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With Hurricane Milton steaming toward Florida’s west coast, some of the state’s hospitals have evacuated, while others are transferring patients and closing clinics ahead of the storm.

As of Wednesday, 16 Florida hospitals have evacuated, according to Florida state officials. A total of 352 healthcare facilities, including 200 assisted living centers and 67 nursing homes, have evacuated ahead of Milton, state health officials say.

Milton appears to be headed for the Tampa Bay region, which experienced heavy flooding from Hurricane Helene less than two weeks ago. Helene delivered plenty of damage to Florida, and 

many healthcare workers lost their homes in that storm

, said Mary Mayhew, president and CEO of the Florida Hospital Association.

Now, they’re bracing for a storm that could be even worse.

“Everything we're hearing is that this has the potential to be historically catastrophic, but it is also compounded by an area of the state that just suffered significant damage from Helene,” Mayhew said.

While some Florida hospitals are evacuating and moving patients, many hospitals are going to be open, or are at least keeping emergency rooms open through the storm.

“We have hospitals evacuating, but we have other hospitals, of course, that have made the decision that they can keep their patients safe,” Mayhew said. “They are remaining open. There will be a significant need for hospital services because of the impact of the storm. It’s important that those services are available 24/7.”

Helping hospital workers who suffered losses from Helene

The National Weather Service in Tampa Bay said Milton could be the most powerful hurricane to hit Tampa Bay in 100 years. Early Wednesday, Milton remained a “Category 4” hurricane, with sustained winds of 155 miles per hour, the weather service said.

But hospitals beyond the Tampa region could be facing significant flooding.

“It's not just the eye of this storm,” Mayhew said. “The extent of the surge and how far down the coast that will extend.”

Magnifying the challenge, Milton is expected to remain at hurricane strength as it moves across Florida, posing threats to a wide swath of communities. “The East Coast, Daytona Beach, they could still be experiencing a Category 2 hurricane,” Mayhew said.

Most hospitals are staying open, and facilities on the coast have transferred patients to sister hospitals in their system, or other hospitals, Mayhew said.

But Mayhew said problems may arise if flooding from Milton forces other hospitals to move other patients or evacuate, because plenty of Florida hospitals are packed.

“If there are hospitals that find it necessary to partially or fully evacuate, if they don't have other hospitals within their system that can receive or they are an independent hospital, the state will be helping to coordinate where there is capacity elsewhere,” Mayhew said. “Again, a lot of hospitals are already largely full, so this is going to require significant coordination.”

While forecasters warned of powerful winds capable of producing significant damage, hospitals are most concerned about flooding of their facilities.

“Flooding is the most significant concern and threat to hospitals, both in terms of damage to their buildings, impacting electrical,” Mayhew said. “Then it would be creating challenges for transportation to and from the hospital, for patients, for staff, so that is front and center.”

Tampa General Hospital is remaining open and has installed its “

,” a barrier designed to protect the main hospital campus from storm surge. The main hospital campus sits on an island in Hillsborough Bay.

Erinn Skiba, assistant director of public safety for Tampa General Hospital, said the organization has detailed plans in place to serve patients in the storm.

“Our fence around the Davis Islands campus is up, supplies are stocked at all hospital locations, and the teams stand ready to provide care through Hurricane Milton,” Skiba said in a statement.

The fence withstood heavy flooding from Helene, and it’s going to be tested again. Tampa General could face a difficult test with Milton, as the National Weather Service said Wednesday that the peak storm surge in Tampa could reach 8 to 12 feet. The AquaFence barrier is designed to prevent surges of up to 15 feet above sea level.

Tampa General built a new energy plant in 2022 to provide more resilience in Florida’s extreme weather. The plant sits 33 feet above sea level.

In addition to the main hospital campus, Tampa General’s hospitals in Brooksville, Spring Hill and Crystal River are staying open. Some freestanding emergency departments, clinics and outpatient facilities will be closed.

HCA Healthcare operates more than 40 hospitals in Florida, and the health system has evacuated some of its facilities.

 has evacuated West Tampa Hospital, Bayonet Point Hospital, Pasadena Hospital and Englewood Hospital and transferred patients to other facilities. A few HCA Florida hospitals are open for emergencies only, and HCA has also closed several freestanding emergency rooms.

In addition to dealing with another hurricane in Florida, HCA also operates seven hospitals in 

, including Mission Hospital in Asheville. 

 are assisting hospitals in the region in the wake of widespread destruction from Helene.

The BayCare Health System is keeping most of its hospitals open, but Morton Plant North Bay Hospital has been closed, the system said. The system has postponed all non-emergency surgeries Wednesday and Thursday. BayCare operates 16 hospitals in west-central Florida.

