Electronic Health Reporter

Guest post by Mark Jahn, vice president, healthcare practice, Atrilogy Solutions Group. 

Will your healthcare organization be ready for the Oct. 1, 2014, ICD-10 implementation date, as mandated by the Department of Health & Human Services? By now, most organizations should be in the middle of their ICD-10 implementation, or at least nearing the end of their assessment and planning.

Based on my ICD-10 industry knowledge, here are aspects of implementation your organization can expect to experience.

Where is my ICD-10 budget?

Many organizations will struggle to gain the right level of budget to make the ICD-10 transition successful. Most will likely have one budget cycle remaining, at most, before the ICD-10 go-live date. You’ll likely have to compete with other initiatives to secure funding.

However, what many organizations fail to realize is that 100 percent of their patient-related revenues are at risk if ICD-10 is not properly implemented and its risks mitigated. As a result, most organizations will not have budgeted enough for ICD-10 and did not allocate enough contingency to account for the unknowns of implementation.

When considering your ICD-10 budget, make sure you account for:

• systems upgrades
• replacements for non-compliant systems
• additional computer capacity to perform and test upgrades
• additional staff needed during the transition from ICD-9 to ICD-10, to account for loss of productivity
• staff training costs
• ICD-10 conference attendance costs (e.g. AHIMA, Wedi, etc.)
• 25 percent to 40 percent more coders because of the added coding complexity of ICD-10
• sufficient cash reserves (at least 25 percent of revenues for at least six months) for the time when your cash flow is impacted by ICD-10 implementation
• new computer assisted coding technologies
• program/project management

Allocate at least 25 percent contingency when budgeting for the ICD-10 implementation. While we can take some budget lessons from organizations in nations that have successfully implemented ICD-10, such as in Canada, the reality in the United States is that with a health system as vast and complex as ours, there are just too many unknowns, the implementation process is still too new and best practices are still evolving – all factors that account for the unpredictability of ICD-10 implementation. In some ways, it’s like embarking on a trans-ocean voyage with a clear destination in mind, but little advance notice of what you might encounter at sea.

What metrics and measurements are you using to prioritize and direct ICD-10 initiatives?

Many organizations are realizing they need to complete a financial impact analysis to assess the financial impact of ICD-10 on their reimbursements, mainly because of DRG shifting. The financial impact should be re-measured at strategic time points during implementation (we recommend at least every six months) and then in three-month intervals after the ICD-10 go-live date. Financial impact results provide key metrics and are analogous to metrics required to fly a plane. What measurements have you have taken to assess the areas of highest risk to your ICD-10 implementation?

Have you begun thinking about staff training yet?

Because of the uniqueness of ICD-10, you will likely need to outsource at least part of your ICD-10 training to an external organization and/or purchase ICD-10 training solutions. Your coders will need to start earlier than other roles in your hospital, learning anatomy and physiology first (to comply with these key requirements in ICD-10), and then moving to more advanced ICD-10 training topics, specific to their assigned areas. Physicians also will need to be trained; there are several technology-based training solutions enabling physicians to learn on their smartphones and other mobile devices in small snippets of time, as opposed to being required to sit through multi-hour presentations. All departments impacted by ICD-10 will need some level of ICD-10 training and education.

Are your physicians ready?

Physicians are critical to getting ICD-10 properly implemented. Getting them onboard will be a critical success factor. Initially, there will likely be significant resistance to the change from physicians.

Physicians will need to document with more specificity then ever before. Industry metrics indicate that physicians will spend 4 percent of their time – or 45 seconds more time, on average, per case – documenting cases under ICD-10, versus 3 percent  of their time under ICD-9. These metrics may not appear to be significant, but they represent a 33 percent increase in the time required for physicians to document cases. However, when physicians are reimbursed based only on the number of patients they see, and the exactness of the ICD-10 codes that ultimately are coded, then physicians will pay greater attention to and get more involved in the ICD-10 effort.

Be sure you have physician representation on your ICD-10 steering committee and consider using a physician liaison to work between HIM and other physicians. Launch your clinical documentation improvement (CDI) program as soon as possible, since it will take time and practice to implement CDI appropriately, and to get physicians to document correctly. If you have already have a CDI program, make sure your program covers your ICD-10 needs. At key milestones in CDI implementation, the medical records will need to be audited to see if the CDI program meets your ICD-10 implementation needs.

Have you allotted time for testing?

How your organization effectively tests all of the changes to ICD-10 will be critical. This includes changes to clinical documentation, business and clinical processes, systems, interfaces with business partners, and more.

Our estimates suggest that testing could represent 40 percent of the overall ICD-10 implementation effort. Few organizations are prepared and have the experience for performing an end-to-end test of their revenue cycle management processes and systems. Identifying and creating the necessary ICD-10 test data could become a major effort by itself. Does your IT department have the computer capacity to replicate your current IT environment to perform an adequate end to end test? Consider participating in the HIMSS/Wedi ICD-10 National Pilot Program for ICD-10 testing to leverage their test data, results and testing processes.

Are you prepared to take action?

There are many other aspects to successful ICD-10 implementation that you will need to consider as well, including streamlining your business processes, deciding coding standards and practices specific to ICD-10, implementing new revenue cycle management analytics and other solutions. Also, don’t overlook ICD-10 awareness as part of your ICD-10 training plan – keep abreast of industry trends, industry announcements and updates, survey results and best practices, in order to improve and adjust your ICD-10 program.

To gauge your organization’s ICD-10 progress, relative to recommended guidelines, check the online resource from the Centers for Medicare and Medicaid Services – click the link here. It helpfully provides a variety of ICD-10 timelines and checklists, depending on organization type and size. Another useful online resource is the HIMSS ICD-10 Playbook, a compendium of information to help health care providers successfully transition to ICD-10.

Three hundred years ago, British essayist Joseph Addison coined the famous saying, “He who hesitates is lost.” He also advised that “swift and resolute action leads to success.”

The actions you take (or don’t take) over the next year-plus will likely spell the difference between your ICD-10 success or failure. Although go-live planning is likely still several months away for your organization, start to visualize now how your ICD-10 go-live will work, what major steps will be performed, and who will be involved. Having this end state in mind will help your ICD-10 implementation be more successful.

Mark Jahn is the vice president – healthcare practice at Atrilogy Solutions Group, based in Irvine, Calif. He was instrumental in forming and managing the Minnesota ICD-10 Collaborative from 2010 through 2011. In 2012, Jahn assisted the California ICD-10 Collaborative in building ICD-10 Collaborative awareness and helped facilitate the development of the California ICD-10 Collaborative operating model. He has been a speaker at a HIMSS conferences and webinars on various ICD-10 topics and has been quoted in professional journals and in blogs on ICD-10 topics. He is currently one of the work group co-leaders of the HIMSS/Wedi National Pilot Program.