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ICD-10 delay causes challenges for HIM professionals:

Moving forward during uncertain times

 By Mike Evans, RHIA, CCS, vice president of coding and compliance at In Record Time, Inc.

When the ICD-10 delay was announced in April, most HIM professionals cringed at the thought of having to spend yet another year in limbo preparing for the transition. Working with an extended timeline has posed variety of challenges that physicians, legislators, and others in favor of a delay had not likely considered. Following are some of the most striking ones that affect HIM professionals directly.

Expensive coder refresher training. Many organizations had begun to provide coder training in anticipation of the original October 1, 2013 deadline and subsequent October 1, 2014 deadlines. Not only must these organizations now provide ongoing refresher training, but they’ll also need to consider careful strategies to retain coders in whom they’ve invested significant training dollars. Personnel changes complicate matters. As coders come and go (e.g., as coders find new jobs elsewhere, take time off, or retire), it becomes more difficult to maintain a secure set of knowledge.

Increased overall costs. In 2012, CMS estimated that a one-year delay could cost the industry as much as $6.6 billion. This statistic was reiterated in a letter from the Coalition for ICD-10—a constituency of organizations across the healthcare spectrum—to CMS dated April 11, 2014. According to a February 2012 Edifecs survey of industry reaction to the potential delay of ICD-10, 49% of respondents estimated that every year of delay would increase their required budget by 11%-25%. Thirty-seven percent estimated an increase of 26%-50%. Increased costs can largely be attributed to the need for ongoing training as well as outsource coding assistance so internal coders can gain hands-on experience with ICD-10. The longer the industry works with both ICD-9 and ICD-10, the greater the impact on overall productivity and cost.

The need to regain executive buy-in. HIM professionals may unfortunately bear the brunt of CFO frustration with ongoing ICD-10 costs. When the most recent delay was announced, many CFOs made the decision to drastically reduce ICD-10 budgets or even cut them entirely. Now, HIM professionals must restart facility-wide momentum even in the midst of ongoing skepticism. HIM professionals must re-engage executive leaders and medical staff in the ICD-10 effort. This will not be an easy task during a time when initiatives such as Meaningful Use, EHR implementation, hospital acquisitions and mergers, and a variety of other changes are vying for physician attention and hospital resources.

The need to re-engage physicians. It was difficult to engage physicians before the delay was announced. Now, it’s even more difficult to convince them that ICD-10 will, in fact, go live on October 1, 2015. Engaging physicians is an expensive and time-consuming effort that often requires the identification of physician champions, detailed documentation auditing, and personalized physician education sessions. Many physicians may be particularly resistant to learning the nuances of ICD-10 because they are unconvinced of its importance. This creates ongoing challenges for HIM professionals who must find creative ways to obtain physician buy-in.

Fear of the unknown. Experts agree that coder productivity could decline as much as 50% in ICD-10. The specific decrease will depend on a coder’s experience and education as well as system integration. Coders have been coding with this fear for several years. Some coders have even retired out of fear. Managing workers in an environment in which uncertainty and fear remain high has been—and will continue to be—challenging.

 As organizations continue to uncover challenges resulting from the ICD-10 delay, it’s important to consider these tips:

 ·         Provide ongoing refresher training for coders. This should include training in anatomy, physiology, pathophysiology, and ICD-10 guidelines. Allow coders to dual code regularly as well as attend state and local coding chapter meetings where they can receive cost-effective training. Also explore other free and low-cost training options.

·         Talk openly with coders so you can understand their short- and long-term employment plans.

·         Open the lines of communication between HIM and the C-suite. Set realistic expectations for budgeting that will allow for flexibility while also ensuring enough dollars for ongoing training.

·         Re-examine coder responsibilities. As the industry moves closer to ICD-10, coders must focus specifically on coding. If their duties also include abstracting or release of information, for example, consider reassigning those responsibilities to other staff members. This will help mitigate productivity loss and give coders more time to practice ICD-10.

·         Identify physician champions who can assist with physician re-engagement.

·         Consider outsourcing some or all of your coding. Maintaining an internal coding department may not be a cost effective solution at the present time.

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