From the Contributor’s Corner: When Disaster Strikes…Call Me, Maybe? Part II

Health Wolters Kluwer Law & Business will periodically feature posts from outside contributors who are members of our Advisory Board. Today’s post comes from Allan P. DeKaye, MBA, FHFMA. For Part I of this post, click here.

It would be nice to think that Superstorm Sandy was in the rearview mirror. The after effects will be felt for quite some time. It was reported that between Virginia and Maine (the path of the storm) that some 25% of cell towers were initially damaged because of electrical service interruptions. So instead of the next smartphone, how about a better way to ensure cell phone communications—maybe with solar powered devices, and satellite backups to handle emergency levels of call volumes.

Now in the aftermath, not only individuals—but state and local governments will be picking up the pieces, and trying to put all of the pieces back together again. At the federal level, the senators and representatives of New York and New Jersey are in the nation’s capitol to seek aid to rebuild and strengthen the weakened infrastructure that demonstrated just how vulnerable we are. This political theatre coming amidst the “fiscal cliff” and other nonsense doesn’t play well in communities that went to the polls when there was no power to make their voices heard despite the crises they faced. Now is the time to act responsibly.

The storm also put the health care profession to the test. In talking to some of my clients, the most pressing concerns for hospitals was maintaining power. For many facilities in low lying areas, especially near the water (as some were), there were mandatory evacuations (which started days before the storm was expected to hit). One neighbor, who is also a nursing administrator, told me that for her facility to cope with the influx of hospital transfers as well as nursing home patient transfers from those facilities in low laying regions, the National Guard sent in a medical unit to work solely with the incoming transferees.

Another client reported that many ER visits and some admissions were largely to refill prescriptions as drug stores and pharmacies may have been flooded or simply without power (or both). In some cases, patients were homeless—some temporary—as their homes became uninhabitable—some permanently—as some homes were destroyed. Others may have been injured or incapacitated as a result of the storm.

Several hospitals remained shuttered as a result of the storm, not only depriving the communities they serve with access to care, but temporarily (hopefully not permanently) furloughing workers causing a spike in unemployment. Much has already been said about the failure of Long Island’s Power Authority (LIPA) to implement preparedness recommendations after past storms, and the recent resignations of its COO, and Board chairman will do little to ensure that corrective actions will happen to prevent future mismanagement, and lack of preparedness. But the axing of a few heads will by no means assure a better outcome the next time. This is not dissimilar from a compliance audit failure of great magnitude.

After the storm, they’ll put their collective heads together to determine how best to rebuild, repair and strengthen infrastructure. At first, one New York City hospital that experienced flooded basements disrupting generators was criticized for the location of their generators. Days later, the critics acquiesced, saying that generators can’t be placed on the roof. So what’s the solution?

Hospital audit failures are met with reviews, and corrective action plans; hopefully preventing the next occurrence. Even years after Katrina, the new hardened levees were put to the test. For the most part they worked; but the diverted water flooded other areas—not as severely as before—though adequate–but not perfect.

Is perfect possible? We talk about having best practices. Maybe we need “better” practices first. We’re told there are limited resources. But we also argue that we need to work smarter, not just harder. Perhaps the lesson learned is we need to do both. They say that much of Long Island’s storm related damage came first from flooding due to storm surge; but the elongated period of time it took to restore power came from numerous downed trees hitting power lines. The conventional wisdom says “it’s too expensive to bury the wires.” However, if after two severe storms in a relatively short span each causing billions of dollars in damage, we need to rethink the wire burying option, or invest in tree trimming (which was not funded), or figure out ways to harden everything from sewage plants to electric substations (all of which sustained outages and damage).

Trains were stopped early to shelter the rolling stock. However, one of the transit authorities stored their train cars in a low-lying area—they lost quite a few railcars. Bridge and tunnel traffic was stopped. But the image of flooding tunnels will stay in the minds of many for a long time to come. Many argue that people should not live at the water’s edge; however, that didn’t stop the ocean and bay coming together and flooding and destroying many coastal communities. The resulting storm surge caused flooding in areas that were not in the flood zone maps.

There is also much in the news these days about teacher evaluations. Our elected officials should also know that they will be evaluated in the days and months to come. It won’t be a question of “did we fix it,” but did we rebuild it better so that it will last!

Allan P. DeKaye, MBA, FHFMA, has over 40 years of experience in the healthcare field. He is President and CEO of DEKAYE Consulting, Inc., a national firm specializing in Revenue Cycle Management. Mr. DeKaye has an MBA in Healthcare Administration from Baruch College of the City University of New York. He currently serves on the editorial advisory boards of several industry publications. He is a Fellow in HFMA, and has received several of their merit awards, including its Medal of Honor.

He is the author of the well-respected text, The Patient Accounts Management Handbook. He has written many articles appearing in various industry publications. Mr. DeKaye’s Emphasis on Education(sm) programs have been attended by over 7,000 participants, and he is a frequent speaker at national, regional and local trade association conferences. DEKAYE Consulting, Inc., also maintains strategic alliances with data, decision support and technology companies.