Instead of wishing for more time, the leadership team of one New York hospital has been working hard to ensure it is ready when the conversion finally happens on October 1.
While it's impossible to know for sure if ICD-10 will go into effect as planned on October 1, 2015, the hospital and health system executives I have spoken to recently are not banking on—or even hoping for—another delay.
[CMS says there will not be another delay.]
"I'm not sure there will be another groundswell that will delay it further. Of course, there is always the potential that the doc lobby will push for a delay, but I don't think you'll find at this point that [hospitals are] interested in seeing another delay. I think most hospital providers would prefer to take the hit than to keep doing this start and stop sort of thing," says Mark Bogen, chief financial officer and senior vice president, finance at South Nassau Communities Hospital in Oceanside, NY.
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Instead of wishing for more time, South Nassau's leadership team has been working hard to ensure the organization is ready when the conversion finally happens. According to Bogen and Richard Rosenhagen, South Nassau's assistant vice president, electronic medical record, health information management and clinical documentation improvement, the hospital has implemented several strategies to help with readiness:
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Mark Bogen |
1. Reducing Staff Anxiety
South Nassau has been preparing for more than three years for the transition to ICD-10, which has given the hospital time to develop plans and put them into place in a thoughtful manner, Bogen says.
"We kicked off our steering committee in November 2011… This has helped because nobody feels like we are in crisis mode. We've been able to give it a lot of thought, energy, and attention, and we've been able to update our technology and tools."
By giving itself enough time to get ready, South Nassau has significantly decreased the level of anxiety its staff has regarding the change.
"The fact that we started early—about three years ago—to prepare staff has decreased the degree of angst because the concept is not really scary for staff now," Rosenhagen says.
"Sometimes the media jokes about coding things like 'skis caught on fire' or 'hit by bird' and these kind of things can make ICD-10 seem scary. But, our coding staff has been engaged in this over a long enough period where any angst or anxiety has been dealt with, and they know we are going to give them the toolset they need to enable the best coding possible based on the best documentation we can provide them. I think if we had started any later, that may have been a problem, but I don't think it will be for us."
2. Creating Physician Buy-in
South Nassau has also worked to mitigate apprehension amongst physicians. Three years ago, South Nassau formed a physician hospital organization to become clinically integrated in preparation for new state and federal regulations governing the healthcare industry. As part of this new partnership, the hospital sponsors quarterly education sessions for physicians and their office staff to help them prepare for ICD-10.
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"This relates to the impact ICD-10 will have on physicians. It has nothing to do with the impact to the hospital. It's about what physicians' practices really need to know and how to document under ICD-10 for their own practices and professional billing," Bogen says.
"That has engendered a lot of good will because it is primarily driven by the impact it will have on individual physicians."
3. Hiring Coders from Within
South Nassau is located in a densely populated area on New York's Long Island and competes with other healthcare organizations to hire and retain coders—something that has been a particular challenge for the hospital. By focusing on ICD-10 for such a long lead time, South Nassau has been able to train coders from its existing employee base.
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"It has been tough to both recruit and retain coders. In the past, most hospitals preferred to go out and find experienced coders and were poaching from each other and driving up the market from a cost perspective. We are always interested in getting good, experienced coders, but we decided in terms of recruitment, it may be easier to grow our own, although that can take more time," Bogen says.
"More and more employees are at least going to the coding classes and getting the certification because when working in HIM, there is a substantial difference in pay for those who are doing clerical work versus those doing coding."
On the retention side, South Nassau is allowing fully trained coders to work from home, which is a benefit many employees value highly and an advantage for a hospital that is pressed for office space.
"With our enhanced tool kit, we can now manage productivity from a remote site as well as we can when someone is within the four walls of the hospital. This also benefits us because we are not taking up valuable hospital territory with something that is not necessarily the best use of the space," Bogen says.
4. Upgrading Technology to Maximize Revenue
Another critical piece of ICD-10 readiness is having the technology in place to manage the process and maximize its potential positive impact on revenue. South Nassau has worked with a vendor to make the necessary enhancements to its IT systems.
"We have gone through and have now upgraded our systems and installed a suite of products that is ICD-10-compliant and has the ability for us to start coding in 9 and 10. The sooner you can start the dual coding, the better, even though it obviously creates issues from a productivity standpoint," Bogen says.
"You really need six months with dual coding to feel like you have any shot of being successful when the light goes on October 1st. This is to us where the opportunity lies and, to some degree, where the risk mitigation is."
The hospital has also installed a computer-assisted coding and natural language processor tool that "lays on top of the EMR," to improve its clinical documentation, Rosenhagen says.
"Using the CAC and NLP, we are able to uncover hidden components in the medical record that we might otherwise miss. With the tool examining the text, it allows the CDI nurse to get a really good picture of the case as early as the first day, and it promotes better documentation. When it sees some fuzzy documentation, it requests clarification and helps assure that the codes are accurate," he says.
Having more specificity in the clinical records will not only be important for coding correctly in ICD-10, it will also likely lead to more revenue for the hospital, Bogen adds.
"Better documentation is always a good thing and often leads to higher acuity and higher payments."
Rene Letourneau is a contributing writer at HealthLeaders Media.