“At the end of the day, I want to serve the healthcare community”, Dominesey stated.  “When I began to meet with members of the TrustHCS team it was clear this organization shared my desire to serve.  The values of TrustHCS and their emphasis on maintaining a solid relationship with their clients made it an easy decision to join the team.”

Read more on this latest news by clicking here.

As we look forward to the next few years making it through the big ICD-10 transition and getting past major implementations like Computer Assisted Coding (CAC), there are other twists, turns and major drops on this roller coaster.

After the dip from dual coding, many are looking to address their Clinical Documentation Improvement initiatives in preparation for physician education in the area of ICD-10.  When the query process picks up, productivity may experience another dip.  We will all catch our breath from those back-to-back drops only to have a massive hit again on October 1, 2014.  If Canada’s experience with the transition is a realistic expectation, this will be the “major thrill” of the ICD-10 productivity roller coaster.  We could see an immediate dip of 53%.

However, don’t worry.  The roller coaster will likely end with a leveling out at an overall 19% productivity hit (again, if Canada’s experience plays out here in the United States).  The last bastion of hope to off-set that 19% dip in productivity rests with Computer Assisted Coding.   CAC could come in and make up the difference for the productivity dip, and it’s expected to deliver on that hope.

Any way you slice it, productivity of an already overburdened coding staff is just now entering the thrill portion of the ICD-10 ride.  Hold on tight!

With various studies and groups looking at how the transition will affect health information management and the entire healthcare industry, there are still a few final steps we should all take to prepare.

Make sure the Tower can Guide us In

The jumbo jet that is ICD-10, is only one of many “jumbos” on the radar – [think Computer Assisted Coding, Electronic Health Record, Meaningful Use, Accountable Care Organization initiatives, Clinical Documentation improvement, etc.].  We need to ensure we have a proper plan in place that outlines not only what Health Information Management and the coding staff needs to do but also roles and responsibilities of the rest of the revenue cycle team.  An overall plan for all involved parties is essential to making the transition without any major bumps.

Ensure the Pilots and Crew are Prepared for Landing

Our physicians are going to play the most critical role in “sticking the landing”.  They are the pilots we need providing the coding crew updates from the cockpit.  Clinical Documentation Improvement programs will need to be operating properly to ensure communication from the physicians to the coding team is accurate and appropriate.  Without proper communication in the form of CDI it’s likely to be a bumpy landing.

Know the Emergency Exits

With all the preparations we take for a proper landing, there is still a need to be ready should an emergency take place.  Securing additional coding resources for potential dips in productivity once ICD-10 is active is important.   With the expected demand of coding resources greatly outweighing the number of coders readily available, securing a plan now for where you will turn when the need arises ensures you’re ready for any unforeseen issues.

Our arrival time has been secured.  Let’s get the wheels on the ground and make ICD-10 a smooth landing!

Know Your Role.

Before implementation begins, clear lines of communication must be set and jobs delegated.  Synergy must be established between clinical and operational chiefs. For example, Chief Operating Officers are   important links.  Their responsibilities cover both clinical and administrative sides of an organization. When roles are well defined and communicated, organizations avoid the ‘too many cooks in the kitchen’ syndrome.

Learn New Technologies and Policies.

Training everyone on new technologies, policies and procedures is crucial for success.  Neither ICD-10 nor Meaningful Use implementation rests solely on the shoulders of one department. The C-suite must champion the training and education process across all departments to ensure changes are embraced and adopted. Strong executive ownership of education avoids future obstacles and ensures a solid return on your investments.

When it comes to both ICD-10 and Meaningful use, every position has a place in the implementation process. It all comes back to collaborative and coordinated leadership at the senior levels of each and every organization. Leaders that develop and oversee strong implementation teams, robust lines of communication and consistent monitoring of progress towards their goals will certainly serve-up a delicious pie.

It’s important for physicians to understand ICD-10’s impact and how it can ultimately benefit quality of care and their practice.

