REPORT TO THE BOARD OF DIRECTORS – July 2014 | NYC Health + Hospitals

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REPORT TO THE BOARD OF DIRECTORS – July 2014

RAMANATHAN RAJU, MD
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
JULY 24, 2014

STATE MEDICAID WAIVER FUNDING UPDATE

On June 26th, HHC submitted its initial planning applications for the Delivery System Reform Incentive Program (DSRIP), a $6.42 billion component of the 1115 Medicaid Waiver program. This program is intended to both transform care delivery in NYS and significantly reduce Medicaid costs, with an overall program goal of 25% statewide reduction in preventable hospitalizations over 5-year timeframe. HHC was recently awarded approximately $150 million from the IAAF (Interim Access Assurance Fund), another component of the 1115 waiver to assist safety net hospitals in severe financial distress and major public hospital systems to sustain key health care services while developing DSRIP proposals.

Our non-binding planning application was to explore up to seven Performing Provider Systems (PPS), each of which will undertake 7-10 clinical projects intended to improve the health of Medicaid and uninsured patients in its local geographic area. NYS DOH is in process of reviewing all NYS applications, and we expect to receive their input/guidance by late July or early August. We will incorporate their advice into our future efforts leading to a binding, final application in mid-December.

The work of strategic alignment, partnership formation, community needs assessment, and project selection is being conducted under guidance of a Corporate Steering Committee and with support from a consultant vendor, and aims to have a completed application by December 2014 which will assist with the strategic transformation of our healthcare delivery system over the next 5 years.

SUPPORT FOR EXPANDING ACCESS TO LONG-ACTING REVERSIBLE CONTRACEPTION

On July 17, I joined State DOH Commission Dr. Howard Zucker, City DOH Commissioner Dr. Mary Basset, and HHC Deputy Chief Medical Offer Dr. Machelle Allen at Bellevue Hospital Center to mark a change in New York State Medicaid policy that will help increase birth control options for women.

The State Department of Health in April changed its Medicaid policy to cover long-acting reversible contraception when given to women immediately after childbirth. Reimbursement for these types of contraceptives had only been available in an outpatient setting. That meant that Medicaid patients usually had to wait six weeks after childbirth to receive these types of contraceptives at their first postpartum well visit.

At HHC, we have been offering these options to women after childbirth for some years now, regardless of their ability to pay or insurance status.

We believe that the option for a woman to choose a birth control method that suits her needs should be restricted only by medical evidence. And the latest medical evidence – much of which was pioneered through research at HHC and our Jacobi Medical Center in the Bronx – has shown that IUDs are safe and effective when used immediately following birth.

The decision to reimburse for IUDs and contraceptive implants immediately postpartum is visionary, and an example of a progressive agenda that fights for women and not against them. This new policy to cover our costs for providing this effective and proven method of birth control removes an important barrier and supports HHC’s commitment to expand timely access to safe and effective birth control to even more women across New York City.

U.S. COURTS SPLIT ON SUBSIDIES ON FEDERAL HEALTH INSURANCE EXCHANGE

Earlier this week, two federal appeals courts issued conflicting opinions on the question of whether the federal government could provide subsidies when people purchase health insurance through the federal exchange. That exchange operates the insurance marketplace created by the Affordable Care Act in the 36 states that declined to create a state exchange. However, the law is clear that State-run exchanges can provide such subsidies, so the New York State exchange is not affected by the rulings. The split decisions bring more conflict and confusion around this important health care reform effort, which now may end up before the Supreme Court. In the meantime, the Obama administration said it would continue enforcing the law’s requirement that subsidies — Advanced Premium Tax Credits — be paid in all exchanges. About three-quarters of New Yorkers who enrolled in private health insurance through the state exchange were eligible for these subsidies.

CITY COUNCIL ALLOCATES $600k TO HELP REOPEN NCBH LABOR & DELIVERY

I want to thank Bronx New York City Council Member Ritchie Torres and the other members of the New York City Council Bronx delegation for securing a capital fund allocation of $600,000 to assist the renovation and reopening of North Central Bronx Hospital’s comprehensive labor and delivery services. The funds will be used to upgrade patient-care areas in the maternity unit as we prepare to restore the services in the fall.

