December 1, 2011

ICD-10 and Physicians: Critical Success Factors

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Most organizations by now have realized the impact of ICD-10 implementation. Many currently are undergoing global readiness assessments, looking at not only the obvious coding, information systems and infrastructure issues, but also more tangential issues such as contract renegotiation, claims tracking, analytics and reporting. A question heard more and more throughout the industry is “do physicians understand the impact, and can we get them ready?” For hospitals to succeed under ICD-10, physician cooperation and collaboration will be essential. So what are the “physician-related” critical success factors for ICD-10?

1. Early Awareness

Physicians generally look at ICD-10 implementation as another relatively unnecessary intrusion by the legal and regulatory spheres of influence into the practice of medicine. This notion is reinforced by the cost of conversion, which will be a direct out-of-pocket expense for physicians. If hospitals, through their actions or inactions, allow opposition to ICD-10 to build, the impact on operations (especially revenue cycle function) will be impacted severely. Let’s translate this risk into an actionable strategy.

ICD-10 makes clinical sense. Physicians should be approached now, through educational presentations, to build recognition of the value of ICD-10 to the profession of medicine. It is a far better clinical system than ICD-9, which is more than 35 years old and rife with outdated clinical terminology, inconsistent language and global lack of specificity (we can’t even indicate laterality in it). We are also far behind the global healthcare community, as evidenced by Great Britain’s adoption of ICD-10 in 1995 as well as adoption by our Canadian neighbors to the north in 2001.

2. Early Collaboration

Where is your medical executive leadership as it relates to ICD-10? Is your CMO/ VPMA/chief of staff integrally involved in ICD-10 planning? If not, you are risking engendering unnecessary resistance in the medical staff. The medical staff should be made aware that medical leadership is working in collaboration with hospital leadership to do as much as possible to limit the negative impact of ICD-10 on the day-to-day practice of medicine. Transition timetables should be discussed with physicians. Educational planning should be laid out thoroughly within the next few months. Solutions to potential problems should be discussed at the leadership level and shared with the medical staff.

3. Operational Infrastructure

Here’s an opportunity to establish the collaboration discussed above. How are you preparing for ICD-10-PCS documentation and coding? Recall that hospitals will not be able to submit bills for inpatient services unless all procedures are coded with all seven alphanumeric characters. This will require an unprecedented level of documentation specificity for surgical procedures, cardiac catheters, interventional radiology and a vast array of other procedures. At the same time, however, physicians will continue to bill their inpatient professional services (procedures) using CPT procedural codes. Note the disconnect? So, what are your plans to ensure concurrent documentation of all seven alphanumeric digits for every procedure? I recently met with the leadership of one health system. Members of the physician leadership were discussing with HIM, IT, clinical documentation leadership and others how best to support physicians. They were looking at IT solutions, for example, that would present to the physician (based on intraoperative documentation by the circulating nurse) critical parameters for operative dictation and then, using technology, pull all the specificity necessary in an algorithmic manner. This is just one example of collaborative planning.

4. Practice Viability

Perhaps the greatest ICD-10 risk for many physicians will be the loss of practice autonomy. Many small practices, particularly in family medicine, internal medicine and pediatrics, simply will be unable to afford the practice costs of conversion to ICD-10 in light of the IT conversion costs, needs to retrain staff and loss of productivity by office staff. For many, this may be the straw that broke the camel’s back. Leadership, meanwhile, can let the chips fall where they may. The predictable result will be open hostility between physicians (whose practices will fail) and hospitals (which physicians will see as having the revenue and viability).

 


 

Would it not be a more appropriate strategy to make the medical staff aware of the risks and consider alternatives such as group practice consolidation, MSO services, group purchasing of I-10 compliant software, regional collaborative billing practices, or, ultimately, employment arrangements? Managing the knowledge gaps of the medical staff along with the inevitable changes in the practice of medicine, coupled with decreasing reimbursement and loss of professional autonomy being felt by many physicians, will challenge even the most adept medical leadership.

Many healthcare organizations are working toward a renewed sense of medical professionalism as physicians assume stronger leadership roles in collaborative hospital management. Success will require attention to all the above listed critical success factors, but at a more fundamental level it will require the ability to lead, educate, mediate, facilitate and negotiate in a professional and highly interpersonal manner.

About the Author

Paul Weygandt, MD, JD, MPH, MBA, CCS, CPE, is a Certified Physician Executive (CPE) with more than 20 combined years of experience in medical management, legal counsel and orthopedic surgery. He has served as a hospital VPMA, improving documentation across all DRG payers. Dr. Weygandt is vice president of physician services for J.A. Thomas & Associates and is a partner in the firm.

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