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Bronx Annual Public Meeting
Lincoln Medical & Mental Health Center
Tuesday, November 19, 2013

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, our City’s public hospital system. Thank you for being with us tonight for our Bronx annual public meeting, the second of five borough-specific meetings we convene each year. As always, I am eager to hear what HHC’s communities have to say about our performance, especially during what continues to be a challenging time in healthcare generally and for HHC specifically.

First, let me recognize HHC’s senior executives here in the Bronx. Our hosts this evening are Denise Soares, Senior Vice President of Generations Plus Network and Milton Nunez, Executive Director of Lincoln Hospital. Also in attendance is Bill Walsh, Senior Vice President of the North Bronx Healthcare Network and Executive Director of Jacobi Medical Center. I thank them all for the excellent work they do every day as leaders helping us to render the best possible care to Bronx residents.

I also want to acknowledge the support and guidance of our Board of Directors, under the leadership of Dr. Michael Stocker. My special thanks to Board members who are here tonight and to the members of our Lincoln, Jacobi, North Central Bronx, Belvis, and Morrisania Community Advisory Boards, who advocate on behalf of our public system and help keep us grounded and responsive to the needs of our patients and communities.

Hurricane Sandy

Last year, I spoke about the impact of Hurricane Sandy on the city and on HHC. While our facilities in the Bronx were not damaged significantly, our employees here certainly suffered storm-related effects as many found it difficult to get to work because of transportation disruptions and fuel shortages, and some experienced personal hardships that were storm-related. Despite these challenges, our Bronx facilities remained adequately staffed throughout the storm and our employees ably staffed the Special Medical Needs Shelters in the Bronx, during the difficult days that followed.

Across our public system, we have had to repair several severely damaged facilities, notably Coney Island Hospital, Bellevue, and Coler Specialty Hospital and Nursing Facility. Additionally, we have been working to make our at-risk facilities more resilient to minimize the impact of any future severe storm. These resiliency efforts include elevating or hardening critical electrical and mechanical systems as well as fuel and water pumps.

The Challenges

As you would expect, the storm added an additional burden to the significant financial challenges we already face. These challenges will continue to intensify as we confront projected reductions in revenue and a daunting budget gap. Medicaid cuts and reforms in the State’s budget will reduce HHC’s reimbursements from the state by more than $50 million this coming year. Over the past five years, HHC has absorbed cuts that now total an astonishing $540 million annually.

In addition, we will receive nearly $10 million less in our annual Medicare revenue going forward as a result of the federal sequester.

Yet even with these deep cuts, we are increasingly in an environment where we will be expected to deliver better care, with better patient outcomes, and to do so at lower cost. More and more of our funding will be tied to our ability to accomplish these three things. While healthcare providers throughout the country are also dealing with these same expectations, the challenges for HHC are greater because we provide care for so many uninsured patients. Indeed, last year we served nearly 500,000 patients without insurance.

As you have heard before, HHC has worked hard to control costs internally. Over the past four years, we have implemented a cost containment and restructuring plan that, in the aggregate, has reduced our projected budget shortfalls by more than $1.7 billion since FY 2010. As part of that plan, by the start of this fiscal year last July 1st, HHC also had successfully met its workforce reduction target of 3700 full-time equivalent positions one full year ahead of schedule, which contributed to an annualized $600 million reduction to our budget gap. Most of this workforce reduction has been achieved through attrition and has not involved direct patient care positions and, to the credit of our dedicated employees, we have maintained virtually the same service capacity across virtually all care settings.

Going forward, our financial plan assumes another $193 million in savings in FY2014 based on our implementation of remaining restructuring initiatives as well as additional cost containment measures. These measures include efforts to consolidate targeted services, centralize procurement, improve revenue collection and maintain our lowered workforce headcount. These efforts, when fully implemented, aim to achieve savings of $390 million in FY15, $386 million in FY16, and $383 million in FY17.

HHC’s senior leadership team has been exploring every way to close our budget gap while continuing to provide high quality, safe care to our patients and maintain our capacity to adequately serve the communities that depend on us. That said, maintaining the full scale and scope of current services will be very challenging, given the reductions in federal funding that started this year.

And under the Affordable Care Act, beginning in 2014 the federal government will make significant reductions in supplemental Medicaid and Medicare funding that supports public hospitals. These cuts increase dramatically by 2017 and ultimately could reduce HHC’s federal funding by more than $325 million annually. Although we are advocating against this destabilizing loss of essential federal funding, there is very little prospect of Congress re-visiting the wisdom of these looming, devastating cuts.

It is important for our communities to understand how serious HHC’s fiscal situation is, and why we have resorted to extraordinary measures such as targeted layoffs, the closure of some small community clinics, and the outsourcing of certain services. And it is important that all stakeholders fully appreciate the severity of our financial challenges and the forceful advocacy required to preserve HHC’s mission and to enable us to continue to meet community needs. While in the past we have relied on increases in governmental funding to keep our system solvent in the face of rising costs that were outside our control, the current economic conditions at all levels of government, the clamor for reducing healthcare costs, and gridlock in Washington, make additional significant government support unlikely for the foreseeable future.