CHANGES SUGGESTED FOR FEDERAL FUNDING OF
WORLD TRADE CENTER TREATMENT PROGRAM

After more than three years of administering the James Zadroga 9/11 Health and Compensation Act of 2010, HHC is assessing whether any changes are needed in the law as several elected officials are considering re-authorization of the law. HHC administers the World Trade Center Environmental Health Center located at Bellevue, Elmhurst and Gouveneur. Currently over 7,000 individuals are enrolled in the HHC-administered survivor program and are eligible to receive services at these Centers of Excellence. These programs provide services for those who were harmed by the terrorist attack of September 11. A reauthorization bill may be introduced in Congress on September 11 this year by Members of the New York Congressional delegation.

The two changes that HHC is suggesting to the Mayor’s staff to be included in their reauthorization request are a repeal of the requirement that all applicants be checked against the Terrorist Watch List, and to amend the law to allow payment of transportation expenses within the New York City area when necessary for medical treatment.

CITY REACHES LABOR AGREEMENT WITH DC37

The City recently reached a negotiated agreement with DC37. You will remember that last month I announced that the city had also reached agreements with NYSNA, which was overwhelmingly ratified by the membership, and with Local 1199, whose contract is currently pending ratification by the membership. The agreement with DC37, which is subject to union ratification, covers the period March 2010 to July 2017. Like the NYSNA and 1199 contracts, this agreement conforms to the pattern established by the teacher’s union earlier this year. It includes wage increases of 10% over the term of the contract as well as the $1,000 lump sum cash bonus payable upon ratification. It also contains the healthcare savings that were agreed to by the Municipal Labor Committee as well as a union funded Additional Compensation Fund that could be used to purchase mutually agreed upon recurring benefits. The parties also agreed to establish a Joint Recruitment and Promotion Study Committee to look at ways to increase the recruitment, retention and promotional opportunities for minorities and women in DC37 titles. Lastly, the parties agreed to make good faith efforts to ensure due process protections for Provisional Employees in HHC.

PATIENT AND EMPLOYEE SAFETY AND WELLNESS FORUM

On June 30, the Corporate Office of Patient Safety and Employee Safety convened a forum at Jacobi Conference Center entitled “Patient Safety Begins with a Compassionate Healthcare Provider.” The keynote presenter Richard Cheu is a neurophysiologist, EMT, ordained deacon, hospital chaplain, and stress management consultant.

The goals of the forum were to demonstrate how compassionate healthcare teams improve patient outcomes; learn how to stay compassionate even in a stressful work environment; develop positive self-care strategies and healthy rituals to help us to better care for ourselves and our patients; and, differentiate how compassionate care may be manifested in acute, palliative, and hospice care settings.

More than 170 HHC staff attended this important learning session and all received a copy of Dr. Cheu’s book, “Living with Chronic Illness: A Practical and Spiritual Guide.”

EMPLOYEE WELLNESS

Supporting employee wellness in an important part of our efforts to engage our workforce and improve employee satisfaction. I’m happy to report that the summer edition of the popular HHC Employee Wellness Focus newsletter was recently released. The summer issue provides employees with valuable information on ways to protect from sun damage and cancer, boost heart health, and to practice healthy eating habits. A copy of this edition is included in your Board materials.

EMPLOYEE PATIENT SAFETY CULTURE SURVEY

In June we conducted the 2014 all employee patient safety culture survey, an effective way for our workforce to anonymously share their opinions and suggestions about the safety of our workplaces. Almost 25,000 surveys were submitted, giving us a statistically significant response rate of 63% across the enterprise. Early data show that more than 70% of respondents believe that HHC is committed to organizational learning, and 65% acknowledge the management’s support for patient safety.

While the final results will tell us where we still have much work to do, the preliminary data reveal that patient safety improvement is recognized by our workforce as a focus and priority for our organization and within our culture.

HHC EXECUTIVES RECOGNIZED FOR OUTSTANDING LEADERSHIP

Three HHC senior executives have received outstanding recognitions this month for the quality of their leadership in healthcare.

LaRay Brown, Senior Vice President for Corporate Planning, Community Health, and Intergovernmental Relations has been invited to co-chair one of the targeted workgroups as part of the state of New York’s Medicaid Redesign Team: Social Determinants of Health Group. This important endeavor, as you know, has been a major policy undertaking in seeking to deliver better value and better care in New York State’s Medicaid program.

