A N A D V E R T O R I A L T O P R O D U C E D B Y S O U R C E M E D I A M A R K E T I N G S O L U T I O N S G R O U P

ADOPTING

THE TRANSITION WILL BEMONUMENTAL

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DEADLINE LOOMS, WILL ACTION FOLLOW?ICD-

Indeed, according to a study conducted in June of 2013 by the Medical Group Management Association (MGMA), Englewood, Colo., only 4.8 percent of medical practices reported that they have made signi cant progress when rating their overall readiness for ICD-10 implementation.

e transition to ICD-10, with its substantial impact on documentation of clinical care, physician productivity and practice reimbursement, is unprecedented, stated Susan L. Turney, MD, MGMA president and CEO. It is proving to be one of the most complex and expensive changes our healthcare system has faced in decades. Adding to the implementation challenge and clearly taxing all stakeholders, ICD-10 will arrive at the same time that a number of other transformative federal policies go into e ect, such as health insurance exchanges and Stage 2 of the CMS Meaningful Use EHR Incentive Program.

An earlier study conducted in February of 2013 by the Workgroup for Electronic Data Interchange (WEDI) shows that organizations have not really taken advantages of the extra time a orded them when the deadline was pushed back from 2013 to 2014 but instead have simply dragged their feet.

It has become clear that many entities postponed

their work until much later, says Stanley Nachimson, director of the North Carolina Healthcare Information and Communications Alliance/WEDI timeline initiative for ICD-10. Indications remain that signi cant numbers of industry participants have a considerable amount of work to do in a very short time.

e study, which surveyed representatives from about 950 organizations, found that a third of providers said that the compliance date extensions prompted them to shi their timeline for their ICD-10 projects by more than six months, while a quarter of vendors admitted such changed priorities. When questioned further about their compliance plans, about 40% of providers said they didnt have an estimated completion date for their ICD-10 impact assessment about 40% also said they were unsure of when they were going to complete ICD-10 business changes. Further, about half of surveyed providers said they werent sure when they would be able to begin external testing with health plans or other trading partners.

AN IMMOVABLE DATEWhile some organizations and leaders are calling for

yet another extension, at this point, it doesnt look as if

Its often said that theres no better motivation than a deadline. Yet healthcare organizations dont seem like they are on track to transition from International Classi cation of Diseases, Ninth Revision, Clinical Modi cation (ICD-9-CM) to the International Classi cation of Diseases, Tenth Revision, Clinical Modi cation (ICD-10-CM), despite the fact that the federal governments October 1, 2014 deadline looms in the not-so-distant future.

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3M Health Information SystemsKnown for market-leading coding solutions and ICD-10 expertise,

3M Health Information Systems delivers innovative software

and consulting services that raise the bar for computer-

assisted coding, clinical documentation improvement, and

natural language processing. With a robust healthcare data

dictionary and terminology services to support EHR expansion

and accuracy and 30 years of healthcare experience, 3M is the

choice for organizations wanting to improve quality and nancial

performance.

CONTACT3M Health Information Systems575 W. Murray Blvd. | Murray, UT 84123800-367-2447 | 3MhisSales@mmm.com | www.3Mhis.com

As changing regulations exert new demands on healthcare providers, rural hospitals and clinics, with limited staff and fewer resources, must nd new and innovative ways to prepare for regulatory mandates. Hays Medical Center exempli es this kind of innovation. A health system on the front lines of technology adoption, Hays began transitioning its records to an electronic health record (EHR) system in 2004, well ahead of many other facilities. Today, about 95 percent of Hays records exist as discrete data within its EHR, enabling better access to patient information for caregivers across its multi-county region.

The advent of ICD-10 and the growing volume of data in the EHR had the potential to impact coding speed, documentation accuracy and timely billing. Deloris Farthing, HIM director, realized her department needed to streamline coding and CDI processes to head off the expected ICD-10 productivity impact.

The reality is that in the new ICD-10 environment, you can either work

harder or work smarter. We chose the second option, she said. For Farthing, the who was equally as important as the what in choosing an integrated computer-assisted coding (CAC) and clinical documentation improvement (CDI) solution.

More than simply acquiring new software, Hays wanted a vendor they could count on. Having previous experience with 3M, Farthing says, was an important factor in their selection.

Our coders have used 3M coding software since 2002 and 3Ms DRG Assurance program has helped us keep our documentation on track since 1998. Once we heard that 3M had released an inpatient computer-assisted coding program, we didnt even look at any other vendors.

After a year of success using 3Ms CAC technology, Hays signed on to be the rst beta site for the 3M 360 Encompass System, going live in December 2011. Farthing says the process has been smooth. Taking on the responsibilities of being a beta site

isnt something shed be willing to do with every company.

