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 hosts Dr. Ann Sullivan, Senior Vice President of the Queens Healthcare Network and Tony Martin, Executive Director of Queens Hospital Center. Another member of HHC's executive leadership team here in Queens is also with us, Chris Constantino, the Executive Director of Elmhurst Hospital.

l want to acknowledge 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 formidable 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 Stocker, a family practice physician, healthcare policy expert, and senior health plan executive, who was appointed by Mayor Bloomberg in September.

Before we hear from tonight's speakers, I will provide an overview of some of HHC's accomplishments this past year and, more specifically, highlight a few of the achievements of our Queens facilities.

However, at the outset, In light of the financial turmoil and uncertainty widely reported in the news media, let me 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 31st and $122 million in coming state fiscal year. The state's budget deficit for the coming fiscal year is now expected to reach $15 billion, and the Governor's upcoming budget proposals to close that gap will undoubtedly include significant cuts that will exact a heavy toll on the funding of HHC's hospitals, health centers and nursing homes.

Another 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 in city funding for the current year; and $4.7 million in reduced funding for next fiscal year. These cuts are likely the first installment of reductions in city funding, given the fiscal challenges that the City will have to address.

In an increasingly uncertain financial climate, our initiatives to reduce expenses and improve efficiency are 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 the way we operate day-to-day, 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. High performance and public accountability are essential to remaining competitive during fiscally challenging times. We are committing to sharing meaningful clinical data with the public because we think it builds trust with our communities and helps us to drive performance improvement. 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.

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:

• Elmhurst hospital performs better than the majority of hospitals in the United States on all 11 federal quality performance indicators related to the treatment of heart attack and heart failure, as well as the two performance indicators related to the prevention of surgical infection.

• Queens Hospital outperforms the majority of hospitals in the nation and the majority in the NYC region on the federal performance indicators related to the prevention of surgical infection. Queens Hospital also has one of the lowest mortality rates in the HHC system.

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.

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 percent increase from the previous year's total. In fiscal year 2008, Elmhurst Hospital tested more than 16,000 individuals and Queen Hospital tested nearly 12,500.

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.

HHC facilities 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 routine part of our primary care services. In fiscal year 2008, we screened 72,000 patients across our system. We will look to increase that number by 50 percent this fiscal year and to screen virtually all of our patients in primary care who have diabetes. We know that untreated depression can be a significant impediment to engaging patients in the management of their diabetes and other chronic diseases.

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.

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.

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 last 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 $18 million dollars for new equipment and upgrades to our Queens facilities, including the new six-story cancer center at Elmhurst Hospital. We have also invested more than $12 million in capital projects in Queens that are in progress or are scheduled for next fiscal year; and approximately $52 million for projects in Queens to be completed in fiscal year 2011 or later.

The Joint Commission is a national organization that surveys and accredits more than 15,000 health care organizations and programs in the United States, assessing these organizations' commitment to meeting nationally established standards on quality, safety-of-care, 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 Queens Hospital Center - all of which achieved successful survey results and unconditional accreditation.

Our system also gained a very special recognition from the Joint Commission this year as well. In October, the Joint Commission and 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 and, of course, the compassion, creativity, and commitment of the men and women who staff our health centers and hospitals in Queens 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.