New York City Health and Hospitals Corporation
|New York City Health and Hospitals Corporation|
|Jurisdiction||New York City|
|Headquarters||125 Worth Street New York, New York|
|Agency executives||Alan D. Aviles, President and Chief Executive Officer
Michael A. Stocker, MD, MPH, Chairman of the Board
Reverend Diane E. Lacey, Vice Chairman of the Board
|Parent agency||City of New York|
The New York City Health and Hospitals Corporation (HHC) operates the public hospitals and clinics in New York City. A public benefit corporation with $6.7 billion in annual revenues, HHC is the largest municipal healthcare system in the United States serving 1.3 million patients, including more than 475,000 uninsured city residents. HHC was created in 1969 by the New York State Legislature as a public benefit corporation (Chapter 1016 of the Laws 1969). It is similar to a municipal agency, but has a Board of Directors. It operates 11 hospitals, four nursing homes, six diagnostic and treatment centers, and more than 70 community-based primary care sites, serving primarily the poor and working class. Through its wholly owned subsidiary, MetroPlus, HHC operates a Health Plan which enrolls more than 400,000 members in Medicaid, Medicare, Child Health Plus and Family Health Plus health insurance programs. HHC Health and Home Care also provides in-home services for New Yorkers.
Each year HHC's facilities provide about 225,000 admissions, one million emergency room visits and five million clinic visits to New Yorkers. HHC facilities treat nearly one-fifth of all general hospital discharges and more than one third of emergency room and hospital-based clinic visits in New York City.
The most well-known hospital in the HHC system is Bellevue Hospital, the oldest public hospital in the United States. Bellevue is the designated hospital for treatment of the President of the United States and other world leaders if they become sick or injured while in New York City. The president of HHC is Alan Aviles, an attorney and health care administrator.
History and mission
In 1736, HHC’s oldest hospital, Bellevue was founded as an infirmary for smallpox and other contagious diseases on the top floor of a public workhouse and jail. Bellevue Hospital was formally named in 1825. At the turn of the 20th century, Bellevue’s medical college merged with University Medical College into what would later become the New York University College of Medicine.
In 1920, Bellevue founded the Children's Psychiatric Service, the first program in the United States devoted to the study of child autism and training child psychiatrists. Bellevue continues to provide through this day comprehensive pediatric services and renowned psychiatric services, as well as highly regarded emergency and trauma services. Bellevue remains the principal teaching hospital for its affiliated New York University School of Medicine. HHC’s other hospitals were founded in the late 19th century and early-to-mid-20th century.
In 1965, Medicare and Medicaid were created and quickly accounted for 86 percent of the income received by the municipal hospital system. Patients with private insurance opted to use private hospitals and Medicaid raised its eligibility. As a consequence, New York City hospitals saw patient numbers and funding decline precipitously. According to a 1967 study just two years later, the conditions and quality of care at public hospitals in New York City were deplorable.
In 1969, New York City created HHC to replace its Department of Hospitals operating city hospitals and other health care facilities. HHC was formed as a quasi public agency to enable it to benefit from private revenues and funding. HCC’s fiscal condition nevertheless has varied periodically since its formation, and it has gone through periods of instability.
Today, HHC's mission remains to provide care equally to, and to protect and promote the welfare of, New York City residents of all income levels, and to join with other health workers and communities to promote and protect health:
To extend equally to all New Yorkers, regardless of their ability to pay, comprehensive health services of the highest quality in an atmosphere of humane care, dignity and respect;
To promote and protect, as both innovator and advocate, the health, welfare and safety of the people of the City of New York;
To join with other health workers and with communities in a partnership which will enable each of our institutions to promote and protect health in its fullest sense -- the total physical, mental and social well-being of the people.
Each year thousands of New Yorkers support HHC and its mission through donations to the HHC Foundation. More than 8,000 volunteers each year also contribute over one million hours of service to HHC facilities. Volunteers participate in a range of activities and interests in helping patients at HHC's facilities throughout New York City. Volunteer opportunities are described on the volunteer page of HHC's web site.
