Finance piece overlooked in pandemic response plans
Payer rules 'may no longer be reasonable'
Financial issues that fall directly under the purview of patient access departments are among the areas most frequently overlooked in pandemic planning, suggests Valerie Sellers, MHA, CHE, vice president of health planning for the New Jersey Hospital Association (NJHA).
The NJHA has published the first installment addressing supplies, logistics, and support services of a 10-module guide that hospitals can use to develop or assess a pandemic flu response plan. Still being developed are modules on communication, ethics, human resources, leadership, and finance, among other topics.
"The financial piece is what I'm enjoying the most," Sellers says. "There are challenges I don't think anybody has thought through at a fine level of detail. If we're planning effectively, we're in the position of saying, 'What do we need to do differently to facilitate getting patients [into the hospital] and cared for at a time when only half of us may be at work.'"
A big part of the challenge, she notes, has to do with the rules imposed by Medicare, Medicaid, and other third-party payers, such as managed care companies.
"There are certain administrative protocols that accompany each patient that [in the event of a pandemic] it may no longer be reasonable or possible to comply with," Sellers says. "We're working with managed care plans to say, 'You can't have the same protocols, the same admission criteria. We can't submit paperwork in 30 days we won't be able to process all that.'"
The message that must be delivered to third-party payers and others, she adds, is "We can't do business as usual and you can't do business as usual or both operations will be compromised."
The managed care companies with which the NJHA officials are holding discussions have been "initially receptive" to the ideas presented, Sellers says. "It helps that the [state] Department of Health, the Department of Banking and Insurance, and the Department of Human Services, which has oversight of the Medicaid program and Medicaid HMOs, are at the table and have an understanding of the need for different policies and procedures."
Standardization among payers
It's going to take time, she says, but the goal is to move toward standardization among payers. "The last thing you want to deal with is one health plan that has no concurrent review but requires notice of admission in 72 hours, and another that says it is suspending notice of admission but will [require concurrent review]."
Instead, Sellers says, the approach is "there will be one standard procedure and this is what it will be. We hope [payers] will voluntarily agree. If not, we will explore doing something legislatively."
There will be issues with human resources and employee health to be dealt with during a pandemic, she continues, and a "whole new environment" of patient care: "How do you maintain cash flow to the hospital, and how do you make sure the patient gets from the point of talking to the registrar to being seen by a physician in a state of fear and possibly panic and distrust?"
Communicating with frightened patients who speak a variety of languages and who don't understand what is happening will be another challenge, she points out, particularly with limited staff and limited time.
In some cases, individuals on the front line such as access personnel may be asked to go to a nursing unit and help provide clinical care, Sellers says. "Job reassignment is one of the things talked about [in the NJHA guide]."
Access staff could be sent to a patient floor to help move patients or change linens "whatever is needed to keep the continuity of care moving," she adds. The guide's assessment tool for hospitals may ask, for example, "Do you have a policy regarding non-clinical staff assuming clinical duties?"
The purpose behind the modules NJHA is creating is to "go down to a fine level of detail" to prepare hospitals for what they will be dealing with in a pandemic, Sellers says.
"In the finance module, we are developing a DVD of vignettes so people see an actual scenario," she adds. "Maybe three patient access [employees] are told to report to med-surg at five to help the nurses. Two will go, and the other says, 'I'm not going. I didn't sign up to do patient care.'"
At that point the DVD might stop, Sellers says, and direct those watching through a series of questions that will help the hospital define a policy: "Are you punitive, or do you reward those who do respond? [Hospitals] need to come up with very specific policies."
Another question is what happens if some employees are working at home, she notes. "What about liability coverage?"
One health care organization that did an excellent job of caring for both patients and employees during the SARS crisis, Sellers says, was North York Hospital in Toronto. Among other accommodations, the hospital paid employees in cash, she adds, "because they couldn't go to the bank because they were in quarantine."
ED will be 'most difficult place'
During a pandemic, Sellers notes, when the hospital is full to capacity, people will keep coming to the ED seeking care. That will include "the worried well," she adds. "How do you sort through those who have been infected vs. those who aren't sick but want medications?"
"The ED will be the most difficult place," Sellers says. "People will be screaming at you because they want their child protected. They think if one person is treated one way, they should be treated similarly."
Patient tracking will become a huge issue, she predicts. "How do you know that Aunt Jane has been seen and admitted, in the face of 30% of staff out and an overwhelming surge of patients?"
Hospitals working under difficult circumstances still must be cognizant of policies to which they must adhere, and of the rules imposed by HIPAA and EMTALA, Sellers says. "In a declared state of emergency, the federal government will have some waivers in place, but that has not yet been clearly defined."
The last module that will be released and the "most critical" deals with regulatory issues, she adds. "We've contracted with a law firm to do this one, and the man putting it together has done extensive work with Hurricane Katrina. It addresses what [hospitals] can do, what they should do, and how they can prepare."
When the final module comes out, NJHA also will release a DVD containing all 10 installments, Sellers says. "All that should be done by June." The modules are free, she adds, and will be available on the web sites of the NJHA and the American Hospital Association.
One of the most important components of any health care disaster response, Sellers notes, will be "the ability of those on the front line to have the skills to calm people and get [people] to hear them, and to communicate in multiple languages."
"That is such a daunting task," she says. "You have to have people trained."
One of the phrases that best characterizes the importance of preparing for a pandemic, Sellers adds, came from one of the leaders at North York Hospital. "He said, 'You should not be developing policy in the middle of a crisis. Failing to plan is planning to fail.'"
[Editor's note: More information is available on the NJHA web site at www.njha.com.]
Financial issues that fall directly under the purview of patient access departments are among the areas most frequently overlooked in pandemic planning, suggests Valerie Sellers, MHA, CHE, vice president of health planning for the New Jersey Hospital Association (NJHA).You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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