understanding the cms emergency preparedness rule
Moderator:Emily Lord, Jennifer Pitcher, and Craig Camidge
December6, 2016
1:30 p.m. ET
Operator:Good afternoon, my name is (James) and I will be your conference operator today. At this time, I'd like to welcome everyone to the Understanding the CMS Emergency Preparedness Rule Conference Call.
All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question and answer session. If you would like to ask a question during this time, simply press star then the number one on your telephone keypad. If you would like to withdraw your question press the pound key. Thank you.
Now I'd like to introduce Jennifer Pitcher, Executive Director of the MESH Coalition. Ms. Pitcher, you may begin your conference.
Jennifer Pitcher:Welcome everyone. As (James) said, my name is Jennifer Pitcher and I am the Executive Director of MESH Coalition. MESH is a non-profit public, private partnership that supports healthcare in mitigating, preparing, responding and recovering from emergencies. We provide preparedness and planning, training and exercise, and intelligence and policy analysis.
MESH held a Grand Rounds on this rule last month that it was a huge success. So due to continued demand, we are very fortunate to partner with Emily Lord and Craig Camidge to bring you this webinar.
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Emily is the Executive Director of Healthcare Ready, a non-profit organization established in the wake of Hurricane Katrina to ensure that the catastrophic breakdowns in patient access to health care would not happen again.
Craig is the Regional Healthcare Coordinator and Executive Director for the Near Southwest Preparedness Alliance in Southwest Virginia. He works at the nexus of healthcare, private business, local and state government and public health industries to further the coalition model of disaster preparedness.
Thank you so much, Emily and Craig. And with that, I will turn it over to Emily.
Emily Lord:Great, thank you, and welcome to everyone. Next slide, please.
We're very happy you can join us today. Just a couple of housekeeping items before we get started on the webinar. For those of you who are on the webinar, some of you are accidentally sharing your webcam, and might want to take a look and then be sure that your webcam is on or off if you want it used.
Otherwise, if you have questions throughout, we like to hold all of the final questions to the very end. Questions can be asked through the phone line. But if you want to type any questions to us in the meantime, go ahead and type in the WebEx and it'll come right to us here and we'll pop in and out throughout and try to answer them for you.
So today, we're here to talk about the newly released CMS Emergency Preparedness Rule. I want to be clear that this is a 650-page rule that came out in September that has a year now until November 15th for healthcare providers to implement. It's going to be impossible to get into the nuances of everyone of the providers and everything that's being covered in it. So we're hoping to give a broad overview of the rule and of the major parts of it today. And then we're more than happy to talk to you offline about specific provider requirements and what's needed for various specific different step.
But today really, we're just trying to give the background and the basic. And we'll talk a little bit as well about how it's going to be audited and enforced. But before that we're just going to talk a little bit, I’ll first talk about Healthcare Ready and I'll turn it over to Craig to talk about NSPA.
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So Healthcare Ready is a non-profit. We were created after Katrina to ensure patient access to healthcare no matter what happens in times of disease or natural disaster. And we do that by working to partner the public and private sectors together so that they can coordinate and plan and then respond to really protect patients when they need it most.
And we actually have an emergency operation center. So when events happen, we are working to solve healthcare business interruption or emergency management problems or help public health with their response as well.
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When we're not doing the responses, and we are often – as this year has been a very busy year - but when we're not, we also work on education issues, policy issues and research issues to talk about critical healthcare preparedness problems and talk about unique solutions. And really to bring a lot of visibility to this space for a lot of folks that may or may not be what they do every single day, but always with the goal of bringing together public and private sector health and protecting patient access.
And the CMS rule is just really, it’s a big part of that. And we are – we know it's a big change in how we're viewing preparedness and resiliency in healthcare, so we're there to try to help folks as they're adapting to the rule and understand what's going on, and we're doing that through a lot of talks such as these and presentations.
At the National Coalition Conference next week, we'll be presenting on how healthcare coalition can really sees this opportunity. Craig and I will be co-presenting there. But we also have a knowledge center at healthcareready.org where we're sharing a lot of information and tools on the rule as well.
