Report to the HHC Board of Directors
President and Chief Executive
As you know, the economic downturn has increased dramatically the number of uninsured patients seeking our services. During 2009, the uninsured who sought services at HHC hospitals and health centers increased to nearly 453,000 – a 13 percent increase from calendar year 2006, when HHC served some 396,000 patients without health insurance.
The demand for HHC services from a growing number of uninsured comes at a time when our public hospitals and health centers now receive about $240 million less in Medicaid revenue annually than was received in 2006 as a result of three successive years of State budget Medicaid cuts. To make matters worse, the recent proposed State Executive Budget would cut HHC’s Medicaid funding by another estimated $85 million. The proposed State Executive Budget also left unclear whether HHC will continue to be granted access to $300 million in Disproportionate Share Hospital (DSH) funding that we did receive during the last two state fiscal years to help cover our rising indigent care costs.
At the same time that the state has reduced Medicaid funding to help address its own projected budget deficits, supplemental Medicaid funding for safety net providers like HHC has also eroded substantially. For the last five years, the two sources of such supplemental federal funding – DSH and Upper Payment Limit (UPL) funding -- have averaged $1.4 billion annually. Starting next year, the combined baseline funding for these two programs will drop by at least $200 million (and by as much as $500 million if the State budget does not ultimately grant us access to the continued $300 million in DSH funding).
Added to these extraordinarily adverse shifts in our funding is an exponential growth in fringe benefit costs for our workforce. Pension costs have risen from just under $50m in FY 04 to projected costs for FY 2011 of just under $340m – a nearly 700% increase. We also have experienced a near doubling of health insurance costs for our employees during this time frame which has added another $180m to our expenses.
As a result of these and other factors, our total projected expenses for the next fiscal year, which begins in July 2010, will exceed our total projected revenue by more than $1 billion. And this extraordinary budget deficit – which amounts to nearly 20% of our total operating budget of our entire healthcare delivery system -- will only continue to increase in the coming years.
And, as much as we still hope for national healthcare reform – which seemed so close but now appears to have receded on the horizon like a mirage – its enactment would still not solve our monumental fiscal dilemma and its impact on the patients whom we serve would be limited. This is true because the proposed Medicaid expansion in the prevailing reform proposals would not increase Medicaid eligibility in New York where the eligibility threshold is already among the most generous in the nation. And, most critically for New York City, national healthcare reform will not provide coverage for undocumented immigrants (and may deny affordable coverage to most immigrants with legal residency status). Nonetheless, we remain hopeful that the President and our Congressional leaders will find a way to move reform forward and persevere to finally make affordable access to healthcare a reality for a significantly greater number of Americans.
In our city of immigrants, where nearly 40% of city residents are foreign born, there are an estimated 500,000 immigrants without legal documentation. The vast majority of these undocumented immigrants are uninsured and these uninsured New Yorkers rely disproportionately on HHC for their medical care. Serving as the primary safety net for the new immigrant communities of our City has been a proud part of our core mission for generations and, despite the financial challenges we must surmount, we will not turn our back on these patients and communities.
We know we cannot just sit back and passively watch this evolving crisis unfold. We must do all in our power to address our projected budget deficit, even as we continue our work to further enhance safety and quality, and to foster innovation that will enable even greater clinical effectiveness and operational efficiency.
As we advocate against further funding cuts, facility leadership and staff across our system have been intensely engaged in finding ways to balance their budgets while remaining true to our mission. We project that these measures, which include a hiring freeze now entering its second year, significant cuts to OTPS spending, a radical curtailing of our capital program, and a limited number of targeted program closures last year, will save us over $200 million this year and about $300 million next year.
With our adoption and implementation of Breakthrough, a standardized performance improvement methodology that employs front-line teams empowered and supported to undertake sequential rapid improvements to eliminate waste and streamline operations, we are making steady progress in cutting costs and increasing our billing revenue. Our Breakthrough teams have already achieved more than $30 million in cost savings and improved revenue collections, and we anticipate that this work will yield us more than $100 million in combined savings and optimized revenue in the coming year.
Despite the work done, and to be done, to maximize our efficiency, we know that more will be necessary to address our daunting budget gap. Unfortunately, the cost of personnel constitutes roughly 70% of our budget and it is not possible to reduce our expenses as much as we must without further impacting our workforce. We already have shed more than 1,000 jobs through a hiring freeze over the course of the last year. We project that we will have reduced our workforce by about 1,300 full-time positions by June 30th of this year. We will need to further reduce our workforce by roughly twice that number of jobs in the coming fiscal year.
