A recent survey sponsored by four hospitals in central Arkansas indicates that most patients who have received hospital services in the state within the past year were extremely satisfied with the care that was provided. The survey of 900 Arkansans, conducted by Flake-Wilkerson Market Insights, a Little Rock research and consulting firm, showed that patients who had received services--either inpatient, outpatient, or ER--gave an average score of 4.16 out of a possible 5 points (reflecting an extremely high level of satisfaction) in the category of general satisfaction with the services.

Survey respondents were also asked to rate the importance to them of several factors involved in choosing a hospital. According to the results, 91% of those responding said well-qualified doctors was the most important selection factor, followed by quality emergency services (89%); skilled nursing staff (86%); availability of advanced technology (82%); and a full regimen of services (80%). Only 43% said that the hospital's community involvement was an important factor.

The poll also included questions relating to the participants' health insurance coverage. Findings revealed that 85% of Arkansans have health insurance coverage. Of those, 36% have traditional coverage, while 31% are covered through managed care plans, including health maintenance organizations and preferred provider organizations. Twenty percent were Medicare beneficiaries.

Flake-Wilkerson Market Insights could not disclose the names of the hospitals that sponsored the survey. However, they can provide a copy of the full survey report to interested parties. Contact the firm at (501) 221-3303.

Arkansas Rural Health Forum

Approximately 56% of Arkansas' population is located in rural communities, and a large portion of incorporated communities have a population of less than 15,000. Some rural areas, especially the Delta region, are experiencing economic decline which will eventually have a major impact on access to healthcare. Additionally, migrant workers and immigrants are placing pressure on healthcare providers, especially with a lack of insurance, language barriers, and cultural differences.

The Arkansas Department of Health has established the Arkansas Rural Health Forum for the purpose of studying rural health needs and developing plans for confronting rural healthcare issues. Organizations participating on the Forum's steering committee are the Arkansas Hospital Association, the Arkansas Medical Society, UAMS, the Arkansas Cooperative Extension Service, Arkansas Farm Bureau, the Arkansas Nurses Association, and representatives of the House and Senate.

The mission of the Forum, which has applied for a $10,000 grant for a year (September 1997 through August 1998), is to:

-- Determine the issues of concern facing rural communities/rural healthcare professionals.

-- Develop a network of communications among the individuals and organizations.

-- Serve as a forum to develop policy and

legislation to ensure access to healthcare in rural areas.

Arkansas Students Attend MASH Camp

Approximately 250 Arkansas high school students qualified last summer for medical careers camps at 15 Area Health Education Centers (AHECs) and rural hospitals in the state. The camps, called Medical Application of Science for Health (MASH) are an important feature of a strategy to help communities place more rural students in medical education. Studies show they are the future professionals most likely to stay in rural practice.

The MASH camps are funded by the Arkansas Medical MENTOR Partnership formed in 1994 in response to the loss of rural medical professionals in recent years.

Partners are the AHEC program and the Center for Rural Health at UAMS, Arkansas Blue Cross Blue Shield, the Arkansas Academy of Family Physicians, Arkansas Farm Bureau, Arkansas Community Health Centers, Electric Cooperatives of Arkansas, and ENTERGY.

Students must apply for MASH, and good grades and school recommendations are important for selection. The statewide partnership pays $200 per student for camp costs, with community organizations cosponsoring the students by paying $50 each. Students report their camp experiences to their cosponsors as a way to help build early relationships between future medical professionals and their communities.

Arkansas Home-Care Company Sold

HealthCor Holdings Inc. of Dallas has purchased CareNetwork Inc. of Little Rock. The transaction adds four offices to HealthCor's 96 offices in nine states and gives the home health-care company about 1,500 nurses in Arkansas. Barry Solomon, president and a majority owner of CareNetwork, said he and his wife, Pat Solomon, the company's administrator and second majority owner, will remain in management roles at the nursing service. He said he expected no cuts in staff as a result of the deal because HealthCor bought the company expecting to grow its business.

