Follow the patients – future funding for crisis response

Just as Willie Sutton robbed banks because “that is where the money is,” we must reframe future health security efforts to place health systems front and center because that’s where the patients will be. The nation’s battle against COVID-19 has been marked by extreme patient surges. In several Southern states, demand recently outstripped availability of ICU beds, and some Western states formally declared “crisis standards of care.” When health care services must be rationed and patients are turned away from receiving care, the system has reached a point of failure.

Twenty years after the Sept. 11 attacks — which precipitated the creation of new structures focused on homeland security and health care emergency preparedness — we must take stock and ensure that any shortcomings are urgently addressed. Our essential public health institutions deserve more support, attention and funding, as is clearly demonstrated in recent reporting from the New York Times and public health cannot lead alone.

Health care systems — including large academic medical centers — must be recognized for their unique role in public health preparedness and more strongly supported for their critical function in responding to catastrophic health emergencies. Hospital and health system “readiness” — the ability to respond to natural and man-made disasters while simultaneously meeting the everyday health and medical needs of the community —  requires focus and investment.  

Investing in the capabilities that comprise an improved response should be top of mind for lawmakers contemplating the Biden administration’s Build Back Better Act. Funding for health security efforts requires investments in the public health agencies, emergency medical services, as well as emergency management agencies hospitals and health systems depend upon to fulfill their lifesaving duties. It also requires investments in hospital and health system infrastructure. Future capabilities needed to manage catastrophic public health emergencies will require solutions focused beyond “pandemic or high consequence biological threat events.”

We recommend two key improvements: 

First, federal plans going forward should be built on a platform that accommodates “all hazards.” Bio threats, nuclear threats, threats linked to climate change, and cyberattacks all need to be addressed. Such plans must recognize and prioritize the role and contributions of hospitals and healthcare systems. They have critical resources, personnel, data and expertise. Most important, they will have the patients, regardless of the cause of the disaster. Therefore, they will form the basis for creation of a data-enabled public health response to future challenges.

Second, like other national security priorities, funding should support health care’s role in our nation’s health security beyond current investments. While Congress has funded the Healthcare Preparedness Program (HPP) and pilot projects to support the Regional Disaster Health Response System (RDHRS), HPP has never been funded to its full allotted allocation. HPP’s 2021 funding amount is less than half of what it was when the program began in 2003, and the RDHRS is currently only engaging with four lead healthcare systems.

Hospitals are community anchors, with the broad expectation that they are always ready. This readiness is costly, and federal financial support has been insufficient and erratic. Supplemental appropriations have been made available in a panic-neglect cycle following past emergencies, including Ebola and COVID-19.

Yet, tied to specific activities this funding all too often forces recipients to plan for the last emergency rather than invest in activities and capabilities that increase overall readiness. When hospitals do step up, building expensive bio-containment units during the Ebola crisis and turning their hospitals into giant intensive care units to care for astonishing numbers of COVID-19 patients, reimbursement requires congressional action.

Funding HPP to its fully authorized level annually and significantly expanding RDHRS would be an important start. Congress should also revitalize and generously fund the Public Health Emergency Fund, which has been without funds since 1999. In addition, new funding programs should be established to support and expand the robust emergency management functions that now exist within many large health systems. 

Hospitals and health care systems are a key operational partner in preparedness and response. Larger, more flexible funding, combined with comprehensive, capability-focused planning, will facilitate stronger integration between and among the health care delivery system and response agencies. Such integration can lead to improved regional coordination and better management of limited healthcare resources. It can also drive clinical innovations that lead to increased readiness and better clinical outcomes, such as aggregating de-identified patient care data and applying the latest tools in advanced analytics to help clinicians make better choices at the bedside.

Above all, we should recognize the role health systems play and invest in them accordingly. Because that is where the patients will be.

Jenna Mandel-Ricci leads emergency preparedness and response initiatives at the Greater New York Hospital Association, a regional association supporting 160 hospitals and health systems in New York, New Jersey, Connecticut and Rhode Island.

Dr. Dan Hanfling is an emergency physician and a national expert on health care system and public health preparedness and response. He is co-chair of the National Academy of Medicine’s Forum on Medical and Public Health Preparedness for Large Scale Emergencies and Disasters.