Health care organizations search for a cure for the millennium bug
Here’s expert advice for fixing your Y2K woes
Case managers are in a uniquely uncomfortable position as the calendar continues to move relentlessly toward Jan. 1, 2000. The newspaper headlines and the nightly news reports are flooded with predictions of system failures the so-called millennium bug may cause. And, because of the many data gathering, contracting, coordination, and communication activities that are daily fare for most case managers, the sheer number of vendors, providers, and systems that must be checked for year 2000 (Y2K) compliance is daunting at best.
The term millennium bug refers to a host of problems that some computer programs and systems, as well as durable medical equipment, machinery, and computerized processes, may experience starting Jan. 1, 2000. Many computer programs use two-digit date codes. For example, they read "98" for 1998. When 2000 arrives, these programs will read the "00" as 1900. Any program that relies on date differences for the calculation of ages or time periods may falter or even crash when the clock strikes midnight on Dec. 31, 1999.
Jeff Bonham, MBA, vice president of the Marion,IL, consulting firm Medicare Training & Consulting, says the focus of agencies he works with — both as a consultant and as a director of the Illinois Home Care Council — is that there is more to be concerned about than whether your computer system will crash. "And even systems that don’t crash may produce flawed data. It’s important that people realize that any analysis or spreadsheet they run will be flawed unless someone goes back in and puts in four-digit dates."
Others agree that computer systems are just one component of the Y2K problem. For example, medical devices that use computer chips, such as IV drips, heart defibrillators, blood gas analyzers, and dialysis machines equipped with safety features requiring periodic service, may suddenly stop working on Jan. 1, 2000, because they "think" a hundred years have passed since the last calibration, explains Albert W. Shay, a partner with Sonnenschein, Nath & Rosenthal’s Washington, DC, office and a member of the law firm’s Y2K task force.
"The other very real scenario is that the machine continues to function but gives bad data," Shay says. "This is a more insidious problem. The health care system has become very reliant on technology, and most of that technology uses embedded, date-sensitive computer chips built into them which may fail. We tell clinicians that they must empower themselves to use their own clinical judgment. If a reading seems out of line, don’t accept it. Measure it by another means." (See Y2K test plan, p. 5, for ideas on testing your own systems.)
In addition to equipment failures directly linked to patients, there are many medical decisions physicians, case managers, and other clinicians make that depend on accurate information, Shay says. For example, computer systems may use a patient’s age to determine normal or abnormal test results, or a patient’s age may be critical for determining correct medication dosages or dosages for radiation therapies.
How do you determine what’s worth worrying about, and how should you assess Y2K exposure? Here is some advice from attorneys, consultants, and health care executives who already have started the process:
1. Create an action plan. Before you start checking systems, you should sit down and create an action plan. Not only will this give you a road map to follow, but it could serve as proof that you took reasonable care to protect your business and your clients from harm should litigation arise from a Y2K system problem. (For more on the legal liabilities your agency might face, see story, p. 7.)
Larry Leahy, CHE, CHCE, MHA, is director of program integrity at Ruth Constant & Associates, a Victoria, TX, company that owns three home health agencies. He only recently started preparing for Y2K. One of his computer equipment vendors ran a free Y2K audit. "We knew we weren’t going to be compliant," he says, noting that the agency had planned to upgrade or buy new and compliant systems in 1998 but didn’t because of budgetary constraints.
After the vendor finished the audit, it developed a plan to bring Ruth Constant into compliance, says Leahy. "Our focus has been on internal operations, billing, and scheduling." Part of the solution will be a new operating system that allows seamless data input from start of service through billing and payroll. That will eliminate problems the current proprietary scheduling system and separate billing program could cause.
Written statements are not enough
Highly specialized, industry-specific software products, such as case management software, are most likely to be vulnerable to Y2K problems, adds Greg Cirillo, a partner with the Washington, DC, law firm of Williams, Mullen, Christian and Dobbins. "And you can’t assume that just because a software product is relatively new it must be Y2K compliant. If a product was developed more than 12 months ago, I would check it out thoroughly," he says.
