“Industry experts observe that less than 10 percent of provider organizations have begun to prepare for ICD-10,” said George Huntzinger, president and CEO of HMG. “The reality is that provider organizations are already stretched beyond present limits in efforts to meet healthcare regulatory and compliance requirements. It’s not a case of lack of attention to ICD-10, but a lack of resources, bandwidth and time required to thoroughly digest the implications associated with ICD-10 readiness and implementation.”

To this end, HMG has invested in healthcare subject matter experts like Chapman who can assist in mitigating the impact to operations costs before, during and after ICD-10—not to mention critical assistance to avoid potentially delayed and reduced reimbursement. Chapman, who recently authored a white paper on the topic for HMG, is leading the charge.

As HMG’s Practice Director, Chapman will also be responsible for leading and facilitating client efforts in revenue cycle operations and financial performance improvement objectives through identification and implementation of technology and processes. Clients will benefit from Chapman’s past successes in defining and implementing strategies to optimize reimbursement opportunities and identify greater efficiencies throughout the revenue cycle, particularly as provider reimbursement challenges with healthcare reform and ICD-10 continue to increase.

“As healthcare organizations continue to face challenges with regulatory compliance and changes in reimbursement models, we want to be in a position to assist them with their efforts,” Huntzinger said.  “Nancy’s expertise and leadership provides HMG with the resources to do so.”

About The Huntzinger Management Group, Inc.
HMG provides advisory and managed services consulting to the healthcare industry. We focus on clinical and operational business performance optimization by ensuring alignment between IT, clinical, and ambulatory areas to position our healthcare clients for the future. For more information, visit www.huntzingergroup.com

Kaufman spoke to a group of more than 75 healthcare leadership professionals invited to a private luncheon hosted by HMG last week. Kaufman’s presentation, “Preparing for the Inevitable Perilous Journey from Entitlement to Accountability,” proved dynamic and provocative, said George Huntzinger, HMG’s CEO.

“Nathan’s message was abundantly clear: embrace change and leverage the incredible flow of innovation sparked by Healthcare Reform to be successful in the new marketplace,” Huntzinger said. “We truly have the opportunity to redefine healthcare. We can lose time and money waxing conventional, old times, or embrace the opportunity of the present.”

Kaufman spoke at length about the megatrends surrounding Healthcare Reform, and identified several strategic themes healthcare organizations should consider while transitioning to the new marketplace. An active discussion followed the presentation with one physician in attendance commenting, “This is the most informative and useful presentation on the topic I have ever attended.”

About The Huntzinger Management Group, Inc.
HMG provides advisory and managed services consulting to the healthcare industry. We focus on clinical and operational business performance optimization by ensuring alignment between IT, clinical, financial and ambulatory areas to position our healthcare clients for the future. For more information, visit www.huntzingergroup.com

About Nathan Kaufman

Nathan Kaufman is the Managing Director of Kaufman Strategic Advisors. KaufmanSA provides strategic and tactical advice to many of the nation’s largest health systems and medical groups, specializing in board and management retreats, managed care negotiations, all aspects of hospital-physician collaborations/employment, and fair market value assessments.  For more information, visit www.kaufmansa.com

Click Here to read the full Press Release.

The critical question each healthcare provider – physicians, hospitals and health systems of every size and level of care – faces is not how IT systems will address the migration. The primary players in the healthcare vendor space have proven time and again that the technology will be ready before our organizations are prepared. Likewise, payers – a narrowing group of larger players – have been preparing for the ICD-10 Transition for many years.

Once providers are more fully informed about the real changes that will occur with the ICD-10 Transition, the challenge that must be confronted is the looming magnitude of productivity impacts upon physicians, IT analysts and coding staff. Add to this reality that every other provider organization is likely to come to the same conclusion at roughly the same time, with the same requirements for assistance during the same implementation planning, go-live and post-support timeline, and all of a sudden, the “big deal” about ICD-10 becomes apparent.

Usually, the next realization dawns when providers consider the operations costs of locating, hiring or retaining third-party assistance required to support the ICD-10 Transition. At that point, the reactions to early estimates for ICD-10 budgets that were originally dismissed as preposterous, take on a sobering, and all too possible, reality. The majority of costs associated with ICD-10 Transition are operations in nature, not capital.

