Though ICD-10 is upon us and there is little, if anything, that can be done at this point other than wringing your hands in disbelief or praying for peace with the patience of a saint (depending on your religious worldview and personality), we wait for the storm to hit, then pass and roll on a bit for a time. And it will pass. The storm will dissipate.
For some reason, when I think of the current state of ICD-10 and its impact to healthcare I’m reminded of a hurricane. The analogy of a hurricane seems like an apt example of the phase healthcare currently is in in regard to ICD-10.
The road here has been long – there has been much fear and anticipation of the coming storm. Surges of energy, wind and waves have met us and battled at the banks of the beach. The wind and thunder has been loud, the elements seem to have shaken the very foundation of our lives and our “homes.” Pain, fear, struggle and stress have been the order of the day. But at last we’re here. The storm is upon us, in fact it is half over, and we stand in its eye, one of the most beautiful and peaceful times one can ever experience.
Peace, calm expectation and a subtle excitement of the storm’s beauty are in the eye, as is anxiety of the anticipation of what’s to come — the second half of the storm. Having personally stood in the eye of one of the largest hurricanes on US record, and having survived one of the most terrifying storms of my life, I can tell you that the eye of the storm is a brilliant, calm and peaceful place in what is actually an extremely deadly and dangerous place to be.
However, when the eye passes, the storm rages again, even more fierce than the penetrating force of the first half of the storm. Again, there’s more fear; more stress; more panic. Finally, the storm passes, slowly and subtly. The wind disappears, the sun breaks free and among the chaos, birds sing with striking clarify and beauty. It’s as if their songs are the only remaining sound because the storm has sucked all else away. Their song is an encouragement as you assess your losses and determine the first steps required to put your life back together.
Certainly, ICD-10 is not deadly, nor is it as dramatic as surviving a killer storm, but the process has been stressful, and painful and chaotic for millions. We’re in the eye, half way between beginning and end. Much has happened, but there is still a great deal more to come. I image that’s how many of you are feeling today; trying to ride out the storm — in peace, in fear or maybe a combination of the two. So, on this occasion, as we wait, I thought I’d provide a few final thoughts about ICD-10 from those working alongside you, in the trenches, who are also weathering the storm. Hopefully these insights provide you some peace, and help you get through this stressful time.
With the transition to ICD-10, we expect three types of industry disruption occurring at different times. First, starting in the first few days after the Oct. 1, 2015 cutover, when providers start transmitting claims containing ICD-10 codes (between 10/3 and 10/10), we predict that providers that chose to ignore the ICD-10 mandate will receive a monumental wake-up call when clearinghouses and payers immediately reject their ICD-9 coded claims as non-clean HIPAA transactions. We believe that most of the nonconformists will be smaller, rural professional providers and small practices. They will scramble to get ready in short order if they wish to be paid for their services.
Second, by mid- to late-October, providers will start receiving payments based on claims submitted using ICD-10 codes. Most professional claims are reimbursed based on the CPT/HCPCS codes and therefore are not susceptible to payment shifts. Institutional claims are paid via a wide range of reimbursement mechanisms, mainly due to combinations of both ICD-10 diagnosis as well as procedure codes. ICD-10 testing between providers and payers illustrates that four out of five payment disputes are because of poor coding accuracy from the provider. We see an increase in phone calls to payers and an elongated revenue cycle collection timeframe.
Third, throughout 2016, we see overall data quality issues emerging as the industry stabilizes and acclimates to the new code set. Although CMS relaxed coding accuracy requirements for Medicare fee for service claims, commercial payers have not followed suit. Be prepared for an increase in chart reviews and ongoing adjustments to previously paid claims.
Coastal Orthopedics has been serving the coastal South Carolina region for more than 30 years, and has helped countless members of our community regain and maintain a full quality of life. In those years of serving our community, ICD-10 has without a doubt been one of the biggest challenges that our practice has faced to date. With major overhauls to our practice workflow and ultimately our ability to provide the best care to our patients on the horizon, we set out early to meet the demands of the ICD-10 transition proactively.
The success of our transition to ICD-10 has been two-fold. One: our software partners (SRS Soft EHR and Allscripts Practice Management) have continued to deliver exceptional tools that have allowed our practice to leverage the power of healthcare information technology to expand our ability to provide exceptional care exponentially. Two: The dedicated staff and physicians of our practice, who truly love getting to be a part of helping our patients live their best life, have invested countless hours of preparation into being sure that our patients continue to receive only the best care. After months of updating our office systems/processes, working with care partners across the community, working with our software partners to fine tune our systems, and working with insurance companies to ensure that our patients get the most of their benefits, we’re ready to take ICD-10 head-on.
