May 5, 2014

Time to Take a Pulse of Your ICD-10 Program

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Transitioning to ICD-10 has been a challenge to providers due to resources, time, and monetary restraints. Various providers (or organizations) performed an initial assessment and were rushing to do the following:

  • Determine what is needed to be compliant on October 1, 2014;

  • Determine how can we ensure that we will have a smooth transition, post-October 1, 2014.

To meet the compliance date, the Program Manager‘s (or Project Manager’s) job was divided into oversight and governance of the ICD-10 tasks—communication, information tracking, go-live preparation, etc.

The ICD-10 compliance project proved to be difficult, as the organizations were striving to meet the compliance date while working through uncharted territory, and the project metrics were:

Plan

Scope

Schedule

Budget

ICD-10 Project

Define the deliverables

(as per CMS guidance or modify plans)

Implement ICD-10 by October 1, 2014

ICD-10 project was given a top priority, so cost exceeded the budgeted amounts.

Effective March 31, 2014, the deadline for ICD-10 has been pushed to October 1, 2015, or later, and the reaction from the various stakeholders has ranged from shock to sheer relief. Provider reaction to the delay has been to scramble and revise strategy, sustain what we built, slow down till the compliance date, or wait until a new direction is issued by the CMS.

How to Proceed Now?

The industry stakeholders are recommending that every entity continue working toward ICD-10 compliance, but with no compliance date as a target, it is hard to maintain any momentum on the project. The CFO is looking at the return on investment, while the CIO is focused on addressing other priority projects. Due to the delay, this is the perfect opportunity for providers to pause (for a couple of days) and assess their existing ICD-10 programs by deploying some basics, utilizing Earned Value Management techniques to determine their own progress to date.

Looking back to the announcement of the ICD-10 compliance date (October 1, 2014), a project team was assembled (months ago), developed a comprehensive project plan, and scoped the entire project. All efforts and/or energies were devoted to meeting the deadline. The ICD-10 program objective was to get started right away. There were many questions unanswered. Was the plan thoughtful and complete? Many provider organizations do not have a project office where the ICD-10 progress was well tracked. Project management regarding the ICD-10 status goal is to review and analyze budgeted amounts versus the actual costs to date. The variance between the budgeted amount and the cost amount is used to gauge the success and/or failure of the project. Looking at the cost vs. budget today, if the actual cost was in sync with the budgeted amount, the conclusion is that we’re right on schedule and doing fine with meeting the compliance date.

To monitor the progress to date, there are areas where we need to ask:

Plan

Scope

Schedule

Budget

Progress to date

(through March 31, 2014)

Have the tasks as laid out in the project plan been completed?

How long did it take to complete the tasks? (when compared to the project plan)

How much did we spend to complete the tasks?

Based on the progress to date, organizations need to ask: “What we are getting for what we are spending?” 1

“Earned Value is a concept—the concept that an estimated value can be placed on all work to be performed, and once that work is accomplished that same value can be considered to be ‘earned’.”2

Deploying EVM is a small task (as defined by the provider organization). A full-blown EVM deployment is made up of 30+ variables and computations. To take a current gauge, there is no need to deploy all the variables. Provider organizations can deploy a few variables: actual costs to date, total budgeted amount allocated, planned value, and earned value. The EVM can be deployed by taking the current project plan as a baseline, and for measurement of the actual results.

Deploying EVM gives the organization variances from the planned schedule and the true cost variance. This variable and the variances can determine the early warning signs of your ICD-10 program, informing the providers whether they are over-budgeted or under-budgeted, and whether there is poor technical performance to date or it is not scoping at 100 percent.

In summary, given our current program to date regarding ICD-10, what is the probability that we could meet the compliance date, based on the schedule and the budgeted amount?

As we have time until the next compliance date is announced, taking a pulse of the ICD-10 program is essential in obtaining a report card on our program. Given the status of ICD-10 and the conclusions derived and answering the reasons behind it gives us a report card.

Based on the report card, appropriate action can be taken in order to improve on our strengths and/or minimize our weaknesses.

About the Author

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.

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References:

1: A Practical Guide to Earned Value Project Management – Charles I. Budd, Charlene S. Budd

2: Earned Value Project Management – Quentin Fleming and Joel Koppelman

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.