From GovHealthIT.com | June 16, 2015
Denny Brennan, Executive Director of the Massachusetts Health Data Consortium and David Delano, Project Director for the Mass eHealth Collaborative
Many healthcare providers and payers – large and small – are advancing toward ICD-10 readiness after two to three years of planning, assessment, design, implementation, testing and contingency planning. These organizations have substantially reduced their exposure to ICD-10 financial, technical and operating risks.
Many other organizations, however, have delayed their ICD-10 preparation; for these organizations, the risks posed by opting to hold off on implementation are much greater. The limited time remaining reduces their tolerance for errors and delays in executing this transformation successfully.
Agile methodologies streamline and simplify complex technical projects where complexity is high, requirements are fluid and time is short. By incorporating agile elements in their ICD-10 implementation, health care organizations can speed attaining the essential levels of training, documentation and coding required to survive October 1st and build an effective program for enhancing these competencies in the months that follow.
For two years, ending March 31 of this year, the Massachusetts Health Data Consortium (MHDC) convened 88 of the Commonwealth’s payers and providers to meet the challenge of achieving ICD-10 compliance well in advance of this October’s deadline. With the program management support of the Massachusetts eHealth Collaborative (MAeHC), the ICD-10 Project spanned all facets of ICD-10 preparation (e.g., assessment, design, testing, and implementation).
Among the many strategies, tactics, methods and insights produced by the ICD-10 Project were seven agile approaches that could substantially reduce wasted effort and improve the productivity of ICD-10 implementations for organizations who have delayed their conversion to the new standard, specifically:
Know the time, not how the watch is built. When time is tight and success is measured in achieving rapid and increasing ICD-10 effectiveness, traditional project management tools and methods will slow progress to a halt. Replace project management software, presentations and progress reports with more and briefer daily project status meetings to accelerate progress and keep the team on track.
Aim, fire, ready. If you were relocating to France on October 1st, and did not yet speak any French, you would not adopt a traditional French curriculum today to meet your communications needs four months from now. Chances are you would learn the basic French words and sentences necessary to meet your basic needs when you arrive and build your knowledge of syntax, case and conjugation over time. Traditional ICD-10 programs are not unlike traditional French curricula. They place a greater emphasis on comprehensiveness — assessment, governance, process documentation and project management — than on utility. While this level of structure is useful to support long-term transformation, it will impede the rapid, iterative methods that build essential competence more efficiently. Dedicate some of your ICD-10 program “infrastructure” to “rapid action” initiatives that will enable your organization to acquire a basic level of ICD-10 competence as quickly as possible.
- Get real. For many organizations, ICD-10 remains the imposition of an uncertain, complex future rather than new codes to describe the same work. While both perspectives are true, only the latter is actionable. The more organizations incorporate ICD-10 into daily operations, the more staff and physicians will consider it something useful and worth caring about. Start coding, if only as notes, an increasing number of patient encounters. Create ICD-10 flash cards and “cheat sheets” that users can affix to their workstations. Conduct weekly team briefings to review the new codes, their documentation requirements and other relevant information.
- Get help. Organizations just starting their ICD-10 transitions will have very limited, if any, access to external validation and testing with commercial and government health plans, given the testing deadlines and long lead times. Numerous online resources enable the rapid look-up, verification and validation of ICD-10 codes. Check with your clearinghouse or billing service to determine what on-line ICD-10 resources they provide. Knowing that you have validated your coding and that your clearinghouse or billing service is ready to, and can, receive and process your ICD-10 codes will reduce your technical risks substantially.
- If you stopped today, what would you have accomplished? No organization can risk being “almost ready” on October 1st. Conventional ICD-10 implementations are long on gradual and systemic improvement and short on frequent and closer-to-real-time deliverables. Rapid, repeated small-scale successes trump gradual systemic improvement when time is short. If during your weekly team meeting, you hear many gerunds (e.g., proceeding, studying, evaluating, determining) used to describe progress, you need to fix the cause of delay or shrink the scope of work to ensure more tangible progress and results reporting.
- Team up. Co-located and collaborating teams produce results superior to those based on working in largely segregated processes with unique goals. Assemble a multidisciplinary team with clinical, financial, technical and operational smarts. Have the team work in the same room (or very close), ensuring frequent interactions and face-to-face meetings over delegation of responsibilities and email communications.
- Just in case. No matter where organizations are at this point in their conversion efforts, they should have a contingency plan for October 1st in place before then. Work through failure scenarios, e.g., documentation shortfalls, system failures and coding inaccuracies, to determine how the organization will manage these situations should they arise on, or after, the deadline.
Agile approaches to achieve ICD-10 readiness speed new programs and enhance existing programs that are at risk of failing to meet the Oct. 1 ICD-10 deadline. The increase in organizational focus and speed will support achieving necessary ICD-10 readiness and support working beyond the October 1st deadline as productively as possible.
Denny Brennan is the Executive Director of the Massachusetts Health Data Consortium. David Delano is Project Director for the Mass eHealth Collaborative.