electronic health records (EHRs) allows providers to earn incentive payments, and increases the functionality of their EHR systems. The Affordable Care Act does not address preparedness per se, but the Medicaid parity to Medicare provision does allow for higher Medicaid payment rates, which could create more possibilities for preparedness. The patient-centered medical home model of care fulfills many of the criteria for disaster-based capabilities. Finally, accountable care organizations are moving health care toward a value-based continuum of care, which also means a shift toward population-based or community pediatric care, creating the potential to help many more children, Needle said. It also provides the opportunities for collaboration, networking, and data collection.

Other opportunities include community coalitions, and networks to share resources and create economies of scale. Needle also suggested recovery memoranda of understanding or contracts that could pass on Stafford Act disaster recovery funds to office-based practices, perhaps similar to how for-profit debris removal services are contracted by the state for disaster services.

Bruce Clements of the Texas Department of State Health Services raised an additional financial issue for private providers. He relayed the concerns of a private provider following Hurricane Katrina who felt that the disaster clinics were putting the provider out of business. States are good at quickly deploying resources when needed, but deciding when is the right time to demobilize medical assets post-disaster is a very difficult decision, Clements said. It is a delicate balance between supporting the community and threatening the current infrastructure. Needle concurred noting that the free clinics were often the only source of care in the first few days to weeks after Hurricane Katrina. But as time went on, patients wondered why they should pay a $20 copay at their providers office when they can go to the free clinic instead. Experience from Haiti and other disasters shows that staying too long can set up this care conflict and actually undermine the self-sufficiency of the local health care system. Needle suggested the need for a regional health care coordinator: someone who could coordinate and assess the health care situation from the integrated system as a whole, and better define current needs. Moving forward, coordinating the needs of children through private practice providers, private insurers, hospitals, and federal-level policy makers could help to alleviate the disjointed framework that currently plagues reimbursement and finance for children’s care after disasters.



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