CDI: Easier Said than Done

In January, For The Record published an article on the difficulties and benefits of implementing a clinical documentation improvement (CDI) program. As well as input from me, it includes valuable insights from Drs. William Walker and Jerri Williamson. Including physician input to the article underscores one of the main success factors of any CDI program. That is, the need for physician involvement.

When we say physician involvement we really mean involvement! Peer to peer communication is widely viewed as the best practice in any physician interaction.

Physician champions are essential for training and explaining. They are needed to not just explain the “what” of CDI but also the “why”. Giving good reasons to alter documentation behavior, backed by actual case examples and financial impacts, greatly increases your medical staff’s motivation to change.

Another key point mentioned in the article is healthcare’s natural tendency to link CDI with coding and reimbursement. Instead, I propose that HIM professionals and physician advisors are better served to focus on quality data, accuracy of severity and acuity.

Much of a hospital’s coded information gets translated into publicly available physician ratings and rankings. And since physicians are extremely competitive, they will work hard to protect their image and make sure they are not an outlier of adverse outcomes. Accurate documentation portrays the correct severity of illness of a presenting patient and therefore communicates the correct outcome.

Finally, better documentation improves patient outcomes. All healthcare professionals who subsequently treat the patient see a complete picture of condition and treatment.

In summary, the goal for HIM and CDI professionals is to train and educate physicians about coding and reimbursement implications while also stressing the end product: improved patient care and better quality indicators. Your commitment to these goals, clearly communicated, results in stronger physician commitment and better clinical documentation.

Making Mistakes. Check Your ICD-10 Education Budget.

If you are going to make a mistake, make it in the direction of action. Clearly an adage the 2011 Congress never understood. From my experience, embracing action instead of perpetually chasing perfection makes more sense—and gets better results. Since no one in the U.S. has implemented ICD-10 coding, mistakes will happen and providers will be caught off-guard.

A recent AHIMA survey confirmed that most organizations are uncertain about ICD-10 education and training requirements. There still seems to be some confusion about how much to budget and when to start. When asked what they “expected to budget” 40 percent thought a low amount was adequate. However among those that have actually budgeted for ICD-Training, only 27 percent were low while 39 percent budgeted high amounts. It seems that those that have thought it through are finding there is more than meets the eye. The survey was done by AHIMA and is available here: HTTP://journal.ahima.org/2011/12/12/expecting-a-bargain-on-ICD-10-training/ . While they did not state the actual numbers of the high and low estimates, they did say that there was a $2000 difference per coder between high and low.

It is true that approximately 50 hours of training is required for learning the technical aspects of ICD-10. But there is a wealth of biomedical information required to understand the granularity of coding in I-10. If you are going to have a “miss”, it is likely that it will be in the area of bio-medical education, a mistake that will most certainly cost organization in both time and money..

All of the international experience with ICD-10 shows that countries wish they had started earlier and budgeted more. But those countries do not use I-10 for reimbursement. The U.S. revenue model is going to complicate implementation further. So on top of all else, your revenue stream is at risk.

Make the investment of time and money to educate and train-and make it now. In 2012, training should be condensed and budgets formulated for a shorter period. Assess the base knowledge levels of your coders now (AHIMA has the tools). Then spend 2012 laying the educational foundation for success. In 2013, conduct technical ICD-10 training.

It is always best practice to do something. Even, if it is a mistake-make it in the direction of action. I think you will find, in this case, that it is not a mistake!

What’s A MAtter with Them?

The AMA in their infinite wisdom voted in November of 2011 to “work vigorously to stop implementation of ICD-10.” They characterize the system as having no direct benefit to individual patient’s care and being a significant burden on the practice of medicine.

Well, they are half right; it will be a significant burden, one that has been coming for years. The announcement that it will go live on Oct. 1, 2013 has been in place for years, but the AMA has waited until now to say “we don’t want to!”

In a recent ICD10Watch.com poll, the majority of readers believe ICD-10 is written in stone and AMA’s efforts will not succeed. Only time will tell, but a quick tour of  ICD-10′s benefits is certainly in order.

Every civilized country in the world is on ICD-10 and has been for as much as 15 years. We are the lone laggards who still use the out dated, inadequate ICD-9 classification system. Oddly, the other countries seem to see a clinical benefit of having more accurate, granular information describing a patient’s health status.

Yes there is a lot going on in healthcare at this time, but I do not remember when there was a time without a lot going on. So, bite the bullet and do the work and the pain shall all pass.

HHS has helped the cause by delaying the meaningful use (MU) stage 2 deadline to 2014 for eligible professionals and hospitals. The announcement was made by Dept. of Health and Human Services Secretary Kathleen Sebelius. The announcement was cited as part of an initiative to speed the use of health IT in physician office and hospitals to improve healthcare and create jobs nationwide. Both goals are admirable.

