ICD-10: Partner, Prepare, Prioritize

Healthcare delivery organizations are hurdling toward the looming ICD-10 Oct.1 compliance date, now just six months out. Partnering, preparing and prioritizing are essential to be as ready as possible.

Baptist Health in Montgomery, Ala., has analyzed its claims data to pinpoint problematic conditions for documentation and coding to better target its ICD-10 training and mitigate its financial risks.

Partner

The organization originally conducted an assessment in 2011 but the delay in the ICD-10 implementation date caused everyone to lose momentum, says Jeri Pack, director of revenue solutions.

“We knew we still needed to keep moving. We were looking for a way to assess our financial risk so that we could plan for the 2014 and 2015 budget years.”

Baptist Health then worked with a firm to analyze two years’ worth of claims data. “We can parse and sort the data by service line, by physician, by coder, by DRG, by procedure and more.” Looking at the data, Pack says she realized this was the “big data” everyone has been talking about which “can be used to identify patients who would benefit from preventive measures, improve outcomes and mitigate the financial risk for high-risk patients.”

The data show that all 885 claims with a negative impact were from one facility and that all associated claims shared the same principal diagnosis code. They also identified the top at-risk codes by admitting and operating specialties and isolated the physicians and coders associated with the identified high-risk encounters.

The organization developed dashboards to track progress. Rather than an initial report, having a way to measure your progress is very valuable, Pack says.

Prepare

Baptist Health has been working to apply all the findings. They have prioritized ICD-10 efforts to support the higher risk facility and developed a staffing and support plan based on the risk. They have identified specific areas in ICD-9 where a more specific code and improved documentation would offset potential ICD-10 risk.

Pack says the analysis offered immediate value because it allowed the organization to project its risk and begin working to “mitigate our financial risk to the best of our ability. We will not eliminate our risk—no facility will.”

For example, they learned that urinary tract infections cost the organization $340 per length of stay. They predicted that 8,851 patients were at high risk of the complication. They also learned that angioplasty performed before an acute myocardial infarction (AMI) results in better patient outcomes and reduced costs to the tune of $9,000 per length of stay vs. $5,500 per length of stay. Just more than 3,000 patients were targeted as being at high risk of AMI.

The next steps include implementing a dual coding approach, ICD-10 curriculum development, managed care contracting review, controlled chart review, testing approach and documentation improvement opportunities.

Prioritize

“ICD-10 is one of the biggest changes, if not the biggest change, to impact a hospital,” says Katrina Belt, Baptist Health’s CFO. “There is no way to get through everything; you have to prioritize.” There are many opportunities to optimize, not just comply, with ICD-10, she says, so “prioritizing becomes paramount. There is not time to do everything, so good planning for both the basics and enhancements is key.”

Belt says she is most concerned about the “physical and emotional bandwidth of our facility and system directors. We are striving to balance the budget with providing more day-to-day help so that our system leaders can help us think more clearly about the future.” These leaders are charged with thinking through future workflows while managing their departments’ current workloads so must find a balance between the two demands. It’s a “difficult place for leaders in this kind of prolonged transition,” she says. “We are sensitive to that pull, but have to shift from a ‘best effort culture’ to an ‘accountable to the project culture.’”

Healthcare providers have to retool every system that includes ICD codes, says Pack, and then retrain employees. “We have multiple interfaces between those systems that also have to be retooled. It’s almost overpowering.” She advises others not to underestimate the IT work stream and the systematic impact ICD-10 has across all technology in an organization.

The move to ICD-10 is not just an IT project, she says. “There are multiple work streams we have developed as we move through our preparations; however, it only takes one interface or program not appropriately configured to accommodate ICD-10 codes to have our billing system grind to a halt.”

Cost is an issue as well. Aside from upgrades and training, Baptist Health plans to augment its coding staff so the teams can prepare for ICD-10 while managing with their daily coding workload. Plus, “they will slow down when we get to the implementation date. It’s just going to happen.”

Organizations need to start now, Belt urges, because she’s found it’s not just eating an elephant one bite at a time. “You’ll realize we are being asked to eat a herd of elephants.”