June 18, 2013

ICD-10 — No More Delays. The Date Is Set: HHS’ Mostashari

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WASHINGTON ---The second day of the ongoing HIMSS ICD-10 Forum began with Farad Mostashari, MD, ScM, the U.S. Department of Health and Human Services (HHS) national coordinator of health information technology, staking his claim and making a stand. No more delays. No more postponements. The compliance date for ICD-10 is set, and it will not change.

Mostashari’s words marked the first of many key messages delivered to Monday’s HIMSS attendees. Talks about implementation strategies, electronic health record (EHR) vendor readiness, ICD-10 testing and true DRG shifts captivated an audience of more than 200 HIT, HIM, consulting and vendor professionals. Later in the afternoon, topics of discussion included employee readiness, coder staffing, clearinghouse remediation and understanding the financial risk presented by ICD-10.

Multiple speakers encouraged attendees to pair ICD-10 efforts with partnering with those already engaged in meaningful use. Beginning with the end in mind, Mostashari laid out three tenets of future healthcare reimbursement: care coordination, patient engagement and population management. ICD-10 implementation coordinators should keep these three factors in mind while driving the production of data needed to reach healthcare’s “northern star”: better health and better care at a lower cost.

Because healthcare providers also operate in the real world, however, Mostashari identified several practical ways in which to ease ICD-10 burdens incrementally:

  • Use Region Extension Center (REC) resources for ICD-10 implementation support, particularly for small physician groups and clinics.

  • Establish crosswalks between SNOMED and ICD-10, relying on EHR documentation in SNOMED to smooth the path.

  • Align documentation incentives among hospitals and physicians while providing physicians with feedback data and quality scores based on existing clinical documentation.

  • Use ancillary personnel alongside data from other systems as contributors to clinical documentation, thereby reducing the documentation load for physicians.

Test Today, Prevent Problems Tomorrow

Christian Omba, an earned value professional (EVP) of program management at the Lott QA Group, urged attendees to begin end-to-end testing for ICD-10 as soon as possible, even if manual efforts are the only option. Manual efforts involve some heavy lifting, but they lead to faster testing and enhanced ICD-10 know-how. Omba advised keeping in mind that clinical skills will be needed alongside real medical record cases.

Omba also reiterated that payers won’t be able to test with everyone, noting that some hospitals aren’t equipped for industrial-strength testing. Testing tips from Omba and subsequent speaker Mark Lott, CEO of the Lott QA Group, include:

  • Don’t wait for your IT systems or payers to be ready; start now.

  • Begin testing with the trading partners you work with most often.

  • Test using real de-identified medical records, not maps or fake data.

  • Implement dual coding as the first step in testing, then identify documentation gaps and train coding staff.

  • Reduce costs by testing collaboratively and sharing test data.

Lott concluded by noting that “end-to-end testing is risk mitigation for everything else organizations spend on ICD-10.” Yes, testing is that important!

Measuring DRG Shift, EHR Benchmarks and Employee Readiness for Change

Jill Wolf, vice president of compliance at VitalWare LLC, Brian Levy, CMO at Health Language, Inc., and Kristen Lilly, consulting manager at Pershing Yoakley & Associates, provided invaluable advice regarding the expected DRG shift with ICD-10, EHR readiness, and employee impact, respectively. Each speaker reiterated that waiting until 2014 to prepare for ICD-10 was unacceptable.

Wolf stressed that action must be taken now, noting that the time for predictive modeling is done. Real charts must be placed in front of real coders, today. Additionally, Wolf told attendees that true DRG shifts (reimbursement gains and losses under ICD-10) can be measured only through actual ICD-10 coding. If such coding is postponed until 2014, organizations will experience negative shifts in case mix, similar to those experienced in 1984 when DRGs first were introduced.

EHRs also must be prepared for ICD-10, according to Levy. To meet meaningful use, physicians must document problem lists using SNOMED. EHRs should roll out SNOMED to ICD-10 behind the scenes, making the entire ICD-10 transition easier on clinicians and their staffs. Expecting physicians to learn ICD-10 overnight is not feasible. Using technology to facilitate the conversion is. Front-end user interfaces also must be updated for ICD-10, while underlying databases must continue to support ICD-9 codes for analytics, reporting and data normalization over time.

Finally, the human factor of ICD-10 was addressed by Lilly. Employees within HIM, IT, revenue cycle, physician offices and post-acute care settings all must be brought up to speed regarding ICD-10. A bi-directional flow of information and communication “mitigates the loss of effectiveness for individuals and organizations,” Lilly said. How employees feel about the shift to ICD-10 also impacts how successful individual providers will be in implementing the new code set. Simple anxiety results in decreased morale, while frustration drives down productivity. A few other important observations provided by Lilly included:

  • Patient access and utilization review departments ranked highest in terms of anxiety regarding the upcoming shift to ICD-10.

  • Front-line managers are key players in the transition.

  • Employees want a “heads-up” from their employers with regard to ICD-10.

  • Organizations must have an on-site, centralized project manager for ICD-10.

Too Late for Timelines!

Levy also noted that, simply put, the time for timelines is past! Monday’s audience at the HIMSS ICD-10 Forum concurred. This is the year in which organizations must ready themselves for the biggest change in healthcare since the introduction of DRGs. So rally your troops. Round up your vendors. Dive into the ICD-10 waters. And keep your eyes fixed on that “northern star”: better health and better care at lower cost.

About the Author

Beth Friedman is founder and principal of The Friedman Marketing Group (TFMG), a full-service public relations agency for healthcare. She is an active member of AHIMA, HFMA, and HIMSS, with 10 years' provider experience in coding and HIM.

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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.

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