Welcome back to the ICD-10 blog.
In previous entries, colleagues Marty Fattig and Linda Reed addressed a couple of critical issues: Why should the CEO care about the transition to ICD-10 and should we really take the Oct. 1, 2015, deadline seriously? After all, the deadline has been delayed twice, and there’s renewed effort by some constituencies to enact another delay. Some experts say a delay will happen; most seem to think it won’t.
Even with a little uncertainty hanging over our heads, it’s important that we’re serious about getting ready. There’s a lot that will go into making the transition, not the least of which is physician engagement.
Ultimately, our success is linked to physician documentation. A key challenge on that front is working with physicians to change documentation habits to align with requirements of ICD-10. Doctors, like the rest of us, don’t want to change what they do without compelling reasons. Making the case for change would be easy if the new coding system directly impacted patient care.
ICD-10 is not really designed to improve clinical care for individual patients. Specificity in coding for asthma, hypertension or orthopedic surgery does not directly impact the care of the patient during an encounter. The greater specificity is designed to better represent and communicate the clinical scenario. How is this useful to doctors and, more importantly, to patients?
The more precisely we document and code, the more precise the data will be that’s mined from EHRs to elucidate gaps in care. By painting a more accurate picture of individual and aggregated attributed patients, ICD-10 potentially will enhance a physician’s ability to do population health management. Additionally, physician-specific public transparency efforts underscore the need for accurately representing the care they provide.
A clinician’s reputation is his or her life’s blood. The Centers for Medicare & Medicaid Services’ Physician Compare website and private payer tiers will impact patients’ decisions about where to access care. They will also impact the inclusion in payer contracts and preferred networks. For proceduralists, accurate reporting of observed-to-expected ratios of complications depends on accurate coding necessary to determine acuity and risk-adjustment. The accuracy and specificity inherent in ICD-10 will impact risk-adjusted measures of clinical quality and, ultimately, impact access to patients.
Why else should doctors care about ICD-10? Other than the reasons delineated above, it really depends.
First of all, it depends on compensation models. The degree to which a physician’s compensation is linked to productivity impacts how motivated he or she may be to make the switch from ICD-9. Just as hospitals depend on proper coding to optimize revenue and ensure compliance, so do physicians.
Secondly, it depends on the physician’s primary service location. While there will be work to do, hospital-based physicians won’t face the same level of preparation as their office-based colleagues. Hospital coders, clinical documentation improvement specialists, and case managers will assist hospital-based physicians. These team members will instruct doctors prospectively and query them concurrently. This will not be the case for office-based physicians who often do their own coding. For the most part, many office-based physicians will be on their own to navigate the transition.
The time, planning, staff and money needed to transition a hospital or a physician’s practice to ICD-10 is daunting. Burying our heads in the sand about this reality and hoping for another delay will not provide solace or solutions when revenue plummets, denials mount and risk-adjusted quality metrics suffer. It is real, it is coming, the implications are numerous, and prepared doctors are crucial to meet the opportunity head on. Systems and physicians who want to avoid these pitfalls are wise to collaborate on this complex and difficult transition.