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Don't Wait for Disaster to Strike
Preparing for Emergencies Can Help FPs Avoid Business Losses
By Barbara Bein
Because the clinic had no structural damage, their business insurance didn't cover the loss. When the clinic's FPs, Darla Cowart, M.D., and Karen Allen, M.D., contacted the Federal Emergency Management Agency for aid, they received the same message. Finally, they contacted the vaccines' manufacturers.
Examine Business Insurance and Communications Plan
During a season when tornadoes have devastated northern Alabama -- and, more recently, southwestern Missouri -- when the swollen Mississippi River has spilled over its banks in Vicksburg, Miss., and when the Red River in North Dakota has flooded for the third spring in a row, Bomgaars said family physicians should prepare well in advance of potential disasters to protect their homes, their offices, their records, their equipment and their staff.
"These natural disasters will only increase over time," said Bomgaars, who recently was appointed to the AMA National Disaster Life Support Education Consortium. "Every disaster is local. And that's where family physicians live and work."
According to Bomgaars, addressing insurance issues is important. Family physicians in small practices sometimes don't have the right insurance or enough of it to cover the losses that can occur during a disaster.
"Family physicians should not think these disasters can't happen to them," Bomgaars warned. "They can happen to any one of us. We have to prepare and expect them to happen."
According to Gail Jones, manager of practice management in the AAFP Division of Practice Support, practices sometimes overlook communication and information access issues when they try to prepare for disasters.
AAFP Has 'Breach of Information' Resources
"It's all rubble," Goff recently told AAFP News Now. "It's just devastated. There's nothing left."
For Goff and other family physicians affected by this or a similar disaster, the AAFP offers this reminder: If patients' medical records have been lost or destroyed, certain actions must be taken under the Health Insurance Portability and Accountability Act, or HIPAA.
Fortunately, according to Gail Jones, manager of practice management in the AAFP Division of Practice Support, the AAFP has information on federal breach of information notification requirements, as well as what FPs should do in the event of a breach.
According to HHS' Breach Notification Rule, HIPAA-covered entities must notify patients -- in written form or via e-mail -- after they discover a breach of protected health information.
The notification should include a description of the breach, the types of information that were involved in the breach and the steps affected patients should take to protect themselves from potential harm. In addition, physicians should provide a description of what the practice is doing to investigate the breach, mitigate any harm and prevent further breaches.
Under certain conditions, the practice may meet the breach notification criteria by posting a notice on the home page of its website or by providing notice in local print and/or broadcast media.
"Now, with electronic medical records, it is important to make sure there is a backup somewhere other than the actual practice and that there will be a way to retrieve the information," Jones said. "If the practice still uses paper charts, they need to have a plan for retrieval and for protecting the records."
FPs can do practice drills and so-called tabletop exercises to prepare their staff members for an emergency, she suggested.
Keep Preparedness Plans Updated
Michelle Reitan, the health system's emergency preparedness manager, told AAFP News Now that their plans include the following elements:
- Refrigerators that store vaccines have alarms indicating when temperatures have gone out of the safe range. If such a signal is sent, it goes to an information technology, or IT, center so that managers are notified to check on the refrigerator.
- If a power failure affects one refrigerator, vaccines are located to another refrigerator. If a system-wide outage occurs, vaccines are put into large coolers with ice packs. The coolers can be moved to clinics that have backup generators or to the hospital, which has multiple levels of generator power.
- The health system has a "trigger list." Managers know the effects of different river heights on the various facilities, including the three clinics that are closest to the river. As the river starts to rise, plans are made to relocate the clinic and its services.
- The IT building, which contains the servers that maintain all electronic health records, or EHRs, is a top protection priority in the event of a flood. A number of measures are taken to avoid flooding in that building.
- Many clinics have basements with drain tile and sump pumps that continue to pump water out throughout the winter.
A number of teams throughout the community -- from both the health system and independent clinics -- collaborate to prepare for flood season and identify the most vulnerable clinics, Reitan explained.
"We started looking at what accommodations could be met when negotiating with the insurance companies," said Reitan. "We look at that pretty hard now."
Meanwhile, back at Total Sports Care in tornado-stricken Huntsville, Ala., Alexander continues to take an external hard drive that contains a backup of the practice's EHR information home with her each day. She also takes home a kit of practice information, and the practice is considering buying a generator.
The practice's family physicians and staff members also have looked at their insurance options, including adding coverage of vaccine losses as part of their basic policy and interruption-of-business insurance.
"There is probably no way we couldn't have lost our immunizations," Cowart said. "Having the coverage for insurance is the main thing we can do. That's the message to other practices."
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