Ebola Preparation Will Bankrupt My Hospital

[Dani]

This is interesting. In caring for an Ebola patient, it seems there is a fairly high cost associated with PPE's (perhaps $10,000 a day) and the disposal of same. However, this snippet of news about a conference call held between the CDC and hospital representatives brings up another concern- the costs of isolating a patient. A related cost would be the loss of revenue from patients that go elsewhere out of fear of contracting Ebola in the hospital. Texas Ebola Hospital Becomes a Ghostown Should hospitals shoulder this burden alone? Is there any kind of assistance available from the government to help hospitals who care for Ebola patients (if they are foreign nationals, they are not likely to be insured)?


Ebola Preparation Will bankrupt my Hospital

However you look at it, I tend to agree with Dr. McCaughey about the cost of all of this. I think it would bankrupt an average hospital, primarily through loss of revenue due to an inability to care for other patients. I also would like to know- is this the first conference call about Ebola that the CDC has had with hospital administrators regarding Ebola? If so, it should have happened weeks ago.

One more thing- Dr. McCaughey mentions the use of PPE very different from past CDC protocol. I wonder if the guidelines have been updated?

 

[Zac]

Re: Ebola Preparation Will Bankrupt My Hospital

This is interesting. In caring for an Ebola patient, it seems there is a fairly high cost associated with PPE's (perhaps $10,000 a day) and the disposal of same.

But, those costs really shouldn't be that high. Most of that cost is profit. Tyvek coveralls are inexpensive and ebola contaminated medical waste (unlike something like anthrax spores) could be disinfected in an autoclave or simply by boiling it in a large vat (like those used to make canned soup). If necessary, they could set up such equipment in the hospital parking lot to avoid the logistics of transporting the waste.

 

[AnnaLisa]

Re: Ebola Preparation Will Bankrupt My Hospital

It can't be solved by going cheap on PPEs! There won't be any staff left willing to care for patients!

This hazardous waste issue is overblown, burn it to ashes!

 

[Dani]

Re: Ebola Preparation Will Bankrupt My Hospital

But, those costs really shouldn't be that high. Most of that cost is profit. Tyvek coveralls are inexpensive and ebola contaminated medical waste (unlike something like anthrax spores) could be disinfected in an autoclave or simply by boiling it in a large vat (like those used to make canned soup). If necessary, they could set up such equipment in the hospital parking lot to avoid the logistics of transporting the waste.

It's not profit. Those figures came from the MSF, that's what they reported that they spent per day on PPEs.

 

[JJackson]

Re: Ebola Preparation Will Bankrupt My Hospital

The problem is quantity with each complete set of PPE only lasting about 45 minutes when used in a West African clinic, burial teams use 9 complete sets per body. I dare say the manufactures make a healthy profit and, despite it being a sellers market, any attempt to price gouge is likely to be highlighted and be a PR nightmare for the company attempting it.

 

[Shannon Bennett]

Re: Ebola Preparation Will Bankrupt My Hospital

It isn't just a gown, or a pair of gloves it is also anything that comes into contact with a patient. Sheets, pads, adult diapers, toweling, plates, cups, tubing, etc... the list is staggering. All of it is hazardous waste. And you can't just burn it as a lot of the stuff is resistant or hazardous to burn. Plastics are a good example as are adult diapers which are extrememly resistant to burning. So it isn't just the cost of replacement, although that has to be a daunting expenditure, but also how do you get rid of the garbage? The mindset of hospitals was/is this is not going to happen in a first world nation so we don't really have to prepare for that kind of eventuality.

We have a long time poster here who also happens to be a nurse. He went to his hospital administrators and asked if he could put together a program and manual describing how to care for an Ebola patient. He was laughed out of the room. Judging by additional reading and the fiasco that was described by the Texas hospital, I would hazard a guess that only a tiny handful of hospitals actually are prepared for the 'unexpected' Ebola patient. And that is exactly what we can expect. A student going to a local university, a wife being brought over by a husband who has been here for years, a missionary, a health care worker, a businessman or woman, an American working in a nearby oilfield or mine, the list goes on and on.
There will be unexpected cases in some very out of the way places. You can count on it.

 

[AnnaLisa]

Re: Ebola Preparation Will Bankrupt My Hospital

Is it possible to use high temperature incinerators? No doubt the amount of waste is bad. I have worked in facilities during Norovirus outbreaks, it's bad. I think the cat is out of the bag and our defense is how well we case manage and right now, I am not impressed.

