Cancer Registry: The Forgotten Issue?

HIM Directors are keenly aware of the transition to ICD-10 (see our blogs). Meaningful use of EHRs, 5010 billing changes, RAC audits and staffing issues are front and center on the list of threats facing healthcare today. HIM departments and CIOs are confronted with an ever-expanding list of “to dos” coupled with decreasing margins and cries to cut expenses.

In light of all the pressing issues, have you remembered to plan for and implement important changes in Cancer Registry? We hope so. Since the new schedule for abstracting and editing started in Jan. 2011.

The new burden on registries is enormous. Not only are the schedules changing but all four reference books are in flux. Here’s the TrustHCS official list of registry changes:

• Changes in schedules
• Changes in all four reference books
• Changes in cancer reporting requirements and standards
• Changes in cancer staging
• Additional field and software changes
• New rapid reporting requirements will be implemented and enforced

While changes are difficult to manage, they are here for a reason. Together they make reporting more current and provide important information leading to better cancer treatments and saved lives. It’s that old “saved lives” concept that makes changes hard to ignore.

Don’t let Cancer Registry be forgotten in your organization. Set the stage with your senior management to get the resources you need before it becomes a crisis. Be proactive and implement the change. Somebody has to do it! We’re here to help.

‘A funny thing happened to me on the way to the asylum…’

I hail from Missouri, specifically the Ozarks of Missouri.  Anyone who has ever visited this part of the country would likely agree that it is strikingly beautiful and ever-changing.  In fact, the metamorphic scenery and seasons is what makes this region so beautiful.   Nothing ever looks the same from one day to the next. The same could easily be said for the healthcare industry.  I know, calling the healthcare industry a beautiful thing might be a stretch but if you are a professional who thinks an environment that requires resourcefulness, flexibility and endurance is a beautiful thing, then you are in heaven!

Over the last few years, we’ve seen the sweeping impact of the legislative changes created by HIPAA, HITEC and ARRA. These monolithic pieces of legislation don’t move at a glacial pace however.  They spread like wildfire and they are no respecter of  person or position.  Daily, we hear of the failings of pedestrian and premier facilities alike.  The challenges facing this industry today are great and numerous and no one seems to ever be prepared enough – if ever there was such a state.

Sure, nostalgia takes over a bit as we look back on some of the past challenges – think Y2K.  We all took our turn in the pulpit crying “the sky is falling”, certain that our lives were forever about to change as the clock rounded midnight.  If we were all absolutely honest with each other we might even admit that we were all a little disappointed that the sky didn’t fall and that midnight came and went somewhat, if not entirely, uneventfully.  Take heart though my fire and brimstone friends – we’ll have our chance again to preach to the masses as we consider the implications of ICD-10 – think Y2K on steroids.  There is little doubt that this event is more genuinely impactful by comparison.  We have our Canadian colleagues to the north to thank for their early warning.  By comparison, even the most optimistic outlook of the impact of ICD-10 on productivity and staffing is nightmarish.  Considering the fact that Canada’s precipitous decline in productivity was limited to the impact of ICD-10-CM alone, we’ve got a rude awakening ahead of us if we don’t at least consider the additional impact of PCS.

Currently, we’re scrambling to embrace the challenges and implications of 5010 readiness, EHR implementations, medical necessity, RAC and meaningful use – just to name a few.  These challenges, like seasons, march on whether we like it or not.  No doubt, it makes our professional lives more exciting and, after we make it through a particularly challenging season, more rewarding.  I mean really, who wants to do the same-old-same-old every day?  Just remember your mantra… “I love change, I live for change, change is good” and you’ll be OK.  Oh yeah, and it doesn’t hurt to keep a fresh supply of tissues, a bottle of aspirin and your colleagues on speed dial either.

Triskaidekaphobia: The Fear of 13

Triskaidekaphobia

ICD-10 code: F40.298 other specified phobia

Triskaidekaphobia is fear of the number thirteen. For the entire healthcare industry, the number 13 has significant meaning. On October 1^st, 2013 the world will change for many of us. Are you ready? How your organization even started? If not, you’re already behind.