With 3M it wasnt an issue because we worked together. They listened to our pain points and always asked for our suggestions for improvement.

True to its reputation for leading innovation, Hays is well on its way to achieving ICD-10 readiness.

With the 3M 360 Encompass System, Hays Medical Center has realized a 45 percent increase in inpatient coder productivity and a 20 percent increase in outpatient coder productivity. Staff members who shied away from the automation changes now embrace the bene ts. Since implementing 3M 360 Encompass, Hays has seen a marked increase in coder and CDI staff satisfaction.

To get more information about the positive results Hays Medical Center has received with the 3M 360 Encompass System, download the full case study, at www.3Mhis.com/Hays360

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Vitera Healthcare SolutionsVitera Healthcare Solutions provides end-to-end clinical and nancial technology solutions

so physicians and medical professionals can work with patients, not paperwork. Physician-

focused and patient-centric, Vitera Healthcare Solutions provides electronic health records

and practice management systems serving more than 415,000 healthcare professionals

including 85,000 physicians and several specialties such as primary care, OB/GYN,

pediatrics, cardiology and orthopedics.

CONTACTVitera Healthcare Solutions4301 West Boy Scout Boulevard | Suite 800 | Tampa, FL 33607(877) 932-6301 | www.viterahealthcare.com

What are the most important elements of a comprehensive approach to ICD-10?

The idealand most effectiveapproach to the ICD-10 transition engages all areas of the practice, and includes both a high-level and in-depth analysis of operations. A checklist for successful ICD-10 adoption should include:

Comprehensive planning. Identify all systems used to create, store and transmit ICD-10 codes, and work with associated vendors to understand their timing and customer support in regards to ICD-10.

Education and training. Develop a training program for all staff members who will be affected, including front of ce and billing staff. Ensure staff understands the rationale behind the migration from ICD-9 to ICD-10 and how important a smooth transition is for the practicefrom an operational, nancial and care perspective.

Technology preparation. Prior to conversion, medical practices must have assurances that their practice management (PM) and electronic health record (EHR) systems are ready for ICD-10. All of Viteras solutions, including Vitera Intergy, Vitera Stat and Vitera Medical Manager, will be ICD-10-enabled by the end of 2013.

Testing. To ensure users are as comfortable as possible with the new system, the practice should schedule its upgrade as far in advance of the October 2014 deadline as possible and be prepared to conduct testing with other stakeholders early in the process.

How can healthcare organizations best manage the transition to ICD-10 while also addressing other IT projects such as Meaningful Use?

There is little question that ICD-10 adoption will impact practice operations, cash ow and staff productivity. Ongoing efforts to comply with the next stages of Meaningful Use will only compound the challenge, for both staff and leadership. Practices that adopt a change management attitude toward these transitions and create a comprehensive roadmap will be able to minimize disruption, maintain their revenue stream and achieve their goals more ef ciently.

It is key that practice staff understand the two initiatives and why each is important to the practices future. Upfront training and ongoing education will help engage staff and empower them to make necessary adjustments to their work processes.

Both projects, of course, require that staff managing IT efforts adopt a plan that considers whether existing PM

and EHR software can be updated or if a new solution is needed. The IT strategy must not look only at the current challenges, but ensure their system is robust and scalable to serve the practices future HIT needs.

How can healthcare organizations best work with various software vendors to ensure a smooth transition to ICD-10?

Without a doubt, practices will look to their technology partners for assistance with preparation, implementation and ongoing support. From the onset, practices must understand that this transition is not a coding or billing challenge; rather it represents a signi cant IT project.

Collaboration and coordination between the practice and software vendor is crucial. An intentional and well-planned ICD-10 implementation strategy includes planning, communication, testing and training that engages both staff and all vendor partners. Forward-looking vendors like Vitera are actively helping providers prepare by offering regulatory readiness resources, including those at www.viterahealthcare.com/regulatoryreadiness, in addition to ensuring the technology they provide comply with all upcoming regulations.

BY MATTHEW J. HAWKINS, CEO

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the federal government will cave in. In a letter sent to the AMA in February of 2013, CMS Administrator Marilyn Tavenner clearly supported moving forward with ICD-10 to modernize the health care system. She emphasized that delaying the move to ICD-10 would mean that the healthcare industry would have to continue relying on outdated ICD-9 codes that soon will be incompatible with general health care needs and new technologies.

Many in the health industry are under way with the necessary system changes to transition from ICD-9 to ICD-10, Tavenner wrote. Halting this progress midstream would be costly, burdensome, and would eliminate the impending bene ts of these investments. Many private and public sector health plans, hospitals and hospital systems, and large physician practices are far along in their ICD-10 implementation and have devoted signi cant funds, resources and sta to the e ort.

