Updated on: March 16, 2016

Do No Harm; Next, Focus on Documentation Improvement

Original story posted on: October 13, 2014

We’ve heard the concerns and questions from multiple corners of the healthcare industry: Will physicians, especially those in small practices, be ready for ICD-10 implementation? What can we do to motivate them to start moving toward the inevitable (or so we hope) change? How can we communicate the urgency to do so?

Although there is no one-size-fits-all answer, a recent Talk Ten Tuesdays broadcast focused on fostering communication with small physician practices. Several guests shared the physician viewpoint on ICD-10, and others presented the administrative priorities to prepare for implementation.


Walk a Mile in Their Shoes

Physicians really care about their patients and their families, so they see everything through the lens of how ICD-10 implementation will affect them, said Tricia Maddrey Baker, executive director of the Pitt County Medical Society, Greenville, NC.

“They are concerned about having to take the time away from their patients to choose an exploded code,” she explained. “In ICD-9, they only had to choose one code, in ICD-10 they may have to choose six. They also are afraid of choosing the ‘wrong’ code and not getting paid.”

The physicians in her medical society also have many unanswered questions, said Baker. For example: Will dual coding be feasible and when? What’s a realistic implementation cost for a practice, such as six physicians with a total staff of 45?

Dr. Nicole Einhorn, the chief content officer for ICDLogic, views physicians from the inside out since she is one herself (an orthopedic surgeon). She believes that physicians are “overly challenged” right now and “fearful of the unknown.”

“We resist because we are concerned about patient care, and want to protect our resources and time, which, as everyone knows, are already stretched to the max,” she says, agreeing wholeheartedly with Baker’s comments above.

Her advice to physicians is down-to-earth: Be proactive and pragmatic. Become familiar with all of the electronic tools available, learn about CDI, improve your coding skills and translate necessary information to the patient record, and look for cost-effective solutions. This can make the transition less stressful, Dr. Einhorn believes.

Acknowledge the Uncertainty

Leigh Williams, a partner with Propel Health IT, who works with physician practices, also observes that they are concerned about another implementation delay, and Holly Louie,co-chair of the ICD-10 committee for the Healthcare Billing and Management Association, agrees that previous implementation delays have fertilized a lack of credibility.

“Many of them are taking a wait-and-see approach until the new Congress is seated, and we find out what it will do about the SGR [sustainable growth rate] and whether it will kick ICD-10 down the road again,” says Louie. “They don’t know these answers, and they don’t have extra time or money to spend for something that may not be viable.”

Although ICD-10 is a concern, Holly says that it is “a very small part of a very big story for practices.” Consideration must be given to payment cuts of commercial payers, other initiatives that have penalties, PQRS, meaningful use, increased denials, etc.

In spite of our electronic world, “Most of these cannot be automated and are very high-touch processes that require human time, either physician or staff,” she said. “Physicians must plan for all of this at the same time. It has tapped out multiple resources.”

Lessen the Stress

In her work with practices, Williams advises physicians not to get wrapped up exclusively in preparing for ICD-10 implementation but to focus on overall process improvements. Such focusing, she says, “relieves anxiety” about yet another delay.

Like other Talk Ten Tuesdays guests, she believes that it’s very important to just listen to physician concerns and find out what they care about most. In addition, help them to understand what the changes mean.

“We talk to them in terms of ‘better health, better healthcare, lower costs,’ says Williams, who emphasizes to them that granularity in the patient record can improve clinical decision-making as well as the comprehensive details that coders need.

Stanley Nachimson, founder and president of Nachimson Advisors, believes that the best advice to offer physicians is this: “Concentrate on your documentation. Move slowly through your most important codes and improve your clinical documentation. These are the most important things.”

Deb Grider,a healthcare consultantwith Karen Zupko & Associates, agrees that documentation is the physician’s burden and “documenting smarter” should be the goal. She believes that performing an ICD-10 readiness audit will help.

“Look at your ICD-9 codes and map them to ICD-10 for specificity and see what’s lacking or missing. It’s not always about coding or documenting more, it’s about documenting smarter,” she said. 

Nachimson also believes physicians must come to understand that there are clear benefits in improving documentation, including better billing and better patient care. And they need to know that they are not 100 percent responsible for preparing for ICD-10.

“There is a need for collaboration among hospitals, health plans and physicians, and there are plenty of resources available,” Nachimson emphasizes.

Delegate the Administrative Details

Even though physicians may want to only concentrate on their patients, they must improve their documentation, and they, or someone in the practice, must address all of the other administrative details involved in the transition to ICD-10.

Greg Adams, president of the consulting division of Panacea Healthcare Solutions, joined the Talk Ten Tuesdays broadcast to address the financial aspects, saying that the needs of physician practices, especially the smaller ones, are similar to those of hospitals.

However, he says, “Physicians could find themselves in much more dire straits than hospitals, primarily due to much more limited resources.”

Adams says he is a big proponent of cash-flow management and believes it should be a priority. “There’s no disputing the fact that I-10 implementation will hurt cash flow,” he said, and provided the following suggestions for physician practices.

  • Increase upfront cash collections. Realize that in the changing healthcare insurance marketplace a larger portion of each bill is the patient’s responsibility. Set goals to increase cash to offset the negative impact of this.
  • Set a goal to increase cash by October 1, 2015. Be practice-specific, and be realistic about what a cash-flow hit will mean to you.
  • Talk to your bank now about increasing your lines of credit and short-term loans

“Educate bankers now about the ramification of ICD-10 implementation and why you need the cash,” Adams said. “Don’t assume they understand what will happen with I-10. Provide as much information as possible to bankers so they will be more willing to provide loans when you need them.”

In addition to agreeing with the advice offered by Adams, Grider highlighted a few of the seven steps she included in an article that appeared in the October 7 issue of ICDmonitor.

One priority, she believes, is to make sure the electronic tools, including the electronic health record and the practice management systems, are modified to support ICD-10. Physician practices also should contact their top 10 to 15 payers, and work with them to get a firm date for end-to-end testing, realizing that “many payers will have limited testing”—a fact that may go back to Congress for a resolution.

Another important step is to develop a transition plan and appoint an in-house leader to lead the project. This, she says, “ensures cohesiveness.”

“Choose someone who is focused and can execute well and communicate effectively,” she writes in her article. “Taking things one step at a time will keep the challenges less daunting and will help you move in the right direction toward a successful transition to ICD-10. Rely on industry experts to assist with your transition to ICD-10. Yes, this will be a difficult challenge, but organization and focus is the key to success.”


Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.

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