Aftermath of Florence Raises Concerns as Floodwaters Recede

By
Original story posted on: October 3, 2018

  • Product Headline: RACmonitor Compliance Webcasts Subscription
  • Product Image: Product Image
  • Product Description:

    Compliance Education for Every Department at Your Facility

Medicaid beneficiaries appear to be vulnerable following Hurricane Florence.

The wildfires in California, as well as Hurricanes Harvey, Maria, and now Florence demonstrate and present new challenges. The intensity of the wildfires and the incredible rainfall brought far worse risks to life, property, and recovery than prior natural disasters would historically indicate. People were caught off-guard.

Experts have suggested that this level of destruction is the “new normal,” brought on by prolonged drought and warmer oceans.

What are the implications if this is new normal? New questions arise: how long will it take to rebuild? What about my job, my business? What about my health coverage? Will the safety net, which includes Medicaid, be there for me if I lose these things? The story of society’s most vulnerable gets little attention, but in this case, it must. I fear that this story ultimately will involve many, many more people.

After Harvey, the Texas Gulf Coast instantaneously lost 27,000 jobs. According to the Federal Emergency Management Agency (FEMA), more than 40 percent of smaller businesses never reopen after a disaster, almost entirely because of lack of financing. Health insurance coverage is an early casualty. Providers with reduced revenues, even if temporarily, feel exacerbated pressures from unreimbursed care, especially in non-Medicaid expansion states. Not my words, but from providers.

After Harvey, payers announced temporary relief to help mitigate some revenue flow disruptions. Blue Cross announced plans to do the same in the aftermath of Florence. But this doesn’t pay the insurance premiums or address the resulting lapses in coverage. Will there be a safety net, i.e. Medicaid?

The immediate solution for many: getting healthcare in the ED.

Some call this a public health crisis. But I predict very soon, this will become a population health management challenge. Instead of congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), we will be increasingly addressing the effects of loss of the basics for a prolonged period. Will this type of population health management become commonplace?

What will it look like if it does? How will the response be made sustainable?

Financing is becoming available for population health, including homelessness, in some states for the Medicaid population, but these programs are still in their infancies. The future becomes unclear if federal dollars decrease.

To affect a safe discharge, many providers feel pressure to assist with a supply of medications, plus finding solutions of where to call home and how to provide meals, and seasonally appropriate clothing. It becomes an all-encompassing task for social workers in EDs, and in acute settings, it’s mostly unfunded. What if those patients do not qualify for Medicaid in their states? EDs have already seen a leap in non-emergency presentations, such as the elderly or chronically ill, with no place to go, no one to care for them, and no payor.

This discussion needs to take place. Florence continues to be horrendous. Can communities absorb the massive losses? Look at the lingering effects of Katrina and Maria. If history means anything, healthcare providers will be called up to be part of the plan. What are our disaster plans to manage these lingering, possibly permanent issues for those to who look to us for help in sustainable ways?  

That’s something for future discussions.

 

Comment on this article

Marvin D Mitchell, RN, BSN, MBA

Marvin D. Mitchell, RN, BSN, MBA, is the director of case management and social work at San Gorgonio Memorial Hospital, east of Los Angeles. Building programs from the ground up has been his passion in every venue where case management is practiced. Mitchell is a member of the RACmonitor editorial board and makes frequent appearances on Monitor Mondays.

This email address is being protected from spambots. You need JavaScript enabled to view it.

Related Articles

  • New Payment Models from CMS Target Kidney Disease and Radiation Therapy
    President Trump issues an executive order on kidney disease and a new payment model for radiation therapy. As reported by Dr. Ronald Hirsch on the RACmonitor.com Monitor Mondays webcast, last week the president issued an executive order on kidney disease.…
  • News Alert: CMS Proposing to Cover Acupuncture
    Coverage would include those suffering from chronic lower back pain who are also enrolled in approved studies. The Centers for Medicare & Medicaid Services (CMS) is proposing to cover acupuncture for Medicare patients who suffer from chronic lower back pain…
  • Supreme Court Decides on Judicial Deference to Agency Interpretations of Regulations
    Swing vote by Chief Justice John Roberts reflects his support of judicial precedent. On June 26 the U.S. Supreme Court issued a decision (https://www.supremecourt.gov/opinions/18pdf/18-15_9p6b.pdf)  on how courts should handle ambiguous government regulations.  Many people, including me, expected that the case…