Risk Management

Tip

As the millennium quickly approaches, many physicians are scrambling to ensure that their offices will continue to run smoothly in spite of the dreaded Y2K bug. In order to help offices toward that goal, here is a brief guide that highlights primary areas of concern for the physician office.

WHAT IS THE Y2K PROBLEM?

The Y2K problem is simple. From the early 1950’s through the 1990's computer programmers used a 2-digit date program instead of a 4-digit date program on all computer functions involving an automatic date text. As a result, all equipment using date sensitive chips with this programmin are no capabl of recognizing the year 2000. Such equipment is deemed to be "non-Y2K compliant." Most experts predict that non-compliant equipment will simply fail to function when the date code rolls over to January 1, 2000.

The solution to the Y2K problem is not so simple. On March 5, 1999 the Physician Insurers Association of America Newsbriefs stated that "9 in 10 doctors are unaware of potential Y2K problems with medical devices." The April 2, 1999 Kiplinger Washington Letter recognized that a big worry is the fact that healthcare and Medicare are lagging behind other industries.

LEGAL EXPOSURE

Y2K is a new source of liability exposure for physicians and their offices. In the Kiplinger Washington Letter, March 26, 1999, legal experts are predicting that "Y2K will be a windfall for lawyers; expecting legal fees to exceed asbestos, breast implants, Superfund and tobacco fees combined." All businesses affected by the Y2K bug must be able to show that they took the appropriate steps to minimize problems, especially where there is a potential for harm to patients or others. Just as each physician must follow a standard of care for medical practice, likewise, physician offices will be held to a standard of care regarding Y2K compliance. The Y2K problem is compounded by the fact that manufacturer warranties, many insurance coverages and current legal theories do not afford the physician legal protection.

WHAT SHOULD THE PHYSICIAN OFFICE DO?

Medical devices, billing, accounts receivable, accounts payable and office systems are among the highest areas of risk for the physician office. Just as with any compliance program, the first step towards Y2K compliance is an awareness of the problem and solutions. Assign one person to perform the duties of the Y2K compliance officer. That person's charge is to educate personnel, patients and ensure the office takes reasonable steps toward reducing the impact of Y2K.

GENERAL GUIDE FOR THE PHYSICIAN OFFICE Y2K COMPLIANCE OFFICER

MEDICAL DEVICES

STEP 1: Compile an Inventory List

Involve each staff member by asking him or her to identify all technology they use to perform their job functions. Separate these into categories: computer hardware, computer software and medical equipment and devices. Determine your office's priority for remediation based upon potential severity of damage caused by failure of each device, i.e. the degree of risk of harm to patients or employees. Focus initially on top priority items, and then proceed to those of lesser priority as time permits. Be sure to include phone systems, elevators, security and all other building systems in your Y2K evaluation.

STEP 2: Ascertain Y2K Compliance

There is a vast amount of information available on the Internet regarding Y2K compliance. The FDA has a website that is frequently updated which identifies the Y2K compliance status of a large number of medical devices. It is called the Federal Y2K biomedical equipment clearinghouse (www.fda.gov/cdrh/yr2000/yr200.html). If you are not able to determine the compliance status of equipment or a device through the Internet, contact the manufacturer or vendor. Document the status and source of verification in a Y2K compliance log. Consider writing a letter to all vendors asking them to submit a copy of their Y2K plan to you. This will ensure that your vendors are working on their compliance plan as well. If you work closely with a hospital or pharmacy, include them in your Y2K compliance verification.

STEP 3: Determine How to Deal with Non-Compliant Equipment

There are three basic choices for dealing with non-compliant equipment: conversion, replacement or retirement. Technical expertise from consultants will be necessary to help determine the method of remediation. The compliance officer must ask the following question regarding each piece of non-compliant equipment: Can the problems related to the non-compliant equipment or device be minimized or eliminated? If so, implement a plan outlining the steps to take in the event the device fails. If not, find an alternative to using that compromised system.

BILLING AND ACCOUNTS RECEIVABLE

Billing and accounts receivable are usually the largest computer functions in a physician office. Create a back-up system to be used in the event of a failure for these functions, as well as for payroll or any other accounting system. Include a plan to ensure accuracy of billing in the few months following January of 2000. Remember that Medicare deems submission of false claims to be fraudulent. Anticipate a delay in cash flow due to interruption of accounts receivable.

PATIENT SCHEDULING AND STAFFING

Computerized medical records, follow-up appointments, pharmacy prescription logs and patient scheduling systems may also fail. Keep such information in a hard copy form from late 1999 through the first few months of 2000. Inform patients in late 1999 that the office may not be able to continue to remind them of their follow-up appointments. To avoid staff problems, keep a hard copy record of educational credits and other credentialing requirements including peer review or utilization review quality assurance. Transcription dates and times should be dictated, as opposed to leaving it up to an electronic attachment for the date or other specific information.

v REMEMBER: (1) Document everything your office does to guard against the Y2K problem; (2) have contingency plans in place; and, (3) be sure you document your suppliers’ and vendors’ Y2K compliance. The AMA has published a comprehensive Y2K guide, complete with flow sheets, checklists and references. AMA members can download the guide from its website, www.ama-assn.org.

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