3 Reasons Congress Will Kill the Hospital Preparedness Program in 2017

3 Reasons Congress Will Kill the Hospital Preparedness Program in 2017

It’s been nearly four years since the Assistant Secretary for Preparedness and Response (ASPR) pivoted from offering states the Hospital Preparedness Program (HPP) to offering the National Healthcare Preparedness Program (NHPP) – four years and most states continue to muddle through as if they have unlimited time to figure out how to build effective, sustainable healthcare coalitions. They don’t. The laissez-faire approach taken by too many states has left ASPR with few shining examples to put on the table as Congress decides whether to reauthorize the Pandemic and All Hazards Preparedness Act (PAHPA).

On June 30, 2017 Congress is likely to kill the program. Unless… 

We'll get back to that. Let's clear a few things up first.

There is little doubt that PAHPA will be reauthorized because, among other things, it reauthorizes the Centers for Disease Control and Prevention (CDC) Public Health Emergency Preparedness Program (PHEP) – a key program connecting the Nation's, federal, state, local public health systems – and the very existence of ASPR itself. But, whether the NHPP will be included is a bit more uncertain.

ASPR’s argument for inclusion of the NHPP is hindered most by the failure of too many states to implement effective, sustainable healthcare coalitions, which are at the very heart of their healthcare preparedness strategy. ASPR’s strategy is on target, but making it translate on the ground requires the program’s 62 awardees to get on board. Some have, some haven't.

The greatest evidence of problems lie with those that haven't yet drank the Kool Aid, or are just now – in year four if the five-year project period – trying a sip to see if they like it. And even some of those who were on board from the beginning are struggling to make their coalitions all they should be.

It has become convenient to blame healthcare coalition struggles on sizable funding cuts experienced in recent years, but the argument loses its teeth when states and their sub grantees leave millions unspent at the end of each grant year.

Could the program use more funding? Absolutely! Would it suddenly lead to hundreds of functional healthcare coalitions? No. Not if states cannot quickly get the NHPP funds out of their bureaucracies; not if many continue to go around their healthcare coalitions to fund hospitals directly; not if healthcare coalitions fail to develop an organizational foundation that can support an effective, sustainable quasi-nonprofit or nonprofit organization.

Holistically, the NHPP is not as effective as it should be. The question remains if Congress will see it as a failed experiment or a promising work in progress. Much of that depends on progress made in the next 18 months.

Now, let's dig into the three reasons Congress is likely to kill the program in 2017.

Failure to Spend Down Allocated Funding

In 2013 NHPP funding was cut from $331,759,862 to $228,500,000, which is less than half of what was authorized at it’s highpoint of $498,000,000 in 2004. The uproar from the states and healthcare providers was deafening. “How can we possibly maintain what we’ve built with such cuts, much less build healthcare coalitions that serve far more provider and supplier types than hospitals.” It's a fair question, but...

One of the key indicators that the Office of Management and Budget (OMB) in the Executive Office of the President and the Congressional Budget Office (CBO) looks at when allocating annual funding for programs is how many dollars were left unspent in prior years. When it comes to the NHPP, there have been and continue to be red flags.

In the eyes of the bean counters, the 2013 cuts were justified based partly on unobligated dollars in years prior. Right or wrong, they clearly felt that the program could operate with less funding going forward. Despite the cuts, states continue to hold millions in unspent funds at the end of each grant year. 

Their inability and that of their sub grantees to use their NHPP funding is a very real problem that justifies Congress’ prior belt tightening and is a ticking time bomb for the NHPP.

The easy answer is to just spend for the sake of spending, to buy more stuff before June 30 of each year. Well, just ask the folks at the Federal Emergency Management Agency (FEMA) what happens when the states and their sub grantees buy a bunch of unnecessary stuff and don’t know where it is.

If NHPP funds are not spent down – appropriately and effectively – Congress will kill the problem in 2017!

Continued Focus On Buying Stuff

Stuff, also known as supplies and equipment, is the classic catch-22 for states and their sub grantees. Buying stuff is a quick, easy way to get rid of a bunch of dollars – an easy way to move $200,000 a week before the grant obligation deadline. Stuff solves the problem of unspent dollars on the books, but the end of year panic strategy is no secret and it's killing the program.