HealthCor plans to offer three services to patients, physicians, and managed healthcare insurance companies: respiratory and infusion therapy; medical equipment services; and nursing services. Before the CareNetwork acquisition, HealthCor lacked the nursing component. HealthCor purchased I Care of Arkansas Inc. in Little Rock to gain its infusion therapy business just over a year ago and through that purchase got to know CareNetwork, which traded referrals with I Care, Solomon said. Now, the two Little Rock companies will merge to form I Care Network, a subsidiary of HealthCor, Solomon said. In December, HealthCor bought Wynne-based United Medical Inc. to gain its medical equipment business.

It's the Law

The Health Insurance Portability and Accountability Act (HIPAA), which took effect July 1, ensures that most staffers who change jobs receive continuous health insurance without regard to many pre-existing health conditions. During the next six months, many nonprofits will be affected by the new law's certification requirements.

HIPAA, which President Clinton signed into law in 1996, allows employees who have been covered by health insurance for 12 continuous months to switch jobs and employer insurance plans without having to undergo waiting periods for pre-existing conditions. On April 1, the U.S. Department of Labor released official guidance on how to implement the health insurance portability act.

The Departments of Labor, Health and Human Services and Treasury posted revised guidance and a pamphlet for implementing the HIPAA on the World Wide Web. The Web site features a question and answer format that includes the questions you can anticipate from staffers about the new law, along with responses based on the Department of Labor's interpretation. The site also includes sample forms and guidance to design certificates of group health plan coverage and notice to employees of their right to health coverage documentation.

The information can be found at:

http://www.dol.gov

From this site, you can access and print out or download the text of the model certificates. A copy of the pamphlet also may be obtained by calling the Pension and Welfare Benefits Administration Publication Hotline at 1-800-998-7542.

Deadly Fumes Force Five-Day
Evacuation of Arkansas Hospital

Suppose your hospital had to be evacuated for five days, with only minutes warning - would your disaster plan work? Helena Regional Medical Center (HRMC), a 155-bed facility located in the heart of the Arkansas Delta, found that its plan did work very well.

On May 8, 1997, a chemical plant exploded in West Helena spewing toxic smoke and fumes across the town, forcing hundreds of people to leave their homes and businesses. Three firefighters were killed and approximately 30 people were injured.

That event alone would cause a hospital to put into place its practiced disaster plan. However, the pesticide-fueled factory blaze also forced evacuation of Helena Regional Medical Center, which is about a half-mile from the plant. The blast was heard and felt by employees at the hospital who immediately called the Office of Emergency Services. Within 15 minutes, hospital officials were told to call a Code White--total evacuation of the building.

Jan Chambers, director of marketing, said, "Most hospitals have some sort of disaster plan. But very few have a total evacuation plan." She said the hospital had a mock drill of the evacuation plan about six months prior to the explosion.

On May 8, the hospital had 44 patients and approximately 150 employees to move to other locations. Within 10 minutes of the Code White, the first patients left the hospital. By prior agreement, most patients were taken to Phillips County Community College. Six, including four who were in the ICU, were moved to Baptist Memorial Hospital in Forrest City, and to a Clarksdale, Mississippi facility. Family members picked up other patients.

The HRMC transportation service, vehicles from Mid Delta Transit and school buses assisted with patient transfers. By 4:30 p.m., three hours after the plant exploded, the last employee left the building.

Following containment of the fire, hospital officials worked with representatives of a HAZ MAT team from West Memphis, the Arkansas Department of Health (ADH), and the Environmental Protection Agency and Centers for Disease Control concerning safety and clean-up issues. The ADH worked diligently with the hospital to help re-open as soon as possible. Because of negative air levels, the entire facility underwent "ceiling to floor" cleaning with QUAT 26. HRMC re-opened five days later.

Dr. P. Vasudevan, chairman of HRMC's Professional Standards Review Committee and Quality Assurance Committee, said, "The employees of Helena Regional Medical Center did an outstanding job. Special mention should be made of Karen Wade, director of quality assurance; Beverly Winney, director of nursing; Betsy Arnold, safety director; administrative staff; the entire maintenance team, as well as all department heads and nursing personnel.

Sandra Nichols, M.D., director of the Arkansas Department of Health, sent a letter to Jim Teeter, president of the Arkansas Hospital Association, praising the hospital's staff and spirit of cooperation. She said:

The hospital could not be reoccupied until all surfaces had been cleaned, all supplies restocked, and all air filters had been changed. Staff worked throughout the weekend to accomplish this monumental task. On the evening of Tuesday, May 13, Helena Regional Medical Center was reopened for business.