 

[Vibrant62]

Re: Ebola Preparation Will Bankrupt My Hospital

Another factor to consider is how resilient are the health insurance companies with respect to re-imbursing patient costs? How many patients before they would go under without assistance - and not just in the US?

Most developed healthcare systems in the world require patient payment or insurance, at least to some degree.

The potential outcomes are a) hospitals refuse to see patients who could be ebola suspect cases; b) hospitals cut corner on costs with substandard PPE and other measures, with the consequence that HCWs get infected who then refuse to work c)medical insurers refuse to pay for ebola costs beyond a standard level of payment that is not sufficient or d) the uninsured or poor simply dont step forward for treatment, becuase they cannot afford it, and spread the virus widely.

Any one of these outcomes would be disasterous.

Governments everywhere need to consider underwriting costs if we are to avoid a potentially major problem with outbreaks.

 

[Dani]

Re: Ebola Preparation Will Bankrupt My Hospital

The problem is quantity with each complete set of PPE only lasting about 45 minutes when used in a West African clinic, burial teams use 9 complete sets per body. I dare say the manufactures make a healthy profit and, despite it being a sellers market, any attempt to price gouge is likely to be highlighted and be a PR nightmare for the company attempting it.

In thinking about it, it's possible that the care of a single US patient requires as many PPE's as an MSF clinic uses in one of their facilities. They care for multiple patients at once with the same PPE, working from least ill to most ill. And care for an Ebola patient in the US is just incredibly labor intensive owing to the standard of care. Over 75 people had direct contact with Mr. Duncan. Whether this is a good thing is open for debate.

Regarding price gouging, that may well be true, but that's not something the hospital can control. Price gouging is certainly unethical, sand as you say, really bad PR. But it only lasts until supplies catch up, and in the meantime a lot of companies will be scrambling to tap into that market, and then the supplies will go up.

Still, the loss of revenue for a hospital is what will bankrupt it, not the cost of the PPE. As I've mentioned before, $10,000 a day isn't peanuts, but hospitals often take care of patients who run up bills like that, and it gets written off as charity care. The problem is with using up most of the ICU, temporarily diverting the ER and worst of all, the patients who will refuse to come to Texas Presbyterian while an Ebola outbreak is happening. The damage to that hospital will run into the millions. It's a good thing they're part of a fairly robust system, or they would be in serious financial trouble.

 

[AnnaLisa]

Re: Ebola Preparation Will Bankrupt My Hospital

This is catastrophic for hospitals and will be catastrophic for insurers, also many hospital systems have their own HMOs which gives them double exposure. I don't think the system can financially hold up.

 

[AnnaLisa]

Re: Ebola Preparation Will Bankrupt My Hospital

Also, consider that many health care providers are at or near retirement age. How many will remain if protocols are not improved? It's possible that we could see an exodus of health care workers.

It just seems odd to me that we don't have health system strategists that would have foreseen these issues.

 

[Dani]

Re: Ebola Preparation Will Bankrupt My Hospital

Also, consider that many health care providers are at or near retirement age. How many will remain if protocols are not improved? It's possible that we could see an exodus of health care workers.

It just seems odd to me that we don't have health system strategists that would have foreseen these issues.

The impression I have is that there are the epidemiologists, Federal authorities, and ID experts who know about Ebola; and there are the practicing doctors, nurses and administrators who actually provide the care in the US.

Apparently, these two groups did not talk much with each other. In my opinion, that is the crux of the problem and why we are facing disaster now.

 

[Vibrant62]

Re: Ebola Preparation Will Bankrupt My Hospital

Then national governments will have to underwrite costs of investigation and treatment, or nations wont have a healthcare infrastructure left to meet this challenge.

It seems clear to me that for economic as well as healthcare infrastructure reasons, they are going to have to set up dedicated investigation/ treatment centers if cases start to appear in any numbers, and plans for a more widespread outbreak (which we should be making on a just in case basis) may have to think outside of the box, so that hospitals stay running for 'normal' healthcare.

Development of a new and sensitive ebola test that can detect low levels of virus i.e people in the early incubation stage of disease, would make it feasible for every patient to be screened upon admission, and infected people could then redirected to an appropriate centre.

Just as a thought for planning: Specific hospitals could be designated as treatement centers. The question is what could be done about isolation / quarantine centers? I wonder how viable would it be to temporarily rehouse nursing home residents in 'normal' hospital wards so that nursing home facilities could be seconded as isolation centers for suspect cases, as most nursing homes have one toilet per room and basic provision for oxygen and other basic medical care inbuilt for each bed, much like hopsitals (at least they do in the UK), with floors etc that could easily be disinfected. Just an idea.

