CMS' emergency preparedness deadline looms, and many facilities may not make the cut

After Hurricane Katrina in 2005, Amedisys decided it needed to upgrade its disaster plan. The national home healthcare and hospice provider began conducting risk analysis and factoring in potential local hazards to develop a plan to ensure staff and residents at its U.S. facilities could weather natural disasters. From this came several changes: greater coordination with first responders, regular drills and closer collaboration with other Medicare providers.

The plan, which sent disaster response teams to check in on patients at home and bring them food, water and cleaning supplies, was implemented during last year's floods in Louisiana. It helped keep Amedisys staff and residents safe.

But now Amedisys and other providers like it are being asked to step up their efforts. Many of the nation's healthcare providers are facing a deadline to implement new federal requirements that standardize how they handle natural disasters and terrorists' threats.

In September, the CMS finalized a rule requiring 17 types of healthcare providers to set new policies that result in better coordination with emergency personnel and frequent tests and adaptations of emergency plans.

While most experts support the regulations, others worry that many facilities, especially small and rural ones, will fall short of meeting the requirements. That could mean providers would be dropped by Medicare and Medicaid.

"I do not see how all facility types can and will be in compliance by Nov. 15," said Denise Braun, senior manager for healthcare solutions at Evans Inc., which is advising healthcare organizations on their emergency preparedness plans.

For some facilities, it means wide-scale changes. Because the CMS didn't offer much clear direction in the requirements, many stakeholders may be noncompliant, said Jocelyn Montgomery, director of clinical affairs at the California Association of Health Facilities. The CMS in October said it would publish its guidance on the rule by this spring. But that hasn't arrived yet.

"The beauty of writing the regulations so that they can be interpreted a number of ways is that they let providers be able to work that out for their unique situation," Montgomery said.

Experts believe providers who already meet the Standards of Care for Disaster Preparedness and Response set by the Joint Commission should be well-positioned to meet the new CMS regulations. "I think hospitals themselves feel like they're in better shape in terms of coming into compliance because of that leg up," said Nancy Foster, vice president of quality and patient safety for the American Hospital Association. Long-term care and hospice facilities, as well as ambulatory surgical sites, home health agencies and dialysis centers, would face "a much heavier lift," she said.

"They are the ones that are absolutely in a uphill battle to be in compliance," said Scott Aronson, a principal with Russell Phillips and Associates, a leading healthcare emergency management consultancy.

The CMS estimates the total cost for providers to adhere to the rule would be more than $370 million annually.

The preparation requires input from local public health departments, acute-care hospitals, and police and fire departments. By Nov. 15, nursing homes must conduct a multi-jurisdictional disaster exercise that includes drills with multiple emergency response agencies.

"For some hospice providers that's going to be a challenge in forming those relationships," said Jennifer Kennedy, senior regulatory and quality director for the National Hospice and Palliative Care Organization.

Facilities located in states with frequent earthquakes or violent storms are already mandated to have emergency plans in place that call for coordination with first responders. Most other long-term care providers have focused on being self-sufficient.

Montgomery also wonders whether emergency response agencies could even help or coordinate with long-term care facilities given their number. The U.S. has more than four times as many nursing homes as hospitals.

Calls to several emergency response agencies were not returned.

Montgomery adds that some facilities are waiting for the CMS' guidance to start crafting plans. Other providers hope the agency will extend its deadline.

But the CMS said one year of preparation was more than enough. "Some thought Medicare was not going to take this too seriously," Braun said. "I think that's a dangerous attitude to take."