Time to Do a Disaster Review

Victoria Jarvis will never forget the day last winter when the snowfall — 30 inches in less than 24 hours — became too much even for Vermont.

It was March 7 and the marketing coordinator for Omni Medical Systems in Milton, Vt., nearly panicked when she realized she could not traverse the mounds of snow on the road leading to the company’s offices. She also could not access her email, use her cell phone — no service in the area — or log onto Omni’s website for instructions.

“I knew my patients would be taken care of. All of them have a backup system,” says Jarvis about the clients who use the company’s non-invasive incontinence product. But she was worried about her coworkers.

Omni employs fewer than 20 people and they are like family to one another. Jarvis wanted desperately to know they were all OK. “We have one death [in the state] each year as someone is trying to get to work,” she says.

What to do? It came to her finally … Then it came to her … meet at the Park ‘n’ Ride. That was Omni’s plan should there be a disaster that meant employees couldn’t get to the office. As swiftly as she dared, Jarvis made her way to the lot — where everyone else was waiting for her.

“They knew exactly what to do!” Jarvis says.

That’s the thing about disaster preparedness plans: You don’t know how good they are until a disaster strikes. The same thing can be said about business insurance.

“It’s kind of a learn-as-you-go [process],” says Wayne Knewasser, vice president of public relations and government affairs for Louisville, Ky.-based Premier Home Care. In the last three years, his company has dealt with wind and ice storms and tornadoes, he says.

“You think you’ve got everything worked out and then there’s just one patient you can’t serve as you want to and you have to look at your plan again.”

So, in the wake of recent tornadoes, fires and floods, how good is your disaster plan? And how good is your insurance?

Be Prepared, and Test Your Plans

Taking stock of both disaster plans and insurance is something home medical equipment companies should be doing regularly, perhaps even more so than other small businesses, according to accreditation and insurance experts. HME providers, while they have some commonalities with other commercial businesses, have some unique needs, they say.

For example, when disasters occur, providers still need to service their patients. They have ownership of and responsibility for equipment that is not on their property but in the hands of patients who might be some distance away from the provider’s location — perhaps where a disaster has struck.

Providers need to keep their businesses going, says Knewasser, because “we are in a 24/7 business” and patients’ lives often depend on their equipment.

But how do you do that when the unthinkable happens and your offices are destroyed, oxygen vendors are unable to supply your oxygen cylinders or your vehicles are sucked up into a tornado?

“You have to go beyond thinking, ‘What would we do in an ice storm or a snowstorm and if the power goes out,’” says consultant Mary Ellen Conway, president of Bethesda, Md.-based Capital Healthcare Group. Noting the calamitous weather-related disasters across the country so far this year, she says, “People are saying that their disaster plans can’t even cover the kind of things they are going through … Who would have thought they would have to have out-of-state providers come into their towns to take care of their patients?”

Continues Conway, “There are lessons to be learned from these things that don’t seem to be common problems. Test emergency plans once a year. Consider fires, giant power outages due to ice storms, giant flooding — and what you would do if you really couldn’t do anything.”

Mary Nicholas, executive director of the Healthcare Quality Association on Accreditation in Waterloo, Iowa, which accredited Omni, says it is “a matter of imagining the unimaginable and putting that into writing.”

It’s quite possible nothing bad will ever happen, she acknowledges. But when it does, that plan can make a world of difference.

Jarvis agrees, admitting that Omni questioned the need for defining a meeting place away from the office and spelling out procedures from there.

“It was a running joke around here,” she says of the requirement that the company devise a plan in case people couldn’t get to work. However, she says, “We took accreditation extremely seriously. We felt every standard needed to be understood by every employee, so we drilled them. We had PowerPoint presentations and that sort of thing.

“We told them what to do in case of an adverse event as far as a tornado or something like that where people would be trapped, but we never considered an emergency where people were trying to come to work but just couldn’t make it.”

After all, she adds, “We are Vermonters.”

But on March 7, the “silly” plan that seemed an over-the-top requirement kicked in, and all the drilling Omni did with its employees paid off. The plan “worked seamlessly,” Jarvis says. “After that day … I saw that people were carrying around compliance cards, so I could see they thought the standards saved them.”

Knewasser, too, says his company has learned from the disasters it has faced. When a 2008 windstorm caused a tremendous amount of damage in trees and downed power lines, he says, “we had an opportunity then to see how the protocols worked. We had to take action to get patients tanks. Fortunately, we didn’t have one of our patients who ended up back in the hospital or the emergency room because they didn’t have tanks.”

One of the major things Premier Home Care learned, according to Knewasser, is that “when [patients] called asking for more tanks, you couldn’t assume that they were at their homes. We had to ask where they were. And because they moved, you couldn’t assume that the roads were going to be open to get to them.”

He was also grateful, he says, that Premier has long stored its daily backup data at a far off-site location, so it was never lost or inaccessible. “You want to lose as little data as possible,” he says. “You want to be able to recover as quickly as you can.”

Nicholas advises providers to review preparedness plans frequently, especially during high-risk months of the year, and to recheck backup systems as well. Make sure everyone knows who activates the plan and what their own role is, she says, and consider developing an arrangement with another company to cover your patients in case of an emergency or disaster. Then, make sure everyone is well versed about the plan.

“If something happens, knowledge is power,” she says.

One of the questions providers need to ask themselves, according to Tim Safley of the Accreditation Commission for Healthcare in Raleigh, N.C., is what do you really do in a disaster? Whatever it is, it should be reflected in your plans so all employees are aware of the company’s protocols.

“You need to write down what you do, not what you think we want to hear that you do,” Safley says.

