keeping icd-10 relevant amidst change -...
TRANSCRIPT
Keeping ICD-10 Relevant
Amidst ChangeRVHIMA – April 10, 2015
John Stearman, RHIA, MS
Ellen Arnold, RHIA
John Overview
Why do I care?
How Congress works
How a federal bill becomes law
How ICD10 was derailed last year
How everyone can be involved in the process
Keeping an eye on Congress
Influencing your leaders
Why do I care?
ICD-9 is a 1974 Ford Pinto in a Ferrari world
We as individuals and collectively as HIM professionals can influence the
process.
Time, money, effort, and – most importantly - our sanity is at risk.
How a federal bill becomes lawaka Welcome back to high school civics
Creating bills is the job of the House of Representatives
Once the bill passes the House it then goes to the Senate
If the bill passes the Senate, it then goes to the president for signature
If all the above happens successfully the bill becomes law
http://kids.clerk.house.gov/grade-school/lesson.html?intID=17
Throwing a Wrench in the Process
Vetoes
Over-riding a veto
Presidential pocket veto
Riders
How ICD-10 got derailed last time
H.R. 4302 Protecting Access to Medicare Act of 2014
The ICD10 part was a rider – passed the Senate
03/31/2014 and was signed into law by the president
the next day
Throwing a Wrench in the Process -continued
There was speculation killing ICD-10 would be
tacked onto the spending bill to keep the Federal
government moving in December 2014 – it did not
The bill left the House and was confirmed by the
Senate
Influencing the Process
All of us have the right / obligation to influence bills
How?
VOTE!
Contact your Representatives
John Yarmuth
Contact your Senator
Mitch McConnell – Senate Majority Leader
Rand Paul – running for President
Phone calls, emails, snail-mail letters
Influencing the Process - continued
Lobbyists
Party Politics
Mailing lists
For example, Meaningful Use Stage 3
Proposed rule is announced – comment period
The Federal Register
If we don’t make ourselves heard
we get what we get!
Useful Websites Who is my Congressman?
http://www.contactingthecongress.org/
What is going on with a bill?
https://www.govtrack.us/
The Federal Register
https://www.federalregister.gov/
WEDI ICD-10 Readiness Survey Results
WEDI ICD-10 Readiness Survey conducted in February 2015
1,174 participants
Healthcare providers
Vendors
Health Plans
Conclusions
ICD-10 readiness is not what it should be
Healthcare organizations were wary to put resources into ICD-10 preparation
There are concerns that the ICD-10 deadline would be delayed again
Although the latest delay was meant to give more time to prepare for ICD-10
implementation not enough healthcare organizations took advantage of the time
WEDI ICD-10 Readiness Survey Results
Healthcare Providers
•1/3 of healthcare providers report completion of ICD-10 impact assessments
•Hospital systems were ahead of physicians by a margin of 3 to 1
•50% of hospitals report external testing has started
•10% of physician practices report external testing has started
•25% plan to start external testing in second or third quarter of 2015
Vendors
•All have started product development
•Only 60% were ready and available for testing
•This is down from the same survey conducted in August, 2014
Health Plans
•Progress on finishing their impact assessments
•50% report external testing has begun
•25% plan to test with most of their healthcare providers
•60% plan to just test with a sample of healthcare providers
•10% plan to test with just clearinghouses
Priorities
Planning
Testing and resources needs
Dual Coding plan
Payer testing
Coder review and training
Education and communication
System remediation and testing
Post Implementation and follow up
Coder Education
Coder retention of ICD-10 knowledge
Evaluate current coder knowledge and capabilities
Coders trained to meet the previous 10/1/2014 ICD-10
deadline may have forgotten much of what they
learned
Keep coders engaged with ICD-10 as much as
possible
Refresher courses (online, instructor led)
Boot camps
Dual coding
Coder Education
Dual coding strategy
Ongoing practice and feedback is essential
If unable to implement dual coding other avenues for practice must be explored
Metrics gathered during the dual coding process have multiple benefits
An estimate of the amount of productivity loss from the ICD-10 implementation
An estimate of the areas of concern with regard to clinical documentation
An estimate of potential revenue loss
DRG Shift – gains and losses
Productivity loss = increase in AR days
Coder Education
Dual coding strategy – questions to answer
What is the impact that a diagnosis like hypertension will
have on DRGs and CMI after 10/1/2015?
Which medical records are un-codable in ICD-10 today
without some form of query or other intervention?
How are common CCs and MCCs that were applied in ICD-9
not applicable in ICD-10 causing a DRG shift?
How many coders and CDI specialists will be needed to deal
with increased numbers of queries, concurrent or
retrospective, for ICD-10 documentation issues?
Will CMI go up, down, or remain the same when ICD-10 is
implemented?
Coder Education
Dual coding strategy
What approach works best for your
organization?
Create a workflow diagram of how the
process will work
What are your feedback mechanisms?
Communication is key
Regular meetings for coders to discuss
issues
Coding staff will need to be supplemented
Physician/Provider Education
ICD-10 is really a clinical documentation improvement initiative
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
Resistance from physicians makes progress in the ICD-10
implementation slow and painful
Physician/Provider Education
Why are physicians so resistant?
Healthcare industry interest groups have generated mixed messages about
the value of ICD-10—if its so important why all the delays?