This will be painful and cannot be accomplished simply by continuing attrition. For this reason, later this year we will have to undertake additional program closures, service consolidations and other efficiency measures as we restructure our system in ways that will allow us to reduce our staff further. We continue to work closely with a retained consulting firm in analyzing utilization data across our system to fashion a reasonable restructuring plan. This restructuring plan, once complete, may mean that some services available at a number of HHC facilities now will need to be consolidated to fewer locations and this may inconvenience some patients. However, we are going to strive to ensure that whatever changes we need to make are as fair to all our facilities and communities as possible, and that we retain the capacity to meet the full range of healthcare services that our patients across the City require.
And whatever else may change, we will remain firmly committed to HHC’s mission: to serve all patients without regard to their ability to pay or their immigration status.
Let me now turn to some of last year’s accomplishments across our system. Nearly three years ago, we became the first hospital system in our State to make public system-wide and hospital-specific performance data related to quality of care and patient safety. This past year we have continued to expand the type of quality data that we share publicly on our internet website.
For example, in 2009 we posted to our website for the first time the results of federally-mandated patient satisfaction surveys at each of our hospitals. The results for HHC hospitals are encouraging, with our average patient satisfaction scores exceeding the scores of most of New York City’s voluntary hospitals. In many parts of our city, HHC hospitals outscored the vast majority of local non-public hospitals in overall patient satisfaction.
We also posted data to our web site that reflects the quality of our maternity and infant care services, an especially important area of focus for us because our hospitals deliver nearly one out of every four babies in New York City – about 23,000 deliveries a year. Our data show that delivery is very safe in our facilities, with extremely low maternal mortality rates, despite the fact that we handle a disproportionate number of the high-risk deliveries in our City.
In another clinical area where HHC has excelled, our hospitals have made great strides in lowering the number of inpatient hospital-acquired infections through the consistent use of evidence-based best clinical practices in our ICU’s, inpatient units, and operating rooms. Preliminary data for 2009 reflects that our rate of ventilator-associated pneumonia, which has declined by more than 80% in the last three years, declined significantly yet again. However, it appears that our central line infection rates, which had declined by more than 60% in the last three years, increased this past year. This is a reminder that continuous improvement does not happen spontaneously and that focused and sustained vigilance in the implementation of best clinical practices is both difficult and essential. Once this hospital-acquired infection data for 2009 is verified and finalized, we will post it to our public website.
While our system accomplished a great deal this past year that elicits pride, on a personal level it was a particular honor to be a featured speaker at a plenary session of the National Patient Safety Foundation’s annual conference in Washington, D.C. My presentation was described by NPSF to conference participants as a discussion of “how a resource-challenged system has become a beacon for patient safety”. Such recognition by one of the leading patient safety organizations in the nation is a tribute to the innumerable staff across our system who work so hard and so collaboratively to render safer care to our patients.
Last year, HHC also laid the groundwork to become a national leader in the field of medical simulation. In November, I was joined by Mayor Bloomberg to mark the start of construction for HHC's medical simulation center at Jacobi Medical Center to train healthcare providers. The HHC Institute for Medical Simulation and Advanced Learning (IMSAL) will be New York City's largest and most advanced medical training technology center. We are also the first public hospital system in the nation to offer such training, which will improve clinical skills and render complex patient care more safely.
The center will be modeled after similar simulation learning centers at Harvard University, the Mayo Clinic and the North Shore - Long Island Jewish Health System. We expect to train more than 14,000 physicians, nurses and other HHC clinical staff during the first three years. The opening of the HHC Institute of Medical Simulation and Advanced Learning next Fall promises to be among the highlights of 2010.
And speaking of 2010 -- a few years ago I set an ambitious agenda to move HHC to the forefront of patient safety as one of the safest healthcare systems in the county by the end of 2010. The year is here, and I believe that we are meeting that challenge.
While there is currently no national consensus for the criteria to use in ranking the safest healthcare institutions, our ambitious safety agenda and achievements are getting national recognition. We know we have moved the mark dramatically on most of those performance indicators that demonstrate safe care, including the incidence of medication errors, hospital acquired infections, blood transfusion errors, surgical errors, falls, deep vein thrombosis, and pressure ulcers. And we are strengthening our teamwork to prevent common errors that arise when clinical team communication and coordination fail.
But, as always, there’s more work to be done. This year, we will redouble our efforts to further lower the incidence of all forms of preventable patient harm and focus on strengthening a non-punitive “just culture” where we can most readily learn from mistakes and safety concerns that are reported promptly without fear of retribution.
