In the Event of an Emergency

Why it’s critical for your supply chain’s disaster preparedness plan to include non-acute sites

Billion-dollar destruction events due to extreme weather or natural disasters are no longer outliers in the United States.

Natural disasters cost the United States $91 billion in 2018, according to the National Oceanic and Atmospheric Administration. Since 1980, when NOAA began tracking this data, 2018 ranks fourth in the highest number of events with 14 disasters, ranging from floods, to hurricanes, to wildfires and winter storms. The 2018 costs ($91 billion) were also fourth, only behind the years 2017, 2005 and 2012.

It’s not a matter of if, but when.

Most hospitals and health systems have a plan in place for acute facilities. However, more and more are recognizing the need to build an effective disaster preparedness plan for their alternate sites as well.

Unintended consequences
In terms of patient value – those patients that touch the alternate care space vs. the patients that touch the hospital or acute side – more patients get put out in an alternate care situation with a disaster.

Visualize a vast network of alternate site care providers during a natural disaster, and the vast amount of alternate care patients that all of a sudden lose their network. These patients have a myriad of conditions and needs, from chronic care, to regular care with newborns or childcare. If the alternate sites are down, the acute setting will be “clogged up” by low acuity illness (think flu, colds, ear infections). “When you don’t have a plan for the alternate care space, all of those patients funnel through the acute space, and into the emergency department,” says Joe Kenis, national account manager, Healthcare Services, Henry Schein. “So you have the true emergency patients going through the emergency department, and now you have the non-acute patient population seeking care.”

Or, the non-acute patients will seek care in other places. “They’re going to go where there is care,” says Kenis. “We’ve seen that when hospitals shut down in certain markets, patient populations move to sites that are open.”

Kenis says there are many other unintended consequences of not having a plan in place for alternate sites. For instance, employees are affected. How are non-acute providers cared for during this time? You may have a plan, but if you don’t have people, your teams will be exhausted because there are no teams to replace/help carry the load.

“And think of hourly workers,” Kenis says. “How do they get to the site? You can ask your professional staff, if able, to get there, but you’ve got to be able to have support staff there too. We saw employees being poached in markets affected by disaster events. We saw hospitals losing workers that were going to businesses (like restaurants and retail shops) that were paying more money.”

A health system’s non-hospital sites may experience damage or outright destruction of buildings during a natural disaster. Lack of electrical power. Lack of communication. Manpower shortages. Insurance carriers not being aligned. Damage or destruction to essential medical equipment. It’s a lot to consider.

Henry Schein Medical can provide insights and experience working with hospital and health systems through a myriad of disaster events. The company offers a disaster relief hotline in advance and during a disaster, as well as a Road to Recovery program coordinated through local organizations and medical associations that provides resources and various forms of assistance to help providers get back on their feet.

It’s a portfolio of tools, resources and insights gained from experience. Within the last 2-3 years alone, Henry Schein has assisted customers in regions affected by hurricanes, flooding, wildfires and more. “You think you know what to plan for, but you learn a lot during a disaster,” says Kenis. “Having exposure and seeing what happens in different situations gives you a lot more to think about and a lot more bring to a plan.”

What to consider
Building a disaster preparedness plan for non-acute sites starts with supplies, and the ability to avoid disruption. Henry Schein’s distribution network is structured to maintain the ability to support a community or region that’s impacted by a natural disaster. “Instead of local warehouses that may get impacted in a market, our warehouses are out of the market, but still well within range to supply, and we can pull from more than one location,” Kenis says. “When we were in the Florida Panhandle after Hurricane Michael in 2018, we pulled from Jacksonville, Florida, and Greenville, South Carolina. We could also pull from Indianapolis. We had multiple warehouses that we could pull from to support a market.”

Considerations for non-hospital site planning include:

  • Non-acute equipment and supply lists will be needed for both short- and long-term incidents or displacements (days/weeks versus month). Henry Schein Medical has readily accessible products needed in the non-hospital space, and the capability of reviewing and guiding disaster teams on supply/equipment lists.
  • It is critical that non-hospital sites have involvement in the health system’s overall disaster planning.
  • The health care providers need to have language in their agreements that supports the system’s strategies.
  • The non-hospital sites must have agreements with their insurance carriers to allow patient care and reimbursement during physical location unavailability and use of temporary permanent and non-permeant structures
  • Patients must understand the plan as it impacts them. This will help to make sure that low acuity patients are not utilizing high acuity services (i.e. Travel/transportation around non-acute plan).

The key is to have those conversations well in advance. By the time a disaster strikes, it’s already too late.

“As you can imagine, when you’re in a disaster and your market gets destroyed, it’s very difficult to make decisions and make things happen,” says Kenis. “The timing is so short, and the whole market is pulling resources, so it’s hard to get those resources.”

Questions to ask

Supply Chain needs to have a focus on how the alternate care clinics will manage their patient populations during a short- and long-term disruption. Questions to ask include:

Where will the patient be seen during the time when normal clinic space is unavailable?

  • Is there a long-term strategy to bring in temporary structures?
  • Do we have supply and equipment lists developed?
  • Do we have essential, long lead time, equipment and supplies identified?
  • Does my distributor have a disaster strategy and a diversified footprint to support my strategies?

What are essential and non-essential services that should be provided during a short and long term disruption?

  • What are the capabilities with power, water, generator needs-type of generator- (one phase, three phase)?
  • Site selection and contingency locations depending on the situation and damage

Is there a plan for employed and contracted physicians?

  • Is the plan outlined in health care provider agreements?
  • Is there a strategy to deploy providers from other markets?
  • Have you created a strategy with your insurance carriers? (This will allow for care of patient populations in temporary locations.)
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