Reports to the Board
RAMANATHAN RAJU, MD
HHC PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
MARCH 26, 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.
ROMA TORRE - PUBLIC CHAMPION OF COLON CANCER AWARENESS
Today I am delighted that we are joined by New York 1 news anchor Roma Torre. She’s been the face of NY 1 for 23 years. Last year, Roma underwent a routine colonoscopy screening and was diagnosed with colon cancer. Now cancer-free, Roma and NY 1 have joined forces with the Health and Hospitals Corporation and members of the Citywide Colon Cancer Control Coalition (C5) to promote colon cancer awareness, an effort the Health and Hospital Corporation has spearheaded for over a decade.
Roma has publicly shared her colon cancer diagnosis, surgery, and recovery in a compelling public service announcement. NY 1 has also been airing a series of very moving personal video journals Roma filmed during her treatment.
I wanted to take just a few moments today to watch Roma’s important public service announcement, which promotes the benefits of colon cancer screening, prevention and early detection. [Show the video]
Please join me to thank Roma and NY1 for unwavering support of an issue that means so much to the patients we serve. We are happy to present her with these small tokens of our appreciation.
DSRIP UPDATE
Capital requests from our PPS, OneCity Health, totaling $742 million were submitted to the State on February 20. Funding will be available sometime in June, at the earliest.
OneCity Health is producing clinical guidelines that will guide DSRIP projects. Our implementation plan, which helps define milestones toward our goals, will be submitted to the state Health Department on April 1. We look forward to launching hub-based planning in April.
As part of engaging our partners on cultural competence, we had a very helpful interactive partner webinar on February 27th.
FEDERAL UPDATE
Sustainable Growth Rate (SGR) Advances
The House of Representatives has passed legislation to permanently replace the Medicare physician sustainable growth rate (SGR) formula, which if not fixed before March 31st, would result in a 21 percent cut in Medicare payments to doctors. The legislation also includes language which would extend the Children's Health Insurance Program for two years.
The House legislation also includes changes to the current schedule and amount of Disproportionate Share Hospital (DSH) cuts. Current law has DSH cuts starting in FFY 2017 and extending through FFY 2024. The House legislation would postpone the initiation of the DSH cuts until FFY 2018 and extend the DSH cuts through FFY 2025 with more aggressive reductions in funding over the last three years, than what is in current law.
As a result of advocacy by the hospital community, the House bill did not include language concerning: reductions to Hospital Outpatient Department (HOPD) payments, cuts to Indirect Medical Education (IME), or immediate implementation of the Medicare Two-Midnight Rule. Proposals for site-neutral HOPD payments would have resulted in cuts to HHC of $19 to $23 million per year. Proposals for a 10 percent reduction in IME payments would have cost HHC $10 million per year. The House bill delays implementation of the Medicare Two-Midnight Rule until FFY 2016. Implementation of this rule would have cost HHC an estimated $23 to $38 million in Medicare revenue each year.
HHC Pushes CMS for ACO Rule Interpretation
A rule of the Centers for Medicare and Medicaid Services (CMS) has resulted in unintended consequences for our six Elected Teaching Amendment (ETA) hospitals. Many of the patients they serve will no longer be counted toward their Accountable Care Organization (ACO) numbers. On April 1, this anomaly will result in these patients being automatically reassigned to other entities.
We have established an ACO that treats a large number of the most vulnerable ---dual-eligible--- patients. Using CMS metrics, our ACO was among the best performing Medicare Shared Savings Programs (MSSP) in 2013. During the past year, however, the number of patients attributed to our ACO according to CMS has undergone a precipitous decline.
Health and Hospitals Corporation urgently seeks an updated methodology in order to allow ACOs that include Elected Teaching Amendment (ETA) facilities to continue their participation in the MSSP.
The New York State Department of Health and CMS recently began a Fully Integrated Dual Advantage (FIDA) demonstration program that will passively enroll Medicare-Medicaid beneficiaries into managed FIDA plans starting April 1. Once patients are enrolled in FIDA, they are no longer eligible for ACO attribution.
We are working closely with the State and CMS to rectify this situation, so that the patients we are servicing as part of our ACO are not deleted permanently from our attribution and automatically-assigned elsewhere.
STATE UPDATE
The Governor and Legislature are busy negotiating the details of the State Budget, which must be passed by next Wednesday, April 1.