BayCare has also closed its medical group and urgent care clinics Wednesday and Thursday, but is making telehealth services for those with the BayCareAnywhere mobile app from Wednesday at 7 a.m. through Friday at 7 p.m.

Some BayCare staffers lost their homes from flooding by Hurricane Helene. BayCare has created a 

 to support staff in need, and the system is committing $10 million to the fund.

Sarasota Memorial Health Care canceled all elective surgeries Wednesday and Thursday and has closed urgent care centers Wednesday. Many outpatient facilities are closed Wednesday and Thursday. 

, and all VA clinics in Tampa are closed through Thursday. The VA said appointments were being converted to virtual visits or being rescheduled.

The  C.W. Bill Young VA Medical Center in Bay Pines has closed its campus, including the emergency department. Outpatient appointments are being postponed or done via telehealth.

As of Tuesday afternoon, Florida hospitals were faring well when it came to supplies, Mayhew said. Hospitals were focused on having ample supplies of fuel if power is unavailable for an extended period, she said.

She said she is concerned about gasoline supplies for hospital staff. Patrick De Haan, a gasoline analyst for GasBuddy, said more than one in five Florida gas stations were out of gas as of 8 p.m. Tuesday.

Mayhew praised the preparation and coordination of state officials working with health systems. More than 500 healthcare leaders participated in a call with state health and emergency officials early Tuesday afternoon. She said 11 shelters have been set up around the state to accommodate individuals who are not in hospitals but require power for their medical equipment.

It’s unclear how many Florida hospital workers lost their homes after Helene, Mayhew said, but the association is working to get that data. She also dreads the prospect of more hospital staff losing homes or suffering serious damage from Hurricane Milton.

“We will obviously now be looking at it comprehensively, between these two hurricanes, the extent to which our healthcare employees have suffered significant damage to their homes,” she said.

The powerful storm approaches a region still recovering from Hurricane Helene less than two weeks ago. Hospitals are bracing for the potential of catastrophic flooding.

Topic

Hurricane Milton: Florida hospitals, more than 300 healthcare facilities evacuate

It has taken longer than some healthcare advocates would like, but a measure to extend key telehealth programs is moving forward in Congress.

This week, the House & Energy Commerce Committee passed the 

 with more than bipartisan support. The committee approved the measure unanimously with a 41-0 vote Wednesday, along with a host of other health bills.

The bill (H.R. 7263) continues many telehealth flexibilities for an additional two years, through the end of 2026. The legislation would also provide a five-year extension for 

Kyle Zebley, senior vice president of public policy for the American Telemedicine Association, hailed the unanimous vote for the bill.

“We owe a great debt of gratitude to our telehealth champions in the House for their unwavering and ongoing support of telehealth and to bringing needed care to the American people, especially those in underserved communities,” Zebley said in a statement this week.

Republicans and Democrats sponsored the bill. U.S. Rep. Earl L. “Buddy” Carter, R-Ga., one of the prime sponsors of the legislation, is hoping the full House of Representatives will vote to approve the bill sooner than later.

“Seniors, individuals with mobility issues, and those living in rural areas rely on telehealth to bring qualified health care professionals right to their home,” Carter said in a statement. “I urge a swift House floor vote on this bill, so that we can get Medicare beneficiaries the life-saving health care they need.”

After the House acts, the Senate would have to approve the legislation.

they expect Congress to extend telehealth provisions

, which were first enacted in response to the COVID-19 pandemic. But some also said they worried Congress may not act too quickly this year, especially with most lawmakers running for re-election this fall.

 with Chief Healthcare Executive®, Zebley projected that Congress may not get the bill to President Biden’s desk until late in the year, and it appears that forecast is accurate.

“It's going to get done,” Zebley said in June. “It's just going to really be stressful in the act of getting done.”

U.S. Rep. Lisa Blunt Rochester, a Delaware Democrat, said 

 has been “one of the few positive outcomes of the COVID-19 pandemic,” and she hopes the extension is enacted as soon as possible.

“We are one step closer to ensuring that anyone who needs these services, especially seniors, those with disabilities, and people living in rural areas, can access the care they need when it’s most convenient for them, all while lowering prescription drug costs,” Rochester said in a statement.

Some healthcare advocates were hoping to see permanent telehealth reforms, but they acknowledged another extension of flexibilities would be more likely.

“Although we believe these provisions should be permanent, we understand the current dynamics and support a two-year extension,” Zebley said in a statement.

Healthcare leaders are particularly happy for the five-year extension for hospital-at-home programs. As of Sept. 17, 345 hospitals are offering acute care at home in 39 states, according to 

 from the Centers for Medicare & Medicaid Services.

Telehealth advocates are also pressing for the approval of extensions allowing the remote prescription of some controlled substances, such as Oxycontin and Xanax.