Leahy also plans to determine compliance with the companies with which Ruth Constant does business. He sent out letters asking them to state whether they, the goods they produce, or the services they supply will be affected by Y2K, and if so, what they are doing to remedy the problems and when they will be compliant.
However, Y2K consultants caution that written statements of compliance are not enough. "If it’s a vendor or provider you depend on in your practice, demand that they demonstrate’ not simply state’ their Y2K compliance, advises Sandra Bell, an Atlanta-based attorney and Y2K consultant.
In addition, if a vendor is essential to your operations, consider a face-to-face meeting to discuss Y2K compliance, suggests Cirillo. "You should have a sliding scale based on how integral a vendor is to your daily operations. For some vendors, a telephone call or letter confirming their Y2K compliance may be satisfactory. For other vendors, a meeting may be necessary. And no matter what you are told about a product’s or system’s functionality on Jan. 1, 2000, you still have to run your own tests."
In addition, if a vendor or provider reports concerns about Y2K compliance or reports that they’re still working on a troubling Y2K problem, case managers should consider using someone else, advises John Gilliland, JD, of the law firm Gilliland & Associates in the Cincinnati suburb of Crestview Hills, KY.
Leahy is checking Ruth Constant’s communications system, which is a key area. "Everyone in home care depends on cell phones and pagers," he says. "We are talking to phone companies, our stationary phone system providers, our cell phone companies, and pager providers to find out where they stand. If those systems go down, we have to find an alternative form of communications," he says. That alternative plan will be included not just in the Y2K program, but also in Ruth Constant’s emergency plan.
In addition, he has contacted the power company to see whether it is prepared. "If we have a patient on oxygen and power goes off, we have a problem," he says. So far, the utilities have calmed his fears.
An Atlanta-based Y2K group to which Bell belongs has spent several months unsuccessfully attempting to get Y2K compliance information from Atlanta-area utilities, she says. "We have a utilities subcommittee that has been calling and writing the utilities on a daily basis. Hospitals and other health care providers cannot function without utilities. There are predictions of nationwide utility outages that last anywhere from a few days to a few months," she explains. "Do you have a contingency plan for operating without water or electricity?" Holiday Inns of America, for example, has developed an aggressive contingency plan that includes digging wells at many locations because the hotel chain doesn’t believe the water supply is going to be dependable, she adds.
2. Assess your exposure. Joe Cortese, director of management information systems at Montefiore Medical Center Home Health in Bronx, NY, largely has completed the systems upgrades his agency needs to comply with Y2K. He says he received help from the agency’s affiliated hospital and his colleagues in deciding what to put on his checklist. Such networking can be key in finding programs, machines, and systems you might not otherwise think to check. (An equipment checklist appears on p. 6.)
One area of concern is whether your organization can survive the millennium bug’s financial impact. "From my standpoint, the financial aspect is most important," says Bonham. "You have to worry if you will have access to funds you have in the bank, whether your payroll program will run."
There also is the big question of whether payments will come in on time. The Health Care Financing Administration (HCFA) in Baltimore has announced that its systems are not Y2K- com pliant. This could be particularly troublesome for health plans with Medicare and Medicaid product lines. Financially, you should consider whether and how you will survive if you are cut off from funding for three to four months, Bonham advises.
Frail elderly are at-risk
If you work as a case manager in a home health agency, rehabilitation hospital, skilled nursing facility, or tertiary care hospital with a high percentage of Medicare or Medicaid patients, you should consider building reserves between now and Jan. 1, 2000, Bonham says. "You may have some salvation if you live in a market where you can diversify now, bring down your reliance on Medicare and start doing work that is paid for from other sources. If the market is there, that might also give you a better chance."
Leahy agrees cash flow is a potential problem. "If the HCFA system crashes, then the checks stop coming," he says. "We get electronic deposits every two weeks. We have to look at our lines of credit to ensure we can keep going." He is less worried about fund disbursement from private sources and the state of Texas, which make up about 35% of Ruth Constant’s business.