The Senate and Assembly agreed to the Governor’s proposal to modify the way the State distributes the Upper Payment Limit (UPL) for Health and Hospitals Corporation. These changes will allow us to receive more than $1 billion in outstanding payments for services provided in 2011-2014.
Both houses have agreed to extend the current methodology for distributing Charity Care funding for three years. However, there continues to be disagreement about providing the State flexibility to revise the distribution if federal Disproportionate Share Hospital (DSH) funding cuts are implemented. That flexibility is important to protect Health and Hospitals Corporation from absorbing a disproportionate amount of the cuts.
We strongly believe that charity care dollars should go to those providers who are providing care to uninsured people. We continue to vigorously advocate for this position in Albany.
HHC TESTIMONY AT CITY COUNCIL HEARING
This Monday I appeared before the City Council to testify at the City's Preliminary Budget Hearing. I outlined our top priorities and spoke in some detail about the challenges we face in meeting them. I spoke about our five-year financial plan, the large deficits we face, and corrective actions that we are taking to address them. I also spoke of the recent designation of our diagnostic and treatment centers as a Federally Qualified Health Center look-alike, and our significant efforts, together with our many partners, to support healthcare delivery reform through the ongoing development of OneCity Health.
I also addressed our ongoing capital improvements, particularly at Gouverneur Health, North Central Bronx Hospital, and Elmhurst Hospital.
Finally, I shared details of the recently announced FEMA award of $1.7 billion to partly rectify the damage caused to HHC hospitals by Hurricane Sandy. We are working closely with the Mayor's Office of Recovery and Resiliency to monitor the work that we need to complete.
Council Member Corey Johnson, Chair of the Health Committee voiced strong support for Health and Hospitals Corporation at the council hearing. We appreciate Council Member Johnson recognition of our essential role in New York City’s overall health and wellness.
CONEY ISLAND HOSPITAL EARNS KUDOS FROM JOINT COMMISSION
I am very happy to report that -- not only did Coney Island Hospital sail through a full Joint Commission survey last week with flying colors -- it managed this while being inspected by a number of other regulators like College of American Pathologists (CAP), the Accreditation Council for Graduate Medical Education (ACGME), and the Joint Commission’s Detox team during the same timeframe.
Arthur Wagner and his team deserve our strong thanks. They have set a high standard for other HHC facilities to meet.
REDUCING ANTI-PSYCHOTIC MEDS HELPS
THREE HHC NURSING HOMES EARN TOP FIVE-STAR RANKINGS FROM CMS
Our nursing homes at Gouverneur, Sea View and McKinney have all earned the top five-star national rating from the federal Centers for Medicare & Medicaid Services (CMS), due in part to our leadership’s work to reduce the use of anti-psychotic medications.
LINCOLN MEDICAL CENTER EARNS BABY-FRIENDLY STATUS
Congratulations to Lincoln Medical Center, which has become the first hospital in the Bronx to be designated “Baby-Friendly." This status was earlier awarded at Harlem and Queens hospitals. We are grateful for this international acknowledgement of our commitment to better health for mothers and their babies through strong breastfeeding support.
The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) has designed the Baby-Friendly initiative to promote breastfeeding. It recognizes birth facilities worldwide that offer mothers the information, confidence and skills needed to successfully initiate and continue breastfeeding their babies. The prestigious “Baby-Friendly” designation is given only after a rigorous on-site survey is completed, and is then reviewed every five years.
HHC TOMORROW CONVERSATION ON APRIL 7TH
As the end of my first year as President of Health and Hospitals Corporation draws to a close, we are taking an opportunity on April 7th to review where we have been as an organization, and to chart a course for what lies ahead. I've invited leaders from our facilities and departments, and outside guests, to join me at John Jay College to talk about how we will thrive in the post health care reform era. I look forward to seeing many of you there.
HHC HOSPITALS CONTINUE TO KEEP PATIENT SAFETY FIRST
This month we observed Patient Safety Awareness week -- recognition of the extraordinary level of patient safety protocols and activity we build into our work every day.
I was thrilled to see so much excitement and enthusiasm during this year’s Patient Safety Jeopardy battle. Obviously we’ve made tremendous progress in our work to avoid errors and in keeping patients safe.
The next frontier is translating this degree of patient safety excellence to outpatient care, so that we continue to keep patients safe, while we also keep them out of the hospital.