During the HIMSS annual conference in March, Tavenner again stated that the federal government plans to stick to the October 1, 2014 deadline.

And, while many industry stakeholders are worried that the

ICD-10 transition is just too much of a burden considering other regulatory imperatives such as meaningful use, the government is holding strong to the October 2014 date.

While delivering the keynote address at the HIMSS Media ICD-10 Forum in National Harbor, Md., on June 17, Farzad Mostashari, MD, the national coordinator of Health IT, once again stated that there would be no ICD-10 extensions. Indeed, Mostashari has contended that there is potential synergy between the two initiatives, as organizations that are using certi ed EHRs for clinical documentation could have an easier transition to ICD-10. A HUGE JOB

Providers, however, might perceive the job as an overwhelming one, prompting many organizations to stay in procrastination mode. To start, there is the increased volume, with ICD-10 including about 68,000 codes, compared to just 13,000 in ICD-9. e new codes are also more complex and provide greater speci city to identify disease etiology, anatomic site, and severity (see chart on page A8).

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Haugen Consulting Group, Inc.Haugen Consulting Group, Inc. (HCG) offers custom readiness assessments, implementation,

education and documentation reviews for ICD-10-CM/PCS. Assessments include

identi cation of risks, recommendations for organizational readiness, and strategies to

prepare people, processes, and technology for the upcoming conversion from ICD-9 to ICD-

10. HCG also offers The Haugen Academy, an instructor-led training and web-based learning

center for ICD-10. The Academy provides training and education to ensure learners become

con dent and pro cient with ICD-10.

CONTACTThe Haugen Consulting Group, Inc1873 S. Bellaire St. | Suite 620 | Denver, CO 80222720-502-7690 | www.thehaugengroup.com

With so many organizations behind in their ICD-10 preparations, what can be done to pick up the pace and meet the Oct. 2014 deadline?

If preparation for ICD-10 has not gotten started at your organization, the rst step is to quickly compile a team of your strongest go getters and surround them with a supportive executive team. The role of the executive team is to create a sense of urgency and ensure participation of project staff. Executives should also eliminate as many barriers as possible so that your project can move swiftly ahead.

The next step is to establish a Steering Committee and individual focused workgroups. Workgroups should report back up through the Steering Committee so that ownership is guaranteed. Communicate progress, roadblocks, and budget needs on a structured and regular basis.

Since ICD-10 impacts so many areas in your organization (from preauthorization, ABN, scheduling, CDI, documentation, coding, billing and cash) any current work ow process or procedure that is

functioning poorly in ICD-9, will create even more dysfunction and negative nancial impact. Focus on aggressively xing processes that do not work in ICD-9, and correcting all the workarounds staff have been forced to adopt due to lack of automation, cooperation or training. Attack the areas that are most vulnerable.

If training has not started for your coding and CDI team, select and implement a training plan and consider how non-productive time spent in training will be managed. The day-to-day work must continue and cash must continue to ow. Backup coding services, overtime, or training rotations will be required to ensure adequate coding coverage during training time. Identify all areas in the organization that will need to be trained and determine a strategy and timeline so the right training occurs at the right time to the right staff.

Identify, upgrade and thoroughly test all impacted IT systems, including interfaces, registries and databases. Communicate with the organizations most common payers on their plans related to ICD-10, remembering such

things as series patients, straddle patients (patients that are pre-authorized prior to implementation for services after 10/1/14) and non-HIPAA covered entities.

Organizations are traditionally rich in data and poor in information. Ensure that the organization has a strategy to manage data during and after implementation. Prioritize report needs based on patient care, regulatory and nancial impact.

Do not lose sight that many organizations are still using a superbill or fee ticket. The translation of a one-page superbill in ICD-9 could result in a 20 page superbill in ICD-10. Identify all superbills in the organization and determine a plan for implementation and training of a new structure to ensure proper coding and charging in the of ces and clinics.

The implementation of ICD-10 cannot be accomplished by a few individuals. It will take a variety of staff with expertise and knowledge of the current state and a comprehensive understanding of the vast impact of ICD-10 to be successful.

BY MARY BETH HAUGEN, MS, RHIA | PRESIDENT & CEO

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Clearly, to meet the ICD-10 transition deadline, healthcare organizations need to start preparing sooner, rather than later. More speci cally, providers need to address a variety of issues such as sta education and

training; business process analysis of health plan contracts, coverage determination and documentation; change to superbills; and information technology system changes.

e following steps could help health care organizations get on track:

Identify your current systems and work

processes that use ICD-9 codes. Talk with your practice management system vendor

about accommodations for ICD-10 codes. Discuss implementation plans with clearinghouses,

billing services, and all payers. Ask payers how ICD-10 changes may a ect your

contracts, payment schedules, and reimbursements. Identify needed changes to your business

processes and documentation. Evaluate sta training needs.

