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Federal Flu Fighters


Experts say that a pandemic flu outbreak will hit the United States—a pandemic large enough to stretch our healthcare resources to the breaking point and overwhelm hospitals.

“They say it’s not if, but when,” says James C. Pile, MD, FACP, Division of Hospital Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, an infectious diseases specialist with a longstanding interest in bioterrorism/pandemic preparedness, and former editor of The Hospitalist.

Your Government at Work

The federal government is taking a lead role in preparing for this outbreak or outbreaks. President George W. Bush issued a National Strategy for Pandemic Influenza in November 2005, which focuses on measures to slow or stop the spread of a pandemic flu and on “sustaining infrastructure and mitigating impact to the economy and the functioning of society.”

That strategy charges the Department of Health and Human Services (HHS) with leading federal pandemic preparedness. The HHS is working with state and local agencies on planning and has made $600 million available for state and local preparedness efforts, including the exercising of pandemic plans across communities and at all levels of government.

Total congressional funding for pandemic flu preparedness, says Dr. Pile, is “somewhere in the neighborhood of $5 billion dollars.”

Policy Points

It Pays to Be on Medicare

According to a new study released by the healthcare ratings firm HealthGrades, hospital patients on Medicare who were treated at hospitals ranked in the top 5% nationwide have almost a one-third better chance of surviving than patients admitted to other hospitals. The study focused on patients admitted to top-rated hospitals for various procedures and diagnoses, including cardiac surgery, angioplasty and stent, and heart attack and heart failure. The study also found that patients who underwent surgery at these hospitals had a 5% lower risk of complications.


CMS Declares Pay-for-Performance Trial a Success

The first national pay-for-performance trial launched by Medicare has been declared a success. Hospitals participating in the Premier Hospital Quality Improvement Demonstration reported significant improvement in quality of care across five clinical focus areas, measured by more than 30 standardized quality indicators. More than 250 hospitals participated in the demonstration project, and the average improvement in performance in the project’s second year was 6.7 percentage points, for total gains of 11.8 percentage points over the project’s first two years.

Source: Medicare News press release, 1/26/07

House Law Would Require Price Negotiations for Medicare Drugs

On January 12, 2007, just days after the new Congress convened, the House of Representatives voted 255-170 to require HHS to negotiate with pharmaceutical companies over prices for prescription drugs covered by Medicare Part D. H.R. 4, the Medicare Prescription Drug Price Negotiation Act of 2007, would repeal a provision in the current law that prohibits negotiating with drug makers. President Bush has threatened to veto the bill.

Sources: Modern Healthcare Alert from 1/12/07 and =com_content&task=view&id=742&Itemid=

A Working Plan

In May 2006, President Bush released the Implementation Plan for the National Strategy, which stipulates more than 300 actions for federal departments and agencies and sets clear expectations for state and local governments. It also provides guidance for all federal departments and agencies on the development of their own plans.

The latest update on the Implementation Plan (released in December 2006) lists dozens of action items, including:

  • The Department of Homeland Security will provide emergency response element training (e.g., incident management, triage, security, and communications) and provide assistance, when requested, to state, local, and public health entities within six months.
  • HHS will work with state and local governments to develop protocols for the distribution of critical medical materials such as ventilators in times of medical emergency, also within six months.
  • HHS will prepare guidance for local Medical Reserve Corps coordinators describing the role of the Corps during a pandemic. The Medical Reserve Corps comprises teams of local volunteer medical and public health professionals who can contribute their skills and expertise during times of need.

For the latest details on the Implementation Plan and the status of these and other action items, visit

Federal, State, and Local–A­­ Crucial Mix

In addition to providing overall planning and support, says Dr. Pile, “the federal government will also be responsible for helping to supply assets to states and regions that may be overwhelmed” during a pandemic flu outbreak.

Specifically, the government oversees the Strategic National Stockpile (SNS) program, which manages large quantities of medicine and medical supplies. These materials are stockpiled, ready to use in the event of a public health emergency. When federal and local authorities agree that the SNS is needed, supplies will be delivered to any state within 12 hours. Each state has plans to distribute so-called push packs of medicine and medical supplies to affected communities as quickly as possible.

“I’m not sure the federal government will be able to reliably deliver these push packs in a timely manner in the event of a severe, multi-state pandemic,” says Dr. Pile. “During Hurricane Katrina, which certainly posed challenges different from a pandemic flu outbreak but also included a number of similarities, we saw the struggle of the national government to react quickly.” He believes that the stockpiles may not be adequate in a worst-case scenario, such as a pandemic flu on the scale of the 1918 flu epidemic.

“It’s clear there just aren’t enough mechanical ventilators in the country to provide adequate surge capacity in the event of a severe pandemic, with best estimates of 80,000 to 105,000 ventilators nationally, most of which are in use at any given time,” he says.

Another issue is how much help the federal government can actually provide in the event of a pandemic flu. “Some government agencies and individuals have stressed that if there is a really catastrophic national influenza pandemic, the cavalry is not necessarily going to be coming,” says Dr. Pile. “Individual hospitals and regions will very possibly need to rely on their intrinsic resources, at least initially.”

So when a pandemic flu outbreak begins, where can hospitals find support? “HHS will take the lead role at the federal level,” says Dr. Pile. “State departments of health will oversee the response for each state. And at the city and municipal level, it will vary.”

The Role of Hospitalists

At this point, while all levels of government are still shaping plans for handling pandemic flu, what should hospitalists do?

“Hopefully, they’re involved in planning within their own institutions and regionally,” says Dr. Pile. “If not, that’s a great role for them. However, a lot of the people involved in [pandemic flu response] planning are not familiar with hospitalists.”

Woodruff J. English II, MD, hospitalist and co-director of Hospitalist Program, Providence St. Vincent Medical Center, Portland, Ore., is in charge of emergency preparedness, including pandemic flu, for his institution. He worked with his state department of health and the CDC. After conducting a tabletop exercise, Providence St. Vincent Medical Center has a plan in place that includes a number of tents that can set up as triage space for admitting and screening patients, plans to secure the hospital against riots and looters, staffing issues, and much more. “We’re figuring out what questions to ask; I wouldn’t say we’re prepared,” says Dr. English. “We’re taking a careful look at how we do business.”

When a pandemic flu outbreak does occur, hospitalists throughout affected areas will definitely be involved.

“They’d play a front and center role,” speculates Dr. Pile. “Critical care would be rolled out of the critical care unit into other areas of the hospital. Clearly, there wouldn’t be enough critical care physicians, so hospitalists would have to step in.”

At this stage of the government’s Implementation Plan, your hospital medicine program may be called upon to help create your hospital’s preparedness plan for pandemic flu. If you haven’t been asked, check with your director or administrator to see if such a plan exists, perhaps as part of a general emergency preparedness plan.

With the support of the federal and state government, your hospital should be able to take some steps toward preparing for a major outbreak of pandemic flu. TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

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