I am pleased to report that the awards and recognitions continued to arrive throughout 2009 – even after a busy award year in 2008 when we received the prestigious Eisenberg Award for Patient Safety from the National Quality Forum and The Joint Commission and high praise for our strides toward higher performance from The Commonwealth Fund.
Here are some of the award highlights from 2009. Lincoln Hospital earned national and international recognition as a Surgical Safety Checklist Monitor Hospital, one of eight in the country designated by the Institute for Healthcare Improvement and recognized by the World Health Organization. Queens Hospital Center was recognized by the Healthcare Association of New York for its exemplary work in reducing central line bloodstream infections.
And Jacobi Medical Center and North Bronx Central Hospital were the proud recipients of the 2009 national AHA NOVA Award for Project BRIEF, the innovative HIV rapid testing and treatment program that brings HIV testing to non-traditional hospital locations, most often the Emergency Department. It uses interactive computerized tablets to increase access to screening, risk reduction education, and testing, and, in collaboration with community organizations, helps link those who are HIV-positive to proper care. Toward the end of 2009, more than 29,000 individuals had been tested through Project Brief, and 134 patients newly diagnosed as HIV positive had been linked to care.
Our corporate-wide patient safety work of the past few years will continue to receive special attention at the 2010 National Patient Safety Foundation's Annual Congress. Several HHC submissions have been accepted for presentation on the use of TeamSTEPPS to enhance team performance, the role of a “just culture” in promoting patient safety, medication management and rapid response teams. Our staff will also participate prominently in the planning for a Simulation and Learning Center that will be created at the 2010 Congress.
Last year, our MetroPlus Health Plan once again was rated the top Medicaid health plan in New York City, based on quality scores and member satisfaction surveys. The designation comes from the New York State Health Department in its recently published 2009 Consumer's Guide to Medicaid Managed Care in New York City. The ratings are based on measures that include preventive and well-care for adults and children, quality of care for members with chronic illness and patient satisfaction with access and service.
And once again, our facilities performed exceptionally well in the accreditation surveys conducted by the Joint Commission. The Joint Commission surveyed four facilities in 2009 -- Coney Island Hospital, Kings County Hospital Center, Lincoln Hospital, and Sea View Hospital Rehabilitation Center and Home. All four received high praise from the survey team. The survey Team Leader openly shared with all of us how impressed she was with our facilities and especially with the obvious commitment all employees had to HHC’s mission and their active focus on quality, patient safety, and continuous performance improvement.
Too often we refer to ourselves at the city’s public hospital system when, in fact, we are much more than that. We are an integrated healthcare delivery system that includes a vast ambulatory care network, a home care division, and four high-performing long-term care facilities that provide the kind of extended skilled nursing care and rehabilitation services that acute care hospitals are simply not equipped to offer.
Coler-Goldwater, Gouverneur Healthcare Services, Sea View Hospital and Rehabilitation Center, and Susan Smith McKinney Nursing and Rehabilitation Center have a long track record of being responsive to the needs of their communities and have been at the forefront of HHC’S patient safety agenda.
At Coler-Goldwater, Gouverneur and Susan McKinney, the incidence of patient falls is approximately 1/3 of the national average, reflecting the staff’s concern for keeping patients safe and their diligence at doing so.
Gouverneur was one of two HHC facilities that received the highest rating available – five stars – when the federal Centers for Medicare and Medicaid Services (CMS) launched a new quality rating for nursing homes in December of 2008. Only 12% of the nearly 16,000 nursing homes rated nationally received this top rating, which is based on health inspection surveys, quality measures, and staffing levels.
Both Coler-Goldwater and Gouverneur continue to move forward with a resident-centered care model called Culture Change, which creates a more home-like, community-oriented environment for residents. Coler holds monthly community meetings with staff and residents to improve communications and resolve problems; they have aligned the assignment of nursing aides so that residents have consistency and more personalized care; and they have held a series of leadership training sessions around the Culture Change concept.
In 2009, Sea View continued to excel across all three performance indicators published on our website, with the incidence of pressure ulcers among high risk patients at less than 50% of the national and state averages, pain control for short-stay residents better than national and state averages, and the fall rate among residents more than 50% below national and state averages.
HHC facilities provide nearly 40 percent of hospital-based inpatient mental health services in the city, and we serve a disproportionate number of New Yorkers with serious and persistent mental illness.
