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Public Reports and Testimonies

Queens Annual Public Meeting
Elmhurst Hospital Center
Monday, November 23, 2009

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 am, as always, pleased to be in Queens, the home borough of Elmhurst and Queens Hospitals. Since I started my HHC career here in Queens, I'd like to think it is the one venue where I have a home court advantage.

Let me start this evening by acknowledging what a difficult year this has been for Queens, in light of the still-reverberating impact of the closing of several community hospitals and the first outbreak of H1N1 influenza last spring. In responding to the demands of 2009, the senior leadership of the Queens Health Network - including, our hosts QHN SVP Dr. Ann Sullivan, Elmhurst Executive Director Chris Constantino, and Queens Hospital Executive Director George Proctor - have excelled in every way. I thank them and their staff for the exceptional work that they do every day on behalf of the patients and communities that we serve.

Before Mr. Levy calls on tonight's speakers, I will provide a brief overview of the challenges HHC is facing as well as our plans to address those challenges. I will also highlight some of HHC's accomplishments over the past year, particularly those related to our Queens facilities.


Let me begin with our financial challenges. Some in this room may have heard me, Dr, Sullivan, Mr. Constantino, or Mr. Proctor discuss the large financial deficits HHC faces in the years ahead. They 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. As Medicaid and other revenue sources are decreasing, our costs -- for prescription medications, medical equipment and supplies, and pensions and other guaranteed employee benefits, are rising alarmingly.

In addition, the faltering economy led to reductions in City support for HHC, with more on the horizon, while an increasing number of patients with no health insurance are seeking care in our facilities. We served 450,000 uninsured patients in 2008, an eight percent increase from 2007, and that number continues to rise.

And, as if those challenges were not enough, there's more. HHC receives two kinds of supplemental Medicaid payments to cover shortfalls in fee-for-service and managed care payments, and to cover the costs of treating uninsured patients. For the last few years, these payments have averaged $1.4 billion annually. Starting next year they are being reduced by $500 million.

Unless we take action to address this evolving crisis, beginning in July 2010, our projected expenses will exceed our projected revenue by about $1 billion. And this extraordinary budget deficit will only continue to grow.

Working with our facility leadership, we have identified various ways to cut costs and to legitimately increase our billing revenue. Some of this work involves operational improvements, greater efficiencies, and the reduction of waste through a process we call Breakthrough. Queens Hospital was the first HHC facility to actively adopt Breakthrough and the Queens Network remains an HHC leader in the use of this tool to work smarter and reduce expenses. We project that these measures - as well as a hiring freeze implemented in December 2008 - will save us about $200 million this fiscal year and $300 million next year.

It's an encouraging start, but it's not enough. We will continue to advocate strongly for more financial assistance from government at all levels to support our mission; however, our expectations must be realistic given the deepening City and State budget deficits.

And, unfortunately, we cannot look to healthcare reform to solve our financial dilemma. While we still hope that Congress will pass legislation that will expand coverage for the uninsured, the pending bills would -- long-term -- dramatically reduce supplemental Medicaid and Medicare funding for HHC and public hospitals across the country. For us, 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 has hired a consulting firm to help us determine how to restructure our large system for greater efficiency and to better position HHC facilities to compete in a post-healthcare reform environment.

This restructuring plan may mean that some services available at a number of HHC facilities now will be consolidated to fewer locations and this may inconvenience some patients. However, we will strive to ensure that whatever changes we make are as fair to all our facilities and communities as possible, and that we retain the capacity to provide the full range of healthcare services that our patients need.

Finally, we will remain firmly committed to HHC's mission: to serve all who come to us without regard for their ability to pay or their immigration status.


Let me now turn to some of our recent accomplishments across our system and here in Queens. In 2007, HHC became the first hospital system in our State to make public system-wide and hospital-specific performance data related to quality of care and patient safety. This past year we have expanded the quality data that we share publicly on our Internet site.

For example, we posted the results of federally-mandated patient satisfaction surveys at each of our hospitals. The results are encouraging, with our average patient satisfaction scores exceeding those of most New York City hospitals. In Queens, both Elmhurst and Queens Hospitals outscored the majority of New York City hospitals in overall patient satisfaction. Both Elmhurst and Queens Hospitals showed strong performance in the category of doctors communicating well with patients. Elmhurst also scored very well on giving instructions to patients about what to do to help with their recovery once they leave the hospital.

This year we also published data to our Web site that reflects the quality of our maternity and infant care services, an especially important area of focus for us because our hospitals deliver one out of every four babies in New York City - about 24,000 a year. And one in four of those newborns - more than 6,000 babies - begin life in Queens. Our data show that delivery is very safe in our facilities and we have extremely low maternal mortality rates, despite handling a disproportionate number of New York City's high-risk deliveries.

HHC facilities have also excelled in lowering the number of hospital-acquired infections through the consistent use of evidence-based best clinical practices in our ICUs. Our facilities have cut the rate of central line blood stream infections in half since 2005, and the rate of ventilator-associated pneumonia has been reduced by 90% during that same four-year period.

The Healthcare Association of New York State has recognized Queens Hospital Center for its work on reducing central line bloodstream infections, and holds it out as a model for other hospitals in the State. And Elmhurst has gone more than a year without a single case of ventilator-associated pneumonia in its Respiratory ICU and without a single central line infection in its Intensive Cardiac Care Unit.


Two other areas where we have made significant strides over the past year are behavioral health and chronic disease management.

HHC facilities provide nearly 40% of hospital-based inpatient mental health services in the city, and we serve a disproportionate number of New Yorkers with serious and persistent mental illness. Those who suffer from serious mental illness have life spans that are, on average, 25 years shorter than the general population, often due to concurrent chronic disease.

