ICD-10 Transition

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Client Profile:

13-hospital health system with an academic medical center, community hospitals, specialty hospitals, community medical group and a payor plan.

Challenge:

On October 1, 2015, CMS required all healthcare providers to migrate onto the ICD-10 code sets.

By the fall of 2014, the health system had turned over the project management role four times and was in desperate need of project stability, guidance and focus.  With just a year left on the timeline, our team was deployed into the leadership role and other support roles to aid the health system during the migration onto ICD-10.

Using core project management methodologies, our team quickly identified the need to restructure the ICD-10 client project team and realign the work tasks, communication lines and re-focus the project. Within weeks, our team was able to mobilize key resources to address the following:

• Provided clear expectations for the leadership team:  A key first step in assuming control of this project was to redefine the roles and expecations for each member of the team.  This was the first time the health information directors had ever been asked to work together on a project as well.  Not only were they new to each other, they were largely new to project management as well.
• Refocus the training effort for providers:  Prior efforts had focused on classroom style training to providers.  The providers struggled with this approach because it: a) did not give specific feedback into their particular documentation needs, b) was not timely to their documented charts, and c) was not part of their normal training program and required extra time away from patients to complete.  We overhauled the training program to be driven through the clinical documentation improvement (CDI) team, allowing the providers to receive specific knowledge about how their documentation practices needed to change in order to support coding in ICD-10.
• Established payer testing forum: Payors varied greatly on how they allowed providers to test with them prior to the onset of ICD-10.  With the myriad of client stakeholder groups all clamoring for more information about how and when they were allowed to test, we created a payor test group focused solely on connecting to the payors.  As a result of the diligence of this group, the client experience no major payor delays or issues through the transition.
• Dedicated resources to IT testing:  One of the greatest areas of risk during this project was the systems impacted by the switch to ICD-10.  To complicate the go live, the client was converting onto a new health information system (HIS) just 30 days after ICD-10 go live.  This meant that we needed to test not only in the legacy system, but also complete thorough planning and testing in the new HIS environment.  With significant competing priorities for IT resources, we were challenged to stay focused on preparing for ICD-10 and ensuring all of the systems were ready for the transition.
• Gained control of the budget:  This project was given a $24 million budget for all hospitals and all tasks.  With two delays handed down from CMS, this project was at risk for going over budget in the final year of preparation.  i3 restructured the budget, eliminated some unnecessary components and realigned resources to meet budget restraints.
• Created integrated communication plan:  Prior to i3 assuming control of this project, communication was infrequent and cumbersome to follow.  We tapped into existing communication protocols and created messaging that was easy to digest, disseminate and track.  We also created an executive report card that was shared with each individual hospital leadership team that allowed them to know how we were progressing at the system level and at their locally controlled level.

As a result of our work, the hospital had an extremely smooth transition onto ICD-10. In fact, physicians cited that they almost did not notice the transition because they had been working to change documentation practices in the months leading up to the cutover date. This project also came in over $1 million under budget.