October 1st will be just another day of providing exceptional orthopedic care to our community for Coastal Orthopedics.
The day before, the day of and the day after ICD-10 goes live, it will be too late. But, as we get closer to ICD-10 go live, there are some final preparations that you can do before it does, and some remediation that can be done post go live. Physician practices and hospitals can focus on the procedures and visit types that drive their practices. We call this focus, the Codes that Matter. A very small percentage of procedures and visit types drive 95 percent of revenue so focus on those key areas to protect your revenue.
In addition, the physicians and hospitals need to take a snap shot of financial and revenue cycle performance prior to going live. This is especially critical at this point. The hospitals and physician practices have to know where they are today so they can effectively evaluate their financial and revenue cycle performance post go live. Financial “fire drills” need to be conducted to practice and prepare for revenue cycle impacts. How to prevent 10 percent to 15 percent revenue hits? If we see those issues arising, how do we quickly address and how do we rapidly deploy teams to close the issues. Waiting until the day before, similar to cramming for the test will not work well for the October go-live. There are a couple of things listed above that can still make a difference so the time is now before the die is cast.
Michele Hibbert-Iacobacci, CMCO,CCS-P, vice president of information management support, Mitchell International.
Michele Hibbert-Iacobacci
With the October 1 implementation date for ICD-10 just around the corner, many providers are in need of a quick, at-a-glance refresher to their training. The implementation of ICD-10 has been delayed twice, so many providers that had solid plans for training in advance are not as prepared as they had intended to be.
Quick reference guides are in even higher demand considering the influx of codes required by ICD-10. Currently, ICD-9 includes 13,800 three to five digit, primarily numeric diagnostic codes. By contrast, the ICD-10 code set will contain roughly five times that number, totaling approximately 69,000 three to seven digit, alphanumeric codes.
To alleviate the last minute training scramble, ICD-10-focused readiness material and courses from widely accepted and well-known organizations may help ensure a smooth transition come October 1.
American Association of Professional Coders (AAPC) have go-at-your-own pace online courses for both ICD-10-CM and PCS.
Are you ready to transition to ICD-10? The countdown is on. As those of us in healthcare know, next week the industry in the United States will (finally) undergo a significant change as we transition from ICD-9 to ICD-10. ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems and is used primarily to document diagnoses in a codified manner. The most recent revision has nearly five times more codes than its predecessor because of its increased complexity and specificity of ICD-10 codes.
Healthcare organizations in the U.S. have been preparing for the ICD-10 transition for nearly five years. Multiple delays, brought on by substantial lobbying efforts against the transition, led to elongated wait time, but the time has come and we’re ready to launch. Personally, I’m glad. I look forward to healthcare moving beyond this conversation; the infighting ICD-10 has caused among members and associations in the community has done us all a disservice. Perhaps, on October 2, the day after the implementation deadline, we can begin to move on to other issues — slowly, of course — so that the brilliant minds in healthcare can once again focus on more pressing, important issues than the dollars and cents of claims and the numbers needed for them to be paid by our payer partners.
As the transition date draws near, make sure you’ve got all your priorities and details in line. ICD-10 is no lightweight matter, as you have likely discovered. Cerner created the following video, “10 Things You Should Know to Get Ready for ICD-10,” that I’m posting here, with the company’s permission. Though my publishing it is a bit last minute, the video offers some tips that might help you prepare for “doomsday.”
This video reviews what Cerner considers the top 10 things you need to do to prepare for ICD-10; it also covers technical pieces related to Cerner’s Millennium solutions, as well as operational pieces to help with the transition. Overall, it’s a nice resource that may provide you a bit of last minute ICD-10 insight and comfort for the change again. Here’s to your ICD-10 health. Enjoy!
Guest post by David Thompson, senior director, product management, LightCyber.
David Thompson
A targeted data breach is one of the most vexing problems facing healthcare organizations today. Just in the first three months of 2015 alone, 99 million patient healthcare records were compromised—that’s about one-third of the entire U.S. population, and those are just the ones we know about. According to some sources, 90 percent of healthcare organizations have already been breached, but we aren’t sure which ones.
The cybercriminals behind a targeted data breach do not want to be exposed—and make no mistake, these breaches are run by people, not autonomous software. Unlike the hackers of earlier days, these operatives want to stay hidden and conduct their work in secret. Even if they have successfully completed their initial goals—let’s say exfiltrate patient medical records—a cybercriminal team will likely want to stay undiscovered to continue to steal more data as it is collected, or leverage this access to break into another company. Often this will involve commandeering valid credentials from the first organization to gain access to another, perhaps a partner healthcare organization, an insurance company, an independent lab or some other entity.
