While Ebola has faded from the head­lines, cost of pre­pared­ness still weighs on hos­pi­tals

Modern Healthcare - - COMMENT - By Ken­neth Raske

In to­day’s 24/7 media cy­cle, yesterday’s news quickly fades as the press moves on to the next story. But some­times those for­got­ten sto­ries leave be­hind im­por­tant un­re­solved is­sues.

That’s cer­tainly the case with Ebola, and for Amer­ica’s hos­pi­tals, the un­re­solved is­sue is the lack of fed­eral fund­ing for the mil­lions they’ve spent on Ebola pre­pared­ness.

Ebola dom­i­nated the head­lines last fall, spread­ing fear and un­cer­tainty across the na­tion. In New York, the Greater New York Hos­pi­tal As­so­ci­a­tion and the healthcare work­ers’ union 1199SEIU held an Ebola ed­u­ca­tional ses­sion in Oc­to­ber at the Jav­its Cen­ter that was at­tended by of­fi­cials from the Cen­ters for Dis­ease Con­trol and Preven­tion and more than 5,000 healthcare work­ers and hos­pi­tal ex­ec­u­tives.

Dur­ing that anx­ious time, a Stan­ford Univer­sity in­fec­tious-dis­ease pro­fes­sor said that, “It is quite pos­si­ble that ev­ery ma­jor city will see at least a hand­ful of Ebola cases.” That didn’t hap­pen, but two days af­ter the Jav­its event, Doc­tors With­out Borders vol­un­teer Dr. Craig Spencer was rushed to Belle­vue Hos­pi­tal, where he tested pos­i­tive for Ebola.

The out­stand­ing treat­ment Spencer re­ceived at Belle­vue taught us that car­ing for Ebola pa­tients in real time is ex­tremely costly and re­quires as many as 150 work­ers for a sin­gle pa­tient. We also learned that even the best-pre­pared in­sti­tu­tions can treat only a very small num­ber of Ebola pa­tients at any one time.

While the GNYHA and its mem­bers co­or­di­nated their Ebola-re­lated ac­tiv­i­ties with the New York City and New York State health de­part­ments, the fed­eral gov­ern­ment re­peat­edly urged hos­pi­tals to do ev­ery­thing pos­si­ble to pre­pare for re­ceiv­ing a sus­pect or con­firmed Ebola pa­tient. Con­sid­er­ing the fed­eral gov­ern­ment no less a part­ner than the city and state, New York’s hos­pi­tals—par­tic­u­larly the 11 in­sti­tu­tions that stepped for­ward to be­come des­ig­nated Ebola treat­ment cen­ters— an­swered the call.

Ac­cord­ing to a GNYHA sur­vey, New York’s Ebola treat­ment cen­ters have al­ready spent more than $42 mil­lion to stand ready, to­day and in the fu­ture, to treat Ebola and other in­fec­tious dis­eases. These ex­penses in­clude cre­at­ing the in­fra­struc­ture to be a des­ig­nated cen­ter, se­cur­ing per­sonal pro­tec­tive equip­ment and train­ing large num­bers of staff. They did these things be­cause that is what hos­pi­tals do, but they were also re­spond­ing to ur­gent ap­peals from the CDC, and with the im­plicit un­der­stand­ing that the fed­eral gov­ern­ment would help them cover their size­able Ebo­lare­lated ex­pen­di­tures.

In De­cem­ber, thanks largely to the lead­er­ship of Sen. Chuck Schumer (D-N.Y.), Congress ap­pro­pri­ated $576 mil­lion to HHS’ Of­fice of the As­sis­tant Sec­re­tary for Pre­pared­ness and Re­sponse (ASPR) for Ebola re­sponse and pre­pared­ness ac­tiv­i­ties. It was a promis­ing de­vel­op­ment.

But of that to­tal, New York’s Ebola treat­ment cen­ters (ex­clud­ing Belle­vue) are slated to re­ceive only $100,000 a year per cen­ter, an amount to­tally in­ad­e­quate to main­tain their on­go­ing readi­ness. Equally trou­bling, ASPR has yet to al­lo­cate $340 mil­lion of that $576 mil­lion. Mean­while, the Ebola spend­ing short­fall for New York’s Ebola cen­ters to date is at least $36 mil­lion, and as much as $2 mil­lion an­nu­ally for the on­go­ing readi­ness of some down­state cen­ters.

This is not what Congress in­tended. The fed­eral gov­ern­ment has an obli­ga­tion to­ward hos­pi­tals when there is a healthcare cri­sis. It’s an im­plicit part­ner­ship that car­ries an ex­pec­ta­tion that hos­pi­tals will re­ceive fund­ing for their no-ques­tions-asked re­sponse to emer­gen­cies—es­pe­cially when Washington has im­plored them to do so.

And make no mis­take, the need for fed­eral fund­ing to help hos­pi­tals pre­pare for Ebola is far from a New York-only is­sue. Hos­pi­tals in ev­ery part of the coun­try have ac­tively pre­pared to re­ceive a sus­pect Ebola pa­tient. As Dal­las can at­test, an Ebola pa­tient can show up any­where.

When the next healthcare cri­sis ar­rives—and there’s al­ways a next time—will the fed­eral gov­ern­ment be a gen­uine part­ner that will treat hos­pi­tals fairly?

By en­sur­ing right now that des­ig­nated Ebola cen­ters—in New York and across the na­tion—have the nec­es­sary Ebola-pre­pared­ness re­sources, Washington will not only en­cour­age the en­tire hos­pi­tal com­mu­nity to main­tain its readi­ness and rapidly re­spond to the next healthcare emer­gency, but also live up to its end of a deeply im­por­tant part­ner­ship.

Ken­neth Raske is pres­i­dent of the Greater New York Hos­pi­tal As­so­ci­a­tion.

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