Thoughts on Recent CMS Proposal

The following comments apply only to hospitals as described in Table 18 on page 79176 of the Federal Register. These comments were mailed on February 24 to the Center for Medicare and Medicaid Services (CMS) and Environmental Protection Agency (EPA).

We have not seen any empirical evidence demonstrating that increased testing of emergency power supply systems (EPSS) over and above what has been approved for inclusion in the consensus-based standard, NFPA 110, Emergency and Standby Power Systems, would improve reliability during power outages. With the lack of such evidence, we cannot comprehend how this increased testing would increase patient safety. On the other hand, it is a proven fact that whenever loads are switched from electric utility power to emergency power — and then back to the electric utility source as required by this proposal — there is an increased chance of anomalies and failures.

To form the basis for their consensus-based standard, the members of NFPA 110 Technical Committee expended considerable effort interviewing service companies and manufacturers to gather information and data about the minimum requirements to assure reliability of EPSS components. Their objective was to construct a minimum protocol that could be used by mission critical facilities. The result of this research was the triennial 4-hr test at 30% of nameplate rating, with transfer of all automatic transfer switches (ATSs). Unless the CMS can present data to show increased testing would have benefit, logic argues that the existing standard’s criteria should be accepted as sufficient for reliability and patient safety.

Note: EPSS failures during the last three major hurricanes were not the result of inadequate testing.

The CMS proposal certainly carries serious ramifications. The first is cost. The revenues required to conduct two additional annual tests, in addition to the triennial test now required by NFPA 110, will exceed $26,663,757 — not the $4,509,862 figure mentioned on page 79174, when taking into account only fuel cost and staff time. These figures DO NOT include the use of outside labor when the hospital must bring in a load bank to conduct a “LOADED” test. These expenses, according to our documented evidence, could exceed another $8,000,000. None of these expenditures are reimbursable by the CMS.

A second consequence of this proposal is the effect on the equipment itself. If the generator tests are conducted with no load, as the proposal is now written, the result will be an exacerbated “wet stacking” condition of the diesel gen-sets (99.2% of on-site generators are diesel vs. natural gas) that could very well damage the engines — a fact that can be verified by contacting the engine manufacturers. Testing the generators with load is of paramount importance.

The environmental impact of increased testing would be enormous. The combined testing of all acute care facility generators would result in 9,874,135kW being generated by diesel engines for 4 hr every 12 months. The exact amounts of emissions can be calculated using the tables found at http://www.epa.gov/ttn/chief/ap42/ch03/final/c03s04.pdf. Did the CMS contact the EPA for input before crafting the proposal? I would be interested in EPA’s response, as they limited testing with their Final Rule on June 28, 2006.

In addition, facilities in “non-attainment” areas, such as Atlanta and Houston, will have difficulty conducting these tests without violating local ordinances.

My background of more than 40 years of testing and maintaining 10,000+ generators and EPSSs in health care facilities and data centers have made me a believer that a “well-tested EPSS is a healthy EPSS.” The question becomes, “What is the minimum time and frequency an EPSS should be exercised to guarantee reliability?” I submit that the answer is not universal and that different combinations of EPSS components dictate the protocol. One size does not fit all. With this said, the NFPA 110 standard at 8.4.9 states the consensus of industry experts.

I would be more than happy to assist and supply the CMS with documented data/evidence.

Note: The CMS has extended its deadline for receiving public comments on the proposed rule until March 31. There have been several comments made already, but as you know, volume speaks loudly. No matter how brief your comment, we encourage everyone to make themselves heard. See: http://www.regulations.gov/#!docketBrowser;rpp=25;po=0;D=CMS-2013-0269;dct=PS.  According to the CMS, they extended the comment period to March 31 after receiving requests from some providers asking for additional time to submit comments.

Chisholm, president of MGI Consulting, Orlando, Fla., has provided emergency power supply systems (EPSS) consulting services and education to more than 1,500 health care facilities. He serves as a member of the National Fire Protection Association's Technical Committee responsible for NFPA 110, Emergency and Standby Power Systems and the Electrical Section of NFPA 99, Health Care Facilities. He also serves as a primary emergency power consultant to the U.S. Army Medical Department (AMEDD) and the Department of Defense.

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