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Imagine that. Ingenious. Surviving and Thriving in the ICD- 10 Transition Joy C. Burnette, RN, BSN, AACC, CHTS-IM, CPHIMS February 2014

Surviving and Thriving in the ICD-10 Transition

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Surviving and Thriving in the ICD-10 Transition. Joy C. Burnette, RN, BSN, AACC, CHTS-IM, CPHIMS February 2014. Introduction. Hard deadline of October 1, 2014 Two perspectives- clinical and administrative Steps for ICD-10 transition Benefits beyond the ICD-9 sunset - PowerPoint PPT Presentation

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Surviving and Thriving in the ICD-10 TransitionJoy C. Burnette, RN, BSN, AACC, CHTS-IM, CPHIMSFebruary 2014Imagine that. Ingenious.IntroductionHard deadline of October 1, 2014Two perspectives- clinical and administrativeSteps for ICD-10 transitionBenefits beyond the ICD-9 sunsetTransform data into informationInformation translation to business and clinical practiceICD Past, Present and Future1853- First International Statistical Congress1893- First International List of Causes of Death- U.S., Canada and Mexico1948 World Health Organization International Statistical Classification of Diseases (ICD)1976- ICD revision 91989- ICD revision 10October 1, 2014- U.S adoption of ICD-10Why Not ICD-11?Web basedMulti-purposeCoherent classification across nationsFunction in the EHR/EMR environmentDifferent from ICD-10 Definition of diseaseDescriptive characteristicsTwo PerspectivesAdministrativeRequired to process billsBusiness intelligence reportingClinicalRequired for bill processing and paymentIncreased documentationIncreased time for administrative dutiesWorkgroup for Electronic Data Interchange (WEDI) ICD-10Survey since 2009- status of industry readinessOctober 2013Reasons for delayChange in compliance dateCompeting prioritiesOther regulatory mandatesStaffingVendor readinessWorkgroup for Electronic Data Interchange (WEDI) ICD-10Benefits of ICD-10Consistent with current clinical practicesRoom for additional codes, identifying clinical diagnoses and modes of careBetter dataMeasure quality, safety, and efficacy of careReduce need for attachmentsConducting researchSetting health policyDesigning health care delivery systemsResource utilizationDetect fraud and abuseTrack public health risksMove beyond compliance to competitive advantagePatient Benefits of ICD-10Improve patient outcomesBest of care- evidence based medicineFinancial fitness- decrease risk of fraudHealthcare delivery systems improvementsPublic healthSteps to ICD-10Form a multi-disciplinary leadership team- align expectationsImpact assessment- workflow perspectiveReach out to the vendor(s)Software toolsInternal testingExternal testingTraining planChange managementAdditional coder timeAdditional IT supportDocumentation, coding and business analyticsPost transition surveillance

Transition MethodClinician bills with ICD-9 and billers code ICD-10 (25% of WEDI)Learning curve initially on the biller sideClinicians lag in specificity of documentationClinician learning curve postponedIncreased communication for clarificationsIncreased time to process claimsPotential to lengthen revenue cycleClinicians bill with ICD-10 (50% of WEDI)Learning curve is shared by clinician and billerDocumentation issues resolved jointlyICD-10 Code CapturePaper superbillData abstractElectronic charge/bill captureEHRBilling charge capture

Develop protocols for clinical data capture and documentation

After the ICD-9 SunsetBenefits of ICD-10PatientClinicianInstitutionBig data analyticsAvoid data paralysisStart small, well defined questionProspective vs. retrospectiveData transformed into informationInformation translated to clinical practiceBusiness intelligence

Post-implementationSurveillanceContinuing process of improving clinical documentationBusiness analyticsClinical outcomes monitoringReadmissionsMortalityChange managementCanadian Experience with ICD-1010 year experienceImprovements in careDiabetesAcute myocardial infarctionInjury preventionGEMS as a tool for ICD-9 to ICD-10The GEMS shortcuts made learning curve longerNot a long-term solutionSummaryStart the ICD-10 transition planning nowBudget requirementsMilestones- anticipate roadblocks and pitfallsContingency plansTraining- ongoing processPost implementation surveillanceAnalyticsBusinessClinicalAn ounce of planning is more valuable than a pound of procrastination