He also says the company’s relationship with the local bank will stand him in better stead in any kind of fiscal crunch than if Ruth Constant banked with a big national player. (For more on where HCFA stands on Y2K compliance, see p. 9.)
However, even other payers have concerns about HCFA’s failure to update its systems. GuideStar Health Systems in Birmingham, AL, has elderly members who depend on Medicare as their primary insurance. "We pay what HCFA doesn’t cover for these patients. We can’t make payment until HCFA pays. If HCFA doesn’t pay, we can’t pay," says Karen Chambers Knight, RN, CCM, CDMS, director of utilization management for GuideStar. "I’m wondering whether providers will continue to provide care if Medicare fails to pay. In addition, these members receive food stamps and other benefits they depend on. I’m wondering if they’ll develop nutrition problems or be unable to have their prescriptions filled. Even if payments and benefits are only delayed for one to two weeks, it could be critical for the frail elderly."
The risk to patients is as important as your financial risk, Cortese says. He suggests that one of your first assessments should be of any equipment that has direct contact with patients or impact on patient care. "If a patient gets sick, or worse, if the equipment stops working, that should be a big priority for you," he says.
In addition to equipment failures, Bell notes that distribution systems may fail. "I consult with many physician practices and tell my clients that they should stock at least six months’ supply of any product or drug that is essential to their practices," she says. "Most people don’t realize that distribution tracking and monitoring systems are run by satellites, which may fail and prevent products from being delivered."
Did your supplies arrive?
GuideStar Health Systems plans to track whether patients who have supplies delivered to their homes receive them as scheduled during the first few months of 2000, notes Chambers Knight. "We have patients who have supplies sent out on a monthly basis. There are also patients who rely on deliveries from mail order pharmacies. We are identifying those patients with critical needs. We plan to keep a list of those patients for whom it’s critical that supplies are delivered on schedule and track whether those supplies arrive. The list will have to be continually revised based on current acuity as we move closer to the year 2000," she says. "Luckily, our system allows us to track scheduled deliveries."
You also will want to look at the less vital aspects of your business, such as your scheduling system. If any of your systems are proprietary, you need to ask the developer or programmer if they’re Y2K-compliant. If you can’t locate that person, says Cortese, contact one of the many consultants who can evaluate and modify what you have. But don’t forget to ask for references. "There are consultants and technical testing companies all over the Internet. These people are coming out of the woodwork. Ask for references and check them before you hire a Y2K consultant," Cirillo says.
3. Start remediation program. Once you know your risk, you need to create a plan for operating with noncompliant programs. Contingency plans can be simple. For instance, if you are worried about whether your computer payroll program will work, have a checkbook, pen, and calculator at hand, says Bonham. You may even want to consider having enough cash on hand to pay your staff because your bank may not be compliant and may be unable to honor your checks, he notes.
But keep in mind there could be tax liability problems in keeping more cash on hand at the end of the year, Leahy warns. "I think our approach will be to ensure we have good lines of credit that will see us through one quarter."
A fax machine that won’t date stamp your incoming and outgoing faxes automatically can be dealt with by having a manual date stamp on hand. Voice mail systems can include a reminder for callers to include the date and time they called.
Remediation programs also can be complex and involve the purchase of new computer systems, securing a bank loan or line of credit, or trying to change your patient mix so you rely less on Medicare and Medicaid payments.
If you haven’t done anything yet, your first step should be to develop contingencies, says Greg Solecki, vice president of home health care for Henry Ford Health System Home Health in Detroit. "Assume you will go down and develop a plan for that," he says. "Then, with whatever time you have left, go back and attack the issues."
Solecki offers a picture of the future with less gloom and doom than others do. "I think that the worst thing that will happen is that your computer systems will crash. If you have a contingency plan for some sort of manual record keeping, I think you’ll be fine. We were there before, we can do it that way again."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content