By Mike Evans, RHIA, CCS, vice president of coding and compliance at In Record Time, Inc.
Now that ICD-10 has been delayed until October 1, 2015, many organizations are left wondering how to make the most of this interim time. Our experience has been that as many as 50%-60% of hospitals slowed their ICD-10 efforts when the delay was announced. Although many organizations have chosen to put ICD-10 on a back burner for now, this isn’t necessarily the best solution, nor will it yield the most effective long-term results. Instead, HIM professionals—with the support of executive leadership—should devote as much time as possible to auditing, documentation improvement, and physician engagement.
Consider the following strategies:
1. Be transparent with physicians. Any major change can be scary and overwhelming, and the transition from ICD-9 to ICD-10 is no different. Even though they may not admit it, physicians could be among the most anxious about the new coding system because they know that their documentation will affect code assignment directly. Physicians may feel as though there simply aren’t enough minutes in the day to document some of the details required by ICD-10. To complicate matters, physicians face many other administrative challenges as well, such as Meaningful Use and quality reporting, both of which can affect their bottom line. Many of today’s physicians feel overburdened by a healthcare system in which third-party audits continue to mount, and additional regulatory requirements seem to grow annually.
The American Medical Association and various subspecialty organizations have voiced considerable opposition to ICD-10. Many physicians feel as though ICD-10 is being forced upon them rather than integrated into their daily workflow based upon their own input. This could be because many physicians weren’t involved in ICD-10 since the very beginning of its clinical modification for the United States. Although HIM professionals can’t rewrite history, they can talk openly with physicians, address their concerns, and most importantly, acknowledge their frustrations. Consider these tips:
· Keep physicians in the loop. Send regular communications to medical staff about ICD-10 developments and news. Physicians will appreciate the outreach.
· Focus on severity of illness (SOI). SOI has become incredibly important in terms of outcomes and data reporting. Every physician must understand how his or her documentation affects SOI scores because eventually, this information may affect one’s ability to participate with hospitals and insurers that will only want to contract with those who have the best quality outcomes. As Accountable Care Organizations continue to grow, only the best and brightest physicians will likely survive and thrive.
· Listen. Simply listening to a physician voice his or her frustration about documentation requirements may go a long way in terms of changing his or her behavior. Let physicians know that the HIM department is available to answer questions and serve as a resource for physicians.
2. Ensure time for dual coding. Although it may be difficult to justify dual coding indefinitely, coders need hands-on practice with ICD-10. This critical practice time coding records in both ICD-9 and ICD-10 allows coders to identify documentation gaps and educate physicians accordingly. Working with an outsource coding vendor can help create time for internal staff to dual code without interrupting cash flow. Start with high volume and/or high cost diagnoses and procedures to maximize efficiency.
3. Identify a physician champion. HIM professionals know that it can be difficult at best to change physician behavior. If organizations haven’t already identified a physician champion, they should take the time provided by the delay to do so now. Consider these tips:
· Choose an individual who is well-respected and an excellent communicator.
· Look for someone who has excellent EHR skills and whose documentation can set an example for others.
· If possible, identify one physician champion for medical cases and another for surgical cases. This avoids overburdening one individual, and it also helps send a message to the entire medical staff that the organization values their input enough to devote multiple resources to the effort.
4. Work with your outsource vendor to identify additional strategies. Organizations that outsource all or a portion of their coding to a vendor should work closely with that vendor to identify opportunities for documentation improvement. A reputable vendor should perform ongoing quality reviews and audits and be willing to share that information with the organization.