The clock is ticking. On November 15, 2017, under the federal government’s Emergency Preparedness Rule, Medicare and Medicaid providers and suppliers must have emergency preparedness plans in place to address natural and human-caused disasters. Seventeen types of healthcare facilities—from hospitals and ambulatory surgical centers to rural health clinics and hospices—must be in compliance by this date. The question is this: “Are you ready?”
The government’s Centers for Medicare and Medicaid Services (CMS) gave facilities a full year to comply with the regulation, which went into effect on November 16, 2016. The goal is admirable—to ensure that providers are educated, trained and ready to handle the healthcare outcomes of a disaster. Following the deaths in October of 14 elderly patients at a Hollywood, Fla., nursing home struck by Hurricane Irma, the regulation’s implementation is timely.
While CMS’s objective has merit, the ability of many organizations to be compliant with the new rule by November 15 is problematical. “CMS wants to bring all facilities to a level where they have sustainable health systems during a large-scale disaster,” said Christopher Sonne, director of emergency management at HSS Inc., a Denver-based security and consulting provider that partners with clients across the U.S. “While emergency preparedness is nothing new for an acute care hospital—they’ve been doing this for a long time—other types of facilities did not have truly robust emergency management programs.”
He added, “Not everyone is ready, with many CMS providers and suppliers outside of acute care facilities struggling the most.”
Where There’s a Need
The government began the regulatory process that culminated in the final emergency preparedness rule in the aftermath of Hurricane Katrina in 2005. The disaster forced the evacuation of many hospitals and other healthcare facilities, jeopardizing the health and safety of Medicare and Medicaid patients.
A 2006 report by the Office of the Inspector General found that every single nursing home in five Gulf Coast states affected by the hurricane had experienced problems in patient evacuation and sheltering. The facilities generally were unprepared for the disaster and/or their administrators and staff failed to follow through on their emergency plans.
Other problems included insufficient food and water, and little in the way of collaboration between the providers and state and local emergency groups. Subsequent disasters, including hurricanes in New York, New Jersey and Florida; flooding in North Carolina and Louisiana; and wildfires in the western United States added to the urgency of promulgating a final rule.
The regulation emphasizes emergency preparedness planning, as opposed to the prior rule, which addressed a facility’s response to a disaster. The new rule requires facilities to train staff in emergency preparedness and conduct routine drills. Providers also must demonstrate their ability to coordinate patient care within the facility, across regional health care providers, and with state and local public health departments and emergency management systems. Each provider must incorporate these plans, procedures and policies in its certification application to CMS to continue to participate in the Medicare or Medicaid program.
The regulation’s critical requirement is the need to apply an all-hazards approach in assessing the risk of a disaster affecting the facility’s capacity to care for patients. Such hazards may include, but are not limited to, care-related emergencies, equipment and power failures; interruptions in communications (including cyber attacks); physical loss of a portion or all of a facility; and interruptions in the normal supply of human essentials such water and food.
An Uphill Climb
Complying with the regulation is not for the faint of heart. “CMS published 651 pages telling providers what they want them to do, but not specifically how to do them,” said Sonne. “There isn’t much in the way of clear directions. Some facilities like rural long-term care centers and hospices operate on very thin margins. It’s not like they have internal staff with a knowledge base to address compliance in time to meet the deadline.”
The conditions certainly are strict. For instance, providers and suppliers must test their emergency plans each year in a full-scale mock disaster exercise. This test must be community-based and multi-jurisdictional, involving drills with a myriad of emergency response agencies. A second facility-based disaster exercise also is required annually, as are tabletop exercises of simulated scenarios. On top of these mandates, facilities must update their emergency plan each year.
What Can Be Done Now?
Many healthcare providers and suppliers are behind the eight ball, compliance-wise, because they under-appreciated the extent of the new rule’s mandates. “A lot of organizations waited until this past spring to get interpretative guidance from CMS on how to build a comprehensive emergency management program,” said Sonne. “These facilities are struggling now to meet the deadline.”
To ease these struggles, he advised that providers and suppliers focus on the four key components of the new rule—the development of (1) a comprehensive risk assessment and emergency plan identifying hazards in relation to care emergencies; (2) a foundational plan of communications within the facility and with government agencies; (3) specific policies and procedures complying with federal and state laws; and (4) the training and testing of the emergency plan. “My advice would be to address these mandates first,” said Sonne.
To get the ball rolling, assistance is available from the U.S. Department of Health & Human Services, via the Office of the Assistant Secretary for Preparedness and Response. ASPR has launched a website called TRACIE, for Technical Resources, Assistance Center and Information Exchange, staffed by specialists to provide assistance on compliance. The site features an information exchange where facilities can discuss concerns and issues in real time.
TRACIE also includes a repository of technical resources. “Emergency preparedness professionals from across the country have submitted useful technical documents (to the website) outlining how they’re complying with the rule, so other organizations don’t have to reinvent the wheel,” said Sonne. “It’s a very good starting point.”
Another recommendation to close the gap in emergency preparedness is to become involved in the healthcare coalitions developed and sustained by the Hospital Preparedness Program (HPP). Federal funding supports HPP to assist regional healthcare preparedness. “They’re helping different facets (of the healthcare complex) to work together in preparation for a disaster incident,” Sonne said.
In addition to these information sources, providers and suppliers can avail the emergency response guidance and services of the Grainger safety service network, of which HSS is a member. The network provides hands-on disaster preparedness planning, training, exercises and business continuity.
Grainger can help facilities conduct an annual Hazard Vulnerability Analysis (HVA) to identify and fix cracks in their risk assessment and emergency plan. Other services include the development of proper policies, planning documents and procedures generated by the risk assessment and emergency plan.
Network members like HSS can assist the creation of the communication plan coordinating patient care and support services within the facility and across other healthcare providers and government agencies. “We also have particular expertise in designing and conducting the mandated disaster exercises, from full-scale events to tabletop discussions,” Sonne said.
Such assistance is likely needed, given the looming deadline and general unpreparedness of many healthcare facilities. For more information on how your organization can act more quickly and forcefully, log on now to this on-demand webinar. Time is of the essence.
Kym Orange Jr. is an accomplished healthcare strategy, marketing and sales professional with experience in strategic planning, employee development, sales and marketing, and business management. His current responsibility and focus since 2011 includes creating unique healthcare value through insight-driven solutions and ensuring the delivery of positive customer experiences through various Grainger business channels. Kym holds a BA from Indiana University in Bloomington, IN.