Vaccinating your facility against the Y2K bug - includes related article on insurance industry's policy on Y2K coverage - preparing healthcare facilities for the year 2000 date change problem

Nursing Homes, Oct, 1999 by Matthew Murer

LIMITING YOUR LEGAL LIABILITY

There's still time - but have you taken these steps yet?

It's New Year's Eve and the new millennium is bearing down on you and your facility. The weather is bad outside, staff have called in sick, families are being demanding, and you were supposed to have left the building two hours ago. You ask yourself if it can get any worse.

Of course the answer is yes. The facility elevator stops between floors, IV pumps stop for no apparent reason, heart monitor alarms go off without cause and the facility's fiscal intermediary's computer just began rejecting all of your Medicare claims. Physicians can't be contacted for emergencies, the pharmacy is not delivering all of the necessary prescriptions, and you still haven't bought your last holiday gift.

Could this nightmare happen? Maybe. Unfortunately, no one knows the full extent of the crisis that Y2K could bring us. It could be the biggest nonevent of the century, or it could test the nation's healthcare infrastructure. The answer probably lies somewhere between these two extremes.

Do nursing home and long-term care facility operators need to be concerned about Y2K? If recent data concerning the industry's preparedness are any indication, the answer is a resounding yes. A recent study by the Office of the Inspector General found that the readiness of nearly 80% of long-term care facilities to deal with Y2K issues is unknown. While this lack of knowledge of the industry's readiness does not guarantee a crisis, other figures indicate that providers should be concerned. A recent survey conducted by Rx2000 found that 62% of all healthcare organizations nationwide have already experienced Y2K problems. A recent Senate report found that 60% of hospitals and 90% of physicians had done nothing to prepare for Y2K issues.

The lack of interest on the part of healthcare providers is certainly not caused by a lack of information. The media, consultants and Congress have been warning of a coming crisis in healthcare for the past 18 months. Even the Health Care Financing Administration (HCFA) went so far as to send 1.1 million letters to hospitals, doctors, nursing homes and other providers regarding Y2K issues. HCFA also sponsored several Y2K conferences throughout the country and set up an 800 hotline to provide advice on fixing computer systems. Unfortunately, only 2% of the estimated 10,000 providers invited to the conferences attended (at a recent conference in Las Vegas, only 25 healthcare providers attended, with only one long-term care provider among them), and fewer than 1% of providers have actually used the hotline.

Perhaps a crisis-management mentality prevents providers from taking the Y2K threat too seriously - or it could be that providers are so used to getting bad news from the federal government about programs that end up being implemented two years late that no provider can believe that Y2K will show up on schedule. Despite providers' malaise, HCFA has taken significant steps to address the Y2K issue, including spending more than $200 million to test mission-critical systems, both in-house and the intermediaries'. In one test of an intermediary and more than 400 providers, HCFA encountered problems with 28% of the claims. HCFA now claims that it has completed its work and everything looks fine. Joseph Broseker, HCFA's Y2K coordinator, recently stated "If providers get claims to us, they will get paid." Broseker also stated that claims processing "should be no worse than what you have normally experienced over the years." So if HCFA has its house in order, how does yours look?

While January 1, 2000, is right around the corner, there are still many steps you can take to reduce your liability and eliminate potential headaches. Your first responsibility is to identify where potential problems can arise. For long-term care providers, these problems fall into three areas: facility infrastructure, patient care and reimbursement. These areas overlap and impact each other and, just as a problem in one area will negatively affect another, a contingency plan in one area will often benefit the others.

Facility Infrastructure. One scenario that consultants and analysts have suggested as a possibility is a loss of power and support services. Is your facility prepared to operate without outside power, phones or other support? For many facilities a loss of power is the easiest to address, since most facilities are required to maintain an emergency generator that must be tested regularly. A full review of your emergency power capabilities now might save you some pandemonium in January. Key questions providers should ask are:

If your facility has an emergency generator, what systems are tied to it?

Are all critical support systems tied into the emergency power source, or is a reconfiguration necessary?

What devices or equipment must continue to receive power? All staff should be aware of this critical equipment.

Do you have cellular phones in the facility in case your phone system is knocked out? Would staff know who has such a backup?