The President Choice Patient Safety Champion Award went to the staff of Harlem Hospital Center's Pharmacy Department, for tirelessly working to reduce errors and risk. Congratulations to them and congratulations to all HHC Patient Safety Champions. And thank you especially to SVP Caroline Jacobs and her team for pulling this event together and doing a phenomenal job.
HHC HOSPITALS CELEBRATE NATIONAL SOCIAL WORK MONTH
March is National Social Work Month, a time to recognize the important role that HHC’s dedicated social workers play in providing truly patient-centered and holistic care. Their commitment to compassionate care is evident in every patient interaction, counseling session, discharge plan, and linkage to a service.
We know that social workers are indispensable members of multidisciplinary care teams across the system. Whether it’s arranging for child care for a parent in need or connecting a patient to a better housing option, social workers have the expertise to leverage NYC's resources and do everything they can to make our patients healthier and safer. This month, and all year round, let’s remember to appreciate and honor their contributions.
HHC FEATURED PROGRAM: PALLIATIVE CARE PROGRAM
As you know, each month we highlight programs that demonstrate the compassion, heart and soul that is the Health and Hospitals Corporation.
Today I call your attention to our Palliative Care Program. I couldn’t be prouder that our corporation has been at the forefront of the Palliative Care evolution taking place across the medical field. We’ve been very much out front on this. We’ve lead many of our competitors in recognizing how palliative care enables our patients to make the most of life---and maximize the gift that is every day.
Since launching our initiative in 2005, we’ve embraced a philosophy which, at its core, is about empowering patients and their families to take control of debilitating symptoms and pain, often at the end of life. This allows them to focus on what matters most.
Palliative care is not about giving up. It’s about offering a lifeline of medical and psychological support, comfort and compassion to patients during the last part of their lives when they need it most. Our palliative care teams exemplify the kind of culturally competent, patient-centered, family-oriented health care that is Health and Hospitals Corporation.
A team of people have worked very hard to make this happen. I particularly want to thank Donna Leno-Gordon, RN, and Dr. Susan Cohen, Co-Chairs of our Palliative Care Council, for spearheading our efforts over the long term. Congratulations.
HHC FEATURED INDIVIDUAL: MONICA RODRIGUEZ, PATIENT NAVIGATOR
As you know, we use this portion of each board meeting to shine a spotlight on an employee or volunteer who is doing something outstanding on behalf of our patients.
Someone who is going the extra mile, extending themselves to patients beyond their duties, to deliver the quality and compassionate care that we are all about. This month I would like to introduce you to Monica Rodriguez.
Six years ago Monica had a close family friend who was struck with breast cancer. Monica spent a lot of time visiting and doing what she could to make her friend more comfortable and less anxious. At the time she learned first-hand how the American Cancer Society and Queens Hospital staff helped her friend pull through, both physically and emotionally. Monica resolved that she wanted do this sort of work herself. And without blinking an eyelash, she set about getting the proper training and qualifications to work in the field.
For the past five years Monica has worked as a patient navigator at the Queens Cancer Center, where she excels at what she does. She serves as an indispensable source of comfort, information, advocacy and guidance for her patients.
Please join me in recognizing Monica Rodriguez today and in thanking her for a job well done.