So we’re really trying to help everyone understand from that 650-page rule down to what it actually means for you. I'll pause there for a second and turn it over to Craig to introduce his organization.
Craig Camidge:Sure. Good afternoon, everybody. My name is Craig Camidge and I am – as introduced, the Regional Healthcare Coordinator and Executive Director for the Near Southwest Preparedness Alliance.
You could see on your screen our beautiful State of Virginia and the Near Southwest is labeled as such there. The blue-ish area, we are one of six Virginia Department of Health designated healthcare coalitions in the State of Virginia.
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Our region is made up of 17 hospitals including some critical access to acute care. We have trauma centers, state mental health facilities, long-term care facilities, public health districts, counties, cities. And our main goal is to provide for a regional approach to preparedness especially focused on continuity of operations planning and for medical surge. And those are two things that are both part of the CMS rule and so we are excited to be able to participate in this opportunity today to help spread some awareness and some information about on what CMS has in store for this condition of participation. So Emily.
Emily Lord:Great. Thanks, Craig. So before we get into the very specifics of what's included in the preparedness rule, we wanted to give you all a little bit of background about the origins and how this rule came to be.
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So it's been a long time coming. We saw a draft rule coming out of CMS little over three years ago. And really it goes back a lot farther than that. Healthcare preparedness in the United States is often and traditionally has been funded through grants, through the Hospital Preparedness Program and through other grants that were made at the federal level to help healthcare systems prepare.
This rule from CMS is a real shift from that. It's the first time we've ever seen the federal government change and mandate healthcare preparedness. And that's a big difference. Now, CMS is stating with the release of this rule that being ready and being prepared for different kinds of events is just good business and it's a basic of being able to do business with Medicare and Medicaid. And that's a huge change.
And it's really a reflection of seeing big disparities across the healthcare landscape. Some healthcare providers have been very strong and when events disasters or anything occur, they've been able to withstand it and others, not so much. And it's a real reflection that there needs to be more done across a lot of different types of healthcare providers to make sure that they're all ready and all there to protect the patients and their community. And really it is a shift where – I think we're going to continue to see it on mandating some of these things versus incentivizing it through grantsand a lot of different ways. A lot of providers, if you take big healthcare systems, big hospitals, they've already had a lot of requirements through the Joint Commission accreditation process.
And those – and we'll see in a minute– but those are very similar to what these rules come out. But other accreditors and other healthcare providers, they haven't had that same level. So this is a big shift to try to push that across the whole landscape.
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So what is it? The purpose is to establish a national emergency preparedness requirement across provider and supplier type. It is a condition of participation or condition of coverage. Meaning, you have to meet it in order to participate with Medicare and Medicaid. Just like many of the other rules, rules that have even been released and changed this year, it is just a basic level that you have to certify that you've met in order to participate with those plans. And it's huge, because something like 90 percent of healthcare providers in the United States participate with those plans. So that means, 90 percent of healthcare provides are going to have to meet this requirement by the end of next year in order to keep participating with them. It applies to 17 different provider types, which will show you in a minute, but it's both inpatient and outpatient, and so that's a big change as well.
A tip for those of you, the actual rule as I said is about 650 pages. For those of you that don't want to read 650 pages, I don't know why not, but if you don't – if you skip to the second half, it goes section by section, by provider type and talks about what was in the proposed rule and what is in the final rule. And you can kind of go right down to the providers that you're interested in. And it can save you a lot of time from having to wade through the first 350 pages or so are really just CMS commenting back on all of the comment letters that were submitted and explaining the rationale for a lot of the rule in there. So, you don't have to read the whole thing in order to understand what's needed for you. You can really jump to that second half.
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So who does it apply to? Of course, those hospitals and healthcare systems as we've seen already and as we would expect. There's a lot of other ones here that I think a lot of folks would not have expected, especially things like home health agencies and hospice. There's a lot of folks here, types of providers here, that certainly have not been in a lot of these healthcare preparedness conversations.
