Homeland Security Watch

News and analysis of critical issues in homeland security

March 17, 2014

Sometimes government regulation is good; or how Medicare/Medicaid increased preparedness

Filed under: Biosecurity,Business of HLS,General Homeland Security — by Arnold Bogis on March 17, 2014

The phrase “government regulation” usually implies something bad.  But sometimes, a few new seemingly minor regulations can have a positive impact. The Centers for Medicare and Medicaid Services (cms.gov) provides the latest example:

Describing emergency preparedness as an “urgent public health issue,” the proposal by the Department of Health and Human Services offers regulations aimed at preventing the severe disruptions to health care that followed Hurricane Katrina and Hurricane Sandy. More than 68,000 institutions would be affected, including large hospital chains, “mom and pop” nursing homes, home health agencies, rural health clinics, organ transplant procurement organizations, outpatient surgery sites, psychiatric hospitals for youths and kidney dialysis centers.

It might seem like common sense, but previously health care organizations and facilities were required to do very little in terms of preparedness. Because of the market share that Medicare and Medicaid holds, that is going to change:

The regulations would require hospitals, nursing facilities and group homes to have plans to maintain emergency lighting, fire safety systems, and sewage and waste disposal during power losses, and to keep temperatures at a safe level for patients.

Those inpatient facilities would also be expected to track displaced patients, provide care at alternate sites and handle volunteers. Transplant centers would need to identify alternate hospitals for patients awaiting organs — a challenge because centers maintain different transplant criteria.

Home health care agencies would be required to help patients create personalized disaster plans. Hospices and others caring for frail, homebound patients would need procedures to help rescuers locate them. And health care employees would have to conduct disaster drills, while administrators might have to coordinate drills and response plans with local business competitors.

What is aggravating is that the seemingly sensible is so strenuously contested:

One of the most contested of the requirements calls for hospitals and nursing homes to test backup generators for extended periods at least yearly rather than once every three years, as is currently recommended. The generators have sometimes failed catastrophically during prolonged power losses.

This is not a narrow effort, but instead applies to a wide range of health care organizations:

The current proposal is unusual because it applies to 17 types of providers at once, which together serve an estimated nine million fee-for-service patients each month, as well as other patients covered by Medicare Advantage and Medicaid. Federal officials said this broad approach was needed to ensure that the health care system pulls together and that poorly prepared institutions do not stress others during a crisis.

You can read more about this effort, including the push back , here: http://nyti.ms/1fndiuP

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Comment by John Comiskey

March 17, 2014 @ 8:51 am


Medicare and Medicaid-Preparedness Requirements are welcomed by this blogger.

Preparedness is all too often perceived as spending money (that we do not have) on things that probably will not happen (low-probability: high-consequence events). See: Five Days at Memorial for improbable events that happened: http://www.amazon.com/Five-Days-Memorial-Storm-Ravaged-Hospital/dp/0307718964/ref=sr_1_1?ie=UTF8&qid=1395063062&sr=8-1&keywords=Five+Days+at+Memorial

Noteworthy is the likelihood that “mom and pop” health care facilities will be hardest hit by regulations. HLS-preparedness should not be the “Walmartization” of health care, i.e. “mop an pop” shops undone by monetary costs of regulations.

Comment by William R. Cumming

March 17, 2014 @ 9:41 am

Good medicine is not the driver for this sector of the economy! IMO gross negligence [criminal?]is the norm for this sector. After all over 500K die annually after admission from what most would consider malpractice.

Champerterously [sic] perhaps I if a plaintiffs attorney would seek judgment against the adminstrators of this sector.

The real driver for Medicare adoption in 1966 was the ongoing bankruptcy of America’s lower middle class as they struggled to pay the medical bills of their OWN PARENTS largely uninsured and with little or no personal savings.

Disclosure: I was enforcement liaison for the Assistant Commissioner STABILIZATION of IRS during phase II of the Nixon Wage/Price/Rent controls. Over 3,000 corporate tax auditors were diverted from tax audits to STABILIZATION. This period 1971-73! I had several friends and contacts in the field enforcement staff and HQs. They came to me with a problem. They were trying to find out what the health providers did with the Medicare funds they received and how they billed MEDICARE. So I arranged with MEDICARE OFFICIALS for an official visit from me and 1/2 dozen senior audit officials. That visit occurred. HEW at the time not HHS. The meeting should be of great interest to all even NOW!

My auditors collectively started the meeting by asking MEDICARE officialdom if they could see the audit trails of the MEDICARE PROVIDERS. HEW’s answer!

I was offered generous money to leave Uncle Sam and work for the providers. Politely declined after reporting the offers to appropriate officials. I became very suspicious of the health care lobby and concluded that they were one of the most well-financed and vicious lobbies in D.C. Only the most venal would have been comfortable.\\

And the health care sector of the PRICE COMMISSION led by an honorable man C.Jackson Grayson had a health subcommittee (Grayson did not pick many of his key staff] was a woman named Dorcas Hardy [brilliant BTW] who had previous experience as a Georgetown Boutique owner.


Comment by William R. Cumming

March 17, 2014 @ 10:05 am


I left IRS on July 1st 1974 for HUD. I was a GS-13 and since reporting to IRS on July7th 1967 I had a fun time out from the tax world for 2 years, 10 months, 7 days, and 4 hours with the U.S. Army. Many of my contemporaries from 1967 in IRS were GS-14s and 15’s.
So the prospects at HUD looked better. I had three different main clients at HUD. The non-statutory IG at HUD Charles Dempsey, the Federal Insurance Administrator, and the Federal Disaster Assistance
agency Administrator.

Perhaps it should be noted that I worked with OEP during Phase I of STABILIZATION and also on TROPICAL STORM AGNES during my STABILIZATION TIME!

Back to HUD! Also while at HUD I worked on drafting, and providing technical advice to Dempsey and the OIG community for what became the 1978 Inspector General Act. But even before that I helped draft the statute behind the first statutory INSPECTOR GENERAL that being one for HEW! And guess which sector of the economy did NOT want a statute IG in HEW? That law became effective in 1976. And perhaps no surprise few appointees in HEW were in favor of a statutory IG.

Did you know that DHS got its first PAS [presidentially appointed Senate confirmed] IG in over three years of a vacancy in that position and various ACTORS in the meantime?

Comment by William R. Cumming

March 17, 2014 @ 10:09 am

And Arnold clearly DHS agrees with you with over 200 FTE assigned to medical preparedness issues and policy!

Comment by Arnold Bogis

March 17, 2014 @ 11:21 pm

John, while I agree with you about not wanting to be too hard on “mom and pop” outfits, I suppose I’d go to your often suggested “bill of responsibilities” to explain why they shouldn’t be exempt. If you operate a health care related enterprise, you should be responsible to some base level for preparedness in case of interruption or difficulty. Not unlike the original case for what became the Obamacare mandate, if you can afford it you shouldn’t push the cost of preparedness or response on the rest of society. In other words, you can make money in good times, but shouldn’t be exempt from preparing for the bad.

Bill, 200!?! Is OHA that large now? Or are you counting the residual individuals responsible for the health of their particular op-div?

Comment by William R. Cumming

March 18, 2014 @ 7:30 am

Chris! Maybe more!

Also Arnold any org running a congregate care center, not just medical, should have an emergency plan.

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