The simple truth is that most healthcare organizations lack the means to detect an active data breach. First, let me define a data breach, since there is so much confusion over the term. A breach is the entire process—from initial network penetration through data exfiltration— cybercriminals go through to achieve their goals.
Often a breach is perceived as only the initial penetration into the network or infection of a machine. This one act is over in an instant, but it is the focus of considerable security resources. In other words, a large proportion of security resources are devoted to preventing single step in the breach process that lasts less than a minute, but is only the first step toward a goal.
Also, initial penetration is not as easy to spot and block as you might guess. Since the way into the network may be accomplished through the use of valid credentials acquired through social engineering or clever spear phishing, detecting the intrusion can be difficult. Effective prevention of intrusions is based on use of statically defined descriptions of software code or behavior (signatures and hashes), so it is successful mainly when known malware is used to conduct a breach. So, preventing an intrusion has a marginal success rate, but it is often seen as the last change an organization has in defeating a targeted breach.
Once an attacker is inside the network, most organizations lack the ability to find them. At the same time, an attacker is inherently at a disadvantage, having landed inside an unfamiliar network. This disadvantage is quickly dissipated since they can often go completely undetected for weeks, months or even longer. The industry average dwell time is around six months, plenty of time for an attacker to explore a network and get at assets.
Why is it that organizations are seemingly powerless to find an active data breach once an intruder has penetrated a network? There are four main reasons.
Guest post by Brett Meyers, senior business analyst and ECM product lead, The Gordon Flesch Company.
In the wake of the recent Ashley Madison hacking scandal, cyber breaches have become a hot-button issue. Poking fun at high-profile people caught in the midst of a scandal has nearly become a national pastime in recent years, but the hack itself is no laughing matter. After all, just six months ago, a data breach at Anthem, Inc. revealed as many as 80 million records had been exposed during what the company characterized as a “very sophisticated external cyber attack.” Certainly, no one was laughing then – not the millions of people whose birth dates, Social Security numbers, addresses and income information were exposed — and certainly not Anthem, which now faces dozens of class action lawsuits. The costs may include millions of dollars in damages and a major hit to the insurance company’s brand and reputation.
One lesson these two very different breaches brought home is that businesses of every type and size are vulnerable to cyber attacks and identity theft. If Anthem were the only health-related business to have been hacked, it would still be a disturbing event; but in fact, the U.S. Department of Health and Human Services maintains an entire website devoted to healthcare-related data breaches of 500 or more records. So far, there are more than 1,300 cases on file, with targets that include individual practices, university-based research facilities, public and private hospitals, and major insurance companies.
In 2012, the U.S. Department of Justice’s Bureau of Justice Statistics reported that 7 percent of the U.S. population 16 and older had been the victim of identity theft, and direct and indirect losses that year amounted to about $25 billion. That’s staggering. What’s even more alarming is that about one-third of those victims spent weeks or months trying to untangle the financial mess long after their information was stolen.
It’s easy to think the impact of identity theft is limited to financial implications, but the government report had one more startling bit of data revealing just how far-reaching the effects of a data breach can be on its victims. According to the data, “Victims who had personal information used to open a new account or for other fraudulent purposes were more likely than victims of existing account fraud to experience financial, credit and relationship problems and severe emotional distress.”
Healthchat is a communications platform that allows patients, physicians and medical staff to communicate and collaborate in a more efficient manner through the use of short videos sent through their mobile phones. This simple and secure application is available to physicians for a low monthly fee and free for patients and medical staff.
Elevator pitch
Healthchat is a HIPAA-compliant video-sharing app to connect healthcare providers and their patients – with speed and convenience.
Founders’ story
Chris Chowquan
Founder and CEO, Chris Chowquan, is an IT veteran, who has spent much of his career managing technology for healthcare payers. After many years of interfacing with physicians and patients he saw the need for a simpler, more efficient communications solution. Healthchat was founded in 2015.
Origin story
As a father and full-time employee who has to take time for doctor visits, he figured there must be a better way.
Marketing/promotion strategy
Healthchat’s sales team will be marketing to physicians directly. In addition, Healthchat will launch an integrated marketing campaign aimed at reaching all three groups who can benefit from this product: physicians, medical staff and patients.
