D'Arcy Gue

Get Your ICD-10 Leadership Right — NOW

October 24, 2013

ICD-10 4 Minute Read

When I talk to CFOs and CIOs of small to medium size hospitals – which is nearly everyday – it’s apparent that many still don’t have a sense of who should be involved in their ICD-10 conversion projects. If the hospital hasn’t started its effort, or is just getting started, these folks talk about how the HIM Director is “getting on it,” or the IT Director will make sure that the vendors “take care of it.”

ICD-10 will impact so many systems and processes that your entire organization will have to work together, beginning at the executive level, to have an on-time, successful conversion. If there ever was a project that required a multi-disciplinary steering committee in your hospital, this is it!

Your hospital won’t get paid if you continue to use ICD-9 codes for services provided on or after Oct. 1, 2014.  So, with less than a year to go, the only way to arouse and motivate the complex culture that is your hospital, is to establish a broad-based steering committee that will plan, oversee, delegate, and hold all parties responsible for their particular roles.  Immediately.  As in yesterday.

We’ll talk in a minute about who the lucky members of the steering committee should be, but let’s discuss criteria first. From every impacted department, you will need people who get up in the morning and think leadership, strategy, discipline, and structure. Even if some of your members are reluctant adopters of EHRs, ICD-10, and the lot (could I be thinking of physicians?) — if they have the above characteristics, they will make your ICD-10 initiative happen.

You know who these people are. Every hospital knows who they are; they are the staff who say “Yes!” more than “No” or “But.” They’re the people, high or low, who get thingsicd-10 leadership done. They’re also, more often than not, people who care a great deal about your hospital and the community you serve.

A major purpose of the steering committee is to provide a centralized authority that will vocally and enthusiastically put its imprimatur on converting to ICD-10. The committee will insist on a consensus-driven direction, an aggressive plan and a collaborative approach of the highest priority, that will result in achieving ICD-10-based transactions by October 1, 2014. No ifs, ands or buts.

Who should be tapped for this special honor (and its daunting challenges)?

Certainly, members of your C-Suite.  Given the complex project management features and the revenue cycle risks, we recommend that either your CFO or CIO lead the group. Your HIM Director will be essential to your success too, and should be a key knowledge leader in the process. It’s equally critical to recruit influential physician and nursing champions; if you can gain sponsorship from the CMO and/or CNO, you’ll be way ahead of the game.

Executive leadership and sponsorship are just the beginning, but represent a crucial start to building a strong team and sustaining long term organizational commitment. In some hospitals, governance may be divided into an executive steering committee and a separate project management office focused on project execution, with some representatives from the PMO included on the steering committee. In many smaller hospitals, this bifurcated structure is impractical, both from a staffing and an operational standpoint. At this late date, divvying up ownership (translation: accountability) should be considered with caution and careful planning.

Either way, your ICD-10 governance should include stakeholders from impacted areas across the breadth and depth of your organization. This interdisciplinary team should be comprised of business expertise, IT, and HIM subject matter experts. Examples include representatives from information systems and information technology project management, the business office, revenue cycle management, ancillary and clinical services, HIM, and quality assurance.

Hard-driving leadership and project management skills are absolutely essential to putting all the pieces together:

  • managing vendors and payers
  • ensuring proper systems and processes updates
  • developing your coding solution
  • documentation-related training
  • revenue cycle management and risk mitigation
  • budget management
  • systems testing
  • effective change management,  and more.

If you have gaps in these areas, especially in complex project leadership skills or in overall ICD-10-related knowledge, you may have to bring in outside oversight or technical support. If so, don’t delay.

Finally and simply, the key job of your ICD-10 steering committee is to make it happen through your people — without putting your organization at serious operational or financial risk.

The steering committee literally must lead the charge and keep rallying the troops for an intensive 11 months or so.  This should include “marketing” the ICD-10 initiative internally, through regular and creative communications; think about how you promote your other internal causes.  Securing united support by your people with positive, targeted messages to anticipate the benefits of ICD-10, and embrace the needed effort to achieve them, will make all the difference.

Begin recruiting and educating your team with our Impact of ICD-10 presentation. Use this presentation to educate and prepare your staff for the impacts of the new coding system so they are ready for the transition and the changes they will experience when the October 1, 2014 deadline hits.


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