The most striking demonstration of HHC’s progress in behavioral health in 2009 occurred at Kings County, where the new $153 million Behavioral Health Pavilion opened last February. Within the Pavilion, staff are successfully implementing a comprehensive plan to radically change for the better the patient experience for the roughly 10,000 behavioral health patients of all ages seen at Kings County annually. The vastly improved physical environment, together with new leadership, has helped foster an altered culture of more patient-centered care, anchored in compassion and respect, with an emphasis on sustainable recovery and re-integration into the community.
While the new building is welcome – and a vast improvement – even more significant are the reforms underway that are slowly yielding significantly better results. Dramatic reductions in both the average length of stay and the average number of patients in the CPEP at any one time have been achieved over the course of the last year. New procedures ensure much closer monitoring of all patients during the entirety of their stay in the CPEP. More generous staffing ratios are enabling more expeditious and more effective screening, evaluation and treatment. New personnel known as “behavioral health associates” with training in de-escalation of aggression and crisis intervention have replaced uniformed security personnel in the CPEP, and peer counselors have been deployed across all three tours in the CPEP as a further resource for engaging patients in crisis constructively.
In 2009, we also reached an amicable resolution of litigation brought against HHC and Kings County Hospital Center in 2007 by the New York Civil Liberties Union and the Mental Hygiene Legal Services alleging deficiencies in the hospital's psychiatric program. And we simultaneously reached an agreement with the US Department of Justice to resolve similar concerns.
Over the last year, we worked closely with all parties to the pending litigation to identify and begin implementing reforms that go beyond merely correcting deficient conditions alleged in the original lawsuit. The result has been the creation of the comprehensive plan that has already fundamentally overhauled the psychiatric program at Kings County to create an emerging model of safe, compassionate, patient-centered behavioral health services that others in the city and the country will want to replicate.
Also this past year, thanks to $300,000 from the Fan Fox and Leslie Samuels Foundation, Woodhull Hospital began implementation of Project IMPACT, an evidence-based model to improve treatment of depression in the elderly by integrating geriatric mental health services with primary health care. Woodhull’s Geriatric Wellness Center, which opened last February, is home to the IMPACT team and the source of an array of primary care, behavioral health, and chronic disease resources for the North Brooklyn senior community.
Our award-winning North Central Bronx Violence Reduction Protocol (VRP) has been implemented across our system and has helped identify and screen psychiatric patients with a potential for violence so that specialized treatment plans can be developed collaboratively with patients and staff. This has reduced patient and staff injuries, and increased patient satisfaction with treatment. At the same time, over the past two years, HHC has reduced the use of restraints and seclusion dramatically across our psychiatric units, with particularly impressive results at Jacobi Hospital.
To fundamentally improve the health of the communities we serve, we continue to promote broadly accessible and robust primary and preventive care. Our system-wide efforts to provide smoking cessation, cancer screening, and routine HIV testing services have produced significant and measurable benefits for our patients.
Last year, despite some confusing controversy among national experts this past year, we did not change our fundamental practice of referring women for annual mammograms after the age of 40, or providing annual cervical cancer screenings to young women who are sexually active, or making both screening tests available to other women who have particular risk factors. As you know, HHC has made it a priority to expand access to cancer screening to low-income and uninsured women. Over the last five years, we have provided more than 500,000 mammograms and more than 700,000 cervical cancer screenings to our predominately low-income female patients.
Last year, we also continued expanding our use of clinical information technology to advance safe, effective care. As we have already done with diabetes, we launched a Cardiovascular Risk Registry -- an electronic disease tracking program that significantly improves a clinical team’s ability to monitor and manage cardiovascular disease among patients. The registry has identified more than 49,000 patients with high blood pressure and 31,500 patients with high cholesterol whose treatment is being closely monitored and better managed.
As the data posted to our public website attests, we succeeded in improving the health status of our adult diabetic patients again this past year, with a greater percentage reflecting healthy blood sugar levels. To further assist our diabetic patients, we also launched a new online diabetes resource -- www.nyc.gov/hhcdiabetes, a new website designed to help patients manage their diabetes at home and become more active participants in their care. The HHC Diabetes Wellness Center is available in multiple languages and features advice from HHC doctors, nurses and nutritionists, patient success stories, healthy eating and exercise tips, access to free blood monitors, and a comprehensive list of support groups and diabetes wellness classes available in all of our 11 public hospitals.
