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, Angelo Mascia, Executive Director of Sea View Rehabilitation Center and Home, and Peter Wolf, Senior Vice President of our Southern Brooklyn and Staten Island Health Network.

I would like to especially acknowledge the support that the HHC nursing homes, health centers and hospitals enjoy 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 will not be able to successfully overcome the challenges on the horizon.

Finally, while she is not here this evening, 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 of Directors, Dr. Michael A. Stocker, a family practice physician, healthcare policy expert and accomplished 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, including those made in Staten Island, and to outline some of the investments we will make over the next two to three years to improve Staten Island residents' access to healthcare.

Across our entire system, we are working to provide safer care that prevents unnecessary harm to our patients, to provide effective care that better manages chronic disease, and to provide preventive care that averts disease or that diagnoses disease at an early stage. Our success on these fronts - which has received both local and national recognition -- speaks to the commitment of our staff to our mission and to our patients.

However, before I go further describing HHC's successes, I want to briefly summarize what we know about the effect the massive changes in the economy have had on the state and city budgets and the potential impact on HHC.

To ensure the state's fiscal stability in response to the national economic downturn and the subsequent loss of jobs and revenues from the tumult on Wall Street, the state must close a new $1.5 billion shortfall for the current fiscal year. The Governor has asked the Legislature to develop plans to cut $2 billion from the current fiscal year, which ends in March 2009, to bring spending in line with revenues. The state budget gap for next fiscal year is estimated to be $12.5 billion. It is anticipated that one way the state will seek to achieve the necessary reductions will be to reduce Medicaid funding, the major source of funding for HHC's hospitals, health centers and nursing homes.

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. 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, the importance of our initiatives to reduce expenses and improve efficiency is more critical than ever. For example, over the past few years, and with great success, HHC has undertaken multiple initiatives to improve our supply chain efficiency - ensuring that we procure and obtain high-quality products, in a timely way, at the lowest possible cost. 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.

Public accountability and high performance are critical during fiscally challenging times. Our commitment to data transparency to drive performance improvement is evidenced by our Quality Transparency Initiative. Last year 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.

The information includes data reported to the federal government on how often HHC facilities follow best clinical practices in treating heart attacks, heart failure and pneumonia, and in preventing surgical site infection; how well HHC nursing homes are doing in providing quality care, including preventing falls; and how HHC hospitals and nursing homes fare against established state and national benchmarks.

We also 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.

Public and healthcare industry response to HHC's disclosure of performance information on our transparency Web pages has been strongly positive. In fact, last month we were selected by the National Quality Forum and The Joint Commission as the recipient of the prestigious Eisenberg Award in Healthcare Innovation for our transparency work.

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. Sea View has done very well on each of the three standards related to nursing home care.

Specifically:

• Pressure ulcers among Sea View's high risk patients decreased to 4 percent from 8 percent the prior year. In fact, Sea View's rate of pressure ulcers is better than the national average of 12 percent, the New York State average of 14 percent and the HHC average of 12 percent;

• Only 1 percent of Sea View's short-stay nursing home residents reported moderate or extreme pain within 7 days of admission for the time period from July through September 2007, decreasing from 2 percent for the prior year. Sea View's rate was considerably better than the national, New York State and HHC averages of 4 percent, 3 percent and 3 percent, respectively; and

• Sea View also achieved a dramatic decrease in the rate of falls to 5.3 percent for the period of April through June 2007, from a rate of 10.4 percent in the previous quarter. Sea View's prevalence of falls among its residents was significantly lower than the New York State average of 15.7 percent and lower than the HHC average of 5.9 percent.

In fact, Sea View has been honored for its achievements. The Joint Commission for the Accreditation of Healthcare Organizations named Sea View a 2007 recipient of the 11th annual Ernest Amory Codman Award. This award recognizes excellence in patient care quality and improved patient outcomes. Sea View was the only 2007 winner in the long-term care category and the first such facility to receive the Codman Award in the past five years.

Patient safety is HHC's highest priority. Our goal is to make HHC one of the safest healthcare systems in the nation by the year 2010, and I am pleased to say that we have made steady progress toward reaching that goal.

Our patient safety initiatives have contributed to a steady reduction in patient harm and preventable deaths, even as the number of patients we serve has increased over the past years.

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 among surgical patients.

We have also implemented the Colors of Safety program in our hospitals and long-term care facilities; the program includes the use of standardized color-coded wristbands to visually communicate patients' high-alert medical conditions and help prevent medication errors, allergic reactions and falls.

The Joint Commission on the Accreditation of Healthcare Organizations surveys, accredits and certifies more than 15,000 healthcare organizations and programs in the United States, and measures 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 -- Bellevue Hospital Center; Coler-Goldwater Specialty Hospital and Nursing Facility; Harlem Hospital Center; North Central Bronx Hospital; Queens Hospital Center and Woodhull Medical and Mental Health Center - all of which achieved successful survey results and unconditional accreditation. In his overall summary, the survey team leader said that "HHC was among … the best healthcare organizations reviewed by the Joint Commission."

Sea View Rehabilitation Center and Home, as well as Coney Island, Kings County and Lincoln hospitals will be surveyed by the Joint Commission in 2009. I am confident that all will do well.

Across our system, and in partnership with the New York City Department of Health and Mental Hygiene and Mental Hygiene, we have increased our efforts to prevent or detect early the diseases that disproportionately effect many low income New Yorkers. Our efforts to promote smoking cessation, colon cancer screening, and expanded HIV testing have produced significant and measurable benefits for our patients and New York communities. Last year, we increased participation in our smoking cessation program for the third year in a row, enrolling roughly 23,000 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 expect to enroll about 23,000 smokers in cessation programs again this year.

