February 25, 2014

HIMSS: ICD-10 is ICD-10…mostly.

EDITOR’S NOTE: Tom Ormondroyd, vice president and general manager of Precyse Learning Solutions, will offer a series of upfront and personal accounts of his observations and experiences at HIMSS 14, taking place this week in Orlando, Fla. This is the second of his daily dispatches.

Food, along with a few other things, seems to be a major theme of my HIMSS experience. Once the exhibit floor opened, it initiated a nonstop barrage of conversations, discussions, bad jokes (well, I guess those were all just mine), and productive exchanges of information on ICD-10. Unfortunately, this busy schedule led to no lunch, no snack, and no OJ again (isn’t orange juice a somewhat plentiful crop in Florida?).

Although today I almost collapsed from lack of nutrition, I was able to have some interesting conversations within our booth about some settings and professionals that have not been talked about as much in the ICD-10 discussion.

ICD-10 and Post-Acute Care

The first of these was post-acute care organizations: home health, hospice care, LTACs, SNFs, behavioral health, rehab, long-term care therapies, assisted living, and other post-acute care. We had meaningful conversations about how to prepare for ICD-10. From a holistic approach, they were evaluating documentation, coding, and operations just like the acute side. But it was interesting to discuss how ICD-10 impacts standing processes, protocols, and standards, such as OASIS reporting and IRF-PAI.

The key message I extolled was that ICD-10 is ICD-10; however, it is important these organizations ensure education, technology, and other plans are specific to their setting. Each of these settings might have an overarching impact, the same as acute care, but other impacts are more specific and need a tailored approach. Whether the post-acute clinician is at a patient’s home providing care or it happens within a facility, granular documentation of this care is paramount for ICD-10, no matter the setting.

Physician Offices: Tight Spot

The second group I have been worrying about is physician offices. From the pre-conference symposium to yesterday, I saw far more activity than at prior HIMSS conferences from this group regarding getting ready for ICD-10. Whether it was a health system that owns practices or an independent medical group, these individuals were inquiring about how they can prepare their doctors in this setting, as well as their non-clinical staff, non-physician clinicians, and coders.

Again, the message is that ICD-10 is ICD-10, but they also need a specific approach. One of the key risks in this setting is that many of the providers assign or choose their own codes. Many providers were never taught ICD-9, but learned by doing. This is the opportunity to not just make them coders, but rather to teach them the core principles and rules around coding. ICD-10 also allows them the ability to fully capture true severity of illness and medical necessity of the care provided, due to ICD-10 being more clinically-based than ICD-9.

Lastly, this education and preparation will hopefully push them or coders away from choosing unspecified codes that do not provide granularity and will certainly increase risk of audits and denials in ICD-10.

Financial Impact and Preparation

Another major topic with this group is financial preparation. Many speakers and physicians I spoke with discussed securing lines of credit to handle the few months after the ICD-10 go-live, when payments may be delayed due to added work to assign the codes, reducing productivity leading to fewer patients being seen, and delaying collection of payments. Education and preparation can reduce and mitigate some of the risk, both financially and operationally, but this was another safety step many spoke of.

And lastly, I usually come to these conferences and am lost in the strict black, white, and gray attire, but there is something about the Florida sun that has caused people to go back in their closets and pull out their bright, colorful ’80s shirts and blouses. This makes it easier in a booth when you can identify people by shirt color and not just ‘The man over there with the black hair.’ I’m hoping this colorful theme continues in Chicago in 2015! (I also hope the warm temperatures we are having here continue to Chicago, but that is unlikely.)

About the Author

Thomas Ormondroyd, BS, MBA, is vice president and general manager of Precyse Learning Solutions. Heoversees Precyse University (www.precyseuniversity.com), an online learning system and program built to deliver education to prepare healthcare professionals for the challenges of today and tomorrow.