The impact of record hurricanes Harvey and Irma have generated a lot of focus on emergency preparedness in healthcare. There have been countless articles whether it be by Becker’s Hospital Review, local media sources, KHN, or the recent article by Sheri Fink and Neil Reisner in the New York Times inspecting the level of preparedness and ability to endure a disaster.

There has been speculation on whether or not the new CMS Emergency Preparedness Rules are driving the right actions for healthcare preparedness and in all honesty, it is too soon to tell. Let’s break down a couple of key points.

Timing and Scope-

While the regulatory and accreditation community has been slowly building standards and CoPs for literally the last decade, that has mainly only applied to hospitals. The other 16 provider types have had inconsistent standards by state and accrediting bodies and really only had consistent direction since Fall of 2016. In all honesty, effective comprehensive emergency preparedness programs are not developed in just one year, they evolve over years of consistent process improvement.

HVAC and Emergency Power-

A lot of focus has been placed on the Long Term Care facilities (Skilled Nursing, Nursing Homes, etc) and what systems are powered by the emergency generator. As the NY Times article illustrated there is a fair amount of vagueness around how providers should provide critical functions. This is not a new tactic for CMS or Joint Commission, those agencies typically say providers have to meet certain standards and how you exactly do it is up to the provider. This is evident in the CoP Language:

§483.73 Emergency preparedness:

The LTC facility must comply with…(b) (1) The provision of subsistence needs for staff and residents, whether they evacuate or shelter in place, include, but are not limited to the following: (ii) Alternate sources of energy to maintain (A) Temperatures to protect resident health and safety and for the safe and sanitary storage of provisions;

This language is consistent throughout the CoPs and is not unique to LTCs affecting various residential facilities.

While LTCs are called out in this event it is not unusual to find hospitals that have not fully powered their HVAC systems as well and lack of HVAC is a root cause of evacuation.

Evaluation and Deadlines-

Finally, the deadline for compliance with the new rules is November 15th, and as I talk and work with diligent non-hospital providers they are struggling to meet this date. Even after that providers, the level of scrutiny by surveyors is uncertain as identified in a recent Kaiser Health News article. Additionally, surveyors are typically generalists and not necessarily experts in emergency preparedness and their online training on how to evaluate providers on compliance with the CMS Emergency Preparedness rule was published this summer.

As I have stated before these are not one-dimensional issues and in a majority of the affected 17 provider types there is not a dedicated individual eating and sleeping emergency preparedness. This along with funding streams being cut on top of already thin margins lend to slow forward progress, but we are still seeing forward progress, for example, “In Houston, Most Hospitals [are], ‘Up and Fully Functional’” post-Harvey. Many hospitals (and accreditation organizations like The Joint Commission) have learned from events Katrina, Sand, Joplin Tornadoes, and several others but it has taken years to develop into resilient organizations.

Unfortunately, we are probably a year or two away from seeing the true impact of the CMS Emergency Preparedness Rule in the extended provider community.


Crisis Focus, LLC has focused expertise in healthcare emergency management, including CMS compliance. Please visit Crisis Focus’ CMS Emergency Preparedness resource page or contact us for more information.

An earlier version of this post originally appeared on Jody Moore’s LinkedIn Account and is cross-posted here as a resource.