Budget time and money for soft ware updates,

system changes, and training. Test transactions using the new codes with your

payers, billing services, and clearinghouses.

ICD-9 ICD-10

3 to 5 characters in length 3 to 7 characters in length

Approximately 13,000 codes Approximately 68,000 available codes

First character may be alpha (E or V) or numeric; characters 25 are numeric

Character 1 is alpha; characters 2 and 3 are numeric; characters 47 are alpha or numeric

Limited space for adding new codes

Flexible for adding new codes

Lacks detail Very speci c

Lacks laterality Has laterality (i.e., codes identifying right vs. left)

Source: What You Need to Know for the Upcoming Transition to ICD-10, American Medical Association

COMPARISONS OF DIAGNOSIS CODES, ICD-9 TO ICD-10

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Streamline Health Solutions, Inc.Streamline Health Solutions, Inc. is a leading provider of knowledge management solutions

for healthcare providers. The companys comprehensive suite of solutions includes:

enterprise content management (ECM), business analytics, integrated work ow systems,

clinical documentation improvement (CDI), and computer assisted coding (CAC). This unique

combination of solutions is designed to help healthcare organizations navigate the business

challenges of healthcare now and prepare them for the future.

CONTACTStreamline Health Solutions, Inc.1230 Peachtree Street NE |Suite 1000 | Atlanta, GA 30309888-99-STREAM | www.streamlinehealth.net

How important is adequate planning when considering a large project such as ICD-10?

A lot of money has been invested in technology to help mitigate the risks associated with ICD-10, but there is still a lot at stake and much of it is unknown. Preparation is key to success and should include securing the appropriate tools to aid in the transition. One of the solutions that is a core component in ICD-10 preparation is a computer-assisted coding system (CAC) that can handle both ICD-9 and ICD-10 codes.

Many providers are naturally worried about productivity losses, so we recommend using a dual coding approach, in which they can work in both ICD-9 and ICD-10 at the same time without toggling back and forth, or outsourcing to a third party. Dual coding can help maintain productivity levels after the transition because it will help improve familiarity with the new code set and speed up chart completion, which will be especially important in the rst few months after the transition.

How can healthcare organizations best manage the transition to ICD-10 while also addressing other IT projects such as Meaningful Use?

The short answer is: analytics. Analytics has become critical to all industries, and healthcare is no different. Major changes in reimbursement models, such as

ICD-10 as well as Meaningful Use are creating a scenario that makes a new generation of advanced analytics a must-have for all healthcare organizations. ICD-10 is not just a coding issue. The data can be leveraged to understand the impact code changes have to a companys bottom line through predictive modeling.

Meaningful Use is not so much about getting stimulus payments in exchange for using an EMR. It is about setting the stage and changing behavior for value-based purchasing and healthcare reform. Advanced analytics will provide the data and the information that is needed and will be used to improve health. Attesting for Meaningful Use and completing the transition to ICD-10 is not the end of the road but opening the door to the next level of analytics, the prescription for a lot of the goals we care about in our industry, not the least of which are improving quality and reducing cost.

What are the most important elements of a comprehensive approach to ICD-10?

Providers may want to consider rethinking the traditional ow of information through their organizations by initiating health information management (HIM) and coding processes at the time of service, or prior to service, rather than post discharge. Natural language processing (NLP) and other advanced

technologies can help providers automate many traditional tasks, and enable them to take place much earlier in the patient lifecycle.

By using NLP and analytics, a hospital could determine admitting diagnosis or admitting procedures assignment more accurately than they are today. The hospital can use this information to enforce standard protocols for how the patient is managed nancially and clinically, further ensuring that the business process is aligned to the most effective metric. In a healthcare world that is moving toward risk-sharing, hospitals will be forced to implement nancial and clinical protocols that are much more standard and consistent across the enterprise.

How can organizations manage the transition to ICD-10 while avoiding disruption or decline in reimbursements?

One of the keys to success is to support the automation mentioned above with powerful analytics to measure and predict speci c areas of concern including reimbursement, utilization and quality. By aggressively monitoring and managing these metrics, healthcare organizations can use the information to adjust the necessary processes. We envision the management of these metrics as key, not only to a successful transition to ICD-10, but to the success of our healthcare system in years to come.

BY ROBERT E. WATSON, PRESIDENT AND CHIEF EXECUTIVE OFFICER

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WWW.HEALTHDATAMANAGEMENT.COM

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