PreparednessHHS proposes rules to govern health-care facilities’ disaster preparedness

The Centers for Medicare and Medicaid Services (CMS), a federal agency within the Department of Health and Human Services, has proposed new requirements for health-care facilities intended to ensure these facilities are prepared to care for patients during disasters. The regulations aim to prevent the service disruptions which occurred during Hurricane Sandy and Hurricane Katrina, when an estimated 215 deaths occurred in hospitals and nursing homes in Louisiana.

“In New Orleans it seems very likely that dozens of lives could have been saved by competent emergency planning and execution,” the proposed rule said. The proposal which will impact more than 68,000 institutions, was issued on 27 December 2013, and is open for comment until the end of March 2013.

The New York Times reports that in response to the proposal, the American Hospital Association, in an advisory to its members, said that federal officials “may have significantly underestimated the burden and cost associated with complying with this rule.”

The proposal requires that all nursing facilities and group homes have plans to maintain emergency lighting, fire safety systems, sewage/waste disposal options, and temperatures at a safe level for patients during power losses. Inpatient facilities must be capable of tracking displaced patients, provide care at alternate sites, and handle volunteers during disasters. Transplant centers would need to have alternative hospitals for patients awaiting organs, which the Times notes is a challenge because transplant centers maintain different criterias.

The proposed regulations do not require hospitals to maintain water supply systems which might be needed to support decontamination stations, bathrooms, and air conditioning.

Some industry experts sayt that the CMS should instead support emergency management standards developed by the Joint Commission, an organization that accredits health care facilities, or standards developed by the National Fire Protection Association, whose recommendations should cover “90 percent or 95 percent of things that may go wrong,” said Robert Solomon, who oversees the association’s building and life safety codes.

One of the most contested requirements requires all hospitals and nursing homes to test backup generators for extended periods at least once a year rather than the currently recommended once every three years. Critics warn that the four-hour, full-load tests could be costly. The proposal also requires health care facilities to protect power sources against damage from floods and other hazards, but only newly installed systems are capable of meeting that requirement, due to regulatory codes.

Retrofitting current power systems could be too expensive, but some hospitals are already taking a proactive approach. New York University’s Langone Medical Center is investing in a multimillion-dollar cogeneration plant capable of operating independently of the power grid. The project, planned before Hurricane Sandy in which the hospital lost power and millions of dollars in damages, is expected to provide a reliable source of power and climate control during extended power grid failures.

The proposal, which applies to seventeen types of health care providers, will require many facilities to adopt the regulations in order to participate in the Medicare and Medicaid programs. The CMS will have three years to finalize the rule, and the Times reports that if the requirements become law, the financial impact will be an average of $8,000 for hospitals the year the rule takes effect, and roughly $1,262 per year for skilled nursing facilities. Some facilities will be required to spend more depending on their size of operation.