Imagine that. Ingenious. 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 Transform data into information Information translation to business and clinical practice

ICD Past, Present and Future First International Statistical Congress First International List of Causes of Death- U.S., Canada and Mexico 1948 World Health Organization International Statistical Classification of Diseases (ICD) ICD revision ICD revision 10 October 1, U.S adoption of ICD-10

Why Not ICD-11? Web based Multi-purpose Coherent classification across nations Function in the EHR/EMR environment Different from ICD-10 – Definition of disease – Descriptive characteristics

Two Perspectives Administrative – Required to process bills – Business intelligence reporting Clinical – Required for bill processing and payment – Increased documentation – Increased time for administrative duties

Workgroup for Electronic Data Interchange (WEDI) ICD-10 Survey since status of industry readiness October 2013 Reasons for delay – Change in compliance date – Competing priorities – Other regulatory mandates – Staffing – Vendor readiness

Workgroup for Electronic Data Interchange (WEDI) ICD-10

Benefits of ICD-10 Consistent with current clinical practices Room for additional codes, identifying clinical diagnoses and modes of care Better data – Measure quality, safety, and efficacy of care – Reduce need for attachments – Conducting research – Setting health policy – Designing health care delivery systems – Resource utilization – Detect fraud and abuse – Track public health risks Move beyond compliance to competitive advantage

Patient Benefits of ICD-10 Improve patient outcomes Best of care- evidence based medicine Financial fitness- decrease risk of fraud Healthcare delivery systems improvements Public health

Steps to ICD-10 Form a multi-disciplinary leadership team- align expectations Impact assessment- workflow perspective Reach out to the vendor(s) – Software tools – Internal testing – External testing Training plan Change management – Additional coder time – Additional IT support Documentation, coding and business analytics Post transition surveillance

Transition Method Clinician bills with ICD-9 and billers code ICD-10 (25% of WEDI) – Learning curve initially on the biller side – Clinicians lag in specificity of documentation – Clinician learning curve postponed – Increased communication for clarifications – Increased time to process claims – Potential to lengthen revenue cycle Clinicians bill with ICD-10 (50% of WEDI) – Learning curve is shared by clinician and biller – Documentation issues resolved jointly

ICD-10 Code Capture Paper superbill Data abstract Electronic charge/bill capture – EHR – Billing charge capture Develop protocols for clinical data capture and documentation

After the ICD-9 Sunset Benefits of ICD-10 – Patient – Clinician – Institution Big data analytics – Avoid data paralysis – Start small, well defined question – Prospective vs. retrospective Data transformed into information Information translated to clinical practice Business intelligence

Post-implementation Surveillance Continuing process of improving clinical documentation Business analytics Clinical outcomes monitoring – Readmissions – Mortality Change management

Canadian Experience with ICD year experience Improvements in care – Diabetes – Acute myocardial infarction – Injury prevention GEMS as a tool for ICD-9 to ICD-10 – The GEMS shortcuts made learning curve longer – Not a long-term solution

Summary Start the ICD-10 transition planning now Budget requirements Milestones- anticipate roadblocks and pitfalls Contingency plans Training- ongoing process Post implementation surveillance Analytics – Business – Clinical

…An ounce of planning is more valuable than a pound of procrastination