While some predict that doomsday will arrive at midnight Dec. 31, 1999, others expect the millennium to be ushered in with nothing more than a few minor inconveniences. What actually will happen probably lies somewhere in the middle. If you haven't prepared your office, any date-sensitive device could malfunction and you may start the new year unable to track appointments, bill for services or perform some procedures. If you've already decided that it's too late or too expensive to prepare for Y2K, think again. There's still plenty to do now to prevent your practice from coming to a grinding halt in January — and not all of it is time-consuming or expensive. Some of it doesn't even require that you touch a computer.
Use the remaining time before 2000 to make contingency plans, document your preparedness efforts and get extra cash on hand.
Develop a contingency plan by identifying what could go wrong; then focus on finding solutions for those things that will have the greatest impact on your ability to provide care.
Contact 911 and the hospitals, pharmacies, outside vendors, utilities and third-party payers you use to assess their readiness and contingency plans.
Maximize the time remaining
If your computer system isn't already compliant, at this late date it's doubtful that it will be by Jan. 1. By all means continue to work toward compliance, but don't focus all of your energy on your computers. Why? Because even a Y2K-ready system won't guarantee you smooth sailing in January. Outside factors, such as a third-party payer who can't process claims and a supplier who can't deliver, will have just as much impact on your ability to treat patients. That's why everyone should have a well-thought-out contingency plan in place prior to Jan. 1.
Develop contingency plans
Start by assuming that computers (yours or someone else's) will malfunction, and build your plan from there. Developing a contingency plan just for Y2K may seem overwhelming, but it needn't be. Instead of starting from scratch, consider adapting your practice's disaster preparedness plan if you have one. While Y2K is likely to be more of a glitch than a disaster, the steps you should take to prepare your office are similar to those used for disaster planning. If you don't have a disaster plan, you may want to refer to the Y2K-preparedness model developed by the Rx2000 Solutions Institute (www.rx2000.org/data/documents/reports/title.asp) or to the FPM article “Could Your Office Cope With Disaster?” September 1999, for practical guidance.
The first step will be for you and your staff to identify the ways Y2K could adversely affect your practice. Then determine which ones on the list will have the greatest impact on your ability to care for patients. Concentrate on finding contingency solutions for those. Keep in mind that while the effects of Y2K may be felt most strongly during the first few days of the new year, it's likely they'll continue to a lesser degree throughout the month.
Identify what may go wrong
Opinions range widely, but most experts agree that the majority of small and midsize businesses will experience at least one system failure related to Y2K. Imagine arriving at work on Monday, Jan. 3, 2000, only to be told by your staff that the computers are malfunctioning. The schedule of patient appointments can't be accessed, nor can your patient records, your accounting programs, inventory lists, or most forms your practice uses to conduct its daily business. Your phones are working sporadically at best, and the telephone company isn't much help. As you're contemplating what to do, you realize that the office is uncharacteristically cold. Should you just pack it up and go home? That's one option, but how well would this serve your patients? And what would it do to your bottom line? With a little planning and a little extra office help in December, you'll be prepared to work around these problems and continue to provide uninterrupted patient care in January. Here's how:
Prepare your appointment schedule
Before your practice closes for the New Year's holiday, print out your computerized appointment schedule (including patient contact information) for the first few weeks in January so you'll have paper copies to fall back on. Try not to schedule elective surgeries in early January in case your medical equipment won't work properly. If something goes awry and the cause is found to be Y2K-related, you may find yourself facing a malpractice suit that probably won't be covered by your professional liability insurance. (For a list of date-driven medical equipment that could pose a risk to patients if they fail, check the U.S. Food and Drug Administration's Web site at www.fda.gov/cdrh/yr2000/cdrh/phrds/phrds.html.)
Designate a staff member or hire a temporary worker to telephone patients during the end of December to confirm early-January appointments and to reassure them that you'll be open for business as usual after the holidays. Tell patients that you're aware that Y2K might affect the phone system and that even if they can't reach your office on the day of their appointment, you'll still be expecting them. That way, if telephones really aren't working properly after Jan. 1, your patients will have been notified and you'll have minimized the number of no-show appointments.
Print out selected patient records
If you have computerized patient records, use the last weeks in December to print out the medical records of those patients with appointments scheduled during the first few weeks of January. While this won't prepare you for emergency appointments, you'll at least have paper records for those patients you're scheduled to see.
Bill patients and third-party payers early
If your billing software fails and you're not prepared, you won't be able to generate bills or complete claims forms required by third-party payers. If your payer's computers fail, your payments could be delayed, you may not be able to check patients' eligibility, and you could end up providing services for which you'll never be paid. The result might be a drain on income that few practices can afford.