The Drug Enforcement Administration and the Department of Health & Human Services agreed last year to a temporary extension allowing for telehealth providers to write prescriptions for some controlled substances, but that provision expires at the end of 2024. The American Telemedicine Association is urging Congress to push the DEA and health department for an additional two-year extension of remote prescriptions.

“If left unaddressed, this issue could create dire consequences,” Zebley said in a statement.

Patient usage of telehealth has dipped recently, but it remains far more popular than before the COVID-19 pandemic. In 2022, 30% of adults engaged in telehealth, down from 37% in 2021, according to the 

Centers for Disease Control and Prevention

However, analysts continue to see strong demand for telehealth options in some areas, 

, CEO of Carilion Clinic, touted the value of telehealth this week at an 

 held by The Coalition to Strengthen America’s Healthcare and Politico. Agee, the chair of the coalition, talked about the system’s expanded use of telehealth.

“The pandemic just put a huge catalyst into that. Suddenly we were doing tons of telehealth-care throughout our whole region,” she said.

Carilion employs several doctors across the country who are full-time virtual physicians. “They never see a patient in person,” Agee said. “They do everything through telehealth.”

She also pointed out that telehealth can reach more remote communities, as well as help seniors and those with disabilities who can’t easily visit a doctor in person, even if the clinic is close.

“When you think about telehealth, it’s not just to reach into rural areas, though that’s critically important. It’s also what we can do in general,” she says.

“I think telehealth is just a real gift to the way we do healthcare delivery today,” she says.

The American Telemedicine Association is also pressing Congress to approve a bill (

) that would expand access to virtual care for workers by allowing employers to offer stand-alone telehealth benefits to all employees.

How hospitals and health systems could do more with telehealth

The House Energy & Commerce Committee has passed the legislation, but some key provisions for telehealth are slated to expire at the end of the year.

Telehealth extension bill moves forward in Congress, but clock is ticking

Hospitals nationwide are dealing with a shortage of IV fluids due to the closure of a key plant in North Carolina due to Hurricane Helene.

Health systems are conserving IV supplies after Baxter International, a medical technology company, has been forced to shut down a plant in Marion, North Carolina that experienced flooding from Helene. The plant is the nation’s leading supplier of intravenous and peritoneal dialysis solutions, according to Healthcare Ready, a nonprofit organization that works to ensure access to care during emergencies.

Now, hospitals are asking the federal government for help to deal with the shortage. Some hospitals are already postponing non-emergency surgeries to conserve IV supplies due to the shortage.

The American Hospital Association sent a 

 to President Biden Monday asking the government to take steps to obtain more supplies and approve other measures to help health systems.

Rick Pollack, president and CEO of the American Hospital Association, wrote in the letter that the Baxter plant produces about 60% of the IV solutions used every day in the United States, or about 1.5 million bags. Baxter and other suppliers of IV solutions have put strict limits on orders from health systems and are not accepting new customers, Pollack wrote.

“As a result, our members are already reporting substantial shortages of these lifesaving and life-supporting products,” Pollack wrote in the letter. “Patients across America are already feeling this impact, which will only deepen in the coming days and weeks unless much more is done to alleviate the situation and minimize the impact on patient care.”

Baxter has said it is communicating with customers and is trying to boost production of IV solutions at the company’s other facilities.

, Baxter said that it’s unclear when the North Carolina plant will be able to resume operations.

“We are working with the greatest urgency, but we do not yet have a timeline for when operations will be back up and running,” the company said.

Dockworkers’ strike should be a ‘wake-up call’ for healthcare supply chain

Some health systems are delaying some elective surgeries to conserve their supplies of IV solutions. The American Hospital Association says some of its members are postponing procedures.

UVA Health in Virginia is among the health systems taking that step. UVA Health University Medical Center is postponing some non-urgent surgeries this week to help conserve supplies and minimize disruptions to patient care. UVA Health’s hospitals in Culpeper, Haymarket and Manassas are also rescheduling some surgeries.

“We are grateful for our patients’ patience and understanding as we do our part to work through these shortages,” Josh Barney, a spokesman at UVA Health, said in a statement. “We’re doing our very best to ensure that all our patients continue to receive the best care possible.”

In Minnesota, Allina Health and M Health Fairview are also delaying some surgeries to conserve supplies, according to 

Enloe Health, a 298-bed hospital in Chico, California, is postponing non-emergency surgeries. “Enloe Health will be pausing on elective procedures. Emergency and lifesaving operations will not be affected,” the hospital said on 

The American College of Emergency Physicians sent out an 

 Monday encouraging members “to help conserve the supply and work with your hospitals to establish protocols for reserving these IV fluids for the most necessary use cases.”

