March 26, 2013

ICD-10 Date Is Final: How Are Physicians Reacting?

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In a March 19 Talk Ten Tuesday poll, 466 participants responded to the following question: “How are physicians at your facility reacting to the ICD-10 transition and their role in CDI?” The responses, shown in Table 1, are unsettling.

We know that the American Medical Association (AMA)-induced implementation delay from Oct. 1, 2013 to Oct. 1, 2014 created high degrees of ambivalence among physicians. Even into this year, the AMA was requesting that ICD-10 not be implemented at all. It isn’t surprising, then, that 45 percent of poll respondents felt that physicians at their facility had little or no enthusiasm for ICD-10, and another 13 percent felt that physicians have had no reaction at all.

Until Marilyn Tavenner’s recent announcement that ICD-10 implementation would face no further delays, many physicians felt no motivation even to consider the implications or the process of ICD-10 implementation. Centers for Medicare & Medicaid (CMS) and AMA ambivalence transferred efficiently to physicians.

We can, perhaps, learn more by looking at the extremes of the responses elicited by the poll. Fifteen percent of respondents related that their physicians are “livid with the increase/changes in documentation requirements.” What was not addressed was whether this perception is based on knowledge of ICD-10 or simply ignorance of the realities of the transition. If one considers that almost 60 percent of physicians have little or no reaction to the pending shift (as discussed in the first paragraph), and that much of this can be attributed to the prior CMS delay and AMA opposition, again, is the expressed anger based on knowledge, or unrefined perception?  Are there any aspects of ICD-10 implementation that would give rise to physician anger? Absolutely! The cost issue alone is daunting for many physicians. Yet much of the anger also can be attributed to erroneous statements by the AMA and others regarding the value of ICD-10. It’s easy to hate something you don’t understand.

Perhaps the most intriguing response produced by the poll (albeit from a selected group of respondents who are fully engaged in preparing for ICD-10) was that only 1 percent of respondents indicated that their physicians have “great enthusiasm and participation.” It is important to note the way in which the questions were presented. These respondents were not indicating an opinion that 1 percent of physicians nationwide have great enthusiasm for ICD-10, but rather, at their facilities, their physicians are enthusiastic and participating in the transition to ICD-10. That 0response specifically came from just three participants. There is something puzzling here – why do only three out of 466 facilities have engaged medical staffs? Or perhaps the real question is: How did they do it?

I have had the opportunity to work with several hospitals at which the medical staffs are engaged in the ICD-10 transition. Certain characteristics inevitably emerge at them. First, physicians involved in clinical research tend to be early adopters of ICD-10, recognizing how antiquated and insufficient ICD-9 data is for epidemiology or clinical research. So at academic centers in particular, leadership can gain traction by educating departmental leadership on the benefits of ICD-10 implementation.

On the other hand, I also have seen community hospitals where the groundwork has been laid to gain physician endorsement of ICD-10 and collaborative building of the necessary infrastructure. Those hospitals typically began high-level orientation of the medical staff and education about the benefits of ICD-10 as early as 2011 or 2012. They discussed with medical leadership the overall goals and objectives to be accomplished in ensuing years. We have worked collaboratively with those hospitals to develop specialty-specific education, eliminating many of the myths of ICD-10 and rendering the transition much less daunting to any given subspecialty.

But the key to the 1 percent actually is contained within the terminology provided: “Great enthusiasm and participation.” As with all documentation-related initiatives, medical staff enthusiasm only can be built on medical staff participation. Don’t try to impose ICD-10 solutions on physicians; partner with them. We have learned from years of experience that CDI programs championed by medical leadership and focused on quality have much higher collaborative response rates than programs imposed on physicians.

The 1 percent may seem small, but their approaches and successes should be emulated as we enter a period of very rapid transition to ICD-10.

Podcast Date:

3/19/2013

 

 

Attendance:

466

 

 

 

 

 

 

How are physicians at your facility reacting to the ICD-10 transition and their role in CDI?

 

Number of Response(s)

Response Ratio

A. Great enthusiasm and participation

3

1%

B. Some enthusiasm and participation

52

26%

C. Little to no enthusiasm and participation

92

45%

D. Livid with the increase/changes in doc requirements

31

15%

E. No reaction at all

27

13%

Total Results:

205

100%

About the Author

Paul Weygandt 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, a Nuance Company.

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Paul Weygandt, MD, JD, MPH, MBA, CPE