Caroline M. Jacobs, Senior Vice President for Safety and Human Development, last month assumed the role of Chairperson of the Board of Directors of the Essential Hospitals Institute. The Institute supports America’s Essential Hospitals — formerly the National Association of Public Hospitals and Health Systems — through research and puts research into practice through transformation and innovative change. Key strategic objectives of the Institute are aligned with several of HHC’s priorities including: improving quality and preventing patient harm, reducing healthcare disparities, healthcare delivery system reform, patient centered care and expanding community based-services.

And third, but not least, the work of another HHC executive was applauded this month at the centenary celebration of the Medical Journal of Australia. Topping the list of the most cited papers in the 100 year history of that journal was a study led by our own Dr. Ross Wilson, HHC’s Chief Medical Officer and Senior Vice President of Medical and Professional Affairs. Dr. Wilson’s paper, “The Quality in Australian Health Care Study,” published in 1995, was the first national study in the world on the prevalence of unsafe healthcare in hospitals. Dr. Wilson’s publications in patient safety continue to be amongst the most frequently cited internationally, including his most recent paper from March, 2012 in BMJ addressing patient safety in developing countries of Africa and the Middle East, with the World Health Organization.

I know the Board joins me in offering our congratulations to Ms. Brown, Ms. Jacobs and Dr. Wilson for their continued leadership and contributions.

HHC LEADER TO JOIN THE NYC DEPARTMENT OF HEALTH
AS A DEPUTY COMMISSIONER

Gary S. Belkin, MD, Ph.D., HHC’s Senior Director for Psychiatric Services, has been appointed to serve as the Executive Deputy Commissioner of Mental Hygiene at the NYC Department of Health and Mental Hygiene effective August 25. Prior to his role at Central Office, Belkin served as the Deputy Chief and then the Interim Chief of Psychiatry at Bellevue Hospital Center. He has been with HHC for 10 years.

Dr. Belkin will be missed at HHC, but New York City’s mental health services and programming will be well-served by his commitment to improving patient care as well as his leadership skills. In his new position, Belkin will still have the opportunity to regularly interact with his HHC colleagues – as a Deputy Commissioner, he will represent DOHMH on HHC’s Board of Directors.

FEATURED COMMUNITY HEALTH PROGRAMS: “MUSIC & MEMORY” AND
LINCOLN HOSPITAL’S TAXI AND LIMOUSINE
HEALTH SCREENING INTITIATIVE

I wish to highlight for you today two quite special community health programs:

Music & Memory

The first program that I wish to highlight for you this afternoon is the Music & Memory program. The Music & Memory program is a music therapy initiative that brings iPods loaded with personalized music selections to patients with Alzheimer’s disease, dementia, or other cognitive loss to enhance their memories and enrich their lives.

HHC has been an early adopter of this program at Coler, Carter, and Sea View. With the help of The Fund for HHC, we plan to soon expand the program to Gouverneur, McKinney, Elmhurst Hospital Center, and Bellevue Hospital Center. And we ultimately hope to have Music & Memory programs in all our major facilities.

HHC and its Fund for HHC has collaborated with and supported the producers of a moving, award-winning documentary film entitled “Alive Inside” that powerfully documents the ability of this intervention to positively alter lives. I wish to share with you the two minute trailer for this film in which HHC briefly appears.

Lincoln Hospital’s Taxi and Limousine Health Screening Initiative

The second program I wish to highlight for you centers upon that unique group of New Yorkers who drive New York City cabs, liveries, and limousines, providing a vital service in across our city. These men and women drivers are mostly immigrants, typically with no medical home and too often unconnected to healthcare for many years. They are frequently the primary bread winners in their families, here, and in their homelands. Their health status should be a concern to all of us.

In 2005, our community-minded staff at HHC Lincoln Medical Center in the Bronx found a way to reach these individuals and provide the healthcare they needed by doing what we know works — they went to where the cab drivers work — where they gather to begin and end their days.

HHC staff brought the health care to the people instead of doing what we typically do in health care: wait for the people to come to us.

For nearly ten years, the Community Health Education and Outreach team at Lincoln has been visiting taxi bases across the South Bronx and Northern Manhattan, bringing life-saving education messages, screening exams and an invitation to make Lincoln their medical home.

Taxi and limo drivers have been learning about how to manage their diabetes, how to keep blood pressure under control, how to recognize the signs of stroke, the dangers of smoking and the importance of HIV testing and cancer screening.

