Get Your ICD-10 House In Order

By Ken Congdon

Behind on your ICD-10 planning? Don’t panic. Instead, take a look at how Palomar Health is preparing for the transition, and adopt similar principles in your facility.

As it stands now, things don’t look too promising for a smooth ICD-10 transition come October. Numerous studies and reports indicate a lack of preparedness for ICD-10 among healthcare providers. For example, an August 2013 QualiTest Group survey found that nearly 75 percent of providers are not ready for upcoming ICD-10 coding changes. Likewise, a December WEDI (Workgroup for Electronic Data Interchange) study concluded that only half of providers have completed an ICD-10 impact assessment. Even our own research indicates that 6 of 10 providers feel unprepared for the forthcoming ICD-10 transition.

While I can appreciate the scope of the undertaking (and even procrastination to a point), I find it frightening that so many providers are so woefully behind in their ICD-10 planning. It’s not as if this major coding change came as a surprise. To the contrary, the move has been in the works for years. The industry was even granted a deadline extension in August 2012 when HHS moved the ICD-10 transition date from October 1, 2013 to October 1, 2014. Even with everything that is on a healthcare provider’s plate these days (e.g. healthcare reform, Meaningful Use, etc.), I can’t see how ICD-10 isn’t the top priority given the impact it will have on provider cash flow. Then again, who am I to judge? I’m just a journalist. I’m not a healthcare professional in the trenches actually dealing with these challenges on a daily basis. But Ben Kanter, CMIO of Palomar Health, is. Unlike most providers, Kanter believes Palomar is adequately prepared for the upcoming ICD-10 transition, and he happens to share my sense of urgency regarding the initiative.

“MU has not had the disruptive impact on healthcare that ICD-10 will have. Providers need to realize this before it’s too late.” Ben Kanter, CMIO, Palomar Health

“So much of the healthcare industry seems to be disproportionately focused on Meaningful Use, which is simply designed to instill universal processes around EHR use,” says Kanter. “MU has not had the disruptive impact on healthcare that ICD-10 will have. Providers need to realize this before it’s too late.”

The good news is it’s not too late. There are a little more than eight months before ICD-10 deadline hits. If you’re a provider behind on your ICD-10 planning, perhaps you can take a page or two out of Palomar’s playbook to get your transition efforts on track.

ICD-10 Is Not Just For Coders

For Kanter, ICD-10 preparedness starts with getting the right people involved throughout the organization. And, contrary to what many believe, this includes more than just coders and administrators.

“There is a large chunk of ICD-10 that should not be owned by administration, coding, and/or finance,” he says. “For example, the medical staff needs to take ownership of the clinical documentation process. If they do not, you run the risk of not gaining the clinician buy-in necessary for success, and problems will ultimately result.”

For this reason, Palomar has formed a multi-disciplinary ICD-10 leadership team that includes not only coding and financial personnel, but physician and nursing leaders as well. The team also includes senior executives that have the authority to make quick organizational and financial decisions to support the ICD-10 conversion.

Staffing, Testing & Training Win The Day

The right team is an indispensable first step, but ultimately, proper staffing, testing, and training is necessary for ICD-10 success. Providers need to ensure they have enough coders on staff schooled on the new code set. While Palomar plans to meet these staffing needs internally, others may opt to hire outsourced temporary labor for the months prior to and immediately following the transition. Additional labor will be necessary because several hospital systems will need to be tested to ensure they are ICD-10 ready, and periods of dual coding may be required prior to the actual conversion date. Furthermore, it will likely take some time for coders to get comfortable with the new code set. Individual coder productivity will undoubtedly dip as a result, and additional coding labor will be necessary to maintain the status quo. You’ll want to work as soon as possible to secure this support because it will be at a premium come Q3 2014.

From a training perspective, special attention should be given to preparing your medical staff. “We’re taking a just-in-time approach to medical staff training at Palomar,” says Katner. “We want a minimum of six months to get our clinical staff accustomed to preparing the right kind of documentation to support ICD-10. We’ll likely start this process sometime in March.”

Adopt A Financial Mitigation Strategy

Like many providers, one of Palomar’s biggest concerns surrounding ICD-10 is the cash flow problems that are likely to result from the conversion. “Based on the talks I have been exposed to and what experts in the field have estimated, we are anticipating a significant drop in cash on hand in the months following the ICD-10 transition,” says Kanter. “The question is: what can we do ahead of time to build up reserves?”

In response, Palomar is putting a mitigation plan in place to proactively address the financial strain the provider will likely face beginning in October. This process involves assessing the financial risks at play and identifying opportunities to drive revenue between now and the ICD-10 deadline. Palomar’s strategy is to create a stockpile of cash on hand that it can quickly access to keep its operations flowing as normal, even if incoming revenue is impeded for an extended period of time.

IT & ICD-10 Go Hand-In-Hand

Information technology is also playing a key role in Palomar’s ICD-10 efforts. “Technology will be instrumental to our ICD-10 success,” he says. “Since we won’t be hiring an army of people to support our medical staff, we need to have the right IT tools in place to automate certain processes and streamline workflows. Likewise, the efficiency of our coders probably won’t get back to ICD-9 levels without an investment in computer-aided coding solutions.”

Most of Palomar’s ICD-10-related IT efforts are focused on integrating coding productivity tools with the provider’s Cerner EHR. For example, the provider is integrating natural language processing technology from Nuance and J.A. Thomas & Associates with Cerner to analyze the quality of clinical documentation in near real-time, and provide immediate feedback and assistance in line with ICD-10 protocols. Palomar is also implementing a suite of solutions from Intelligent Medical Objects (IMO) geared to assist medical staff analyze patient problem and diagnosis lists. The IMO tools will also help medical staff select ICD-10-compliant coding, ensuring providers use ICD-10 where appropriate and SNOMED where appropriate.

“Without these technology tools embedded in our EHR, the manual labor required to pull off the ICD-10 conversion would simply be too much for our medical staff to handle,” says Katner. “The volume of post-discharge coding inquiries alone would be overwhelming. Technology helps to level the playing field. It gives us the support we need to cope with an event as disruptive as ICD-10.”