Instead, take time now to contact your payers and ask how they're prepared to function without working computers. If you ordinarily submit claims electronically but payers will accept your claims on paper, prepare by printing out the forms you usually send electronically. If they won't accept handwritten forms, find a typewriter. Keep copies of every form you send so that you can update your computer records later. Work with staff to compile a list of other essential forms and print out extra copies of those forms that are computerized.
Increase your inventory
While some experts are urging physicians to keep on hand a 90-day supply of their most frequently prescribed drugs, others feel that doing so will only contribute to widespread shortages. Call your pharmacy, ask what the pharmacists are recommending and act accordingly. It is a good idea, however, to increase the inventory of your most commonly used medical supplies so that you don't run short if your suppliers' deliveries are delayed.
Take financial precautions
While it may not be a popular decision, avoid giving staff time off in December and January. Instead, increase staffing in December, if necessary, and catch up or get ahead on billing and collecting outstanding accounts. Submit all Medicare claims you can before Jan. 1 to maximize the chance that you'll receive payments without delay. This is especially important if Medicare plays a significant part in your practice's cash flow.
To compensate for possible delayed payments and a disruption in cash flow, consider asking your bank to increase your line of credit, or make sure you'll have extra money on hand throughout January. Some experts advise having access to up to six months' worth of billing revenues while others recommend having only enough to cover basic operating costs for one month. Remember that submitting claims by the end of December won't guarantee that you'll receive prompt payment. Take steps to protect yourself.
Determine whether payroll and year-end statements such as quarterly income tax can be compiled and processed before the end of the year. Provide employees with copies of W-2 forms, pension and 401K statements so that inaccuracies can be cleared up by the end of December. This may not be possible for larger practices who outsource their payroll and accounting, but do whatever you can to have your financial house in order so that you can concentrate on your patients in early January. Also take time to meet with your insurance broker to talk specifically about Y2K issues. Loss of revenue related to Y2K may not be covered. Understanding this now may influence the way you plan.
Take legal precautions
Most insurance companies, citing the length of time physicians have had to correct Y2K problems, will exclude coverage for damages related to Y2K. If you make no attempt to make your practice Y2K-compliant or don't document the steps you've taken to address Y2K problems, you and your practice could be liable.
To protect yourself legally, document every step you've taken to address Y2K issues. Keep copies of all Y2K-related written correspondence, print out e-mail conversations, and write a brief description of any phone calls you've made or received regarding Y2K. At the very least, use the time remaining to formally inquire about the Y2K readiness at all of the hospitals, nursing homes, home health agencies, pharmacies and other facilities you deal with. Contact the health plans you contract with and ask for a statement of readiness and Y2K compliance regarding their claims processing systems. Contact local 911 and other emergency services to determine what steps they have taken to ensure continuity of service during the first few days of the new year.
You can save time by using the sample vendor letters and response forms supplied in the AAFP monograph “Family Physicians and the Year 2000: Preventive Medicine for the Millennium Bug” (available at www.aafp.org/fpnet/y2k or by contacting the AAFP order department at 800-944-0000; item A-710). If you send letters, use registered mail, return-receipt requested. Get started now and make at least three attempts to contact vendors and other outside organizations, noting on the copies, “First request,” “Second request,” etc. And keep the return receipt as proof that your letter was successfully delivered to the recipient.
Auld lang syne
It's our hope that on New Year's Eve you're ringing in the new millennium with a celebratory toast and not wringing your hands in despair over your computer keyboard. Being aware of the Y2K problem and taking action now to address compliance issues within your practice can go a long way toward assuring peace of mind for both you and your patients. If Y2K turns out to be a mere bump in the road, you'll be prepared. If it's a disaster, you'll be prepared for that too, and your practice will be a valuable resource for your community.
Useful Y2K resources
The following agencies and organizations maintain Web sites that address Y2K issues affecting health care.
Viewers can read the AAFP monograph “Family Physicians and the Year 2000: Preventive Medicine for the Millennium Bug” in its entirety.
American College of Physicians – American Society of Internal Medicine
The ACP-ASIM Year 2000 Information Center provides a tool for addressing Y2K problems with computers, medical devices and outside vendors.
American Hospital Association
This site contains informative resources such as a Y2K health care guide for patients. The links to the Y2K Web sites of other agencies and associations are particularly useful.
American Medical Association
Members can access the AMA publication “The Year 2000 Problem: Guidelines for Protecting Your Patients and Practice” at no charge.
Health Care Financing Administration
The “Sample Provider Y2K Readiness Checklist” offers a brief overview of the types of equipment and systems that could be affected by Y2K.
U.S. Food and Drug Administration
www.fda.gov/cdrh/yr2000/year2000.html The Biomedical Device Y2K Compliance Database lists medical devices that could pose a high risk to patients if they fail to function as expected.