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.  First, let me acknowledge our hosts, Angelo Mascia, Executive Director of Sea View Rehabilitation Center and Home, and Arthur Wagner, Senior Vice President of our Southern Brooklyn and Staten Island Health Network.  I want to thank them and the other senior staff from our Staten Island facilities and from our central office who are here tonight for the work that they do on behalf of the patients and communities that we serve. 

Before Mr. Levy calls upon tonight’s speakers, I will provide a brief overview of the challenges HHC is facing as well as our plans for addressing those challenges.  I will also highlight some of HHC’s accomplishments over the past year, particularly those that relate to our work in Staten Island.

FINANCIAL CHALLENGES/HHC ORGANIZATION-WIDE RESPONSE

Let me begin with the financial challenges going forward.  Some in this room may have heard me, Mr. Mascia, or Mr. Wagner speak about the large financial deficits HHC faces in the years immediately ahead.  Those projected deficits are the result of a kind of perfect storm that began with the national financial downturn and the enormous -- and still growing -- New York State budget deficits that have resulted in deep cuts in State Medicaid reimbursement to every HHC facility.  And even as our Medicaid and other revenue sources are decreasing, the costs of prescription medications, medical equipment and other supplies, as well as the fast-growing cost of pensions and other guaranteed employee benefits, are rising alarmingly. 

In addition, the faltering economy led to some reductions in City support for HHC and, compellingly, as unemployment in the City has risen, we have seen an increasing number of patients with no health insurance who are seeking care in HHC facilities.  In 2008, we served 450,000 uninsured patients, an eight percent increase from 2007.  And the number of uninsured coming through our doors continues to rise. 

And there is more.  HHC receives two forms of supplemental Medicaid payments:  upper payment limit (UPL) payments which cover shortfalls in Medicaid fee-for-service payments; and disproportionate share hospital (DSH) payments that cover shortfalls in Medicaid fee-for-service and Medicaid managed care payments and the costs of treating uninsured patients.  These supplemental payments to HHC facilities have averaged $1.4 billion annually over the past few years.  Starting next year they are reduced by $500 million annually.

As I said, all of these factors together amount to a financial storm of unprecedented magnitude.  As it stands now, in our next fiscal year, which begins in July 2010, projected expenses across HHC will exceed projected revenue from all sources by about $1 billion.  And this extraordinary budget deficit would get even worse in the following years.

We cannot just sit back and let this crisis unfold, and we have already taken a number of steps to address our projected budget deficit.  Working with facility leadership we have identified various ways to cut costs and to legitimately increase billing revenue.  We project that these measures, which include an ongoing hiring freeze, will save us about $200 million system-wide this year and about $300 million next year. 

As encouraging as these cost-cutting and revenue-generating efforts have been, they are not sufficient to fully address the financial challenges we face.  We will, of course, continue to advocate strongly for more financial assistance from government at all levels to support our mission; however, we must be realistic in our expectations on this front, given the large budget deficits that both the City and the State now face.

And, realistically, we cannot look to healthcare reform to solve our financial dilemma.  While we still hope that Congress will pass healthcare reform legislation that will expand coverage for the uninsured, all of the pending health reform bills would -- long-term -- significantly reduce the supplemental Medicaid and Medicare funding for HHC and other public hospitals across the country.   For HHC, this would mean the further loss of hundreds of millions of dollars in federal funds that cover the costs of serving uninsured patients – including undocumented immigrants who will not be covered by federal healthcare reform.

Given these harsh realities, HHC recently engaged a consulting firm to help us think through how we might restructure our large system for greater efficiency and to better position HHC facilities to compete in a post-healthcare reform environment.  This restructuring plan, once complete, may mean, for example, that some services that are now available at several HHC facilities will need to be consolidated to fewer locations.  However, we are going to strive to ensure that whatever changes we need to make are as fair as possible, and that we retain the capacity to meet the range of healthcare services that our patients across the City need.  We remain fully committed to further developing our ambulatory care infrastructure in Staten Island. 

And, whatever else may change, we are firmly committed to the tenets of HHC’s mission: to serve all patients without regard to their ability to pay or their immigration status.   

TRANSPARENCY AND PATIENT SAFETY

Let me now turn to some of our recent accomplishments across the HHC system and here in Staten Island.  In 2007, through our Quality Transparency Initiative, we became the first hospital system in New York State to make public HHC’s performance data related to quality of care and patient safety.  This type of public accountability and high performance are particularly critical during fiscally challenging times.  On our Web site, www.nyc.gov/hhc, under the heading HHC In Focus, you can see that our hospitals and nursing homes compare well to state, regional, and national standards on a number of important quality measures.

