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This year, the adage better late than never’ takes on new meaning
Year 2000 (Y2K) compliance is a task that every department has to take seriously this year. You as a quality professional are under a special mandate to oversee the work, not only from the standpoint of the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, but also from the more global standpoint of being in charge of quality maintenance.
"Y2K is a global problem," says Wendy Walschlager, RN, director of health information at Good Samaritan Hospital in Downers Grove, IL. (See next month’s issue of Hospital Peer Review for an article on the Joint Commission’s expectations regarding Y2K preparedness.)
Although computer-related duties typically fall under the aegis of information management departments at most hospitals, this is not an issue you can assume others are taking care of. A first priority is to make sure the equipment you are using for your quality management tasks is Y2K-compatible. But you cannot stop there.
If you find that your organization has been putting off dealing with the crucial millennium bug issue, the good news is that all is not lost. There’s still time to begin emergency procedures. But don’t get too comfortable: The bad news is that workable solutions must be constructed as soon as possible. Y2K is a problem that has to be addressed, and today’s the day to start. This is not the time for fixing blame for the delay. Whatever the cause of the delay, time is now of the essence.
"Those entering the remediation calendar late can head off most Y2K problems," says Audie G. Lewis, director of material program development at Lee Memorial Health System in Fort Myers, FL. "If you’ve got six months or less, you’re not going to be doing major capital acquisitions replacement. But you do have time to do contingency planning — deciding what you’re going to do when this happens."
At the very least, you should be able to institute a number of contingency operations plans, Lewis says. "In the same way as if you suddenly learned that a flood was coming tomorrow, you have a day to quickly prepare for it."
Here’s how to condense your Y2K program in a limited amount of time. Experts say the first step is education, even when you start this late in the game. Present a senior leadership retreat or other educational program so each of your key leaders clearly understands what he or she has to do over the remaining next few months.
Then assess your facility’s internal and external risk exposure by conducting a Y2K compliance survey. Inexpensive, off-the-shelf software is available for such self-assessments.
There are two ways in which an abbreviated, emergency Y2K plan is different from one that has been developed over a long period. First, the necessary steps have to be apportioned among a larger group of people to ensure the same tasks are accomplished within a shorter time frame.
For example, a review of risk management processes may be completed by one or two employees when an organization has 12 to 24 months to prepare. The same task may require 10 employees when reduced to a 60- to 90-day timetable.
Experts advise that Y2K project leaders be given full responsibility for their areas of concern. Their duties should not be compromised by conflicting responsibilities. Use assembly-line techniques: Divide tasks into manageable pieces that can be executed by several individuals at the same time.
Second, financial resources may not be available for major midyear fiscal budget adjustments that will be necessary to accommodate Y2K initiatives. Money issues may be further complicated by the possible loss of Medicare and other receivables likely to occur after Jan. 1. (See article on Medicare readiness on p. 56.)
Organizations typically have needed to suspend at least 30% of their annual operating budgets in order to reach their Y2K compliance goals. The cost of compliance is high, but the cost of complacency is much higher, says Lewis.
How can you work with a 30% budget cut without sacrificing quality of patient care? Tighten your belt in the following ways:
• Postpone expenditures that are not absolutely necessary for current operations.
• Eliminate excess inventories of supplies that are routinely held in reserve.
• Consume those second-choice inventory items not routinely used by staff because of personal preferences.
• Review major projected cash-related capital equipment expenditures that cannot be postponed to determine if they can be converted into lease or credit purchases. Purchase contracts might be structured to contain a buy-out clause that can be exercised later.
• Lessen personnel requirements by soliciting temporary help and volunteers from the community.
Address anticipated payment interruptions, such as those from Medicare, with a contingency plan. Some manual payment and audit arrangements may have to be established prior to the millennium changeover to guarantee uninterrupted payments. Test them before the deadline to uncover and correct problems.
Similar preventive measures should be taken with companies that handle outsourced business functions for your hospital, such as payroll and accounting services. Canvass them, too, to ensure Y2K compliance.
Experts advise that you be prepared for less than 100% accuracy. "Even when we think we’ve fixed everything within a hospital’s accounting system, for example, keep in mind that the best tool out there for remediating lines of code is 99% accurate," says Lewis. "No one is offering anything better than that. If you’ve got 10 million lines of code and a 1% error rate in finding and correcting dates, that can mean a lot of problems down the road. They may not all show up on Jan. 1, but will eventually surface. It’s a toss of the dice whether those affected dates crop up in mission-critical functions."
It might be possible to quickly adapt another facility’s compliance and contingency operation plans to your facility. Lewis advises, "Borrow expertise from other successful organizations that have completed their projects and that are willing to loan experienced project managers and team members. Even if you have to sign hold-harmless agreements, that’s better than entering the millennium without having something accomplished." (Hold-harmless agreements are disclaimers that limit risk of the institution providing assistance.)
Also approach the companies that make your equipment, their vendors, and independent service companies for help. (See next month’s issue of HPR for an article on equipment problems.)
Should you purchase Y2K insurance to deal with risk exposure? It is expensive, but some agencies are offering refundable policies that provide coverage at the same rates as nonrefundable plans, meaning the upfront premiums are partially refundable if the number and dollar amounts of Y2K claims turn out to be lower than anticipated.
Be prepared for the fact that Y2K troubles don’t go away quickly. A facility can do a great job of preparing for Y2K and still be hurt by post-Y2K issues. Be sure to create audit trails to prove what you have done. Problems such as litigation issues, financial recovery issues, and business recovery operation issues will probably raise their unwelcome heads, says Lewis. "Even if internally you’ve done everything you need to do, if you can’t prove it, you’re going to have a rough time not only with lawsuits, but with insurance providers and other third-party payers."
He points out that there’s a lot of connectivity in this business — interfaces and external partners such as suppliers, the Health Care Financing Administration, and other players. "Someone is going to cause you harm," Lewis says. "Also consider the domino effect of patients not getting paychecks on time. All these factors will impact health systems."