Market opportunity
Despite mandates to improve the patient experience, accessing healthcare services remains highly inefficient. Healthchat addresses the problem – and stands alone as the only HIPAA-compliant, mobile-friendly communications platform for patients and their providers to connect about their healthcare.
Guest post by Terry Edwards, president and CEO, PerfectServe.
Terry Edwards
Each day, healthcare professionals need to communicate with colleagues, patients and others outside of their organization. These communications often contain critical information about dosage changes, requests for a consultation and other healthcare information that can have life-or-death consequences for patients.
From email and texting to calls and overhead pages, there are a dozen different ways healthcare professionals can communicate with one another. Many of these modes of communication are fairly new, and clinicians are still continuing to teach each other the rules of the road and associated etiquette.
But as healthcare transforms to be more focused on value-based care, it’s becoming even more important to get this right. To coordinate patient care across the patient’s entire journey within the health system, clinicians need to know how to reach each other in the best way. Although communication is an essential part of the job for clinicians, a recent survey of 955 healthcare professionals1 conducted online by Harris Poll and commissioned by PerfectServe, shows that clinicians aren’t always communicating in the way that they’d prefer.
Lessons learned:
Find a way to speak in person when possible: For complex or in-depth conversations within their organizations, healthcare professionals say they prefer to speak face-to-face (41 percent for physicians; 37 percent for non-physicians). This preference is particularly strong with nurses, with 55 percent of nurses surveyed saying their preferred method is face-to-face communication for complex or in-depth conversations with physician care team members. Speaking in person allows clinicians to focus on the conversation. Many of the clinicians I work with say taking time to speak in person gives them the opportunity to build a stronger rapport with their colleagues, which can make it easier to foster care coordination.
Think before picking up the phone: Phone calls are by far the most frequent form of communication with care team members outside their organization. More than half (55 percent) of clinicians say they most frequently use a phone call to connect with physician care team members outside of their organizations, and 48 percent most frequently use the phone to communicate with non-physician care team members outside of their organization. But while everyone is picking up the phone, only about a quarter of clinicians actually prefer phone calls for that kind of information sharing (29 percent for brief communications with physician care team members outside of their organization; 25 percent for outside non-physician members). In my work with clinicians, many say that the ring of the phone is an interruption to their work, and more than two-thirds (67 percent) of clinicians reported that they often receive pages or calls that are of low priority, which disrupts patient care.
Guest post by Will Hayles, technical writer and blogger, Outscale.
Will Hayles
Last year, 2014, was the year the wearables market really took off. No end of wearable technologies were released, each promising to hook users into the personal analytics and quantified self trends. Of course, many of those releases went nowhere, and even some of the big companies saw their wearable devices fizzle rather than pop — the obvious example being Google Glass, which received an unprecedented amount of attention, much of which was negative. But there were many successes, and later this year Apple will be entering the fray with the Apple Watch and its bundle of sensors.
Last year the wearables industry was worth around $2.8 billion. Over the next five years it’s expected be to worth more than $8.3 billion. But there is a market with the potential to dwarf the consumer fitness monitoring market, and that’s chronic illness management, which has, unfortunately, if understandably, seen far less attention from startups. As J.C. Herz notes in a Wired article on the subject, the entire market for fitness trackers is vastly outstripped by the size of the market for blood glucose test strips, which are an essential tool in the monitoring of diabetes.
Herz takes a harsh tone with an industry that has failed to focus research and development on solutions for people who stand to benefit the most, but I’m more optimistic. Healthcare outside of the fitness sphere is a difficult market, with a heavy — and necessary — regulatory burden and entrenched ideas about treatment and patient monitoring. Unity Stoakes, co-founder of StartUp Health, recognizes both the challenges and the potential for innovation that can significantly improve people’s lives:
“Unlike other industries, healthcare is plagued by regulation and longer product development timelines. Bringing successful products to market is challenging for both large industry players and digital health entrepreneurs. Startups need access to advisors, peers and dollars, while large companies need ‘batteries included’ entrepreneurs fueling innovation. The unprecedented level of change gripping the healthcare industry today presents both challenges and opportunities for both.”
There is recognition both within the healthcare industry and among technology companies that monitoring tools and other applications of wearable and mobile technology offer an opportunity to substantially change healthcare and the lives of people who suffer with chronic illnesses.
According to a recent study from the Health Research Industry, 42 percent of healthcare providers are comfortable relying on at-home test results for prescriptions. Sixty-six percent thought mobile solutions have the potential to help with the management of chronic diseases. And as we’ve discussed on this blog several times before, mobile technology and wearables are helping caregivers better collaborate and coordinate care.
