March 13, 2012
Will we see ICD-10? Maybe...
intriguing world we live in. Here we sit, after exhausting efforts to
encourage, develop and begin executing
strategies for the ICD-10 transition, with an
indefinite timeline but equally definite actuality. Most major players in the
industry have shared their perspective, opinions and speculations on the delay.
It is obvious to say there are individuals and groups on both sides of the discussion.
My objective in this post is to stay away from opinion and focus on strategy,
which requires some speculation.
to address is how long will the delay be. I was in Las Vegas with many others
attending HIMSS just after the delay was announced. I looked for a place to set
my over/under bet, but never did find one. Kidding aside, here is a good way to
rephrase this question in an actionable way, “What if they only push it by one
year?” It’s certainly a possible scenario. In this scenario, can you afford to
decelerate or reprioritize your resources? I think many might say that this actually
puts their programs on schedule. If you haven’t started addressing your ICD-10
strategy yet (you know who you are), you are now just less behind than you were
experienced resources are at a
premium. Shifting the focus away from ICD-10, with the potential of just a one-year
delay, may result in several disjointed projects and potentially wasted time
leads me to my second question, “Why are you doing some of the things you are
doing?” The easy answer is ICD-10. It is common to see code upgrades, computer
assisted coding, migration to concurrent coding, clinical documentation
integrity strategies (CDI), etc. as a part of a comprehensive ICD-10 program
approach. I encourage everyone to think about the ‘collateral benefits’ of
these various elements of your ICD-10 strategy. An investment to create or
enhance your CDI program will result in better clinical documentation, with the
goal to get documentation that can support ICD-10 coding. Without documentation
to support the codes, nothing else really matters. You can invest millions in
computer assisted coding and coder training, but if the documentation isn’t
there those investments are worthless. That is the ICD-10 response.
know that CDI programs will also result in improved case mix indexes (CMI),
which in turn results in more accurate (higher) reimbursement in our current
ICD-9 world? Just ask anyone who has done it. It is all about a more accurate
reflection of the acuity of the patients and complexity of care that is
actually being provided. It should also reduce potential liability under the
Recovery Audit Contractor (RAC) program. The RACs are feasting on incomplete
and inaccurate clinical documentation today. You can do this exercise with
almost every element of an ICD-10 strategy, with the exception of the coder
training and find value in continuing execution.
of those key strategies accounted for, ‘crunch time’ can become more focused on
the variables which you have much less control over, like payer readiness. You
will have more time to achieve documentation integrity improvements,
essentially eliminating that major concern from your list of ICD-10 transition
anxieties. Now this bit may sound opinionated, but is actually just fact. We
live in a political environment where timing of elections and the importance of
appeasement is discernible. Stepping
back and looking at the big picture, despite the imperfections and the room for
improvement, if we want to be able to understand the health and the care of
populations, we have to be able to codify health data in a way that reflects
today’s practice of medicine. ICD-9 is based off of what we knew about medicine
in the 1960’s. It is insufficient to maximize the actionable analysis of
my thoughts, getting to ICD-10 is too important for us to avoid. It is necessary
for us to accomplish many of the goals in the Federal HIT Strategic Plan and much
more. It will likely happen sooner rather than later. Many of the projects that
are underway now will have ‘collateral benefits,’ and put your organization in
the best position possible when the transition does occur.
Roy Foster leads a team that consults health care provider organizations in developing strategies that position their organizations to proactively respond to the current and future health care economy. This includes education and comprehensive strategies for surviving and thriving post American Recovery and Reinvestment Act of 2009 and Patient Protection and Affordable Care Act of 2010.
Foster joined Cerner in 2001 as a Solution Delivery Consultant responsible for installing electronic medical record systems. During his career, Foster has implemented EHR’s at over 70 organizations and 200 facilities that range from small community hospitals to large IDN organizations. Prior to his current position, Foster lead the growth and development of Cerner’s clinical quality consulting practice. Clinicians in that practice worked with health care provider organizations advancing the use of the EHR to proactively manage clinical quality metrics by embedding core measure awareness and capture into the clinical workflows and by utilizing clinical quality dashboards. Foster earned a BA in biology with an emphasis in chemistry from Ottawa University. While attending college Foster worked in the laboratory at the VA Medical Center in Leavenworth, Kan.