Home Health & Hospice Week

Hurricane Gustav may not have been as bad a storm as predicted, but many home care providers still have major challenges in its wake.

The impact on the home care industry began before Gustav's landfall on Sept. 1. Home health agencies, hospices and home medical equipment suppliers put into place their emergency plans generated for just such events.

HHAs: HHAs are required as part of their state licensure to have such emergency plans, notes Warren Hebert with the HomeCare Association of Louisiana. In the days prior to Gustav, agencies were contacting patients to implement their individual emergency plans and reporting patients who needed help evacuating to local governments, He-bert tells Eli.

Oxygen: In the same time period, home oxygen suppliers worked to ensure that any patients in need of care as the storm hit were "quickly located, identified and provided the equipment, supplies and services they require to maintain their therapy throughout the duration of the crisis," says the Council for Quality Respiratory Care, a coalition of the biggest oxygen companies.

Oxygen providers across the state completed their delivery routes and were supplied extra carts of cylinders for emergency use in advance of the storm, CQRC says. Providers set up phones to remotely route to other areas with service.

"We have addressed emergency plans in each location and have contacted high acuity patients to make sure they are safe and understand their own evacuation plans," Andy Ingram, Apria Healthcare's vice president of operations for the Mid South Region, said in the CQRC release. Apria also informed patients of other locations around the region and explained to them that it had set up at least 12 depots in local towns where they could come by and get supplies, if needed.

Electricity outages are hard on oxygen patients, who require power for their concentrators, the Council maintains.

Hospice: Four of the United States' 15 deaths attributed to Gustav occurred with hospice patients who died while waiting to evacuate, Rich-ard Zuschlag, chairman and CEO of Acadian Am-bulance, told CNN.

Home care providers' emergency plans have been implemented much more smoothly this time around, thanks to equally good preparation on the part of the federal and state government, as well as patients, Hebert judges. Those are lessons learned from Katrina and Rita.

Publicly traded home care chains Amedisys Inc. and LHC Group Inc., both headquartered in Louisiana, report minimal business disruption due to the storm.

But providers still face many challenges post-Gustav. First is knocked-out communications, Hebert says. Phone landlines are down in affected areas and cell phones can be difficult to use due to heavy volume. That's despite the extra mobile cell phone towers companies have brought in to assist with the load, he notes.

After the storm, 12 Amedisys locations along the Gulf Coast were either without power or experiencing network communication problems, the Baton Rouge-based company said. Amedisys was working with local energy and telecom companies to address the issues at these locations.

Fuel crisis: Gasoline shortages will also likely emerge as a problem for visiting staff, Hebert predicts. The industry has asked to be put on the priority list for gas and agencies are hopeful they will have better access.

At press time, HCLA was still working on contacting its members in the path of the storm and assessing their situations, Hebert said. The trade group plans to start a forum on its Web site where providers can exchange information and needs.

The Department of Health and Human Services, the Centers for Medicare & Medicaid Services and the Medicare intermediaries have been quick to react to Gustav. HHS Secretary Mike Leavitt declared a public health emergency in the areas in Louisiana, Mississippi, Texas and Alabama impacted by Hurricane Gustav.

That declaration allowed CMS' emergency measures to kick in, which relax some Medicare rules and requirements. Particularly, CMS expanded "the definition of 'home' to allow those Medicare beneficiaries who are receiving home health services to receive those services in alternative sites," the agency notes in a release.

"Also, CMS will be working with the Federal Emergency Management Agency to manage lost, stolen, or abandoned durable medical equipment," the release adds.

CMS issued a list of survey and certification frequently asked questions that includes a section for HHAs. Most of the questions address the OASIS exceptions allowed under the emergency. They include filling out abbreviated OASIS assessments for start and resumption of care and skipping assessments for discharge and transfer.

But "HHAs should maintain adequate documentation to support provision of care and payment," the FAQs warn. And only agencies and patients in the affected areas are eligible for the regulatory relief.

No excuse: CMS isn't sympathetic if your software provider is located in the emergency area. You should use HAVEN as a back-up, CMS directs.

Surveyors got a heads up to the relaxed requirements in a Sept. 2 memo (08-33).

Regional home health intermediary Cahaba GBA sent out an email to providers outlining its operations during a storm. For example, it would hold electronic fund transfers if the receiving bank was out of power and unable to receive them, the RHHI says. "The transaction would be held and retransmitted on a regular basis, per the sending institution's procedures," Cahaba says.

RHHI Palmetto GBA contacted HCLA by phone before the storm to let the trade group know they were monitoring the storm and its impact, Hebert reports.

Note: CMS' emergency info is at www.cms.hhs.gov/SurveyCertEmergPrep/04_Resources.asp. Medical Review