November 3, 2014

ICD-10: How to Engage the Weary and Wary Physician

By D’Arcy Guerin Gue

As an ICD-10 consulting professional and journalist, I have been fortunate to talk with many hospital CFOs and health information management (HIM) directors over the last year about their ICD-10 efforts.

The contents of these discussions have mirrored the results of several recent industry surveys, indicating that there has been a strong correlation between the size of healthcare institutions and the progress they have made toward full readiness to convert from ICD-9 to ICD-10. However, even organizations that have reported good progress in the past now are experiencing new challenges in their efforts.

One of the most difficult issues is the loss of project momentum. Congress’s surprise delay of the implementation deadline – it was pushed back from Oct. 1, 2014 to Oct. 1, 2015 – has created extraordinary damage, creating major setbacks for many ICD-10 projects and generating strong skepticism about the genuineness of the new deadline among many providers.

Those of you with a physics background might consider Newton’s first law of motion as an explanation for the situation, but there are several factors in play. One factor that doesn’t get enough attention is hospital physician staff participation.

Think about it. Do the hospitals that are succeeding in their ICD-10 efforts have strong physician involvement? Generally, yes. How about those institutions that are failing? Generally, no. Active, committed physician participation, starting with the chief medical officer (CMO) and chief medical informatics officer (CMIO) is critical to the success of every ICD-10 implementation project.

Because of their primary role in directing and providing patient care, physicians are responsible for much of the most important documentation created in healthcare facilities. Accurate, thorough physician documentation drives the production of ICD-10 codes during the coding process. In their office settings, physicians own an even larger part of the ICD-10 pie, as most physician office visits are self-coded by the physicians.

The participation of physicians also has important political significance within hospital organizations. Physicians sit at a very powerful seat at the table. With their political capital, progress towards ICD-10 readiness is manageable; without it, progress can be slow and painful. With outright resistance from physicians, ICD-10 project stakeholders have their hands tied.

Much of the physician reaction to ICD-10 is related to three issues in particular.

It is easy to look at the benefits ICD-10 promises, such as healthcare cost containment and better population health management, and imagine that physicians – who generally are smart people – would intuitively understand and participate in the ICD-10 transition process. Unfortunately, this is not always the case. As we’ve talked to physicians and hospitals about it, we find that physicians are both weary of hearing about ICD-10 (year after year) and wary of its consequences.

  1. Healthcare industry interest groups have generated mixed messages about the value of ICD-10. In contrast to the positives detailed by organizations like AHIMA, HIMSS, WEDI, and the CDC regarding the need for ICD-10, the AMA, AAPC and other large (and loud) organizations have worked for years to stop and/or delay it. As I discussed in September, the government’s multiple changes to the implementation date have only contributed to the confusion and doubts. Physicians are asking: If moving to ICD-10 is so important, why all the delays?

  2. Physicians often have a hard time getting behind ICD-10 because they haven’t been convinced that it offers any value in making improvements to treating patients. What is that value? A big part is the added specificity evident when reviewing previous patient care activity. The 30-year-old ICD-9 code set poorly describes diagnoses and procedures as they are understood in modern medicine. Until ICD-9 is replaced, providers will have to read into the documentation to interpret details that will be plainly communicated in the ICD-10 codes. The provider will achieve additional value from automation. More specific data in diagnosis and procedure coding enables today’s electronic medical record (EMR) systems to offer automated assistance through documentation, improved awareness of medical best practices, and precise, prewritten order sets to speed the admission and discharge processes.

  3. When we communicate to providers about ICD-10, many seem to hear only a narrowly focused message about coding. However, with the exception of office-based physicians, providers’ ICD-10-related activities do not include coding. Hospitals have coding specialists. Physicians’ role in the process is documentation – and good documentation. Documentation that supports ICD-10 coding is good documentation. Communication about ICD-10 may be driven by coding requirements, but it’s more effective to stress the best-practice documentation angle when talking with physicians.

Here are some strategies for getting your physicians on board the ICD-10 train.

  • ICD-10 implementation is, first and foremost, a change management project. ICD-10 is nothing short of one of the largest changes in healthcare since Medicare. Like any major change management effort, the best place to start is with a well-developed communication plan. This shouldn’t be just a marketing effort touting benefits, but a process that should require practical ICD-10 communication and education across the whole facility. One example: if your facility is a teaching hospital, the residents and faculty should begin working the appropriate ICD-10 codes into their lectures, presentations, and grand round
  • Strong executive support is essential. Institutions must send a clear, consistent message that the ICD-10 implementation effort is an organizational priority and that no person, department, or other issue can stand in the way of it. It is critical to stress the reasons for the change and use ICD-10’s benefits to patient care as a primary communication driver. 
  • Organizations should identify a committed, influential physician who will enthusiastically help sponsor of the ICD-10 conversion effort. This physician leader, who may or may not be the head of the medical staff, must have a central role in communicating to the provider team the importance of the ICD-10 project and related physician education. 
  • Institutions should consider how to make ICD-10 assistance part of a larger physician engagement strategy. Hospitals can broaden the reach of their internal ICD-10 educational resources to support ICD-10 learning within associated physician practices. For example, practice staff members can be given access to formal online training and to certified coders who will answer their ICD-10 questions. Volunteering this kind of support will serve at least two purposes: it will demonstrate the importance of the physician to the hospital and at the same time increase the odds that incoming documentation (like lab orders and prescriptions) will be ICD-10-compliant.
  • Organizations should begin incorporating ICD-10 into the clinical documentation improvement (CDI) process now. When physicians are reminded of documentation requirements as a result of queries from the chart reviewers, their documentation quality will improve. If this process is handled properly, the physician should not care if or when ICD-10 is implemented, because the quality of documentation will be the same.

If I can summarize how best to engage your hospital’s physicians in the move to ICD-10, it is to “focus on the pros and outlaw the cons.” The time for weighing in on the negatives – initial costs, complexities, and changes – is over. Organizations that have set this bar early on have already achieved benefits, such as more accurate documentation and resulting cost savings. Their insistence on early physician engagement has also eased apprehension and helped provide a window into the actual impacts ICD-10 will have. While your institution may not have been one of the early ICD-10 movers and shakers, there’s still time to become one.

Starting. Right. Now

About the Author

As a co-founder of Phoenix Health Systems, D’Arcy has had leadership roles in the growth of the company. Currently, she leads overall corporate administration, marketing and industry relations, services development, human resources, and knowledge management. She has led various strategic initiatives, including the development of ICD-10 services, HIPAA-based security and privacy compliance tools, and online education programs.

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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.