In a recent "Talk Ten Tuesday" webinar sponsored by ICD10monitor, Gloryanne Bryant, regional managing health information management director at Northern California Kaiser Hospitals, and Tom Ormondroyd, vice president of consulting and educational services for Precyse, discussed the significance of a multi-phased approach to ICD-10 implementation and why physicians are the foundations of ICD-10 success.
Ms. Bryant advocates hospitals and providers instill a multi-phased, multi-year readiness plan to implement ICD-10, and the first thing to conduct is a coding assessment. A coding assessment looks at the four core competencies of coding: medical terminology, anatomy, physiology and pharmacology. Providing coders this assessment of 50 to 150 questions, ranging from multiple choice to true/false answers, and not allowing resources for the assessment can give a healthcare organization an idea of what type of training needs to be done for ICD-10. "This would just be what [the coder] knows and can answer, and then based upon that assessment, you can see where there is a gap," Ms. Bryant says. She adds that this assessment is a way to look at the staff's strengths and weaknesses and then provide additional education on areas where there are gaps.
The timeline for a hospital's ICD-10 implementation should stick to rigorous deadlines, and Ms. Bryant outlined what organizations should systemically be doing between now and Oct. 1, 2013.
• Foundational education. An organization must assess where it is at in terms of basic coding and billing education. This should occur before the end of the year.
• Prerequisite education. This is when an organization should provide the additional education based on the gaps shown in the foundational education assessments. This could include extra emphases in any of the four competencies, and this education should be provided by Jan. 2012.
• ICD-10 training. While dual coding can currently help coders familiarize themselves with nuances between ICD-9 and ICD-10, organizations should at the very least begin formal ICD-10 training by Jan. 2013.
"There should be enough time, but don't let it go by without all of these phases," she says.
Coders and frontline staff undoubtedly play an integral role in a hospital's ICD-10 implementation, but according to Mr. Ormondroyd, physicians are the true cornerstones of ICD-10 success. "We can train staff to be the best coders of ICD-10 and completely fluent, but documentation specificity holds a far more important role for the success of ICD-10," Mr. Ormondroyd says.
He says there are instances where some physicians do not know there will be a switch to ICD-10, a potentially huge roadblock. Healthcare organizations must educate their physicians on the changes and explain why they are happening. Their documentation of cases, and the specificity of those cases, can affect the entire revenue cycle of a hospital. "This is not something that won't impact them — there will be dramatic rises in queries, which will ultimately impact their productivity," Mr. Ormondroyd says. "Teach them the foundations of documentation in ICD-10, and realize what specificity they will need."
Of course, there are challenges with educating the physician population. Physicians provide clinical care every day, and their schedules usually won't be flexible. Having physicians sit down in front of a computer for an hour is not always plausible, but gradual learning must be a priority, Mr. Ormondroyd says. Additionally, the technical capabilities of all physicians must be understood. Not all physicians are savvy with technology, and physicians need to be reached in different ways. Most importantly, they need to understand the importance of ICD-10 and how it will affect their daily workflow and facility. "If we can achieve this education, we can drive adoption," Mr. Ormondroyd says.
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Ms. Bryant advocates hospitals and providers instill a multi-phased, multi-year readiness plan to implement ICD-10, and the first thing to conduct is a coding assessment. A coding assessment looks at the four core competencies of coding: medical terminology, anatomy, physiology and pharmacology. Providing coders this assessment of 50 to 150 questions, ranging from multiple choice to true/false answers, and not allowing resources for the assessment can give a healthcare organization an idea of what type of training needs to be done for ICD-10. "This would just be what [the coder] knows and can answer, and then based upon that assessment, you can see where there is a gap," Ms. Bryant says. She adds that this assessment is a way to look at the staff's strengths and weaknesses and then provide additional education on areas where there are gaps.
The timeline for a hospital's ICD-10 implementation should stick to rigorous deadlines, and Ms. Bryant outlined what organizations should systemically be doing between now and Oct. 1, 2013.
• Foundational education. An organization must assess where it is at in terms of basic coding and billing education. This should occur before the end of the year.
• Prerequisite education. This is when an organization should provide the additional education based on the gaps shown in the foundational education assessments. This could include extra emphases in any of the four competencies, and this education should be provided by Jan. 2012.
• ICD-10 training. While dual coding can currently help coders familiarize themselves with nuances between ICD-9 and ICD-10, organizations should at the very least begin formal ICD-10 training by Jan. 2013.
"There should be enough time, but don't let it go by without all of these phases," she says.
Coders and frontline staff undoubtedly play an integral role in a hospital's ICD-10 implementation, but according to Mr. Ormondroyd, physicians are the true cornerstones of ICD-10 success. "We can train staff to be the best coders of ICD-10 and completely fluent, but documentation specificity holds a far more important role for the success of ICD-10," Mr. Ormondroyd says.
He says there are instances where some physicians do not know there will be a switch to ICD-10, a potentially huge roadblock. Healthcare organizations must educate their physicians on the changes and explain why they are happening. Their documentation of cases, and the specificity of those cases, can affect the entire revenue cycle of a hospital. "This is not something that won't impact them — there will be dramatic rises in queries, which will ultimately impact their productivity," Mr. Ormondroyd says. "Teach them the foundations of documentation in ICD-10, and realize what specificity they will need."
Of course, there are challenges with educating the physician population. Physicians provide clinical care every day, and their schedules usually won't be flexible. Having physicians sit down in front of a computer for an hour is not always plausible, but gradual learning must be a priority, Mr. Ormondroyd says. Additionally, the technical capabilities of all physicians must be understood. Not all physicians are savvy with technology, and physicians need to be reached in different ways. Most importantly, they need to understand the importance of ICD-10 and how it will affect their daily workflow and facility. "If we can achieve this education, we can drive adoption," Mr. Ormondroyd says.
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