Explain the Benefits of Greater Specificity

ICD-10 incorporates greater specificity, clinical data, and information relevant to ambulatory and managed care encounters. In addition, the structure of ICD-10 allows for the expansion of code numbers. ICD-10 also extends beyond simply the classification of disease and injuries. It includes the ability to code risk factors that are frequently encountered in a primary care setting.

ICD-10’s magnified degree of specificity provides more detailed information encouraging and supporting providers, payers, and policy makers to:

• Establish appropriate reimbursement rates.
• Improve the delivery of healthcare.
• Improve and evaluate the overall quality of patient care.
• Effectively monitor both service and resource utilization.

Invest in Physician Champions

It will be difficult for physicians to embrace ICD-10. Change is difficult and the transition may be costly. Therefore, HIM professionals and group administrators must focus on helping physicians understand the dynamics involved with the new code sets, and the greater level of specificity required.

To do this, organizations are advised to first identify and invest in the development of a few select physicians. These physician “champions” should understand the ICD-10 processes and support the transition. Let their knowledge of ICD-10 model change for other colleagues who may resist migrating from ICD-9 to ICD-10.

With a little education, encouragement and support all your physicians can successfully make the leap!

Two strategies for staffing augmentation are to build and to buy: grow your own staff and outsource for back-up support.

Build a Team—and Grow

The “grow-your-own” strategy requires providers to identify internal ICD-10 experts now and ensure they receive in-depth training. Once trained, these experts serve as the organization’s ICD-10 specialists to lead ongoing staff development efforts. You can use a variety of instructional materials and learning approaches, including:

• onsite classes
• web-based materials
• partnerships with local community colleges

Costs for a “grow-your-own” program vary based on the existing knowledge base in biomedical sciences (anatomy and physiology, pathophysiology, advanced medical terminology, and pharmacology) and the training methodology used.

The best candidates for internal education are:

• coders who currently work in outpatient coding areas and who are familiar with CPT coding
• nurses and other ancillary professionals
• medical transcriptionists

Buy a Team—Secure Outsourcing Partners

Coding, billing, and CDI outsourcing companies are all recruiting from the same labor pool. So contracting for the best and brightest professionals now, rather than waiting until 2014, is critical. Below is a checklist of sample questions and talking points to ensure you’re covering all bases when searching for qualified outsourcing partners:

• Productivity, Quality, Turnaround Time
• Technical Support: Provider and Vendor
• Sufficient Ramp-Up Time: Average on-boarding time for an outsourced coding vendor is 40 to 60 days.
• References
• Credentials
• Processes
• ICD-10 Competency

Many healthcare provider organizations are financially unable to take advantage of both internal and external options. If your internal resources do not allow the “build” approach, arm yourself with enough “buy” research to fit an outsourcing partner to your specific needs.

Stay tuned for next month’s blog on my recommendations for a multi-partner approach.

Effective implementation of a CAC solution requires the same thoughtful approach utilized in any other successful technology deployment.  There are no “plug and play” solutions in healthcare anymore.  Organizations must develop realistic timelines and expectations for CAC deployments and be willing to do end-to-end testing to ascertain the realistic impact and benefits of its use.  Potential impact and actual impact are miles apart.  We must learn from our past naiveté and enter into this next generation of HIM technology with our eyes wide open.

NOT a Magic Elixir

What CAC will NOT do is replace your coders.  It is not a magic elixir.

CAC systems perform well only when complete, accurate, and terminology rich documentation is fed into them.  CAC can only code what is provided to them in electronic format.  These systems only recognize and read digitized data. Scanned or handwritten text simply will not suffice.

Even analyzing the digitized data is a skill set that is best accomplished by well trained coders. Hidden details and nuances are the realm of human coders.

It is estimated that in the months following ICD-10 adoption coder productivity will decrease significantly, most reports forecast an initial drop of as much as 50 percent and sustained losses of 20%, optimistically. CAC may be able to make up most of that downside – but only if you get it up, running, tuned, and integrated into your workflow soon.  This is a process best perfected before the ICD-10 storm hits.  Plus, if you are going to dual code in order to test – you will want to integrate your CAC into that testing.

For more information about the relationship between CAC and ICD-10, read our earlier blog on the 5 Steps to Continue for ICD-10.