We also continue to focus heavily on cancer screening, performing more than 90,000 mammograms and 165,000 cervical cancer screenings last year. Last year, for the third year in a row, we also performed more than 20,000 colonoscopies, considerably more than twice the number performed just four years ago. As a result, we are more often detecting colon cancer at an earlier stage when the prognosis is better. Equally important, we have removed pre-cancerous polyps from nearly 14,000 patients over the past five years and we know many of these patients would have gone on to develop colon cancer.

In fiscal year 2008, we funded the Women's Outreach Network to conduct 691 mammograms on Staten Island. We have also made funding available to the two hospitals on Staten Island for cancer screening when we engage in a city-wide campaigns directed at prevention and early detection.

Our efforts to reduce health disparities 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 financial assistance program or Options made healthcare more affordable, accessible and inclusive for uninsured 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. We are promoting our HHC Options Program broadly with communication material that has been translated into the twelve languages most commonly spoken by our patients.

To ensure that HHC is positioned to meet the needs of the next generation of New Yorkers, we continue to move forward with our capital program to provide therapeutic environments that support the practice of modern medicine and to make available technology that facilitates better outcomes for our patients.

On Staten Island, our capital program has included not only expenditures for improvements at Sea View, but also investments in expanding access to ambulatory care services for the borough's low-income residents. During fiscal year 2008:

• Patients' beds were replaced throughout Sea View;

• Sea View's campus roadways were resurfaced;

• Extensive capital renovations were made to the Community Health Center of Richmond site at 235 Port Richmond Avenue. Specifically we have spent nearly $1 million to add 3,000 square feet of exam rooms and other program space. This investment will enable the health center to nearly double its capacity to provide primary care to adults and children; and

• A mobile medical unit was purchased and fully equipped at a cost of $308,000. The mobile medical unit will provide 4,000 primary care visits annually on Staten Island.

Our unwavering commitment to increasing access to healthcare for all New Yorkers extends to all of New York City. Over the past three years, we have made significant progress toward our commitment to increase uninsured and low-income Staten Island residents' access to health care. Specifically we have:

• Continued to subsidize the operations of the Community Health Center of Richmond (CHCR) with more than $4 million in expense funding in fiscal year 2008. HHC subsidized more than 90 percent of the health center's operating budget this past year. This level of support does not include the capital funding provided to the Center to double its capacity, nor the extensive amount of HHC staff resources spent providing technical assistance to the Center's Board and administration;

• Extended through December 2008, the Staten Island Health Access (SIHA) program, which was a temporary program, or “bridge,” between the Community Health Center of Richmond's establishment, receipt of federal designation, and expansion of visit capacity. More than 6,600 individuals have participated in the SIHA program since its inception; as of September 30th, 2,089 people have been enrolled in public health insurance programs through this program and more than 2,000 people (who are not eligible for public health insurance) have received healthcare services through the program. In fiscal year 2008, HHC spent nearly $2.5 million on the SIHA program;

• Continued to fund the Institute for Behavioral Research (IBR), a Staten Island-based provider of services for persons with disabilities. IBR has received funding for providing diagnostic consultation and training services to HHC clinicians who are treating patients who may have complex psychiatric, psychological and developmental conditions; and

• Funded the Women's Outreach Network to conduct mammograms on Staten Island.

We will continue to invest in expanding healthcare access on Staten Island. Over the next two years we will implement a $16 million plan that includes:

• Adding adult medicine and specialty services capacity at the Stapleton and Mariners' Harbor clinics;

• Fully implementing our mobile medical unit. The mobile unit will provide a full range of primary care and select specialty services in five locations throughout the borough;

• Implementing an affordable pharmacy program for uninsured Staten Island residents served by our programs through contracts with Staten Island-based retail pharmacies. What patients pay will be consistent with our HHC Options Program;

• Continuing to provide financial support to the Community Health Center of Richmond;

• Expanding access for some radiology services at Sea View for patients of the mobile medical unit and the Mariners' Harbor and Stapleton clinics; and

• Continuing to work with Staten Island clergy and community-based organizations to develop effective and responsive outreach programs and to design our future programs so that the most vulnerable borough residents are assured access to healthcare.

In addition, by 2011 and 2012 we anticipate opening two comprehensive diagnostic and treatment centers, which will offer primary care, dental services and an array of specialty and diagnostic services. One of the centers will be located at 155 Vanderbilt Avenue, a facility purchased in June 2007; the other will be at 51 Stuyvesant Place in the fully renovated District Health Center building.

Over the past several years, there have been many individuals who have attended these Annual Public Meetings and have spoken about the need for affordable senior housing. As many of you know, in fiscal year 2007, the HHC Board of Directors approved a long-term lease with the Arker and Domain companies for the conversion of the Nurses Residence on Sea View's campus into 104 apartments for seniors. It is my understanding that applications for the apartments are available and occupancy is expected to begin in January 2009. HHC is pleased to have been able to contribute toward the development of this important opportunity for the borough's seniors.

In October, the Commonwealth Fund, the national private foundation that advocates for a high performance healthcare system, published a comprehensive case study about HHC that praises the improvement initiatives we have undertaken. The report recognizes that HHC has become a "provider of choice" and has achieved higher levels of performance through our clinical information systems, our work to improve chronic disease management, our effective clinical collaboratives, our efforts to secure financial health, and our continued commitment to expand access and create a patient-centered healthcare system.

HHC is a better organization 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.

As I mentioned earlier, these achievements 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 Mayor Bloomberg and all our elected officials, and, of course, the hard work, commitment and creativity of the men and women who staff our health centers, nursing homes and hospitals throughout our city.

Thank you for your attention and your support of our public hospital system. I look forward to hearing your comments tonight.