On August 29, 2005, Hurricane Katrina invaded the Gulf Coast, with New Orleans at the center of the storm. Not long after, the city was . There was a mandatory evacuation, and everyone -- doctors and hospital staff included -- was forced to leave. We were not able to return to the city for several months. My practice was significantly impacted. Since I had a lot of time, I wrote a book, , which discusses the lessons I learned from the disaster and the preparation practices one should take before a catastrophe occurs.
I have watched the recent news about the wildfires in Los Angeles and saw that many Angelenos were given short notice to evacuate ahead of the fires. Many, including physicians, were left with only the clothing on their backs.
To help medical practices nationwide prepare for future crises, this blog offers guidelines and suggestions to put a plan in place before a disaster occurs. Any disaster planning may seem the work of pessimists; however, in the aftermath of 9/11 and Hurricane Katrina, and with increasing environmental threats, every medical practice must have the necessary plans to guide its activities in the context of unforeseen events. An effective disaster plan has checklists that should be regularly reviewed before a disaster arrives. Under any circumstance, practices need to ensure their employees' safety and continue providing care for their patients even when they cannot access the office or hospital.
The Components of a Disaster Plan
Creating a disaster plan involves the entire staff. Begin by assigning parts of the plan to each staff member and encouraging them to research their assignment.
The doctor and the bean counters need to conduct a risk assessment. This consists of predicting the revenue loss associated with various levels of disaster. It also includes understanding how a break in business continuity will affect your relationships with patients and referring doctors.
Planning also requires maintaining essential contact information. For example, a list of employees' telephone numbers and e-mail addresses should be stored at an off-site location, such as at the doctors' or office managers' homes, in a bank box, or online. A current list of vendors, business associates, utility companies, and insurance company contact information is critical too.
Up-to-date contact information can help your practice maintain communication with employees. They should be kept appraised of the status of the practice, and informed when they are expected to return to work and if the practice has changed locations. I also suggest a call order or hierarchy so that employees who are most essential are contacted first. Copies of this list should be distributed to physicians, office managers, and other key employees.
A phone chain or phone tree can instruct who calls whom. You might even consider testing the phone tree one evening to see that everyone is going to be informed of the situation. The key components of the employee contact list include:
- Name of employee
- Position
- Key responsibilities
- Cell phone, home phone numbers
- Emergency contact numbers, relationship to the employee
- Email address
- Home address including street, city, zip code
It is also imperative to have a vendor list, which includes the following information:
- Name of vendor
- Product or service provided
- Address and email address
- Contact person's name
- Name and phone number(s) of the company responsible for the service or device
- Copies of service contracts for equipment in the office
Maintaining other business information is also essential for the survival of the practice. A good "continuity of operations" checklist includes:
- Insurance policies (name of company, the number of policies, memo of riders, proof of current premium payments)
- Tax records for the past 3 years
- Financial statements
- Aged accounts receivables
- Bank account information
- Real estate ownership records (location of deed, purchase, and building costs)
- Licenses (state, county)
- Organization documents, such as articles of incorporation
- Malpractice documents
- Partnership agreements, office lease
- Building plans and construction permits (should you be required to rebuild the brick and mortar facility)
- Employee manual
- Inventory of office equipment (consider a video inventory of office furnishings and equipment)
- Patient records from the electronic health record
Related to that last bullet point, we cannot forget about our patients: it's vital to backup patient data. This backup plan can be electronic and store the data in the cloud. If your practice takes that approach, you must have several cloud backup sites in case the disaster impacts the data stored at one of the sites.
The patient information checklist includes:
- Patient's name
- Address
- Contact person's name
- Contact phone numbers
- Alternate names and numbers for the patient
- E-mail address
- Date of next appointment
- How the patient can access their records if they must see another physician/practice
- Recent diagnoses and medications
To notify patients as to how the crisis is impacting the office or hospital, you could: Post a message on the practice's website; email patients; or record an update on the answering machine. This must be done immediately after the disaster.
The plan becomes a work in progress and must be reviewed and updated annually. Certainly, the most difficult aspect is getting your disaster plan started. The next step is keeping it current and up to date. A plan that is several years old will probably not be effective, as phone numbers, employees, and circumstances have changed.
Don't have business interruption insurance? Consider getting it. Business interruption insurance -- also known as business income protection, profit protection, or out-of-business coverage -- will provide funds to make up the difference between your normal income and income during a forced shutdown after a disaster. Often, curtailed revenue and patients establishing relationships with other physicians or practices in the immediate aftermath can lead to a medical practice being forced to close permanently. Business interruption insurance can be vital to long-term survival. (Note, this blog is not intended to cover all the components of insurance needed for a disaster plan. Other types of insurance may also be useful for your practice.)
Finally, one of the lessons I learned after Katrina was the importance of a plan regarding medications used in the office. The medications that required refrigeration or expired became worthless and were not replaced by pharmaceutical companies. Your disaster plan should include a provision that all medications from the office -- especially expensive medications that require refrigeration, and medications with abuse potential -- should be transported in a refrigerated container and kept refrigerated until you can return to the office.
Hope for the Best, Plan for the Worst
Bottom line: the probability of a catastrophic disaster impacting your practice is low. A disaster plan, however, is like liability insurance -- it provides comfort in knowing that if a major catastrophe occurs, your practice will not be in financial ruins. There is no way to completely bulletproof your practice from a disaster; however, you can lessen the impact, losses, and heartache if you have a written disaster plan. Be sure to have a plan in place long before you need it. You hopefully will never need to use the plan, but you will have peace of mind and be prepared to weather any storm.
Neil Baum, MD, is a urologist in New Orleans, the corporate medical officer of , adjunct professor at the Tulane University School of Medicine in New Orleans, and the author of .