Updated on: March 16, 2016

What is Data Analytics—and How Can It Help You Prepare for ICD-10?

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Original story posted on: March 22, 2012

EDITOR’S NOTE: The following is the first in an occasional series of articles about what providers should be doing in the interim as CMS re-examines the timeline for the implementation of ICD-10.

 

“Data is the new bottom line for organizations. Management of data will determine success or failure in today’s healthcare environment,” says Barbara Godbey-Miller, QuadraMed’s vice president of HIM client development.

 

Being able to examine your raw data and draw informed conclusions that will aid in future planning for ICD-10 implementation is no small reward for intensive analysis and, what’s even better, she says, is that there are many other rewards, including being able to identify risk areas.

A high number of hospitals and other providers are already benefiting from the data-crunching process. A poll conducted on one January ICD-10 webcast indicated that 34 percent of the respondents have performed data analytics on switching from ICD-9 to ICD-10 coding to determine their documentation risk. More impressively, 40 percent said that they hadn’t done any analyzing but they plan to do so. Seventeen percent are uncertain, and 7 percent say the question doesn’t apply to them.

The reasons that leaders of healthcare organizations have turned to data analytics are many but a primary one is the need to examine patient financial data. As Godbey-Miller says, “They can then draw conclusions in preparation for the ICD-10 transition and continue with ongoing assessments. Knowing what the data says allows better decisions with regard to not only how ICD-10 will impact reimbursement but also the risks of inadequate documentation and coder productivity.”

Data analytics can even help in the area of education with a focus on implementing a clinical documentation improvement (CDI) program. CDI professionals need to be able to interpret and analyze performance results and effectively use that information to improve healthcare quality in addition to accomplish the following:

  • Identify areas to focus on documentation efforts
  • Reduce regulatory audit risk
  • Improve case mix, clinical document and data integrity.

In addition to learning about, and learning to use, all of the available data banks, Godbey-Miller instructs providers to focus first on their risk areas, such as identifying the immediate return on investment (ROI) to implement CDI programs and provide physician education related to better documentation. Risks uncovered with a CDI program would be ranked from high to low, and for the financial risks connected with ICD-10 implementation, areas of highest risk would be identified and then addressed.

With DRG reimbursement reports, providers can uncover the impact of ICD-10 vs. ICD-9 reimbursement, analyzing the DRG movement when cross-walked from one to the other. Grouping the highest-weighted DRGs and lowest-weighted DRGs allows a full view of the reimbursement impact by DRG group. You will be able to follow your progress and re-audit high-risk cases and re-educate staff where necessary.

Knowing exactly what’s going on in your organization is a must in this high-stakes healthcare world. It’s worth the time to understand data analytics and how you can drill down and use the information wisely.

Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.