Awards and grants
HHC has won a number of awards and grants in recent years for its quality of care and innovative community-based programs. In 2006, a study by the federal Centers for Medicare and Medicaid Services (CMS) ranked quality of care at HHC among the highest in New York City in the areas of heart attack, heart failure and pneumonia. HHC reported that of the 50 hospitals in New York City that voluntarily submitted quality data to CMS, HHC hospitals held seven of the top nine places – and all ranked in the top 17—when judged by 10 specific measures of healthcare quality for the treatment of patients with life threatening heart and pulmonary conditions, and that Brooklyn’s Coney Island Hospital achieved a first place ranking among all New York City hospitals, public or private.
On September 30, 2008, the Centers for Disease Control and Prevention (CDC) awarded HHC a $10 million grant to be administered by the National Institute for Occupational Safety and Health (NIOSH). The grant, which will provide up to $30 million over three years, is to provide health services to non-responder populations in New York City affected by the World Trade Center attack. Under the grant, HHC will provide medical examinations, diagnostic testing, referral and treatment for residents, students, and others in the community that were directly affected by the dust and debris from the collapse of the World Trade Center buildings on Sept. 11, 2001. Other recent grants to HHC include to expand access to neonatal care and to improve health literacy among low literacy patients.
HHC has won several other prestigious awards in recent years.
- The American Hospital Association awarded HHC’s system-wide palliative care program a Circle of Life Citation of Honor, the first time that such an honor was bestowed on a public hospital system. HHC’s program was judged to be among the top eight of more than 100 national competitors.
- The National Association of Public Hospitals and Health Systems recognized Kings County with a Safety Net Award in the Health Information Technology category for its use of healthcare IT to reduce the incidence of hospital-acquired infections in its surgical intensive care unit.
- The National Quality Forum and The Joint Commission recognized HHC with the 2008 John M. Eisenberg Award for HHC In Focus, a HHC web site where the public can review how HHC facilities compare to state and national benchmarks on quality indicators. The award recognizes HHC's work to make quality and safety data transparent.
- The 2008 HANYS (Hospital Association of New York State) Pinnacle Award for Quality Improvement and Patient Safety was awarded to HHC's North Bronx Health Network. The Network, which includes Jacobi Medical Center and North Central Bronx Hospital, was also recognized for its Violence Reduction Protocol in psychiatric services. HANYS awarded Woodhull Medical and Mental Health Center the Honorable Mention for a 2008 Community Health Improvement Award for their Artist Access Program.
- Harlem Hospital Center was the first hospital in New York City to receive the "Baby Friendly" certification granted by Baby-Friendly USA, part of a global initiative sponsored by the World Health Organization (WHO) and United Nations Children's Fund (UNICEF). The Initiative selects hospitals and birthing centers that implement the recommended 10 steps of a comprehensive breastfeeding program.
- Sea View Hospital Rehabilitation Center & Home earned the 2007 Ernest Amory Codman Award from The Joint Commission for the use of outcomes measurements as a means to achieve improvement in the quality and safety of health care.
- Elmhurst Hospital Center was assigned a "Magnet" designation by the American Nurses Association to recognize quality patient care and nursing as well as innovations in professional nursing practice.
- HHC earned the 2007 Life and Breath Award by the American Lung Association for contributions to the prevention of lung disease in New York City.
- New York magazine, in its lists of the Best Doctors in the City each year, identifies several HHC physicians throughout the public hospital system as notable in their field.
- Woodhull Hospital in Brooklyn and Lincoln Hospital in the Bronx earned, respectively, the Gold and Silver Performance Awards, designated jointly by the American Heart Association and American Stroke Association, for applying evidence-based best practices in the treatment for Coronary Artery Disease and Heart Failure.
Lawsuit and allegations of abuse and neglect at HHC unit
Conditions at the psychiatric unit of Kings County Hospital in Brooklyn, one of 11 HHC hospitals, remain the subject of a lawsuit and scrutiny by the press. In May 2007, the New York State Mental Hygiene Legal Service, the New York Civil Liberties Union, and Kirkland & Ellis, a private law firm, filed a lawsuit against Kings County Hospital. The plaintiffs charged that its psychiatric unit was "a chamber of filth, decay, indifference and danger."
