2018 Year in Preview


In The wake of the 2017 annus horribilis, preparedness rules to get tougher

Susan Ladika
Police cordoned off the Rehabilitation Center at Hollywood Hills, which had no air conditioning after Hurricane Irma knocked out power in much of Florida. Fourteen people died at the center, and there are now a dozen bills under consideration in the Florida legislature that would toughen nursing home regulation. (John McCall, South Florida Sun-Sentinel/TNS via Getty Images)

Disaster seems to be a new kind of normal, still unpredictable but no longer unexpected. It’s impossible to say what calamities 2018 will bring, but payers, providers, and regulators are going into the new year with an armamentarium of tools—and new requirements—for responding when large numbers of people suddenly have new health care needs.

Telehealth is one of the tools. After Hurricane Harvey battered Texas and Louisiana in August, LiveHealth Online, a subsidiary of Anthem, announced it would provide free telehealth services to any resident of those states who had been impacted by the storm. It made the same offer to all Florida residents in September after Hurricane Irma raked the state. LiveHealth Online President John Jesser says no one at the company questioned the need to offer the service at no cost to anyone in those states, regardless of whether they were Anthem customers. “This was really about how we could get in there to help people who need help,” he says. American Well and MDLive were among those also offering free services to consumers because of the hurricanes.

Cigna responded with a free, 24-hour telephone helpline for people affected by hurricanes and also set up a helpline following the mass shooting in Las Vegas. “We just think it’s the right thing to do,” says spokesperson Mark Slitt. “It’s part of our sense of corporate responsibility.” LiveHealth Online also offered free telehealth services in Las Vegas.

Insurers in Florida and Texas also helped out after the hurricanes by relaxing some rules—eliminating higher charges for out-of-network care, for example.

But the disasters of 2017 also revealed some severe shortcomings in preparedness. In Florida, 14 residents of the Rehabilitation Center at Hollywood Hills nursing home died after Hurricane Irma knocked out power to the air conditioning system—even though, according to CBS News, “just across the street was a fully functioning and cooled hospital.” Residents remained in the sweltering facility until rescuers evacuated them. The deaths prompted lawsuits and an ongoing criminal investigation, although the medical examiner later ruled one death was not linked to the hurricane.

In Texas, law enforcement and state regulators are investigating the circumstances surrounding the rescue of dozens of residents of the Lake Arthur Place nursing home in Port Arthur, after Hurricane Harvey swamped the facility. The official in charge of the nursing home had refused to allow the evacuation and had to be handcuffed until police and volunteers could remove the residents.

Federal and state officials have moved this year to impose some preparedness requirements on providers that will have an effect in 2018 and years beyond. CMS finalized emergency preparedness rules for health care providers that serve Medicare and Medicaid patients more than a year ago, but they only went into effect last month. Under the new rules, facilities must:

  • Develop an emergency plan, focusing on steps necessary to be prepared for a whole range of emergencies, as well as disasters specific to the location of the provider.
  • Develop and implement policies and procedures based on the plan.
  • Develop a communications plan that complies with federal and state laws.
  • Develop and maintain training and testing programs, and conduct drills and exercises to test the plan.

“Nursing homes always had an obligation to deal with emergencies,” says Toby Edelman, a senior policy attorney at the not-for-profit Center for Medicare Advocacy. However, she says that enforcement tends to be “incredibly weak. Rules are only effective as they’re implemented and enforced.”

It’s important for people in the nursing home industry to “think beyond the walls of their facility,” and focus not just on potential risks at a nursing home, but on disasters that can threaten an entire community, says Erin Prendergast, senior manager for quality improvement at the American Health Care Association, which represents nursing homes and similar facilities. Nursing home administrators, she says, must connect with first responders (police and fire departments) and other health care facilities well before a disaster strikes.

Some state officials are also getting tough on lack of preparation. In Florida after the Hollywood Hills deaths, Gov. Rick Scott ordered backup generators to be installed at nursing homes and senior living facilities by November 15. But a judge said the emergency rule was an overreaction. Scott appealed the decision, which left the rule in place for the time being.