The planning that occurred at Helena Regional Medical Center prepared the staff for a swift and efficient response when the events of May 8th occurred. The cooperative nature of Medical Center staff after the evacuation and subsequent reentry was also swift and efficient. Without the presence of these factors, the health of the patients and staff would have been compromised. The administration and staff are to be commended for their exemplary actions.

Arkansas Joint Venture, Mergers and Affiliations

-- The Sisters of Mercy Health System-St. Louis, Washington Regional Medical Center in Fayetteville and Arkansas Blue Cross and Blue Shield (ABCBS) have finalized a joint venture agreement to enable the organizations to partner in the creation and delivery of healthcare services and insurance plans serving 21 counties in northwest, south central, and west central Arkansas. Under the arrangement, called Arkansas Health Partners, ABCBS and participating hospitals and physicians will work together to offer managed care plans to groups and individuals in each of the three regions. Participating Sisters of Mercy hospitals include St. Edward Mercy Medical Center in Fort Smith and its affiliated hospitals located in Paris, Waldron, and Ozark; St. Joseph's Regional Health Center, Hot Springs; and St. Mary-Rogers Memorial Hospital in Rogers.

-- Columbia/HCA Healthcare Corp. has announced plans to build a new $60 million, 118,000 square foot, 85-bed hospital and a 54,000 square foot physicians' office complex in North Little Rock, across from the site where Baptist Memorial Medical Center is under construction.

-- St. Joseph's Regional Health Center in Hot Springs and HSC Medical Center in Malvern have announced an affiliation of the two hospitals. The affiliation agreement will allow HSC Medical Center's management, board, and physicians to have an opportunity to participate in strategic planning and community needs assessments as part of the Sisters of Mercy Health System which operates St. Joseph's.

-- The Sisters of Charity of Nazareth Health System (SCNHS), a multi-state health network which owns and operates St. Vincent Infirmary Medical Center in Little Rock, and Catholic Health Initiatives, a national healthcare organization based in Denver, have signed a letter of intent to consolidate.

-- Carroll Regional Medical Center in Berryville is now a member of St. John's Health System in Springfield, Missouri.

Computers vs the Year 2000

Computers, for the most part, have made life better for almost all of us. While we may occasionally be told "Our computers are down" when we call an airline or a bank for information, the fact that massive amounts of information can be stored, retrieved, and processed almost instantaneously is usually beneficial. In the medical industry, hospitals can track patient and hospital costs much more accurately; pharmacies can quickly know a patient's drug history; physicians can find information to help diagnose an uncommon illness.

Inside the computer is the software; the programmer's directions that tell the computer step by step how to process the information fed into it. During the 1970s and into the 1980s, the cost of computer hardware was extremely expensive, and care was taken to use it wisely and sparingly. One of the areas in which this care was exercised was in the programming. As the year 2000 approaches, one specific trick used by the 1970s programmer is about to cause some potentially serious problems.

Dates (as in month, day, and year; not the food, or the taking in of a movie by a couple holding hands) are extremely important to a computer. It uses them to sort and retrieve data, to compare one piece of information with another, to know which information to process and when to process it. Probably ninety-five percent of the programs ever written use dates for some purpose.

During the 1970s and 1980s, programmers, especially those writing in the computer language called COBOL, specified dates using two digits for the month (01-12), two digits for the day (01-31), and two digits for the year (00-99). Dates were usually entered into the computer and printed on reports in the form of 10/30/80; or specified as 80/10/30 for sorting and comparison purposes. What this saved in terms of storing data in the computer was the two digits of the year which designated the current century, as in '19'80. In today's computers, this is a trivial matter, but twenty years ago, computer memory and storage space costs were high enough to justify the procedure.

As the year 1999 ends and the year 2000 begins, however, computers will begin to do strange things. A person born in 1950 will be recognized as 49 years old ('99' - '50') in 1999, but will be considered -50 in the year 2000 ('00' - '50'). Interest calculations at banks and savings and loans may come up negative. Medical records may be ignored or erased because the computer thinks a patient hasn't been born yet. Many experts feel the problems possible are incalculable, and one information technology research firm has placed the worldwide cost of correcting this problem at between $300 and $600 billion.

