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The Path to ICD-10 Success

A multi-faceted approach includes investing in people, processes and technology

With the timeframe for the ICD-10 transition now measured in months, healthcare organizations face multiple challenges tied to preparation, training and effectively managing the implementation. Organizations that are simply preparing for the short-term, planning to address long-term impacts after initial go-live, are taking a significant risk. At Aria Health, the answer to mitigating risk and achieving positive financial and operational outcomes with the ICD-10 transition centers on a multi-faceted approach.

This multi-faceted approach includes investing in people, processes and technology. By engaging this process, healthcare organizations can proactively assess potential impacts and create a framework for success. An understanding of group productivity metrics, for instance, will allow healthcare leaders to make informed decisions about staffing to mitigate potential declines in productivity. Technologies exist that can be used to measure individual coder proficiency, as well as group productivity. Additionally, clinical documentation improvement (CDI) programs can play a supporting role in the context of larger organizational objectives.

No matter where an organization starts, a proactive approach to ICD-10 takes a mix of personnel and technology-based training, testing, assessment and analytical tools.

Paving the ICD-10 path: Start with coders
Most experts suggest starting coder training with a refresher course on foundational elements - like anatomy and physiology - to align coder knowledge with ICD-10's stronger focus on terminology and understanding of individual procedures. Yet allocating sufficient training time can be a challenge. Attempting to train coders as part of their normal work week or increasing their work hours can result in lower ICD-9 coding productivity, high levels of stress and a deficient learning experience.

A more effective alternative is to dedicate one day per week for coders to receive formal classroom training, and use contract coders on that day to mitigate potential revenue shortfalls. Although there is a cost associated with paying for contracted coders, the investment will be justified by higher coder productivity during the ICD-10 transition.

Recognizing that all adults learn differently, a multi-layered training approach is also valuable. The "layers" of an effective learning program might include:

  • interactive elements such as modular computer based training (CBT)
  • live webinar training that allows coders to connect with instructors
  • formal in-person classroom training  

There are a number of high-quality modular CBT courses for ICD-10-CM and ICD-10-PCS which allow organizations to set specific learning objectives for coders. Additional support might include supervisors acting as proctors during the training program and facilitating discussion among the staff around the ICD-10 coding principles.

Ideally, formal coder training should be started no later than January and largely completed by June of 2014. At that point, focus should shift to a "practice and measure" mode, using the organization's own charts, DRGs and documentation. Being able to practice on their own charts and DRGs, rather than standardized templates, creates a more realistic experience for coders.

The first objective during this phase should be to achieve ICD-10 coding accuracy, then focus on increasing productivity. Using technology that enables coders to immediately see where and why they are making mistakes, as well as where they are proficient, accelerates the learning process. A technology solution is critical because it is simply too expensive and impractical to use auditor-level personnel to assess and correct ICD-10 training scenarios. For our organization's needs, our educational program's "one-two punch" of training and practice functionality provided the foundation needed to effectively usher our staff through the implementation process.

At Aria Health, our "learning loop" is completed as the technology directs the education of the coders when an error is made in real time. Through this process, each coder is directed to the portions of the chart that support the correct code so they can clearly see why the error occurred. In addition, from the chart, the coder has the option to re-take specific CBT learning modules that reinforce the training for this topic.

In addition, supervisors can analyze individual and group performance and provide help where needed. The impact of this will be focused retraining initiatives prior to October 1, 2014 that will enable our organization to mitigate the financial impact of ICD-10 upon go-live. The technology will not only call out where the most common errors are made, but it will also calculate the impact on CMI and revenue. With this approach, the technology works to streamline what would otherwise be a financially burdensome and resource-intensive manual undertaking.

Training and support for clinical staff

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CDI in the Outpatient Setting

Outpatient services are primed to benefit from clinical documentation improvement

The American Health Information Management Association (AHIMA) suggests all clinical staff who generate documentation used for coding receive role-based ICD-10 training. There are a number of ways to support these efforts, including CBT and interactive training sessions, as well as specialized smart-phone apps that provide the correct ICD-10 terminology for any medical encounter.

For many healthcare organizations, CDI staff also factor into the system-wide equation. For instance, new CDI programs can now start incorporating ICD-10 nomenclature on all provider query forms. Doing so allows physicians and clinical staff to slowly begin absorbing ICD-10 concepts and terminology before the go-live date, plus it helps staff become accustomed to the additional level of detail required for ICD-10. Adding further support, CDI staff might attend physician meetings to provide updates and information on key ICD-10 concepts and CDI results.

Smoothing the path to implementation and beyond
Publicly available research suggests that coder productivity may drop by as much as 50% during the initial ICD-10 transition, then level off at 20% below current levels. To protect against both short-and long-term revenue loss and ensure coder preparedness, healthcare organizations should develop a comprehensive plan to train all appropriate staff on ICD-10.

Given the size and scope of the ICD-10 transition, it is also imperative to prepare for significant course corrections after go-live. Feedback and responses from public and private payers will ultimately determine how cash flow is impacted and which areas will need improvement. While the transition will affect all healthcare organizations differently, it is critical to be prepared ahead of time, and to continue those efforts well after Oct. 1, 2014.

Taking a strategic, holistic approach to ICD-10 means employing a multi-layered educational program and analytics to create business plans based on critical performance and productivity metrics. By leveraging technology-based learning, practice and assessment, healthcare organizations can accelerate and individualize the process, ensuring financial and operational success during the ICD-10 transition and beyond.

Sigrid Warrender is the corporate director of HIM for Aria Health, one of the largest healthcare providers in the Philadelphia area, consisting of three community hospitals and a major network of outpatient centers and primary care physicians.

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