Our outreach team at Lincoln has provided more than 6,500 blood pressure and glucose screening tests, enrolled more than 470 drivers in health plans and 233 in the HHC Options program. They have facilitated more than 850 medical appointments.

This is such an effective model, that in 2008, the program received national recognition for improving local health conditions from the Robert Wood Johnson Foundation.

There’s no doubt that this patient-centered model of care has helped to improve the health of the drivers. But we’ve also seen another very important outcome of this effort.

Some of the very same taxi drivers we helped connect to care have now become active participants in our Community Advisory Boards. They have become an extension of this outreach effort and a direct link to a community of New Yorkers who would have easily been left out of the healthcare they deserve if it were not for HHC and our caring staff at Lincoln Hospital.

Here today is one of those taxi drivers, sole owner of Llama Car Service and a member of our Community Advisory Board at HHC’s Morrisania Diagnostic and Treatment Center, Mr. Carlos Llama. He has a cab and is now on our CAB! HHC’s own Maria Ramos and Marcelo Villagran, members of the outreach staff at Lincoln, were the co-creators of this program back in 2005.

Thank you Carlos and Marcelo, for your service to HHC and our patients. Let’s give them a round of applause.

EMPLOYEE RECOGNITION: BEHAVIORAL HEALTH PEER COUNSELORS
AT KINGS COUNTY HOSPITAL CENTER

Now I want to tell you the story of Melissa Edwards, a story that Melissa has courageously permitted me to share with you.

Melissa was diagnosed with depression at a very early age. She was born in Jamaica, and she remembers those feelings as far back as when she was five years-old. Her father’s death and her grandmother’s illness contributed to her condition.

At age 11, she attempted suicide. At age 12, she moved to the U.S. and she remembers things getting better. But a year later, she was the victim of a sexual assault. Her depression returned. More hospitalizations followed and she was officially diagnosed with an anxiety disorder.

At 18, her mother kicked her out of the house. She lived on the streets for a while, then in a homeless shelter and spent a lot of time living with friends. She lost her job and struggled with her weight, which she says reached over 400 pounds, which further contributed to her depression and anxiety.

Fortunately, Melissa found her road to recovery at Kings County Hospital Center.

Her counselors in the Behavioral Health Day Treatment program recognized her potential. They encouraged her to get involved. She became one of our patient representatives on the Consumer and Family Advisory Board, one of the many transformation initiatives that today mark the behavioral health program at Kings County as one of the most successful patient-centered models of care in our city and nationwide.

But Melissa’s story does not end there, as a patient success story.

Melissa is now a member of the HHC staff and the HHC family. In September of last year, Melissa finally accepted our offer of employment. She had turned us down before, still doubting her ability to manage a full time job. She was afraid of taking on too much stress and possibly undoing the great progress she had made to get control of her life.

What Melissa did not know was that this job at HHC was going to be part of her recovery, part of her life’s story of will, hope and inspiration.

Today, Melissa is one of our Behavioral Health Peer Counselors — proud HHC employees who are sharing their unique personal experience to help us help others.

Peer Counselors personify our philosophy and orientation toward wellness and recovery from mental illness, and have become a vital part of the fabric of our clinical teams.

As Peer Counselors, Melissa and her colleagues, David Genna and Leo McKinnis, offer emotional support, share knowledge, teach skills, provide practical assistance, and connect people with resources, opportunities, and extended communities of support.

These three individuals, like many others like them across our system, are uniquely skilled and effective in forming important, positive personal relationships with our behavioral health patients. They have the unique capacity to appreciate the challenges that our patients face and the persistence, passion, empathy and respect to successfully engage hard-to-engage individuals.

Melissa, David and Leo can share wisdom like no other medical provider can. They share their recovery in authentic ways that help inspire hope and trust. They represent the best of HHC.

I’m proud to have our HHC employees, Melissa Edwards, David Genna and Leo McKinnis, here with us. Let’s show them our appreciation.

