March 16, 2015

ICD-10 Project Teams Transitioning from Being Submerged to Being Successful

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Uncertainty about ICD-10, delays, projects on hold, the looming prospect of another postponement of the implementation date: It’s enough for a project manager (PM ) to start looking for a new job. But all of this isn’t why a PM signed up for the job. The point is to get control of the organization’s ICD-10 transition project and to meet the compliance deadline within budget, on time, and with available resources.

What happened? After the delay implemented in the first quarter of 2014, the industry’s options were:

        • Pause or cancel projects
        • Slow down
        • Continue as planned 

During the first quarter of 2015, the U.S. House of Representatives Energy and Commerce Committee’s Subcommittee on Health held a hearing “Examining ICD-10 implementation.” Subcommittee Chairman Joe Pitts (R-Pa.) commented during the hearing that “I support moving forward to ICD-10 rather than another delay. It will end the uncertainty, in my opinion.”

The primary goal for the PM is to have the organization meet the Oct. 1, 2015 compliance date and to transition the ICD-10 project to the operational team. In other words, the goal is to launch a successful implementation that will allow the organization to thrive under ICD-10.

Many organizations and PMs concentrate on the scope, schedule, and budget, but fail to focus closely enough on the project team itself.

The Team – Why Does It Matter?

The project team and its inner workings are often overlooked. Every organization will create a project plan, assign a key individual to lead it, and schedule the tasks, but the assembling of the project team can be:

  • Based on politics
  • Based on availability of resources
  • Performance-based
  • Task-based
  • Other

Lencioni’s “Five Dysfunctions of the Team” mentions the absence of trust, fear of conflict, lack of commitment, avoidance of accountability, and inattention to results as the primary reasons that teams and projects fail. 

For the ICD-10 project team, there are intangibles that can be applied so that the ultimate objective is achieved.

Team Composition

With the Major League Baseball season ready to start soon, every team will have its combination of rookies and experienced players. So should  the ICD-10 project. The PM should sort out the experienced and non-experienced staff, and based on the level of experience/education, a separate training and/or coaching plan should be created for each staff member.

For example, say that the coding manager has experience in ICD-9 inpatient coding. The task is to conduct a clinical documentation review for inpatient and outpatient settings. Since the coding manager lacks experience in the outpatient setting, a training plan would help his or her work with both settings. Being trained on inpatient/outpatient settings will help the team member assess existing documentation practices, conduct a clinical documentation review, and create ICD-10 documentation awareness.

Being on the Team

After the project team is assembled, each individual team member should be asked “Is the ICD-10 transition project something you want to be part of?” If the answer is affirmative, they should be shown the project organization and where they fit on the project plan and/or project organization chart. The purpose is to let the team member and the entire team know who is accountable for what. The team member should feel as though he or she is part of the transition or that he/she is helping the organization move toward the transition.

Having the team unified in achieving the goal helps the PM implement the project plan for the organization.

For example, if a physician is part of the team, and his/her mindset is such that “ICD-10 will be delayed again,” then the PM (along with the CFO/CIO/CMO) should have a meeting about awareness and the current actions being taken in the healthcare marketplace at large. The goal is to have the team member physician be part of the ICD-10 transition.

Expectation

As a PM, having the right team is key, but the expectations for the team should be clear. Deliverables being met on time and within budget should be expected. The task success factors need to be determined.

For example, for coder education, the training plan should be thorough and customized to the organization’s settings. At the end of the training, the coders should be certified on ICD-10 by a certain date, and with a passing accuracy of certain grades.

Direct communication with the team is essential to set all expectations up front. A bar needs to be set – what is expected versus not expected. If there is a departure from the plan, direct communication and further investigation need to be performed. 

Evaluating Performance – After Every Task

Having finished the key tasks of the project plan, a review of the deliverables needs to be performed. The PM needs to evaluate what worked versus what did not. The PM should ask the team to explain, in detail, the problems, issues, and the consequences. The team should be open to discussing the issues so that early intervention can be applied.

For example, consider getting on a physician calendar to talk about the provider training needs. Why is the provider inattentive? Does he or she still think that ICD-10 is going to be delayed? Non-participation may delay the implementation of the project.

The PM needs to address whether the issue is due to perception, lack of commitment from the provider, education-based, awareness-based, etc. The PM needs a plan to address these issues and be prepared to make modifications to the plan.

Time

Having to address all of the intangibles requires time and effort. Many PMs do not allocate extra time to address the issues, and thus they end up working 70-plus hours week after week. The project plan should allocate adequate time to address the intangibles.

For example, communicating with the payors regarding their ICD-10 plans and testing may become a prolonged process due to the payors’ internal workings and their external communication. The organization’s project plan should have a backup strategy to deal with this issue.

Project Plan 

The basic premise is to plan the project and then do the work to meet the compliance date. Many organizations/PMs spend considerable time planning so that they can start the work quickly. For ICD-10 there are many intangibles, so the plan must be thoughtful and complete. The project plan should be a work-in-progress document, to be completed so that it will get delivered on time and within budget. 

The PM should try to demonstrate his/her focus on meeting compliance and demonstrate to the team that he/she is willing to do what others are not. 

Conclusion

In order to meet the compliance date and ensure smooth operations thereafter, it is important to assemble a team with the same goals, with a project plan that is a constant work in progress – thorough and complete, with the PM able to execute. 

To reiterate – ensure that the team is well-trained and experienced, and that the expectations are set. Then monitor the deliverables after every sub-task. 

About the Author

Paresh K. Shah is president of MindLeaf Technologies, Inc. in Bedford, Mass. He is also a member of the HIMSS ICD-10 Taskforce and co-chair of the HIMSS Playbook.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Paresh K. Shah

Paresh K. Shah is president of MindLeaf Technologies, Inc., and a member of HIMSS –ICD-10 Taskforce as well as the co-chair for HIMSS Playbook.