Preparing for disaster

The past year has taught us that danger lurks in many places and the unthinkable is possible. Between the COVID-19 pandemic, California wildfires, and record number of hurricanes and tornadoes and other extreme weather that affected millions, disasters became something of the norm.

Being unprepared was a hard lesson for many physicians to learn. The pandemic proved that any practice — no matter where it is located — can be at risk.

John E. Bertini Jr., M.D., FACS, a urologist at Gulf Coast Urology in Houston, says to assume a physician practice will never endure a disaster is folly.

“Disasters happen everywhere, whether they are natural catastrophes, large-scale accidents, civil unrest or a pandemic,” he says. “Even a loss of power due to a blown transformer can derail practice operations for a period of time.”

That’s why thinking ahead about possible scenarios can help a physician and their practice better prepare instead of just reacting when the unexpected inevitably occurs.

“Working as a team to create a written disaster plan is key to this process, and it can serve two purposes,” Bertini says. “First, it can guide the practice through a disaster response, fostering order and a sense of calm. Second, it can enable readiness throughout the year because backup systems are current, contact information is up to date, and so on.”

As the COVID-19 pandemic began to unfold and executive orders mandating the immediate closure of practice sites were announced, many primary care physicians turned to their professional societies and physician organizations for assistance in developing not only a natural-disaster plan but also a business continuity/recovery plan.

Ewa Matuszewski, CEO of Michigan-based physician organization MedNetOne, says most primary care physicians and their practice teams did not have a basic emergency preparedness plan in place, nor were they aware of the four phases of an effective plan: mitigation, preparedness, response and recovery.

“Many quickly found themselves creating simple response and recovery plans for both the health care and business areas of their practices,” she says. “Today, primary care physicians have developed and tested their personal disaster preparedness, having learned that the first and most effective intervention to reduce the impact of disasters is to have a plan.”

Creating a plan

Depending on the type of practice, a physician may have to figure out how to ensure uninterrupted care. For example, if their practice provides dialysis or chemotherapy, they will want a plan that addresses how to continue treatments during the crisis.

Bertini says creating a disaster plan involves sitting down with staff and going through the systems and processes that support clinical care and business operations and figuring out how those would be affected by a loss of essential services such as heat, power or internet.

“It entails talking through different scenarios and deciding if and how you will keep the doors open and the lights on,” he says. “We find it valuable to include all members of the office staff in developing the plan because each person can offer things that others may have forgotten or overlooked. We also review our plan periodically to make sure it’s up-to-date and reflects the type of disasters our practice could experience.

Although every practice’s plan will be different, there are some common areas to address.

First, the plan should cover backup systems. Questions to ponder include: “How frequently should we check battery backups for phones and computers?” “How will we provide backup for electronic medical records if the power and/or internet are down?” “What about generators? Do we need them?” And if so, “Where will we get them?”

Operational considerations may relate to the answering service, vendors, payroll systems and supplies. If a practice has refrigerators with drugs in them, can the refrigerators be switched to backup power? Are there critical drugs that will spoil? These all need to be accounted for in the plan.

Supplies are another area to review. If deliveries are delayed and you haven’t thought through how to maintain adequate supplies to hold you over, you may be facing challenges that could have been prevented, Bertini says.

“How you handle this situation may depend on where you’re located and what types of disasters you typically face,” he says. “If your area has a ‘disaster season,’ such as forest fires, mudslides, tornadoes, hurricanes and so on, you’ll want to establish a different preparedness level during that season in terms of supplies and alertness.”

Hamid Abbasi, M.D., chief medical officer for Inspired Spine in Burnsville, Minnesota, recommends always knowing what supplies are on hand and how to secure supplementary supplies in case something happens to halt the supply chain.

“Ascertain that all medications and vaccines, particularly those that are critical, such as insulin, are available in sufficient quantities to meet demand,” he says. “Prepare ahead of time, especially if your practice is located in a disaster-prone area.”

At Gulf Coast Urology, an old-fashioned ring binder houses Bertini’s disaster plan. Because it doesn’t rely on electricity or battery power, he can access it during almost any disaster. It’s also easy to add information when needed.

Timothy Irvine, M.D., a family medicine specialist in Spring, Texas, who has had to deal with floods, hurricanes and extreme weather over the past year, says a disaster plan is essential because it aids in mitigating the impact of a tragedy and is the simplest way to ease the burden if one occurs.

“It is important to have practice drills in place to prepare staff and patients alike for natural disasters,” he says. “Still, most practices aren’t prepared for large-scale disasters even with ample planning and practice. It is important to emphasize intending to utilize the knowledge you learned during practice drills and applying them when disaster strikes.”

Donna Childs, author of Prepare for the Worst, Plan for the Best: Disaster Preparedness and Recovery for Small Businesses, says it’s important for physicians to obtain backup and alternate contact information from patients, employees and vendors in case some evacuate to other locations.

“As part of your practice planning, help each of your staff to develop and implement business resilience plans for their families and households,” she says. “Your staff will be of limited help during a disaster recovery if they are distracted with worry about their families and homes.”

Communication concerns

Patient communication is a further consideration. When a disaster occurs, patients may be unsure whether an office remains open. Bertini experienced this with the recent winter storm in Houston.

“As things got better, people wanted to know when we were going to reopen,” he says. “Anticipating those calls — and putting staff in place to answer them — is critical to keep patients abreast of what’s happening. Using your website in these scenarios is helpful because you can update it in real time. Having those capabilities is something to think about before disaster strikes.”

The plan should also describe scenarios where a practice can reach out to patients ahead of a disaster to let them know what to expect. Bertini uses an app that is Health Insurance Portability and Accountability Act-protected to interact with patients via text, video and phone messaging.

“If we know a disaster is coming, such as a hurricane, we can look ahead at our list of patients and start calling them,” he says. “Depending on the patient’s illness severity and need for care, we prioritize those communications differently.”

Money matters

Physicians should have business interruption insurance, which will replace revenues lost when disaster closes their medical practice, Bertini says. Although this coverage has been the subject of controversy in the context of the pandemic, it is still important to replace revenues lost to more traditional disasters, such as fires or floods.

“From a payer perspective, you should anticipate that your billing and collection cycle may be interrupted,” Bertini says. “Payers may not grant billing and collections grace periods depending on the disaster’s size, scope and location.”

Matuszewski says practices need to review their most recent fiscal years, establish an annual budget and make it a goal to save a minimum of 4 to 7 months’ operating expenses in case there is a loss of service.

After the event

Once a disaster happens, physicians should touch base with their office staff. Cell phones are great for this unless the cell phone network is down. Consequently, it’s a good idea to have more than one way to reach people.

“You have to be flexible to accommodate people’s circumstances,” Bertini says. “When you talk about disaster preparedness, there is an emotional aspect to it. As a physician and an owner of a practice, you should acknowledge the importance of your employees’ mental and physical health.”

If the people and the facility are available, you should start your response and begin meeting patient needs.

Once the disaster is over, it’s important to debrief when things are fresh in your mind. Was there something you overlooked when planning ahead? What could be done differently? Based on those conversations, you can update your plan.

“The bright spot about a disaster is that, if you manage it right, it can bring people together,” Bertini says. “As you work side by side, you begin to see people in a different light. Doctors might be pushing stretchers because you’re short of people in transportation. Or you’ll discover that your receptionist has an amazing ability to prioritize and complete phone calls quickly. It becomes a great team-building exercise that often strengthens everyone’s ability to work with each other.”