Health-Care Industry Taking A Big Dose Of Prevention -- Rural Hospitals And Medicare Billing Are Largest Concerns In The Nation's Vast, Sprawling Medical-Care System.
Seattle Times Staff Reporters
Rosemary Adkins rattles off the names of her medications like a pharmacist.
She knows how each drug fights her advanced diabetes and its complications. She knows what to take, when, and at what dose.
This year, Adkins also knows exactly how much she has. She's storing extra drugs: Two weeks of propulsid, which helps keep her food down, and a month of insulin. She hopes to squirrel away at least a three-month supply of all her medications by year's end.
It's her hedge against the millennium.
"I don't usually go around all gloom and doom, but I want to be prepared," says Adkins, 51, of Bremerton. "I think Y2K can just be devastating for people who don't prepare."
People with medical concerns aren't the only ones worrying about the health-care industry's readiness for the year 2000. When it comes to preparing for Y2K, the health-care industry has been tagged as the sickest industry around.
A Senate committee in March said doctors and hospitals just weren't ready for the next century. The committee pinpointed three vulnerable areas: biomedical devices, poor rural and inner-city hospitals, and Medicare.
Industry surveys nationwide have had low response rates and detected low levels of awareness about potential problems.
"Obviously, I'm worried," says John Nowak, the information-services chief at Jefferson General Hospital in Port Townsend. "There's so much that's unknown. You just don't know what is going to work and what isn't when the time comes."
In part, health care seems more vulnerable to Y2K problems because it depends on technology. A patient faces a computer at every point in the hospital, from admitting to the machines used in treatment to the billing systems.
The health system also isn't much of a system: It's fragmented, with pharmaceutical companies, insurers, hospitals, doctors, medical-device manufacturers and the federal government all scrambling to kill the Y2K bug, often with sporadic communication.
Unlike utilities or banking, no one is in charge of watching all the parts of health care and of making sure the industry fixes the problem, which stems from a date shortcut.
The shortcut lies buried in millions of lines of software code that rely on two digits to stand for four-digit years. Unfixed, computers might recognize 2000 as 1900, or in some cases, as 1986.
It's only a date. But for precise medical tests, a date can mean a 1,000 different results. Take the fetus that comes up with a gestational period of negative-700 weeks, for example.
"Being a hospital, it's pretty important, it's pretty critical," says Brad Cummings, hired specifically to tackle Y2K at the University of Washington Medical Center and Harborview Medical Center. "What we do here is literally life and death."
Rural hospitals vulnerable
A purple pencil on Nowak's desk at Jefferson General says "Year 2000 compatible." At first, that's about all he was sure of.
The trim 37-bed hospital on the Olympic Peninsula is about 50 miles from the closest hospital. It is precisely the type of hospital that Y2K experts worry about.
Rural hospitals are having the toughest time getting ready for Y2K, because they have limited money and few resources to battle a computer bug. Many still use older equipment.
After Nowak helped to set up Jefferson General's new information and voice-mail systems, he started working on Y2K. And he found out that come Jan. 1, 2000, the voice-mail system would start losing messages. The information system wouldn't recognize the year.
So far, Jefferson General has spent $1.5 million on Y2K - a big price tag for a public hospital with only $16 million a year in revenues. Four people including Nowak have been working on Y2K, but only part time. Nowak says all their efforts add up to the work of only half a full-time person.
In contrast, Harborview and the University of Washington Medical Center started tackling Y2K full time almost two years ago, with eight full-time workers and lots of part-time help. The two hospitals are spending about $6 million each on the fixes.
Most of the hospitals in Washington are tackling Y2K with what resources they can, says Robb Menaul, senior vice president of the Washington State Hospital Association.
"I'd be flabbergasted if there's a hospital out there not doing anything to prepare for Y2K," Menaul says.
The WSHA began warning its members about Y2K in December 1997. At the time, only about a third of the hospitals were thinking about the potential problem.
But a year later, in December, the hospitals that responded to an association survey said they were up to 80 percent done with their Y2K planning and inventory. Still, only 40 percent of the state hospitals responded to the survey.