HHC continues to work to make rapid HIV testing a routine part of medical care. We tested 187,732 patients in Fiscal Year 2009. That is a 17% increase from the 161,089 patients tested the year before and a 200% increase from just four years ago. More than 1,800 patients tested this past year learned that they were HIV positive and were linked to care. Most of those who tested positive were unaware of their HIV status and are now connected to potentially life-saving care at one of our Designated AIDS Centers.
With the strong support of the Mayor and the City Council, in 2009 HHC continued to expand access to primary care services for the residents of Staten Island.
Last April, we launched the HHC Health Connection Mobile Medical Office staffed by a doctor, a registered nurse, a patient care associate, and a financial counselor. With a patient reception area, two exam rooms, an electronic medical records system, and modern diagnostic equipment, the medical unit offers primary care services five days a week in five Staten Island communities -- New Brighton, Tottenville, Midland Beach, Concord, and Park Hill. At each of these locations, we have partnered with local community-based organizations that offer additional social and other support services.
We also added Adult Primary Care capacity at the Mariner’s Harbor Family Health Center in November of 2008 and at Stapleton Family Health Center in June of 2009. Since then we have provided more than 1,800 adult primary care visits at these two HHC facilities.
With $1.6 million in renovations funded by HHC and completed last year, the Community Health Center of Richmond was able to double its capacity to provide primary care services to adults and children. In addition to our capital investments, HHC has provided more than $7.8 million in funding to help subsidize the Center’s operations since 2006. And beyond our financial support, HHC staff members have offered extensive technical assistance to the Center’s Board and Administrative staff.
In March 2009, the Community Health Center of Richmond finally became a federally qualified health center. During the time that the Richmond Center was awaiting this designation, HHC developed and funded (in the amount of $6.6 million) the Staten Island Health Access (SIHA) program, which served more than 6,600 people. Once the Richmond Center received federal designation, HHC worked to ensure the smooth transition of SIHA participants to HHC’s Family Health Centers, the MMO and the Richmond Center through intensive outreach and education in partnership with community-based organizations including Project Hospitality, El Centro del Inmigrante, Make the Road New York, the African Refuge, and the Jewish Community Center.
Another example of HHC’s commitment to ensure access to health care for Staten Island residents is our continued grant funding of the Jewish Community Center, or JCC, for the provision of facilitated health insurance enrollment services. From July of 2008 through June of 2009, as a direct result of HHC’s funding, JCC assisted 867 Staten Island residents to obtain public health insurance coverage. By virtue of HHC’s grant funding to JCC, which began in 2005, more than 3,100 Staten Island residents have secured health insurance coverage. We have extended our grant funding of JCC through June of 2010, to provide ongoing public health insurance enrollment assistance, and continued outreach to former SIHA participants who are not yet linked to primary care.
Last Spring, New York City faced an unexpected outbreak of a new influenza stain, H1N1, which caused thousands to flock to our emergency rooms in search of treatment and in search of information and reassurance. From the beginning of the H1N1 outbreak, HHC played a critical role in the city’s coordinated emergency response and preparedness efforts. We took immediate steps to ensure that patients received the care that they needed, despite dramatically increased patient volume in our emergency departments and many of our primary care settings. We also opened Fast Track Flu Centers across the city to help meet public demand for both seasonal and H1N1 flu vaccinations.
The new influenza, along with new regulations that would have mandated healthcare employees to get vaccinations, set the stage for a very aggressive internal campaign to ensure that both our patients and our staff received the necessary vaccines to stay healthy.
Flu immunization of healthcare workers has been an integral part of our patient safety campaign in recent years, since it can prevent transmission of influenza to patients whose health is fragile. By 2008, we had raised our employees' flu vaccination rate to 49%, well above the reported city-average for hospitals of 32%. With a state mandate for employee vaccination looming for several weeks (before it was lifted), the uptake of seasonal flu vaccine by staff was exceptional during the last months of 2009. Once the final numbers are compiled, we expect the rate of seasonal flu vaccination among HHC staff will be significantly higher compared to the previous flu season.
Since September, we administered more than 250,000 doses of seasonal flu vaccine and more than 100,000 doses of H1N1 vaccine among patients and staff.
HHC’s Palliative Care Initiative, launched with $3 million in seed funding, has been expanding in HHC facilities since its introduction in 2006. Palliative care teams include doctors, nurses, social workers, chaplains, psychologists, ethicists and others with specialized expertise who can help patients and their families deal with seriously debilitating or fatal illness.
In 2009, we saw a 33 percent increase in the number of inpatients who opted for palliative care services based on the principles of comfort, support, hope and dignity. For patients facing the end of life, the HHC palliative care teams support patients and families as they face tough and highly personal decisions. Team members explain available options, including where the desired care may be best provided, and also offer guidance through counseling and family meetings.
