RAMANATHAN RAJU, MD
HHC PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
July 30, 2015
Good afternoon. As customary, I will highlight just a few items from the full version of my report to the board. The full version is available to all here and will be posted on our website.
HHC Launches Redesigned Newsletter for Public; Features Staff Diversity Video
In June we launched a redesigned monthly e-newsletter entitled “Patients First.” The newsletter tells stories of New Yorkers whose lives have been changed in a positive way through the care they received at our facilities. They are living proof of our new brand promise. They are living the healthiest life possible because of our care.
The newsletter is sent to approximately 100,000 readers and is meant to both increase awareness about our work and to drive people to our website for additional engagement.
We also use the newsletter to promote MetroPlus, our extended hours and positive patient experience. HHC’s diverse workforce and our focus on cultural competency was highlighted in July’s video. Let's watch.
Strengthening Our Brand Identity
To achieve our strategic vision for 2020, we must be able to provide a positive patient experience and create an emotional connection with our patients. We must be able to differentiate ourselves from our competition and help patients choose us among many NYC healthcare choices. That means we have to work differently and also look different.
Yet our brand today lacks uniformity, consistency and does not impart the value of one strong healthcare system. We have dozens of logos. And the materials we publish vary greatly in their quality as well as their look and feel. We need to change that.
We have begun to develop a new brand direction with the help of focus groups, leadership interviews and stakeholder input. The feedback has been very positive and I will be sharing more details with the Board in September.
The ultimate goal is to help bring our brand to life with a consistent and unifying expression of our look, tone and feel across all communications platforms and our entire portfolio of brands. We want to build on the strength of our mission to care for all New Yorkers, without exception, and communicate a new brand promise that reflects our transformation, excites our stakeholders, including our workforce, and supports our growth for the future.
We want to make it easier for everyone to identify with the NYC Health and Hospitals as one strong, inspired, integrated health system – no matter if you enter the trauma center at Bellevue, visit a primary care doctor at Gouverneur, deliver a baby at Elmhurst, get a visit from one of our home health nurses, live in one of our nursing homes, or even sign up for MetroPlus.
Our new brand strategy will help us deliver a clear message that we are one unique and essential health care system that offers exceptional quality, affordable services and culturally responsive health care in every community.
The New York City Department of Health and Mental Hygiene has confirmed a cluster of at least 30 cases of Legionnaires Disease in the South Bronx since July 10th. Some of the ill individuals presented to, and were treated at Lincoln Medical and Mental Health Center.
The Department of Health is investigating and, at present, has been unable to confirm the source of the infection. So far, two cooling towers, including one at Lincoln Hospital, have been discovered to contain Legionella bacteria.
There is no evidence of any link between this tower and the Legionnaires patients Lincoln has treated. No one at the hospital has gotten sick, and we know the patients under our care contracted the disease elsewhere. In fact, the Health Department found that the cases discovered to date are not clustered around any single location. Our environmental and infection control team has begun an aggressive decontamination regimen at the Lincoln cooling tower, which will remain in operation while under careful monitoring by the decontamination team to ensure the safety of all patients and staff. Testing is being undertaken as well at other Health and Hospitals facilities in the Bronx. An ongoing regular regime of testing is being implemented system-wide.
HHC Assumes Responsibility for New York City Correctional Health
In June, a formal announcement was made by the de Blasio administration that the provision of care to patients in the NYC jail system will become the responsibility of HHC. In conjunction with the return of management of correctional health services to HHC, the City will not renew contracts with Corizon, Inc. and Damian Family Care Centers, Inc. after their expirations in December 2015 and August 2016, respectively.
As the largest public health care delivery system in the nation, and widely recognized for its quality care and services, HHC’s oversight of correctional health services will provide for greater continuity and coordination of care between hospital and jail-based health services, and access to HHC’s geographically convenient ambulatory care centers will improve continuity of care after release.