With these realizations, informed healthcare leaders become rapidly frustrated with firms focusing on the basics of project management methodologies. What gains leadership’s attention are healthcare subject matter experts that can assist in mitigating the impact to operations costs before, during and after ICD-10 – not to mention critical assistance to avoid potentially delayed and reduced reimbursement.

Industry experts are predicting that current staffing levels will be completely redefined as a result of the ICD-10 implementation and not just for physicians, coders and IT staff. While this assumption is not without some merit, healthcare software vendors continue to develop and deliver technologies to assist coding staff and physicians with the required process changes associated with ICD-10. Firms that have traditionally provided coding and IT resources are preparing by recruiting and educating new staffing complements and developing new business models including greater access to off-shore resources. Consulting firms are providing the interim levels of assistance required to manage and lead providers through the time-consuming and complex array of tasks involved in preparing for and implementing ICD-10.

Still, industry experts continue to observe that less than 10 percent of provider organizations have begun to prepare for ICD-10. Very few provider organizations have progressed in ICD-10 awareness and readiness to the extent that ICD-10 solutions and assistance are requirements, not simply available options.

Critics observe that ICD-10 awareness and preparation are slow to gain traction in the healthcare provider sector. The reality is that provider organizations are already stretched beyond present limits in efforts to meet healthcare regulatory and compliance requirements. It’s not a case of lack of attention to ICD-10, but a lack of resources, bandwidth and time required to thoroughly digest the implications associated with ICD-10 readiness and implementation.

While the industry has faced challenges before that required singular focus upon meeting regulatory or compliance requirements, it has never faced a challenge such as that presented by ICD-10: all industry sectors – providers, payers and government – required to change core processes and technologies on a single implementation date of October 1, 2013 in order to be reimbursed for patient care.

WHAT HEALTHCARE PROVIDER ORGANIZATIONS CAN DO NOW TO PREPARE FOR ICD-10

Understanding the basic daily rhythms and relationships of the people, processes and technologies associated with delivering, documenting, billing and reporting patient care is an absolute requirement as healthcare organizations prepare for ICD-10 and its impact.

Much remains unknown about how significantly ICD-10 will impact any given organization. What is understood by too few clinical, revenue cycle and IT subject matter experts is that regardless of the technologies that are currently or imminently available to healthcare providers, fundamental processes must change with the advent of ICD-10. And the time to change most of these processes is now, well before the ICD-10 implementation go-live on October 1, 2013.

Get Serious about Clinical Documentation Improvement: Until recently, clinical documentation improvement (CDI) efforts have been informal or limited processes in most provider organizations. With the industry’s increasingly rapid pursuit of electronic medical records and implementation of CPOE, physician documentation and rules-based work-flow technologies, the need to review clinical documentation increases with the migration from paper to electronic records.

With ICD-10, CDI programs become even more important to provider organizations because of the direct relationship of clinical documentation and reimbursement. Unlike many aspects of ICD-10 preparation, implementing an effective CDI program can occur now. As nurses and other professionals with background in Quality or Case Management work with physicians to assure that levels of specificity, lab and radiology results, complications and comorbidities are captured and documented, behaviors rapidly change. Providers working with CDI teams are more likely to get into improved documentation habits that can lead to higher case mix indexes. CDI teams can also assist in identifying specific needs for physician education – at the individual provider level – as ICD-10 approaches.

Take Concurrent Case Management to 100 Percent Review: Like CDI programs, Case Managers are in an advantageous position to review patient’s records while patients are still in-house. This is yet another opportunity, and perspective, to work with providers in improving the clinical documentation. Two additional considerations need to occur as ICD-10 becomes a reality: 1) 100 percent review targets should be set for concurrent review; and 2) concurrent coding data entry should occur to provide for earlier scrutiny and exception reporting for improved case mix index and subsequent reimbursement.

