I’m very happy to be back at HHC and to mark my first board meeting as President of this great organization. I’ve been on a listening tour, meeting with many HHC leaders and staff, to get reacquainted and hear what’s on their minds. I will continue these visits over the next weeks and look forward to seeing many old friends and hearing about the great achievements and the innovative work that’s going on to bring expert healthcare services New Yorkers.
At many HHC facilities this month, bilingual health insurance enrollment counselors have been available on-site to help New Yorkers access affordable health insurance before the Affordable Care Act (ACA) deadline. On my first day at HHC, I was able to meet with several of my colleagues at Bellevue Hospital, to watch first-hand as counselors helped HHC patients. HHC facilities partnered with HHC’s own health plan, MetroPlus, to provide walk-in hours for new patients and appointments for existing patients to meet with bilingual counselors, free of charge.
The lack of access to bilingual counselors has been identified as a major barrier for enrolling limited English-speaking New Yorkers in health insurance. In response, HHC made available certified, bilingual enrollment counselors to inform and educate the community about the best health insurance options and ways to minimize premiums and out-of-pocket costs.
HHC’s health plan, MetroPlus, is one of the options on the health insurance marketplace. MetroPlus offers access to a network of more than 12,000 primary care physicians and specialist sites across the city and has the most affordable options in three of the four levels available on the marketplace. As of April 22nd, more than 90,000 shoppers on the NY State of Health website — the official health insurance marketplace in New York — chose MetroPlus as their preferred health insurance option, making it one of the most popular choices among New York City residents.
I’m pleased to report that HHC will continue its traditional May Breast Cancer Awareness campaign in honor of Mother’s Day and all women in New York City. The annual campaign will once again remind female patients and staff who are 40 or older to schedule a mammogram every one to two years. We have a lot to be proud of in the area of breast cancer awareness. We perform more than 100,000 mammogram screenings a year. We have always been at the forefront of making breast cancer screenings part of routine primary and preventive care. We have also contributed greatly to the decrease of breast cancer disparities in New York City by providing access to care to underserved populations.
But there is more work to be done. More than 1,200 women die from breast cancer in New York City each year. Through innovative programs, such as increasing care access for women with disabilities, I am confident we can continue making impact and further contribute to the decrease in the number of breast cancer deaths in New York City.
Please join me in helping spread the word about the lifesaving mammograms through this year’s “Your Mammogram Can Be A Lifesaver” campaign. Visit our mammogram webpage at nychhc.org/hhc for more information about our May Mammogram Awareness Campaign.
Physical disability should never be a barrier to receiving quality healthcare. The obstacles disabled women face in receiving care are substantial and too often prevent them from seeking preventive health screenings like pap smears and mammograms. But we have learned that these obstacles are not difficult to overcome for healthcare providers.
I’m proud to announce that HHC will be making a commitment to expand access to healthcare for disabled women in New York City, and will update a number of our public health centers across the city with special equipment and infrastructure that will accommodate disabled women who often have a difficult time receiving healthcare because physicians’ offices are not properly equipped to handle their special needs.
With the generous support of $5 million from the New York City Council, under the leadership of Council Members Maria Del Carmen Arroyo and Julissa Ferreras, we will be able to expand a successful pilot program now at Morrisania Diagnostic and Treatment Center and at Woodhull Medical Center, where we introduced larger exam rooms for women’s healthcare, along with special lifts, scales, exam tables and other equipment that allow women in wheelchairs to receive gynecological care and cancer screening procedures in a more comfortable setting.
We have partnered with the Independence Care System (ICS), a non-profit Medicaid managed long-term care plan that is specifically designed for people with physical disabilities, to conduct environmental assessments at several facilities, and based on their recommendations we will continue to make improvements at Morrisania and Woodhull, and will upgrade infrastructure and equipment at an additional six HHC health centers across all five boroughs, with the intent to go to more centers in coming years. HHC will also train staff to better recognize the obstacles disabled patients face in obtaining care, and ways to help overcome those obstacles.
The Joint Commission conducted its triennial survey of Bellevue Hospital Center and North Central Bronx Hospitals in March and April, respectively. Both hospitals performed extremely well; no condition-level findings related to CMS’ Conditions of Participation were identified, nor were there significant findings at either organization in direct clinical patient care.
