September 29, 2011

ICD-10: The Game Theory

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I have developed a theory about ICD-10 implementation building on the old cliché that “everything I need to know I learned in elementary school.”

Too often we forget those studies from so long ago, but here are some examples of lessons learned:

My first three years of elementary school were spent in Dumas, Texas, north of Amarillo. In first and second grade we enjoyed a game called “Red Rover.” Children formed two lines – one on each side in a large, open area – and then joined hands and chanted for someone on the other side to run over and break the chain. The chant was “red rover, red rover, let Billy come over, ”then the child answering the call ran across the field, scanning for the weakest link to break through the opposing chain … and sometimes succeeded.

Does that mental image remind you of how you feel when you stand in front of administration or the medical staff to talk about 5010 or ICD-10? Faces staring at you, determined not to let you – or at least anything you say – break through their preconceived notions?

Then there was dodgeball, one of the more sadistic creations of elementary schoolteachers’ aggregate mind. The point of this “game” was to hurt anyone else in the other three squares of a court by hitting them as hard as you could with the projectile in hand: a white, not particularly soft rubber ball resembling a soccer ball.

This is remarkably similar to reporting to management on your progress with your 5010 or ICD-10 implementations – except they are the only ones with the big, white, not particularly soft rubber balls. You’re merely the target.

Of course, any discussion about the trials and tribulations of a typical second-grader must include the three joyful times of the school day: a) morning recess, b) lunch and c) afternoon recess (“nap time” was just a smoke break for the teacher, and pure misery).

Certainly, recess was a mixed bag; one always had to weigh the bad against the good. On the one hand, it always included Red Rover and dodgeball, so I can’t really say it was wonderful, but on the other hand it was outdoors and there was not a single finger-painting exercise or arithmetic work paper in sight.

Similarly, facing the medical staff or reporting to management may not be fun, but it is a respite from your real job (or perhaps it’s just penance for working in healthcare in 2011). The key is to recognize that every presentation represents both a challenge and an opportunity. The challenge is to convey your message to an audience exhibiting varying degrees of interest. The opportunity lies in taking credit for what you and your team have accomplished. Above all, the first rule of any presentation applies: odds are that you know a great deal more than anyone in your audience about your topic. Were this not true, you wouldn’t be there.

My second elementary school (ignoring the four months I lived in Fort Worth, Texas) was in Bentonville, Ark., and it was … strange. I usually took my own lunch rather than face the infamous school lunch program and bought two or three little cartons of chocolate milk for two cents each (which works out to 32 cents a gallon.) But there was a zinger to lunch that I never really accepted with any grace: the school cafeterias were segregated by gender, (boys on one side, girls on the other, with teachers in the middle). All we boys could do was look, smile and wave – or look down at our food and hope that the wrong girl wasn’t looking, smiling and waving back at us.

This is similar to the situation whereby you find yourself with your hospital or practice on one side and a shipload of regulators – starting with CMS – on the other. You need to complete your ICD-10 conversion in the time allotted, because you will be held responsible if you fail (think “scapegoat”). At the same time, competing for your attention are staffing and other budgetary constraints to consider, a management team that may not understand what must be done and CMS sending e-mails out on a weekly basis reminding you that “Jan. 1, 2011 (5010) is only three months away” or that “Oct. 1, 2013 (ICD-10) is coming up fast;, time to get with it!”

A folk trio of my youth – Peter, Paul and Mary – had a routine they performed built around the phrase “don’t look at ‘em.” So that’s my advice: don’t look at ‘em, just stay focused on your ICD-10 implementation plan. And don’t let your stakeholders “spook” you, even if it is Halloween.

 


 

George Santayana, the 20th-century Spanish-born philosopher, once wrote that “those who cannot remember the past are condemned to fulfill it.” So pause occasionally and recall what you learned in elementary school. It will serve you well.

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for  Revenue Cycle Management of MedAssets, Inc. His office is in Plano, Texas.

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Read 43 times Updated on September 23, 2013
Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.