Year 2000 Problem: Less Than 15 Months and Counting

A recent survey of hospitals revealed that more than 40% of respondents do not expect to complete Year 2000 preparations by the turn of the century, and that few have coordinated their strategies with other participants in their care network. Shocking? Read on.

In preparation for a mid-summer meeting of the Senate special committee on the Year 2000, Senate staff compiled studies demonstrating that: 80% of hospitals are "looking" at the problem, but that only 30% have formal Y2K plans; 90% of physicians are taking no action in their highly-computerized offices; and, following an exhaustive inventory of its medical equipment, the Veterans Administration found that 20% of it needs to be fixed or replaced.

In the United States, there are 6,000 hospitals, 50,000 nursing homes and 700,000 physicians - all facing the need to locate and repair billions of lines of faulty computer code, which will be unable to function properly after December 31, 1999.

The National Patient Safety Partnership, a coalition in which the American Hospital Association (AHA) participates, wants device manufacturers to make available information about their products to customers no later than January 31, 1999. The coalition also called for the establishment of a national clearinghouse for information on problems with medical devices used in hospitals and homes, making the information accessible to the public and the healthcare industry.

AHA members now have access to the Year 2000 Resource Center on the association's Web site, http://www.aha.org. Sign on, request a password if you don't have one for the AHA site and then check out the executive briefing that provides a checklist with a detailed five-phase project guide covering awareness, inventory and assessment, and implementation planning and processes. The site also includes information on sample contracts to ensure compliance. Readers are reminded that compliance requires using, or agreeing upon, a set of definitions of what compliance really means once the clock strikes midnight on Dec. 31, 1999. The resource center also includes a bibliography and links to related articles; a listing of and links to national, state and metropolitan organizations that are hosting Year 2000 activities; regulatory updates; educational opportunities; search assistance and opportunities to provide feedback.

Medical Device Vendors Create Problems

Of more than 1,600 manufacturers contacted in the past year by the Department of Veterans Affairs, 84% have sent responses on their efforts to identify millennium-date problems with their products. But many responses were no help:

• 201 manufacturer surveys came back marked "return to sender."
• 187 respondents said they were not responsible for alterations, that they had merged or were bought out by another company or were no longer in business.
• 53 manufacturers gave a courtesy reply, saying they were still analyzing their products, and no other information was available.
• 34 makers reported a total of 182 models that are not year-2000 compliant, are considered obsolete and will not be updated.
• 102 companies reported a total of 673 models that are not compliant but are scheduled to be repaired or updated this year.
• 694 manufacturers said their product lines are year-2000 compliant. No response was received from 233 manufacturers.

As a result of mergers, buyouts or other actions, the VA paired its list to 1,504 vendors and contacted them again in June to verify existing data or otherwise allow them to respond before the information is released outside the federal agency.

(Source: Dept. of Veterans Affairs)

Arkansas Nursing Homes Win Suit

The Arkansas Health Care Association (AHCA), which represents nursing homes throughout the state, won a lawsuit recently against the Department of Health and Human Services (DHHS), paving the way for an increase in state Medicaid nursing home rates. The lawsuit was filed earlier this year by AHCA, which charged that the state was violating Act 1360 of 1997 by refusing to pay higher Medicaid reimbursements to nursing homes to compensate for federal minimum wage increases.

The Arkansas General Assembly passed Act 1360 with the intent of providing nursing homes reimbursement for their added expenses related to minimum wage increases mandated by the federal government. Governor Mike Huckabee vetoed the law, saying the nursing homes failed to provide sufficient information justifying the increase. The state legislature then overrode the governor's veto, but DHHS officials continued to withhold the rate increase, which led to the lawsuit.

Pulaski County Circuit Judge John Ward ruled in favor of AHCA in the matter, declaring the act constitutional and requiring the higher nursing home Medicaid rates to be paid. The increase will mean that Arkansas' private nursing homes will now be paid about 108% of their aggregate costs, versus the current 103% of costs now paid, according to DHHS attorney Breck Hopkins.

