HIMSS: Geisinger talks ICD-10 transition

NEW ORLEANS—Aside from the numerous technological and organizational challenges the transition to ICD-10 offers, there are potential strategic advantages as well, said speakers during a March 6 session at the Health Information and Management Systems Society (HIMSS) annual convention.

Those organizations that “didn’t necessarily celebrate the [ICD-10 transition] delay are much further ahead,” said John Dugan, CPA, partner with PricewaterhouseCoopers (PwC). They have completed almost all their needed assessment activities, are establishing comprehensive work plans and working through remediation steps.

But for those who aren’t that far along, Dugan said the first step is to perform an enterprise-wide assessment to determine what ICD-10 means to your organization strategically, operationally and financially. The process should identify where the gaps in people, process and technology create the greatest risk for strategic imperatives.

Establish an ICD-10 interdisciplinary working committee with leaders who represent each functional area to uncover critical information, he suggested. Commit to the process early on by dedicating internal resources and engaging an external vendor to assist with project management and the structuring of a formal assessment approach. “One of the biggest signs of future success is the commitment of resources to the project early on.”

Provide ICD-10 education for better strategic, management and operational decision-making in advance of detail planning, he said. “if you invest time upfront appropriately, you’ll be more successful.” But remember that “you can’t have enough ongoing education.”

The more time you spend looking at historical information, the better off you’ll be, he said. “Follow the revenue. Who drives revenue? I’m willing to bet that less than 20 percent of your physicians drive 90 percent of your revenue. Drill down on a service line basis and a physician-level basis and that will drive the roadmap for training.” And once you have that, plan your training appropriately, he said. “You’ve got one shot to train referring physicians.”

Susan Trewhella, associate vice president of revenue management for Geisinger Health System, based in Danville, Pa., which covers 2.6 million residents in 44 counties of Pennsylvania, then discussed the organization’s ICD-10 efforts to date.

“We knew we needed to engage the entire organization, not just coders so we brought in PricewaterhouseCoopers.” Geisinger conducted an enterprise-wide impact assessment in spring 2011 to understand the key risks and opportunities and then established an ICD-10 inter-disciplinary working committee with leaders that represent each functional area. PwC and these functional leads facilitated working sessions with more than 200 participants from key functional areas.

Follow the code, Trewhella said. She started by looking at all the places the organization uses codes. The highest volume code is hypertension so “we ran a detailed report through the physicians to identify which would need the most training.” Since physicians are the coders in many office practices, they worked to determine how and which ICD-10 codes to present to them. Physicians are the codeers in many office practices. What codes presented to them, how choose?

Through its assessment efforts, Geisinger learned that 80 systems will be impacted by ICD-10, she said. The IT department is keeping a list of all systems and keeping in touch with vendors on their readiness. They ask vendors for their plans and when they will have the ability to test. “If they don’t have a good answer, they might not remain a Geisinger vendor.”

Today, Geisinger is in the process of designing and constructing workflows and preparing to start advanced training.  

Geisinger’s governance structure has been critical for its ICD-10 efforts, said Trewhella. The executive steering committee is made up of physicians, operational executives, IT executives, financial executives and revenue cycle leaders. “We have oversight at the top operational level and project management ties it all together. We are trying to get the silos together and make everyone cross-disciplined.”

Dugan discussed several critical steps in the transition process. Optimize execution across workgroups through a workgroup-level project plan. “If your people are really capable, this will pay off in dividends.” Evaluate performance, outcomes, risks and issues and more efficiently respond to sponsors. Continuously improve through informed decision making, lessons learned and corrective action. A strong communication plan that includes your employee newsletter and other outreach, will keep up the momentum, Dugan said. And, remember that education and training will continue to evolve.

The usability of new health IT tools, coding strategy and user adoption all add up to a successful ICD-10 transition, Trewhella said.