Physicians should take advantage of this “breathing room” and implement ICD-10. It seems the large effort to try and stop ICD-10 could be better utilized to help implement ICD-10

ICD-10: Will Coders Retire or Retool?

There is some speculation and anecdotal evidence suggesting that a substantial number of the more experienced, long-term coders are going to retire rather than retooling for ICD-10. While there will be some that take the early retirement route, it is my contention that these numbers will be few.

Coding is a puzzle and has always had new changes…every October 1^st. Furthermore, coders are inherently problem solvers. Most, I believe, will step up to the challenge that ICD-10 and the changes to CDI will bring.

Keep in mind you may still need a few top of the line ICD-9 coders for some time to come. For starters not all health plans must transition to ICD-10. Non-covered entities do not maintain HIPAA compliance can opt to remain on ICD-9 as they do not send electronic claims.

There will also be RAC audits with three-year look back periods—another area for ICD-9 coding expertise. Finally, ICD-9 coders could be placed in the centralized business office to help with ICD-9 denials.

Given the scarcity of experienced coders, it may behoove you to incent some ICD-10 naysayers to remain on board for a few more years. It’s just another staffing strategy to consider during these tumultuous times.

You Are Cordially Invited, Please RSVP

Well, here we are closing out the year 2011 and the urgency to get ICD-10 training has finally started to receive attention. It is starting to move – glacially.

The latest AHIMA survey (August) showed 85% of respondents have at least begun work on planning and implementation work for ICD-10. This is up from 62% reported from a year earlier. The survey also determined that the organizations are further along in creating ICD-10 budgets and assessing training needs for staff. The bad news is that only 49% report have actually made changes based on their assessments.

As far as we can tell, 100% of the research says there will be major training needs as well as considerable clinical documentation improvement needed. The question is are you going to be ready for ICD-10 by doing it right over the next two years; or are you going to try and “pull the all-nighter” and cram for this at the last minute?

If you wait until the last minute do not expect a lot of help. The best and the brightest resources are getting locked–in. They’ll all be committed and unavailable to help the laggards. In fact, their dance cards are already getting filled.

TrustHCS is gearing-up with highly skilled, certified trainers. We are offering training, webinars, and/or e-learning tools tailored to your individual needs. But you need to RSVP!

On a parallel path with training is the need to upgrade your clinical documentation…now. We have expertise and credentialed resources  to help in this process, and coordinate CDI plans with the training effort in coding and other departments. View some of our CDI blog post contributions to ADVANCE’s  CDI: Time to shine series at http://comminutiy.advanceweb.com/blogs/hi_19/default.aspx

Alice Zenter is a world Class resource – she’s here to help!

TrustHCS Forms Three-Year Partnership with Allegiance Health for ICD-10 Training, Coder Back-Up and Clinical Documentation Analysis

Coding Consulting Firm also Protects Hospital’s Revenue Stream with DNFB Assurance Program

Springfield, MO, September 28, 2011:  TrustHCS℠, a HIM, compliance and revenue cycle consultancy firm for hospitals, clinics and physician practices, today announces a three-year contract with Allegiance Health of Jackson, Michigan, for their complete ICD-10 Educational Services and DNFB Assurance Program. The announcement was made by Torrey Barnhouse, Chief Executive Officer for TrustHCS. TrustHCS will serve as Allegiance Health’s core ICD-10 training and coding services partner by providing:

• Coder assessments and training
• Ancillary staff training
• Back-up coding support and outsourcing services
• Clinical documentation assessments and physician training

“Allegiance Health took the right approach to ICD-10 education by creating a multi-year plan and getting started now,” mentions Barnhouse. “Based on assessment results and already identified areas of need, TrustHCS will begin training for our 22 coders in late 2011, continuing through the end of 2013, “explains Terrie Vilminot, RHIA, Director, Health Information Management, Allegiance Health.

“It is such a relief to know our training needs will be taken care of by experts allowing us to focus on the many other components of ICD-10 implementation,” mentions Vilminot. In addition, Vilminot’s coders get a jump-start on their education with advanced anatomy and physiology courses, also through TrustHCS.

“We’re employing a very prescriptive approach whereby TrustHCS will establish our training schedule, project manage the entire educational component, and customize our program,” adds Vilminot. “When trying to design what we needed to do for ICD-10 training, it wasn’t until we met with TrustHCS that our team realized this is exactly what we are looking for.”

How is Your Foundation?

June 15 was national 5010 testing day. Did you participate? The statistics show that most did not.

The new 5010 standard goes live on Jan. 1, 2012 and is the foundation on which ICD-10 is based. Not to mention all HIPAA covered entities will be required to use the 5010 set in all electronic transactions, including claims submission, eligibility checking, claims status inquiries, and electronic remittance advice. CMS surveys suggest that vendors are the furthest along the path to 5010, followed by payers and lastly by providers. MGMA surveys show that physician groups are even further behind the learning curve than hospitals are.

