Millennium bug: Who’s got the cure?

Here’s expert advice for fixing your agency’s Y2K woes

Everyone has computer problems. Some are merely glitches, requiring nothing more than rebooting the hard drive or calling an 800 number, while others mandate that trained professionals, laden with heavy manuals, shirt pockets full of pens, and boxes of tools render assistance.

However, on Jan. 1, 2000, no computer help line in the world will be able to undo the damage if you haven’t prepared for the year 2000 problem, also known as Y2K and the millennium bug. No matter which designation you choose, the problem is the same. Computer software, systems, and pieces of equipment that perform computerized operations may not be able to recognize the year 2000 date. That’s because most computer programs use two-digit date codes (1998 is written as 98, for example). When the new millennium arrives, in about 13 months, these programs are expected to read 00 not as 2000 but as the year 1900. Any program or system that relies on dates to perform certain functions, such as calculating ages or time periods or payroll, is at risk of faltering or even crashing when the clock strikes midnight on Jan. 1, 2000.

Unlike computer viruses, which in most cases respond to anti-virus programs, there is no simple cure for the Y2K bug. What’s more, depending on the nature of the problem, there may be no solution other than replacing the computer system or equipment with something that is Y2K-compliant.

Who’s on first?

While for the owners and management of freestanding home health agencies the line of responsibility for handling Y2K compliance is clear, this is not true for hospital-affiliated agencies. Who is in charge of determining Y2K’s potential impact and implementing a response plan? Is it the hospital’s administration? Is it the home health agency’s executive director? Is the information service (IS) department responsible? If so, is it the agency or the corporate IS department?

"It scares me that there will be people who sit back and assume Y2K compliance will be taken care of," says Greg Solecki, vice president of home health care for Henry Ford Health System Home Health in Detroit. "It’s impossible because there just aren’t enough resources. The belief, and one of the negative byproducts of system thinking, is that someone else is taking care of this. It gives a false sense of calm and security."

With 24,000 patient admissions in 1998, the Henry Ford system must make sure its employees are working with and not against one another in solving their Y2K issues. "In a freestanding scenario, I would be master of my own destiny," says Solecki. Still, taking the bull by the horns is not a bad idea, he says, referring to the approach he has taken with his agency’s Y2K problems. (See related story, below.)

"I’ve told all my operations managers that they are accountable. If something goes down, it’s your responsibility; don’t blame IS,’" he says. "If our corporate technology support doesn’t help them assess and diagnose the problem and help with the more technical things, we’ll deal with this, but ultimately it’s not the responsibility of home health IS or corporate IS. It’s theirs."

Henry Ford’s corporate management was pleased by Solecki’s approach. In fact, the organization’s chief information officer is putting out memos with the same message: You will be accountable for the success or failure of your area.

Solecki urges system affiliates to make good use of the corporate resources. Henry Ford, for example, formed a Y2K overview committee called the year 2000 operations group on which Solecki serves. "It has helped us to understand which vendors had already been approached because of corporate contracts and which ones hadn’t, so we were able to whittle away at our to-do list," he says. "The group has given us input and advice on how to handle things and how things are progressing."

Race for the cure

Whether freestanding or hospital-affiliated, home health agencies face identical problems in assessing potential areas of trouble and finding solutions. What should you worry about and how should you approach assessing your exposure? (For a list of areas you should check in your agency, see box, at right.) Here are some tips from consultants and home care executives who have already started the process:

1. Create a plan of action.

Before you start checking systems, you should sit down with hospital administrators and IS staff 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. (One agency’s path to compliance is discussed in a related story, p. 178. For more on the legal liabilities your agency might face, see story, p. 181.)

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 the company for Y2K. One of the vendors from whom Leahy purchases computer equipment ran a free companywide Y2K audit. "We knew we weren’t going to be compliant," says Leahy, noting that the agency had planned to upgrade or purchase new and compliant systems in 1998 but didn’t because of budgetary constraints related to the interim payment system.

After the vendor ran the audit, it started developing a plan of action to bring Ruth Constant into compliance, says Leahy. "Our focus has been on internal operations, billing, and scheduling," he says. Next, Leahy will determine compliance with the companies with which Ruth Constant does business. He will start by sending 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.

Hospital-affiliated agencies will do well to cross-check their vendor lists with their hospital’s to avoid duplication of efforts. With any luck you may find, just as Solecki did, that some vendors are taken care of under your hospital’s contract.

One key area Leahy will check is Ruth Constant’s communications system. "Everyone in home care is dependent 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," he says. That alternative plan will be included not just in the Y2K program, but also in the emergency plan for the agencies.

Leahy also 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 assuaged Leahy’s fears.

2. Assess your exposure.

Joe Cortese, director of MIS at Montefiore Medical Center Home Health in Bronx, NY, has largely completed the systems upgrades his agency needs to comply with Y2K. He says he received a lot of help from the hospital and his colleagues in deciding what to put on his checklist. Such networking can be key in finding programs, machines, and systems that you might not otherwise think to check.

Indeed, there is more to look at than the computer system in your office. One area of concern is whether you can survive the Y2K’s financial impact. "From my standpoint, the financial aspect is most important," says Jeff Bonham, MBA, vice president of the Marion-IL consulting firm Medicare Training & Consulting. "You have to worry if you will have access to funds you have in the bank, whether your payroll program will run."

Will your agency get paid?

There is also a big question about whether payments will come in on time, especially Medicare and Medicaid payments. The Health Care Financing Administration (HCFA) in Baltimore has already announced that it is not in compliance for Y2K. Financially, you should consider whether and how you will survive if you are cut off from funding for three to four months, advises Bonham.

"I think a lot of freestanding agencies won’t be able to make it," he says. "They typically don’t have the kind of capital they would need. Unless you can get a personal line of credit, or have money in a certificate of deposit that you can borrow against, I think you’ll have a problem. Banks just aren’t willing to lend that kind of money to home health agencies."

For Solecki, this is less of a worry. As he sees it, "While [HCFA is] not saying the cash flow will stop, they’re preparing for a cash slowdown, and there, at least in theory, is the benefit of belonging to a system. We have a cushion and possibly can function without cash longer than freestanding agencies."

As important as your financial risk is the risk to any patients, says Cortese. He suggests that one of the first assessments you make should be 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.

Then you can look at the less vital aspects of your business. For example, you should check whether your scheduling system is Y2K compliant, he says. If any of your systems are proprietary, you need to find the developer or programmer to find out if they are compliant. If you can’t locate that person, says Cortese, contact one of the many consultants who can evaluate and modify what you have.

3. Start remediation program.

Once you know your risk, then you must create a plan for how to operate without those noncompliant programs. Contingency plans can be simple. For instance, voice mail systems can include a reminder for the person leaving the message to include the date and time he or she called.

But remediation programs can also be complex and involve purchasing completely new computer systems, securing a bank loan or line of credit, or trying to change the mix of patients so that you rely less on Medicare and Medicaid payments.

If you haven’t done anything at all yet, the start of your plan should be developing contingencies, says Solecki. "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."

Even with predictions of a grim future, there are those who see 2000 with a little less gloom and doom. Solecki offers a slightly more sunny picture of the future. "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." (See Year 2000 Test Plan, inserted in this issue.)