Ramping Up

BUDGETARY CONSTRAINTS

One area of uncertainty in all of this is how much an ICD-10 transition will cost. Among those who are scratching their heads are leaders at CentraState Healthcare. During budget planning last year, HIM Director Judy Gash put a preliminary figure into the budget for ICD-10 services, but it was quickly blown out of the water after ICD-10 risk assessment requests for proposal came back.

The quotes from the five vendors that submitted ranged from $100,000 to $600,000 and left Neal Ganguly, vice president and CIO, as well as the state's CHIME StateNet vice chair, perplexed. His committee is now drilling down into the proposals to see how much of what's recommended really needs to be done. At last year's CHIME Fall Forum, Ganguly remembers being astonished when hearing quotes of an ICD-10 transition costing in the millions for a community hospital. “We're trying to validate some of that because that just seems way off the mark from our perspective,” he says. “There's a lot of work that needs to be done, but I don't know if it's at that scope. One of our concerns is, are we missing something?”

Five Things You Can Do to Start Your ICD-10 Transition

CIOs and HIM directors cite several things that you can do to begin your ICD-10 journey today:

• Perform a comprehensive impact assessment and systems inventory to identify which information systems will be affected by the transition and what hardware and software upgrades will be needed.

• Decide if you have the internal talent to manage this multi-disciplinary project or if you have to outsource a project manager.

• Educate a super user on the clinician and the coding side with a program like AHIMA's Academy for ICD-10.

• Identify the top diagnoses and procedures within your organization and create “before and after scenarios” that show the specific wording and codes necessary for ICD-10.

• Be realistic about future coding needs and be creative about recruiting and retaining your human capital.

Another wrinkle related to budgetary issues is whether to outsource the management of an ICD-10 transition, or marshal the resources internally. “Organizations are realizing now that they can't pull their existing pool of resources and devote them to work on ICD-10 all the time,” says Jacobs. “More and more organizations are outsourcing to outside vendors.” She says that in the past month she has gotten more requests for proposal than all last year put together.

“The key thing is identifying if you have the strong, disciplined project management expertise inside your doors, or not, because that's where you're going to need the help because ultimately this has a direct impact on reimbursement which makes all the difference in the world,” Ganguly says.

IMPLEMENTATION AND TRAINING

Podesta says that the key to ICD-10 training is to start physician awareness and education early. His team has created “before and after scenarios” for specific procedures and diagnoses that show the specific wording and codes necessary for ICD-10. “We're doing that with a small group now to gauge the impact,” he says. “But we think it's going to be huge because all the systems downstream will be affected by how well that documentation is done.”

Not only will clinicians need to be trained in ICD-10 documentation, coders will also need significant education. “The big difference with ICD-10 is that it's not just expanding a field two digits; it is a completely different coding methodology,” says Jacobs.

Some organizations, such as CentraState Healthcare, are already providing anatomy and physiology training for their coders. CentraState also sent several physician informaticists and executive team members to a four-day ICD-10 boot camp sponsored by the New Jersey Hospital Association. Future plans are for a high-level coder to be trained by the American Health Information Management Association (AHIMA) as a certified ICD-10 trainer to help prepare the organization's other coders. Jacobs says 2011 is the time for awareness-building, but still too early for ICD-10 coding training, as coders won't be able to actually start coding till 2013. She recommends starting to train six to nine months before the transition, so codes are fresh in coders' minds.