There are a set of critical paths required to achieve success in the ICD-10 world. One of them is the 5010 implementation. You can build your foundation on quicksand or on bedrock. Clearly, a bedrock-based foundation is far superior. Now is the time to check your organization’s progress towards testing and implementing the 5010 standard. ICD-10 simply can’t happen without it.

Another foundation for ICD-10 success is training and education. Lay your bedrock foundation for training and education now. Do not put it off until the deadline approaches, like many of you seem to be doing for 5010. Get prepared, for the light at the end of the tunnel may be an oncoming train.

Coder Training: It’s Going to Cost How Much?

Looking at the level of training required to adequately prepare coders, it is clear that this is going to cost healthcare organizations a lot. Two approaches to tackling this challenge appear to be emerging. In the first approach, institutions are picking up the tab – in terms of both time and dollars.  These facilities are scheduling the training during work hours and increasing their departmental budgets to cover the related costs. One word of caution here: departments who engage in this method of training must also plan to address the DNFB / un-billed workflow issues created by the coders’ absence from their “normal” workweek.

The second, and less popular, approach places more of the burden on the coders themselves, making ICD-10 training a condition of their employment.  To their credit, the organizations implementing this second method are, most often, paying for the training courses that coders complete on their own time.

Regardless of the method selected, the vast majority of organizations agree that the combined cost of training and DNFB / un-billed workflow issues will still pale in comparison to the long-term costs of post-implementation, ICD-10-related productivity changes.  A permanent loss in coding productivity of 30-50 percent should be expected, although a minority believe that a 10 percent drop is achievable.  Few however, debate that the initial productivity loss will be at least 50 percent – a drop that will very likely last for several months.

To identify the potential impact of lost labor at your organization, consider the following equation:

-          Each FTE represents 2080 hours per year.

-          Assume 80% of those hours are productive, leaving 1664 available for actual coding.

-          If 500+ of those hours are required for ICD-10 training, you will lose 30% (or more) of productive hours per FTE.

HIM Directors and financial executives need a plan for dealing with the financial impact of ICD-10. This can range from forecasting the financial hit and living with it, to hiring more staff or backfilling with outside contractors throughout the transition period. If using outside contractors is your option, lock them in now. The best coders are being signed-up even as I blog.  On your mark, get set…

Chasing Top Guns in ICD-10

If fighter pilots go to Miramar for Top Gun School to be the best of best, then where do coders go for ICD10? Coders go to AHIMA to be the best of the best. And so does TrustHCS.

We are pleased to be the first company in the nation to offer the AHIMA Foundation Education Program to educate and prepare coders for ICD-10. By combining the AHIMA curriculum with our already extensive ICD-10 preparedness services, we’re creating a full-service solution that can be tailored to meet our individual customer needs.

Over the next six months we will work with AHIMA to focus on ICD-10 preparation and assessment through overview curriculum and education in anatomy and physiology, pharmacology and medical terminology. From there, we’ll assess each organization’s staff and physicians. More in-depth, customized training programs will be created to address specific gaps in coder knowledge and physician documentation patterns.

Just like fighter jets screaming upwards beyond the clouds, the ICD-10 learning curve gets steeper as you go. The longer you wait, the harder it will be to change coder and physician behaviors and long-standing practice patterns. With AHIMA and TrustHCS by your side, let’s get moving!

Wrong…By an Order of Magnitude?

Most of the estimates for training inpatient coders on ICD-10 are in the 50 hour range. But recent findings suggest estimates could be off by an order of magnitude—maybe even a magnitude of 10!

The 50 hours suggested by AHIMA refer specifically to the technical application of ICD-10 coding. This is the training AHIMA recommends for 2013 and is needed to prepare coders for go-live. However, these 50 hours do not include bio-medical training, ICD-10 overview courses, or training on the six additional body systems. The largest discrepancy is in bio-medical training.

Bio-medical training, as suggested by AHIMA, involves essentially three college level courses including:

• Anatomy and Physiology
• Pharmacology
• Medical Terminology

The estimated number of  hours of effort required for this training is 480! Nine times greater than the initial 50-hour estimate.

Skewing the estimates even further is the need for ICD-10 overview courses.  AHIMA has four, which will take nearly 20 additional hours. Finally, the six additional body systems courses add approximately another 12 hours. In total, you could be looking at over 500 total hours of new training to prepare a coder for ICD-10.

Our experience suggests that most coders will need all the training suggested above—particularly the bio-medical courses. Even the most experienced coder’s knowledge will be tested when they are asked to employ the anatomical and physiological acumen required under ICD-10 guidelines.  Given the extent of training that is required, it makes sense to start now. By doing so, you can spread the cost out over three or four years; and the time requirements. Not too late to start. But no time to wait!