On September 8, the Federal Register published the “Final Rule” from Center for Medicare & Medicaid Services (CMS) regarding their requirements for Emergency Preparedness. This is the other shoe dropping, the first of which came almost three years ago, when the proposed rules were released. There was a brief comment period, long expired, and many people thought the proposed rules would “time out” – dying after three years of no action. Wrong.
The final rule document is 651 pages, most of which document comments received and CMS’ response to them. There are very few changes to the rule proposed back in 2013.
CMS makes a strong case that healthcare providers and suppliers are a key part of our national infrastructure, and lays out a history of how healthcare has been impacted by natural and man-made disasters. It makes the case that providers do not practice emergency preparedness broadly enough, and it aims to change that by modifying its “conditions of participation” – the rules by which a hospital, long-term care center, or other “provider or supplier” must operate if it will receive Medicare and/or Medicaid reimbursement for charges. This affects over 72,000 healthcare providers across the country.
This broad impact gives Healthcare Preparedness Coalitions (HPCs) the chance to show that they are the most effective and efficient way for providers and suppliers to meet these new requirements, and to enhance healthcare preparedness around the country.
The rules focus on three areas:
- safeguarding human resources (patients and staff);
- maintaining business (healthcare) continuity;
- protecting physical resources (healthcare facilities and equipment)
The basic requirements, applicable to all 17 different types of providers and suppliers, include:
- Risk assessment and emergency planning, with a focus on:
- Community-based, all-hazards approach;
- Required capacities and capabilities;
- Location-specific risks and planning
- Policies and procedures that support the execution of the plan
- Communications capabilities:
- Within the facility (reaching staff, physicians, patients, etc.)
- Between facilities (including patient information transfer)
- Between facilities and other emergency partners (emergency management and others)
- Training and testing:
- Training for new and existing staff
- Annual refresher training
- Drills and exercises
While the specific requirements vary slightly between provider type, they all encompass these four elements.
All facilities must comply with all rules within one year from the “effective date” which is most likely this November 16. In other words, providers and suppliers who haven’t conducted a risk assessment, developed a plan, with supporting procedures, trained on it, and exercised it by November 16, 2017, will be “non-compliant” and risk losing reimbursement for Medicare and Medicaid patients.
Is your healthcare coalition prepared to seize this opportunity?
CMS’s responses to the comments they received often repeat the concept that healthcare coalitions are the best way to meet the requirements, both for large hospitals and for smaller facilities. Phrases like, “we encourage these facilities to engage in healthcare coalitions in their area for assistance in meeting these requirements” appear twenty-nine times!
So, what exactly can healthcare preparedness coalitions do to ensure the timely, effective and efficient compliance? Exactly what they were chartered to do. And, at the same time, make a powerful case for ongoing financial support from their local healthcare partners.
There are significant opportunities for healthcare coalitions with respect to each requirement:
Community Risk Assessment: CMS agrees “a hospital could rely on a community- based assessment developed by other entities, such as their public health agencies, emergency management agencies, and regional healthcare coalitions…” In fact, all healthcare providers in any particular “community” share the same risks for earthquake, hurricane, tornado, and many other risks. Instead of each provider and supplier conducting the same community assessment, the regional coalition can conduct one all can share. This should be done in concert with local emergency managers and public health officers, who already conduct similar community risk assessments.
Plans and Procedures: While each facility must create its own plans and procedures for internal staff actions, coalitions are the right place to coordinate plans and procedures that require cooperation among providers. For example, it’s likely that local emergency management, public health, and emergency medical services would interact with each provider in their regions the same way. In addition, the coalition can identify resources for transportation and alternate sources of supply that would benefit all providers and suppliers. A central review of plans would ensure best practices become shared, and that multiple providers are not relying on the same resources in the event of an emergency.
Communications: Again, each facility must make its own arrangements to contact its staff and patients, but the rule requires “patient care must be well-coordinated within the facility, across healthcare providers, and with state and local public health departments and emergency management agencies and systems to protect patient health and safety in the event of a disaster.” Who better than a regional coalition to bring these providers together to share information?
Training and testing: The coalition is the obvious choice to bring training on NIMS, HICS, Disaster Life Support, regional planning, and other disciplines to the providers in each region. CMS says, “healthcare coalitions also commonly conduct and support community-based exercises and encourage participation from other providers in their localities.”
This is the golden moment for healthcare coalitions. They need to stand up and say, “We can help.” They will create an ongoing reason to exist, even flourish, and improve community preparedness while meeting CMS rules.