EyeNet Magazine

Practice Perfect: Compliance & Risk Management
Flood, Quake or Fire: How to Bounce Back From Disaster
By Miriam Karmel, Contributing Writer

Disaster happens. Just ask Neil F. Notaroberto, MD. After Hurricane Katrina struck, the New Orleans ophthalmologist had to close up shop for nearly three weeks. When he finally reopened, about 30 percent of his established patients were gone—displaced by the storm.

Still, he said, “I’m very fortunate.” Because his two offices lie outside the floodplain, he was spared the suffering that so many colleagues endured. Many lost records due to water damage. Others still await insurance money. Some of the nearly 6,000 physicians who were initially displaced will never practice again in New Orleans. “It’s like an atom bomb went off,” said Dr. Notaroberto, a solo practitioner with offices about 45 miles apart, in Harahan and Slidell.

But fortunately the New Jersey transplant had heard enough stories about hurricanes to know that a disruptive event was inevitable. “So I made the preparations.”

Create a Plan

Preparation starts by acknowledging that disasters happen, said Carol Poindexter, JD, a partner in the National Health Law Practice Group of Shook, Hardy & Bacon LLP in Kansas City, Mo. “My concern is the It can never happen to me mentality. If you’ve never thought about what you would do in the face of a practice disruption, your chance of successfully coming out on the other end is severely impeded.”

Beverly Prudhomme, practice administrator for a midsized group ophthalmic practice with two satellite locations in the New Orleans area, agreed that “people have to play out the worst-case scenario. That’s the best thing you can do.” Her advice? Assess your individual environment. Play out your risks and create a recovery plan. Then put it in writing and share it with every staff member. “You really have to have some kind of disaster plan on paper.”

Protect Your Records

Make backups of everything on your computer: billing, scheduling, patient lists and financial data.

“We’re diligent about doing a nightly backup,” said Ms. Prudhomme. Every night at closing time, the day’s transactions are backed up on a cassette or disk for storage at a staff member’s home.

Also, she suggested that you choose a computer vendor who provides good support service. Ms. Poindexter, who agreed that the computer vendor is key, added that you should ask your vendor for advice on sending the backup to an off-site location.

Consider EMR

Ms. Prudhomme’s offices didn’t flood, but a lot of doctors lost records due to water damage. Electronic medical records can safeguard against such loss, but that’s a large investment for a small or even midsized practice. A practice like Ms. Prudhomme’s, with three full-time and two part-time physicians, would require a capital investment of $50,000 to $80,000. “That’s just upfront capital outlay.” She predicts that more and more practices, including hers, will switch to EMR. In the meantime, she said, “That’s probably our biggest area of vulnerability.”

In 1999, Dr. Notaroberto took steps to “wire” his practice. Now every transaction is done electronically, including imaging. Everything is backed up in both of his offices as well as routed over the Internet to off-site storage facilities in Georgia and California. “If there’s an earthquake in California,” he said, “I have a backup in Georgia.”

Electronic records raise security concerns, which are addressed in HIPAA’s security regulations.

Who Are You Going to Call?

If you lose access to your office, will you also lose access to the phone numbers that you need to rebuild your practice?

Every staff member should possess a list of phone numbers for everyone in the office. Consider that cell phones might not work, so include a landline number, too. And if you are concerned about a large-scale disaster, such as a hurricane, you should think about those landline locations. If employees’ homes are located in areas that also might be affected by the storm, then they should consider providing the phone number of a contact person who resides outside the storm region.

In addition to staff numbers, create a list of all the practice’s critical business partners and vendors, such as your attorney, landlord, bank, insurance agent, computer contractor and third-party billing company.

Finally, have a plan for contacting patients who have upcoming appointments.

Plan Evacuation Procedures

Prior to law school, Ms. Poindexter worked as an administrator for an ophthalmology practice that was located on an upper floor of a building in Kansas City. She recalls the day that fire alarms sounded and patients, including several in wheelchairs, had to be carried down seven flights of stairs. “We all knew how to get out of the building. But we hadn’t thought of how to evacuate the disabled.”

Ms. Poindexter advises conducting periodic mock fire or disaster drills. Have the staff go through the evacuation process and make notes of what did and didn’t work. Plan how to get patients out of the building and where you will take them. Also, create a plan for auxiliary lighting and/or assisting patients who are left in dark examining lanes during a power outage.

Ms. Poindexter recommends coordinating your evacuation plans with the building owner and fire department. Invite the fire department to walk through your office and offer fire safety and evacuation suggestions. Many fire departments will help conduct fire drills and point out ways to streamline the evacuation process.

Is Your Insurance Adequate?

An estimated 25 percent of small businesses that shut down due to a disaster never reopen, according to the Institute of Business and Home Safety. But a good insurance policy could provide the necessary funds to get your practice running again. Ms. Poindexter noted that some doctors don’t have the right type of insurance, or they don’t fully understand their policies. For example, the exclusions may not cover water or flood damage, or they cover one and not the other. Or you may need a special “rider” for natural disasters.

She suggested some areas of concern. Do you have business interruption insurance? Do you know the difference between water and flood damage, and does the policy cover each? Are you covered for earthquake damage? Do you understand your policy limitations?

Also, do you have “key man” insurance, which is intended to protect the practice should one of the physicians die unexpectedly? If so, who is the policy beneficiary? If the beneficiaries are the other shareholders, they may individually be protected, but the practice itself may be left without sufficient resources to continue operating. “Those kinds of things you really have to sit down and think through,” she said.

Beyond the Office

Despite his careful planning, Dr. Notaroberto admits that if he’d planned better, he would have thought about where his displaced employees would live. Since Katrina, he’s moved farther from the floodplain to a bigger home that has space for his employees, should the need arise. “They’re crucial,” he said, likening them to family. And your practice can’t bounce back without them.

Be Prepared

What is your worst-case scenario? Fire? Earthquake? Flood?

How you respond to a disaster will depend, in part, on your particular vulnerabilities. Practice size matters, too. A three-physician group and a 15-member group will do some things differently. But no matter the size of your practice, or its location, some precautions are universal.

Create an evacuation plan. Enlist the fire department in your planning efforts. Stage an evacuation drill. Know how you’ll get your patients from the building, especially geriatric patients or those in wheelchairs.

Establish a phone list with every employee’s number and important business contact. Include cell phone and landline numbers.

If you have a satellite office, make sure it’s ready to pick up the slack if the main office goes down.

Know your insurance policy limitations. Consider “rider” insurance for natural disaster.

Back up your computer data on a daily basis. Bring saved data home every night. Consider storing data with an off-site data manager.

Check with your state and local medical societies. Some groups have created preparedness and response information packages.

Las Vegas, November 11-14, 2006

Learn more in Las Vegas. Dr. Notaroberto will be sharing emergency preparedness tips during an Instruction Course (#669; Tuesday, Nov. 14, 9 to 10 a.m.) and a Breakfast With the Expert (#B248; Sunday, Nov. 12, 7:30 to 8:30 a.m.). Advance ticket sales open on Wednesday, June 28 for Academy and AAOE members. For more information, visit www.aao.org/meetings/annual_meeting.

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