This past year, we have continued to expand the type of quality data that we share publicly on our internet web site.  For example, this year we posted to our web site for the first time the results of federally-mandated patient satisfaction surveys at each of our hospitals.  The results for HHC hospitals are encouraging, with our average patient satisfaction scores exceeding the scores of most New York City hospitals. 

In 2009, Sea View performed well on each of the three standards shown on the site related to nursing home care.  First, the rate of pressure ulcers among Sea View’s high risk patients, 6.3%, is well below the national average of 13.2%, and New York State’s average of 14.2%.  Second, pain was well controlled for 88% of Sea View’s short-stay nursing home residents within seven days of admission, again better than national and New York State averages.  Finally, Sea View’s fall rate among its residents, 5.1%, is significantly lower than national and State averages of 13.2% and 10.8% respectively. 

JOINT COMMISSION SURVEY AND OTHER OUTSIDE EVALUATION RESULTS

These are not the only measures that show how well Sea View performed last year. As you may know,  the Joint Commission surveys and accredits more than 15,000 healthcare organizations and programs in the United States.  It measures these organizations’ commitment to meeting nationally established standards on organizational quality, patient safety, and the safety of the environment in which care is provided. Four HHC facilities, including Sea View, were visited this year, and all achieved successful survey results and unconditional accreditation. 

In August, Sea View also received a deficiency-free rating from the New York State Department of Health during an Article 28 survey.  And in December of 2008, Sea View received the highest rating available, five stars, for quality from the Centers for Medicare and Medicaid Services.   All of this performance data is a tribute to the excellent care provided by staff here at Seaview.

CAPITAL INVESTMENTS

Turning to capital investments, to ensure that HHC is positioned to meet the needs of the next generation of New Yorkers, we continue to move forward to provide therapeutic environments that support the practice of modern medicine and to make available technology that facilitates better outcomes for our patients. With the strong support of the Mayor and the City Council, HHC continues to expand access to primary care services for the residents of Staten Island.  A total of $5 million in capital projects have been recently completed or are under way, and we have $12.75 million of projects in the design and development phase. 

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.  Capital funds have been committed for the purchase of mammography and sonography equipment, which will be housed at Sea View, to further expand access to radiology services for our family health center and Mobile Medical Office patients.  We anticipate that these services will be available in 2010.  We are also in discussions with the New York City Office of Management and Budget concerning a major modernization project at Sea View.   

In addition, $1.6 million of renovations funded by HHC have been substantially completed at the Community Health Center of Richmond, our critically important primary care delivery partner.  These renovations will double the Center’s capacity to provide primary care services to adults and children.  In addition to our capital investments, HHC has provided more than $7.8 million in funding to help subsidize the Center’s operations since 2006.  And beyond our financial support, HHC staff members have offered extensive technical assistance to the Center’s Board and Administrative staff.

HHC’s INVESTMENTS IN HEALTHCARE IN STATEN ISLAND

Our work with the Community Health Center of Richmond is just one example of our commitment to increasing access to comprehensive primary care for uninsured and low-income Staten Island residents.   This year, we made additional investments in support of that commitment.

We added Adult Medicine capacity at the Mariner’s Harbor Family Health Center in November of 2008 and at Stapleton Family Health Center in June of 2009.   Since then we have provided a total of 1,828 adult medicine visits at these two HHC facilities. 

To provide additional access to primary care services for adults, in April, we launched the HHC Health Connection Mobile Medical Office, or MMO. The MMO is staffed by a doctor, a registered nurse, a patient care associate, and a financial counselor.  With a patient reception area, two exam rooms, an electronic medical records system, and modern diagnostic equipment, the MMO offers primary care services five days a week in five Staten Island communities -- New Brighton, Tottenville, Midland Beach, Concord, and Park Hill.  At each of these locations, we have partnered with local community-based organizations that offer additional social and other support services. 

Staten Island residents who are patients at Mariner’s Harbor, Stapleton or the MMO who require specialty care and/or diagnostic services are provided these services at Coney Island Hospital.  We have developed a convenient shuttle service to and from Coney Island hospital for our patients.  In addition, routine radiology services are available at Sea View.

Another example of HHC’s commitment to ensure access to health care for Staten Island residents is our continued grant funding of the Jewish Community Center, or JCC, for the provision of facilitated health insurance enrollment services.  From July of 2008 through June of 2009, as a direct result of HHC’s funding, JCC assisted 867 Staten Island residents to obtain public health insurance coverage.   As a result of HHC’s grant funding to JCC, which began in 2005, more than 3,100 Staten Island residents have gained health insurance coverage.     