HHC IN THE NEWS HIGHLIGHTS
Broadcast
New York Ebola Survivor Says He Was Unfairly Cast as a Hazard and a Hero, NY 1 News, Bellevue
Fit Kids: Program Gives Low Income Moms Tools to Prevent Childhood Obesity,
NY1 News, Bellevue: Dr. Mary Joe Mossito
Bronx Hospital Midwifery Program, News 12 Bronx, NCBH: Dr. Michael Zinaman, Chairman of Obstetrics & Gynecology, North Bronx Healthcare Network; Susan Papera, CNM, Director of Midwifery Services; Belinda Parisi, RN
Hand Washing Demonstration for Patient Safety Week, News 12 Bronx, Jacobi
Home Visiting Service, NY 1 News, Harlem: Marcia Pierre, Nursing Asst. Director, Tiffany Reid, RN
76-Year-Old Harlem Shooting Victim Speaks Out, WABC, Harlem
Kings County Sleep Clinic, News12 Brooklyn, Kings County: Samir, Fahmy, MD, Medical Director, Sleep Diagnostic Center; Josianne Regis, Associate Respiratory Therapist, Polysumnographer
Colon Cancer Screenings Still a Reach for City's Uninsured, NY 1 News, Woodhull: Barbara Blase, Patient Navigator
Lincoln Medical Center attains ‘baby friendly’ designation, News 12 Bronx, Lincoln
City Hospitals Help Patients Screen Risks with Colonoscopies, NY1 News, Woodhull: Dr. Harry Winters, Chief of Gastroenterology
On the Use of Antipsychotics for Dementia Patients, The New York, Times, Dr. Ram Raju, HHC President
Having and Fighting Ebola — Public Health Lessons from a Clinician Turned Patient, New England Journal of Medicine, Bellevue
Doctor who survived Ebola Says he Was Unfairly Cast as a Hazard and a Hero, The New York Times, Bellevue
Kennedy Airport passenger does not have Ebola virus, officials say, AMNY, Bellevue
H.H.C. facing a $753 million deficit, Capital New York, Dr. Ram Raju, HHC President
HHC votes to renew Sandy contract, Capital New York, HHC, Marlene Zurack, Senior Vice President
Cuomo's quiet health care-funding challenge, Capital New York, HHC
Health reform: 'The challenge of moving to scale so quickly', Crain's Health Pulse, HHC
HHC goes to Albany, Crain's Health Pulse, HHC: Dr. Ram Raju
UHF Grants, Crain's Health Pulse, HHC
Coney Island Rebuilds, Crain’s Health Pulse, HHC, Coney Island
Medicaid Managed Care, Crain's Health Pulse, MetroPlus
Many New Yorkers Can STILL Sign up for Health Coverage Due to Special Enrollment Period (March 1 Through April 30), Reuters, MetroPlus: Seth Diamond, COO
Medicaid/Medicare Patients Rely on MetroPlus, Queens Tribune, MetroPlus: Seth Diamond, COO; Roger Miliner, Deputy Executive Director, Marketing
New Executive Director at HHC Metropolitan Hospital Center, Manhattan Times, Dr. Ram Raju, Anthony Rajkumar, Executive Director, Metropolitan
Anthony Rajkumar named executive director of HHC Metropolitan Hospital Center, Amsterdam News
39 HHC health centers and clinics join together, become community health center, Nurse.com, Dr. Ram Raju; Dr. Walid Michelen, Gotham Health CEO
Top hospital inspector spent 7 years investigating a single case, New York Post, Coney Island
Suspended guard who punched Obama impersonator paid $240K, New York Post, HHC, Jacobi
City HR honcho accused of using power to hire six family members, New York Post, HHC
Medical and dental residents reach tentative agreement with the city, Amsterdam News, Dr. Ram Raju
NYC Councilmember Eugene presents $2.8 M to Kings County Hospital for new PET/CT scanners, Brooklyn Daily Eagle, Kings County: Ernest Baptiste, Executive Director
My Patient Doesn’t ‘Do’ Vaccines, The New York Times, Bellevue: Dr. Danielle Ofri, Internist
Growing number of city hospitals offer premature babies donated breast milk, New York Daily News, Bellevue
Free Seminars on Colon Cancer at Coney Island Hospital, Bensonhurst Bean, Coney Island
SNUG Program to Stem Soundview Violence, The Bronx Times Reporter, Jacobi: Noe Romo, MD, SUV Medical Director; Erika Mendelsohn, Stand Up to Violence (SUV) Program Director
The Secret to Successfully Quit Smoking: Support and Gradual Cessation are Essential, Bronx Free Press, Lincoln: Akinola Fisher, MD
City Council Slams Rikers Medical Provider at Hearing, DNAinfo, HHC
Honors for Women's History, Queens Chronicle, Elmhurst: Atiya Butler, Director of External Affairs and Marketing
Queens Hospital Center: Improving Patient Services, Queens Tribune, Queens: Pam Rios, Associate Director; Dr. Farshid Radparvar, Director of Cardiology; Dr. Edouard Belotte
Elmhurst Hospital: An Outline For Achieving Preventive Care, Queens Tribune, HHC, Queens, MetroPlus Elmhurst: Claire Patterson, Senior Associate Executive Director, Queens Health Network
Physician Residency Training Gets Boost from Quality Improvement Clinics, The Hospitalist, Harlem: Maurice Wright, MD, Medical Director; Paroma Mitra, MD
Brooklyn BP Adams presses hospitals to open borough's first burn unit, Metro NY, Jacobi, Harlem
