There's still time to avoid Y2K disaster

There's still time to avoid Y2K disaster

Tick, tick, tick. The 21st century arrives in only a fewmonths. If your practice isn't ready, it may be time for damage control.

You can reschedule many events, but not Jan. 1, 2000. If your practice'scomputers can't handle the date change, you could be in big trouble.* It'snot just that bills and correspondence might be dated Jan. 3, 1900, insteadof 2000. Your computer could shut down and refuse to reboot. Your cash flowand practice's operations could be severely disrupted. You could be vulnerableto malpractice actions.

Even if your computers are year-2000 compliant or you don't use computers,you may not be safe. You're dependent on third-party payers, suppliers,and utilities, and Y2K failures on their part could make it difficult orimpossible to see and treat patients.

Thankfully, about 90 percent of doctors have at least thought about howthe year-2000 computer bug could affect their practices, according to Healthand Human Services' Office of Inspector General. But about half don't yethave a Y2K-compliant billing or financial system.

If you're one of those who has done little more than think about theyear-2000 issue--or if you've been ignoring it completely--it's time totake action.

First, a little background: The year-2000 problem has arisen from thedecades-old computer programming practice of using two digits to refer tothe year, like 99 for 1999. This saved memory space back when memory wasextremely limited, but it has left many computers and software programsvulnerable to breakdowns when confronted with 00 in dates. Some computersand software packages treat 00 as 1900 instead of 2000, and others don'trecognize it as a valid date. Faulty computers and electronic equipmentmay generate bad data, crash, or fail to restart if turned off.

If this happens to your practice computer, you won't have access to youraccounts receivable. How will you bill your patients and third-party payers,or even know which payers owe you? Without access to patient schedules,how will you know which ones are coming to see you and what slots are availablefor scheduling?

If you're lagging, it's time for Y2K triage

"It may be too late now to become completely compliant, but youcan take steps to minimize the impact," says James R. Kalyvas, whoco-authored the American Medical Association's manual. Your best approachis to take a quick inventory of your practice, decide where you're mostvulnerable, and act immediately to set things right.

Think first of what could actually harm your patients, such as medicalequipment that might malfunction. The FDA has stated that the "vastmajority" of medical devices will function correctly after Dec. 31,1999. Nonetheless, on its Web site, the FDA has identified potentially high-riskmedical devices by type.

"Anything with an embedded chip, such as a cardiogram or spirometrymachine, could stop working," says Nicolette Francey, a New York CityGP, whose consulting firm, Corporate Wellness Management, helps doctorsdetermine whether their practice is Y2K compliant.

Also, in-office laser procedures could be affected. "It's not justa matter of an incorrect date showing up," says Kalyvas. "Theembedded chip calculates the intensity of the beam. If the calculation isincorrect, a lot of damage could be done."

With time running out, you need to check your equipment's Y2K statusimmediately. The FDA Web site also has information on the Y2K status ofsome specific equipment, and links to manufacturers' Web sites. Be aware,though, that manufacturers voluntarily supplied this information. Not alldevices are listed. And of those that are, many have been dubbed Y2K compliant.But the FDA hasn't verified the accuracy of those claims, so consider thislist just a starting point. If you have any doubt, get in touch with themanufacturer.

Many other computer systems are shipshape

Even if you haven't prepared for Y2K, plenty of others have. HCFA, forexample, says it's ready to process acceptable electronic claims. But foryour Medicare claims to be considered acceptable, your computer hardwareand software must be year-2000 compliant. Don't give HCFA--or any otherthird-party payers--an excuse to delay payment.

Many leading software vendors have been supplying upgrades or patchesto customers with service agreements. Medic, for instance, had providedmost of its clients with upgrades by June 30. If you haven't heard fromyour vendor, better find out why. It may be one of the 124 medical softwarefirms that went out of business this year, mostly over the inability tooffer Y2K upgrades, according to Jewson Enterprises, a Menlo, CA, consultingfirm that tracks the practice management systems market.

If you've received an upgrade or patch, you still may not be out of thewoods. Your equipment may be too outmoded to use it. If that happens, you'llmost likely need a whole new system.

It can take six to nine months to select and install a system that includeshardware and a customized practice management program, convert data, andtrain staff, says Carl Cunningham, a practice management expert with theAmerican College of Physicians-American Society of Internal Medicine. Butyou'll have to act more quickly, or the system may not be up and runningby year-end. To avoid that possibility, you should sign a contract by Oct.1, at the latest, says Tammy Swanson, of Medic Corp., in Raleigh, NC.

If your practice hasn't done anything by now, you might have to scaledown expectations of what can be accomplished by the end of the year. "Thedata we can convert in the months remaining might be limited," Swansonsays. "We can deliver a system, say, early in December, but your staffmight be sitting there for a few weeks punching in what you need."

Training is something else to factor in. "Vendors usually hold trainingclasses at their facilities for new customers," says Michael Spurchiseof Health Care Data Systems in DeWitt, NY. "But as the year winds down,classes will be filled as people rush to get Y2K compliant, at the 11thhour. Vendors can do on-site training, but that's more costly."