At Bellevue, the surveyors complimented the organization on the engagement and participation of all staff in the survey process, particularly the medical staff. They were impressed with the services provided by the organization, and their demonstrated commitment to the patients and community they serve. The surveyors deemed the Rehabilitation Brain Injury Program “world class”; praised the inpatient Behavioral Health Services, which serves a vulnerable population; were highly complimentary of Ambulatory Care Services; and, praised the organization’s multi-disciplinary approach to patient care.
At North Central Bronx, the surveyors recognized the “observed commitment and dedication of staff, which was excellent”. The organization’s performance improvement processes were clearly a “robust, living, breathing process.” Surveyors were particularly impressed with the Dental Clinic, the Breast Clinic, and the Sexual Assault Response Team (SART) program. They encouraged the facility to submit the SART Program to The Joint Commission’s Leading Practice Library as a best practice. Most of all, the surveyor’s experience was that the facility “had the best interests of the patients and community at heart”.
Congratulations to the leadership and all of the staff of both hospitals for a job well done:
Bellevue Hospital Center – Executive Director Steve Alexander; Medical Director Nate Link, MD; Chief Nurse Moftia Aujero, RN; Associate Executive Director, Clinical Management/Regulatory Affairs Marcia Peters; and all of the staff of Bellevue Hospital Center.
North Central Bronx Hospital – Senior Vice President William Walsh; Chief Operating Officer Sheldon McLeod; Acting Medical Director John McNelis, MD; Chief Nurse Elizabeth Gerdts, RN; Director of Regulatory Affairs Karen Carroll; and the staff of North Central Bronx Hospital.
The three facilities remaining to be surveyed this year are Coler, Henry J. Carter and Woodhull.
The Medicare payment rate for physicians would have decreased by 24 percent on March 31, unless Congress enacted new rates. A permanent fix was supported by many, but no agreement on how to pay for it was possible. Thus, Congress adopted legislation that keeps the rate from decreasing until March 31, 2015. The bill provides a 0.5 percent increase through Dec 31, 2014 and no increase from Jan 1, 2015 to March 2015. The bill did not include the many funding methods that HHC has opposed including: Hospital Outpatient Department reimbursement reductions — a loss of $187 million to HHC over 10 years — or reducing payments for Graduate Medical Education — $215 million loss to HHC over 10 years.
A funding method that was included in the legislation was a cut to Medicaid Disproportionate Share Hospital (DSH) funding. Specifically, ACA DSH cuts originally slated for FFY 2014 were delayed to FFY 2017, and an additional year of DSH was added – through FFY 2024. Nationwide the cuts now total $35.1 billion in Medicaid DSH funds over eight years. The loss in federal DSH funds to HHC from FFY 2017 through FFY 2024 could be $ 2.6 billion.
Last year, Congress enacted new criteria for facilities to qualify as Long Term Care Hospital (LTCH). To receive payment as an LTCH, a facility had to show that 50 percent of all of its medical discharges have either: (1) been in an ICU for 3 days prior to admission; or (2) received ventilator services for more than 96 hours. Unfortunately, the requirement included that the 50 percent of discharges had to be based on only Medicare patients. Thus, if a facility had less than 50 percent Medicare patients it would never qualify as an LTCH. In recent legislation, HHC worked with the Ways and Means Committee to get amendment language that included only the “Medicare Fee For Service” discharges in the denominator, instead of all payers, thus allowing the Henry J. Carter Specialty Hospital to continue to qualify as an LTCH.
In August 2013, CMS issued a rule to clarify that patient stays in hospitals for less than two midnights would be considered outpatient care and not inpatient care for purposes of Medicare reimbursement. HHC estimates that this rule could cost HHC $23 — $38 million in Medicare revenue each year. CMS delayed enforcement until October 1, 2014. Recent legislation authorized HHS to extend auditors’ prepayment “probe and educate” policy through March 31, 2015. Also the bill prohibits auditors from conducting patient status reviews on a post-payment review basis for inpatient claims for admission from October 1, 2013 to March 31, 2015. The legislation, however, did not establish a short-stay payment mechanism.