The solution to the problem is simple: change the computer programs so they will process dates in the form of 10/30/1980 (or 1980/10/30), using four digits for the year. The hitch is that the scope of the task is unbelievably enormous. The current estimate is that it will cost roughly one dollar for every line of computer code in use today to correct the problem. Chase Manhattan, one of the world's largest banks, has around 200 million lines of code to check, and has budgeted $200 million to do it; it is estimated the banking system alone has more than nine billion lines of code overall to proof.

As happens with almost any business problem, analysts are predicting various results. Some businesses will not make the required changes, and some of these will literally go out of business. Many will be in the process of making the changes when January 1, 2000 arrives, and will suffer business losses because of it. Most companies will make the change ahead of time and be ready to open for business for usual on 01/01/2000.

Companies who are not ready on the first day of the year 2000 may suffer in many ways. Some will have to remain closed until they have finished making changes. This will not only mean lost revenue for the period of time they are closed, but they may lose customers to similar businesses that completed the conversion on time. If a company has a significant number of stockholders, and especially if their stock is publicly traded, there could possibly be legal action taken against the officers and directors for negligence. The company's stock price is sure to drop drastically. And some of these problems may even develop before 2000 if a company's auditors discover the company is not adequately preparing for the conversion and they are forced to issue their audit with a qualified opinion.

Some companies may successfully complete the changes just as the year 2000 begins, meaning they will not have had time to adequately test the programs. Since massive program changes such as those required here can easily create other errors, most software experts feel at least one full year of testing will be necessary to make sure any 'bugs' created can be corrected. Information technology specialist Kevin Hamel, formally with Alltel Corporation and now with IBM, says, "I believe there will be companies that will not reopen after January 2 because they haven't tested very well, or they thought they had solved [the problem]."

Companies who complete their conversions early, test them thoroughly, and are fully ready for the first day of the year 2000 may still have problems, if their computers talk directly with, or receive data by way of tape or disk from, the computers of companies who have not converted their software. One Wall Street firm, Morgan Stanley, is set to complete their conversion well before the end of 1998. They then plan to spend 1999 not only testing their own software for newly created bugs, but also evaluating the progress of people with whom they do business so they can decide if they will continue doing business with them.

Insurance companies face a double problem. The number of lines of code in their software is huge, and the programs use dates for every conceivable purpose. There conversion task is therefore very difficult. Plus they are likely to be hit with an enormous number of claims by companies claiming business interruption losses because of closures, both temporary and permanent.

For the business whose software contains this 'Year 2000' snafu, but does not have its own staff of programmers, there are three possible solutions. First, they can hire some. If management has been considering this anyway because of legitimate business needs, this would be the time to do so. If not, then the new employees would simply have to be let go once the conversion is complete.

Secondly, they can 'outsource' the work; that is, hire outside consultants and contractors to perform the conversion. Even some large corporations with a programming staff are doing this. Both of these solutions hinge on being able to find qualified personnel.

The third solution is to convert to completely new software, and possibly even new hardware. Almost all programs written during the 1990s has been written using four digits for the year field in the date. If a company's software is outdated, or doesn't provide management with adequate information, it may be a good time to go through a total conversion. And it could be very cost effective; ITT Corporation is replacing its 'mainframe' computers (the very big ones) that originally cost $40 million with a PC network that will cost just over $2 million.

Whichever solution is chosen, the choice should not be put off. A company's first step is to determine if it has the problem; if it doesn't, management can relax with a big smile. If it does, then management needs to decide which solution to pursue. Because of the wide scope of the problem, data processing personnel will become scarce during the next three years, and finding someone qualified may be difficult. Plus, as is always true with the law of supply and demand, as the number of qualified people available shrinks, the cost of those that are available rises. A recruiter at the Boston-based Romac International, Inc., feels that as we get closer to 2000, COBOL programmers may be able to command six digit salaries.

As is true in most areas of business, the best place to begin is with other companies in your field. Check with them for references of a data processing firm with whom they have dealt successfully (or just as importantly, one to avoid). If your industry has a membership association or organization, ask them to send out a questionnaire requesting recommendations. The important thing is to get started; not even an act of Congress can postpone this deadline.