1. Medical Surge Capacity Planning: A National Perspective Jeanne S. Ringel, PhD June 8, 2008

2. The Need for Medical Surge Capacity in a Pandemic Will Be Substantial, Even Under a Moderate Scenario Pandemic Severity ModerateSevere Hospitalizations865,0009,900,000 ICU Care128,7501,485,000 Mechanical ventilation64,875745,500 Source: Pandemicflu.gov

3. Many Different Stakeholders Are Involved in Surge Capacity Planning & Implementation Medical Surge Capacity Veterans Administration Public & Private Hospitals State Health Departments Nongovernmental Organizations HHS Nursing Homes Clinics & Individual Providers Nongovernmental Organizations Local Health Departments Home Health Care

4. Roles & Responsibilities are Complicated by the Structure of the Health Care & Public Health Systems Medical Surge Capacity Veterans Administration Public & Private Hospitals State Health Departments Nongovernmental Organizations HHS Nursing Homes Clinics & Individual Providers Nongovernmental Organizations Local Health Departments Home Health Care

5. We Focused on the Federal Role, Specifically HHS Medical Surge Capacity Veterans Administration Public & Private Hospitals State Health Departments Nongovernmental Organizations HHS Nursing Homes Clinics & Individual Providers Nongovernmental Organizations Local Health Departments Home Health Care

6. Outline Approach Conceptual Framework Findings Conclusions

7. Outline Approach Conceptual Framework Findings Conclusions

8. 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

9. Conceptual Framework Helps Identify & Organize Resources Needed for Surge Capacity Hospital Care Non-Hospital Care Clinics Nursing Homes Home Health Care Alternative Site Supplies Staff Structures Policies Supplies Staff Structures Policies Medical Surge Capacity

10. 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

11. Outline Approach Conceptual Framework Findings Conclusions

12. Lack of Vision and Stated Goal at the Federal Level is 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

13. 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

14. 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

15. Outline Approach Conceptual Framework Findings Conclusions

16. 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