ICD-10 aftershocks: 5 ways for hospital CEOs to prepare for the inevitable

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ICD-10 is all about balancing opportunity with risk, and no one should understand this better than a hospital's CEO. This delicate balancing act certainly doesn't end on October 1, 2015 — rather, it continues and requires constant monitoring and analysis.

"The ICD-10 transition has a profound impact on just about every aspect of our organization," says Al Pilong, president of Munson Medical Center in Traverse City, Mich., and senior vice president of hospital operations. "It is a game-changer for our industry in terms of the way we document diagnosis and treatment and how we ultimately get reimbursed for our services."

He adds that all CEOs must strive to accomplish the following goals in the wake of ICD-10 implementation:

  • Monitor the healthcare organization for stability.
  • Communicate the connection between clinical documentation and quality patient care.
  • Facilitate communication with community partners.
  • Adjust growth strategies as opportunities arise.
  • Explore new data specificity to create opportunities for growth and process improvement.

This article elaborates on the five goals that Pilong describes above and highlights the steps that CEOs should take in the aftermath of ICD-10.

1. Ensure the hospital continues to perform high-quality patient care.

Despite thorough testing and proper planning, ICD-10 has the potential to disrupt business operations. Templates will look different. Coder productivity will decrease. Technology problems could occur.

It's a CEO's job to navigate these challenges smoothly and rally the troops in such a way that patient care remains top priority. This may require proactive planning to address physician EHR concerns, hiring of additional coding professionals or securing around-the-clock IT support.

Reach out to the ICD-10 Program Team within the organization to determine how you can best support every department and keep patient care in the forefront. What will various departments look for in the wake of ICD-10 go-live? What are employees' concerns, and how can you assist them?

2. Monitor the industry for best practices post ICD-10.

CEOs should have a pulse on industry trends and challenges at all times and particularly in the wake of ICD-10. Can any best-practice techniques be applied internally? What are other organizations doing to mitigate problems or even begin to capitalize on ICD-10 specificity?

CEOs are also charged with keeping tabs on updated productivity standards and other revenue cycle performance benchmarks. For example, in the weeks and months following go-live, how does your organization compare with the latest industry-published key performance indicators, including gross days in A/R, coding accuracy and productivity, case mix index, query rates, query response rates, CC/MCC capture rate, DNFB, and denial rate?

Our analysis suggests that even the most prepared hospitals will experience an initial decrease in coder productivity. This decrease could be as much as 35 percent and last through January 2016. Coder productivity should increase steadily over the first six months, leveling off about 25 percent below ICD-9 benchmarks in the spring of 2016. Some experts fear that coders will never truly regain ICD-9 efficiencies. This is echoed by Canada's transition to ICD-10. How might this translate to days in A/R and other operational indicators? CEOs must be able to calculate these numbers quickly and regularly.

Finally, CEOs must continually monitor organizational progress in terms of getting back on track, staying on track, and even making strides to improve the revenue cycle post ICD-10. The greatest benefits lie in an organization's ability to capitalize on ICD-10's greater levels of data specificity. These goals are certainly attainable — it just takes time and direction.

3. Keep tabs on hospital-owned practices and clinics.

Many hospitals have devoted time and resources to helping these entities get up to speed with ICD-10. However, it's important to continue to keep the lines of communication open. For example, practices and clinics must provide ICD-10 diagnosis codes on all hospital diagnostic orders. Do hospitals have a process in place to monitor orders post go-live, and translate them, if necessary?

Ask practices and clinics whether they are experiencing any technical or operational difficulties post go-live. We expect physician practice coders may experience a 10 percent to 15 percent productivity loss initially. Physicians themselves may experience a 15 percent to 20 percent productivity loss that may be offset with the help of medical assistants or technology-enabled tools. By continuing to reach out to any hospital-owned entities, CEOs can help ensure smoother handoffs, greater efficiencies and more enhanced population health management.

4. Prioritize changes required to expedite remediation.

It's the CEO's responsibility to identify the most pressing challenges and barriers and then devote ample resources accordingly. Cash liquidity will be paramount. For example, the CEO must maintain constant lines of communication with the CFO, revenue cycle director and HIM staff to determine whether payments will be delayed or technical glitches may prohibit claim submission. Addressing these challenges may take priority over other operational initiatives.

5. Maintain a culture of positivity and empowerment.

With a predicted 90-day stabilization period, employee uncertainty and anxiety will reign supreme during the first few months of ICD-10. Productivity decline will not only impact coding and physicians, but also patient access, billing, CDI and others. New performance benchmarks should be established. In our analysis, the productivity impact could last until at least June 2016, at which point performance across all impacted roles should take a turn for the better.

Note that employees may become frustrated by a multi-month — or even year-long —stabilization period in terms of productivity, and CEOs should be prepared to address this frustration with a clear plan for success. Reiterate to employees that although 100 percent effort is expected, returning to ICD-9 levels of efficiency is not likely. Use public speaking opportunities to talk about challenges as well as successes. Transparent communication will make employees feel valued and respected.

Forging ahead

As the leader of the organization, a CEO must be able to navigate ICD-10 aftershocks smoothly and serve as a source of support and leadership. Executives play a key role in driving organizational change — including changes spawned by ICD-10.

About the Author
Kelly provides strategic and global program management, healthcare product development, and competitive intelligence at Whittle Advisors. Prior to Whittle Advisors, she worked at Trinity Health, leading the ICD-10 physician network program. Prior to joining Trinity Health, she transitioned Thomson Reuters' hospital product portfolio to ICD-10-CM/PCS compliance. Kelly can be reached at kelly.whittle@whittleadvisors.com.

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