On April 14, 2014, AHA, GNYHA, HANYS and others, filed two related lawsuits in the Federal Court for the District of Columbia, challenging the Federal government’s “two-midnight” policy, which imposes an arbitrary limit on Medicare reimbursement for medically necessary inpatient stays. The suit challenges as arbitrary and capricious: (1) CMS’ across-the-board 0.2 percent reduction in payments; (2) the rule’s limitation that a patient can be considered an “inpatient” only when expected to stay two midnights; (3) the requirement that there be a physician order that the patient needs care for two midnights; and (4) CMS’ imposition of a one-year filing limit on hospitals’ requests for Part B payment after a Part A denial, when Recovery Audit Contractors (RAC) take several years to review.
On April 14, Governor Cuomo announced that New York reached agreement with the Centers for Medicare and Medicaid Services (CMS) on the details governing the five-year, $8 billion Medicaid 1115 Waiver related to Medicaid Redesign Team (MRT) initiatives.
The Waiver’s terms and conditions, along with a number of appendixes, outline how this funding can be used to improve quality, expand access, lower costs and transform the healthcare delivery system. Although the bulk of the waiver remains consistent with what the State Department of Health (SDOH) has recently presented, there are several noteworthy areas of difference. The key components of the waiver are as follows:
DSRIP is available to safety net providers, which are defined very broadly so that approximately 77 percent of the State’s hospitals will qualify. All DSRIP participants will be required to collaborate with other providers on innovative projects focusing on system transformation, clinical improvement and population health improvement. Unlike previous Waivers, with the exception of Planning Grants, funds will only be distributed after the provider achieves project milestones, based on process and performance outcomes.
SDOH will determine how much funding is available to a DSRIP provider, using a detailed process for assigning overall value of their application. Providers must choose from a variety of pre-approved projects that assigned varying values. One of the significant changes in the Waiver is that DSRIP providers will be assigned a specific population of Medicaid patients, for whom they will assume responsibility. The size of the Medicaid population the provider is serving will be one of the factors used in determining project value. Patients will be assigned to only one provider based on their history of healthcare usage.
SDOH estimates that DSRIP applicants will receive approximately $500,000 for planning grants to be used for expenses associated with developing their application. This may include conducting a Community Needs Assessment, drafting business agreements and retaining legal counsel. Applicants will be required to submit a Letter of Intent in mid-May and a Planning Grant Application in mid-June. Complete DSRIP applications, including project plans, will be due in December. Unlike what has previously been described, the first year of the five-year Waiver period will not begin until April 2015.
There is a public comment period for the Waiver: 15 days for the terms and conditions, ending April 29th, and 30 days for the appendixes, ending May 14th. HHC is reviewing the details of the Waiver and actively coordinating with the other public providers and SDOH to develop comments for submission.
On April 28, more than 150 HHC staff members from all HHC facilities, MetroPlus and Health & Home Care will participate in a half-day training on appropriate and sensitive healthcare for lesbian, gay, bisexual and transgender (LGBT) persons. The trainer will be Shane Snowdon, director of the health and aging program of the Human Rights Campaign (HRC), the largest civil rights organization working to achieve equality for LGBT Americans. It will be held in the Harlem Hospital Auditorium. The purpose of the training is to improve access to HHC healthcare for LGBT individuals and help to reduce health disparities related to sexual orientation and gender identification. The training is consistent with my commitment that our public hospital system is responsive to the healthcare needs of all New Yorkers, especially for those who have historically experienced healthcare inequity.
In 2013 the HRC designated Metropolitan Hospital Center as a “Leader in LGBT Healthcare Equality,” naming it as an organization that has made a special effort in training staff members, and ensuring it has anti-discrimination policies and publicly disseminating those policies. The April 28 training is the most recent action for many HHC facilities to follow their lead.
The Health Resources and Services Administration (HRSA) conducted a site visit in response to HHC’s application for designation of our six Diagnostic and Treatment Centers as a Federally Qualified Health Center Look-Alike (FQHC-LAL) under a public entity co-applicant governance structure known as Gotham Health. The site visit took place March 26 through 28. The aim of the site visit was to determine Gotham Health’s compliance with HRSA’s statutory and regulatory requirements.
The site visit team reviewed Gotham Health’s policies and operations pursuant to HRSA’s 19 Program Requirements covering areas such as Administration and Finance, Governance, and Clinical Management. Overall, the outcome of the site visit was positive — with only 4 of the 19 Program Requirements identified as unmet or partially met.
