Prior to September 11 significant public attention focused on escalating health care costs. The repercussions from September 11 will only exacerbate this situation.
Most hospitals have extensive emergency response plans in place for natural disasters unique to their specific service areas—such as earthquakes, floods, hurricanes, blizzards, etc. In addition plans are in place to respond to man-made disasters such as fires, transportation accidents, chemical explosions, etc. September 11 redefined the meaning of disaster preparedness for hospitals in the United States.
To adequately protect and serve their communities in the event of a bioterrorism attack, hospitals will need to modify their disaster plans. Inventories of specific antibiotics, antitoxins, antidotes, ventilators, respirators and other medical supplies will need to be maintained. Personal protection supplies like gloves, gowns, masks, canister masks, etc. may need to be maintained in larger quantities.
Facility modifications for greater decontamination capabilities, lockdown ability, enhanced auxiliary power, increased fuel storage and large volume water purification may need to be made. Additional time will be required in staff training and drills to address bioterrorism. Medical and public safety communications may need to be modified. Mental health resources must be prepared to not only handle victims but also family members, emergency personnel and staff.
Hospitals just like most other organizations must enhance their own internal security. Hospitals are a key component of the infrastructure of the communities in which they exist. They must protect their property and employees from any external threats. In addition, hospitals must ensure all other resources used in patient care, such as medical supplies and drugs, are safe and reliable at all times.
Over the last decade managed care and stringent federal Medicare and state Medicaid reimbursement policies have resulted in drastic reductions in hospital inpatient capacities. Adoption of business techniques, such as just-in-time inventories, has significantly reduced on-hand medical supplies and drugs. These cost reduction techniques were not only necessary for hospitals to maintain an adequate level of financial viability, but also were strongly encouraged and at times required by payors and government regulators. For many hospitals the ability to expand capacity to adequately prepare for bioterrorism threats will be very difficult and expensive.
Hospitals will need to maintain a constant surveillance of their emergency departments, clinics and outpatient facilities for sign of bioterrorism activity. Diligent communication with other health authorities such as the Center for Disease Control, targeted staff training and perhaps additional medical testing will be required of hospitals as they act as the front line detectives in the search for signs of bioterrorism in their communities.
All of these activities and preparations will add significant costs to our nation’s health care system. Safety net, highly specialized hospitals will no doubt bear the brunt of these costly activities. However, all hospitals will need to participate at some level to ensure our country is adequately prepared for these new terrorist threats.
September 11 has had other direct impacts from a government perspective that will most certainly impact health care costs. Nearly 60 percent of the average hospital’s patients receive medical coverage through the Medicare or Medicaid programs. The overnight funneling of billions of dollars to the war on terrorism and homeland defense will have a significant impact on the ability of Congress to adequately fund health care. Our government’s ability or desire to adequately fund its health care obligations was once again heading towards a "crisis" stage due to the economic downturn prior to September 11. That looming crisis is now here in force.
In addition to the direct reduced government funding implications for health care, the need for Congress to focus its attention on the war on terrorism and homeland defense has resulted in the deferral of other important health care legislation. Included in the list of deferred legislation is Medicare prescription drug coverage, patients rights legislation, enhancements to Medicare HMOs and other general Medicare reforms. The delay in addressing these issues will hinder the effectiveness of the Medicare program and in some cases increase the overall cost of health care. IBI