A rapidly intensifying Hurricane Milton has Florida and its healthcare providers gearing up for another severe weather event less than two weeks after similar preparations for Hurricane Helene.
As of midday Tuesday, over 200 healthcare facilities, including 12 hospitals and freestanding hospital emergency departments, have initiated evacuations, officials and the Florida Hospital Association said. The evacuations are primarily focused in Florida's Pinellas and Hillsborough counties, which include St. Petersburg and Tampa.
"The challenge as a result of Helene is that those areas that are likely to be significantly impacted by Milton are still contending with debris everywhere, the sand and other debris clogging drains," Mary Mayhew, president and CEO of the Florida Hospital Association, told Fierce Healthcare Tuesday. "Milton is forecasted to have a significant surge along the coast and a volume of rain, so the vulnerability to extreme flooding is significant."
Hurricane Milton jumped ahead of weekend forecasts when it strengthened to a Category 5 storm in the Gulf of Mexico midday Monday, according to the National Weather Service.
It is expected to drop to a strong Category 3 by the time it makes landfall late Wednesday or early Thursday near Tampa—still “a very large and powerful hurricane … with life-threatening hazards at the coastline and well inland,” the service warned. Unlike September’s Hurricane Helene, which brought destruction to the states north of Florida, it is projected to move east through Florida and out to the Atlantic.
While a strong storm in its own respect, the short turnaround from Helene has officials worried that saturated groundwater, strained infrastructure and, in particular, uncleared debris could compound the damage.
“That creates a huge hazard,” Florida Gov. Ron DeSantis, who signed a state of emergency declaration for 51 counties, said during a Monday afternoon press conference.
During Monday and Tuesday addresses, the governor noted that the state was prioritizing hospitals alongside other critical infrastructure, and had recently coordinated the construction of a flood wall around an unnamed hospital.
Florida’s Department of Health has deployed almost 600 emergency response vehicles, including more than 350 ambulances on hand to support first responders, officials said.
Florida’s Agency for Health Care Administration (AHCA) said it is conducting daily calls with the Florida Hospital Association and Florida Healthcare Association alongside other emergency event reporting procedures. The groups had relied on similar coordination efforts leading up to Helene, during which a total of six hospitals across the state were forced to evacuate patients.
As of Tuesday morning, AHCA said it had received reports of 212 healthcare facility evacuations, including 10 hospitals, two freestanding hospital emergency departments, 115 assisted living facilities and 50 nursing homes.
AHCA has also made nearly 700 phone calls to providers ahead of the storm's landfall, and said it has "waived all prior authorization requirements for critical Medicaid."
Fortunately, Mayhew said that the state's hospitals had not suffered "any significant damage to their physical plant" as a result of September's Helene, which she credited to comprehensive investments in flood mitigation systems, electrical infrastructure and other areas.
However, the homes of many hospital employees living in Helene's path were affected, "and so certainly the ability to staff and support our employees is critically important as we brace for Milton."
Additionally, Mayhew noted that hospitals are already dealing with a shortage of IV solutions after a plant supplying over 60% of the country's supply was shut down by Helene. Further disruptions are "clearly part of the equation for concern if this storm compounds access to those supplies or any other critical hospital supply," such as fuel for hospital generators, she said.
Preparations to minimize disruptions in patient care are a priority at the moment, but Mayhew acknowledged that much of the hospitals and her group's work will come in Milton's wake.
"One of the roles we seek to play as an association is gathering real-time data and information to inform areas of need and opportunities for engagement and coordination among our hospitals in response to emergencies," she explained.
The could relate to transferring patients if a facility is damaged, coordinating supplies and picking up the slack for community-level care.
"The impact on retail pharmacies, on assisted living facilities, is critically important," she said. "We've had hospitals that have had to fulfill that role, that have a retail pharmacy license when the local retail pharmacy was offline. There are patients in our hospitals that may be ready for discharge back to their assisted living facility, and yet that assisted living facility is no longer functional because of the impact of the storm. All of that will be part of the equation as we respond and as we recover."
The work extends to regulatory and administrative issues that could become barriers to care immediately and in the weeks following a disaster, Mayhew continued.
The association will work with the state's health agency to request certain flexibilities "primarily from the Centers for Medicare and Medicaid services related to patient care," she said. That said, in Florida much of Medicare and Medicaid is administered by private insurers, she explained, leaving state and federal government agencies "limited authority to require these private insurance companies to adhere to important flexibilities" like prior authorization.
The Florida Hospital Association will make its case to these private insurers, though Mayhew said that a warm response isn't guaranteed.
"I would love to say that this has been readily embraced by insurers, but that has not always been the case," she said. "We will certainly work closely with them to ensure not only that it it is embraced, but that they are communicating with our hospitals related to these flexibilities."
Also on the table would be accelerated and advanced payments, which could help hospitals avoid a cash flow issue that impedes care. Such assistance was authorized by the federal government last week for those reeling from Helene's damages.
In regard to Milton, "until that is specifically requested or guidance provided by the state and the federal government, I don't expect that we will see that," Mayhew said. "But again, [as] we understand the full impact of the storm and how long it may disrupt operations and impact revenue, we certainly may seek that assistance."
HCA Florida Healthcare, the 48-hospital subsidiary system of for-profit giant HCA Healthcare, told Fierce Healthcare Tuesday it was “actively working” to transfer patients from five of its most threatened hospitals to other sister facilities.
These hospitals include HCA Florida Englewood Hospital, HCA Florida Fawcett Hospital, HCA Florida Largo West Hospital, HCA Florida West Tampa Hospital and HCA Florida Pasadena Hospital—the latter of which required several days to bring patients back in during the wake of Helene.
HCA Florida’s other preparations are being quarterbacked by its Enterprise Emergency Operations Center in Nashville, which has an almost-200-person multi-disciplinary team "ensuring our hospitals have enough staff, medications, supplies, food, water and generator power to continue to operate and care for our patients during and after the storm,” it said in a statement.
Pinellas County, which is a peninsula located on the western side of Tampa Bay, has given evacuation orders for residential healthcare facilities in the majority of its evacuation zones. Hillsborough County, which contains Tampa, has also issued mandatory evacuation notices for multiple evacuation zones.
Tampa General Hospital, the region’s only Level I Trauma Center, wrote in a Tuesday morning update that its hospitals will remain open and "as we demonstrated with Hurricane Helene" are prepared to handle an emergency.
The organization said it has activated its emergency response plan and “stands ready to meet the needs of patients throughout the state who require care after the storm has passed.” Much like during Helene, those preparations include a central energy plant built to withstand a Category 5 hurricane, supply stores and an “AquaFence” barrier able to withstand up to 15-foot storm surges. Several other outpatient and clinic locations will be closed from Tuesday to Thursday.
BayCare said it initiated an evacuation of its Morton Plant North Bay Hospital on Monday morning, and that elective procedures elsewhere have been canceled for Wednesday and Thursday. It also will be offering one free telehealth visit for anyone using its BayCareAnywhere app (using the coupon code "MILTON").
James A. Haley Veterans' Hospital, in Tampa, and all of its affiliated outpatient clinics will be closed for in-person appointments and elective surgeries from Tuesday to Wednesday.
Other Florida health systems like AdventHealth and UF Health said their hospitals remain open but that some operations and service offerings may change as they monitor the hurricane’s development.
