So far, CIO Linda Reed, CEO Marty Fattig and I have attempted to make a compelling case for taking ICD-10 seriously. Simply waiting to adjust your business strategy until after the transition in October would be unwise. The potential impact on quality reporting, specificity of documentation and revenue cycle are profound. Hopefully, our previous blogs have motivated each of you to proactively manage the transition for your facility and with your medical staff.
Motivation is key, but is not a good plan any more than hope is a good strategy. Your IT and clinical leadership teams likely have been preparing for months to ensure that the inpatient electronic health record is ready and that nursing and ancillary staff are trained and equipped. But we can’t lose site of another important piece of the health care puzzle: preparing providers and staff in our outpatient settings. The sheer number of outpatient EHRs introduces daunting complexity.
What we can offer depends in part on whether the providers are employed or independent. Employment by a hospital or health system allows greater latitude to provide tools, resources and training. We can provide whatever assistance is feasible without running into regulatory roadblocks. We can even keep their practices financially whole during the inevitable initial reductions in revenue.
Independent providers, especially those with primarily ambulatory practices, are a different story. These providers are already struggling under the weight of meaningful use Stage 2, the Physician Quality Reporting System, primary care medical homes and payer contracts with more dollars at risk. The prospect of available codes jumping from 15,000 to approximately 70,000 is daunting and, frankly, more than many independent practices can accommodate without significant support. Unfortunately, our freedom to assist independent ambulatory providers is constrained by the regulatory landscape.
So, what can we do?
The following list provides a good place to start for inpatient providers, whether independent or employed:
- Meet with the general medical staff to impress upon them the need for engagement.
- Provide specialty-specific training on what is changing and how to document appropriately to ensure adequate coding.
- Have the clinical documentation improvement staff begin queries focused on ICD-10 now so that the clinical staff begin to think that way.
- If your EHR uses templates, update them now to provide the specificity of documentation necessary.
- Begin testing!
What can we do for independent ambulatory providers?
- Provide continuing medical education, newsletters and other information impressing the need for preparation.
- Recommend that they produce historical lists of their 20 most frequently used ICD-9 codes. You can provide CME-type training focused on how the transition affects documentation for the ICD-10 iteration of those codes.
- Direct them toward materials on the Centers for Disease Control and Prevention and American Health Information Management Association websites designed for providers.
- Urge them to consider utilizing templates designed to capture the new specificity of documentation needed.
- Make available to them a list of trusted third-party vendors to assist with the transition.
- Encourage early testing.
Preparation is critical and should be tailored to the practice location, specialty and degree of alignment.
Adam L. Myers, M.D., is chief medical officer at Texas Health Physicians Group.