September 4, 2011

Remember, The Boat Sank in The Perfect Storm


“The perfect storm:” we hear this catch phrase all the time when referring to healthcare reform initiatives including MU, 5010/I-10, EMR, HIE, ACO, etc. It’s a good analogy considering the magnitude of the storms the Andrea Gail sword fishing boat faced in the real “perfect storm” and the magnitude of the multiple initiatives healthcare organizations are facing.

To refresh your memory of the 1997 book and 2000 movie, after debating whether to sail through the mounting storm or to wait it out, the crew decides to risk it. However, between the Andrea Gail and their homeport, a confluence of powerful weather fronts, which the Andrea Gail crew underestimated, resulted in the capsizing and sinking of the ship with the tragic loss of the entire crew.

The healthcare “perfect storm” pales in comparison to the loss of the Andrea Gail and crew, and while it might seem like it at times, no loss of life is anticipated with these initiatives. We can, however, identify a parallel analogy in deciding either to push through the storm or to try to wait it out and see what happens.

The First Storm

As we set our course for home with 5010, I struggle to understand why so many organizations have underestimated this effort and now find themselves in an undesirable path. Some organizations’ health plans have not mitigated 5010 risk for their data warehouses. Some health systems are relying on their clearinghouses to submit 5010-compliant claims, but have underestimated the 5010 impact on their secondary IT systems. Perhaps most surprising, though, is that some organizations have not started their 5010 conversion and cannot understand why they might not make the deadline.

Once you lay out all that needs to be accomplished in the next four months, the reality becomes quite apparent to any such organization that their chances of making the deadline are limited.

The one common thread with all three of these scenarios is the same: the attitude that “we had other major projects that consumed our resources and we couldn’t handle any more.” Did these organizations underestimate the magnitude of the effort? Did they chart their course paying too much mind to competing enterprise priorities to determine the best path? Did they underestimate the force of the storm?

Would Have, Should Have

I asked each organization if they would have done anything differently, and they all provided similar answers:

  • They would have started earlier to understand the efforts needed. Even though they had a two-year timeline, 5010 was new, and educating themselves on 5010 accounted for a delay in their mitigation activities.
  • They thought they were in better shape with 5010 than they were until they realized they needed assistance. They would have evaluated their progress along the way to re-prioritize earlier.
  • They would have coordinated major initiatives through a central PMO for one point of control and coordination of efforts. They had too many initiatives working in a silo full of staff consumed with their one specific initiative, resulting in inefficiencies and duplication of efforts.

I cannot say where these organizations will be in the next four months, or if they will be safe by January 2012. Would they make different decisions based on their experiences? One organization has, as it now has realized that two years is not a lot of time to prepare for a major initiative like ICD-10 readiness.

All will attempt to go through the same storm, as waiting it out is not an option.

About the Author

John Pitsikoulis, RHIA, is a Strategic Advisory Services Client Executive and ICD-10 Practice leader at CTG Health Solutions (CTGHS). John is responsible for the strategic advisory services such as ICD-10, EMR clinical documentation integration program, and Computer Assisted Documentation Services. John has over 25 years of Health Information Management (HIM), coding, and compliance consulting experience working with clients on ICD-10 services, RAC, coding, and clinical documentation improvement engagements.

Contact the Author

To comment on this article please go to

Read 10 times Updated on September 23, 2013

John Pitsikoulis, RHIA, is the ICD-10 practice leader and an AHIMA ICD-10-Approved Trainer for Nuance Communications. John has more than 28 years of revenue cycle, health information management, coding, and compliance consulting experience. John has developed and led several corporate and client strategic engagements for managing the conversion to ICD-10, including ICD-10 assessments, implementation planning, integrated testing, education plan management and revenue preservation strategies.