These hospitals are spending millions of dollars testing their systems, contacting device manufacturers, talking to the power and phone companies, checking with suppliers and fixing outdated equipment. Some hospitals are replacing equipment. Others are making quick fixes - removing the stylus that records the year 1900 on a defibrillator printout, for example.
All the hospitals are making what-if plans. What if the power goes out? What if the phones don't work?
Hospitals are testing their back-up generators. At 4:30 a.m. on a recent Wednesday, the power went out in the western half of Harborview, the state's trauma center, which cares for the most serious of the most serious injuries.
It was a Y2K test, and half of Harborview ran on generators for a half-hour. Patients didn't notice. Everything worked, except for a few hands-free toilets and a CAT-scanner that needed a manual override.
Manufacturers test equipment
Harborview Medical Center has about 6,000 medical devices.
It's not testing all of them for the millennium.
That responsibility falls to the manufacturers of the products. The manufacturers, who make everything from IV machines to pacemakers, are being asked to tell the Food and Drug Administration whether their devices are Y2K compliant. If they aren't, the manufacturers are asked to say whether there's a fix available.
The FDA has a Web page listing all the device manufacturers who have responded. But the agency says there's no assurance that those who fail to respond are Y2K compliant. And the agency isn't verifying any manufacturers' claims.
Some Y2K watchdog groups, as well as the federal General Accounting Office, have questioned relying on the manufacturers to police themselves.
But a hospital's engineers aren't as familiar with a specific piece of equipment and might miss something during testing, both hospital officials and the manufacturers say.
Many hospitals are doing inventories on their equipment and contacting manufacturers, asking about known problems and potential fixes. Many then double-check date-sensitive equipment.
At Virginia Mason Medical Center in Seattle, 587 of the hospital's inventory of about 4,000 medical devices had a date function, but only 186 needed to be upgraded or changed, says Fred Savaglio, Virginia Mason's administrative director. In addition, there were 211 models of devices that had embedded chips, but they were all Y2K compliant.
"Though there's a danger of generalizing, we have yet to really find a medical device where the Y2K millennium bug makes the device fail or just stop working," Savaglio says.
At Jefferson General, Nowak walks through the hospital, pointing out all the different machines that he worries about: the Corometrics fetal heart monitors and the Lifecare patient-administered drug pumps that needed fixes. The pulse oxymeters, the SCS stockings, the IV pumps, the feeding pumps, which should be fine.
"How's the war on chips?" asks Micheal Haley, the ICU clinical coordinator.
"I think we're winning," Nowak replies. "But barely."
The manufacturers are also trying to track down their machines. It's like a worldwide Easter egg hunt, and some of the eggs were hidden decades ago.
Advanced Technology Laboratories of Bothell has about 30,000 ultrasound machines, somewhere in the world, including one at Jefferson General. Some are old, no longer even manufactured by the company. But that doesn't matter. ATL still has to test them, and say whether they'll work and whether they'll be fixed if they don't work.
"Some of the old equipment didn't understand 2000," says Jacques Souquet, chief technical officer for ATL. "But the newer ones might have understood 2000 but not the leap year.
"There is no logic to explain that. We had to dig back in the guts of a machine in its software and try to understand how it was developed."
A complex billing system
Jefferson General collects half its money from Medicare.
Medicare, the federal program that insures the elderly and disabled, is the world's largest health insurer. The government will process 900 million Medicare claims this year, or about 1,700 every minute.
This is how complicated it is: A Port Townsend doctor bills Medicare for a patient visit. The claim goes to Noridian Mutual Insurance of North Dakota, which checks with the patient's master file, kept in one of nine host sites nationwide, to verifythe patient's eligibility and whether the deductible has been paid. The North Dakota company then decides whether the claim should be paid, and tells the patient's host site whether the patient pays money on the deductible.
This is all done electronically.
This is only one example. It doesn't account for the 10 companies in Washington that contract to insure managed-care Medicare patients, or the claims filed by hospitals, handled primarily by Premera Blue Cross or Mutual of Omaha.
Throw this sprawling billing system together with the very elderly government computer system, and there's a potential government mess.
For many cash-strapped hospitals, government programs supply more than half their revenue, a steady stream of cash. Some doctors depend almost entirely on government health insurance.