Here’s a few recent examples of the stuff problem:

  • A highly respected EMS thought leader recently shared a newspaper article on LinkedIn about a hospital that used $40,000 of its NHPP funds to purchase ‘mass shooting kits’ for surrounding fire and police agencies. The kits are nothing more than trauma bags, a must have on ambulances and fire apparatus for 50 years. These everyday supplies have been funded for decades with local tax dollars, but are now somehow a federal priority?
  • I sat at a late June conference and watched as a hospital emergency preparedness coordinator spend $200,000 on tents. Why? Because his boss told him he needed to spend the dollars down by the grants June 30 obligation deadline. He admittedly did not need them, but buying stuff is the fastest way to move a lot of money.
  • Over the past six months I’ve watched two different healthcare coalitions – actually hospital coalitions at this point – vote to spend 50% of their annual budgets on Med-Sleds for their member hospitals. Sure, Med-Sled has a fine product, but how many can we buy with NHPP funds before someone says enough? And what if it’s the rural nursing home that’s evacuating? Heck, They are not even at the table yet.

So, how many closets and mini storage garages full of Med-Sleds, tents, and trauma bags do we need? Probably none if we knew where the heck everything we've already bought was buried. I assure you that few states have any clue where all the stuff is. And when it comes to the stuff with a shelf life, what’s expired? Let’s not even go there.

Given that Congress has allocated $5 Billion since the inception of the NHPP and its predecessor programs since 2002, and the vast majority of the money has spent on stuff, maybe it’s time to take a deep breath and hit the pause button on stuff; maybe it’s time to build effective regional organizations – like healthcare coalitions – that are sophisticated enough to bulk purchase stuff based on regional needs, efficiently maintain it, triage allocation, and coordinate delivery to where it’s needed.

When it comes to stuff, maybe it’s time that healthcare coalitions provide value to their members by sharing cost and unifying effort to build out:

  • A shared regional inventory system that ideally ties into a state system.
  • A logistics system that rotates inventory of perishable good, and enables all healthcare facilities in a region to share medical surge resources.
  • Implement a Medical Multi-Agency Coordination Center where any medical provider can call to find what they need when crap hits the fan.

If the NHPP cooperative agreement is not used for its intended purpose, Congress will kill it. The HPP of the 2000s is already dead and the stuff strategy was buried with it.

Failure to Prove Effectiveness

In 2012 and 2013, Chris Kosmos, Director of the CDC Division of State and Local Readiness (DSLR) was on the preparedness conference circuit with Dr. David Marcozzi, then Director of the NHPP. They were explaining the move to grant alignment between the NHPP and PHEP Programs, and to a lesser extent the Homeland Security Grant Program (HSGP) and Emergency Management Performance Grant Program (EMPG). And they laid out how crucial metrics were becoming in Washington.

Metrics are Congress’ way of measuring effectiveness. No metrics, no money.

Ms. Kosmos often stated that, “we need to be able to tell our story on the hill (Capitol Hill).” Her point being that programs will no longer sustain for the sake of sustainment, that all stakeholders – federal, state and local governments – must justify not only why the programs matter, but how they are effectively being implemented to reduce human suffering and loss of life. And in the case of the NHPP states can only obtain metrics from their healthcare coalitions and coalition members.

If the metrics ASPR is collecting follow the NHPP cooperative agreement, and the cooperative agreement is all about effective, sustainable healthcare coalitions, and healthcare coalitions have not built organizations sophisticated enough to collect the metrics, much less meet the expectations behind them, then Congress has no reason to believe the program is effective.

The NHPP must be more effective, or Congress will kill it. No metrics, no program.

Stay Tuned!

Most healthcare coalitions are struggling to find their way. And struggling coalitions tend to be less effective, are more likely to have unspent funds at the close of the grant year and, as such, are more likely to panic and buy unnecessary stuff at the last minute.

These are the three primary problems plaguing the NHPP, the problems that will ultimately cause Congress to kill the program. Unless…

Next week I will publish the follow up to this article, 2 (Maybe 3) Ways States Can Save the Hospital Preparedness Program

To be notified when we publish, you can follow me on LinkedIn and sign up for our eNews.

Karl Schmitt, MPA

Karl Schmitt, MPA

Karl is the Passionate Founder & CEO of bParati. He is on a mission to build a national network of effective, sustainable healthcare coalitions. More...

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