Pearls on Preparation: When a Natural Disaster Strikes-Hurricane Ike

By Aaron Miller, MD, MBA

I currently practice in Houston for one of the largest ophthalmology practices in the United States and witnessed first hand how a natural disaster can affect a practice. Hurricane Ike plowed through the Galveston and Houston area recently and we are still feeling the results of its devastation economically. When running a practice, you can plan for many types of patients and various personnel problems. However, the recent storm brought to light several additional situations and suggestions that I would like to share.

In total, our group consists of 36 physicians covering nearly all the subspecialties at 19 different locations throughout the Houston regions. All of these locations lost power due to the storm and several sustained wind and water damage. Our main office is the source of a little less than 50% of our revenue and was without power for one week. My practice location is in the northwest part of Houston, farthest away from the point of impact from Hurricane Ike. It was without power for a little less than a day and had only minor water damage. While the building was physically capable to see patients the first working day after the storm, there were many obstacles encountered that prevented its usual operation.

Through this experience, I realized that having power for my clinic did not guarantee usual operation. The following observations were made:

• While the office had power, most of my patients and staff did not. Many were unaware of our operational status but fortunately we had a toll-free “Hurricane Ike Hotline” voice message system in place. We had a phone number previously reserved previously for emergencies that was remotely accessible, regardless of the phone system status in Houston. On this number, we had information on which offices were open and which physicians would be working each office. Every evening after 7pm, we had the status for the following day updated so employees knew if they could come in for work. Unfortunately, we did not have a similar system in place for patients. We ended up forwarding our main line to this same number but have made arrangements for a separate remotely housed messaging system strictly for patients for future events.
  
• As many fellow private practice physicians can relate, when your practice is not open, you are not making money. Our practice lost an enormous amount of revenue due to lost surgeries and clinic visits. We were on the verge at the end of the week of renting an office generator for our main location. Most commercial generator rental businesses can get one in place within 48 hours depending on your location. They typically require a rental of a minimum of one week and payment up front. The cost for our practice for a one week rental would have equaled our profit for about 3-4 days. Since we could not guarantee a full patient load, we opted to wait it out and fortunately had power one week later.

• While the lost revenue situation is somewhat similar to a physician being on vacation, there were also unique differences which pertained to our hourly-paid staff. Typically when I am out, my staff is still getting paid and is working in my absence. With Ike, they were also not making money. This proved to be a major stressor for many of our group’s personnel because many live paycheck to paycheck. I chose to allow all of my location’s employees to work instead of operating with a reduced office staff to help them. Most were appreciative of this offer and it provided them with access to air conditioning that they did not have at home. Many brought their children with them since the schools and daycares were not open. We were “one big family”. The employees at our other locations were not as fortunate. For the first pay period, we duplicated all hourly employees’ paychecks with their previous pre-Ike paycheck. After things got back up and running, we allowed them to take the choice of using benefit time (a combination of vacation and sick time) to make up the lost hours. We did not have the financial capacity to forgive the lost hours. I have since learned that insurance policies can be purchased to cover employee wages for disasters such as this and our group is looking into if it is financially feasible.

• While the power and land-line phone systems were mostly down, I was pleasantly surprised to find that most cell phones were at least partially operational. I was unable to make individual calls on my cell phone most of the time but was able to occasionally check my voice messages. However, what turned out to be the most effective communication system was text messaging. While the time it took to get the message sent or received from our carrier was variable, most people eventually received the text message. When my office was operational, I sent a message to all of my fellow physicians letting them know that I could see any emergency patients that did not have access to an operational facility. I sent a similar message to the cell phones of many of my referring physicians. This proved to be one of the biggest aids to increasing my patient volume in the days following the storm.

• Despite my office being closed for only a few days and our main office being closed for a week, the effects with regards to patient and surgical volume are still being experienced. Many patients left town and stayed away until their home had power. Most of our surgical facilities were not operational for elective eye cases. In an effort to “catch-up” on lost clinic time, most of our physicians have opened weekend clinics.

• The last major obstacle encountered was the operation of our EMR and scheduling system. Due to our computer servers being housed locally at our main building that was without electricity, we did not have access to patient demographics and contact information. Prior to the storm arriving, I printed out several days of my future schedule with patient phone numbers which proved to be helpful. Our current computer systems cannot operate at our satellite locations without the main server at our main office being operational. While we have an off-site backup for the server, it is not an “operational” backup that our satellite offices can access. Future options that we are considering to address this issue are remotely housing a server backup that is fully operational or adding components to our server at each location to allow emergency operation without access to the main system.