The Oct. 1 ICD-10 implementation deadline is fast approaching after several years of discussions, delays and preparation. All healthcare organizations covered by the Health Insurance Portability Accountability Act (HIPAA) are required to be ICD-10 compliant beginning Oct. 1. There has been considerable angst in the healthcare industry about the impending change, as there is a great deal of complexity with the transition to the new coding set. As previously reported in Healthcare Informatics, several ICD-10 readiness surveys have in the past found levels of preparation and readiness were not high within healthcare organizations and there seems to be varying degrees of optimism for ICD-10 implementation.
However, out on the front lines, progress is being made as most healthcare organizations are moving along with their preparations. Now, it seems, the biggest concern is what happens on and after Oct. 1. The University of Missouri Health Care, based in Columbia, Mo., has been working with health information technology (HIT) vendor Cerner Corporation to prepare for the transition. As the chief medical information officer at the University of Missouri Health Care, Thomas Selva, M.D., is responsible for oversight and system-wide implementation of the health system’s ICD-10 preparation. Dr. Selva recently spoke with Healthcare Informatics Assistant Editor Heather Landi about what to expect before, during and after the conversion and shared his insights about why ICD-10 is important to physicians.
Is your organization ready for the ICD-10 transition?
The preparation has been going well. It’s been a long journey, as you can imagine, as we actually started on this journey more than two years ago. We were preparing for the cutover for Oct. 1 last year, and then when Congress said we’re going to put it off for another year, it just gave us more time to get ready. On the flip side, it forced us to put off other projects we really needed to get started on so we’re happily looking forward to getting past Oct. 1 so we can get started on the other things we want to work on.
Thomas Selva, M.D.
Have you hit any major roadblocks while preparing for the ICD-10 transition?
Not really, as CMS [Centers for Medicare & Medicaid Services] really put out a nice roadmap as a guide, showing where you need to be along the way. We’ve benefitted from a phenomenal project manager and a wonderful team that we’ve put together, which includes information technology, the billing office, medical records office, our revenue cycle people, and we have physicians on the front lines, all in that room having discussions about what are the next best steps. And, a lot of this has been checking our back end business systems to make sure they’ve been brought up to the latest codes, that they are all ICD-10 compliant and that they are all communicating with each other and with the third-party payers. We’ve been through a lot of that validation already and, in addition, we’ve also been working very hard and early on assuring that our providers are educated on what ICD-10 means and how best to be prepared for what that’s going to imply in their specific area of practice.
Do you have any concerns about the transition on Oct. 1?
Many wonder if it’s going to be Y2K…it’s not going to be Y2K. My crystal ball isn’t perfect, but I think October 1st you’re not going to see the world grind to a halt. I think what you’re going to find is that it’s going to be several days after that when you start seeing coders looking at documentation as it relates to inpatient care and they begin calling physicians and saying “I need more specificity.” So now you’re interrupting the provider’s workflow and the coders are working harder. I think a few weeks further down the road, you’re going to start seeing denials from insurance companies for lack of specificity. I think that’s the worry that everybody has, and no matter how well prepared you are for the transition, it’s probably still going to happen. Any time you change the foundational system in the billing and coding world, you’re going to have a shake-out that has to occur.
How has MU Health used new technology to help meet the challenge of the ICD-10 transition?
We’re testing partners with Cerner, so we’ve been testing modules within our EMR. And, we’re using software on the front end to help physicians find codes quickly. We’re using Physician Transition Early, where as a physician is documenting, if they want to look up a code, they have the ability to search the ICD-9 coding catalog is a very rapid way to get down from, let’s say a 150 different ways to describe a disease, to the three that are probably applicable to where they are and what they are seeing and then from that they can get the right (ICD-10) code.
There’s been some new software that’s been developed by Cerner and since we’re testing partners, we’re learning that there might be a better way to get through that search module where you can get to the code that you are looking for faster. So, we’re in the middle of that testing right now and I don’t know how much of that is software design versus the inherent complexity of ICD-10 that just makes it difficult to get to that level, but I think we will get there. Cerner is working on it and there also is intelligent medical objects (IMO), which is like the Rosetta Stone between the natural language description of a disease and fill-in-the-blank coding system, whether ICD-9, ICD-10 or SNOMED. So, there are a lot of tools that we can bring to bear to at least get closer to the bull’s eye, if we can’t get right on the bull’s eye.
What should organizations be doing right now?
Not everyone is going to have access to software on the front end that allows a physician to find a code really fast. So the other part of it is investing in the right educational materials, whether that’s hard materials, so flyers and newsletters, or whether that’s in-person education or online educational modules. All of those investments hopefully have been made now so people are getting spooled up on learning. And then the departments where you think you’re going to have the highest yields, so your medicine department, your pediatric medical department and your surgical department, where you know that level of specificity is going to jump by a quantum leap, right now is when you’re going to see people doing that education; not because it’s late, but because if you do it too early, they’ll forget by the time they really have to start using it.
Looking past Oct. 1, what should we expect?
Well, I think what we’re going to see is a natural progression, just like we’ve seen with anything that changes how physicians document and code. If you get enough call backs from a coder about a specific issue, your documentation is going to become more specific so you don’t get that call again. So I think what you’re going to see is the number of call backs will slowly decrease over time. And, I think we’re going to see the interruptions to physicians’ work flow will decrease over time.
The part that is the big unknown is the answer to any problem when you know there’s going to be more work, which is just to hire more people. And I think a lot of institutions right now have rightly taken the approach of contracting with temp organizations to bring in temporary help to get over that initial hump of needing to get call backs and needing to improve specificity with the coding.
Why is it important for providers to be on board with the transition to ICD-10?
We’re the only country that actually uses the International Classification of Disease coding system (ICD) as part of our billing system. Most countries use it more for surveillance and epidemiology, so we are very late to this party.
Some specialists will say it has no impact on what they do and, the reality is, they are probably right. But on the other hand, when you look at some of our subspecialties, such as surgical subspecialists and orthopedics, there is a whole new level of specificity that is going to be available to them (with ICD-10). So that means, when you go to back to see what is the incidence for a certain disease state or a certain injury, you can be much more specific.
And from a population management standpoint, as you start looking at managing the population of patients and when you’re trying to do epidemiology studies, such as “Are we seeing an increased incident of a certain disease?,” the more specific you can be, the more accurate that surveillance becomes. And, that means you can respond much faster to an outcropping of a certain disease in a certain area.
This is really not something that came out of the blue, as the rest of the world’s been on ICD-10 for a really long time. Because we tie it to billing here in the U.S., it’s just very hard to make that transition. It’s like changing the tires on a very fast moving car – you can’t just stop it and say “We’re not going to submit bills for six months” – that engine has to keep churning along. I think once we get past it, a year or two from now, it will just be the way we do business.