In addition to all the work that lies ahead, much work will go undone. Clinical coder productivity will definitely decrease, and perhaps for a long, long time. Some estimate a 25- 50 % decrease in coder productivity and 5 -15% decrease for other healthcare practitioners.

One proven way to ease the fear of change and minimize the negative impact is through training: multi-year, multi-media and multi-resource. There will be limited AHIMA certified educators/trainers available. And the best of the best will be booked soon. The time to line-up your ICD-10 resources and partners is now!

When it comes to curing triskaidekaphobia, don’t wait and hope that your organization can make this transition at the last minute. The cure – partner with someone you trust and partner today. Triskaidekaphobia can be cured, but there won’t be a single, magic pill.

ICD-10 Education: Five Ideas to Consider Now

The most important aspect of your ICD-10 transition plan is EDUCATION. Pretty much everyone in the institution needs to re-tool their skill set to accommodate ICD-10. Many hospitals are planning to use a train-the-trainer approach whereby several key people get trained and, in turn, they train everyone else. In fact, AHIMA recently announced an “Ambassador” program based on a train-the-trainer methodology.

The problem with this approach is that you lose the productivity of both the trainer and those being trained. Secondly, timing is of great concern. You can’t afford to do ICD-10 training too early and have people forget it before go-live. On the other hand, you can’t cram it all in at the last minute. Yes it’s true: ICD-10 education and training is going to cause some unique challenges. And demand some new, out-of-the box ideas.

As the expression goes you can eat the elephant one bite at a time. ICD-10 training should be the same. That is, ICD-10 education is a multi-year process. It even continues after go-live to ensure accuracy and compliance. Here are some other practical tips for successful ICD-10 education. Start planning now and line up your training resources while you can. Finally, let us know if we can help!

-          ICD-10 education should be a multi-year process

-          Use a multi-media approach: paper, virtual, webinars, conference calls, presentations, self-paced, workshops, etc.

-          For physicians, address unique preferences and needs.

-          Hire trained, accredited educators and assign them 100% to the education task. AHIMA has the only official program at this time.

-          Outsource training if needed and purchase or contract for outside resources to get the job done.

Incompatibility Reaction: 7 Tips for Highly Effective Audits

Nobody likes to have their work subject to oversight, grading, and criticism. But most people do like to get educated, improve their skills and make themselves more valuable to their organization. When positioned as a learning experience, coding audits can be extremely beneficial for everyone involved, including physicians.

Whether your audits are internally-conducted or led by an outside, industry consultant, “how” you present findings is critical. Presenting audit results as an educational benefit tends to yield the best results. Here are seven steps for highly effective and collaborative audits.

1. Communicate early in the process with both coders and physicians. Everyone should be aware of the internal and external “eyes” upon them.
2. Remind everyone involved that no one is perfect and even the best coders / physicians can do their jobs better.
3. Work at the individual level when presenting case or employee-specific findings and recommendations. This is where one to one communication is best.
4. Include findings and new learning objectives as a performance goal in employee evaluations.
5. Garner executive level support for your coding compliance program, particularly as it relates to improving physician documentation. Getting the Chief Medical Officer on board is crucial!
6. Be professional, non-threatening and take the time to listen. Present the facts – not opinions. And remember that listening is the most important part of effective communication.
7. Finally, establish an appeal process should coders or physicians disagree with auditor findings. Allow room for discussion and negotiation.

Yes, physicians, coders and auditors can be compatible…even when they sometimes disagree! Share your top tips for audit success here and thank you for reading.

External Coding Audits: Make the Most of Yours

Time and time again I meet with HIM Directors who fail to realize the full benefit of an external coding audit. Most of the time it’s because audit or recommendations aren’t implemented and corrective actions aren’t taken. Time gets spent. Money gets wasted. But a return on investment is never achieved.

