Expecting the Unexpected
By Sean Price Texas Medicine December 2017

Anything From a Simple Power Outage to a Category 5 Hurricane Can Shut Down a Medical Practice. How Can Physicians Make That Shutdown as Temporary as Possible?

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Practice Management Feature — December 2017

Tex Med. 2017;113(12):31–35.

By Sean Price
Reporter 

By any measure, the staff of Esteban Berberian, MD, made the best of a bad situation after Hurricane Harvey. Their internal medicine office at the East Houston Regional Medical Center flooded up to seven feet in places. Nevertheless, the staff ― thanks to a lot of hard work and improvisation ― moved the practice to another building quickly. Dr. Berberian was seeing patients within a week. (See "A Flood of Problems," November 2017 Texas Medicine, pages 22–35.) 

Mark Owens, Dr. Berberian's practice manager, is proud of that achievement. But he says the flooding also taught a few lessons about how to handle future emergencies. For instance, the lease at the flooded building has some restrictions that may pose problems for the practice down the road. The main tenant in the old building was the medical center ― a major business draw for Dr. Berberian. Given the damage done, though, the hospital might be closed for a long time. Yet Dr. Berberian's lease might force him to return sooner.

"We were in a hospital complex, and even though the hospital may [be gone for an extended period], there's no clause in there that will allow us out of that lease," Mr. Owens said. "It's very lender-friendly. And it's something we just even didn't think about. It was just business as usual ― we wanted to be here for three years. But you don't think of the disaster beforehand."

Emergencies like hurricanes, tornadoes, fires, and floods understandably get physicians thinking about how to respond. Yet many physicians either don't plan comprehensively or don't update their contingency plans regularly enough, says Alan Atwood, Texas Medical Association's associate vice president for technology and information systems. 

"You need to make sure you're ready for every type of potential disaster, not just natural," Mr. Atwood said. "If you get ransomware, that's a disaster. You just have to handle it a little bit differently."

When it comes to emergency preparation, you need to consider insurance coverage, site location and maintenance, and data protection. Here are some suggestions about the most important concerns tied to each. 

Insurance

Many types of insurance can come into play after a disaster, but the most likely one is business interruption insurance. As the name implies, it helps physicians recover if some sort of natural or human-made disaster shuts down business for a while. 

"There are a couple of different types," says Ben Archer, an insurance agent at State Farm in Austin. "One can help pay the overhead while the business is not running, and one can pay the profits of the business while it's not running. It's quite important to have both of those coverages."

Mr. Owens, the practice manager for Dr. Berberian, says it's important to read the fine print in any type of insurance policy. He says the office's business interruption insurance may not cover this event because the damage was caused by flooding, and the language on that is ambiguous. 

"I came in as manager after that policy had been signed and never even thought to look at it because I just assumed it was there," Mr. Owens said. "Any time you have a change in management or bring on another physician, you definitely want to make sure your paperwork's in order."

Mr. Archer goes even further. He says physicians should review their insurance coverage once a year.

"Just like it's important for me to go to an annual checkup with the doctor, the doctors needs to go to their insurance person ― or their financial adviser ― and review the coverages they have," he said. (See "TMAIT Can Help Assess Your Insurance Needs.") 

Spoilage insurance is also important for most physicians because they frequently store valuable medications, Mr. Archer says.

"And so they just got a new shipment of flu vaccines at whatever cost, and then the lights go out for three weeks and the medicine is all destroyed," Mr. Archer said. "That may or may not be covered by their base policy."

Ideally, Mr. Archer says, physicians should keep receipts for all their major equipment ― and store those receipts safely off site. But often that's not practical. So physicians should once a year walk through their practice with a cellphone and take video of all the equipment, art, and furniture. 

"That way, when we're sitting down with the claim rep and you've forgotten the artwork that cost a lot of money … you can say, 'I haven't got artwork now.'" Mr. Archer sad. "The video can be invaluable to you."

Site Location and Maintenance

No medical practice wants to change locations abruptly. But when a disaster forces your hand, it pays to have friends.

Dr. Berberian had no choice but to leave his old offices after they were bathed in seven feet of water from Hurricane Harvey. The practice had to be uprooted. But where to go?

The answer came from fellow physicians who knew about available office space. They helped Dr. Berberian find a new office that has worked out well as a temporary location. 

Surprisingly small things made life difficult during the transition from the flooded office to the new one, Mr. Owens says. For instance, all the practice's business contact information was stored in electronic form on the office computers. For about five days ― while the office was flooded and in the immediate aftermath ― those phone numbers and email addresses were impossible to reach.