Some examples of the areas in which the HRSA site visit team recommended clarification or improvement were Gotham Health’s Sliding Fee Scale policy; Financial Management and Control policies and procedures, relating to HHC’s provision of financial and budget reports to the Gotham Health Board; and Board Authority specifically in reference to certain mandatory board responsibilities.
HHC’s Corporate Planning, Corporate Finance and Legal Departments and the Gotham Health leadership are working together to address the site visit team’s preliminary findings pending receipt of HRSA’s formal report.
Several HHC facilities have celebrated the opening of new facilities that will provide more healthcare services to New Yorkers.
In Queens, on March 28, Elmhurst Hospital Center officials and community leaders marked the completion of the hospital’s new 17,370 sq ft, $16.3 million Women’s Pavilion. The new outpatient healthcare facility will expand access to prenatal and comprehensive obstetrical services for women in Queens. The Women’s Pavilion will offer a variety of women’s health services, including walk-in pregnancy testing, prenatal care, HIV counseling and testing, genetic counseling, high-risk pregnancy services, antepartum fetal testing and postpartum services. The new building will also provide additional space for classes in childbirth, breastfeeding, nutrition, and diabetes education. The new facility will provide 15 percent greater capacity in patient volume, while allowing for five percent annual growth in service capacity over a 5-year period.
In the Bronx, on April 4, Lincoln Medical Center officials and community leaders marked the completion of a major modernization and expansion of Lincoln’s emergency department (ED), a Level 1 Trauma Center and the City’s busiest single site emergency room, seeing more than 177,000 visits every year. The hospital’s new 34,200 square-foot, $24 million state-of-the-art ED expands on the previous space by almost 70 percent, improving patient flow and comfort. Included in the new construction are larger pediatric and psychiatric emergency areas, and “Fast Track,” Lincoln’s urgent care treatment area for adults with non-emergencies. The completion of the adult ED area is the final phase of the expansion project and will be available to patients mid-May.
The opening of the new facilities represent investments of more than $2 billion in facility modernizations that have been made by HHC over the last decade.
On April 17, HHC Global Ambassador Kasseem “Swizz Beatz” Dean unveiled a piece of art he created called Victory to the residents and staff of HHC Henry J. Carter Specialty Hospital and Nursing Facility. Mr. Dean met with fellow philanthropist Henry J. Carter, the namesake of this long-term care hospital, and spent time visiting with residents to learn more about them and hear their inspirational stories. The piece symbolizes the monumental daily effort required as residents work toward rehabilitation goals and physical progress.
The Fund for HHC, the philanthropic arm of the New York City Health and Hospitals Corporation, named Mr. Dean HHC’s Global Ambassador in 2012. Mr. Dean supports HHC’s mission to provide quality healthcare for all New Yorkers, and advocates for the importance of art as a key part of the therapeutic and healing process.
HHC announced the progress of its centralized procurement system for goods and pharmaceuticals that will make purchasing more efficient and transparent, and will save HHC approximately $50 million in its first year.
HHC has combined the purchasing power of its integrated network of 11 hospitals, five long-term care facilities and dozens of community health centers to leverage better pricing for its 58,000 catalogued items — from hospital socks and sutures to services like printing and snow removal — that range in price from under a dollar to tens of thousands of dollars. It will also establish a limited, standardized list of products available for purchase by HHC facilities to reduce waste and duplication, while maintaining the ability to purchase high quality products preferred by clinicians.
Each product category, such as perioperative services, will be guided by a value analysis committee of physicians, nurses and key administrative staff who will evaluate product selections, focusing on quality, cost, service and outcomes. These steps reduce waste and unnecessary variability in our purchasing practices while ensuring that clinical staff has timely access to quality products and all the supplies they need to properly care for patients.
HHC’s effort was recently recognized by the “ECRI Institute” in Pennsylvania with its “2014 Supply Chain Achievement Award,” which honors healthcare organizations that demonstrate excellence in overall supply chain management.
In Fiscal Year 2010, facing a projected $1.2 billion budget gap for Fiscal Year 2013, HHC created a plan that called for $600 million in cost containment and restructuring and $600 million in additional revenue from the City and Federal governments. Supply chain and procurement reforms were identified as areas that could be targeted to meet a revised financial plan.