Employee Recognition

Each spring, National Hospital Week is celebrated across Arkansas. Hospitals plan special events, health fairs, and recognition days. At other times during the year, special days are set aside to honor certain departments in the hospital as well--nurses, emergency medical departments, respiratory care, etc. While these individuals deserve special recognition, this is a costly undertaking for a hospital marketing department and not all professions are honored in such a manner.

In April, the Arkansas Hospital Association's board approved a recommendation by the Arkansas Society for Healthcare Marketing and Public Relations (ASHMPR) that all hospital employees are equally honored during National Hospital Week. "The resolution promotes fairness among employees, all being critical to the body of the hospital," said Becky Baker, ASHMPR president. She cautioned that each hospital should carefully decide whether or not to implement the resolution, and also noted that it does not prohibit celebration of Doctors' Day or Volunteer Week that ASHMPR did not consider to be employment groups.

ASHMPR offers the following recommendations for marketing departments during the transition:

• Let employees know that National Hospital Week will be the time that all staff is recognized for their very necessary contribution to the hospital.
• Encourage professional groups, especially those with national affiliations, to celebrate at this time. Allow them to use hospital premises (dining room, conference room) for their own get-togethers.
• Allow groups to display posters honoring their professional affiliations.
• Budget for department-based employee activities, ensuring that each department is treated equally.
• Develop a plan of promotional ideas for your hospital. Announce the plan prior to National Hospital Week.
• Send a news release to area media about National Hospital Week and ask them to cover your planned activities.
• Make this system policy.
• Assign each department a reporter for your employee newsletter. Ask them to produce an annual department profile and run them at the same time.
• Issue each department a disposable camera. During National Hospital Week, display a collage of their photos depicting activities in their departments.
• Invite your Chamber of Commerce board for lunch and a presentation on what your hospital contributes to the community.
• Pair a doctor or group of doctors with each department. Ask them to work on integrating the doctors into their annual celebration.
• Establish an employee focus group and let them tell you what makes employees feel appreciated.

SNF Rates Published

The Health Care Financing Administration (HCFA) published its interim final rule on the prospective payment system (PPS) for skilled nursing facilities (SNFs) in the May 7 Federal Register. The PPS system takes effect for cost reporting periods beginning on or after July 1, 1998, and has a four-year transition period. During the four-year transition, SNF Medicare payments will be a blend of the facility's specific rate and the national average costs. The congressionally-devised formula for the federal rate gives more weight to freestanding SNF costs and fails to adequately recognize the higher costs associated with hospital-based units.

In developing its SNF rates, HCFA uses Resource Utilization Groups (RUGS) to classify patients into care categories. Similar to DRGs for inpatient care, the RUGs are used to adjust the basic rate for each day of SNF care. Unlike DRGs, there are different base rates depending on the type of RUG (therapy or non-therapy) and the SNFs location (urban or rural). The per-diem payments will be within the range outlined below.

During the first transition year, most SNF's will receive a 75/25 blend of facility specific and the federal rate. New SNFs that did not receive Medicare payment until October 1, 1995 or after will automatically go to the full federal rate. Swing beds are initially excluded.

Volunteer Feedback

Despite the common wisdom that volunteers are "community representatives" to and from the organization, how often are they tapped for their community insight? Not often enough, says Susan J. Ellis, volunteerism consultant and publisher, in Volunteer Leader.

"The fact is that useful feedback from volunteers rarely occurs spontaneously," she says. Their opinions need to be, and should be, sought out. According to Ellis, author of several books on the subject, volunteers bring a different perspective to the healthcare facility than do employees or clients.

"This point of view may result from not being vested in the professional process, from being younger or older, or from simply having the distance a part-time schedule allows," she says. "Not all volunteer ideas may be creative, or even realistic, but the same is true of employee opinions. Yet volunteers may carry a special kernel of insight, especially if the volunteers are more representative of the population served than the hospital staff."

