Two Mass. providers discuss ICD-10 prep

FRAMINGHAM, MASS.--Baystate Health has created four workgroups to manage the ICD-10 transition. Walter Houlihan, corporate director of health information management of the Springfield, Mass.-headquartered organization, spoke at the Massachusetts Health Data Consortium’s Dec. 13 program on ICD-10.

Those workgroups are communication; system and payer analysis; staffing, education, productivity analysis; and finance and business analysis. “We have a high-level plan outlined,” said Houlihan. “I can sleep at night.”

Houlihan showed a graph of the percentage of congestive heart failure (CHF) patients coded as unspecified. Hospitalists were at or below the target rate for the most part, but all other physicians were over the target. “This is a great metric that demonstrates how proper education can change behavior.”

To achieve that goal, Houlihan suggested reviewing operations, bringing business and information systems strategies together, developing a proposed roadmap and gaining senior level support. “The bottom line is continually improve and maintain optimal clinical documentation and coding quality. You need to track, have a game plan and move on.”

Organizations must translate their documentation into optimal codes. “You can treat all the patients you want, but if you don’t do this part right you might be closing up shop.” For example, coding for chronic kidney disease nets an organization $38,000, stage 4 kidney disease nets $45,000, and end-renal renal disease nets $68,000. ICD-10 requires more specific documentation to ensure that providers earn appropriate reimbursement.

ICD-10 represents an almost 900 percent increase in codes, Houlihan said. Despite the enormity of that, he pointed out that contrary to traditional theory, people don’t resist all change. “It all depends on how you present the change. Get people engaged. Be specific and concrete. Clarity dissolves resistance. The sense of progress is critical to instill change.”

Coders are hard to find, Houlihan admitted. Revise your external coding contracts to meet your future potential needs for the next three to five years, he suggested. Providers also should consider coder retention programs, recruitment bonuses and work from home options, he said. Retention is especially important, he said, because you don’t want to incur the expenses of training just to have those coders to go work for someone else.

Baystate Health began 2012 by providing a refresher course on anatomy and physiology for its coders, and is now spending time conducting hands-on training and collecting physician documentation opportunities. If a coder cannot pick out a specific ICD-10 code, he or she will document why and “that will drive my physician education over the next year.” Another goal is to finish ICD-10 training as close to the time to use it as possible.

Baystate Health also just created an associate medical director position with ICD-10 responsibility, Houlihan said. This includes efforts to establish collaboration between physicians and coders and modify the EMR to enhance documentation.

Meanwhile, Partners HealthCare has created an ICD-10 project director and program manager, said coding director Bernice von Saleski.

Awareness is the most important thing, she said. The Boston-based organization with 60,000 employees is using emails, newsletter articles and presentations with key groups to spread the word. “Physicians are the most challenging group to meet with,” she said. “They always have questions we are not prepared for.”

Partners’ training is roles-based, said von Saleski. Some coding staff have taken certification training offered by the American Health Information Management Association and more will do so over time. She said they considered developing their own training resources but decided that was too time-consuming.

To achieve physician buy in, von Saleski has had meetings with physician leadership. The need for increased documentation is the top concern and she found that they wanted to talk about the potential for automation. They also want to know what’s in it for them. “Without documentation specificity, important information that helps us be competitive in the marketplace is lost,” she said.

She also just recently received word that ICD-10 will be required for physicians. The training will be tailored to the physicians’ patients and specialties. Von Saleski recommended keeping training simple and fun and also starting small. She suggested telling physicians when they already are documenting something well. “Each of us wants to know when we’re doing something great.”

Partners has standardized its documentation query forms for passive physician training. Every Partners hospital had a different form, von Saleski said. She has researched the literature for the major changes in documentation required and included those in the new forms. However, those aren’t hitting every type of service, such as outpatient documentation. The team is going to add additional members to look at these other areas and utilize the materials already available that have identified the differences between ICD-9 and ICD-10. She’s also assessing and conducting a gap analysis of current documentation in small samples. “A translation/analytic tool can help do some of the heavy lifting.”

The training team is expanding to include subject matter experts and looking to hire people with experience training for big changes such as HIPAA.