The May 2007 lawsuit alleged that patients at the Kings County Hospital "are subjected to overcrowded and squalid conditions often accompanied by physical abuse and unnecessary and punitive injections of mind-altering drugs."
In December 2007, the U.S. Department of Justice and the U.S. Attorney’s Office for the Eastern District of New York began a separate investigation.
In June 2008, the plaintiffs in the May 2007 lawsuit released a video of Esmin Green, a 49-year-old patient, dying on the floor of a waiting room in King County Hospital after waiting to be seen by at the psychiatric emergency room for more than 24 hours.
Shortly after the release of the video, which was highly publicized, HHC officials agreed in court to implement emergency reforms. Alan Aviles, HHC president, released a statement that he was shocked and distressed by the situation and promised a thorough investigation. Six HHC employees were fired and reforms were implemented.
On February 9, 2007, the plaintiffs in the May 2007 lawsuit issued a joint statement acknowledging that reforms had been implemented but stating that further reforms are needed. Plaintiffs stated:
[T]he hospital remains a dangerous place where patient health and safety is at risk on a daily basis. . . . Clearly, much more works needs to be done. The federal government’s involvement brings a vast array of expertise and resources, and we look forward to working with the DOJ and the U.S. Attorney’s Office in our efforts to make Kings County Hospital a safe, effective, and therapeutic environment in which New Yorkers can receive the professional care and treatment they deserve. It is our hope and expectation that the express willingness of the defendants to work with DOJ and Plaintiff's counsel will, in fact, result in the change that KCHC so desperately needs.
The particular conditions at Kings County Hospital appear to be largely limited to that unit. As part of a broader transparency initiative, HHC voluntarily reported health and safety data for 2008, showing significant declines in infection and mortality rates across its participating hospitals on its HHC Web Site. Procedures across HHC hospitals and centers, however, are largely unstandardized and conditions vary widely.
Mayor Bloomberg has stressed the need for, and improvements in, accountability and transparency at HHC, stating in March 2009, “New York City’s public hospitals are also national leaders in reporting on patient safety, including the rate of infections acquired during hospital stays – a very troubling problem nationwide. Our taxpayers deserve to know that. That’s what accountability is about – and we need to make accountability the norm throughout the country, in big cities and small towns."
Leading medical information technology systems
In recent years, HHC has received recognition for its advanced clinical information system which includes a comprehensive electronic health record (also known as an electronic medical record). HHC public hospitals have won the Nicholas E. Davies award for the use of clinical information technology. HHC President Alan Aviles received the CEO IT Achievement Award from the Healthcare Information and Management Systems Society and Modern Healthcare Magazine for leading use of information technology to advance healthcare excellence. And HHC's North Bronx Healthcare Network was awarded Hospitals and Health Networks' Most Wired Award four consecutive years for its use of information technology in safety, quality, customer service, business processes and workforce training.
In a statement on March 31, 2009, Mayor Bloomberg stressed the importance of HHC's information technology and its utility as a precedent for reform at the national level.
Implementing these principles, and the others the President has stressed, is going to require more than funding. It’s going to require innovation.
And health information technology – which the President is making a strong commitment to – is a potential game-changer. Clay Christensen, a scholar whose work on transformative change in business I’ve long admired, has argued that such transformation is almost always produced by what he calls ‘disruptive innovation.'
Think of how personal computers made mainframe computing obsolete, or of the effect of the internet on information technology generally. That was disruptive innovation. EHR’s [electronic health records] can be that kind disruptive innovation, too.
That’s what we’re finding in New York City, where we’ve created the nation’s largest primary care electronic health record network. It links more than 1,100 doctors with more than a million patients in low-income communities with a prevention-focused EHR.
We’re already seeing that EHRs bring prevention front and center in every doctor’s visit, simply by giving doctors the information that they need when they need it about patient vaccinations, screenings, and other essential disease prevention measures.
EHRs also allow doctors – in many cases for the first time – to actually understand how many patients they’re treating and how well they’re doing in preventing illness. With that data, EHRs also create the potential to reward doctors for actually keeping people healthy. Today, the potential of EHRs is barely being realized; it’s been estimated that across the nation, for example, fewer than two per cent of hospitals have installed comprehensive EHRs.
