July 25, 2011

You Developed Your ICD-10 Strategy, Now What?


As I started writing this article, I thought about the introduction of “this is an exciting time to be in healthcare.” That is what we are saying these days as we continue with landmark initiatives such as meaningful use, EMR implementations, ICD-10, ACOs and others, right? But let’s set that thought aside for a moment and concentrate on the topic on hand, which is ICD-10.

I am impressed with how the industry and individual organizations collaboratively have risen to the challenge with thought, strategy and tactical leadership used to manage the transformation to ICD-10. The industry has taken ICD-10 head-on and has produced quality resources, technologies, products and service offerings to ready itself for this change.

As we all know, a critical success factor in any enterprise initiative is an effective strategy to organize efforts and develop project goals. This is not a new concept, and many organizations already have developed an effective strategy in organizing their efforts regarding ICD-10. Many have found that there are variations to the best approach for ICD-10 readiness. I think most will agree that an effective methodology for approaching the ICD-10 assessment phase would include the following steps, at a minimum:

    • Establish a governing body for oversight;
    • Establish a steering committee for setting goals and objectives;
    • Develop an organizational awareness education campaign;
    • Conduct a preparedness assessment, identifying the impact ICD-10 will have on the people (education requirements), the process (process redesigns) and technology (vendor and homegrown system modifications);
    • Develop a strategic implementation plan; and
    • Advance to the implementation and mitigation phase of ICD-10.

While the above is a logical approach for establishing governance, increasing awareness and conducting a preparedness assessment, this too often has been an overwhelming and exhausting initiative, to say the least.

The implementation and mitigation phase of ICD-10 readiness is and will be a long haul for many. This is due to the fact that many organizations are strapped for resources, challenged with maintaining current workflows with existing resources, and still simply preparing for the implementation phase of ICD-10 – all of this while managing the competing priorities previously mentioned.

As we have learned from industry surveys regarding 5010 readiness, with a looming compliance deadline quickly approaching organizations are in different stages of readiness for both 5010 and ICD-10.

Now What?

That is a common question I hear from organizations that are overwhelmed with competing priorities. How do you manage these priorities when everything is important? The notion of prioritizing tasks, actions and requests is very familiar to many of us. Then why are so many struggling to gain traction with the next phases of their 5010 and ICD-10 initiatives?

I recently attended a meeting of an organization’s ICD-10 steering committee, and the main topic of discussion was considering how the organization could manage such an enormous initiative themselves. The organization had taken all the right steps to ensure that their I-10 initiative was going to be successful. But in recent months, they lost their momentum and fell behind. One person commented that they “started like a house on fire, but quickly burned down.” It wasn’t an issue of the organization not having the right talent. As a matter of fact, as with many organizations they have many talented individuals who are more than capable of managing this initiative from beginning to end. It is not that they were not well informed, either, as they all have done an excellent job of educating themselves (along with the rest of the industry) on the impact I-10 will have on an organization. The steering committee had all the right players sitting at the table, being comprised of the usual multi-disciplinary participants who have become the unofficial organizational standard: C-suite, finance, HIM, IT, CDI, revenue cycle, compliance, clinical, etc. So why had this organization lost its momentum with this initiative?

As we discussed options to consider for gaining lost ground, things became clear when another member commented that “we do not have competing priorities, we have conflicting priorities.” The organization was focusing on achieving meaningful use, EMR implementation, 5010 compliance and their ICD-10 implementation and mitigation strategies, all the while maintaining their current operations. Everything has to be done concurrently, representing parallel initiatives with no room for delays – or the consequences will be enormous.



While the steering committee conversations were enlightening to many, the group therapy session resulted in a unified sigh of relief, and this organization embraced its newfound energy to push forward. Alternative decisions were made that day, providing new rigor, structure and resources to assist the organization with its ICD-10 initiative.

Some Things to Consider

Realize and accept that there’s always more to do than there is time and resources with which to do it.

Be strategic and tactical in your decisions regarding assistance. It is OK to ask for assistance, and not to take on more than you can manage effectively. The goal is to achieve your objectives by performing work well and living to tell about it. Consider what you can do on your own, then look for external expertise to assist you with reaching your objectives. This is not a task-driven initiative, and organizations that approach this as a check-off-the-task-list project will be in an undesirable position come October 2013. Leveraging your internal capabilities through solid business decisions will help you make this sprint a marathon.

Determine if you need a project manager, taskmaster or advisory leader.

With an initiative as complex and widespread as ICD-10, you undoubtedly have a project manager. Ask yourself: how much information, influence and control does the PM have over the individuals responsible for the work being performed? Is the PM responsible for maintaining the ICD-10 work plan and holding people accountable?

Traditional PMs have many organizational skills that will help them keep track of your progress and milestones. Are we expecting the PM also to be a source of ICD-10 subject matter expertise and to hold committee/subcommittee members accountable as well, though? Anyone who has occupied a seat on a steering committee knows it is difficult to call out a colleague who might not be delivering on their assigned responsibilities. As can be expected, many people see things through their own lenses, concentrating on the areas that will impact their worlds the most (HIM concentrating on coder education, CDI concentrating on physician education, IT concentrating on systems, revenue cycle concentrating on claims submission, etc.)

You might want to consider your steering committee structure, plus the roles and responsibilities of its members, to help you reach your objectives. An advisory leader, one who is removed from directing resources and free to complete the predetermined objectives, can provide an independent viewpoint and answerability sometimes needed to keep enterprise initiatives on task.

Evaluate your progress now.

Many organizations are making good progress with their ICD-10 initiatives. They have developed a comprehensive formal documented work plan, and many have organized into subcommittees such as education, technology, operations and reimbursement to manage the initiative into parallel work streams.

A common discussion I have with organizations making great strides with their initiatives involves a request for an external resource to provide an independent evaluation of their work plan and a wider industry perspective on their ICD-10 steering committee progress, activities and milestones.

With any multi-year enterprise initiative, periodic evaluations of the plan, progress and timelines are critical success factors for achieving an end goal. You might want to consider an independent work plan assessment to evaluate the scope of the effort, current progress and defined future goals. It is in the best interests of any organization to take the time to evaluate its own efforts, and potentially to go in a different direction in the short term for a long-term gain.


Managing a multi-year enterprise initiative is a monumental task that requires preparation, collaboration, progress evaluations and alternative decisions. If you approach ICD-10 transition with the right governance structure and a comprehensive work plan, making solid business decisions along the way, you will agree that it is an exciting time to be in healthcare.

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.

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Read 166 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.