Pull Quality into the Conversation: Every healthcare organization is pursuing multiple regulatory and IT initiatives that will eventually lead to reimbursement based on quality outcomes. Yet, rarely do organizations include those most familiar with tracking, measuring and reporting quality in the critical discussions regarding setting expectations and objectives of these efforts.

The Quality staff is generally one of the most informed groups in the organization regarding where existing documentation issues and clinical workflows are challenged. Including Quality staff in broader conversations will serve to surface potential issues now so that alternatives for resolution can be discussed and implemented.

Compile Comprehensive IT and Strategic Projects Timelines: Most vendors provide detailed roadmaps depicting the applications implementation timelines and predecessors required to accomplish that specific vendor’s efforts. Most provider organizations also have some form of systems configuration “map” or picture that adorns a wall in Information Services.

ICD-10 will require a consolidated project and application timeline so that each of the organization’s IT vendors’ upgrades and testing can be planned for execution. The provider organization IT staff and leadership must plan to apply the required resources to test the upgrades once the vendors have delivered the upgrades. Once a comprehensive timeline of the variety of vendors’ products are visible on a single timeline, the breadth of the testing effort and required resources is easier to anticipate.

Take Advantage of Existing Committee Structures: Look for opportunities to integrate ICD-10 awareness and preparation with existing project plans to optimize critical internal resource utilization across the organization. While focused ICD-10 project management and some tasks must remain independently managed, providers must seek every opportunity to incorporate and integrate ICD-10 awareness, preparation and implementation efforts into existing projects, communication strategies and committee structures. In this manner, progress toward ICD-10 Transition Services occurs as part of the organization’s overall roadmap in meeting healthcare reform requirements, practically and efficiently.

Choose and Secure Resources Now: It is a fact that ICD-10 will require additional IT staff to assist in testing processes for all vendors’ upgrades and recasting decisions supporting tools and reports. It is a fact that additional coders will be required to support pre-implementation education and training periods, and post-implementation dual coding requirements and productivity curves. It is a fact that healthcare IT resources enjoy one of the lowest unemployment rates in a remarkably distressed market.

Find, select and secure resources well ahead of the pre-implementation period so that risks associated with productivity can be mitigated. There is no anticipated “just-in-time” staffing pool for provider organizations that wait too long.

Some coding staffing firms are offering early adopter pricing models to provide staffing solutions in 2013 to clients that purchase education programs now. Organizations that have strong coding and IT staffs must consider the increasingly competitive environment for those positions and implement retention strategies now.

Proactive Efforts, Process Readiness Leads to Improved Reimbursement and Case Mix: Far too many tasks must be executed as 2013 begins with IT upgrade deliveries and testing processes. Additional coding resources and IT resources must be ready to step in during the last several months prior to the October 1, 2013 implementation and for the subsequent post-implementation period. Estimates are now ranging as high as 9 to 12 months post-implementation before new productivity baselines can be measured. There are no expectations among industry experts that current staffing levels will return post ICD-10 implementation.

For providers interested in avoiding as many costly risks as possible with ICD-10, the time to act with process changes and reimbursement protection is now. ICD-10 is yet another aspect of healthcare reform that every organization must face in the next 23 months. Indications are strong that a tidal wave of activity and demand will occur very late – too late – in the timeline to protect those provider organizations that do not take action now.

Organizations that act now in preparing for ICD-10 will be far better positioned, as many productivity issues and learning curves can be mitigated through early action. As clinical and business processes are improved, downstream effects on increased reimbursement opportunities will be realized.

Final Considerations: Every organization is somewhere on the path to meeting existing and compelling regulatory and compliance initiatives. Every one of these initiatives shares objectives, outcomes and resources that are or will be affected by ICD-10 transition. Acting now to accomplish multiple objectives with fewer, more efficient efforts, can pay off in big ways for providers, but requires provider organizations to view healthcare reform initiatives with a different perspective.

Technology solutions have paved the way to healthcare reform objectives, but processes will drive the results. And it is very much a race to the finish line for every provider organization.

For more information, contact
The Huntzinger Management Group, Inc. at
570.824.4721 or email at info@huntzingergroup.com

Click Here to download the PDF version of this whitepaper.

Click Here for Conference Flyer and Agenda.

