Magazine Article | January 30, 2014

Proactive Partnerships Key To ICD-10

Source: Health IT Outcomes

Compiled by Jennifer Dennard

According to practicing pediatrician Dr. Peter Masucci, a successful transition to ICD-10 requires physicians to be proactive and maintain a close relationship with their EHR vendor.

The transition from ICD-9 to the far more numerous ICD-10 code set has made its fair share of headlines since first announced by the CMS in 2008. While the CMS granted providers a one-year extension — moving the ICD-10 compliance date from Oct. 1, 2013 to Oct. 1, 2014 — providers still seem to be putting preparations at the bottom of their lengthy to-do lists. A CMS extension of Stage 2 Meaningful Use (MU) attestation deadlines into 2016 may help providers begin to focus more on making the switch, but time is quickly running out for those who have not yet given ICD-10 much attention.

Dr. Peter Masucci, a small private-practice pediatrician in Everett, MA, is likely in the minority when it comes to being ready for ICD-10. He attributes his preparedness to the proactive partnership he and his staff have formed with his EHR vendor. Dr. Masucci explains how the now-or-never situation many of his less-prepared colleagues find themselves in will likely lead them to seek new EHR solutions once the ICD-10 switch is flipped this October.

Q: Where is your practice with MU, and how has that impacted your ability to prepare for ICD-10?

A: ICD-10 was the furthest thing from my mind when we implemented our athenahealth EHR solution in 2006. We’re now in the process of finishing the second half of Stage 2. Back in 2006, I certainly had no way of knowing all of this was coming, though I do pat myself on the back now for going electronic so early on. My main impetus at that time was the need for a cloud-based system. I didn’t want to stay on our very old DOS dial-up PM system, because it was just too inflexible and required updating every seven years to the tune of $30,000.

Meeting MU deadlines and preparing for ICD-10 has not been an issue for us because of athenahealth’s preparedness and overall commitment to both projects. I’m not as scared as I probably should be, because of athenahealth’s support. They’ve already converted our EHR to SNOMED (Systematized Nomenclature of Medicine), which apparently is half the battle when it comes to transitioning from ICD-9 to ICD-10. SNOMED hopefully will become a common denominator and create some uniformity in medical diagnosing. Moving forward, when a patient presents with a heart attack, it’s not going to be written as a heart attack in one chart and a myocardial infarction in another. We’re all going to have the same SNOMED code for that diagnosis.

Histories have already been linked to ICD- 10 equivalents in my EHR order sets and quick picks. Our claims are obviously still going out with ICD-9 codes, but I now get a list of ICD-10 equivalents when I put those codes in. I’m confident we’re ready to switch over, but I’m not so sure my colleagues or their EHR vendors are as prepared.

“Doctors are really going to need to take some initiative when it comes to ICD-10. As with an EHR, you have to be proactive and invested in the technology.”

Q: Should providers now be focusing all of their attention on ICD-10, given that the deadline is just eight months away and Stage 2 deadlines have been extended?

A: They should be giving it a lot more attention than they probably are, that’s for sure. Doctors are funny people. Many still don’t want to make the switch to an EHR, let alone start preparing for ICD-10. Those who have decided to tackle MU first have likely done so because it’s been incentivized, whereas ICD-10 isn’t. Either one of those projects by itself would be enough to take up a good deal of time and effort. Dealing with them at the same time is going to be tough for people who aren’t ready or who may be on older EHRs that just aren’t able to accommodate what needs to be done.

Doctors are really going to need to take some initiative when it comes to ICD-10. As with an EHR, you have to be proactive and invested in the technology, which is why so many providers aren’t happy with their systems. They think all they need to do is open a box and flip a switch to make things run smoothly, and that’s just not the case. You’ve got to do a little homework to get these types of systems optimized for your needs. We’re used to sitting around and having things done for us. Providers are going to have to start rolling up their sleeves again.

Q: How do you think the ICD-10 transition will affect providers’ cash flow?

A: We’re going to find ourselves in a very tricky situation when it comes to cash flow. Initially, we’ll likely see a lot of denied claims coming back six weeks later because some business partners won’t have made the switch. Even if we do everything correctly and are 100 percent ready to go, we don’t know about the hospitals, insurance companies, or the labs. We have no control over what they are doing and whether they are going to be ready. The insurance companies especially worry me. They’re notorious for coming up with any excuse to not make a payment. It’s frustrating to realize that no matter how prepared your vendor and your staff are, you can’t control how prepared everyone else is.

Eventually, we’ll see an uptick in cash flow because we’ll be getting paid more appropriately. That’s not to be confused with getting paid more for a procedure. I don’t think we’re going to get paid any more because of the new codes, but their level of specificity will be a big improvement to patient care. While I’m not looking forward to digging through 300 codes before I can click on one, I do think this higher level of specificity will give you a better idea of what the visit was for and how it was diagnosed and treated. That part will be very beneficial.

Q: What best practices can you recommend to other providers who may be just starting to prepare for ICD-10?

A: Be proactive. Go ahead and start reading up on SNOMED, and take advantage of ICD-10-related webinars or literature put out by your local medical societies. Get your anatomy books back out as well. The high level of anatomical specificity has been emphasized in everything I’ve studied about ICD-10 so far.

As I mentioned before, be prepared to deal with business partners that aren’t as prepared as you are. A good relationship with your EHR vendor will be a must during this time of transition. Talk with them about how they can help ensure your cash flow doesn’t take a big hit because of outstanding claims related to unprepared business partners. athenahealth has promised our practice a cash advance against outstanding claims if we meet certain criteria.

If you don’t have a great relationship with your EHR vendor, now may be the time to consider switching. I have a feeling we’re going to see a lot of providers move to new systems in 2014. There are some hospitals out there that will begin to realize their first- or second-generation EHRs are not going to cut it anymore. They were probably good at the time of purchase, because all they needed to do was document the visit. But with ICD-10, the EHR has to do so much more, and those generations of EHRs are just incapable of doing what needs to be done. It’s going to be a tough year for some EHR vendors. There’s no question that the switch to ICD-10 will be challenging for everybody.