Healthcare is a world rife with externally driven change and ICD-10 may be the most involved, most complicated, high risk driver of change we’ve ever seen.  Even so, some organizations have yet to begin even the simplest assessment of their preparedness.  They assume their people, processes and technology are going to be impacted but they have no idea to what extent.

TrustHCS recently conducted a hospital ICD-10 readiness survey. Our preliminary results indicate the nearly 60% of those surveyed had yet to form or meet regularly with their ICD-10 steering committee.  This basic step serves as a precedent and provides governance for all subsequent initiatives, including assessment.  It is critically important to remember that assessment should be an on-going process, not just a single step in your ICD-10 readiness program. Assessment requires continual measurement and modification.

The Value of Outside Reflection

In the evolving world of ICD-10 modifying the plan to accommodate new developments, unknown hurdles and surprises is the norm.  Engaging outside experts helps assure that unbiased, objectives assessments are getting done. And finally, external consultants share what they learn elsewhere, helping minimize all the “gotchas” that you’ll inevitably experience with ICD-10.

Whether your hospital employs outside consultants or shifts the burden to internal staff, now is the time for the assessment process to begin.

• New Skills
• Expanded Knowledge
• Better Opportunities

With ICD-10, coders must fully understand the ramifications of revenue cycle, audit, and clinical documentation.  This larger view forces coders to step outside the world of HIM and build new skills in communication, tact, and cross department relationship building.

On the flip side, ICD-10 drives new benefits for clinical coders. Doors will open in the areas of new opportunities, expanded professionalism and more career options. To seize these opportunities, coders must insist on expanded education and training from their employers. They must become more clinically adept while also increasing their knowledge of charge masters, revenue codes, modifiers, and UBs.

Get Ready to Shine!

To excel in this new active world, it behooves coders to become much more active in the transition to ICD-10.  You can help drive the process by getting the skills you need now versus waiting until 2014. TrustHCS recently conducted an ICD-10 readiness survey. Nearly 100 percent of respondents stated that coders would (or are) undergoing additional training.

Make sure your training is broad and wide. Understand the impact of ICD-10 across all departments. Think horizontal workflow with ICD-10. And abandon the vertical silos of ICD-9.

For more tips on how coders can prepare for ICD-10 and HIM Directors can prepare, read my September blog here.

With a year delay, savvy HIM professionals and ICD-10 teams should take a second look at every operational area that enters, shares, uses, or reports ICD-9 codes.  Here are three nooks and crannies you may have missed during the initial impact assessment.

• Owned or Affiliated Physician Practices

For hospitals that own or contract with physicians, alignment of all groups toward the goal of a successful ICD-10 implementation is critical.  This means that readiness assessments need to be thorough and identify all possible gaps. Once gaps are identified, detailed plans need to be developed to address the gaps and structured project management needs to be in place.   Look closely at all technology interfaces, patient registration points and clinical documentation sharing. And consider cross mapping to ICD-9 codes for ongoing data tracking after October 2014.

For more information on preparing physician practices for ICD-10, check out Deborah Robb’s blog on this topic.

• EHR Documentation Templates

EHRs must support ICD-10. And they should be part of your complete IT system checklist. But there’s more to EHR readiness than development timelines, version levels and system testing. The electronic documentation templates within EHRs must also be prepared for ICD-10.

Specific narrative within EHRs must support CDI initiatives as well as coding. Begin by assessing documentation menus, check boxes and radial buttons associated with high dollar and high volume DRGs. Will additional clinical details or terms need to be captured? If so, educate clinicians about the changes and then update EHR templates accordingly.  This important step fills documentation gaps and ensures case mix index doesn’t fall in areas delivering highest organizational revenue.

• Payer Interoperability

All processes that involve ICD-9 codes, including pre-authorization for procedures, will be impacted by ICD-10. Even a small hiccup between other systems and organizations has the potential to create reimbursement delays and patient care logjams.

Make sure your payers will be able to process claims accurately and timely! Begin end-to-end testing with all payers as quickly as possible. We predict that payer interoperability may represent one of the biggest “gotchas” of ICD-10.