icd-10 one month in - an industry review
TRANSCRIPT
November 4, 2015
ICD-10 One Month In: An Industry Review
Our Speaker: John O’Neil
30 Years Executive Level Healthcare Leadership Experience Previous Affiliations: ¤ Ascension Health ¤ CEO of St. Vincent’s Health
System ¤ CEO of Our Lady of Lourdes
Memorial
Today’s Agenda
ICD-10 Summary/ Warnings Before
ICD-10 First 30 Days – What Has Been Said
What about you? A Live Poll/Sample of Attendees
Recommendations by Experts
My Recommendation to Tackle ICD-10
ICD-10: What We Knew
ICD-10 CM (Clinical Modification)
Used in Medical Coding and Reporting of Patient’s Health Statuses All care provided is to be in ICD-10 CM beginning October 1, 2015 Contains Codes for: § Diseases § Sign and Symptoms § Abnormal Findings § Complaints § Social Circumstances § External Causes, injury, or diseases
68,000 Codes
ICD-10 PCS (Procedural Coding System)
Utilized to report medical procedures performed on patients admitted as INPATIENTS only
All in patient procedures are to be coded in ICD-10-PCS by October 1, 2015
Contains codes for: § Body Systems § Root Operation – 31 types § Body Parts – specific anatomy within a body system § Approach – 7 ways
72,000 Codes
Challenges
You have the ability to impact the entire organization – it’s not just a coding problem Servant Leadership & High Reliability 2001 – Canada began using ICD-10 § Productivity dropped 40%
Shortage of Coders Coder Education: § PCS anatomy is much more specific. (e.g., arterial repair requires
knowledge of every individual artery – 195 codes) § CM – Femur Fracture – ICD-9 Codes = 40,
while ICD-10 Codes = 2994
Financial Backlog
Financial Backlog
Cannot bill until ICD-10 Specificity is met
Inquires estimated to increase 30% - major physician dissatisfaction
Billing Cycle will see major increase
AR Days increase
Cash decrease (less available for Capital)
Backlog caused by ICD-10 beginning October 1
What Happened in the First 30 Days?
IT Transition Went Smoothly
Things seem to be going smoothly http://www.diagnosticimaging.com/icd-10/at-one-month-icd-10-seems-to-be-going-smoothly
Vendors were ready http://www.healthdatamanagement.com/gallery/ten-things-that-were-surprising-about-ICD-10-51468-1.html
Just a few “blips” mar rollout http://www.modernhealthcare.com/article/20151030/NEWS/151029859?utm_source=modernhealthcare&utm_medium=email&utm_content=20151030-NEWS-151029859&utm_campaign=hits
ICD-10 Data Show Few Coding-Related Claims Denials http://www.ihealthbeat.org/articles/2015/10/30/cms-first-icd-10-update-shows-few-coding-related-claims-denials
Much Ado About Nothing http://www.hcpro.com/acdis/details.cfm?topic=WS_ACD_STG&content_id=322111
What the Market Says
It was not Y2K – IT Systems Are Operating Not enough ICD-10 coders available for hire http://www.nuemd.com/news/2015/10/09/5-early-problems-encountered-with-icd-10
Coding system went down in one Midwestern multi-hospital system: http://www.nuemd.com/news/2015/10/09/5-early-problems-encountered-with-icd-10
Many hospitals don’t have adequate staff (coders, billers, AR staff) http://blog.expeditive.com/4-challenges-from-the-first-days-of-icd-10
Calm before the storm? Too soon to tell? http://healthcare-executive-insight.advanceweb.com/Columns/ICD-10-Front-Lines/First-month-of-ICD-10.aspx
Previously said on October 1: “For many organizations the surprises may take weeks or months to reveal themselves.” http://healthleadersmedia.com/page-1/TEC-321203/ICD10-PostImplementation-Challenges
Doctors are still dictating
What My Contacts Say
“It’s a mess. No one is learning new codes, and we should not hold the physician responsible for coding.” – ICD-10 Consultant in GA “IT has done their job. However, physicians are still providing the same specificity as in the 80s when they dictate. They need a solution to extract the ICD-10 specific information from their head in a method that makes sense from a clinical standpoint rather than from a coding standpoint.” “Accuracy rates with ICD-9 were 92% and declined to 83% accuracy in CAC coding errors with the ICD-10 code set.” - Hospital Administrator from OK
“Hospitals are having less trouble with ICD-10 CM than with ICD-10 PCS.” “We’re over budget on transcription.” – Clinical Informatics Director in TN
How well is it going for you?
Are you still hiring coders? Have queries increased? Are your physicians aligned with your hospital? Are you experiencing delays in billing? Concerned about coder productivity? Is the current state sustainable? Is your CAC handling it for you?
Root of the problem: Physician Documentation
What was/is your plan?
CDI Programs
Computer Assisted Coding Tools
Physician Training
Scribe Use
Speech Recognition
Leverage only EMR
Have these worked?
If your plan is to just use…
Recommendations
Recommendations from Experts
Monitor Results: Top 10 Metrics to Monitor in First 30 Days http://journal.ahima.org/2015/09/22/top-ten-metrics-to-monitor-in-the-first-30-days-of-icd-10/
Get an unbiased review – Use auditors, consultants, or anyone who can give unbiased feedback if necessary.
Don’t get complacent – Calm before the storm?
Stay close to your medical staff.
My Recommendation: Address ICD-10 at the Point of Care
Dictation and EMR is not Enough
Help your physicians help you at the point of care.
A Virtual Assistant can… § Learn individual physician behavior § Dynamically anticipate what information is required § Alert physician when specificity is needed § Preserve physicians’ personal context § Save physicians’ time when documenting § Credit physicians/hospitals for treating sicker patients
Traditional Back End Solution
Dictation/Transcription EMR Coding Billing Payor
26% Query Rate
Clarification
26% of All Surgical Cases Delayed 3-30 Days
Value of a Single Pass: Front End Solution
EMR Coding Billing Payor
Moving Forward
Avoid these Pitfalls
Valuing integration over results
Assuming physicians will retain ICD-10 training
Relying on backend fixes
Not focusing on sustainability and standardization
Not involving your physicians in the solution…
It’s all about the physician.
Questions?