HHC IN THE NEWS HIGHLIGHTS

Broadcast

Summer Sports Clinic, Dr. David Rhee, Pediatrician, Elmhurst, NY1, 7/20/14

State DOH Awards Hundreds of Millions to Hospitals around City, HHC, NY1, 7/9/14

NY’s Medicaid covering post-birth contraceptives, Dr. Ram Raju, President, NY1, WABC, 7/17/14

SNUG program looks to hire former gang members, prisoners as mentors, Jacobi, News 12 Bronx, 7/14/14

City Researchers Work to Edit Genes to Resist HIV, Dr. David Stein, Director of Adult HIV Research, Jacobi, NY1, 7/14/14

Best of the Bronx: Jacobi Medical Center Worker Janice Halloran Wins Sloan Public Service Award, Jacobi, NCBH, Janice Halloran, Sr. Assoc. Dir., North Bronx Healthcare Network, News 12, 7/10/14

City Councilman launching campaign to get guns off the streets, Erik Cliette, Director of Injury Prevention, Harlem Hospital, Osakwe Beale, Group facilitator, Harlem Hospital Injury Prevention Program, Guns Down Life Up, WPIX, 6/30/14

Print

Dr. Raju’s Plan for HHC Future, Crain’s Health Pulse, 7/21/14
NY’s Medicaid covering post-birth contraceptives, Dr. Ram Raju, President, Associated Press, 7/17/14
If you’re sick, city is the place to be as New York’s hospitals offer array of elite medical options, according to 2014-15 rankings released by U.S. News & World Report, Bellevue, Harlem, Jacobi, New York Daily News, 7/15/14

Best Hospitals in New York, Bellevue, Harlem, Jacobi, US News & World Report, 7/15/14

Bronx hospital receives $600,000 gift from City Council before due date for revamped maternity ward, North Central Bronx, New York Daily News, 7/2/14

Council secures funds for NCBH, North Central Bronx, Bronx Times, 7/16/14
HHC awarded $152M in first round of waiver funding, Marlene Zurack, Chief Financial Officer, HHC, Capital New York, 7/8/14

Innovation Grants , HHC, Crain’s Health Pulse, 7/10/14

Transforming Healthcare Delivery, Marlene Zurack, Chief Financial Officer, HHC, City & State, 7/25/14

Thought I Needed a Gay Doctor, But What I Needed Was Respect, HHC, Metropolitan Hospital Comprehensive LGBT Health Center, Dr. Nadia Duvilaire, Christopher Leo Daniels, LGBT Health Center patient, Gaycitynews.com, 6/26/14 (Also covered in Gay City News Pride Issue, Washington Blade and Welcometoharlem.com )

Recruitment Factors to Consider When Employing a Culture of Excellence, Kings County, Nurse.com, 7/14/14

Queens Hospital Center Designated “Baby-Friendly”, Queens Hospital Center, Diana Vientos, MS,CLC, QHC, El Diario, 6/27/14

Coney Island Hospital Wins Maternity Care Award for Third Consecutive Year, Arthur Wagner, Executive Director, Coney Island, Sheepsheadbites.com, 7/9/14

Excellence In Stroke Care Award To Elmhurst Hospital, Chris Constantino, SVP Queens Health Network, Executive Director, Elmhurst, Gordon Cantor, MD, Associate Attending Director of Neurology, Elmhurst, Queens Gazette, 7/16/14

A Spoonful of Medicine May Put Children at Risk, Bellevue, Woodhull, The New York Times, 7/15/14

Prostate Cancer: What Every Man Should Know, Dr. David Schwalb, Lincoln, Bronx Free Press, 6/25/14

Under Her Skin: The Breast Cancer Survival Divide Across Racial Lines, Dr. Kathie-Ann Joseph, Bellevue, The Take Away, 7/7/14

Health: Building Healthy Lives And finding Care, Dr. Marlon Brewer, Elmhurst, Queens Tribune, 6/26/14

Officials Launch Network to Stem Gun Violence, Erik Cliette, Director of Injury Prevention, Harlem Hospital, Osakwe Beale, Group facilitator, Harlem Hospital Injury Prevention Program, Guns Down Life Up, The Epoch Times, 7/1/14

Doctors Council’s new activist agenda, HHC, Crain’s Health Pulse, 7/11/14

A breakdown of New York’s Obamacare numbers, MetroPlus, Capital New York, 6/25/14

Health insurers look for big rate increases in 2015 from state regulators, HHC, MetroPlus, New York Daily News,7/3/14

Using M.C.s as well as MDs to Promote Healthy Eating for Youths, Harlem, The New York Times, 7/8/14

De Blasio strikes deal with 1199, HHC, Capital New York, 6/25/14 (Also covered in New York Observer and Crain’s Health Pulse)

WE ALWAYS PUT PATIENTS FIRST