Another option would be hotels.

 

[DataMom]

Re: Ebola Preparation Will Bankrupt My Hospital

Many people in nursing homes have dementia. Some of those with dementia have FTD which strikes younger people and is the second most common form of dementia after Alzheimers. They are highly mobile, have myriad behavior issues and need extra security. They will not transfer out well to another facility. I think you would be surprised at how many are private pay, veterans waiting for VA space (some have CTE and other issues due to recent wars) and have serious issues with swallowing, speech, etc. There would be quite an outcry from family members to say the least. I don't think co-opting nursing homes is a workable idea.

 

[Dallas]

Re: Ebola Preparation Will Bankrupt My Hospital

But we gave the all those Billions of dollars from taxpaers for just this. Where did that money go? This is exactly what that was for, PPE, protocol, training, etc.

 

[Chicagogal]

Re: Ebola Preparation Will Bankrupt My Hospital

I am not concerned about price gouging...most health networks have pricing structures in place that don't change because of demand. However, during the SARS situation, we saw a run on masks where manufacturers were not able to keep up with demand. There are only a handful of N95 manufacturers (3M being the primary) and they cannot ramp up capacity. Same for Tyvek coveralls. Manufacturers have done everything they can to reduce inventory, given the costs of storage.

I am happy to see intubation is not habitually recommended, because we have only 90,000 working ventilators in the country.

 

[Dani]

Re: Ebola Preparation Will Bankrupt My Hospital

But we gave the all those Billions of dollars from taxpaers for just this. Where did that money go? This is exactly what that was for, PPE, protocol, training, etc.

From a health care standpoint, it wasn't exactly for this at all. The most likely epidemic is influenza, and the PPE training for flu is completely inadequate for Ebola, and apparently normal sterilization isn't enough either. Flu preparedness is much more focused on the community, and so much of that money went to communities to strengthen resources there, and also to public health. There's no reason to think that money has been wasted, in my opinion. We have not seen nosocomial transmission or transmission in the community, which is what pandemic preparation is supposed to prevent. I don't think Ebola infections in HCWs was even on the radar screen when the Preparedness Act went into effect.

However, from a national perspective, I couldn't begin to answer that question. We supposedly have a person in charge of this situation, Dr. Nicole Lurie, whose job was created with those billions of dollars- an Assistant Secretary for Preparedness and Response, under the auspices of the HHS. Where is she? Isn't she supposed to put all the moving parts together in times of crisis? I have not heard a single word from her.

 

[Chicagogal]

Re: Ebola Preparation Will Bankrupt My Hospital

The 2006 funding was for avian influenza preparedness. Remember that fire drill? I actually worked for a major medical company during that time and did a lot in this area, so I can tell you that we were specifically selling BSL-4 supplies to hospitals to use these grants. Suits. Tents. PAPRs.

Where did it all go?

 

[Dani]

Re: Ebola Preparation Will Bankrupt My Hospital

The 2006 funding was for avian influenza preparedness. Remember that fire drill? I actually worked for a major medical company during that time and did a lot in this area, so I can tell you that we were specifically selling BSL-4 supplies to hospitals to use these grants. Suits. Tents. PAPRs.

Where did it all go?

Evidently not to Texas Presbyterian! That's all anyone can say at this point.

 

[USALady]

Re: Ebola Preparation Will Bankrupt My Hospital

Suppliers are going to gouge hospitals under the circumstances, and the crazy part is that the standards for materials and processes have not even been worked out. The level of logic and experience on this problem is pathetic. There are multiple industries that dress out every day, head to toe, multiple times every day and have very low levels of exposure to hazards. It's not that the expertise isn't available. It's the silo effect, and people are more worried about the PR than the problem.

Anyone working with an ill person, I don't care what the CDC thinks of their odds, should be registered with them. Registration ought to last a period of time, you can use a computer to keep track of them and it. That's what f'ing computers are for, not playing solitaire. (sigh) What blows me away is this person went to Ohio, and the CDC was surprised when they found out they flew back sick. SMH

Registration should suspend some activities for the period of registration, hello. Working in a charity food event or restaurant, travel, blood donation, volunteering for schools, etc etc. Telling people these things sounds dumb, but generally people don't think. It's a fact.

The CDC (practical details, standards, and contact registration) and the US Government (grants to handle the cost) are frankly not doing their job. They need to stop blabbering about how safe we are, get off the *R&$%&& podium, and do the practical work to make sure we are as safe as they can manage.