All CIOs and health information management (HIM) directors are hearing the clarion call for the ICD-10 transition that must occur on Oct. 1, 2013 and are starting to lay the groundwork now. Because the transfer to ICD-10 codes touches almost all departments of a healthcare organization, many are finding it difficult to assign ownership of this tremendous task. One such organization, the 450-bed East Jefferson General Hospital in New Orleans, sought to fix this problem with outside help from a consulting firm, Aspen Advisors (Pittsburgh, Pa.). With help, the organization was able to assess the impact of this transition and to work out an implementation strategy, roadmap for compliance, and funding requirements.
There were many compelling factors leading East Jefferson to start its ICD-10 journey with a complete assessment. For one, the organization needed clarification of leadership for this multi-year initiative. “Because ICD-10 migration touches people, process, and technology across the enterprise—access and admissions, patient care, and documentation, coding and charge capture, and billing and reimbursement—East Jefferson struggled with where the project management responsibility for ICD-10 should reside,” says Bob Schwyn, the Aspen Advisors principal involved in the assessment. Another reason for the assessment was to find out the total cost of ownership due to the wide amount of resources this project involved, prior to presenting to the hospital board for funding. Because ICD-10 deals with so many internal departments, East Jefferson didn’t have the internal resources to marshal a long-term horizon view to implementation, says Schwyn. Another factor was that many of the internal resources were already being aggressively applied to its electronic health record implementation with its vendor the Kansas City-based Cerner.
One element exposed in the ICD-10 assessment was the lack of readiness of East Jefferson’s vendors, payers, and providers, who would all be crucial for success. Schwyn says that East Jefferson’s vendors were fuzzy on how they would get their client to ICD-10 compliance, and pointed to system upgrades bundled with meaningful use packages. “All of the vendors that were engaged in the process were not able to provide specific details about release notes in terms of what functionality was actually going to change and what they’d need to do to support the migration,” he says.
Payers were even further behind, and most were not even prepared to have talks about readiness, despite having pledged their commitment. Because of this, Schwyn says, one item, intense preparation to clarify explicitly what work needed to be done with the individual payers and mapping out timing, was added into the ICD-10 roadmap.
Enhancing Clinical Documentation, Maximizing Reimbursement
Another area identified in the assessment that would require a good deal of challenging work was that of clinical documentation to add specificity for diagnosis coding processes. This specificity will be needed to maximize efficiency and accuracy of claims processing, says Schwyn. What was discovered at East Jefferson, like many hospitals, was a hodge-podge of different solutions to capture clinical documentation, like handwritten progress notes and dictation. What the assessment uncovered was a fundamental question East Jefferson still needed to address—whether or not to implement physician documentation systems in the next 18 months, and if so, how to include ICD-10 requirements. Or if East Jefferson chose not to implement electronic documentation, it needed to ascertain how to include ICD-10 diagnosis coding requirements in the paper processes.
“So there’s a multitude of decisions they are going to have to make—can they accelerate moving the physician documentation rather than try to reengineer all these paper processes,” Schwyn says. Either way, Schwyn recommends getting clinical department heads to become physician champions to lead the clinical documentation change, starting with the most challenging diagnosis-related groups (DRGs).
On the revenue side, to maximize net reimbursement, East Jefferson was advised to determine where the significant volume of procedures came from and what procedures created the most revenue. Orthopedics, in particular knee replacements, was found to be one of the highest-volume areas. Additionally, orthopedics will involve a considerable amount of specificity and more documentation for ICD-10 compliance, so Schwyn’s firm recommended a focus on the coding necessities and changes in orthopedics and other high-volume DRGs. Another recommendation was to task the finance workgroup to forecast the financial impact of reimbursement processes to see where were further opportunities to improve coding accuracy to maximize revenue.
East Jefferson will be working toward developing a concurrent system and process interoperability for ICD-9 and ICD-10 transactions. The hospital also plans to implement a translation tool, but according to Schwyn, the market is still dramatically changing to address this requirement and current mapping tools, like the Centers for Medicare and Medicaid General Equivalency Mapping (GEM) tool, are not robust enough. Over the next couple of months, the organization is also prioritizing a selection process for a computer assisted coding (CAC) tool to help prepare coders. Also during this time, the organization will be structuring its multi-disciplinary leadership team and getting operational workgroups engaged. Later this year, an initial wave of education for clinical documentation will be provided. Contingent on vendor readiness, East Jefferson hopes to have its IT remediation finished by the third quarter and then start testing in Q1 2013.
For more on East Jefferson General Hospital’s ICD-10 assessment, check out this Healthcare Informatics podcast with Bob Schwyn.