I am also pleased to report that as of March 1, 2009, the Community Health Center of Richmond is a federally qualified health center.  During the time that the Center was waiting for this designation, HHC developed and funded (in the amount of $6.6 million) the Staten Island Health Access (SIHA) program, which served more than 6,600 people.  Once the Center received federal designation, HHC worked to ensure the smooth transition of SIHA participants to HHC’s Family Health Centers, the MMO and the Community Health Center of Richmond through intensive outreach and education in partnership with community-based organizations including Project Hospitality, El Centro del Inmigrante, Make the Road New York, the African Refuge, and JCC. 

HHC will continue to work with our community-based partners to develop ongoing outreach strategies to ensure that the borough’s most vulnerable residents have access to healthcare.  As part of that commitment, we are extending our grant funding of JCC through June of 2010, to provide ongoing public health insurance enrollment assistance, and continued outreach to former SIHA participants who are not yet linked to primary care. 

HHC continues to develop services that address the emerging health care needs of our patients.  In response to the high incidence of diabetes among our Staten Island patients, we have submitted a Certificate of Need (CON) application to launch a second MMO to provide ophthalmology and podiatry services. We anticipate that these services will be implemented in the first half of 2010.

SENIOR HOUSING

We are pleased to have contributed to the development of senior housing on the Sea View campus.  Park Lane at Sea View, which opened in June 2009, is the first of its kind on Staten Island.  An empty landmarked Nurses’ Residence and cottage were transformed into 104 well appointed and affordable apartments.  

We look forward to continuing our collaboration with City Council Minority Leader James Oddo and the New York City Housing and Preservation Department (HPD) to develop for re-use other existing unused buildings on Sea View’s campus. 

COMMITMENT TO LOCAL COMMUNITY 

HHC’s work in Staten Island goes beyond providing primary and long-term care services. We are also committed to facilitating other organizations’ missions to provide services to Staten Island residents with special needs. This year, by making buildings or space available on Sea View’s campus, we have enabled non-profit organizations such as Amethyst House Inc., Camelot Counseling Centers, and the Grace Foundation to provide much needed services to their clients.  Amethyst House Inc. will operate a residential program for women recovering from alcohol and substance abuse; Camelot Counseling Centers will provide residential treatment for chemical dependency for young male adults; and the Grace Foundation will offer recreation and social skills development programs for individuals with Autism.

As an organization, HHC has always prided itself on its deep connection to our communities and our success in providing healthcare access to community members that would otherwise be underserved.  On that note, I was especially pleased this year that HHC received the Builders of New York Award from the New York Immigrant Coalition, an umbrella policy and advocacy organization of more than 200 groups in New York State that promotes fairness and opportunity for immigrants and refugees.  We were cited specifically for our significant innovations in expanding access to care for immigrants, including our financial assistance policies that provide deeply discounted fees for the uninsured, our comprehensive communications assistance for limited English proficiency patients, and our strictly enforced confidentiality policies that afford new immigrants a sense of security in accessing needed care.

H1N1 

Before I bring my remarks to a close, I’d like to talk briefly about one thing that’s on everyone’s mind – the flu.  From the beginning of the H1N1 outbreak last spring, HHC has played a critical role in the city’s coordinated emergency response and preparedness efforts.  We took immediate steps to ensure patients received the care that they needed, despite drastically increased patient volume in our emergency departments and many of our primary care settings.   

While the supply of both seasonal and H1N1 flu vaccines continue to fall short of demand, we are working to provide vaccinations as efficiently as possible through our primary care clinics, as well as through our 11 designated Flu Shot Centers across the five boroughs.  Our designated Flu Shot Centers in Staten Island include Stapleton Family Health Center, and the five MMO locations.  In October, HHC’s family health centers and the MMO provided nearly 1,400 flu vaccinations to Staten Island residents.  More than 900 community residents have received the flu vaccine at Sea View each year for the past two years.  In addition, 70% of Sea View’s staff have also received the flu vaccine over the past two years.

We have been fortunate that our communities across the city are not yet experiencing the high levels of flu activity that many parts of the United States have seen in recent weeks.  But the number of patients presenting with flu symptoms are beginning to go up, and we continue to monitor the situation closely.

We are proud of the way our dedicated staff handled the flu-related challenges they faced last spring, especially here at Sea View.  We have every reason to believe that our staff will meet the challenges of this flu season equally well.

CLOSING REMARKS

Even more than in years past, the achievements that I have mentioned this evening would not have been possible without the collaboration 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 other elected officials; and, of course, the compassion, creativity, and commitment of the men and women who staff our health care facilities in Staten Island and the other HHC facilities throughout our city. 

As noteworthy as these achievements are, I must close by coming back to the significant challenges that lie ahead for HHC.   I want to assure you that we will do what is necessary to meet those challenges.  And we will be open and honest with our communities about whatever changes are necessary going forward.  With your support, in meeting the challenges we face on the road ahead we will become stronger, more efficient, and more effective in meeting the needs of our patients and communities. 

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