The change in management will not result in staffing reductions or layoffs for DOHMH workers. Almost 300 DOHMH employees currently working on correctional health services will transfer to HHC on August 9th. These staff provide services ranging from information technology to discharge planning and other work essential to ensuring continuity of operations during the transition. Immediately after the transfer of responsibility, HHC will begin a full review of all current staff working with the current vendors.
HHC and a host of City agencies including DOC, OLR, OMB, DOHMH and others are working collaboratively to ensure that the transition of correctional health services does not disrupt the ongoing 24/7 operations and is effectively connected to the broader HHC care network and resources to better serve this vulnerable population.
50th Anniversary of Medicare and Medicaid
I’d like to acknowledge that today is the fiftieth anniversary of the enactment of Medicare and Medicaid.
Before these statutes came into being, the need for medical care or hospitalization threatened older, disabled or the poorest Americans with the risk of destitution.
Those days are thankfully gone. And in their place, for the last half century, has been a fairer, more equitable America.
Unfortunately, Medicaid has never ceased to be controversial. Pressure exists within and without government, calling for deep reductions to the program.
Our political leadership in 1965 recognized that expanding access to care helps safeguard the public health.
We are a healthier, and a better nation as a result of Medicaid. It’s time we in the public health community rose more vigorously in its defense.
Meeting with CMS Acting Administrator Andy Slavitt
On July 16th, I met with the Acting Administrator of the Centers for Medicare and Medicaid Services, Andy Slavitt and his senior staff. LaRay Brown, Dan Wilson and Marlene Zurack joined me as we reviewed HHC’s major issues. This included an overview of our role as an essential provider. We explained how HHC serves all New Yorkers including the City’s most vulnerable populations and had cared for more than 469,000 uninsured patients last year. We discussed the challenges of HHC’s structural budget deficit and the need for timely prospective Upper Payment Limit (UPL) payments.
Mr. Slavitt asked about New York’s DSRIP Waiver. We responded that HHC is the largest Performing Provider System with more than 200 partners; and that while the waiver seeks to dramatically alter New York’s healthcare landscape for the better, DSRIP is both complex and costly to implement. Sustainability after the waiver period ends in 5 years will also be very challenging.
We also discussed how critically important the 340B Drug Discount program is to providers such as HHC. However, the 340B program is under continued threat. Mr. Slavitt acknowledged that access to expensive pharmaceutical regimens required by low income patients with conditions such as cancer, hepatitis C and mental illness were made possible by the 340B program.
Both sides thought the meeting was productive and we agreed to continue collaborating closely in the future.
Supreme Court Ruling on King vs. Burwell
In the last major legal challenge to the Affordable Care Act (ACA), the United States Supreme Court ruled last month in King vs. Burwell that the statutory language of the ACA provides federal tax credits to individuals under both state and federally run Heath Exchanges. Chief Justice John Roberts wrote the decision in the 6-3 ruling. An adverse decision would have jeopardized the future of the ACA, as only 16 states and Washington D.C. have established state run exchanges. Such a ruling would have prohibited 8 million people in the 34 states using federally run exchanges from receiving federal tax credits.
CMS Expected to Modify Two-Midnight Rule for Short Stays
In a new proposed payment rule posted this month, CMS said it plans to allow physicians to exercise judgment to admit patients for short hospital stays on a case-by-case basis. The new proposed rule seeks to address an existing two-midnight rule for short stays that would limit reimbursement for stays that do not span two midnights. Implementation of the existing rule could cost HHC an estimated $23 to $38 million in Medicare revenue each year. Fortunately, the implementation of the existing rule was delayed by Congress until September 30, 2015.
In the proposed new rule, CMS would remove oversight of physicians’ decisions from its administrative contractors and instead engage quality improvement organizations to enforce the policy. The administrative contractors, or Recovery Audit Contractors (RAC), would be directed to focus on hospitals with unusually high rates of denied claims.
The rule was conceived to address a spike in observation stays attributed to hospitals' fear that Medicare audit contractors would challenge their admissions. Many patients’ stays in skilled nursing facilities were determined ineligible for Medicare coverage, notwithstanding having immediately spent days in a hospital because their hospital stays had been billed as observation visits. CMS has found that the number of observation visits lasting more than two days has declined 11% in fiscal 2014 compared with fiscal 2013.
