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September 14, 2018

What the 200+ health care facilities in Hurricane Florence's path are doing right now

Daily Briefing

    Federal agencies and hospitals are in the midst of a full-scale effort to prepare for and react to the havoc wreaked by Hurricane Florence, which made landfall in the Carolinas Friday, Becker's Hospital Review reports.

    Details on the hurricane

    Hurricane Florence made landfall on Friday at 7:15 a.m. in North Carolina with winds of 90 miles per hour. Forecasters warned the hurricane would lead to "life-threatening, catastrophic flash flooding" and will move slowly westward.

    North Carolina Gov. Roy Cooper (D) said, "We know we're in for a long haul... We've rescued over 100 people in New Bern, N.C."

    According to NPR, the hurricane caused almost 500,000 power outages in North Carolina and nearly 30,000 in South Carolina before it made landfall.

    CMS announces waivers

    In response to the hurricane, CMS has issued several "blanket waivers"—those for which providers do not have to apply—to facilitate emergency care at hospitals and other facilities in North Carolina and South Carolina.

    According to Healthcare Finance News, CMS is waiving certain Medicare, Medicaid, and CHIP requirements, and it has opened a special open enrollment period for Medicare beneficiaries and people signing up for coverage through the federal exchange market. CMS also waived certain requirements to make it easier for Medicare beneficiates to replace their durable equipment—such as prosthetics—if they lose or damage them during the storm.

    Further, CMS is using the Kidney Community Emergency Response program to ensure patients have continued access to dialysis. The program will collaborate with End Stage Renal Disease Network of the South Atlantic to assess whether dialysis facilities in the path of the storm have access to power generators, water, and other materials for patients. 

    Some hospitals evacuate—while others have to stay open

    Overall, an estimated 177 hospitals, nursing homes, and medical facilities are in the hurricane's path in South Carolina, and 40 hospitals are in the hurricane's path in North Carolina.

    The South Carolina Department of Health and Environmental Control (SDHEC) announced that 113 health care facilities along the coast had evacuated more than 2,200 patients as of Thursday at 9 a.m. South Carolina Gov. Henry McMaster (R) had ordered the mandatory evacuation of patients—with the exception of a few who are extremely ill—at seven hospitals by the end of Thursday. According to SDHEC, the following hospitals closed:

    • Grand Strand Medical Center (GSMC);
    • Palmetto Behavioral Hospital;
    • Tidelands Georgetown Memorial;
    • Tidelands Rehab Hospital;
    • Tidelands Waccamaw Community Hospital;
    • Vibra Hospital of Charleston; and
    • Williamsburg Hospital.

    According to an SDHEC release, South Carolina granted exemptions to at least eight hospitals to allow them to continue treating their most critically ill patients:

    • Bon Secours – St. Francis Xavier (Roper);
    • East Cooper Medical Center;
    • Health South Rehab Hospital of Charleston (Encompass);
    • MUSC;
    • Roper St. Francis – Mount Pleasant Hospital;
    • Roper Hospital;
    • Summerville Medical Center; and
    • Trident Medical Center.

    Inverse reports that Hilton Head Hospital and Beaufort Memorial Hospital received exemptions as well.

    According to Inverse, the state granted exemptions to hospitals that provide care to patients who would be placed in danger if they were transported to another facility. Dede Carey, clinical manager of the cardiovascular intensive care unit at Roper, said, "Whether it's a breathing machine or medicine that’s going through their veins—those types of medicines and life-supporting measures would make them too unstable to move."

    To stay open during the storm, Roper is bringing additional employees to the hospital and having employees sleep at the facility overnight. Roper brought power generators and stored extra water in case the hospital experiences a power outage or the water supply is cut.

    Meanwhile, patient care teams at the seven hospitals are working with the South Carolina Hospital Association to help transfer patients to hospitals outside the evacuation zone.

    However, Aaron Dix, administrator of emergency medical services for Greenville Health System (GHS), said transportation poses a problem for patient transfers because ambulance services are in high demand during the hurricane.

    The Federal Emergency Management Agency asked Atrium Health in Charlotte to have the system's MedCenter Air helicopters on standby to help the coastal areas with evacuations. As of Thursday, the health system's helicopters evacuated 15 patients from Brunswick Medical Center and New Hanover Regional Medical Center to Carolinas Medical Center and other hospitals.

    According to a report by the Medical University of South Carolina, transferring patients during an evacuation can cost days of planning and thousands of dollars per transport, the Post and Courier reports. 

    Lending a hand

    The South Carolina Hospital Association said at least 22 hospitals have accepted patients from evacuated hospitals.

    Several payers, telehealth vendors, and other health care organizations are offering patients affected by the hurricane access to no-cost telehealth services. Those health care organizations include:

    • American Well;
    • Atrium Health;
    • Anthem;
    • Capital BlueCross;
    • Care iOS;
    • DoctorOnDemand;
    • MDLive;
    • Medical University of South Carolina;
    • Teladoc; and
    • UNC Health care.

    What the hurricane will mean for hospital finances

    Analysts expect hospitals in Hurricane Florence's path will temporarily experience declines in patient volumes and for-profit hospital operators will briefly see stock prices drop, according to Becker's Hospital CFO Report. Brian Tanquilut, a Jefferies analyst, said, "Health care facilities in the projected path of Hurricane Florence will likely see a short-term dip in volumes as patients and physicians reschedule elective procedures, office visits and lab tests."

    Health care systems with hospitals in the path of Hurricane Florence include Community Health Systems (CHS), LifePoint Health, HCA Healthcare, and Tenet Healthcare. Of those health systems, LifePoint is the most exposed to the hurricane, because nearly 30% of LifePoint Health's hospital beds are located in regions of North and South Carolina where Hurricane Florence is projected to reach, according to analysts. A LifePoint spokesperson said, "Health's priority in preparing for Hurricane Florence's landfall is ensuring the safety of our patients, employees and communities."

    Michael Newshel, an Evercore ISI care analyst, in a research report, said, "Community Health is next with 19% of acute beds in the storm's potential path, followed by HCA Healthcare with 9%." Analysts said Tenet is the least exposed to the hurricane's projected path out of the major for-profit health systems, but the hurricane's storm surge could hurt Tenet's four hospitals within 25 miles of the coastline (Ellison, Becker's Hospital CFO Report, 9/13; Coombs, CNBC, 9/12; Spitzer, Becker's Hospital Review, 9/13; Wildeman, Post and Courier, 9/13; Sheikh, Inverse, 9/13; SDHEC release, accessed 9/14; Jones Sanborn, Healthcare Finance News, 9/13; DuChanois, News4Jax, 9/13; Hudson, Charlotte Business Journal, 9/13; Chappell, NPR, 9/14; Wall Street Journal, 9/14).

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