Hospitals and physician practices have been discussing ICD-10 for many years. However, even with a one-year implementation delay, many of them are only now realizing that they are still not ready for the October 1 start date.
In the past month, our ICD-10 consulting practice has received more inquiries for assistance than in the past calendar quarter. We expect this pace will continue well into the coming months leading up to October.
A significant number of inquiries have come from organizations that have considered ICD-10 to be an IT or HIM issue. In fact, when looking at the scope within a hospital or practice that ICD-10 encompasses, there are more than a dozen areas that should be involved, such as revenue cycle and contingency planning. Ignoring any of these areas can have a detrimental effect on ICD-10 readiness.
3 most common ICD-10 readiness problems
Looking at the most frequently asked questions, we see three themes. Organizations often overlook them, but they are key to success: user education, documentation standardization and organizational governance.
1) Lack of adequate ICD-10 education
One would think that ICD-10 education would not be an issue, but in reality, it is probably the most common problem facing the healthcare community. Specifically, the problems we most frequently encounter are lack of education specific to a provider’s specialty, ongoing reinforcement of the requirement and training for best documentation practices within the organization’s electronic health record (EHR) product(s).
Even for non-clinical staff, such as coders, the overwhelming majority admit they need to refresh the skills and knowledge they acquired in 2014, if they are to be a skilled resource in October 2015.
2) Lack of standardized documentation
Another challenge is the wide variability in how clinicians document pertinent information. No one expects every doctor, nurse or therapist to document exactly like their colleagues. But within an organization there should be clear guidelines in place that mandate how clinicians chart key components of the medical record.
The issue comes down to being able to consistently retrieve pertinent clinical information to support the ICD-10 code. If the documentation is there but hidden in some dark recess of the chart, then the chances of clinicians being able to retrieve it for coding is minimal, and the organization risks under-coded charts, which loses money. At the other extreme is the situation where a physician selects a high-value code, but doesn’t chart the supporting documentation, thus over-coding the record. In either case, the outcome can pose a severe obstacle to the financial stability of the organization.
3) Lack of governance structure
The last, but far from least important, topic that we see relates to governance, both operational and clinical. Organizational leadership has to “own” ICD-10 and communicate the importance of ICD-10 readiness for the ongoing viability and financial stability of the hospital or practice.
Perhaps the best way to demonstrate this priority is to allocate the necessary time, money and human resources to assure success of moving into the realm of ICD-10. In addition to your clinicians, you have to consider all those who are involved in patient care as well as billing, coding, quality, utilization and other essential non-clinical roles. They need, at a minimum, a working knowledge of ICD-10 requirements.
Clinical governance requires staff leadership to hold providers accountable for both what to document and how to do it. Yes, the organization must offer the right tools so that proper documentation can occur, but the responsibility for using these skills is clearly within the purview of medical staff leadership.
Using the remaining time wisely
One question remains: “What can I do in the time before the deadline?” This is the most difficult question of all to answer. If an organization is willing to make ICD-10 its primary task through to October, then there is a strong possibility it can achieve a sufficient amount of readiness. It is more likely to be ready to start on October 1 and continue to make improvements and enhancements on an ongoing basis.
If, however, this same organization continues to delay in developing a comprehensive assessment and remediation strategy, then October 1 may be only the start of a descent into a financial abyss from which there is no way out.
If your organization does not have the resources to assess, analyze, develop and implement ICD-10 readiness, contact us. Allscripts can help.