Expect to pay as much as $900 a day for training alone. "It comesdown to more people bidding for the same help," Spurchise says.

Cunningham suggests a low-cost shortcut: Purchase basic, off-the-shelfbilling and appointment software--at prices ranging from $500 to about $2,500.MedWare, Lytec Medical, and MediSoft Patient Accounting are typical examplesof such software. You don't need a full-scale practice management systemto run these programs; you can use them on a PC. But if yours is more than2 years old, you may need a new one.

The differences between those no-frills programs and the software youget with a sophisticated practice management system is that they're notcustomized; no one from the vendor will come to install them for you; andsoftware support will be over the phone only. Still, such a program shouldget the job done, at least temporarily.

But even with this solution, there's no time to waste, because you'llstill have to deal with data transfer.

Another quick fix would be to sign on with a billing service, until youget a new system installed and running. Consider doing this now, for safeand speedy data shifting before the end of the year. "Get it in writing,though, that the billing service is Y2K compliant, before you sign on,"cautions William Zelman, a Medina, NY, ob/gyn who also heads PowerMed Corp.,a firm that produces medical record software.

Or, you might see whether you could hook into your hospital's billingsystem, if its software license would permit that, says Kalyvas.

And Zelman emphasizes that you should make backup copies of everything."I have at least five backups of my critical data, and I print outour records, too," he says.

Finally, you might run a software program such as DD2K's Due Diligence2000 ($60) or Symantec's Norton 2000 ($50). Such programs can't fix anyY2K problems, but they can help to identify them and tell you what you needto do about them. Another program, Trimaran 2000, from Systemic Solutions,doesn't explain what to do about the specific problems it finds, but itoffers additional features, such as an overall Y2K game plan for small-to medium-size businesses. This program costs $300.

Don't neglect to develop contingency plans

"If you do nothing else, at least have a contingency plan,"says Kalyvas. That's smart advice even if you've prepared for Y2K.

"Make a list of 'what ifs,' " Kalyvas says. For example, whatif you show up at the practice on Monday, Jan. 3, and the building has tobe closed because there's no electricity? Would you have ready access toanother location where you could see patients?

Here are some other questions Kalyvas suggests you consider:

-How will you see elderly patients if your building's elevators aren'tworking?

-What will happen at your practice if certain systems or devices, suchas a blood analyzer, fail or function improperly?

-What alternative systems, processes, or procedures will you implementto continue operations?

-How will you avoid injuring others if you can't verify that criticalequipment is year-2000 compliant?

-To whom will each contingency plan be communicated, and how?

-Who has authority to invoke each such plan?

-What will you do if you have an influx of patients due to problems withother practices or at hospitals?

-Carl Cunningham suggests not scheduling patients for the first few daysof the new year, until you can ascertain that your practice and buildingare in working order.

Protect yourself with a paper trail

Failure to ready your practice for the new century could result in malpracticeor negligence suits, if you can't maintain your customary standard of patientcare.

And consider this: Any malpractice claims stemming from a Y2K-relatedmachine failure probably won't be covered by your professional liabilitypolicy.* Most insurers specifically exclude coverage for damages arisingfrom such malfunctions. The reason: Doctors have had enough time to anticipateand correct most potential problems.

The same goes for officers-and-directors insurance, says attorney Kalyvas.If you hold a management position in your group, you have a legal obligationto act diligently and prudently in directing, managing, and operating thepractice, Kalyvas says. This means you're obliged to respond appropriatelyto the year-2000 problem. Ignore it, and you may be personally liable fordamages--even if the practice is set up as a limited liability company orlimited liability partnership. Liability exposure extends to all partners,not just to those in management positions.

To avoid this risk, you must not only take "reasonable" stepsto address Y2K problems, says Kalyvas, but you must also be able to proveyou've taken those steps. Have you, for example, made an effort to findout whether your paging system will function in the year 2000? Or that yourlocal utility will supply electricity? Or that your laboratory will be functioning?Could you demonstrate in court that you did these things?

Your best weapon will most likely be your paper trail. "This wouldwork like patient records do in litigation," says Kalyvas. "Ifit wasn't written down, it wasn't done." Keep copies of each letteryou write; send it by certified mail, return-receipt requested. Also keepcopies of each e-mail communication with a vendor and records of each phoneconversation.

Finally, increase your inventory of patient-care-related supplies toa 90-day level, and establish a line of credit equal to at least 90 days'worth of basic operating expenses, just in case. Even if payers aren't affectedby the millennium bug, there's no guarantee they won't use it as an excuseto delay payments.

If you set aside some time to address those issues, you should be infine shape for the new year. Despite the grim predictions of doomsayers,it's highly unlikely you'll have to dust off an old manual typewriter orresort to candlelight. The sky won't fall, we're pretty sure.

Where to turn for further guidance

The American Medical Association and HCFA are offering regional seminarsfor doctors and health care officials on how to become Y2K-compliant.

It's likely, in fact, that the AMA will continue its seminars into thenew year. "We'll be focusing on recovery plans," says Craig Samuels,only half in jest. He's an attorney with AMA Solutions, a subsidiary. Whilehospital and health care administrators have been turning out for the seminars,not enough doctors have.