So take the small rural hospital, or the rare solo doctor practice, and throw in a money wrench. It could bring some medical business grinding to a pretty quick halt. Jefferson General Hospital, for instance, has enough money in reserves to run for maybe five months.
"There's kind of the specter above our heads that Medicare or Medicaid would not be able to reimburse us," Nowak says. "Financially, there's a huge impact on a small hospital like us."
The Health Care Financing Administration, criticized for not moving quickly on Medicare and Y2K, is spending about $246 million to rewrite about 50 million lines of code, and test and test and test.
The agency has tested and updated all 100 of its critical systems. It also has 20 sets of contingency plans, and it's sending out letter after letter to providers.
In late May, a top HCFA official said the agency would be ready to process and pay claims at year's end. But the agency can't be responsible for the doctors and hospitals who aren't ready.
"Bottom line is, we're gonna be ready," says Pamela Negri, regional HCFA spokeswoman. "The key message is, providers have to be ready. If they don't take any action on their own behalf, there's nothing we can do."
Private insurers, as well, are updating their computer systems to be able to pay out bills and give the OK to procedures. Regence BlueShield, the state's largest insurer, is spending $20 million to update 515 computer systems and business practices.
More than 1,500 of its employees are working in some way on the Y2K problem, testing what would happen all the way up to the year 2024.
True, it's just money. But for patients, money means whether a procedure is covered.
"It's a question of having the resources there for what may be a life-saving treatment," says Chris Bruzzo, spokesman for Regence BlueShield.
An epidemic of fear
Here is the horror story: You have crushing chest pains on New Year's Eve, and you go to the hospital. All of a sudden, at midnight of the Friday that ends this year, the power goes out. Or maybe the ventilator that's breathing for you, hiccups.
But that's about as likely as the insurance company that hands you $1,000, just because.
Still, patients are storing drugs and worrying about getting lifesaving treatments like kidney dialysis if the power goes out. TV shows such as "Chicago Hope" are actually featuring Y2K as a story line. A Third World self-help medical guide called "Where There Is No Doctor" is selling at record levels in America.
Locally, the biggest issues with Y2K and health care could spring from fear. If lots of people stockpile drugs, that could hurt drug supplies. If everyone decides to call 911 - just to check - that could jam the phone system.
So remember this: Health-care providers are precisely the people trained in emergencies. They know how to work under stress. Even in a worst-case scenario, doctors would know how to save lives, in the old-fashioned, low-technology way. Think M # A # S # H.
Hospitals like Virginia Mason regularly do disaster drills for calamities. In some ways, Y2K is easier to plan for because the building most likely won't be physically damaged, unlike in earthquakes, says Beatha Johnson, director of information systems at Virginia Mason.
Recent national reports about the health-care industry have been more reassuring than earlier ones. An American Hospital Association official told Congress last month that 90 percent of hospitals expect no problems.
Only half a percent of the hospitals say they expected complications.
What's likely is that some instruments will have date glitches, but nothing major. There could be billing problems, especially with smaller doctors' offices. Some problems might not show up for months.
Adkins, who lost part of her stomach and intestines to surgery earlier this year, is taking no chances with her fragile health.
She doesn't plan to hoard huge amounts of medicine, but she wants enough to last her through any unexpected troubles - just as she would for a natural disaster that could cut off supply. And she plans to urge fellow diabetics to do the same at an upcoming fund-raising walk.
"I don't think most people have even thought about it, but it's absolutely crucial," she says. "If someone is on life-sustaining medicine, how can you not think about it?"
Cummings, of Harborview and the university, plans to be at the hospital New Year's Eve. He doesn't expect it to be an exciting party.
"I'm expecting to be bored," Cummings says. "I think it's going to be an anticlimax, personally. But as a hospital, we have to be prepared."
Kim Barker's phone-message number is 206-464-2255. Her e-mail address is: firstname.lastname@example.org. Ferdinand M. de Leon's phone-message number is 206-464-2741. His e-mail address is: email@example.com.
------------------ Frequent questions ------------------
WILL MY PACEMAKER WORK? Yes. Pacemakers do not use the current date to operate, so they should be fine.
