CMS rule could hit the little guys where it hurts

By: April 15th, 2014 Email This Post Print This Post

I am a huge proponent of making improvements to any emergency plan, but when regulatory agencies such as CMS start proposing rules that might be impossible for the little guys to implement – I have to feel for them.

Under the new rule, proposed in December and just finishing with the public comment phase, CMS would require hospitals – and ASCs and smaller, hospital-based medical clinics that receive Medicare funding – to prove they can stay open and operational during major catastrophes such as hurricanes, earthquakes and the like. The intent – and a good one – is to avoid mass disruption of medical services on a mass scale such as that experienced during disasters such as Hurricane Katrina in New Orleans, and in New York City during Hurricane Sandy. And of course, compliance would be tied to reimbursement.

The problem is that, as it stands, it will be costly – the new rule would affect 68,000 hospitals and healthcare institutions nationwide and cost $225 million, most of that cost due to upgrades needed on HVAC systems, backup power redundancies, transportation and other life safety necessities that would be called upon to keep a hospital operating as unthinkable tragedy unfolded around it.

Hospitals will likely be the ones who bear the brunt of the cost of the upgrades, but where it will hit the little guys is a proposed requirement that would require all facilities to participate in a mock disaster drill in the community once a year, as well as conduct a facility tabletop exercise to show disaster readiness. If you’re a tiny ASC or medical clinic, that might be hard to do. In a tiny community, resources will be tied up in a crisis.

“Our resources would be closed because all our physicians would be at the hospital taking care of patients,” says Bruce Cunha, RN, MS, COHNS, manager of employee health safety, Marshfield Clinic, Marshfield, WI. Cunha is a safety officer for several ASCs in Wisconsin affiliated with St. Joseph’s Hospital, and as facility’s federally qualified to receive Medicare funds from CMS, he is very concerned about how a new rule would affect his clinics.“Some of the communities they are in don’t have drills very year, and some of them are five-person clinics,” he says. “I don’t know many communities that are going to look at a five-person clinic as part of their emergency plans.”

I’d urge all you little guys out there to watch what CMS does very closely, and I’d also like to know how this issue might affect your facility – good or bad. Always feel free to send me your thoughts at


By Marian Skinner on April 16th, 2014 at 10:25 am

This is a total ridiculous rule for ASCs!! We are in a city population > 100,000 that has two hospitals with beds greater than 400. Our emergency management team does not need or want our assistance. They would rather moving as many persons to safety as possible who are not needed.
It would make much more sense to have the clinical staff remain at hospitals to assist then to have ASCs with limited ability to remain open.
LUDICROUS!!!! Marian

By John Palmer on April 17th, 2014 at 9:20 am

Thank you Marian, for your comment. There’s a lot of people who are feeling the same way!

This would be an impossible requirement for our small ASC. We are a one OR, one surgeon, laparoscopic surgery center. Our surgeon and all staff have credentials/privileges at the hospital across the street. Not to mention, the our contracted anesthesia group would all be at the hospital. Ugh!!!!!!

By Michael Burnett on April 17th, 2014 at 2:22 pm

Where can we find this rule to read?


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