March 20, 2012

HHS Delay: Good for Change Management


Even under the best of circumstances, change is hard. That’s why it is not surprising that there is mixed reaction to the announcement from U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius that the federal government may delay the implementation of ICD-10. The American Medical Association (AMA) has noted that it is pleased with the delay because it will minimize the burden of change for physicians who already are navigating significant payment and delivery reforms. HIMSS has a different perspective, however: it believes a delay is unnecessary. According to its recent leadership survey, 90 percent of healthcare IT executives feel that they are prepared to meet the original deadline.

Prepared or not, ICD-10 implementation delay creates the opportunity for more effective management of change. Organizations that stay the course and continue to take a structured approach to change can minimize disruption, increase satisfaction and have greater assurance that project goals will be achieved prior to go-live.

Timing is Everything

Strategic delays can be beneficial because they enable the design or redesign of change processes, giving constituents time to make decisions and adapt to new dynamics, systems and ways of working. As organizations transition to ICD-10, they should take time to look at their vision and commitment to the goal – which should include a plan for how to address change. Because ICD-10 has wide-reaching effects that go beyond mere coding, the transition requires significant communication, collaboration and coordination across healthcare organizations. This complexity creates opportunity for many things to go wrong. Any additional time provided for compliance will allow us to work through such issues and avoid problems at activation.

When considering effective change processes, timing is everything. The rush to meet the original Oct. 1, 2013 deadline might have left many organizations in command-and-control mode. Without the luxury of time, leadership needs to make decisions quickly and drive readiness rather than allowing individuals sufficient time to adapt to the code change and understand up front all the details of how it will affect their roles.

Whether it involves people, processes or technology, understanding current states and desired future states is a foundational component of driving and sustaining change. An effective change management plan also should include monitoring and post-implementation process improvement to ensure continued success.

While HHS has not clarified the details of the delay, it is assumed that organizations now will have more time to take a best-practices approach to changing management to support a smoother transition. So organizations now also can use this time to minimize stress, identify issues before they become bigger problems, and realize a successful outcome.

Navigating change

There are a number of models organizations use to navigate change, one of which is the Tuckman stages of group development. This includes the concepts of forming, norming, storming and performing – the transitory phases necessary for a team to grow, tackle problems and reach a desired outcome. While the model was developed in 1965, the modern adaption involves putting together a vision, making a commitment to a goal and having sponsorship and governance, all key criteria for successful change management.

With ICD-10, people have to understand what it is and how it impacts their job. Organizations need to do the upfront work to modify their policies and processes to support the new classification system. From a technology perspective, this includes looking at systems, analyzing changes that need to be made, making the changes and performing the testing.

Managing change appropriately allows for testing and minimizes surprises or disruptions that can impact success. Keep in mind that there are often things you cannot anticipate or do not discover until you are testing a new solution or process. Things also often take longer than anticipated, so even if ICD-10 is delayed, preparing for change now is necessary.



Lessons from 5010

Some industry professionals might be displeased with the idea of delay, but looking at lessons learned from version 5010 implementation, delays can be a good thing. For example, even though healthcare providers planned for testing and activation of the updated version of transactions, many quickly realized when they began operating in a live environment that the testing was not complete. This caused interoperability issues and, as a result, organizations ended up with revenue impacts – with some achieving compliance long after the recommended timelines.

Other lessons learned from Version 5010 implementation include:

Starting early is critical

Rather than waiting to engage constituents, begin communications now. Help stakeholders understand the end goal and necessary requirements to reach compliance by the deadline.

Dual processing is valuable

Taking time to perform dual coding can enable organizations to better train and prepare coders for the increased specificity required by ICD-10. Through dual coding, organizations can ensure that documentation is accurate and help healthcare professionals get a glimpse into how they will code in the new system.

Communication is important

There is power in knowledge. When individuals understand change and how it affects their roles, it makes for an easier transition. Encourage dialogue and enable people to ask questions, raise issues and voice concerns. Ongoing communication is also helpful in developing program ambassadors to champion change and increase acceptance.

Understand your scope of influence

With 5010, a hospital’s scope of influence was its affiliates and care center facilities, its own transactions and its payer transactions. However, vendors and payers need to take responsibility for their own affairs and their own areas of influence in order for the entire change process to be successful.

Consider your internal resources

Determine if you have sufficient resources to train coders to learn the new system or to minimize impact to productivity. Use the additional time to revisit your assessments and determine if outsourcing makes sense.

Testing matters

Take the time to perform testing in order to minimize surprises. Identify the processes and business rules you will test, which clearinghouses, vendors or payers to test with, and when to perform the testing. Use testing opportunities for verification and validation or to make changes to ensure a smooth transition.

Appreciating change

The delay is good for change management. Effective change management requires commitment to improvement, project sponsorship, communication and time to do things right. Regardless of the length or details of the ICD-10 implementation delay, organizations should continue to forge ahead with their current plans. Take advantage of any delay time to strengthen plans for the adoption of ICD-10 and to ensure you are ready to hit the ground running at go-live.

About the Author

Veronica Hoy, MBA, is vice president of SOURCECORP HealthSERVE Consulting, Inc. Veronica has been an operating executive for 10 years, focusing on providing strategic leadership and direction to healthcare professionals and organizations. She has more than 20 years of healthcare experience in business process outsourcing, accounts receivable management, coding, billing, release of information, consulting and systems implementation.

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Read 53 times Updated on September 23, 2013