Physicians aren’t convinced that ICD-10 offers any value in making
improvements to treating patients
Physicians seem to hear only a narrowly focused message about coding
Its just for billing
Physician/Provider Education
How do we manage this change?
Strong executive support is essential
Identify a committed, influential physician who will enthusiastically help
sponsor the ICD-10 conversion effort
Consider how to make ICD-10 assistance part of a larger physician
engagement strategy
Offer physician education – online, peer-to-peer/elbow-to-elbow, specialty specific
Work with office staff and educate them as well
Incorporate ICD-10 into the clinical documentation improvement (CDI)
process
Focus on the pros and outlaw the cons
Physician/Provider Education
Greater documentation specificity
requirements
Communicate and direct providers to
education venues
Provide tools to make the transitions
Extensive online education programs that offer
CMEs
Documentation tip sheets/tent cards
Laminated pocket cards
Communicate new specificity required for top
diagnoses and procedures
Offer specialty specific education tracks
Physician/Provider Education
Best avenues of communication?
Tap into existing meetings
Physician leadership meetings
Standing department meetings
Online through existing physician communication avenues
CDI Queries
Coder Queries
Physician/Provider Education
Some things to keep in mind
Physician productivity, just like coder productivity, will drop
Update documentation templates to support greater specificity
Physicians and other providers using an online tool to assign ICD-10 codes
may not be offered the “best” code in the top five to 10 codes that are
displayed
It takes time to look through potentially hundreds of codes to find the best fit
Order placement for ICD-10 compliant orders
Other Areas Where Education is
Necessary
Define the lifecycle of a diagnosis and/or
procedure code
Patient Access
Scheduling
Verification
Advance Beneficiary Notification
CDI Coordinators
EMR Team
Patient Financial Services
Testing Resources
Testing is a team effort
IT
Patient Access
E.M.R. Team
HIM/CDI
Patient Financial Services
Are Your Systems Really Ready?
An integrated test system must be in place so that all ICD-10 affected applications can be tested in tandem
All ICD-10 affected IT applications must be at “keystone” release
The release that will be supported by the vendor going forward (this is not necessarily the first ICD-10 compliant release)
Be sure that a current test set of ICD-10 codes has been loaded into each application’s test system
Be sure that application analysts are aware of the parameters that must be set up with correct dates for ICD-10 testing
Have a clear plan for identifying problems and retesting
Things to Keep in Mind During the
Transition Even if all your systems are tested and ready, it will take vendors
just as much time to release the regulatory changes for Fiscal Year 2016 as it does every year
General timeline - regulatory updates go out to customers in mid to late September
All updates must then be applied to all affected applications and retested
This rarely if ever happens by October 1st
Productivity in all areas will decrease so be prepared and staff up
AR days will increase
Bill to payment days will increase so be prepared
Insurance companies may say they’re ready for ICD-10 but a large number of them will be mapping your ICD-10 codes back to some version of ICD-9
According to CMS Conversion Project
Results Slightly more than 99% of the cases showed no change in MS-DRG when
coded in ICD-10
Of the 1% of the cases with MS-DRG shifts, 45% of those shifted to higher weight MS-DRGs and 55% shifted to lower weight MS-DRGs
The aggregate weight change of the 6 cases that shifted to higher weight MS-DRGs was 0.10% (one tenth of one percent or an approximate increase of 1/1000th of the ICD-9 reimbursement)
The aggregate weight change of the cases that shifted to lower weight MS-DRGs was -0.14% (an approximate reduction of 14/10,000th of the ICD-9 reimbursement)
The net weight change of all MS-DRG shifts in the analysis was -0.04% (4 one-hundredths of a percent, or an approximate reduction of 4/10,000th of the ICD-9 reimbursement)
This is equivalent to a loss of four pennies (.04) per $100 paid under ICD-9
That’s $99.96 to every $100.00 earned today
According to CMS Conversion Project Results
Top 10 DRG Shifts
1. MS-DRG 812, Red blood cell disorders w/o MCC - HIGHER
2. MS-DRG 981, Extensive O.R. procedure unrelated to principal diagnosis
w/MCC – LOWER
3. MS-DRG 391, Esophagitis, gastroent & misc digest disorders w MCC –
LOWER
4. MS-DRG 885, Psychoses – LOWER
5. MS-DRG 066, Intracranial hemorrhage or cerebral infarction w/o
CC/MCC – HIGHER
6. MS-DRG 191, Chronic obstructive pulmonary disease with CC – LOWER
7. MS-DRG 011, Tracheostomy for face, mouth and neck diagnoses with
MCC - HIGHER
8. MS-DRG 974, HIV with major related condition and MCC - LOWER
9. MS-DRG 292, Heart failure and shock with CC - LOWER
10. MS-DRG 037, Extracranial procedures with MCC - LOWER
Remember,
there is an
ICD-10
code for
nearly
everything
www.youtube.com/watch?v=hTq6gW31p3E
Remember,
there is an
ICD-10
code for
nearly
everything
ICD-10-CM FY2015 Version Draft Exposure to Paranormal Forces
X61.112 Fall Into Grave,
Vacated Likely by
ZombieSee Injury by Zombie (ZA0-ZA5) if
Zombie was encountered and
secondary injury occurred