One econ major, three opinions

If you have not been in Sandy or a similar event, or if you have been and you’re responding to your subclinical case of post-traumatic stress disorder (PTSD) by convincing yourself that you’re bored with the topic, then, of course, you’re sick to death of articles about how some frail, elderly people are still stuck in dark, cold, powerless highrises because of Sandy.

Maybe you can muster a little more outrage about The New York Times story about the nursing home that allegedly failed to stock up on emergency food, let its emergency generators go out, then lost track of some of the patients when it finally dumped them in emergency shelters.

I honestly thought I was posting some noble but not necessarily very relevant filler in September when I put up Will LTC Providers Keep Your Clients Safe from Disasters?, an article about a government report on how U.S. nursing homes and the rest of the U.S. acute health care and long-term care (LTC) systems might not be very well prepared for big natural disasters.

Then Sandy hit and made some nursing homes look pretty terrible.

Sandy also has affected New York City hospitals — hospitals that should, in theory, have been hardened by what they went through after the Sept. 11, 2001, terrorist attacks and by years of World War III-oriented disaster planning — so badly that Lower Manhattan still has only one fully functional general acute care hospital.

For me, this got to be a personal matter when I went to walk food and water up to seniors stranded in a highrise that functions as a de facto assisted living facility and found that, a week after the storm, no one had thought to evacuate them, or make official efforts to get food and water to them.

The Center for Studying Health System Change (HSC) has tried to supplement the awful anecdotes with data in a new report on emergency preparedness.

One problem is that resources are limited and health care systems are fragmented, but another problem is that important players, such as “primary care clinicians and nursing homes” typically do not participate in emergency-preparedness coalitions, the HSC researchers said in the report.

When, for example, researchers were trying to figure out how independent physicians might help fight a flu pandemic, “both hospital and community practice respondents acknowledged a sense of alienation from each other,” the researchers said.

“According to respondents, state and local medical societies generally have not played an important role to date in helping small practices to collaborate with each other or other stakeholders,” the researchers said. “Most primary care respondents agreed that physicians are focused mainly on their patients’ day-to-day needs and do not see preparedness as part of their mission.”

To be really blunt, if you’re at a health insurer or LTC insurer, or you’re a producer that works with such carriers, Why aren’t the insurers being “mean” when I’d really like them to be mean?

Why, really, do the carriers pay claims to doctors, nursing homes, hospitals or other care providers that aren’t serious about emergency preparedness?

Some health insurers have announced that they won’t pay claims when, say, surgeons operate on the wrong limb or are responsible for other “never events.”

On the one hand: A failure to have a disaster plan isn’t a never event, there’s no guarantee a disaster plan will work, and providers face terrible, growing pressure.

On the other hand: Making sure that there are a lot of flashlights around, or preparing for an orderly evacuation of a hospital or nursing home when a hurricane comes around, doesn’t seem to be that much to expect.

On the third hand: Why bother? The next disaster will probably affect someone else’s clients (and relatives), not yours. (Probably.)

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