Some at the local level had been involved with their coalition. Some, certainly, especially the ones that are larger, or part of these systems, have plans and have emergency response functions or a program, but a lot of them don't. And a lot of what we’re seeing when we're going out and talking to folks is that they haven't even heard this rule is coming, and they don't have this function at all and they're at a loss, a little bit, of where to start and what to get ready for, to ready to meet that condition. Which is completely understandable if this is not something you've ever been required to do and not something you've ever been focused on before.
One other thing I want to note here is that there are different requirements. CMS try to make it so that requirements weren't one size fits all. So there are different requirements for inpatient versus outpatient. There are some stricter requirements on inpatient.
I have to say, my opinion is, reading the whole thing, is that it was more similar than I would have expected. There are a lot of requirements that are just basic level requirements that are needed for all provider type, but then they just add a few on top of the inpatient providers.
The other thing that's really important to note is that those folks that are in the healthcare system, those folks are able to do one holistic program and plan. So they are able to meet the rule across the board throughout their whole system. So we know some healthcare systems not only have hospitals, but that they have long-term care facilities, you know, they have a number of different provider types. And they're able to make one plan for all of it. And that was something that a lot of folks fought for in the comment letters back to CMS– to let them do it as one function and that is something CMS agreed too.
So the real challenge here will be for those smaller, regional based providers that aren't part of those big networks, and don't have those major resources to put in to really try to meet this rule.
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So with all of that, asasort of a background setting it up, here's the actual nuts and bolts to the rule. Craig in a minute is going to go into more detail on all of these. So when you really boil it down, it's four major things. Coming up with an emergency plan, and to come up with that plan, you need to have done a risk assessment.
CMS is really keeping a lot of this broad. When they say something here using an All Hazards approach, it means they're not going to tell you what to be ready for. They're leaving it up to the providers themselves to decide what their biggest risk and hazards and vulnerabilities are. So they have to do their own assessment and see what the most necessary things are and then make a plan that reflects that.
And so they're not saying that you have to be ready for any specific thing like a tornado or a hurricane, but they are saying that you need to keep aware of all of the areas that it could be in. So it could be some kind of a national disaster or an outbreak or something like that. It could be a facility disruption, a water supply or a long-term power outage. It can also be something like a cybersecurity hack, which is something we're seen more and more of.
So they are saying that you need to be ready and aware of all of those different risks and come up with the plan to address the majority of them as much as you can. They're also hoping that you can take into consideration some of your patient requirements and patient demographics or the region around you and what some of those patients needs are in that area. But they're really letting the facilities themselves decide what their risks are and how to make a plan based on that.
From there, the plan will have policies and procedures. And those vary across provider types and Craig will get in to that as well. But you really have to have plans to track all of your patients , and understand where people are or if they're moving facilities, you have to share that.
And a communication plan. Again, this is varying, but an interesting thing is you have to have a plan that can communicate out with your staff and with other critical folks as well. If you're a home health agency, one interesting thing to note is you have to have a way to communicate with all of your patients within 24 hours. And then have a list where you track their status and who has the highest risk, and then communicate that out to emergency management and public health. So if there are folks that need direct help, you can share that information back out to them and hopefully circle back. And that's something new, something we haven't seen before.
And then finally, with a lot of these emergency preparedness programs, the way that they keep them fresh and alive in people's minds is by having an annual exercise program. So, that really depends but often it's what we call a table top, which is folks getting around the table and working through a scenario. Or some of the inpatient providers, specifically, have to do full scale exercises every single year to demonstrate that they are ready and prepared for everything that's coming.
So, Craig, let me turn it over to you to get in to a little bit more of the specifics on all these elements.
Craig Camidge:Sure. The first thing to note here is that when we talk about the – well, before we get started, Emily made a good comment that is that the rule is this big giant unwieldy stack of paper to look at. I would encourage you to not only check out the section of the rule that applies to your provider type of your facility type, but if it's your responsibility for you organization to manage this rule and to provide the emergency preparedness program, I would encourage you to find what section of the rule that speaks to the comments and the responses for your facility type.