For the ICD-10 transition to be successful, there will need to be a huge effort on the part of medical coders, IT staff, and physicians to put all the pieces together. However, the new code set also presents an opportunity for healthcare organizations to make some big-picture decisions about the future of data governance and the role of healthcare analytics. 2011 AHIMA President Bonnie Cassidy, MPA, RHIA, FAHIMA, FHIMSS, Senior Director of HIM Innovation for Nuance, sat down with EHRintelligence to explain how the ICD-10 decisions you make now can affect your organization in the months and years after October 1, 2014.
What are you seeing right now as providers work towards ICD-10 readiness?
One of the things I’m seeing a lot is a focus on contingency planning. In the work plans or roadmaps, if the organization didn’t allow for contingency planning, they’re now realizing that it’s really something that’s very important. There’s a domino effect. If you find out that you didn’t address something that is critical to the mission or there’s a wrinkle in the plan, they must ask themselves: what did you do to allow for a contingency? It’s like business disaster planning. Maybe one of the vendors went out of business. Or maybe you never approached all of your payers. Whatever the case may be, good contingency planning is an important element to building a strong ICD-10 transition plan.
Providers are also finding out about all of the challenges of working with payers or working with the vendors while they’re addressing everything that has to do with making sure that all their ducks are in a row for ICD-10 readiness. If one of those is out of alignment, it can disrupt your whole plan. Business partners, business associate agreements, IT vendors, contracts…all of those things need to be built in and accounted for in your contingency plan.
What are some of the things providers and hospitals need to focus on right now?
The whole concept of information technology (IT) testing is going to be significant. It’s been announced that CMS will not be conducting testing for providers and payers, so I think there’s a renewed energy around the concept of testing. A lot of organizations are delaying it because they have underestimated the amount of time that it will take to thoroughly and properly evaluate and test their systems. It is a huge effort and many organizations haven’t even gotten to the point of thinking about it. But if you think about all of the systems and all of the databases that have to convert from ICD-9 to ICD-10, you have to test everything because you need to see if the data will flow. You need to prioritize what those systems are, and build separate test databases so you’re not disrupting your actual live transactions.
Do you have a Clinical Documentation Improvement (CDI) program? If you do, what is the goal and focus of the program? You need to do an evaluation, a gap analysis, of your current CDI program –what is your ideal result, and what’s falling in between? You should really look at your specialties, your physician population, and your patient population to see what you need to focus on. You have to get laser focused on your own patient population so you know what your top 25 DRG codes are, and you know what’s missing in your education and documentation. You already know what areas are going to be important to you. If you had to switch to ICD-10 today, you can predict where the trouble spots will be. That’s what CDI programs need to shift to right now.
You most likely also need to have more physician champions to get your physicians practicing the behaviors they need for ICD-10. That means you’re either hiring or contracting with physician consultants or finding physician champions in your organization. In order to do that education in your CDI program, you’ll need to think about what each specialty really needs to know. Physicians communicate best with each other, so physician-to-physician communication is your best strategy for enhancing your CDI program.
The other thing to focus on is your own staff. Have you really thought about what happens if one of your key players leaves the organization? The employee retention program is important. Be certain that you’ve really worked with human resources and established a program to retain your talented resources. Who are your critical success individuals?
If you spend all that investment in getting your coders educated and trained, as well as your clinical documentation improvement (CDI) staff, but you didn’t make the investment in an employee retention program, with the law of supply and demand, we’re going to have major capacity concerns. If those people leave, you might be left without the right staff to get the job done.
Is there anything that looks like it might be forgotten in the implementation rush?
ICD-10-PCS coding for ambulatory surgery. Have you made a decision in your organization about what you’re going to do with ambulatory surgery? Are you going to code ICD-10-PCS for your procedures even though we know we only have to code CPT? The reason I introduce that under clinical documentation improvement is that CDI traditionally is not in the ambulatory setting.
Because of the need for very specific documentation in ambulatory surgery, if you’re going to use that for ICD-10 on the diagnosis side or the PCS side, you will then have clinical documentation requirements that are far more specific in ICD-10 than they are in CPT. You will probably need a CDI effort in that regard, because otherwise you won’t have enough information to code in ICD-10. You’ll have enough for CPT, but you won’t get the specificity necessary for ICD-10.
Many people ask, “Well, why would I want to do that if the only thing that’s required is CPT?” But that connects to the overarching goal of analytics. If you want to be a progressive organization, you need to embark on something that allows you to have better information for analytics. You then will be a step ahead of the game because you’ll have that ICD-10 data in addition to your CPT data.
As we know, the world’s going to go from inpatient to ambulatory with the focus on outcomes and chronic disease management. So that’s going to be another push for CDI, but it’s also a huge organizational decision. It’s very much a strategic decision if you’re focused on your own data analytics in the future.
Online ICD-10 specialty-specific provider training modules coming soon!
Contact us for more details.
On-site, custom ICD-10 training for staff and providers – book your ICD-10 trainer now!
Source: www.ehrintelligence.com; Jennifer Bresnick; August 26, 2013.