If your organization has been bogged down focusing on other priorities like meaningful use, accountable care organizations and implementation of value-based purchasing, you're not alone. The Department of Health and Human Services recently announced its intent to initiate a process to postpone the date for ICD-10 implementation. While it may be tempting to postpone working on ICD-10, it is important that the field not stop its progress on ICD-10 implementation. ICD-10 preparation should still be at the top of your to-do list to ensure a successful implementation of ICD-10-CM and ICD-10-PCS, the more specific coding systems that will replace diagnosis and hospital inpatient procedure coding.

ICD-10 is one of several health care emerging risks, but it has the potential to be the most disruptive. Because hospital payments depend on coding, the financial viability of the hospital could be affected severely if ICD-10 implementation isn't taken seriously. By now, your organization should be busy implementing the plans developed during the planning process. In fact, you should have completed the assessment and impact analysis and have started executing, monitoring and overseeing the implementation schedule for the areas identified during the assessment phase.

What should hospitals be doing?

  • Contact vendors and ask them to share their plans for readiness.
  • Make system changes.
  • Plan and conduct internal testing and validation of system changes.
  • Follow up on the readiness status of business associates.
  • Conduct external testing with business associates when they are ready.
  • Conduct training of coders.
  • Conduct awareness and documentation training of physicians.
  • Assess the potential reimbursement impact to your institution (evaluate potential DRG shifts, changes in case mix index).
  • Evaluate existing contracts with third-party payers and determine whether they are ICD-9-CM code-based, DRG-based, or based on some other methodology.
  • Work with payers to determine how they plan to transition those contracts to the new coding system. Be sure to evaluate any proposed "crosswalked" codes to determine that the codes are, in fact, being mapped correctly.
  • Refine timeline and adjust budgets.
  • Consider reengineering processes and workflows based on a better understanding of internal processes evaluated during the ICD-10 assessment phase.
  • Consider whether to have coders start using ICD-10 a few months prior to the go-live date for internal purposes to ensure they develop the necessary accuracy and proficiency necessary.
  • Develop a contingency plan should business associates not be ready.

Transitioning to ICD-10 is not an easy task and many providers are feeling stretched. It would have been easier to implement 10–15 years ago when the world was less complex. However, ICD-10 is the foundation that will help us gather information that can be used to do a better job of understanding the patients we serve, how we serve those patients, and be able to analyze that information to meet the requirements for bundled payments, health care-acquired conditions, valued-based purchasing or preventing readmissions.

Nelly Leon-Chisen, RHIA, is director of coding and classification for the American Hospital Association and a member of Speakers Express. You can contact her atnleon@aha.org.



Annual Membership Meeting

Registration is underway for the AHA Annual Membership Meeting May 6-9 in Washing-ton, D.C. With the theme "Champions for Care," hospital and health care leaders will discuss a range of critical issues, including the ongoing debate over health reform. Speakers will include political insiders Karl Rove, Robert Gibbs, Howard Dean and Mike Huckabee. Media personalities slated to participate are Dee Dee Myers, Ed Henry, Frank Sesno and Mark Shields. On the last day, attendees will go to Capitol Hill to meet with their states' congressional delegations. Visit www.aha.org.

• Equity of Care initiative releases first resource

Equity of Care, an initiative of five national health care organizations to eliminate disparities in health care, released its first case study guide, which looks at nine hospitals and health systems and summarizes each organization's key successes toward achieving one of the group's three goals: increasing the collection of race, ethnicity, and language preference data to facilitate its increased use; increasing cultural competency training for clinicians and support staff; and increasing diversity in governance and management. In addition to AHA, partners in the initiative include the Association of American Medical Colleges, American College of Healthcare Executives, Catholic Health Association of the United States, and National Association of Public Hospitals and Health Systems..

• Physician Leadership Forum

The AHA's Physician Leadership Forum is a way for physicians and hospitals to advance excellence in patient care. Through the Forum, the AHA will work more closely with the medical community to identify best practices and deliver value-based care. The forum also offers physicians a unique opportunity to participate in AHA policy and the advocacy development process while preparing to collaboratively lead the hospitals of the future. Visit www.ahaphysicianforum.org.