Medical Surge Capacity Planning: A National Perspective

Jeanne S. Ringel, PhD

June 8, 2008

The Need for Medical Surge Capacity in a Pandemic Will Be Substantial, Even Under a Moderate Scenario

  Pandemic Severity

  Moderate Severe

Hospitalizations 865,000 9,900,000

ICU Care 128,750 1,485,000

Mechanical ventilation 64,875 745,500

Source: Pandemicflu.gov

Many Different Stakeholders Are Involved in Surge Capacity Planning & Implementation

MedicalSurge

Capacity

VeteransAdministration

Public & Private

Hospitals

State HealthDepartments

NongovernmentalOrganizations

HHS

Nursing Homes

Clinics &IndividualProviders

NongovernmentalOrganizationsLocal HealthDepartments

HomeHealth Care

Roles & Responsibilities are Complicated by the Structure of the Health Care & Public Health Systems

MedicalSurge

Capacity

VeteransAdministration

Public & Private

Hospitals

State HealthDepartments

NongovernmentalOrganizations

HHS

Nursing Homes

Clinics &IndividualProviders

NongovernmentalOrganizationsLocal HealthDepartments

HomeHealth Care

We Focused on the Federal Role, Specifically HHS

MedicalSurge

Capacity

VeteransAdministration

Public & Private

Hospitals

State HealthDepartments

NongovernmentalOrganizations

HHS

Nursing Homes

Clinics &IndividualProviders

NongovernmentalOrganizationsLocal HealthDepartments

HomeHealth Care

Outline

• Approach

• Conceptual Framework

• Findings

• Conclusions

Outline

• Approach

• Conceptual Framework

• Findings

• Conclusions

Approach

• Conducted a review of surge capacity literature

• Reviewed Homeland Security Council requirements and HHS Pandemic Planning Updates

• Developed a conceptual framework

• Interviewed key informants within HHS on Federal surge capacity planning

– 9 interviews

– HHS ASPR, CDC, CMS

• Synthesized qualitative data

Conceptual Framework Helps Identify & Organize Resources Needed for Surge Capacity

Hospital Care

Non-Hospital Care•Clinics

•Nursing Homes•Home Health Care

•Alternative Site

SuppliesStaff Structures Policies SuppliesStaff Structures Policies

Medical Surge Capacity

Federal Government Can Support Medical Surge in Many Ways

• Facilitating planning at state and local levels– Develop guidance– Provide detailed, scalable plan templates– Provide technical assistance– Identify and disseminate exemplary practices– Make necessary policy decisions– Set standards and monitor performance– Provide funding

• Deploying Federal assets– National Disaster Medical System– Strategic National Stockpile– VA and DoD health care facilities– Volunteer registration & coordination

Outline

• Approach

• Conceptual Framework

• Findings

• Conclusions

Lack of Vision and Stated Goal at the Federal Levelis a Major Barrier to Medical Surge Planning

• There is consensus that there is no vision or articulated goal for the country’s medical surge planning

– Concrete targets for surge capacity and mass care are not widely known

– Stated goal is 500 beds per million people• Hospital centric, does not address broader needs• “Ability to care for XX% of population” might be better

• Lack of vision and stated goal creates problems– Hinders planning at all levels– Feeds misconception that federal resources will assist in

extreme surge event (e.g., severe pandemic), even though this unlikely because resources are insufficient

Various Other Issues Noted as Barriers to Planning at the State and Local Level

• Hospital preparedness funding focused at the facility rather than the state level

• No information from CMS on reimbursement rules in a surge situation

– E.g., Alternate care sites, volunteer providers

• AHRQ tools are rarely tied to/mentioned in guidance, which decreases their utilization

– FluSurge, FluAid, FluWorkLoss

Procurement of Non-Vaccine Materiel Has Not Been a Priority

• Currently available supplies (ventilators, masks, respirators) are inadequate

– BARDA funding for these uncertain

• SNS does not have numeric or temporal targets for pandemic-related materiel, such as antibiotics (including for MRSA) and ventilators

– Purchases delayed or have not occurred– More modeling needed to inform decisions

• States ability to seize private supplies disincentivizes private stockpiling efforts

Outline

• Approach

• Conceptual Framework

• Findings

• Conclusions

Federal Government Needs to Take the Lead in Developing Medical Surge Capacity

• Develop, articulate, and disseminate a clear vision and goal for medical surge capacity

• Develop a comprehensive strategy for reaching the goal– Include relevant stakeholders– Assign roles & responsibilities– Develop benchmarks, milestones, and system for

monitoring progress