For many health care facilities along the Gulf Coast of the United States, and those in Puerto Rico, the 2017 hurricane season proved to be a “worst-case scenario” event that emergency managers and preparedness planners benchmark against, but hope will never happen.
Few, if any, facilities in the region did not experience at least some level of disruption, whether it was running on generator power for hours or days, or taking in evacuated patients from harder hit areas. The spate of hurricanes, along with recent wildfires in California, has tested the capabilities of emergency management plans and systems in all types of health care structures.
The devastating and significant impact these events had on health care systems reminds us why it is imperative to have emergency preparedness systems in place to ensure the well-being of patients and providers during a disaster. This rationale was the genesis of the Centers for Medicare & Medicaid (CMS) Emergency Preparedness Rule, which was put in place and will be enforced starting this November.
The intent of the Emergency Preparedness Rule, as described by CMS, is to “establish national emergency preparedness requirements” for any hazard across the 17 different provider and supplier types participating in Medicare and Medicaid programs. The rule requires affected groups to implement four component standards, including: an emergency plan, accompanying policies and procedures, a communication plan, and implementing a training and testing program.
While these standards are adjusted to reflect the characteristics of each type of provider and supplier, it is important to consider that facilities impacted by the rule are not given any funding assistance in order to meet the rule. This is not as significant a consideration for large hospitals, most of whom already meet preparedness requirements through Joint Commission accreditation standards, and have the financial and staffing resources to devote toward preparedness.
However, the mandate creates an obviously more significant burden for smaller facilities that may not have the financial resources to meet the requirements. These smaller, or less-resourced facilities, must absorb ramped up costs, and many staff will have to serve as preparedness coordinators, learning how to conduct assessments, write plans and establish communications pathways.
With an aim to ensure patients are protected and can rely on health care facilities in a time of crisis, it is important to consider that for many ambulatory care facilities (dialysis centers, homecare and hospice organizations), the specifics of the rule may exceed their bandwidth.
At the same time, the rule mandates partnership through the training and exercise component. Recognizing that many facilities do not have the ability to conduct an exercise on their own, it mandates that these facilities participate in a community exercise. As our team at Healthcare Ready has observed, this type of collaboration creates an opportunity for health care coalitions to assist their members and local impacted suppliers and providers in compliance. Mandating community exercises ensures that organizations must work together to build sufficient capacity and establish relationships before a disaster occurs.
The 2017 hurricane season highlighted the challenges the health care community faces during natural disasters, and underscored why in today’s integrated health care system, it is essential to know and trust your partners before disaster strikes.
We find that each event created unique needs for health care providers to address. During Hurricane Harvey, hospitals in the Houston area had to evacuate approximately 1,500 patients, while nursing homes had to coordinate the evacuation of hundreds of patients. It is encouraging, in light of this, that the CMS rule mandates an evacuation plan to include procedures and processes for tracking not just patients, (and notifying their families) but staff and caregivers as well. In this instance, we saw many health care facilities and shelters become overwhelmed with evacuees, requiring more personnel, medical supplies, medications and other health care needs they did not have the capacity to fill.
In Florida, during Hurricane Irma, we saw a large number of homecare and nursing facilities run out of supplies for their most vulnerable patients. Although these areas felt well-equipped for any storm, they were ultimately unprepared for the scale of the needs that had to be met. We also saw a larger vulnerable patient population with Florida being home to many retired and special needs individuals.
With Hurricane Maria in the Caribbean, we witnessed major power outages in Puerto Rico and the U.S. Virgin Islands. The extended outages underscored the need for a specific type of communications plan—one that accounts for power outages. Similarly, Irma and Maria, arguably more devastating than any hurricane in recent years, highlight the need for a comprehensive plan for generator power.
When looking at the environment of a health care facility (an urban setting versus a more rural environment) there are a number of variations in health care delivery systems and capabilities that have not been recognized or taken into account by the rule. Assessing the dynamics of each event and how they change based on landscape, populations and other factors gives us a better idea of the unique needs of each location, and helps us think critically about how different facilities will be able to comply with these regulations.
With the November 15, 2017, deadline past for the Emergency Preparedness Rule to go into effect, requiring facilities to demonstrate compliance, we hope to see marked change in how health care stakeholders collaborate. The charge this rule makes to health care providers and facilities to prepare together is a beneficial one, and it will allow communities to build in economies of scale to ease the cost burden.
It will also force the sector to recognize and think about what different facilities must do to comply with the regulation, and what this means for their preparedness posture for a real-world event. To that end, we must remain vigilant that it may have the unintended effect of pushing small and independent provider groups out of business, or into larger health care systems. This rule is a step in the right direction and represents an important push for a more resilient health care system, and is something we’ve needed for quite some time. However, for it to be truly effective and beneficial, it is vital that stakeholders—and CMS regulators—think about what the metrics and methods of evaluation look like in order to determine if these rules are truly effective in protecting the well-being of patients.