Our willingness to make tough and, at times, painful decisions has enabled us to avoid closing any major HHC facility and allowed us to remain faithful to our core mission of serving all New Yorkers without regard to insurance or immigration status. However, the unrelenting financial pressure we are experiencing represents a grave threat to our mission and to our long-term ability to maintain sufficient service capacity to meet the needs of our patients across the City. And more tough decisions surely lie ahead.


One way we are meeting the challenge of doing more with less is by achieving greater efficiency through our continued redesign of our operations using Breakthrough, our employee-driven process improvement approach. The implementation of Breakthrough uses frontline staff members to help determine operational changes that allow us to work better and smarter to accomplish our goals. Since its inception in 2007, we have accrued $377 million in financial benefits – nearly $349 in new revenues and $28.5 million in cost savings. 19 of our sites have active Breakthrough teams working to make improvements in 71 areas. The vast majority of savings have come from five broad areas: inpatient services, Emergency Departments, ambulatory care, behavioral health and peri-operative services.

For example, Jacobi Medical Center has used Breakthrough to significantly increase on-time starts in operating rooms, reducing patient waits while also freeing up operating time for more surgical cases. And, over the past year, North Central Bronx has used Breakthrough to decrease the average length of stay for cardiac patients so that they could be safely discharged in 2.8 days, rather than 4.8 days. And there has been no increase in the readmission rate for these patients.

The Generations Plus Network’s Diagnostic and Treatment Centers, which includes Morrisania, Belvis and Renaissance, are all engaged in Breakthrough improvement work focused on improving access and patient satisfaction in adult primary care services, while generating additional revenue and lowering costs. This work includes collaborative efforts with our unions and Community Advisory Boards to create a more patient-centered focus at these facilities, and it is yielding positive results.

At Morrisania, the percentage of patients’ expressing a willingness to recommend that facility to others improved from 50% late last year to 83% in June 2013. At Belvis, patient satisfaction related to access to outpatient services is now the highest among HHC facilities with a score of 77.4% in recent months.

Even as we struggle to make our system more efficient and to manage the formidable financial challenges we face, we continue to offer essential and high quality services to the communities that we serve. To promote wellness, we continue to offer robust primary and preventive care services, with an emphasis on the early detection of disease and the effective management of prevalent chronic diseases such as asthma, diabetes, and hypertension.

We are continuing to transform how we deliver care that is better coordinated and managed. In January of this year, the federal Centers for Medicare and Medicaid Services designated HHC as an Accountable Care Organization in the Medicare Shared Savings Program with a focus on improving the health of Medicare beneficiaries through coordinated, high quality care delivered at reduced costs.

HHC’s investments and demonstrated ability in care coordination and care management also have resulted in our designation as a Health Home here in the Bronx and in three other boroughs. This means we have responsibility for managing the care of Medicaid patients with very complex medical conditions, including serious psychiatric illness and chemical dependency. We are the only organization given this responsibility by the State in more than one borough of the City.

As I have reported previously, all of HHC’s primary care sites have received formal certification as Patient-Centered Medical Homes. Now, all of these sites are in the process of being re-certified under more stringent standards and we expect all to be recertified with the next three months. Already, seven HHC facilities, including three in the Bronx – Lincoln, Morrisania and Belvis – have been recertified for another three years as Patient Centered Medical Homes at Level III, the highest level of certification. HHC’s health plan, MetroPlusHealth, will play a key part in the success of all of these activities aimed at delivering better care, helping our patients become healthier, and at the same time reducing costs. MetroPlusHealth continues to be the highest rated plan in the City on quality and customer satisfaction.

The investments we are making in information technology will have a significant impact on our success in these areas, as well. HHC has purchased a new electronic medical record system that will be phased in over the next five years. Our new system will enable our providers to share information more easily to better coordinate care, as well as give patients ready access to their health information, facilitating their ability to partner with their caregivers to improve their health status. By meeting certain objectives for using certified electronic medical record technology to improve patient care, HHC has qualified for meaningful use designation from the federal government that will result in the receipt of $122 million in federal dollars to help offset the cost of the new electronic medical record.

Additionally, we are completing installation of a new billing and appointment scheduling system. The new scheduling system will be more patient friendly and will enable us to ultimately consolidate multiple call centers. As

the Bloomberg administration draws to a close, I would like to thank the Mayor for the support he has shown for public health in New York City, and for our system in particular, over the last 12 years. We have prepared extensive transition materials for the incoming administration, and expect to begin briefings soon. Based upon his public statements during the campaign, Mayor-elect de Blasio certainly understands the critical importance of the public hospital system and we anticipate that he will continue the same strong support for its mission during these challenging times.

As we work to make our system more efficient, and manage our ongoing financial challenges, we continue to be responsive to the needs of our communities, and especially to the uninsured. In the Bronx, HHC provides 54% of all hospital-based clinic visits and 39% of all inpatient stays made by uninsured residents.

Our Work in the Bronx

Turning specifically to our work in the Bronx, let me first discuss inpatient maternity services at North Central Bronx Hospital.