HHC Palliative Care teams also serve a significant number of patients who are facing serious chronic or degenerative disease and need long-term support to manage their symptoms. During 2009, we saw an 89% increase in the number of patients receiving outpatient palliative services to help manage pain, nausea, shortness of breath and other debilitating symptoms associated with illnesses such as cancer, lung diseases, AIDS, congestive heart failure, dementia and other serious conditions.
In 2009, HHC continued to advance a number of innovative technology enhancements that are designed support our patient safety work, improve health outcomes and yield efficiencies and savings.
Last spring, we began the system-wide rollout of the Hemocare LifeLine (HCLL), a computer system that will manage all blood bank-related ordering and testing while keeping track of patients’ hematological histories, test results, and advisories. The system will consolidate information from HHC's 11 facility-based blood banks into a unified database that will serve the entire corporation, vastly improving the way our hospitals manage their inventories of blood, blood products and reagents. This comprehensive database will provide up to the minute decision support to prevent transfusion reactions and monitor the use blood supply. All but one of our hospital networks have been successfully incorporated in the HCLL network. The project is expected to be fully completed March, 2010.
On August of last year, HHC deployed the PeopleSoft Human Capital Management System at Jacobi, North Central Bronx Hospital, Central Office and Health & Home Care. The system will provide us with the electronic capture and tracking of health insurance benefit eligibility information for employees and their dependents; online recruiting and applicant tracking; and grievance and disciplinary actions. The system also maintains performance evaluations and core and job-specific competency assessments as part of the employee record. It includes an Electronic Learning Management System (ELM) for employees, linking course completion with satisfaction of competency requirements. The second deployment took place earlier this month at the Queens and North Brooklyn Networks. The system is expected to be fully operational by the end of 2011.
With the full implementation of eCommerce, HHC has moved closer to paperless procurement. The system will help HHC achieve cost savings by automating and streamlining the procurement process, through the facilitation of bulk "requirement" contracts, and by reducing inventory levels, with "just-in-time" ordering. The system also gives facilities and departments real time information regarding the status of their requisitions and purchase orders. During the last year, we continued to work on enhancements to the system, including the implementation of a more user friendly requisitioning process that will allow for greater transparency of data to help analyze purchasing trends. The goal is to standardize products across all HHC facilities to enable HHC to further reduce our supply expenses significantly.
We also continue to make progress in the consolidation of our multiple data centers to afford us greater operational cost efficiencies while better protecting the data we gather. All data centers throughout the Corporation will be consolidated into two corporate data centers, with one of the data centers up and running at a site in New Jersey and the other under construction. This which will give us the opportunity to develop, implement and standardize policies, processes and procedures for operating an enterprise-wide IT environment and the opportunity for savings through consolidation of services, maintenance contracts and equipment. Construction of the expanded data center at Jacobi is near completion and expected to go live in April 2010.
As you may remember, in 2008 we selected a new revenue cycle management system, which, among other things, will ensure that we optimize our collection of revenues due us from third-party payors for all services provided to our patients. This initiative brings new technology with a corporate enterprise design creating a single environment for all of our facilities to access. Using Breakthrough methodology, the Revenue Cycle Management (RCMS) team has sponsored some 15 Rapid Improvements Events over the last year to help develop enterprise wide standards for implementation, services and efficiencies, improve and standardize process workflows while keeping the process patient centered. We expect to put the new system in place at some facilities starting in 2011, and will roll it out to a total of 22 facilities by 2013.
Last year, we also initiated a process to develop a centralized clinical credentialing program that will provide accurate, reliable and timely primary source verified credentials and other information for the HHC healthcare provider population that meets accreditation and regulatory requirements. The program will centralize the credentialing for 10,000-12,000 medical staff providers across HHC and MetroPlus, provide efficiency, and eliminate duplication of credentialing functions. We completed the first phase of the project by conducting a comprehensive assessment of the credentialing process currently in place at each HHC facility. We have now entered into the second phase, after selecting a suitable vendor to commence the work starting next month. We expect the new centralized credentialing system to be fully operational by ____.
Over the past three years, we have completed construction on major modernization projects totaling nearly $300 million on the campuses of five facilities. Despite a dramatic reduction in our five-year capital plan, we still anticipate the completion of projects and the replacement of aging equipment and technology over the next five years that total nearly $824 million.
Some of the major modernization projects completed or in progress during 2009 include: