This is why I fly @SouthwestAir The Safe

April 16, 2014 Leave a comment

This is why I fly @SouthwestAir The Safety Speech To End All Safety Speeches #WeAreALLTampaBay http://ow.ly/vRNna

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Tampa Bay has a lot to offer in health a

April 15, 2014 Leave a comment

Tampa Bay has a lot to offer in health and life sciences #WeAreALLTampaBay – http://ow.ly/vNYbk

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ICD-10 go-live delays will cost early adopters and jobs

April 4, 2014 Leave a comment

I thought I would re-post this.  Still relevant a year later….

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The recent announcement by CMS that the date for ICD-10 implementation will be reconsidered will have a number of unintended (or more accurately, not thought out) consequences.

Many large providers, hybrids and academic medical centers are well on their way to meeting the current deadline and have significant investment made in both permanent and temporary staffing to support these projects.  Also, many vendors are working hard to get their systems ready for ICD-10 and have established plans to complete prior to October 2013.

Unfortunately there is a great disconnect between the physician practices/AMA and the larger health systems and hospitals who have already invested considerable time and money working toward the October deadline. In a 2011 survey by HealthLeaders Media, respondents cited, “The No. 1 challenge providers named in preventing them from attaining ICD-10 readiness was physician cooperation” – who knew just how foreboding that statement would be!

Projects, much like aircraft carriers, cannot be stopped on a dime.  There are many factors that have to be considered. First a decision has to be whether the project team needs to remain in place or be disbanded. Typically in large projects, there is a significant burn rate related to project team overhead.  For example, a recent plan for a mid-sized hospital I completed showed an average of $25,000 a month in project burn.  We calculated that based on the timing of an EMR and wanted to have contingency budget in place in the event the EMR remediation was delayed.  For larger systems and conglomerates, this dollar amount could be in the 6-figure range.

Some facilities may disband their teams altogether if the delay is more than 3-6 months.  This will result in lost tribal knowledge, talent and jobs as they look for other opportunities within the market.  This will further strain the talent pool when the new date is set and you once again have the same volume of work with the same number of healthcare organizations racing toward a fixed point in time.

Vendors who have been frantically hiring for talent to support the demand on system upgrades and implementations will now have to reevaluate their talent position.   Since they support projects for customers who may put time lines on hold, this will cause a ripple effect to the vendors.  They will now have too many staff to do work that has been delayed and will be forced to lay off workers in order to remain profitable during the transition.

Finally, it is human nature for people to use all the time they have available to complete a task or project.  In my many years working in information technology, this is especially true.  If given more time, it will take more time.  There is no doubt the Healthcare industry has a lot going on, however, delaying ICD-10 is untenable.  Both for those who were doing the right thing by properly planning and starting work and for those who chose to do nothing.  Either way, the ambiguity introduced into the environment by the “rules process” and the inevitable delay will cost people their jobs and facilities money that they can ill afford to waste.

Critical Access Hospitals at risk. This

October 2, 2013 Leave a comment

Critical Access Hospitals at risk. This is a great article on impacts to CAH http://ow.ly/pq67h Kforce has free tools to help with ICD-10 http://ow.ly/pq6du #obamacare

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Why Leaving Your ICD-10 Strategy to a Tech Vendor Can Be Risky Business

January 29, 2013 1 comment

With the ICD-10 implementation deadline set for October 1, 2014, now is the time for healthcare providers to enact a readiness plan that minimizes financial risk while delivering quality patient care. To help reduce implementation costs in the transition from ICD-9 coding, organizations may be tempted to rely on low cost technology vendors who may have a myopic view of the impacts of ICD-10 on a provider. Having had to unwind a few of these situations, I have found this approach to be limited and not without considerable risk.

The breadth of ICD-10 is extensive, and should involve a long-term strategy around the people, processes and technology that drive healthcare operations. In working within a tech vendor’s strategy, I have found the vendor may use predictive modeling to analyze the diagnosis related group (DRG) shift, identify what is felt to be areas of risk, and list a narrow target of impacted physicians from an ICD-10 perspective. .  A list of DRGs and physicians only scratches the surface of ICD-10 impacts.

For example, it may be determined that only 15% of DRGs shift up or down resulting in a short list of impacted physicians and systems.  Basing a plan of action on such a small subset of directly impacted systems and people leave the other 85% of a provider’s business at risk.  While the other 85% of DRGs don’t shift, the complexity of coding still presents a risk to the organization of proper planning is not conducted.  Tech vendors may excel at their area of specialization, but they become a liability for healthcare organizations seeking to effectively and accurately manage ICD-10 impacts.

In order for healthcare organizations to achieve ICD-10 success, it’s important that they develop a sustainable post-implementation endgame. Ahead of the ICD-10 compliance deadline, organizations need to assess their potential financial risk and develop a strategy to minimize it. They need to ensure they have the adequate resources to code and train for ICD-10.  They also need to ensure a proper review of their contracts to determine the impact of moving to ICD-10 on scheduling and testing.

From assessment to go live, ICD-10 stands to impact not only coders, but several critical areas within a healthcare organization, including physicians, billers, human resources and more. An effective implementation plan should include a change management campaign to help gain buy in, particularly with physicians. Although they won’t be responsible for the coding itself, physicians may face a higher volume of queries from coders if their documentation is not correctly noted for ICD-10. This workflow and documentation breakdown can lead to interruptions in claims reimbursement and the revenue cycle while queries and coding issues are being resolved.

When it comes to ICD-10, software can empower a healthcare organization, but an organization’s ability to manage risk is limited without a structured approach that looks at the entire organization. With a range of complex requirements – from process impacts, software system upgrades, testing and training – ICD-10 requires an effective project management strategy for the people, process and technologies that can make or break a provider.

Bottom line, ICD-10 is a business project, not an IT project.  Treating it otherwise will bring much pain during implementation.

Common ICD-10 Assessment Findings and Impacts

October 31, 2012 Leave a comment

With the ICD-10 compliance extension now finalized, healthcare facilities will need to address a range of organizational issues to achieve compliance. To fulfill ICD-10 requirements, single and multi-facility hospital systems will likely experience impacts to several common ICD-10 assessment areas, including coding, clinical documentation, training, vendor product testing and acceptance, as well as program management.

Why Use an ICD-10 Assessment?

A high-level ICD-10 assessment can present a “ground truth” outlook on potential roadblocks to compliance, as well as highlight competitive opportunities for future growth. An effective assessment should address the people, processes and technologies set to be impacted by the ICD-10 transition. An ICD-10 assessment provides actionable information to guide the implementation, from detailed planning to remediation, stabilization and post go-live. Considerations should be made for budgeting, information technology system upgrades and clinical documentation assessments as well as skills development for coders, physicians and other staff.

What Are the Most Common ICD-10 Challenges?

Lack of program management: The lack of a solid ICD-10 program management office (PMO) can pose a significant risk to readiness. Given the large number of affected systems, processes and people, an internal PMO can help identify standards for implementation and ensure all of the constituencies are working together and coordinated. In addition, the PMO can work with executive sponsors and an identified steering committee to establish and manage a critical implementation schedule, deliver baseline reporting metrics and maintain budgeting.

Poor communications: Another area critical to ICD-10 implementation success comes from efficient cross-functional communications. When it comes to ICD-10 planning, most organizations think of changes to coding and infrastructure, but may overlook areas that are also impacted by ICD-10, such as human resources, compliance, as well as areas directly impacted by the depth of the transition, including nursing, billing and registration. A communication strategy reaching all departments can help address roles and responsibilities, timelines and partners involved. In addition, a comprehensive ICD-10 communication strategy can help address change awareness throughout the organization.

