Reimbursement
Planning for Disaster: The Financial Cost
The Challenge
Our concept of the range and scope of disasters that can strike a health care organization has expanded in recent decades. Natural disasters have been joined by industrial accidents, cyberattacks, public health emergencies, and even reputational and public relations disasters. The frequency and severity of all manner of disasters have increased as well. These disasters can impact the ability of a health care entity to deliver care to patients, manage its employees, and even function. The primary focus in such a crisis is on the direct and indirect damage that the disaster can cause to a facility, the community, and its population. No less significant to the ability to successfully treat patients during the disaster and recovery and long-term operating viability of a health care organization, however, is how well the entity responds to the regulatory challenges that occur during the disaster and how it leverages existing or novel sources of aid.
Manage the disaster with a framework rather than letting the disaster manage you.
The Solution
To be prepared and able to respond to a disaster, a facility needs to undertake in advance a risk assessment, including planning and identifying existing resources and flexibilities, as well as creating a plan to respond and communicate to new and variable flexibilities that may arise during the disaster response. This is a common exercise that hospitals perform as part of the Medicare Conditions of Participation. However, these plans often omit the benefit of prompt outreach to various federal, state, and local agencies and the advantage of pursuing financial assistance available to assist in the organization’s response in real time. There may be assistance to facilitate hospital surge capacity, FEMA, state, private, or insurance reimbursement for disaster relief, and/or public-private partnerships that provide additional resources.
Epstein Becker Green, with the country’s go-to health care practice and approximately 150 lawyers fully focused on health care law, is experienced at helping health care organizations plan ahead to access and utilize known regulatory relief mechanisms and create a team and plan that enables the organizations to respond to and access new disaster-specific relief mechanisms.
We assist facilities in implementing the following measures:
- preparing a plan for notifications and outreach to relevant federal, state, and local agencies and entities that either regulate or reimburse for health care services (creating a “call list” in advance saves time and effort in a crisis and ensures that relevant notifications are made as quickly as possible);
- where established reimbursement or disaster relief programs exist for facility-specific geographies or service types, ensuring that those are identified prior to a disaster and that a plan is in place to seek enrollment or make notifications to those programs, and determining whether community partnerships with major employers may be available to assist with critical resources;
- preparing a plan involving key internal stakeholders (reimbursement, revenue cycle, legal, compliance, etc.) to meet and organize a revenue and reimbursement response team following a disaster, as these groups often have fewer direct patient care responsibilities during an emergency and that capacity can be utilized to assist the organization in providing financial stability;
- ensuring that paths of communication between operational decision-makers and reimbursement stakeholders are securely in place so that operational decisions can benefit from the knowledge of reimbursement implications or alternative options; and
- conducting a mock “reimbursement” disaster response as part of the facility’s tabletop exercises to practice the financial and regulatory response to various types of disasters.
Taking these measures can help a facility ensure that it is able to continue to treat patients in a legally compliant manner, be reimbursed for the care of those patients and the care it renders, and put the facility on the best financial footing to weather the disaster and emerge in as strong a position as possible.