and preventive care as a means of improving the health of the communities we serve. Our system-wide efforts to promote smoking cessation, colon cancer screening, and expanded HIV testing have produced significant and measurable benefits for our patients.
Over the past three years, we have helped more than 25,000 patients to quit smoking successfully. Research suggests that at least one-third of these patients, or about 8,000 former smokers, will avoid smoking-related disease and premature death as a result.
We also continue to focus heavily on cancer screening, performing more than 90,000 mammograms and 165,000 cervical cancer screenings last year. We also performed more than 20,000 colonoscopies, considerably more than twice the number performed just four years ago.
New York remains the epicenter of the HIV/AIDS epidemic in the United States, with the highest number of AIDS diagnoses in country. Among people under 65, HIV is the third leading cause of death in NYC.
An estimated 25,000 New Yorkers – one in four people living with HIV – do not know they are infected. This is why we have aggressively pushed for HIV testing to be a more routine part of care across our emergency departments, inpatient units, and many outpatient clinics.
This past year we tested more than 160,000 people for HIV, a 20% increase from the previous year’s total. In fiscal year 2008, more than 44,000 people were tested in our Manhattan facilities: including more than 11,800 individuals at Bellevue Hospital; more than 6,000 individuals at Gouverneur Healthcare Services; more than 11,500 individuals at Harlem Hospital; and more than 9,500 individuals at Metropolitan Hospital.
HHC facilities do much more than testing to address the HIV epidemic. Our 11 acute care hospitals are also Designated AIDS Centers and offer specialized HIV care to all New Yorkers, regardless of ability to pay or immigration status. We treat 19,000 HIV/AIDS patients annually — roughly 20 percent of the nearly 100,000 people known to be living with HIV/AIDS in New York City.
BEHAVIORAL HEALTH / CHRONIC DISEASE MANAGEMENT
HHC facilities also provide a very significant portion of hospital-based inpatient and outpatient mental health services in this city. In fact, 40 percent of the city’s inpatient psychiatric care is administered by HHC’s facilities. Because we run the majority of our City’s psychiatric emergency departments, we also care for a large percentage of New Yorkers with serious and persistent mental illness, as well as people with substance abuse problems, who often suffer mental disorders as well.
People with mental illness and/or substance abuse problems often suffer from chronic diseases such as diabetes, hypertension, and congestive heart failure. Therefore it is important that we better coordinate the delivery of care between our mental health and primary care services.
For this reason, depression screening is now a more routine part of our primary care services. In fiscal year 2008, we screened 72,000 patients across our system, and, because we know that untreated depression can be a significant impediment to engaging patients in the management of their diabetes and other chronic diseases, we will look to increase that number again this fiscal year.
The incidence of diabetes in New York City has doubled over the past ten years and is still growing, and HHC has nearly 50,000 patients with diabetes who are receiving primary care at our facilities. The medical and financial implications of poorly controlled diabetes for these patients and their families are enormous. Diabetes is the leading cause of kidney failure and adult blindness, as well as amputation of extremities. It also is a major contributor to heart disease and stroke. Our recent significant reduction in prescription medication fees for very low-income patients should help to lower an obvious barrier to medication compliance for patients with diabetes who generally take several prescription medications each month.
All chronic diseases, such as asthma, diabetes, congestive heart failure, and depression, disproportionately impact the diverse communities served by HHC. In light of this, HHC collaborative learning teams have spent the past three years working to develop and implement best practices to help our patients manage their chronic disease more effectively.
EXPANSION OF SERVICES FOR 9/11 VICTIMS
Last year, HHC's World Trade Center (WTC) Environmental Health Center expanded from its hub site at Bellevue Hospital to two new locations: Gouverneur Healthcare Services in Lower Manhattan and Elmhurst Hospital Center in Queens. More than 3,000 individuals are under care for 9/11-related illness at these sites. Evaluation, comprehensive medical treatment, and most medications for 9/11-related illnesses are provided at no cost to those who qualify.
In September, the Centers for Disease Control and Prevention (CDC) awarded HHC a three-year, $10 million per year grant to provide medical examinations, diagnostic testing, referral and treatment for residents, students, and others in the community that were directly affected by the dust and debris from 9/11. This is the first allocation of federal funds to support treatment of those adversely affected by the 9/11 attacks who were not rescue and recovery workers.
Also in September, we began a $5 million marketing campaign to promote awareness of the WTC Environmental Health Center. The campaign, which featured ads in multiple languages, was developed in close conjunction with community members and 9/11 health advocates. As part of the campaign, 10 community-based and other organizations received $2.1 million in grants to conduct outreach to hard-to-reach groups, host educational forums, conduct health fairs, and provide patient navigation services to improve access to care.