Physician resistance: Although ICD-10 will directly impact coders, physicians will also play a role in the success of ICD-10 within an organization. With the transition to ICD-10, physicians will be responsible for providing a more detailed level of documentation, and may also face increased queries. The use of education and change management programs can minimize physician resistance. One particularly effective approach has been the use of physician champions and physician liaisons. Through this approach to physician relations, hospitals can help bridge the gap between leadership and physicians, as well as streamline opposition to ICD-10 changes.

Additionally, healthcare providers using non-hospital contracted physicians can increase adoption by implementing training programs presented at no cost to the physician.

Hospital System Partnerships:

Strategic alliance and joint venture partnerships are consistently overlooked for ICD-10 impacts including relationships with physician practices, rehabilitation and wound care centers, ambulatory surgery centers, imaging centers for radiologists and third parties, as well as home health agencies.

Information Technology (IT) systems, revenue cycle processes and training are among the areas in which compliance risk is typically underestimated. A collaborative, pro-active approach should be used with an organization’s various partners, including open communications to address issues such as compliance objectives and responsibilities, scheduling, as well as system testing. In some cases, executive-level decisions will be required to address ownership and cost burdens.

Assessment Options and Next Steps

To meet the compliance deadline, a cost-effective ICD-10 strategy should include a comprehensive assessment of all personnel,process and technology impacted, along with a detailed budget, work plan and awareness campaign, as well as dedicated governance and project teams. The experience of an ICD-10 solutions provider can support an organization’s ICD-10 transition, helping to maintain efficiency in day-to-day activities throughout implementation.

ICD-10 go-live delays will cost early adopters and jobs

February 17, 2012 1 comment

The recent announcement by CMS that the date for ICD-10 implementation will be reconsidered will have a number of unintended (or more accurately, not thought out) consequences.

Many large providers, hybrids and academic medical centers are well on their way to meeting the current deadline and have significant investment made in both permanent and temporary staffing to support these projects.  Also, many vendors are working hard to get their systems ready for ICD-10 and have established plans to complete prior to October 2013.

Unfortunately there is a great disconnect between the physician practices/AMA and the larger health systems and hospitals who have already invested considerable time and money working toward the October deadline. In a 2011 survey by HealthLeaders Media, respondents cited, “The No. 1 challenge providers named in preventing them from attaining ICD-10 readiness was physician cooperation” – who knew just how foreboding that statement would be!

Projects, much like aircraft carriers, cannot be stopped on a dime.  There are many factors that have to be considered. First a decision has to be whether the project team needs to remain in place or be disbanded. Typically in large projects, there is a significant burn rate related to project team overhead.  For example, a recent plan for a mid-sized hospital I completed showed an average of $25,000 a month in project burn.  We calculated that based on the timing of an EMR and wanted to have contingency budget in place in the event the EMR remediation was delayed.  For larger systems and conglomerates, this dollar amount could be in the 6-figure range.

Some facilities may disband their teams altogether if the delay is more than 3-6 months.  This will result in lost tribal knowledge, talent and jobs as they look for other opportunities within the market.  This will further strain the talent pool when the new date is set and you once again have the same volume of work with the same number of healthcare organizations racing toward a fixed point in time.

Vendors who have been frantically hiring for talent to support the demand on system upgrades and implementations will now have to reevaluate their talent position.   Since they support projects for customers who may put time lines on hold, this will cause a ripple effect to the vendors.  They will now have too many staff to do work that has been delayed and will be forced to lay off workers in order to remain profitable during the transition.

Finally, it is human nature for people to use all the time they have available to complete a task or project.  In my many years working in information technology, this is especially true.  If given more time, it will take more time.  There is no doubt the Healthcare industry has a lot going on, however, delaying ICD-10 is untenable.  Both for those who were doing the right thing by properly planning and starting work and for those who chose to do nothing.  Either way, the ambiguity introduced into the environment by the “rules process” and the inevitable delay will cost people their jobs and facilities money that they can ill afford to waste.