So by including more than $20 billion in funding for EHRs in Federal stimulus funding, President Obama shows he understands just how much our health care system needs a strong dose of disruptive innovation.
2009 State funding cut
In March 2009, HHC announced spending reductions of $105 million and said that it would eliminate 400 jobs because of Medicaid cuts, rising expenses and a growing number of uninsured patients. Alan Aviles, HHC President, said regarding the cuts, "We can try and ensure that patients who are adversely affected can be linked to alternative care. That, of course, will become more and more difficult as we have to dig deeper and deeper."
Local DC 37, a union representing some of HHC's 30,000 workers, announced:
If there is one thing that should be obvious in this economic climate it is that layoffs are not a solution but only compound the problems we're facing. District Council 37 will address this issue aggressively. We are talking to the State to make sure that the federal stimulus moneys are used for the purpose for which they are intended.
Cutbacks will include four school-based health programs, three community clinics, two mental health day treatment programs, and the consolidation of three other hospital-based programs. At the time of the March 2009 announcement, Aviles said these cuts address a fraction of the problem and pointed to additional reductions in the future.
In early April, Aviles circulated a letter to HHC's employees and its community advisory board stating that due to decisions by Governor Paterson the cuts would be significantly deeper than those reported in March.
The effect of the initial and additional funding cutbacks on the ability of HHC to deliver effective community care is unclear. The process by which the cuts were decided upon by Governor Paterson has not yet been reported.
It is unclear whether the cutbacks will impact the efficacy in New York City of President Obama's initiative to expand affordable access to healthcare, or how the cuts will affect New York City's ability to offer HHC's industry leading electronic health record system as a model for integrating modern information technology into the healthcare delivery system at the national level.
List of hospital facilities
- Bellevue Hospital Center
- Coler-Goldwater Specialty Hospital
- Coney Island Hospital
- Elmhurst Hospital Center
- Gouverneur Healthcare Services
- Harlem Hospital Center
- Jacobi Medical Center
- Kings County Hospital Center
- Lincoln Medical Center
- Metropolitan Medical and Mental Health Center
- North Central Bronx Hospital
- Queens Hospital Center
- Woodhull Medical and Mental Health Center
- New York City Department of Health and Mental Hygiene
- List of hospitals in New York
- New York City Department of Health and Hospitals Police
- HHC Website
- "The History of New York City's Municipal Hospitals," HHC Foundation Web Site
- Answers.com, New York City Health and Hospitals Corporation
- HHC, Answers.com
- Funding Universe Web Site
- HHC Web Site
- HHC Web Site
- HHC Foundation Web Site
- Press Release, "CDC Awards $10 million to New York City Health and Hospitals Corporation to provide Health Services to Residents, Other Community Members Affected by 9/11 Attack," September 30, 2008
- HHC Press Release
- HHC Press Release
- HHC Web Site
- NYCLU Web Site
- AP, "Esmin Green, who died on Brooklyn hospital floor, perished from sitting," July 11, 2008
- Chicago Tribune, "Esmin Green's death: the hospital chief responds," July 2, 2008
- Chicago Tribune, "Esmin Green's death: the hospital chief responds," July 2, 2008
- Julia Kantor, Epoch Times, "Bloomberg Urges Support for Obama’s Health Care Reform," April 2, 2009
- York City Press Release, dated March 31, 2009
- Douglas McCarthy, M.B.A., and Kimberly Mueller, M.S., "The New York City Health and Hospitals Corporation: Transforming a Public Safety Net Delivery System to Achieve Higher Performance," Fund Report from Commonwealth Fund, October 17, 2008
- Cinda Becker, "CEO IT Achievement Award: Alan Aviles raises the bar," Healthcare Business News, June 26, 2007
- Release, dated March 31, 2009, New York City Web Site
- NY1, "City's Public Health System To Cut 400 Jobs," March 19, 2009
- Melanie Evans, Modern Healthcare, "N.Y.C. health system faces even deeper cuts," April 10, 2009