The Food and Drug Administration, which regulates medical devices, says most medical devices will work next year. About 15 percent of them now have some date problem. It's most often minor, such as simply printing an incorrect date. For example, seven of the 75 devices made by Medtronic / Physio-Control of Redmond, including an older defibrillator, won't print the date properly. But the devices themselves will work.
A very small number of devices will have a real problem because of the millennium switch if they're not fixed or replaced.
Manufacturers are responsible for testing their own devices and reporting to doctors and hospitals whether they work. WHAT ABOUT MY PRESCRIPTIONS? If you need a drug to stay alive, it might be a good idea to store at least a one- or two-week supply.
The Health Care Financing Administration hasn't yet issued a recommendation on prescription drugs, and many experts are worried that drug hoarding might affect the nation's drug supply.
But patient advocates say that being a little safe is better than being sorry.
WHAT HAPPENS TO HOSPITALS IF THE POWER GOES OUT? Probably nothing. Hospitals are always prepared for disasters, and they rely on backup generators that should kick in within seconds if the power goes out. Lifesaving devices have battery backup.
WILL I BE STUCK WITH MEDICAL BILLS UNPAID BY INSURANCE IF THERE'S A DATE PROBLEM? No. But you might have to cut through some bureaucracy.
Paying medical claims is one of the biggest worries in health care for the millennium switch. But insurers have said they're willing to pay any legitimate bill.
And the Health Care Financing Administration, which administers Medicare and Medicaid, has said about 97 percent of the hospitals nationwide are billing with Y2K-compliant dates and 93 percent of doctors and clinics are.
Regardless of whether Medicare's computer systems are operational at year's end, patients should still be able to get treatment.
"Hospitals can't turn a patient down today and they can't on Dec. 31, either," said Robb Menaul, senior vice president of the Washington State Hospital Association. "In the emergency room, they just do it."
-------------- What to expect --------------
BEST CASE: Computers work. Medical devices work. The infrastructure works. The millennium switch affects the health-care system about as much as a winter storm. Any problems have been anticipated. Hospitals and patients don't hoard supplies, creating an artificial shortage.
WORST CASE: Power and the phones go down. Computer systems fail. Calls for emergency help go unanswered. Hospitals are forced to rely on backup power and contingency plans. Bills are lost. Medicare can't pay. Smaller hospitals have to shut down, because they don't get any money.
MORE LIKELY CASE: Small problems with dates in medical devices, but nothing life-threatening. Some glitches with billing, but only red tape. The power works. The phones work. The hospital is an OK place to be on New Year's Eve, although not the best place to celebrate.
-------------- How to prepare --------------
People worried about the potential effects of the millennium switch on their health should stay calm and prepare as they would for any natural disaster. Here are some tips:
-- Be smart. Don't call 911, just to see if it works.
-- Don't drink and drive. It may be the biggest party night of the millennium, but be careful and you won't land in the hospital.
-- Prepare as you would for any emergency. If you take prescription drugs, have some extra on hand. But don't hoard.
-- Ask your medical providers what they're doing to get ready for the year 2000, especially if you're on kidney dialysis or need regular medical care.
-- Check with your insurer about what they're doing about claims received after Dec. 31.
-- Keep records of the medical services and supplies you get during the last months of 1999 and the first months of 2000. Keep any explanation of benefits notices that you receive.
-- Jot down your medical and dental appointments in case your clinic doesn't notify you.
-- Carry your insurance card with you at all times.
-- Don't give out your Medicare, Medicaid or Social Security numbers to just anyone. Watch for scams, and never give out your personal numbers to anyone who calls you cold.
--------- Web sites ---------
Here are a few Y2K health-care Web sites:
-- RX2000 Solutions Institute:
http://www.rx2000.org -- Health Care Financing Administration (HCFA):
http://www.hcfa.gov/y2k -- Food and Drug Administration (FDA):
http://www.fda.gov/cdrh/yr2000/year2000.html -- Department of Veterans Affairs: http://www.va.gov/Y2KResources.htm -- U.S. Senate Special Committee the on Y2K Technology Problem:
Copyright (c) 1999 Seattle Times Company, All Rights Reserved.