Here are five simple strategies for getting useful feedback from volunteers:

1.    Ask them. Informally and formally, be sure to elicit the opinions of volunteers.

2.    Schedule a regular time for administrators to meet representative volunteers individually and in small groups as a "think tank."

3.    During the orientation, be sure to explain to volunteers how and when to express opinions, both critical and complimentary.

4.    Convene all volunteers carrying the same assignment at least once a year with the employees of that unit so that volunteers can share their thoughts on what is going well, what needs improvement, and what might be planned for the future.

5.    In order for volunteers to be of greatest help, they need accurate information on which to base their opinions. On a regular basis, keep volunteers informed about new services, changes in personnel, and issues affecting your healthcare agency.

Giant Steps for Pediatrics

With today's modern medicine and technology, babies born three months too soon and weighing less than a pound and a half survive. Diseases that often killed or crippled kids--polio, bacterial meningitis--don't even strike anymore or are so rare that many children's doctors have never treated them. Fetuses are now operated on for life-threatening disorders. And mothers-to-be are "pretreated" with drugs or vitamins to avoid dreaded conditions that can disable children or take their lives--blood RH incompatibility between moms and babies, spina bifida.

"The story of children's health in the last 50 years is a shift toward prevention and outpatient care," says Pediatrics editor-in-chief Jerrold Lucey. The journal marked its 50th anniversary this year with a July issue devoted to landmark discoveries in the field.

With all the progress, however, old-time pediatricians might be amazed to see the kids' problems that are just emerging or gaining attention. More than 10% of current Pediatrics articles concern sexual or physical abuse, a subject that just didn't come up 50 years ago. Others concern obesity, skyrocketing suicide, and homicide. Antibiotics targeting specific infections multiplied over the last few decades. Vaccines, too, have dramatically altered the childhood disease picture.

Polio killed 3,145 Americans, mostly children and teens, in 1952. Not a single U.S. child has developed the generic "wild virus" polio since 1979. There's been an average of eight cases per year since 1979, all associated with the live-virus vaccine, says Rebecca Prevots of the National Immunization Program. New federal recommendations to start the vaccine series with a killed-virus shot are expected to cut these cases by 50% to 75%.

In recent decades, vaccines also have nearly eradicated disabling bacterial meningitis and become available to prevent measles, rubella, mumps, and chicken pox. The prevention emphasis is touching children at ever younger ages. U.S. infant mortality hit a new low of 7.2 deaths per 1,000 in 1996, thanks primarily to new medications that accelerate lung maturity in premature babies and rapidly improving neonatal intensive care.

Other dramatic changes have occurred in children's health over recent decades. For example, the cure rate for leukemia, the most common childhood cancer, "was basically zero 50 years ago," says John Laszio of the American Cancer Society. Now it's 75% to 80%, he says. But most children will never face such a serious disease. A sea of change has swept over treatment practices for routine ills. Among major changes:

• Use of aspirin. Widely given to children for fever until 1983 when it was linked to Reyes syndrome. Reyes cases fell as aspirin use plummeted.
• Asthma. Barely recognized as a specific disease 50 years ago. Kids rested, but there was no potent medicine. Now allergy shots, inhalers, and pills battle the causes of airway inflammation.
• Ear infections. Painful lancing of eardrums wasn't uncommon 50 years ago. Now antibiotics are offered. The downside: Many experts think they're overused, and antibiotic resistance is growing.

Progress depends on children's using the medical care available: Federal reports show uninsured kids are six times more likely than the insured to go without needed medical care. In 1996 there were a record 11 million uninsured children, but a federal law passed last year could cover 5 million of them, says Gregg Haifley of the Children's Defense Fund. Still vulnerable: offspring of the working poor, particularly single mothers.