These initiatives are not small endeavors. Transformation of Care and achieving Meaningful Use are highly complex undertakings with numerous projects (both IT and clinical), multiple departments, governance committees/work groups and staff in the range of 100-200 resources. Communication is paramount; yet with all of these disciplines, baseline knowledge and a common lexicon are usually lacking. So, the issues are numerous and typically hard to manage. How does an organization approach these initiatives so that all of these moving parts stay in synchronization and head in the same direction? One approach is to break down the initiative into the critical components that are necessary to be successful. For Transformation of Care, the critical components would include: Governance, Process/Workflow Re-Design, Clinician Proactive Involvement, Evidence-Based Content Development and Management, Technology, Education, Quality Improvement, Behavioral Change Management, and Continuous Assessment. In many organizations that are undertaking these projects, the project driver comes from the acquisition of new technology. There may be business/clinical sponsorship, but the organization, as a whole, will look to the IT Department to initiate or drive the project. Unfortunately, this is backwards from where the project should be. So, let’s discuss each of these components and dissect the timing and how they need to work together:

Governance: Implementation projects of this magnitude require strong investigative and decision making groups in order to set strategy, make decisions and generate/receive value. Detail work groups must also be working in conjunction with the governance structure and the IT project, but, most importantly, all three of these groups must be constantly in synchronization with regard to communication, decisions, strategy and policy. Two areas to guard against are: 1) committees having only a partial picture of the issue or decision to be made; and 2) effective communication flowing back and forth between all of the committees to keep everyone in the loop.

Process/Workflow Re-Design: The Re-Design phase is often driven from the IT project plan and by the software vendor. This phase typically occurs early in the implementation cycle so that adequate time is allotted for the Build phase and testing. However, because it is done early in the cycle, clinicians tend to face two dilemmas: 1) their knowledge of the software and its capabilities are not understood at a deep enough level to make meaningful decisions; and 2) because these types of implementation projects are in the 18-24 month implementation range, clinicians do not engage mentally this early. Hence, a conscious effort must be made to educate, at a detail level, the clinicians and engage them proactively. In addition, Re-Design requires a patient-centric approach and the movement of the patient and his/her interactions with caregivers must be considered. Design processes should follow the patient flow while simultaneously evaluating staff roles, processes, information creation/movement, patient needs/clinical guidelines/policies, and metrics for measuring success.

Clinician Proactive Involvement: As mentioned before, clinician involvement must be constant and proactive and shouldn’t be offset with minimal involvement in the beginning and heavy involvement at go-live. Many organizations compensate their clinicians to be actively involved, and this has proven to be successful. Equally, there are organizations that did not compensate their clinicians and were also successful. The keys to clinician involvement are strong communication, expectation setting (value and benefits to the clinicians), improved/ efficient workflows, the reality of clinical content evidence and a documented path to improved patient outcomes.

Evidence-Based Content Development and Maintenance: With many implementations, evidence-based clinical content development is often thought of as order set builds and are scheduled close to go-live. This is a major mistake, especially if the organization’s clinical strategy is not well developed or if an organization is going through a clinical content standardization process. Clinical content should always be thought of as a “program vs. project”; it needs to start early in the implementation cycle, should include decision support/alerts, should address quality metrics/reporting/improving outcomes and is tied directly to clinician adoption.

Technology: Technology often gets a bad rap for the failings of the implementation project. “The software doesn’t work; it wasn’t testing appropriately; it doesn’t do what I want it to do” are all common complaints. Oftentimes, it is not the software itself, but rather the decisions that went into building the software that are to blame. Just as one doesn’t reprogram MS Excel when creating a spreadsheet, the project team must guard against replicating what the old application did into the replacing application.

Education: Education should be subdivided into four tiers. There is general education that should be conducted early and often with a broad audience of directors, sponsors, executives, and clinicians. There is technical education for the IT resources who will build the software. Functional education is required for key users and clinicians, and this should be done very early in the implementation cycle. Repetitive education on this level is critical to help ensure that good decisions are being made especially with workflow. Functional education should be very detailed and center on actual cases, workflow issues, and/or special processing; and, the more the clinicians are exposed to this, the better they will accept and adopt it. Detailed “how to” education should be conducted right before go-live.