The American Society of Health-System Pharmacists (ASHP)

 has also issued guidance to hospitals and health systems in managing supplies. Health systems should evaluate supplies across the organization and be prepared to allocate supplies to those areas of greatest need, the group said.

Florida hospitals, some of which have already endured substantial disruptions from Helene, are also seeing shortages, according to the Florida Hospital Association. Hospitals are seeing “an on-going and growing supply disruption” of IV solutions, the group said on its website.

Florida hospitals evacuated due to Helene

some Florida healthcare workers lost their homes

 to flooding on the west coast. Florida is also 

bracing for the arrival of Hurricane Milton

, which is expected to hit the state’s west coast Wednesday.

 is working with hospitals and the Ohio Department of Health to provide weekly updates on IV supplies to get an accurate assessment of inventory across the state.

The federal government can take some steps to help hospitals, the American Hospital Association says.

Hospitals are asking the Food and Drug Administration to declare a shortage of sterile IV solutions, which will enable providers to have more flexibility to deal with the shortage. The hospital association is also asking the government to help identify international manufacturers that are capable of producing IV solutions and their containers.

Hospitals are pressing President Biden’s administration to declare a national public health emergency that would allow for waivers of Medicare and Medicaid regulations.

The hospital association has also asked the White House to invoke the Defense Production Act to spur manufacturers to produce more IV solutions and containers. The association is also asking the Department of Defense to make transportation available for emergency supplies from international sources.

Hospitals have become very accustomed to dealing with shortages of key supplies in the past few years. In the spring, 

the American Society of Hospital Pharmacists

 reported “an all-time high” in the shortage of medications, including cancer drugs.

Health systems have also dealt with unexpected shortages of other basic supplies. This year, hospitals have grappled with 

The IV shortage also echoes another disruption of supplies two years ago, when health systems grappled with 

a shortage of contrast dye used in medical imaging

. In 2022, hospitals had to conserve supplies of dye after a GE Healthcare plant based in Shanghai, a major supplier of contrast dye, was closed because the city was shut down for weeks due to a spike in COVID-19 cases.

Health systems are seeing shortages because flooding from Helene has closed a key plant in North Carolina. The American Hospital Association wants help from the White House.

Hospitals are facing IV fluid shortage, and some are postponing surgeries

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Steve Mackin, president and CEO of Mercy, confesses that he’s still a bit astonished when he heard the commitment of Alice Walton.

“I guess I still have to wake up a little bit,” he says.

Mercy, a large nonprofit hospital system, and the Alice L. Walton Foundation last week announced a $700 million, 30-year partnership to improve access to healthcare. The foundation has pledged $350 million, with Mercy also investing $350 million into the wide-ranging initiative to improve healthcare access and outcomes.

The partnership also includes the Heartland Whole Health Institute, founded by Alice Walton, and the Cleveland Clinic, which will be contributing to the expansion of cardiovascular services.

Mackin and Walter Harris, president and CEO of Heartland, spoke with Chief Healthcare Executive® last week to talk about the effort. 

(See part of our conversation in this video. The story continues below.)

Leaders talk about the $700M initiative to improve healthcare in Arkansas and beyond

Mercy, Alice Walton Foundation team up to improve healthcare

Both Mackin and Harris lauded the commitment of Alice Walton, the philanthropist and daughter of Walmart founder Sam Walton. They say she’s driven and passionate about the need to change healthcare, both in Arkansas and nationwide. 

When Harris heard of Walton’s plan to commit $350 million to the effort, he said his initial thought was simply, “Let’s go.”

“When Alice makes her mind up and she makes a commitment, there's no turning back,” he says. “We move forward.”

Heartland Whole Health Institute hopes $700M partnership makes national impact

While Mercy and Heartland leader’s hope to produce successes that can be adopted on a larger scale, much of the focus aims on improving healthcare in northwest Arkansas. They’re aiming to develop expanded offerings in primary and specialty care, more surgical capabilities, and additional outpatient facilities.

The plans call for the development of a new cardiac care center on Mercy’s campus in Rogers, Arkansas.

Cleveland Clinic, a leader in cardiovascular care, will bring its expertise to the cardiac care center, and officials tout the potential of improved and innovative treatments. Mackin says Mercy will

“We appreciate and honor just the level of intensity that Cleveland Clinic brings specifically to cardiovascular care,” Mackin says. “When you visit their centers, there's a level of detail that they put into their patient care, their technologies and their operations, and to be able to tap into that insight and integrate that into a community-based setting is going to be a great thing for the Northwest Arkansas community.”

Harris says Cleveland Clinic’s expertise and reputation will strengthen their efforts in raising the level of cardiac care.

The partnership includes the Heartland Whole Health Institute and the Cleveland Clinic. Steve Mackin of Mercy and Walter Harris of Heartland talk about the ambitious plans.

David Mafe

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