HHC OPTIONS PROGRAM
Our efforts to reduce health disparities through clinical initiatives would be futile if we did not also ensure that patients have access to care regardless of their ability to pay. This past year, revisions to the eligibility standards of our HHC Options program made healthcare and medications more affordable, accessible, and inclusive for very-low-income New Yorkers. Among other actions, we eliminated all outpatient fees for pregnant women and children of families with incomes below 250 percent of the federal poverty level, even as we maintained heavily discounted fees for families with incomes up to four times the federal poverty level. For patients at the lowest income levels, we have reduced our already modest prescription drug fees – to a mere $2 – to further lower barriers to medication compliance. Informational materials regarding the HHC Options program have been translated into the twelve languages most commonly spoken by our patients.
DEVELOPMENTAL CARE AND BREASTFEEDING
HHC’s 11 hospitals delivered more than 23,000 babies in 2007. We treat a disproportionate number of the City’s high-risk pregnancies and, last year, more than 5,500 babies required treatment in our neonatal intensive care units (NICUs). In these units, we are reengineering the environment to minimize stress factors and maximize comfort and developmental support, evidence-based measures that have been shown to improve survivability and outcomes for fragile infants born very prematurely.
We also committed to improving the health of the babies born in our facilities by promoting breastfeeding of newborns through educating expectant mothers about the health benefits of breastfeeding and actively supporting successful breastfeeding post-delivery. We have discontinued the formerly routine practice of distributing free formula samples and formula marketing materials to all mothers. We do, of course, make formula available to mothers who cannot or who choose not to breastfeed.
The percentage of new mothers who are discharged exclusively breastfeeding their well infants rose to 34 percent during the past fiscal year, and it is our goal to reach 50 percent by the end of this fiscal year.
Even as we address how to better meet the needs of our patients and families as a new life begins, we are also grappling with doing a better job toward life’s end. Over the course of the past year, we have allocated dedicated funding to support the deployment or strengthening of palliative care services at all HHC acute care hospitals. This past year, about 1,500 patients received palliative care services across HHC, opting for closure with family and friends in greater comfort. This coming year we expect that number to increase as our palliative care services, supplemented by contracted home hospice services, mature further.
To ensure that HHC is positioned to meet the needs of the next generation of New Yorkers, we have continued our ambitious capital program and have systematically rebuilt much of our aging infrastructure, created therapeutic environments that better support the practice of modern medicine and enabled the use of technology to realize better outcomes for our patients.
During Fiscal Year 2008, we invested approximately $38 million dollars for new equipment and upgrades to our Manhattan facilities. We have also invested more than $35 million in capital projects in Manhattan that are in progress or are scheduled for next fiscal year; and approximately $530 million for projects – including the modernization of Harlem Hospital and Gouverneur -- to be completed in FY 2010 or later.
JOINT COMMISSION SURVEY RESULTS
The Joint Commission is a national organization that surveys, accredits, and certifies more than 15,000 health care organizations and programs in the United States, and weighs these organizations’ commitment to meeting nationally established standards on organizational quality, safety-of-care issues, and the safety of the environment in which care is provided.
In calendar year 2008, The Joint Commission conducted accreditation surveys of six HHC facilities including Bellevue and Coler-Goldwater. All achieved successful survey results and unconditional accreditation.
Our system also gained special national recognition from the Joint Commission this year. In October, the Joint Commission and the National Quality Forum applauded our commitment to make our quality and safety data transparent to the public, and presented the John M. Eisenberg Patient Safety and Quality Innovation Award to HHC.
And, in another noteworthy recognition of our entire system, the Commonwealth Fund, a national private foundation that advocates for a high performance healthcare system, published a comprehensive case study about HHC as part of its series on high performing healthcare systems in the United States. The case study praises the improvement initiatives we have undertaken in recent years and the measurable performance improvements that we have achieved.
HHC is a better organization today than it was just a year ago. We are better at providing access to the people who need us; better at rendering evidence-based care to patients in comfortable, technologically advanced settings; better at keeping patients free from harm in our facilities; better at informing the public about our quality of care and where we need to improve. We are also better at providing linguistically and culturally competent care; better at helping patients become partners in the maintenance of their own health. And, we are better at preparing to face our challenges next year and in the years to come.
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 and our labor partners; the contributions of our volunteers and auxiliaries; the steadfast support of Mayor Bloomberg and our elected officials; (PAUSE) and, of course, the compassion, creativity, and commitment of the men and women who staff our health centers and hospitals in Manhattan and the HHC facilities throughout our city.
Thank you for your attention and your support of our public hospital system. I look forward to hearing your comments.