Client: A not-for-profit 500+ bed acute care level 1 trauma center. Facilities in the system include the main hospital, a Children’s Hospital, and a Women’s Hospital as well as two smaller satellite hospitals and a medical office group. The system offers comprehensive services such as outpatient diagnostic testing and treatment, orthopedic services, 24-hour emergency/trauma center, and more. The health system’s medical group of more than 700 primary care and specialty physicians is the largest network of physicians in the region.
Business Issue: Like many healthcare institutions, this client grappled with the challenge of carrying out an effective implementation of ICD-10. The customer lacked adequate resources, in many cases the expertise, and the time to fully address the implementation and keep up with daily demands of providing quality patient care.
The customer approached a number of services firms in their quest to find an organization that would approach the project in a manner consistent with their values and would conduct a thorough assessment of their application environment impacted by the new regulation.
After a complete evaluation of all possible options, MMY Consulting was selected due to our extensive healthcare industry knowledge, and solid reputation for providing quality consulting services. MMY provided a comprehensive proposal outlining the approach to leading a major initiative for this effort. MMY offered a clear explanation of the methodology for leading the customers through a successful transition to the new ICD-10 code set.
Project Initialization: The MMY ICD-10 Project Team began the project initiative by establishing the foundational components as outlined by the Project Management Institute (PMI). The team selected the PMI methodology due to its best practices for program and project management. Standard project management phases of project initiation, planning, execution, implementation, and project close out were used to govern and control the entire ICD-10 project initiative.
Foundation documentation included a project charter, communications plan, project issues log, responsibility matrix, project statement of work, and the ICD-10 project implementation plan.
Readiness Assessment/Application Remediation: An ICD-10 Readiness assessment tool was developed based on recommendations from leading industry sources. The tool included an inventory of all systems, processes, interfaces, and third-party applications affected by the transition. Use of the assessment tool was a crucial step in ensuring ultimate success as it identified all impacted IT systems, software applications, interfaces, system processes, trading partners, electronic clearing houses, and workflows affected by the implementation of new codes.
Upon completion of the assessment, the project team in conjunction with project stakeholders worked to prioritize the remediation effort and establish a timeframe to complete the remediation. Each sub-project team was briefed on the remediation requirements for impacted areas and then monitored to ensure their portion of the project remained on schedule and critical project milestones were met.
Remediation activities were the precursor to establishing an effective testing strategy for end user, and integrated end-to-end testing activities. Ensuring that all changes made to impacted areas were thoroughly tested decreased the risk of failure at the point of implementation go-live. MMY Project Team members, with the assistance of the facility project team members, developed comprehensive test plans to rigorously test all systems, workflows, charge codes, revenue codes, and departmental processes. The test plans were constructed with the goal of verifying system process workflows that were redesigned to compliment the transition to the ICD-10 codes.
Data Analysis/CDI Improvement: The project team used historical data to identify physician trends related to the most frequently assigned ICD-9 codes so that cross-walk templates could be developed to assist with the familiarization of its ICD-10 equivalent and to assist the Clinical Documentation Improvement Team with their efforts to improve the quality of physician’s clinical documentation. The historical data was also used to study physicians by specialty, for both inpatient and outpatient diagnostic code assignment, the revenue produced by the specialty, the individual physician, and the associated claims denials by category and denial code. All of the information from the physician study was used to create online and in-classroom training programs for physicians to support the transition to the new coding system.
Using historical data was crucial in the development of benchmarks for post ICD-10 implementation to track quality measures, and other key performance indicators (KPIs), such as the number of discharged medical charts that had not been final billed, the average length of a hospital stay, the number of late charges by department, and the average days to resolve accounts receivables. A sudden increase in the numbers for any of the KPI’s is a signal something had not gone according to plan with the ICD-10 implementation.
Testing: Finally, after a successful testing period the MMY Project Team worked with the customer to establish an ICD-10 Command Center to support implementation go-live activities for ICD-10, which were slated for October 1, 2015. The primary objective of the ICD-10 Command Center was to provide a single point of contact for key personnel and super users to report issues related to the ICD-10 go-live. The MMY Project Team developed the Command Center operating instructions, escalation procedures, established hot lines, and schedules for staffing the command center.
Results: The command center was originally scheduled to remain in operation for 30 days’ post ICD-10 go-live. Testing and training activities were so successful that the command center received a minimal number of support calls over the four day period the center was actually operational. As a result, the project was considered a resounding success and the ICD-10 Command Center was closed after less than a week of functional activity. The client saved a significant amount of money due to the reduced cost of manning the center earning praise for MMY’s highly effective results in delivering on-time and under budget.