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Emergency management: Are you prepared for the new CMS rule?


March 23, 2017

Editor’s note: The following is based on a recent HCPro webinar featuring independent safety consultant Marge McFarlane, PhD, MT (ASCP), CHSP, CHFM, CJCP, HEM, MEP, CHEP, and health safety professional Thomas Huser, MS, CHSP, CHEP. The presentation offered tips for successful implementation of the new CMS emergency management rule. (An archive of the presentation, titled “The New CMS Emergency Management Rule: Tips for Successful Implementation,” is available at www.hcmarketplace.com/cms-emergency-management).

Hospitals must implement the new CMS emergency preparedness rule by November 16, meaning many have significant hurdles to surmount in the coming months ahead of that looming deadline.

Since officials have made clear they do not intend to offer an extension, experts say healthcare facilities should plan to invest the time and resources necessary to comply on time—a feat that will require hospitals and systems to collaborate not only within their own walls but also with their communities more broadly.

“This is going to be now the cost of doing business. There are no additional funds that we anticipate to make this happen,” said Marge McFarlane, PhD, MT (ASCP), CHSP, CHFM, CJCP, HEM, MEP, CHEP, an independent safety consultant and principal of Superior Performance LLC in Eau Claire, Wisconsin.

The final rule was published last September, before President Donald Trump won his bid for the White House. So the new administration, which has taken aim at reversing several regulations imposed under Trump’s predecessor, Barack Obama, could delay implementation or consider altering the rule’s provisions. But it remains unclear whether doing so will be a priority.

While the rule spans 186 pages in the Federal Register, Thomas Huser, MS, CHSP, CHEP, said during the webinar that healthcare safety professionals should focus on three key portions: the summary of major provisions (p. 63861), regulatory impact analysis (p. 64008), and individual Conditions of Participation (p. 64012).

The policy—which requires hospitals to conduct risk analyses, draft emergency preparedness plans, establish emergency communications plans, conduct staff training, and test their plans—imposes different rules for each facility type.

“What makes the document so lengthy—and advantageous—is that it really breaks down the individual requirements for each of the different 17 groups that are covered by the rule,” McFarlane said.

Mental health centers and end-stage renal disease (ESRD) treatment facilities, for instance, are not bound by all the same standards as critical access hospitals (CAH) and other facilities, but the new rule anticipates that each will have a part to play in emergency situations.

“Because we live under the threat of mass casualties occurring at anytime and anywhere with consequences that may be different than the day-to-day occurrences, the healthcare system must be prepared to respond to these events by working as a team or community system,” CMS officials wrote in the Federal Register, discussing benefits of the final rule.

As its motivation, the rule cites a number of natural and man-made disasters, including the 9/11 terrorist attacks, subsequent anthrax mailings, hurricanes, flooding, tornadoes, and an influenza pandemic. It aims to take past lessons from these and other real-world events and combine them with today’s best practices.

McFarlane said that level of preparation means planning for multiple overlapping emergency situations.

“You cannot predict that there will not be cascading disasters, meaning one thing has happened and then another thing happens, and then possibly another,” McFarlane said, citing Hurricane Katrina as an example. “The disasters cascade when you least expect them.”

Consider the long-term illnesses of people in your local community, including conditions like diabetes. If the pharmacy closes due to a disaster, where will those patients go for insulin and other ongoing treatment needs? Even after the initial shock of a disaster, hospitals could be flooded with a second and third wave of patients whose need for care is related only tangentially to the inciting event, McFarlane said. Building relationships with other health providers in the area ahead of a disaster is key.

“Everybody needs to be on the same page with the most current information, which is very difficult to do in the heat of battle,” McFarlane said.

Tips for compliance

The new rule requires that hospitals conduct a full-scale community-based hazard vulnerability assessment. But it does not specify what constitutes “community”—introducing some flexibility that Huser said seems to be intentional.

“Community can be different depending on where you are, who you are, and what kind of resources are available,” Huser said. He offered a list of practical steps each facility should take to apply the new rule to its own local community:

  1. Outline the requirements specific to your facility, then conduct a gap analysis. Those currently complying with the Joint Commission standards are likely 90% of the way toward complying with the new CMS rule, Huser said. But the new rule includes several additions and more specific definitions that warrant review.
  2. Create a timeline that lists the steps needed to close each gap. Translating a gap analysis into a to-do list, with deadlines, facilitates effective communication with leadership and enables you to gauge whether you are on track to comply in time, Huser said. “How are we progressing? Here’s where we’re falling behind. Here’s how we need some additional assistance.”
  3. Devise a plan of attack and a cost estimate that you can present to leaders. CMS has tables to help you estimate costs of implementation. For hospitals and those required to do full-scale exercises, “that’s going to be a real budget killer for some locations” due to overtime and materials, Huser said. “So prepare your leadership now.”
  4. Prepare a budget proposal for the first year of compliance. If your fiscal year is just coming up, start planning it now. For those already well into their fiscal year, start looking for what compliance will cost so you can ask for waivers.
  5. Join a healthcare coalition if you are not already participating in one. “You’ll be able to make friends, have resources, talk to people that you may not even know existed previously,” said Huser, who takes part in a central Indiana coalition.
  6. Avoid reinventing the wheel whenever possible. Again, that’s where a coalition can come in handy because others have likely faced the same challenges you will face.
  7. Determine which approach best suits your needs. Should you work as a system, an individual, or in combination?
  8. Review the free resources published by CMS online: www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergprep/index.html

Possible challenges

Figuring out how to prioritize the time and resources needed to adequately prepare for a complex emergency is the biggest obstacle to success, McFarlane said.

“It’s not that emergency management isn’t really important—it’s just that patient safety is important, and patient throughput is important, and performance improvement is important, and accreditation readiness is important, and all of those other things,” she added.

Other obstacles to preparedness include staff turnover and a “lack of mindfulness,” which she described as a preoccupation with failure. Then there are the nuts and bolts of emergency management. Planners need resources to plan, and they need to ensure that their suppliers will have resources in the event of an emergency. So hospitals should check to ensure that their suppliers of emergency fuel or bottled water can deliver the goods they promised and meet their other emergency contracts, McFarlane said. If one supplier promises two nearby hospitals the same shipment of supplies, then a disaster affects both hospitals, that’s a problem.

“The other thing that I have found is uncooperative local authorities,” she said.

Local government leaders or even hospital bosses have their own priorities, and those can inhibit emergency preparedness, especially for less-likely emergency scenarios. You will not have the authority to implement all the changes or training you think you need, so your job is to explain why devoting resources now into planning for unlikely future emergencies is a worthwhile investment, McFarlane said. One way to make the case, she added, is to talk about planning in terms of “business continuity.”

“That is how you can sell this,” McFarlane said. “You can get back to regular business if you do the right planning ahead of time.”

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