Proposed Emergency Preparedness Regulations

On Friday, December 27, 2013, CMS issued proposed new regulations for emergency preparedness by all kinds of medical facilities that receive Medicare and Medicaid payments. The proposed regulations intend to prepare the healthcare industry against a wide variety of natural- and human-caused disasters. The regulations note the increasing frequency of such events, ranging from pandemics to terrorist attacks to hurricanes to tornadoes.

The proposed regulations require that hospitals achieve the highest levels of preparedness, with other facilities having varying lesser degrees of preparedness. But, all facilities receiving Medicare and Medicaid payments are covered by the regulations. This note describes the regulations for hospitals, since they are the most comprehensive, and since they are the basis for other kinds of facilities. This note is NOT examining the cost-benefit analysis offered by the CMS, except to say that I believe strongly that they do not accurately reflect the true cost of implementing the regulations. The regulations require every hospital to perform an all-hazards analysis every year. The analysis will gauge the degree risk from all hazards, and include strategies for addressing all of these emergencies, and all of the potential patient population. The analysis must culminate in a set of strategies for addressing emergency events. Next, the regulations require the facility to implement policies and procedures to implement the plan (as well as a communications plan and a training and testing plan). The major elements of the policies and procedures are to:

• Provide food, water, and medical supplies for staff or patients;
• Provide emergency power for the facility;
• Provide a system to track the location of staff and patients during and after the emergency;
• And other procedures for sheltering, documentation, using volunteers, ensuring availability of medical records, developing arrangements with other providers in case of evacuation, and evacuation.

Of primary interest to healthcare facility operators are the regulations for emergency power systems. The proposed regulations require:

• Location of generators, distribution systems, and ancillary equipment so as to minimize possible damage from disasters;
• Yearly testing of generators at 100% of power load anticipated during an emergency;
• Fuel capable of sustaining emergency power for the duration of the emergency or “likely resupply.”
• Power to “maintain . . . [t]emperatures to protect patient health and safety;”
• Power to emergency lighting and fire detection, extinguishing, and alarm systems; and
• Power to “[s]ewage and waste disposal.”

It is important to note, too, the assumption of the regulations that, during an emergency, “injured and ill individuals would seek health care services at a hospital or CAH, rather than from another provider or supplier.” That is, the hospital has to be ready to deal with surges from all hazards (an example: the regulations assume free-standing outpatient dialysis centers will shut down, so the hospitals will face a larger than normal demand for such services). Mazzetti has been working with the people and organizations who plan, design, construct, and operate healthcare facilities for more than 50 years. We have an office in New Orleans, and we helped hospitals during and after Katrina. We were the engineers of record for the emergency hospital erected after the tornado in Joplin, MO. We have offices in California, who have been working with hospitals before, during, and after earthquakes. We have been working with Project HOPE on international hospitals that have been victims of earthquakes and typhoons. I think we are painfully aware of the emergency preparedness challenges faced by the modern hospital, and a company like ours could make a lot of money helping clients to implement these kinds of regulations. And, I think the regulations are well-meaning. Read the book Five Days at Memorial, that tells the story of what happens to a hospital and its patients and staff following a disaster they were insufficiently prepared for. But, at the end of the day, the real issue is whether our healthcare system can afford these kinds of investments. The costs of healthcare are slowly bankrupting this country. And, we are in the midst of the implementation of the Affordable Care Act, which attempts to reduce costs by expanding coverage to more people. Resources are strained, and every dollar that gets invested into preparedness is a dollar that cannot be invested in delivering healthcare. A doctor friend of mine in California likes to point out the billions we have spent in this state to protect our hospitals against earthquakes, when the total number of people who have died in a California earthquake is precisely zero; compare that to the number of people suffering in the state due to a lack of primary care, because we don’t have the resources. I have read a about the ability of the military to rapidly deploy very effective mobile medical units. I wonder if, rather than hardening every medical center against every conceivable hazard that might present itself, we should, as a society, be willing to build less robust hospital facilities, and develop local, regional, and even federal disaster response plans that allow for rapid deployment and reconstruction following a disaster event. In truth, neither solution, taken to an extreme, will adequately prepare us for those disasters surely to come. But some more rational balancing needs to occur, in the name of being able to direct our resources towards the relentlessly certain and ever present healthcare needs of our people.