Understanding how much money hospitals need to become prepared for a disaster in the post-Sept. 11 world seems to depend on when you ask the American Hospital Association.
As Congress and the Bush administration last week contemplated how much to spend on preparing the country for more terrorist attacks, hospitals' message about the size of their need and where they are in terms of planning for bioterrorism and other disasters is confusing lawmakers in Washington.
The AHA released a report last week that said hospitals need to spend $11.3 billion to "increase their ability to respond" to a nuclear, biological or chemical attack. Capitol Hill sources said that an earlier version of the study had estimated that cost at more than $30 billion. Modern Healthcare was the first to disclose the AHA's $11.3 billion request (Oct. 29, p. 8).
Caught in the confusion, Sen. Edward Kennedy (D-Mass.), chairman of the Senate Health, Education, Labor and Pensions Committee, said at a news conference on Nov. 1 that the AHA had told him that hospitals need $18 billion.
The AHA said, also on Nov. 1, that its current estimate is for $11.3 billion. The association said earlier versions factored in a larger number of patients being treated in rural communities and more staff members needing personal protective equipment than what was later deemed adequate.
Kennedy and Sen. William Frist (R-Tenn.) are planning to introduce legislation early this week that would spend $1.4 billion on bioterrorism preparedness, including about $350 million for hospitals.
Frist, a heart transplant surgeon, has said repeatedly that relatively few hospitals have bioterrorism plans, so preparedness should be hospitals' top priority. "People shouldn't be throwing around money, excessive money, until (hospitals have) got a plan on the table, and only one in five do," Frist said.
Frist said on Nov. 1 that he had not seen the AHA's 10-page Hospital Resources for Disaster Readiness document.
A survey the Premier hospital alliance conducted of 120 of its members over the past two weeks found that 77% have a disaster plan that may be applied in the event of a chemical or biological attack. Some 94% intend to upgrade their existing disaster plans in the next 12 months.
The Joint Commission on Accreditation of Healthcare Organizations requires accredited hospitals to have disaster plans to respond to assessed threats in their environments. The AHA said upgrading those plans should emphasize a modification of the "all hazards" plan they have in place.
The AHA predicts debate over what the public wants from hospitals, said James Bentley, the association's senior vice president of strategic policy planning. The AHA argues that every hospital should meet minimum standards, including having a chemical decontamination facility.
Bentley, who spoke on hospital readiness with AHA President Richard Davidson at a news conference on Nov. 1, said hospitals' needs are staff, staff flexibility, equipment and pharmaceutical supplies, not new facilities. Hospitals should consider how to use local schools, armories, and even their own hallways and cafeteria to expand their capacity, Bentley said.
The AHA plan calls for upgrades in eight areas, including communications capabilities, disease surveillance and personal protective equipment. Plan drafts went to all hospitals in the country and received "overwhelming support" from the field, according to the AHA.
According to the plan, hospitals need to stock 24-hour supplies of pharmaceuticals that would be needed post-disaster. In making projections, the AHA used a disaster scenario in which metropolitan hospitals would receive 1,000 casualties and nonmetro hospitals would receive 200.
The AHA said it is asking Congress to delay the April 2003 implementation date of privacy regulations mandated by the Health Insurance Portability and Accountability Act of 1996 so that hospitals can focus on upgrading their disaster preparedness.