HHC’s new centralized purchasing system was fully operational in December. HHC expects to have 90 percent of its overall purchasing under the new system. As part of the procurement initiative, a new centralized procurement office of approximately 70 purchasing agents was established at HHC, with most staff relocating from other facilities. No employees were laid off.
The Carnegie Hall Weill Music Institute’s Musical Connections program provided concerts in several HHC facilities in recent months, courtesy of its ongoing partnership with The Fund for HHC. The program brings live music and public health messaging to local communities. Concerts at Queens Hospital, Bellevue Hospital, Jacobi Medical Center and Lincoln Medical Center were also opportunities to disseminate information about National Nutrition Month and Colon Cancer Awareness.
On March 14, the United Hospital Fund held its annual event to honor 91volunteers and auxilians who provide exceptional service at hospitals throughout the New York area. Volunteers and auxilians were acknowledged from many HHC facilities, including Bellevue Hospital, Metropolitan Hospital, Kings County Hospital, and Lincoln Medical Center.
I want to end my report by recognizing some special HHC employees. On any given day, any given month, we have hundreds of staff members at HHC that we can point to whose work is critical to providing the outstanding care that our patients deserve.
One such person is Bellevue Hospital’s Danielle Elleman, a Licensed Certified Social Worker, who was recently honored with an award from the NYC Alliance Against Sexual Assault, for her service to victims of crime and sexual assault. At Queens Hospital, one of our professionals honored during Women’s History Month was Dr. Susan Sanelli-Russo, Director of Neurology for 18 years. And at Metropolitan Hospital, the team in the Environmental Service Department was awarded the Simmelweiss Patient Safety trophy for their high standards, vigilance and collaborative team approach to preventing infections.
All of these HHC employees deserve our thanks for their proven commitment to our patients’ wellbeing.
Today I want to bring special attention to another two HHC employees who did not get an award – though they should.
These two individuals work as part of a larger team of MetroPlus certified enrollment counselors who have been instrumental in helping our health plan become one of the most popular choices among New Yorkers shopping on the New York Health Exchange.
I’m told that to be a successful enrollment counselor, employees must demonstrate courtesy and respect above all. They must be good listeners and be prepared to hear people’s life stories and their journey to this point in their life. They must be compassionate. And they must be committed to helping New Yorkers make the best health insurance options — even if that’s not MetroPlus!
I’m speaking of Monica Castillo and Leroy Baresford — together, they have helped more than 1,500 New Yorkers enroll in affordable health coverage that’s now available to them thanks to the Affordable Care Act. Monica and Leroy have worked in Brooklyn and Queens — doing home visits, working at malls, reaching out to the Latino and Guyanese communities they know — and have helped thousands in Brownsville, Bushwick, Bed-Stuy, East NY, Greenpoint, Ridgewood and other neighborhoods.
Monica and Leroy exemplify the values HHC stands for. They represent the dozens of other HHC and MetroPlus employees who deliver on our commitment to help uninsured New Yorkers to navigate the system and access whatever health insurance option is best for them. It is something we do exceptionally well and something we should be very proud of. Please join me in thanking Monica and Leroy for the outstanding work they do every day to help New Yorkers and specifically the HHC Metroplus patient family.