External coding audits require HIM management time, coding resources and a significant piece of the departmental budget. Merely completing an audit accomplishes very little unless HIM directors take a serious look at auditor recommendations, correct deficiencies and improve processes.

Here are three ways to ensure your organization gets the most from your next external coding audit.

• Prepare for the audit (set clear goals, secure executive support, prepare coders, and identify cases)
• Manage the audit (communicate and coordinate with IT, coding management and auditors)
• Review and implement recommendations (conduct exit interviews, use final report as action list, conduct education based on findings, measure improvement)

While some external auditors are now conducted remotely, most are still performed on-site at the hospital or physician practice location. If external auditors come on-site, here are a few final tips to help ease the process and expedite results:

To read more about making the most of external coding audits, visit my article on this topic at: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_043989.hcsp?dDocName=bok1_043989

Registry Change: Ready or Not

It seems building a meaningful EHR at the same time you are converting to ICD-10 at the same time recovery auditors and core measure reviewers are breathing down your neck is not enough. This year, the added pleasure of substantial changes to Cancer Registry needs to fit into your spare time.

When I say substantial changes, I really mean substantial! These changes are as big, if not bigger than those anticipated for coding. They include:

• Changes to all reference books
• Changes to reporting requirements and standards
• Changes to cancer staging
• Changes to reporting software
• Additions to the required data fields
• New rapid reporting requirements
• And more!

Now that these changes are in place, how are you dealing with them? Did you plan adequately for them? Did you evaluate your staffing and educate your registrars? Did you communicate your needs up and down the chain of command?

In the wake of all this change, many registry departments are woefully behind and barely keeping up with new cases. For others, things are fine and you have successfully navigated the disruption. Either way, let us know how 2010 cancer registry changes are impacting you and your organization.

And if you’ve developed any new best practice processes, we’re all ears.

A Small Fix to Unemployment

A recent article in eWeek.com by Don E. Sears on IT Management, titled “Ohio Ban on Offshore Outsourcing Raises more Ire from Asia”, got me thinking about outsourcing. Of course this ban is only for public funds, but there is a lot be said for the idea of keeping work in the good, old U.S. of A.

Clearly, the perceived advantage of off-shoring is cost savings. But cheaper isn’t always better. When comparing quality against cost, quality always wins—especially in health information management (HIM). And better quality is really better value!

HIM Directors simply get more for their money here in the U.S. Heightened HIPAA compliance concerns, privacy issues, quality of staff, education, certification, and familiarity with U.S. regulations all weigh heavily in the value equation. Furthermore, there is definitely something to be said for extra “hands” that know you, your organization and your staff.

Are you struggling to find qualified HIM professionals? Is keeping up with HIM workload a daily battle? Do government auditors and other departments continually heap new demands and responsibilities on your already over-burdened staff? If so, outsourcing is clearly your best option. It’s the “who”, “where” and “when” that must be carefully determined, and assigned.

Yes, the latest proposal from the Buckeye State got me thinking….and my thought is let’s keep the jobs here in the U.S.

Audit, Assessment or Both? Evaluating Revenue Cycles in Practice

Sometimes physician practices need a focused audit. Occasionally a complete process assessment and re-engineering plan fits the bill. And on other days, the practice isn’t exactly sure what corrective action to take. They simply know the revenue cycle is broken and something must change.

Recently I worked with a busy pain clinic in Southern California. We started with a simple practice assessment, but ended up completely re-engineering the revenue cycle. Here are the highlights!

Symptom: A large, unexplained rise in accounts receivables.

Underlying Cause:

Corrective Measures:

At the end of the month, everyone understood the value of correct coding and its impact to the practice’s revenue cycle. They began working as a cohesive team as the focus shifted from reactive to proactive accounts receivable (AR) management. Finally, they aligned job responsibilities with each individual’s strengths and by doing so, achieved optimal performance from each and every employee.

In the final analysis, everyone had positive intent. And so does everyone in your practice! An external set of eyes and ears made all the difference and quickly led to a stronger, more cohesive organization. Perhaps it’s time for every practice to consider the same.