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Making Positive Changes in Your Medical Practice


For practices, managing the change process is critical to success. Start emotionally preparing your team for the ICD-10 transition.

Medical practices will soon face a major change in the way they do business. The deadline for implementation of ICD-10 is less than two months away. This is just one of the many regulatory changes practices must comply with, to stay current in the policy landscape. Instead of dreading "change," how about thinking about it in a different way? You are not changing, your practice is "transitioning" to a new way of doing things.

You may think this is a play on words, but let me explain why it’s not. When people think of change (a nasty six-letter word), they typically do not want to participate - they resist it and think the way they have always done things is right. Medical practices are often not as effective in achieving improvements as they could be. However, change is a necessary component of improving practice work flows and activities, and is part of the technical aspect of modifying a process.

There is another key aspect that practices face, and that is the emotional aspect of change. This is the illogical resistance to change, which occurs when we try something one time and it doesn't work or when change just "feels" uncomfortable.

Let's apply this concept to the upcoming ICD-10 transition. William Bridges in his book, "Managing Transitions," suggests a three-step approach to managing transitions (changes):

1. Ending - This is where we stop doing something the way we used to do it

2. Neutral Zone - The chaos state where we are in the midst of trying new things

3. Beginning - The new way to do things

A transition starts with an end and renews with a beginning.

The technical part of ICD-10 includes all the planning and testing that has been done to date, the staff training that your practice has been through, the crosswalk of old ICD-9 codes to the new ICD-10 codes, and the work processes that have to be revised. These activities are part of the "ending phase" or beginning transition, and also part of the "neutral zone" or the implementation phase.

Hopefully your practice has started its transition by reviewing established patients who will return after Oct. 1 and implementing the cross walk to the new codes. Also, you should identify a date that new patients, seen prior to Oct. 1, will have both codes assigned. This will help in the transition.

You can say that the "change" occurs as of Oct. 1; that is the technical part. The hard part (the transition) will be the neutral zone where apprehension and uncertainty will prevail. This will continue for a few days or weeks until you see payments processed by all major payers.

The actual beginning of ICD-10 (the new way of doing things) may not occur as of Oct. 1, but will eventually become the standard way of doing things, later in the process.

Bridges does suggest that the transition dates be marked in some fashion to help staff members accept the change. So here are a couple suggestions:

• The "end" is Sept. 30, so have your staff dress in black and conduct a mock funeral. Have fun with it! Isolate the ICD-9 books and references (you may need them to dispute a denial for some carriers) from the general staff.

• Celebrate Oct. 1 with balloons, streamers, or a birthday cake. Why? Getting everyone involved and acknowledging the reality of such a change should go a long way to help your staff navigate a new beginning.

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