To address this troubling disparity, Elmhurst, Bellevue, and Woodhull hospitals are collaborating on a New York State-funded project to more effectively address the needs of patients with concomitant psychiatric conditions, substance abuse problems, and chronic health conditions. The project provides coordinated health and mental health services as well as linkage to community supports that help to reduce unnecessary and costly hospital stays.

And this year Elmhurst, which sees more psychiatric patients in its ER than any other hospital in the HHC system, opened a new Comprehensive Psychiatric Emergency Program unit, which is double the size of the old unit. The added space now allows for two physically distinct areas so that adults and adolescents may be seen separately.

We also continue to make progress in other areas of chronic disease management. On May 1, the HHC Cardiovascular Risk Registry became available at all HHC hospitals. The registry is an electronic disease-tracking program that greatly improves a doctor's ability to understand, monitor, and manage cardiovascular disease among patients. Thus far, the registry has identified more than 42,000 patients with high blood pressure and 26,000 patients with high cholesterol whose treatment is being closely monitored and better managed.

Working with our diabetes registry, our clinicians continue to improve the health of more than 50,000 diabetic New Yorkers under care in HHC hospitals. The number of diabetic patients with healthy blood sugar, normal blood pressure, and healthy cholesterol levels increased significantly from last year to this year. The Queens Health Network has been, and continues to be, one of HHC's leaders in helping patients keep their diabetes under control.

To help identify patients whose chronic ailments would be best served in primary care or home care settings rather than as inpatients, the Queens Health Network now deploys care managers to concurrently review all emergency presentations and assist ED physicians in linking patients to the most appropriate level of care. In addition, care managers connect emergency department patients who would benefit from home care to a home care nurse who is posted to the ED.


I was especially pleased this year that HHC received the Builders of New York Award from the New York Immigration 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 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.

A couple of specific initiatives are worth mentioning. In response to the large number of its patients from Southeast Asia, several years ago Elmhurst started an acupuncture clinic as part of its approach to pain management. This year that clinic treated almost 750 patients. And to treat adolescents and young adults with sickle cell anemia, Queens

Hospital has started a Sickle Cell Registry, and instituted a support group that meets every other week. Next month, the Queens Health Network will host an interdisciplinary conference that will include a panel of patients who will provide input on ways to improve coordination of sickle cell care.

As I've noted, Elmhurst and Queens staff members did an outstanding job supporting the community and meeting patients' needs following the closing of Parkway Hospital Center last year and St. John's and Mary Immaculate this spring. Both hospitals ramped up staffing in the Emergency Department and outpatient clinics. Despite increased patient loads - which includes a 36% increase in emergency department visits at Queens Hospital over the last year - both facilities kept length of stay the same or decreased it, while keeping quality and safety standards high.


Turning to capital investments, despite the economic challenges, our hospital modernization program continues to create modern, comfortable high-tech therapeutic environments supporting better clinical outcomes. Those here tonight who remember the old Queens Hospital know how important our modernization efforts are to patients and staff alike.

A total of $37.2 million in capital projects have been recently completed or are under way in our Queens facilities. This year Elmhurst opened its new cancer center, the Hope Pavilion, a state-of-the-art diagnostic and treatment facility. And Queens Hospital is in the process of adding 40 new inpatient beds to better accommodate the needs of Southeastern Queens.

Most recently, in September, SDOH awarded HHC and the Queens Health Network more than $20 million to expand and regionalize cardiovascular and other related specialty services, expand Labor and Delivery services capacity at QHC, support a new Women's Pavilion at Elmhurst, and expand the Geriatric outpatient services at QHC.


Before I bring my remarks to a close, let me briefly address something that's been 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, especially in Queens, the epicenter of last spring's outbreak. We took immediate steps to ensure that patients received the care that they needed, despite dramatically increased patient volume in our emergency departments and many of our primary care settings.

In particular, the emergency departments at both Elmhurst and Queens Hospitals saw large increases in the number of pediatric and adult emergency room visits as a result of H1N1, at times running as much as 100% over the visit volumes for the same time frame in 2008. Despite these exceptional stresses, both emergency departments performed remarkably well throughout the Spring influenza outbreak.

In October, Elmhurst opened three Fast Track Flu Centers to help meet public demand for both seasonal and H1N1 flu vaccinations. In recent weeks, despite limited supplies, staff at these centers has already given more than 2,000 vaccinations.

We have been fortunate that our communities across the city have not yet experienced high levels of flu activity. But whether the flu season has peaked, as some are suggesting, or will surge again in the months to come, we will continue to monitor the situation closely and will be prepared.


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; and the steadfast support of Mayor Bloomberg and our other elected officials.

I want to single out one of those elected officials for special praise tonight. Councilmember Helen Sears, who leaves the Council at the end of the year, has been unwavering in her support of HHC and our facilities in Queens. Our Hope Pavilion at Elmhurst Hospital was made possible because Helen Sears secured for us the lion's share of the capital required to build it. She also secured significant capital dollars toward the building of a new women's health pavilion at Elmhurst Hospital, a project that we are committing to moving forward. Thank you, Helen, for your service to the community and for your support of our public hospital system.

Finally, let me thank the men and women who staff our health centers and hospitals in Queens and our other HHC facilities throughout the city. Their compassion, creativity, and commitment drive our recent achievements across our system.

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 preserve HHC's ability to carry out its mission, and we will always be open and honest with our communities about whatever changes are necessary.

Thank you for your attention and your commitment to our public hospital system. I will now turn the microphone over to Mr. Levy and I look forward to hearing your comments.

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