Most hospitals and health systems have made progress related to the ICD-10 transition, but there undoubtedly is still more work to be done. Many have completed their readiness assessment, identified ICD-10 leadership, assembled their ICD-10 workgroups, planned coder, documentation specialist and other staff education, identified necessary IT infrastructure requirements and recognized the need to renegotiate payer contracts that reference ICD-9 codes. Still, even if all the above elements are in place, on time and functioning well, ICD-10 holds the potential to devastate a hospital’s revenue cycle integrity leading to short-term, if not long-term, losses in revenue.
Another critical piece missing from the list above is: Assuring that your medical staff is ready for the ICD-10 transition. Although many argue ICD-10 is a coding issue requiring coding solutions, we see time and time again surveys that identify physician education as the most difficult challenge in preparing for ICD-10. Why the inconsistency? It actually makes sense from an operational perspective. We can mandate that coders attend necessary education, purchase computer-assisted coding (CAC) solutions and negotiate with vendors to assure that all IT platforms are ICD-10 compliant. But how do you mandate appropriate documentation for ICD-10 from your independent physicians? Short answer… you don’t. It won’t work. That is the most likely reason many health systems have turned a blind eye to the issue of physician documentation for ICD-10. There is a better answer — don’t mandate; collaborate and educate.
Peer-to-Peer Education Is Best
I have been very impressed by the collegial response by physicians of all specialties when ICD-10 education is focused on their practice. Physicians are life-long learners and are interested in better documenting patients’ clinical conditions, particularly when framed in regards to the effect on outcomes and their workflow and practice.
However, many are still trying to find a “workaround” to avoid direct physician education. First and foremost, many health systems are looking at CAC as a bridge from inadequate physician documentation to efficient coding. It is not. We know that inadequate physician documentation has been a challenge under ICD-9. If documentation does not improve, CAC will provide so many erroneous codes to coders that the level of rework will be highly frustrating, requiring many iterative queries to physicians. In turn physicians will be angry, resentful and non-collaborative with a system that appears from a clinical perspective to be duplicative, time-consuming and adversarial. We must provide peer-to-peer, specialty-specific education regarding the specific documentation requirements for diagnoses and procedures as an integral part of overall ICD-10 planning.
Extending a Helping Hand to the Independent Physician
According to a 2010 MGMA survey, the U.S. health care system experienced a steady transition from independent physician-owned medical groups to hospital/health system employment models. Let us assume, for the moment, that hospital-owned practices, due to their affiliation with organizations developing ICD-10 expertise and infrastructure, will be at least relatively prepared for the ICD-10 transition. What will the impact be on health systems when independent physicians and physician groups aren’t prepared?
At a recent presentation to a large group of physicians, I had the opportunity to poll attendees on their current state of preparation for ICD-10. Only 15% of attendees acknowledged that they had, as of yet, done anything to prepare for ICD-10. The potential effect on hospitals and health systems is profound. Yet, a much broader risk has not been fully appreciated, and it will negatively affect health systems, particularly their physician executives. Many independent or small group practice physicians haven’t yet grasped the reality that their professional income will cease if they are not prepared to submit ICD-10 compliant bills as of Oct. 1, 2014. So what will happen as we approach the deadline?
As is typical in human nature, there comes a point where individuals recognize the inevitability of change and begin to adapt. As physicians recognize the necessity of ICD-10 compliance and their inability to assess their preparedness, train their staff and acquire and implement necessary technologies (the cost of which they may not be able to absorb), they will need to turn to some entity for help — and survival.
The inevitable partner will be a larger entity which has prepared for the ICD-10 transition — that is the hospital or health system. Here’s the challenge. At the very time when a hospital/health system CFO is facing the potential of up to a 50% decrease in coder productivity, increases in Discharged Not Final Billed charts (awaiting ICD-10 clarifications) and at least transitional revenue impact, physicians will be requesting (or more accurately demanding) acquisition to allow their survival.
The message is clear. Even for health systems with a high percentage of employed physicians, it is critical to partner now with your independent physicians, as well to assist them in maintaining self-sufficiency during the expensive and potentially difficult transition to ICD-10.
Physicians must have specialty-specific education regarding necessary documentation for ICD-10 in order to not negatively impact coder productivity and the entire revenue cycle. Proactive hospitals are planning to provide this education to their medical staff through a phased approach utilizing learning management systems and expert content delivered via a peer-to-peer, physician-to-physician format. That will greatly mitigate the risks of the ICD-10 transition and will clearly decrease the level of rework, improve coder productivity and positively affect physician satisfaction and an organization’s bottom-line.
Source: iHealthBeat
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