Quality Improvement: Quality improvement has become a proactive science and requires active participation during the implementation cycle. As mentioned before, the Quality Department must play an active role during clinical content development, quality metrics and improvement strategies. Reporting is also an important task to define necessary informatics. Through the testing cycle, Quality should validate its strategies by utilizing the application and reports.

Behavioral Change Management: Just as they say “nothing happens until you sell something,” the transformation of care is all about changing behavior of all of the involved constituents. In today’s world, projects transcend departments and job responsibilities, so it is vitally important that resources understand not only the bigger picture, but also embrace change. Needless to say, it is also time to remove any resource who does not want to embrace change.

Continuous Assessment: One area that does not get much attention, but should, is the continuous assessment of where a project is and how it is progressing. In the past, most projects were monitored by a project status report or a weekly/monthly verbal communication. Although these are somewhat effective, they tend to reflect what the author feels is important, and what they lack is an objective assessment of where the truth really lies. The objective assessment will also allow for immediate and corrective action of any facet of the project and should be reviewed by the executive sponsor and leadership team. The combination of objective measures and the subjective “gut feel” of the project manager/director will allow for a more definitive and truthful view. In summary, each organization faces unique challenges as they strive to transform their care for their patients. The dynamics and organizational heterogeneity creates new and different perspectives that must be addressed. Only by tackling these critical components simultaneously during the life cycle of an implementation can an organization effectively achieve successful results and transform care.

For more information, contact
The Huntzinger Management Group, Inc. at
570.824.4721 or email at info@huntzingergroup.com

Click Here to download the PDF version of this whitepaper.

See The Huntzinger Management Group On Business Day With Terry Bradshaw Video.

HMG’s services are focused on preparing our healthcare clients for the future and to run more effectively by ensuring alignment between information technology, clinical and ambulatory functional areas.

“We recognize that the healthcare industry continues to face many new challenges that drive pressures to improve quality, safety and operational effectiveness,” said George Huntzinger, president and CEO of HMG. “We believe that access to information in particular is an absolutely critical need for maintaining the future of healthcare.”

Glenn Focht, M.D.,President of Central MaineMedical Group, a multi-specialty practice of 300 employed providers with offices located throughout central,western and coastal Maine, is among the guests interviewed for the Business Day segment. Central Maine is a client of HMG and was recently recognized as among the nation’s top 25 MOST WIRED, MOST IMPROVED hospitals. “Our organization is in anenvironment where information technology impacts every single patient, physician, and employee within healthcare,” Focht said. “IT is too important to both our business and strategic direction to fail. Since working with The Huntzinger Management Group, we now have a partner that helps us serve our patients and providers more effectively.”

BusinessDay with Terry Bradshawshowcases positive stories and examples of progress and innovation across America. The show reaches TV audiences throughout the United States, airing on national cable channels and cable networks across the country. Business Day covers medical breakthroughs and advances too, among other healthcare topics.

About The Huntzinger Management Group, Inc.

HMG provides advisory and managed services consulting to the healthcare industry. We focus on clinical and operational business performance optimization by ensuring alignment between IT, clinical and ambulatory areas to position our healthcare clients for the future. For more information, visit www.huntzingergroup.com

The nation’s Most Wired hospitals are making progress towards greater health information technology (IT) adoption, according to Hospitals & Health Networks Magazine. As a field, hospitals are focused on expanding and adopting certain kinds of IT, such as computerized physician order entry, to promote improved patient care and data collection.

Click here for the full press release.

Jayshiro Tashiro PhD BA BSN RN, Robert Tashiro and Dr. Joanne Curry
A half-day workshop that provides participants with an analysis of the challenges faced during implementation of Meaningful Use Stage 1 Criteria. Simply described, the American Recovery and Reinvestment Act of 2009 defined “meaningful use” that healthcare providers need to demonstrate as patterns of application of certified EHR technologies and that such usage could be measured significantly in quality and in quantity.

For More Information download the Rutgers Conference Flyer & Information (PDF)