Hospitals are focused on last-minute efforts needed before the monumental ICD-10 transition facing them.  As they should be.

But, critical as final pre-October 1 task requirements may be, hospitals also must have a strong, defined strategy for what to do on and after October 1. Even in the best-prepared organizations, the adage “If things can go wrong, they will go wrong.” applies. Magnify that expectation to the extreme, if your hospital is one of the many that have been playing serious ICD-10 catch-up over the last few months. It’s time to set up a War Room.

The ICD-10 transition is, undoubtedly, the biggest change to hit healthcare since Medicare back in 1966. The impact on clinical and business operations will be immediate and powerful. On Thursday morning, October 1, hospitals will begin to see expected — or unexpected — results of major IT upgrades, process adjustments, and months of organizational training.

What can go wrong?

• Processes that are new to staff may create higher error rates, leading to rework.
• Computer programs may not function as intended, causing claims processing failures.
• Coders may become overwhelmed with charts that take longer to code, which may initiate revenue stagnation.
• Increased documentation requests may frustrate physicians, and cause delays that will reduce billing productivity.
• Revenue cycle processes may become bogged down with claim edits and denials, slowing down payers’ response times, and, of course, revenue.
• Unmet revenue expectations will disrupt flow of payables processes.
• Other, unimagined scenarios can occur.

If even one of these things happen, it’s a big deal. If it’s more than one, what do you have?   A disaster.

ICD-10 Disaster Planning Using a War Room

In a “traditional” disaster, what’s the first thing to do?   Activate a command center… a War Room.  Bringing key decision makers into one center will simplify communication, enable nimble resource mobilization, and defend your organization against a painful and expensive ICD-10 aftermath.

Here are my recommendations:

Stakeholder representatives from the following departments should be selected immediately:

• Scheduling
• Registration
• Coding
• Billing
• IT
• Executive suite
• Nursing
• Physicians

The team and the physical War Room space should be set up now, so that it is ready to respond quickly and with shared purpose by October 1. Take the time to agree on the center’s leadership, objectives and overall SOPs.  The group should also begin anticipating the kinds of problems that may occur. If the team members have little idea of the latter, they are the wrong team members! If baseline coding productivity, billing, claims and other metrics are available, they should be pulled together and accessible by the War Room team, to help measure ICD-10-related impacts early on. The group should plan to meet face-to-face at least once or twice prior to October 1 to iron out their planned approach.

Once the organization passes the October 1 deadline, all team members should expect to be involved in the War Room’s activities. However, it is unlikely that most will be physically needed there for long stretches of time. Morning and afternoon teleconferences will probably be sufficient when significant issues are not under the microscope.

Implementing a War Room works well in disasters (or scenarios of potential disaster)  because it provides all affected hospital staff a single point of contact for ICD-10 related issues. To enable quick access, consider setting up a hot-line phone that will enable calls to be forwarded to the on-call team member when the group is not actively in session.

Starting with October 1, key milestones are likely to warrant pre-scheduled face-to-face meetings including:

• October 1, when the ICD-10 changes come into effect.
• Probably October 2, the date when ICD-10 charges first drop to bills. In many facilities, these may be outpatient charges from lab and radiology.
• The date when coders first begin coding in ICD-10. (For most facilities, this will probably be October 5.)
• The date the inpatient codes first drop onto a bill, usually the day after the coding begins.
• The date  of expected first acknowledgements from each carrier and the first remits.

Your help desk team can provide special value to the War Room during the ICD-10 transition, if you make it aware of ICD-10. Since some service desk calls may be caused by ICD-10-related issues, the incoming service ticket queue should be monitored, with all potentially related tickets being reviewed by the War Room team.  In our service desk center in Dallas, we’ve trained each of our representatives in ICD-10, and are working with our hospital clients to determine appropriate notification strategies for all potential ICD-10 related tickets.

The War Room approach provides a forum in which the combined knowledge of your team is quickly available to think through process issues, diagnoses and solutions. With a a cross-functional group, any rising concern can be walked back through various organization systems and processes to find its root cause. An example: One of our clients received a denial on an ICD-10 test claim during CMS’ end-to-end testing. A team that included IT, Billing and HIM was able to track the denial back through the system. (FYI: It turned out that the chart was properly coded and produced. We used accounts previously submitted in ICD9, and this claim also had been denied in ICD-9 because the MRI service billed didn’t fit the diagnosis. In this case, the claim was almost certainly a failure of an external physician’s documentation.)

A War Room strategy is also efficient because it prevents duplicate efforts; more than one department may be impacted by a particular issue. One set of properly selected resources will ensure that the right person is doing the troubleshooting.  As an example, an IT person looking at a billing system problem may be less capable to solve the problem than a biller looking at the denied claims, and is likely to miss factors that an experienced biller would identify. A central authority needs to make sure solutions are coming from one person — the right person.

When the worst is over, and the team can stand down, it shouldn’t forget to have a debrief meeting. Lessons learned about the hospital’s strengths and weaknesses in crisis or semi-crisis circumstances, can be very useful in future planning.

We’ve been setting up and supporting command center War Rooms for years. Risk-filled scenarios that warranted a War Room approach have included system go-lives, incident management (e.g. a major security breach), the preparation and testing of disaster plans, hospital bankruptcies, and even Hurricane Katrina. We’re proud to say that our New Orleans client hospital during Katrina was one of only three that were able to stay open — in great part because of the speedy, capable responsiveness of its War Room.

If you have questions, contact us…