NYC man thanks hospital staff for saving son hurt in East Harlem explosion, Dr. Ram Raju, HHC President Denise Soares, SVP, Generations + Northern Manhattan Network, Dr. Arthur Cooper, Director of Trauma and Pediatric Surgical Services, Harlem, aria Lopez, Qualified Medical Translator, Harlem, NY1, WABC, WCBS, WNBC, FOX5, Univision, Telemundo, 4/2/14
Bellevue Hospital Helps Enrollees on Last Day for ACA sign up, Dr. Ram Raju, President, Bellevue, NY1, WABC, Reuters TV, Telemundo Ch. 47, Univision Ch. 41, 3/31/14
Gama Droiville, 13-Year-Old Shot In East Flatbush, Released From Kings County Hospital, Dr. Douglas Lazzaro, Chief of Ophthalmology, NY1, News 12 Brooklyn, WABC, WNBC, WPIX, Univision, WCBS/1010WINS Radio, 4/22/14
Harlem Hospital Center Unveils New Emergency Department, Trauma Center, Denise Soares, SVP, Generations + Northern Manhattan Network, Dr. Maurice Wright, Chief Medical Officer, Harlem, NY1, 3/22/14
Wheelchair-Bound Women Have Trouble Receiving Gynecology Services in City, HHC, Morrisania Dinah Surh, Senior Executive Administrator, NY1, 4/15/14
Elmhurst Hospital Unveils Women’s Pavilion, NY1, 3/28/14
Kings County Hospital offers bilingual help to enroll under Affordable Care Act, Roger Milliner, Deputy Executive Director, MetroPlus, News 12 Brooklyn, 3/26/14
Counselors Help ACA Insurance Sign Up, Dr. Martha Adams Sullivan, Executive Director, Gouverneur, Lincoln, News 12 Bronx, Univision Ch. 41, 3/26/14
DOH: Additional Measles Cases Confirmed on Lower East Side, Dr. Denise Infante, Gouverneur Health, NY1, 4/2/14
13-Year-Old Boy Talks To CBS 2 After Horrifying Shooting In Brooklyn, Kings County, WCBS, 4/17/14
Teen boy shot in eye released from hospital, Dr. Douglas Lazzaro, Chief of Ophthalmology New York Post, 4/23/12 (Also covered in the Wall Street Journal/Associated Press, NY Daily News, Epoch Times, amNewYork)
Teen Recovers From Multiple Injuries in East Harlem Blast, Dr. Ram Raju, HHC President, Denise Soares, SVP, Generations + Northern Manhattan Network, Dr. Arthur Cooper, Director of Trauma and Pediatric Surgical Services, Harlem, Maria Lopez, Qualified Medical Translator, Harlem, The Wall Street Journal, 4/2/14 (Also covered in NY Daily News and DNAinfo)
New centralized procurement process will cut costs and bring long-term savings to HHC Healthcare Purchasing News, 4/16/14
HHC nurses cheer on patients, Monefa M. Anderson, RN, Deputy Director, Nursing Administration, Lincoln, Doris Amalu, RN, Harlem, Nana Lau, RN, Renaissance, Nurse.com, 4/7/14
Harlem Hospital opens new emergency department, New York Amsterdam News, 3/27/14 (Also covered in Capital New York)
Lincoln launches Level 1 trauma center, HHC, Amsterdam News, 4/10/14 (Also covered in Modern Healthcare, Capital New York and Crain’s Health Pulse)
Elmhurst Hospital gets new pavilion for women, President Alan D. Aviles, Chris Constantino, SVP, HHC Queens Health Network, The Queens Courier, Times Ledger, 3/28/14 (Also covered in DNAinfo, Western Queens Gazette andTheRealDeal.com)
City’s public hospitals get Obamacare boost, HHC, Crain’s New York Business, 3/19/14
MetroPlus’ Ad Push, MetroPlus, HHC, Crain’s Health Pulse, 4/17/14 (Also covered in Capital New York)
HHC Global Ambassador Swizz Beatz Dedicates Artwork to Henry J. Carter Hospital, New York Daily News, 4/17/14 (Also covered in New York Post, DNAinfo, InFlexWeTrust.com,TheSource.com, HipHopWired.com, Harlem World Magazine, Rolling OUT)
2014 Top 25 Minority Executives in Healthcare, Dr. Ram Raju, President, Modern Healthcare, 4/14/14
Mayor de Blasio’s cabinet, high-level staffers mostly reside in Brooklyn, Dr. Ram Raju, HHC President, New York Daily News, 4/6/14
Dr. Ramanathan Raju’s First Day, Capital New York, 3/31/14
Simpler Consulting Recognizes Alan Aviles for a Career of Leadership Excellence, HHC, The Herald, 4/10/14
Colon Cancer Screening Could Save Your Life, Dr. Joan Culpepper-Morgan, Harlem, Harlem News Group, 3/20/14 (Also covered in the Epoch Times and The Chief Leader)
Understanding Kidney Disease, Dr. Isaiarasi Gnanasekaran, Lincoln, The Bronx Free Press, 4/9/14
Preventing Teen Violence, Dr. Jay A. Yelon, Chief of Surgery, Lincoln, The Bronx Free Press, 3/19/14
Belvis Black History Program, New York Amsterdam News, March 27-April 2, 2014