Mr. Owens says just having a consolidated list of vendors and other business contacts ― either on paper or stored in the cloud ― would have made things easier.

"Take our appointment reminder service," he said. "If I'd had their contact information, I could have reached out to them to let them know what was going on, when we're opening, where we were at. But you just put everything into the electronic format, and when you lose [access to] all that, you need to have a backup."

Michael Stern is an Austin attorney who has written for TMA on legal issues that affect moving and closing offices. He says changing locations is not just a logistical challenge ― it can also have legal ramifications. For instance, he says, managed care contracts are often credentialed to a physician at a specific location. 

"If [a physician] wants to expand [to another office], they have to get additional location credentials," he said. "I don't think there would be a problem if they 'bunked' at another location [during an emergency], but they would need to check to make sure they will get paid if they offer services at another location."

Some practices making emergency preparations also need to envision what the post-emergency world will look like, Mr. Atwood says. For instance, in the case of storms, flooding, or fires, the practice might need its own backup generator. 

"Otherwise, you may not have power to run your own equipment," he said.

He says many practices can forego that kind of preparation, but others might be crippled if they can't get the lights on right away.

"You need to determine [ahead of time] how long you can be down," he said. 

Data Protection

Physicians generally understand that the most important things to save in an emergency are patient and business records. What they may not know is how to go about that.

Mr. Atwood, the TMA associate vice president for technology and information systems, says each physician's office is unique. Those still relying on hard-copy records are most vulnerable to problems like fire or flood. Most now have electronic systems of some kind, and they are potentially vulnerable to problems like ransomware. Whatever the system, redundancy is vital. 

"Minimally speaking … you need to make sure you've got a secure backup of that information," he said. "That's step one. And if you're talking about hurricanes and fires, you don't want that backup sitting in the same room as the system because it burns or floods right along with the [original] system if it's in the same place."

Mr. Atwood says it's vital to make a contingency plan, like the kind called for by the National Institute of Standards and Technology. (See "Making Contingency Plans.") A contingency plan will naturally involve information technology matters as well as communications and infrastructure. 

"A contingency plan covers a lot," he said. "And if you're doing it right, you're testing your system, training your folks, and you have exercises planned on a regular basis to make sure in a time of non-disaster that you give yourself a scenario and see if the plan works."

Mr. Owens, Dr. Berberian's office manager, agrees that a plan is important. But he says practically speaking, even the best plans might not hold up in an emergency.

For instance, he says one of the key things his office did right before Harvey was put the computers eight feet above the floor in preparation for a flood. This kept them above the seven-foot flood waters. The computers were already backed up on the cloud, so their data could have been retrieved even if the computers had gotten wet. But having the computers safe and dry afterword made recovery from the hurricane faster and easier. 

Even so, Mr. Owens almost didn't take that precaution. 

"With hurricanes in this part of Texas, there are a lot of false alarms," he said. "When I was putting the computers above my head, I was thinking 'This is going to stink on Monday having to pull all these back down. It's probably not even going to flood, right?'"

Mr. Atwood agrees that even the best plans have flaws, but they are far better than having no plan at all ― especially when the alternative is the crippling loss of patient records.

"What it comes down to is planning in advance so that you're not scrambling," he said. "If you'll put the effort into putting the plans together and training people about what the plans are, then generally you're going to be OK."

Sean Price can be reached by phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email

SIDEBAR 

TMA Working for Affected Members

Many Texas practices are still recovering from the shock of Hurricane Harvey. TMA is offering discounted consulting services for practices working to restart. For hands-on assistance, email TMA Practice Consulting or call (800) 523-8776. More information on Hurricane Harvey recovery can be found in TMA's Disaster Preparedness & Response Resource Center.

SIDEBAR

TMAIT Can Help Assess Your Insurance Needs

Physicians should review their insurance coverage at least once a year to make sure it is comprehensive and up to date. Call (800) 880-8181 to schedule a free consultation.

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SIDEBAR 

Making Contingency Plans

The National Institute of Standards and Technology (NIST) of the U.S. Department of Commerce offers several tools that can help physicians who are preparing their offices for future emergencies.  

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SIDEBAR 

Share Your Story With TMA

Has your office ever been affected by some sort of disaster, either natural or human-made? Share your story ― and what you learned from it ― with other TMA members. Email your experience for consideration in an upcoming issue of Texas Medicine.

December 2017 Texas Medicine Contents
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Last Updated On

July 09, 2018

Sean Price

Reporter

(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

More stories by Sean Price