Check Insurance Coverage, Too

In tandem with reviewing disaster and emergency plans, it’s important for HME providers to make sure their insurance coverage is complete so that they can continue operating their businesses.

It is vital to have insurance that covers such things as relocation and allows your company to get back up and running as soon as possible, says Knewasser, whose company has made it a priority to carry business insurance that will allow it to service patients even if a location is devastated.

“Take a couple of hours and do an insurance review every year,” advises Warren Freeman, CFP, FFSI, director of sales and marketing for VGM Insurance in Waterloo, Iowa. “It can be time so well spent.”

While business coverage is very individualized in terms of both type and cost, experts say, there are some general points to consider.

It’s important, for example, for providers to know the actual value of their property and its contents, which means having it evaluated frequently because values do fluctuate, Freeman says. Be sure to include inventory in a warehouse and/or a retail setting, he adds.

“You don’t want to be under-insured and you don’t want to be over-insured,” Freeman says. “But if you are a provider and you are down in Alabama and a tornado hits and you had 100 pieces of equipment that were leased out in the community, you want to make sue you have coverage for that [equipment].”

And that business income insurance that Knewasser talks about? It’s critical, says Freeman.

“Say you have a warehouse that is destroyed and you need to relocate,” he explains. “Now, suddenly, you have additional expenses of leasing a new facility, moving things over there, getting systems set up. A lot of times you’re talking $10,000 to $20,000 a month just to continue your operations.”

Brandy Armstrong, program manager for HOMed insurance offered by McNeil & Co., Cortland, N.Y., gives another example of the importance of coverage for loss of income.

“Say your building burns to the ground and you have to move somewhere else and start over. The contents and property might be covered, but where do you get the money to relocate and pay your employees? How do you keep servicing your oxygen patients? Think about what it would mean if you couldn’t operate out of your [current] location.”

Neither should providers overlook professional liability coverage, which is useful when, for example, a patient is injured in using medical equipment and files suit. Even in normal times, Armstrong notes, providers sell or rent items that often must be delivered into the home and require the delivery technician to give instructions on their use.

“On a basic liability policy, there is no coverage for any type of professional coverage,” she points out. While smaller providers may think they don’t need such coverage because they do not have, say, a respiratory therapist or nurse on staff, Armstrong says “a ‘professional’ could be someone explaining something about the equipment and [use of] the device.”

Marie Gaudette, vice president for health care programs, Smith, Bell & Thompson, a division of Willis North America, Burlington, Vt., says a provider’s location is critical to the type of insurance the company needs to carry.

“For any HME provider located where wind is an issue — Florida, certainly Louisiana, the five boroughs of New York, anything coastal in California and the northeast, South Carolina specifically — most insurers are putting a high wind and hail deductible [on policies],” she says. “That is because of the catastrophic losses that have happened over the last five years. So providers really need to be aware of where their properties are and what their property values are.”

She also advises making sure there is a business continuation plan in place.

“That would be for any catastrophic event, including terrorism. [Providers] need to be thinking of things beyond just their building,” she says. For example, if a key bridge is out, how do you get to patients? How do you reach people, employees and patients, without phone service? How do you protect private patient information?

The bottom line when purchasing insurance: “Buy what you need,” says Freeman.

Insurance brokers should be able to help providers with such plans, the experts say, but they caution that HME providers are best served by companies that know the business and are familiar with its out-of-the-norm needs.

By purchasing the type and value of insurance that your particular company requires, you can ensure not only your viability in a disaster but the welfare of your patients. And that is, in the end, what the HME business is about.

Indeed, says Safley, providers in the maelstrom of a disaster have been “incredible ambassadors for the industry.

“Providers respond quickly, they respond efficiently,” Safley says. “They usually go way beyond their policies to make sure no one runs out of oxygen. I have had people who have given oxygen out to customers other than their own because they really needed it.

“I’ve seen companies give [patients] power wheelchairs until they get their own fixed. One company in a snowstorm was the only one with four-wheel drive vehicles, and it delivered oxygen for its competitor’s patients.

“Providers are in it to help patients,” he says, “and that’s what they do.”

Thanks for the Standard

Victoria Jarvis of Omni Medical Systems sent this letter to HQAA, its accreditor, after a March snowstorm required implementation of the company’s emergency plan:

I wanted to share this quick story with you since I think it really hits home as to the “why” of an HQAA standard. We always understood the “whys” of standards that focused on customer protection, education and product placement and we understood there were reasons behind the facility standards as well. But I admit, not all of the standards made sense to us.

One of the standards requires us to pick a place to meet in case of an emergency. We were really stumped by this standard. We thought, “Why wouldn’t we just call everyone and tell them the building fell down?” We all have smart phones, get our work email within seconds, are all online, etc. It seemed inconceivable to us that we would need a place to meet other than our own building.

But we went along with this requirement and chose the Park ‘n’ Ride parking lot as our meeting place …

Fast forward to yesterday when we experienced the third largest snowstorm in Vermont history, dropping 30 [inches]of snow in less than 24 hours. The company we hired to plow was literally stuck on a mountain road and had not been able to plow the private roads leading up to our building. The result was an impassable road to our facility, even though the highways were accessible.

When I realized I couldn’t make it to work, I didn’t know what to do. There’s no cell phone service in that particular area, so I couldn’t call or get my email or access our website for instructions. Then I remembered — I knew what to do! Go to the Park ‘n’ Ride!

And when I arrived, I found all my employees gathered there, safely. I really can’t tell you how much it meant to me. I knew they were safe, they knew where to go and we had a plan in place to help them …

Throughout the entire accreditation process, I’ve seen the standards improve our business, improve our customer relationships and improve how we conduct ourselves. But I never thought they would make my employees safe and, for that, I am really grateful.