Medicare Reform Bills Introduced In House
Yesterday, members of the House Ways and Means Committee released bills that would change both Medicare Indirect Medical Education (IME) and Medicare Disproportionate Share Hospital (DSH) payments from per-discharge add-ons to lump sum payments. It is still too early to ascertain the impact on HHC. These bills -- the Medicare IME Pool Act of 2015 (HR 3292) and the Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act of 2015 (HR 3288) are part of a reform effort by the Committee leadership.
Also introduced was the Medicare Crosswalk Hospital Code Development Act of 2015 which would create a crosswalk that maps outpatient and inpatient codes in what appears to be an attempt to enable site-neutral payment reform. Site-neutral payments would have a negative impact on HHC. For example, the intent is to pay the same for a hospital outpatient clinic visit as for a physician office visit. At the next board meeting we should have more information on potential impact. These bills were introduced only yesterday.
City Budget Highlights
In the City Budget that was adopted last month, HHC received new expense and capital funding. This included: $137 million was added for Correctional Health in FY 16. This grows to $155 million in FY17 and $156 million in FY19.
Additional funds were added for Collective Bargaining settlements. This includes $7 million in FY16, $11 million in FY17 & 18 and $12 million in FY19.
City Council Discretionary funds of more than $150,000 were added for Lincoln’s Guns Down Life Up program and minor equipment and furniture at Gouverneur. The Council also added $1.5 million to create programs focused on increasing access to healthcare services for immigrants. We will be talking to the Council about how we might be able to tap into these funds to assist in our efforts on Health Equity.
In total, the Administration and the City Council added $23 million for Capital projects at HHC facilities. I want to thank the Administration and members of the City Council for their generosity this year. We are very appreciative of their support for HHC.
OneCity Health Update
The Master Services Agreement (MSA), the contractual document which defines the foundational roles and responsibilities for each entity participating in OneCity Health, has been approved by the OneCity Health Executive Committee. Partner-specific schedules will be developed with each Partner over the course of the next few months. OneCity Health also plans to submit its final State Implementation Plan (SIP) on July 31. The SIP is a blue-print oversight plan and represents a framework for DSRIP quarterly reporting.
OneCity Health has undertaken a meticulous analytical process to understand the operational capabilities of each Partner and identify needs and locations where gaps in the provision of service occur. Once we are fully confident in this understanding, OneCity Health will share an accurate listing of Partners on our website.
Bellevue Designated a National Ebola Training and Education Center
HHC Bellevue hospital continues to receive national recognition for its work with Ebola and other dangerous pathogens. Earlier this month Bellevue was named by the US Department of Health & Human Services as one of three medical research institutions to co-lead a new National Ebola Training and Education Center. The new Center will offer state health departments and health care facilities additional access to the clinical expertise and training capabilities offered by Bellevue and its two co-leaders, Emory University in Atlanta and Nebraska Medical Center in Omaha. Bellevue successfully treated New York City Ebola patient Dr. Craig Spencer during the height of last year’s Ebola concerns, and has isolated and investigated more than 20 suspected cases. The hospital was later named by HHS as one of 55 designated Ebola treatment centers nationally, and in June 2015 was named one of just nine national referral treatment centers for patients with Ebola or other severe, highly infectious diseases.
Coney Island Hospital Re-Dedicates New Ida G. Israel Community Health Center
On July 15, Coney Island Hospital took a huge step toward restoring healthcare services that were lost in the neighborhood during Superstorm Sandy when it cut the ribbon on the new Ida G. Israel Community Health Center.
Built with $7.5 million in resiliency funds from the Federal Emergency Management Agency (FEMA), the 13,000-square-foot facility is a new one-story building elevated to meet FEMA requirements for protection against a future storm surge. The new Center will provide the same services in adult primary care, pediatrics, dentistry, social services, family planning, behavioral health, chemical dependency and rehabilitation and Women, Infant and Child (WIC). The Center is scheduled to open in late-August, pending inspection by the State DOH, at 2925 West 19th Street, between Surf and Mermaid Avenues and across the street from MCU Park, less than half a mile away from the original location. Around 30 members of Ida Israel’s extended family attended the ceremony, along with numerous elected officials and other dignitaries.
State-of-the-Art EMR Showcased in Queens Network
Earlier this month we debuted Epic, HHC’s new electronic medical record (EMR) to all employees at Queens and Elmhurst Hospitals during the first EMR Showcase Days. During special events, staff saw Epic workflow demonstrations, explored specific areas of the EMR, and interacted with IT teams developing the system.
Under the leadership of our Information Technology Division, this important work, called HHC GO, will deliver the next generation of clinical information systems to HHC.
Our IT and clinical teams have worked tirelessly customizing an EMR already in use at the nation’s most prestigious healthcare providers, for HHC’s needs. The new HHC EMR will help ensure that our patients get what they need, when they need it. It will mean that we will spend less time looking for information, and more time delivering the quality care our patients deserve.
The new system is a prerequisite to accomplishing our 20/20 Vision strategic objectives: bringing excellence to patient experience, expanding access to care, and building our patient base.
HHC Staff Lead a Health Panel for Young Women
On Saturday, July 18, four HHC staff members led a health panel at the Soledad O’Brien and Brad Raymond Starfish Foundation’s annual Pow-HER-ful Summit. This is a full-day event giving young women from underserved communities an opportunity to learn from experts in health, finance, science, technology, engineering, and mathematics.
The Fund for HHC partnered with the Foundation to incorporate an hour-long health panel into the event. The session, titled “Here’s How: Take Charge of Your Health with HHC”, drew 250 attendees. The panelists were Jennifer Havens, MD, Director and Chief of Service, Department of Child and Adolescent Psychiatry at Bellevue; Monique Collier-Nickles, MD, Chief of Adolescent Medicine and Director of Adolescent Health Services at Lincoln; Lillian Diaz, RN, Deputy Executive Director and Chief Nurse Executive, Patient Care Services at Metropolitan; and Elet Howe, Assistant Director, Adolescent Health Program at Central Office.
The panel marked the third collaboration between The Fund for HHC and the Starfish Foundation. In the next few months, deeper collaborations between The Fund and the Starfish Foundation around adolescent health will be announced.
Increase in Funding Support for Anti-Violence Efforts
The de Blasio Administration and the New York City Council recently announced the investment of approximately $19 million to support and expand Cure Violence (CV) programs and other comprehensive, community-based strategies to prevent gun violence, such as HHC’s Guns Down, Life Up programs. This investment is about a $6 million increase from 2014.
Of the allocated grant monies, The Fund for HHC will serve as the fiscal conduit for approximately $8 million for Fiscal Year 2016, to support Cure Violence organizations and other hospital-based work aligned with Guns Down, Life Up. The Fund for HHC will soon enter into contracts with provider organizations selected by the City Council and the de Blasio Administration for their respective locations within high-violence areas and for their capability to undertake and execute violence reduction work. The Fund for HHC will oversee these fully grant-funded contracts.
Farewell to Joanna Omi
It is with great sadness that we are saying goodbye to Joanna Omi, who will be leaving us after nearly 23 years of service.
Joanna has most recently been our Senior Vice President for Organizational Innovation and Effectiveness, leading the Breakthrough operational improvement system that has been so central to us for nearly eight years. Breakthrough has brought in about $500 million in new revenue and cost savings and engaged almost 20,000 people across the corporation.
While at HHC, Joanna has brought compassion and an aura of calm urgency to the development of many firsts, including the first Federally Qualified Health Center on Staten Island. Her early work to improve access to 129 primary care clinics across HHC through the Ambulatory Care Restructuring Initiative reinforced her belief that the best ideas and solutions come from the people who are closest to the work – a prime principle of the Breakthrough system.
We wish her the very best, and we will miss her.
Program of the Month:
Healthcare Tailored to Senior Needs
NICHE and NIPCOA
Today I’m glad to call your attention to the ongoing focus on geriatric care occurring at facilities across our Corporation.
But allow me to make this note of full disclosure---It is with self-interest in mind that I highlight these efforts. I want to be absolutely forthcoming and transparent: One day -- not too soon -- but one day -- I plan on being just the kind of older New Yorker who benefits from HHC’s commitment to geriatric care. When my afternoon nap, or my bingo playing, or my square dance lesson is interrupted for care, I’ll know that the treatment I receive will the very best.
The population of older residents of New York City is growing quickly, with more that 1.1 million aged 65 or over living in the five boroughs today. Many have a hard time managing their health, and struggle every day with specialized needs caused by multiple chronic conditions. And a great many are our patients.
Through the Nurses Improving Care for Health System Elders program (NICHE), members of our nursing staff have trained in the most advanced and up-to-date geriatric care practices. NICHE is a nationally recognized, training program designed to bring the most current knowledge and skill in geriatric care to bedside nurses and hospital staff.
At HHC, NICHE designation means improving the outcomes, and the experience, of older patients.
It means we recognize that patient and family-centric care is imperative to better outcomes and experiences.
NICHE means careful consideration of the big picture, like prioritizing closer in-patient care coordination for those suffering from multiple chronic diseases.
It also means devoting a great deal of attention to specifics, like---
--- ensuring that a patient’s normal medication regimen is harmonized with whatever new or additional medications are prescribed during a hospital stay.
---monitoring nighttime lighting to facilitate rest, while still illuminating a patient’s path to the toilet.
HHC has partnered with the Hartford Institute, the geriatric arm of the New York University’s College of Nursing, to implement the NICHE program at seven of our acute care facilities, including North Central Bronx Hospital, Harlem Hospital Center, Queens Hospital Center, Lincoln Medical and Mental Health Center, Jacobi Medical Center, Elmhurst Hospital Center and Coney Island Hospital all of which have achieved NICHE “Senior Friendly” designation. This great work has been accomplished with the enthusiastic engagement of our leadership team at Central Office and at the participating hospitals.
Over the past year HHC has broadened its partnership with the Hartford Institute to bring best geriatric care practices to the ambulatory setting as well. We’ve launched a program called Nursing Improving Primary Care of Older Adults (NIPCOA), which has been awarded $200,000 by the New York Community Trust. Grant proceeds will be used to expand geriatric training to our nurses at nine HHC primary care practices serving large older populations.
Expanding best practices geriatric care to the ambulatory setting is a perfectly aligned with our efforts systems-wide to emphasize wellness and the prevention of unnecessary hospitalizations.
I’m delighted to bring the NICHE program, and its NIPCOA counterpart to your attention today, and to recognize HHC Senior Assistant Vice President for Medical and Professional Affairs and Chief Nursing Officer Lauren Johnson who has spearheaded these efforts.
Individuals of the Month:
HHC Staff Fights Ebola
We’ve talked a lot over the past year about the phenomenal work done Corporation-wide in early 2014 to prepare for an outbreak of the Ebola virus in New York City.
And the heroic efforts of the clinical team at Bellevue last October received a great deal of attention, all of it enormously deserved.
But today, I ‘m proud to take few minutes to highlight the work of HHC medical personnel who have offered care for the afflicted at Ebola’s source, in West Africa.
Over the past 18 months Dr. Julie Hoffman an attending physician at Jacobi Medical Center and Sarah Back, a Nurse Practitioner at North Central Bronx Hospital each traveled to Sierra Leone as part of medical teams assembled by Partners in Health, an international aid organization that brings the benefits of modern medical science to those most in need. Their colleague, Dr. Carol Harris, also an attending physician at Jacobi Medical Center, travelled to neighboring Liberia as part of a medical team coordinated by the international relief and development organization, Heart to Heart.
These brave caregivers spent weeks helping to educate people about the virus, curb its spread and treat those who had become ill. Carol, Sara and Julie each have impressive and long standing records of global community care.
Each have spent their careers answering the call of international relief organizations when medical knowledge and skill and compassion were needed at the scene of a health crisis.
