Aegis Compliance and Ethics Center
Emergency Preparedness Rule to Take Full Effect in November
Last year, the Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) issued a final rule for participating providers to plan for natural and man-made disasters, scheduled to take effect November 15, 2017. Citing terrorism, influenza, and hazardous weather events of the last fifteen years, the Emergency Preparedness Rule aims to provide comprehensive and consistent regulation around how health care providers must prepare for and respond to emergency situations. In the wake of Hurricanes Harvey and Irma, and in looking ahead to the Emergency Preparedness Rule implementation deadline, health care facilities around the country should evaluate their own plans to ensure they are ready for any urgent threat.
Lessons from Superstorm Sandy
The HHS Office of Inspector General (OIG) released a report in September 2014 analyzing the response of hospitals in New Jersey, New York, and Connecticut to Superstorm Sandy in 2012. Of the 172 Medicare-certified hospitals that participated in the OIG survey, 89% self-reported experiencing substantial challenges that affected operations, including loss of electrical power, flooding, a surge of patients from other health care facilities, and staffing shortages. For hospitals that lost power, some even from backup generators, staff struggled to provide patient care typically supplied by machines. Staff at one hospital physically counted fluid drips to ensure IV pumps worked properly, while another hospital provided impromptu training for staff about manual medical procedures, such as suctioning intubated patients.
Loss of electrical power and damage to digital infrastructure from flooding also affected hospitals’ ability to access, maintain, and verify medical records. One hospital admitting patients relied on oral medical histories; another facility waited several days to receive medical records for accepted patients.
The OIG report demonstrates the need for hospitals and other health care facilities to adopt robust emergency management policies. All of the hospitals reported participation in at least one emergency preparedness activity in the year prior to Superstorm Sandy and devised written emergency plans. However, over 80% of the reporting hospitals revised their protocols in response to the storm. In part, as one hospital administrator noted, the storm provided multiple challenges concurrently. For example, a hospital’s staff may have drilled for what to do in case of a power outage, but they did not necessarily plan for how to handle a power outage with patient surges and staffing shortages all at once. With further preparation and training of simultaneous “worst case scenarios,” more hospitals may have avoided some of the debilitating challenges of Superstorm Sandy.
Developing a Plan
The new Emergency Preparedness Rule requires health care facilities to perform risk assessments, individualized for the particular dangers one may encounter in their geographic location, then develop policies and procedures, a communication plan, and training programs, accordingly. Importantly, the final rule mandates that institutions approach these elements with an “all hazards” outlook, planning for each possible circumstance both individually and simultaneously.
Emergency mitigation for health care facilities starts at the local level. In gauging potential threats, a hospital in the Midwest may determine hurricanes do not pose a strong risk. However, the facility may still need to prepare for tornadoes, flooding, blizzards, or a virus outbreak. In the instance of a blizzard, the hospital should prepare for the possibility of power loss and treacherous road conditions that inhibit staff from commuting to work or the dispatch of emergency vehicles. The hospital will need a plan to communicate staffing needs, perform routine medical care under the constrained conditions, and maintain adequate medical supplies, in order to remain fully operational. While not exhaustive of all the potential conditions of a blizzard, this list presents the “all hazards” approach of thinking that a facility should adopt when performing risk assessments and devising training and action plans.
The HHS Office of Assistant Secretary for Preparedness and Response (ASPR) published guidelines to assist health care facilities devise plans in accordance with the new Emergency Preparedness Rule. ASPR provides several activities to create and bolster health care coalitions (HCCs) to facilitate in emergency planning and to further assist with execution. In times of emergency, HCCs—composed of health care providers, EMS, public health agencies, volunteer organizations, and other members—can shoulder some of the executional burden through sharing supplies and information and coordinating care.
Looking Forward after Hurricane Harvey and Hurricane Irma
The events of Hurricanes Harvey and Irma mark the first time on record that two Category 4+ hurricanes made landfall in the United States. While communities in Texas, Louisiana, and Florida rebound from the damage, the reminder of the storms’ impact and the need for emergency planning remains ever-present. The November implementation deadline for the Emergency Preparedness Rule quickly approaches, and health care facilities need to ensure their management plans are in effect and fully operational to remain compliant. With proper preparation, a health care facility anywhere in the country can be ready to take on the worst.