Despite the common goal of providing quality patient care, a deeply rooted divide between hospitals and physicians persists.
This divide exists—in part—due to different payment methodologies. Hospitals receive payments according to DRG classifications while physicians are paid by CPT code. But it doesn't stop there. Separate reimbursement is only the tip of the iceberg.
Hospitals and physicians approach care delivery from two different perspectives. Direct patient care is every physician's priority, which means that EHRs and other mandates are of secondary importance. Furthermore, physicians feel powerless and disenfranchised within healthcare systems that compromise their clinical effectiveness and make it increasingly difficult to do what they do best—care for patients. Physicians also tend to see hospitals as agents of the government, mandating compliance with countless regulatory requirements to which they're able to provide minimal input.
Hospitals, on the other hand, generally view healthcare as a business and a commodity. Although patient care is important, so are bottom-line objectives and financial goals.
As author Rudyard Kipling once said, "Oh, East is East, and West is West, and never the twain shall meet." Is it safe to assume that physicians and hospitals will never be on the same page? Not necessarily. This article lays out three practical steps to bridge the hospital-physician chasm through successful transitions to ICD-10.
Building reciprocal relationships
The only way to truly open the lines of communication and effect change is to devote time and effort to building reciprocal relationships that benefit both parties. ICD-10 is a perfect opportunity to explore this idea—establishing a bridge for collaboration.
ICD-10 is a mandate with which hospitals and physicians must comply. Implementation is costly and time-consuming regardless of setting. However, hospitals often have greater insight into the power of coded data and thus more motivation to implement change. For example, hospitals often use ICD codes for research, data analytics, population health initiatives, and process improvement.
The reality is that physicians don't often derive direct benefit from ICD codes. Physicians understand the value of coded data in terms of improving clinical protocols and research; however, many are unaware of how this information can be used to improve their daily practices. Instead, they view coding as nothing more than a system for reimbursement.
Fortunately, these varying insights into ICD10 can come together to assist in building a better healthcare ecosystem—one that can only be spurred with more specific and reliable coded data.
Hospitals lay the first brick
With a more comprehensive pool of resources on which to rely, hospital executives should consider the following three ways to assist their owned, managed or affiliated physician practices with ICD-10:
1. Ask physicians what they want/need. Some practices may be well on their way toward ICD-10 readiness but need specific assistance with testing, denial management, or even revising their superbills/encounter forms. On the other hand, some practices may have fallen significantly behind in terms of preparation. An April 2015 ICD-10 survey by WEDI indicates that less than one-fifth of physician practice respondents have completed an impact assessment while only one-tenth of practices have started external testing.
Many practices also need assistance with ensuring smooth cash flow. According to a 2015 survey by Navicure, 59 percent of physician practice respondents said their biggest concern with ICD-10 is the potential impact on revenue and cash flow. Hospitals can help practices navigate through some of these concerns, including establishing financial contingency plans and sharing their ICD-10 revenue impact prediction methodologies.
2. Absorb some of the financial risk. Financial concerns are a major barrier and pain point for physician practices. This is despite a recent study by the Professional Association of Health Care Office Management indicating that overall implementation costs are less than originally anticipated. The results of this study were published in the February 2015 issue of the Journal of AHIMA.
Even some degree of resources dedicated to practice readiness can help physicians significantly. Consider sharing the following:
- Clinical documentation improvement (CDI) resources to reaffirm that hospitals are there to help practices, not to demand change irrespective of cost.
- Coders who assist physicians with coding and documentation changes and/or perform audits.
- ICD-10 resources, including copies of specialty-specific cheat sheets, documentation tips, course materials, or webinar records.
Hospital executives should not expect an immediate return on investment. Extending a financial helping hand to physician practices ensures long-term dividends, including but not limited to, improvements in physician-hospital relations, better outpatient documentation to justify medical necessity, and potentially more referrals.
3. Be available as physicians adjust to ICD-10. Many practices simply want to know that the hospital will be available when ICD-10 questions arise, either through onsite assistance or simply ensuring someone in the hospital—an appointed coder, IT staff member, or CDI specialist—is available by phone.
Hospitals may need to appoint multiple "point people" for this purpose, or they may be able to contract with an outside vendor to provide implementation assistance. If hospitals cannot absorb the entire cost of providing this support, they should consider asking practices to share the costs of ongoing ICD-10 services.
Physicians complete the bridge
If hospitals provide resources and guidance to practices as mentioned above, physicians can complete the reciprocal relationship. Physicians can do their part by educating hospital staff about relevant aspects of anatomy, and clinical aspects of diseases and procedures. For example, physicians can provide valuable insight for CDI, nursing and coding personnel regarding diagnoses that include greater coding specificity in ICD-10, such as asthma, diabetes and orthopedic services. Physician-led educational sessions should focus on the following:
- Clinical aspects of disease processes and procedures
- Current clinical protocols for treatment
- How more specific data can potentially be used to make better treatment decisions and enhance research
Tailor physician communications
When discussing ICD-10, hospitals and physicians should try to keep discussions focused on how the new code set can advance research and improve actual patient care—especially chronic diseases that have plagued our population for years. To spark ICD-10 conversations, hospitals can ask physicians these questions:
- What are your concerns and frustrations with current treatment protocols?
- What data would you like to access and why? What diagnoses most interest you as a clinician? Tailor physician education and outreach based on these responses and by specialty. Does the added specificity in ICD-10 address any of physicians' concerns directly? For example, a physician who is interested in better treatments for Type 2 diabetes might be pleasantly surprised to discover that ICD-10 includes code expansions that will make more effective research possible.
Paving the way for what lies ahead
This is an age of information in which consumer focus on health and wellness continues to grow. Patients want—and need—access to accurate information on which they can base healthcare decisions. Patients want to be able to go online, read about effective treatments, and engage in conversations with physicians. Effective utilization of ICD-10 data can help hospitals respond to consumer demands while also driving future research and disease treatments.
When hospitals and physicians band together, healthcare organizations achieve better patient engagement and improved clinical outcomes. Once established, this bridge can be used to enhance longer-term goals such as population health management, improved disease prevention strategies and more. ICD-10 represents a valuable opportunity to achieve common goals and to drive change. Don't let the opportunity pass you by.
Debi Primeau is President of Primeau Consulting Group and has over 35 years of experience in Health Information Management as an Executive Consultant, IS Director, and HIM Director. Previously, Debi worked with various HIM consulting companies as the VP of HIM Services, Compliance of Privacy and Security, responsible for developing and implementing clinical documentation improvement programs, as well as developing and providing education and training programs. She is a graduate of the University of Phoenix with a degree in business management, in addition to a Master's degree in organizational management.
Dr. Gary Flashner, MS, MD, ABFP is a Board Certified Family Physician with a 20-year career in Primary Care, Emergency Medicine, and Emergency Medical Services. His post-clinical career has focused on electronic health records, clinical documentation systems, coding standards/compliance, enterprise-wide hospital information systems, and patient engagement solutions. As VP of Medical Content for Patient Education at Elsevier, Inc., he supervised more than 80 clinicians focused on a comprehensive, evidence-based print and multimedia patient education library totaling more than 4200 titles.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.