Each have selflessly devoted their own time and resources to travel to these places of need, whether they were occurring in Haiti, or West Africa or the far Pacific.
Dr. Hoffman, who joins us tonight, spent six weeks in Sierra Leone earlier this year treating up to 40 patients at a time, in the most trying of circumstances.
It’s summer and maybe you’ve taken your family to the movies to enjoy The Avengers or The Fantastic Four, or Ant Man. But I’m hoping you’ll go home tonight, or pick up the grandkids this weekend, and tell them about real heroes, like Carol Harris, and Sara Back
…and Julie Hoffman, who I am delighted has joined us today.
HHC In the News Highlights
Hospital homecoming for Australian born prematurely in NYC, WNBC, Bellevue: Donna Hennessey, Physicians' Assistant, Neonatal ICU
Celebrating Harlem House, FOX 5, Harlem
Dangers of Synthetic Marijuana, News 12 Bronx, Jacobi: Dr. Ben Raatjes, Psychiatrist; Dr. Maryann Popiel, Chair of Behavioral Health Psychiatry
Jimmy Fallon returns to ‘Tonight Show,’ reveals hand injury was so serious 'usually they just cut your finger off', WNBC, Dr. David Chiu, Dr. Scott Reis, Hand and Plastics Surgeons
Hot weather health tips, News12 Brooklyn, Woodhull: Dr. Robert Chin, Chief of Emergency Medicine
Kings County Farmers Market, News12 Brooklyn, Kings County: Natasha Burke, Chief of Staff; Dr. David Stevens, Chief of Ambulatory Care Services
Jacobi Hospital Burn enter has worldwide recognition, NY1 News, Jacobi: Dr. Bruce Greenstein, Burn Unit Director and Attending Doctor of Department of Surgery/Plastic Surgery; Dr. Michael Touger, Medical Director, Hyperbaric Chamber
City’s Hospital system plans for takeover of Health Care for Rikers inmates, NY1 News
Program to cut premature births through specialized care to start in Queens hospitals, Daily News, Elmhurst
Prenatal Program Comes to Queens, Tribune, Elmhurst: Karen Lockworth, Director of Women and Children Services
Coney Island Hospital dedicates new community health center, Brooklyn Daily Eagle, Coney Island
Coney Island Celebrates Return of Health Center destroyed by Sandy, Sheepshead Bites, Coney Island
Health center reopens in Coney Island, Brooklyn Daily, Coney Island: Arthur Wagner, Executive Director
Bellevue named co-leader of national Ebola training center, Capital New York, Bellevue: Dr. Ram Raju, President
New Farmers Market Opening at Kings County Hospital, DNAinfo, Kings County: Dr. Ram Raju, President
Gouverneur Health Launches New Farmers Market Run by Teens, DNAinfo, Gouverneur: Dr. Ram Raju, President
New Pitkin Verde Farmers Market Debuts in Cypress Hills, DNAinfo, East New York Diagnostic and Treatment Center
HHC Urges: Get tested and know your HIV status, Harlem World. HHC
Lincoln Medical Center receives accolades for stroke care, Amsterdam News, Lincoln: Milton Nunez, Executive Director
Hospital Rates a “Gold” Award, Daily News, Kings County: Ernest Baptiste, Executive Director
HHC Kings County Hospital Center receives national recognition for excellence in stroke care, Our Time Press
For the mentally ill, a daily refuge found at North Central Bronx Hospital, Norwood News, NCBH: Dr. Madeline O'Brien, Director, Partial Hospitalization Program
City names V.P. for correctional health services, Capital New York, Patricia Yang, Dr. P.H., Senior Vice President for NYC Correctional Health Services
Denise C. Soares: Makes history at Harlem Hospital, Caribbean Life, Denise C. Soares, Senior Vice President, Generations+/Northern Manhattan Health Network, Executive Director, Harlem Hospital
Jimmy Fallon’s finger almost amputated after fall, Yahoo News, Bellevue: Dr. David Chiu, Dr. Scott Reis, Hand and Plastics Surgeons