In the months leading up to this past summer, we experienced several senior obstetrician vacancies at both NCB and Jacobi which proved very difficult to fill. Ultimately, we concluded that there was inadequate staffing for us to continue safely delivering babies at both hospitals. As a result, we suspended inpatient maternity services at NCB and consolidated all labor and delivery services at Jacobi Hospital, which had sufficient beds to accommodate the combined volume of both hospitals. Staff were reassigned from NCB to Jacobi to ensure adequate staffing coverage across all shifts, seven days a week. All outpatient prenatal care services were continued at both campuses.

Every expectant mother at NCB was contacted and offered the option of delivering at Jacobi or at other hospitals in the Bronx. The vast majority of expectant mothers from NCB continued to receive their outpatient services at NCB and opted to deliver at Jacobi. Since the consolidation in August more than 250 expectant mothers at NCB chose to deliver their babies at Jacobi Medical Center.

Earlier this month, we notified the State Department of Health that we plan to re-open maternity services at NCB as soon as appropriate staff can be hired to allow us to cover all shifts. A new Chairman of the North Bronx Healthcare Network, Dr. Michael Zinaman, has been appointed and he will oversee inpatient and outpatient women’s health services and labor and delivery services at Jacobi and NCB beginning in mid-December. Dr. Zinaman is a highly qualified physician leader, researcher, professor, and surgeon with extensive experience in all areas of women’s health.

We are confident that under Dr. Zinaman’s leadership, we will be able to step up recruitment efforts for the necessary physicians, midwives, nurses and other staff at NCB so that we can safely re-open inpatient maternity services at North Central Bronx Hospital in 2014.

Now, let me briefly report on some recent accomplishments by our HHC facilities in the Bronx.

This year, the Joint Commission completed its triennial survey of Jacobi Medical Center and the hospital passed with flying colors and accolades from the survey team leaders.

Also this year, Jacobi was recognized by the U.S. News and World Report for the second time as Among the Best Regional Hospitals in New York. Additionally, earlier this month Jacobi was recognized for the third year in a row with the Northeast Business Group on Health’s Leapfrog Award for Outstanding Performance in Patient Safety and Quality.

On November 6th, North Central Bronx opened its renovated and greatly expanded Psychiatric Emergency Room. The new $2.4 million expansion nearly triples the clinical space available for emergency psychiatric services.

Earlier this year, North Central Bronx received the Joint Commission’s Top Performer award for 2012, the first HHC hospital to receive this recognition.

Lincoln Medical Center received the American Heart Association/American Stroke Association Gold Plus Performance Achievement Award for the successful implementation of higher standards of stroke care, aimed at reducing death and disability, and improving the lives of stroke patients.

In addition, Lincoln was included in the American Heart Association/American Stroke Association’s “Honor Roll” for consistent timely administration of clot-busting, thrombolytic therapy within 60 minutes of patient’s arrival to the hospital when such therapy is most effective.

Lincoln was also recognized with the 2012 Outstanding Achievement Award by the American College of Surgeons’ Commission on Cancer, becoming one of a select group of accredited cancer programs to receive this national honor. Additionally, Lincoln’s Diabetes Center of Excellence received re-accreditation for a full four-years.

Lincoln is also one of the pilot sites for a new initiative to give New Yorkers greater access to farmers markets’ produce and increase healthy eating. The Fruit and Vegetable Prescription Program enables patients at risk of obesity to receive Health Bucks, coupons from the Human Resources Administration and the New York City Health Department that can be redeemed for fruit and vegetables at all New York City Farmers Markets. HHC’s eight farmers markets are hosted in partnership with Harvest Home and Greenmarket.

At Lincoln, a multi-phase renovation and expansion of the facility’s Emergency Department is nearing completion. The new Emergency Department, which encompasses adult, pediatric and trauma services, affords much more space and a state-of-the-art environment for one of the busiest emergency departments in the State.

Morrisania was recognized by the Independence Care System and NY Lawyers for the Public Interest for its pilot initiative to increase access to mammograms for women with disabilities and to improve cultural competence in addressing the needs of patients with disabilities. The program has since expanded to gynecology and internal medicine visits. Morrisania also has expanded its hours of operation to 5 evenings per week, and patient response has been very positive. While Belvis currently offers evening hours only twice a week, it will be hiring additional staff so that it can offer more expanded evening hours.

Both the Belvis and Morrisania Centers recently received full three-year accreditation for the continuation of their Mammography Services.


I am proud of the work that our dedicated HHC staff performs every day here in the Bronx and across our city to provide accessible, high-quality healthcare to our patients. I can assure you that the leaders across our organization, as well as our Board of Directors, are advocating at every level of government to secure the resources necessary so that HHC can continue to effectively meet the needs of our vulnerable patients and communities.

We appreciate the strong advocacy support that we receive from our partners in labor, our community advisory boards and auxiliaries, and many community-based organizations that care about our mission. Our strong connection to, and support from, the communities we serve is one of our most important assets.

Thank you for your attention and your attendance. I will now turn the program over to Mr. Russo. I look forward to hearing your comments.