When I recently told a neurologist that my firm was helping organizations transition to ICD-10, he took a deep breath and let me have it. "ICD-10! Just a lot more busywork for me and my partners, no earthly use to my patients or to me in treating them, and, of course, no more money. Sometimes I think it is all part of a plan — EHRs, meaningful use, ObamaCare, now ICD-10. Seems like they want to stamp out independent physicians by making it too hard and too expensive for us to continue to practice this way."
Physicians have the power to make the ICD-10 transition for hospitals easy or difficult, affordable or expensive — all to the extent that they are willing to document the medical record with the specificity that ICD-10 is built upon. It's true that these days there are more and more employed or "aligned" physicians — what with practice acquisitions, ACOs, bundled payments, capitated managed care and more — who might not be quite as intransigent about ICD-10 as my neurologist acquaintance. But independent fee-for-service physicians like him and his partners are still the lifeblood of many smaller hospitals, and plenty of larger ones as well. Most of the time their incentives often don't match up well with those of the hospitals where they admit patients. And many of them are already feeling very put-upon by a healthcare system that is demanding more and more of them in exchange for static or declining reimbursement.
As our firm consults to hospitals and others in implementing ICD-10, we are beginning to see what does and doesn't work in engaging physicians in the ICD-10 transition process. Briefly, we're learning that to become part of the solution rather than part of the problem from the physician’s perspective, hospitals will need to spend money and effort to help make the practice’s transition to ICD-10 simpler, cheaper and easier — not just the institution’s transition. ICD-10 is one more thing that takes physicians’ time and effort away from patient care. The more an organization can afford to do reduce the time and effort physicians personally have to spend worrying about ICD-10 and its impact, the more appreciative (and, we can hope, the more cooperative) the practice will be.
Here are some "best practices" for helping physicians transition to ICD-10. Obviously, you can't do these for every physician who has privileges. But you can and should do them for the vital few practices that really do have to get ICD-10 right.
1. Appoint a physician champion or champions and use him or her to reach out through the medical executive and individually to key practices. This is about getting past whatever skepticism there might be as to the organization’s motivations in reaching out. There is no use sugarcoating the message: ICD-10 is coming, it will impact them, and vendors and payers and practice staff won't be able to get it all done without personal attention and participation from physicians. But hearing that message straight and unvarnished from a physician not employed by the organization is probably your best bet in "breaking through."
2. Offer to train key practices in both the basics and in clinical documentation at no expense to them. This is something the practices will have to do themselves at some point, in some way. Doing it for them isn’t a huge investment: A good general awareness briefing takes 30 minutes. Clinical documentation training takes a couple of hours, but this will pay for itself the first few times time a physician gets the documentation "right the first time" without the need for a query because of the training.
3. Tend the practice/hospital clinical information interface. This has both an IT and a content dimension. Each hospital/practice IT interface is a bit different, but from the content perspective, work with each key practice to create electronic or paper cheat sheets/superbills to help the staff as well as the physicians to get it right the first time.
4. Don't treat all practices alike. Tailor what you offer based on the practice’s specialty. There are indeed about 140,000 codes in ICD-10 and PCS, but most specialties are dealing with a couple of dozen diagnoses and procedures that are their bread and butter. When you train, use a standard CDI approach, but build the examples around the specialty. Ditto for the job aids.
5. Pull the pieces together into an engagement plan for each key practice. The plan should include accountability and timelines for the initial contact; for offering and conducting training; for the clinical information interface; and for continuing follow up. It must be customized not only to the specialty, but to the practice's size, location, relationship to your organization and culture.
Above all, remember that you are sending messages with everything you say and do in your relationship with practices. We've seen approaches to physicians that use scare tactics — those 140,000 codes again — or, that feature non-physicians lecturing physicians about how ICD-10 "will help you practice better medicine." Those fall flat, and no wonder. The steps we suggest above send the message that you understand the pressures on the physician’s time, and that you want to help him or her use as much of it as possible to take care of patients and as little of it as possible in fulfilling "requirements" imposed by others. In creating physician engagement with the ICD-10, transition, that’s the winning message.
Lisa Asbell is a registered nurse and healthcare consultant for nearly 20 years. She currently serves as business development liaison for HealthCare Resolution Services. She is a national speaker and trainer having trained over 50,000 healthcare professionals in hospitals, webinars, seminars and association meetings around the country. Ms. Asbell is an ICD-10 specialist who understands the complex healthcare environment and uses humor in her seminars to make boring topics fun and exciting.